Some really good news, and one small problem

One brilliant piece of news this week: Edwin posted: "Andre asked me to marry him, and I said, 'yes'." Edwin had had an onsite workday when Andre joined him so they could go to Tiffany's to select the rings. They were met by appointment and treated like royalty, with champagne and a full assessment of just what they hoped for. The rings were boxed and gift-wrapped, then they strolled across the Millenium Bridge when Andre went on one knee to pose the eternal question. They then followed the Brazilian tradition of wearing the ring on the right hand during the engagement, to be swapped to the left hand on marriage. Edwin's has a small diamond to tokenise the engagement ring, while Andre's is a heavier solid gold affair.

We were thankful for this wonderful cause for celebration as I, alas, have little news to celebrate otherwise. No one wants the gory detail but, in outline, my gut oscillates from constipation to diarrhoea like Balaam's donkey: it can't make up its mind. For three days, it went on strike refusing even to work to rule. I offered it more carrots or anything else it fancied, but it protested with bouts of severe colic until my body, in protest, spiked a high temperature. At that point, we decided to try to get professional help or support. The doctor's surgery of course just uses a metallic voice to announce: "If it's an emergency like a stroke or heart attack, phone 999. For anything else, phone 111." Ann duly phoned 111 and went through a complex series of multi-choice answers, half of which seemed to refer her to flow charts online, and others to sending her a text message. It is not easy switching constantly between screens on a small phone, or trying to retrieve texts, and Ann was finally abandoned in a labyrinth of complex, contradictory instructions. If this happened to Ann, who was a research officer and used to train students to use computers, what hope is there for lesser intellects; the whole complex business seems designed to deter people from using the system. Then, we thought, we have been given an emergency number for the hospice who are now supposed to be responsible for my care. Alas, it is a hospice where cancer only exists between 9 and 5; it was now 5:30pm, so another recorded message reported that the lines were closed. p

Ann had taken wine at lunchtime so was reluctant to drive; we therefore asked Edwin if he could ferry us to the Emergency Department (ED) at WSH, which he duly did, abandoning a dinner with Andre, their minister and his wife at which they were discussing wedding plans. That is true sacrifice. Ann came to sit with me, although a notice announced, "Wait for triage nurse, 2 hours. Wait for doctor, 4 hours." Later, that notice changed to, "Wait for doctor, 6 hours." It was therefore 01:30 a.m. when I was assessed with a provisional diagnosis of 'hepatic enlargement with possible inflammation of gall bladder and pancreas secondarily to hepatic metastasis of the melanoma", so the registrar decided to admit me to a ward for observations, and to await the result of a CT/PET scan I'd had earlier in the week. By 3:30 a.m. I had been waiting in a hard plastic hospital chair for 8 hours. Edwin too was waiting with me, having returned from his dinner and driven Ann home. Then three chairs without armrests became vacant to I moved across and tried to sleep lying on these. 

Waiting for a bed at 4:30 a.m. after 9 hours at WSH

By 4:30 a.m., the ED outpatients was filled with people dozing in chairs, also waiting for admission. My aches and tiredness had become unbearable, so I went to the front desk and announced that, clearly no bed would suddenly become vacant now, so I wanted to go back to my son's and sleep on his spare bad. The receptionist said, if I discharged myself, I'd have to go through the whole process again when I came back. I said, I wasn't intending to discharge myself, but after nine hours I couldn't stay on those chairs a moment longer, so I merely intended going out for some fresh air and a rest, but would be back in the morning to take my place in the queue for beds. After a moment's reflection, she said she would see what they could do, and led me through the ambulance entrance to the emergency assessment bays. Most were already filled with other people waiting beds, but she found one at the end still vacant, so I could finally get a couple of hours sleep in relative comfort on a trolley in ED. Edwin had brought a flask of tea with him, which was brilliant as no other drinks were available.

It is often reported that it is the elderly who demand hospital attention. But the ED at West Suffolk Hospital was mainly filled with young people; people who, as a GP, I would mostly have assessed to have minimal serious illness but wanting minor treatment or reassurance. Now, GPs are grossly overpaid for doing less and less work and minimal hours. GPs are paid according to the number of patients on their lists. My first solution to the resource problems of the NHS would be to change this scheme and pay general practioners strictly for each patient they attended, with double pay for out-of-hours consultations. This would immediately shift primary care back where it belongs: in the community, and it would relieve the A&E departments of much of the minor care they are obliged to provide now, most of which is neither accident nor emergency.  Despite this, care and professionalism by the staff at WSH was first rate. Doctors, nurses and ancilliary staff without exception treated every patient with consideration, care and respect: young or old, trivial or serious, drunk, depressed or moaning, or even handcuffed to police officers.

At ten in the morning the consultant came round who agreed with the registrar, but thought I should be returned to the dermatology department as they had organised the scan and could take over my management. In the meantime, I was to go back home and treat the pain with paracetamol. Yipee!!