As a companion to my blog entry on what happened to me clinically, this is the story of how it unfolded as a hospital experience. This bit focuses on night 1 in A&E.
At my hospital, oncology patients have a dedicated hotline, and there is an acute oncology assessment service where you go to be assessed, and if necessary admitted onto the oncology wards. I have used it twice. Once for my diverticulitis last year, which led to admission. And once for a few hours review following my immunotherapy rash.
Although the hotline runs 24 hours a day, the AOS is only open from 8-6, or until its last patient has been admitted or sent home.
This time round, it was them calling me, rather than the other way round, following the creatinine reading on my routine bloods. I had just started to develop thirst, but was otherwise asymptomatic. Unfortunately the call came at 5pm, so they asked me to present to A&E as soon as possible. This on a day both junior doctors and consultants were striking. They said they would make sure A&E were expecting me, that I needed to be immediately put on rehydration drips, and that I would transfer to AOS first thing the following morning.
We packed, bundled into the car, and arrived at A&E at around 6pm. The hospital is a large tertiary centre with much of it a modern extension added around 15 years ago A&E is tucked round the back in what was part of the older hospital building. A new A&E is currently being built but is at least a year away. We entered a tiny outer waiting area where I had to stand along with a line of other people in various states to be booked in. This took some time, and there was no evidence they were expecting me. The wristband they printed for me didn’t have any onco case note references on it.
Then, you get to move into the next room, where there aren’t enough chairs. TV showing how many people have attended that day, and how many are still in the facility. Bad news, multiple hundreds, over half still there. Then wait in order to be called to see a triage nurse. After about 90 minutes, I get to see a triage nurse. No sign I am expected. No prior knowledge. I am treated as if I have had a slightly off blood result and have decided to go in. The admissions report goes automatically to my GP and I can see it on my portal “presented with tiredness, dehydration diagnosed”. I am very polite, very very firm, thankfully still very lucid. The nurse makes me a priority 1.
Back to the seats, to be called to pick up my red plastic folder for notes. Then it starts to move a bit faster (it’s getting towards 10pm by now). On into a small area with green chairs. A nurse has 4 failed attempts to cannulate me (no skills to access my port and by this time I am indeed dehydrated).She eventually gets one in between my right thumb and first finger. I am right handed. This makes personal hygiene very very difficult. Then I am moved to a cubicle in the next layer back, now called ED. On the way through I double take as I see someone I know lying on a trolley in a lit corridor. She is in her early 80s. I later learn she had to spend the whole night there.
In the cubicle, I meet a doctor for the first time. I tell him I think this could be an immunotherapy adverse event. He does agree to prioritise large scale saline drip infusions. I try to settle down for the night. The cubicle is kept partially open. There are constant tannoy announcements calling various staff to various places. Then the lady in the next cubicle starts kicking off. She’s 40 ish, well turned out, silk blouse, smart trousers. Had clearly been to a works event or similar that had gone awry and woken to find herself in the ED. Clatter clatter clatter down the corridor followed by a nurse. “Monica, you need to go back to bed”. “Are you calling me a drunk?” “No, I am just saying you are intoxicated and will be safer in bed until you sleep it off”. “Don’t patronise me, I speak 5 languages”. Etc etc at regular intervals throughout the night, until she eventually crashed out or escaped.
At 7am desperate bed manager is wandering around seeing who can go home and who can be sent elsewhere. Thankfully I am wheeled into AOS at 8am, without my red wallet, lost somewhere by the doctor. Yes I got some IV fluid, but I would have been better off left at home with a target volume to drink and told to check into AOS first thing the next morning. Never again. My poor consultant has received a lot of feedback.
It was smoother from then on, but you will have to wait for the next instalment.
