Superheroes don't all wear capes

Picture: Kingston Hospital

Some 16 months ago I was in a room a few minutes’ walk away from the one in which I’m writing this, ruminating on the amazing “pit crew”, as I called them, working on my necrotic foot. That was my first in-patient stay in a hospital for almost 30 years (the only previous occasion being for a relatively cosmetic procedure). But framed in the context of the politics of the NHS, and the-then rampant pandemic in April last year, I wrote of my singular, emboldened appreciation of the healthcare profession and all who work within it (Postcard from the cuckoo’s nest).

Today, however, I’m in our local A&E department for a different reason: the treatment of my 92-year-old mother after she had a fall at home. This is the same A&E unit I came to with my diseased foot, thinking at the time that I’d just be given a bandage and some antibiotics and sent on my way. In the end, I remained at this hospital for three and a half weeks. On this occasion, my mother is propped up on a bed in a bay directly opposite the one I was assessed in, prior to being admitted for that lengthy stay. That, too, was a Saturday lunchtime. 

As we sit there, waiting for something to happen, someone to come by and do something else, my admiration for all those working in this environment continues undimmed. This is, though, supposed to be the crucible, the epicentre of crisis. Every day our newspapers scream of meltdowns in the health service, of dysfunction and inefficiency throughout. And while that may be true elsewhere, my mum was ambulanced to hospital within an hour of her carer calling 999.

While A&E processes and procedures take time, as nurses and nursing assistants comprehensively evaluate my mother, taking blood samples and blood pressure readings, and occasionally carting her off for a CT scan, things are reassuringly relaxed. For now. On the basis of the prevailing media depiction of our hospitals, you’d expect to encounter a scene akin to the Do-Lung Bridge in Apocalypse Now!. Instead, the staff are calm and supremely professional. There is some noise - you’d expect the occasional scream in an emergency department - but there is mostly a low-level hubbub as staff go about their duties. In the middle of the large room with 15 treatment bays is a central IT hub, where junior doctors and other staff clack away at computer keyboards, analysing test results, X-rays and medical records, all part of the ultra-digitised health service. It all looks so joined up, but the reality - I speak from experience - is that while some parts are connected, others need a kick (for the post-hospital treatment of my foot, I had to join the dots myself between my GP, the hospital outpatient team and the local podiatry function).

Occasionally, the hubub is raised a tad by a patient call button being pressed in another part of A&E, resulting in a dull beep that, too, gets tuned out along with all the rest of the background noise. This being a Saturday afternoon, the unit doesn’t appear overwhelmed, but there are plenty of customers: - gardening accidents, a couple of people with clear symptoms of dementia, and so on. In an adjacent bay to my mother’s, a police officer stands watch over a young man, not giving anything away as to whether the patient is a victim or a perpetrator of some Friday night criminality. At various points in the day, the one constable will be joined by three colleagues. Their two police cars are parked outside. At a time where the political mood is intensifying on getting police back out on the street to prevent or solve crimes, the sight of four officers and two patrol vehicles tied up for most of a Saturday both suggests the seriousness of the situation, and also reminds you of how resource-stretched the Met is.

Moreover, the longer we sit here - my wife and I watching our phone batteries ebb away (until we discover the ability to rent a Joos charger for £3 - ker- and, indeed, -ching) - the more you start to see our NHS under pressure. The ambulances are coming in thick and fast as Saturday afternoon gives way to Saturday evening. A second set of police officers appear, looking after another admission.

At the time of writing we’ve now been here ten hours. Somewhere between 7pm and 8pm there appeared to be a change of shifts. As one nurse hands over to another, staffing becomes thinner. A new pair of nurses take over the entire ‘Majors’ area (one of three - the others being ‘Resuss’ and a dedicated A&E unit for children), requiring us to tell my mother’s story all over again. By now, two doctors have seen her, and then the senior duty consultant , who thankfully concludes that she won’t need to be kept in overnight, and that her fall was most likely caused by her getting out of bed too quickly. ‘More haste, less speed’, was a mantra my dad drilled into me. I don’t think my mother was listening.

So the good news is that we should be taking Mum home, but there are still more repeat tests to perform to satisfy someone that she’s OK to do so. To be honest, we’re not sure why, and nor do the evening nurses. At some point we note to them that, apart from a couple of biscuits with a cup of tea, and some of the contents of the picnic we’d been planning to take to a seaside airshow when we got the call to come back to south-west London, she hasn’t actually eaten anything substantial all day. This is eventually rectified by a microwaved roast dinner rustled up for her. We make do with coffee from the last service of the day from the on-site branch of Costa.

And so, as hour gives way to hour, the crosswords from the newspaper my mother had with her completed or dispensed with out of boredom, our phones restored with yet another expensive battery rental, we’re all beginning to stare into space. Mum’s discharge seems no closer. No one seems to say why. It takes a firm conversation with one of the nurses to get some clarity, eventually.

Here, then, is a summer Saturday night in a major A&E department. The central hub is now down to a couple of duty junior doctors, with just the two nurses, despite all the visible bays still containing the patients who’ve gradually come in throughout the day. The nursing assistants - those vital components of hospital life, are even fewer. Not that they’re taking it easy: one, who was looking after my mother, was on Day 6 of her roster, and even that was voluntary - she normally worked in another part of the hospital. She’d also only just returned to work after spending two years battling breast cancer.

This is where you simply can’t be critical. Yes,the system creaks, and in some places is actually falling apart. But Saturday’s experience, even if it resembled an episode of Seinfeld (“a show about nothing”), underlined further the addage that not all superheroes wear capes. Some just wear blue scrubs.

I’ve spent a fair amount of time, now, in hospitals and medical facilities as a result of my diabetes. All of that time, you could say, is self-inflicted (I’m Type 2). But my experiences - save for my inpatient stay last year - have been relatively fleeting. A test here, a consultation there - “maintenance”, as my wife calls it. What you never appreciate fully is just what else goes on under the skin. The tempo of this particular metropolitan emergency department on a Saturday has appeared calm, but that’s just the professionalism protecting reality. For the patient - in this case a lady of 92 - it’s bewildering and exhausting. You can’t help but feeling that she is receiving the best care possible, but it takes time to administer. If her son and daughter-in-law hadn’t been around to ask, would she have been able to get a meal, help with her ablutions, or even an update on what was going on?

With every encounter with a health professional, and especially one working within the NHS, you must feel admiration. Admiration for taking on one of society’s lower-paid jobs, one where you literally and figuratively have to put up with strangers’ shit with stoic professionalism. Occasionally, you have to deal with less successful outcomes than ours. Here’s where fiction and reality separate dramatically: if your only idea of life in a medical environment is one of those slick dramas on TV, especially the American ones, like Grey’s Anatomy, life-or-death situations are not resolved in 50 minutes. Modern hospitals are stuffed to the gills with state-of-the-art technology, but in real life - in the UK at least - there’s no team of highly remunerated hotshot surgeons ready to leap in with every emergency case the ambulances bring to the door. There is just “a” team, mostly of young, foreign professionals working twelve-hour shifts, triaging the unfortunate, the drug-addled, the dementia stricken and, in the case of my mother, the elderly. It’s a miracle our hospitals don’t collapse at all. 

The relative calm we experienced for the better part of ten hours masked, I suspect, the real horror going on in the NHS nationwide. And while it was far from perfect, it was a further reminder of the reassurance that, for good or bad, this most jewelled of British institutions, and it’s dedicated people, is there when you need it.