The worst and best of times

After being crushed by a boat at Lake Wanaka, ODT journalist Philip Somerville spent five weeks experiencing the mercies, marvels and mistakes of Dunedin Hospital.

My five weeks in Dunedin Hospital were both the worst and - believe it or not - the best of times.

It left me full of admiration for the hard work of the nurses and the physiotherapist in ward 3B and impressed with most of my medical care.

But I'm also aware that lots can go wrong.

While this story to be frank and honest has to include what I saw as faults and failings, I'm conscious that these should not outweigh the skills and attention that brought me through danger and well on the way to full recovery.

I've often been asked if I was bored spending the first four weeks on my back unable to move around at all.

During the first several days I was in too much pain and too drugged to care particularly.

Subsequently, I was able to make the most of a new experience in a new place with plenty of new people.

Being heavily dependent, I saw lots of the nurses and I enjoyed their company and their different characters, their care and their - on the whole - cheerfulness.

My curiosity about my injuries and the complexities of hospital operations keep me diverted, and visitors were never in short supply.

What a good opportunity it was for several friends to catch up with me.

But, in common with many patients in hospital, I suffered considerable frustrations, anxiety and difficulties trying to get straight and consistent answers about my problems for much of the time.

I also tired of explaining all about the accident, my reactions and so forth with the string of health professions who took part in my care.

I know that each, in their "initial" interviews, wanted their take on what had happened and how I was, but I did wonder about the professional time that could be saved if I had my own little written version that I could present each time.

I had my daily routines - breakfast, brief visit from the registrar and house surgeon, reading the ODT, being hoisted on a frame and washed . . . and sparring with the cleaner.

She quipped that she wouldn't tell me her name so she personally would not be fingered by complaints to the health board. A few days later I overheard a nurse calling to her and her number was up.

Another nurse, marginally on the plump side, would insist that I needed to put on weight.

While still smallish myself, I can assure her that most of the 4kg I lost, as muscle wasted and fat disappeared, has come back - at least the fat part of it.

My backside bulges once more and my excuses for abs are again well-hidden.

I was also most fortunate to be incapacitated rather than sick.

I could still read (virtually every one of Alexander McCall Smith's gentle and stimulating novels) and watch television - doing so guilt-free because what else was I supposed to do.

Time in hospital was memorable family time. My wife, Shona, took the first week off work to help and continued to come in briefly in the mornings, at lunch times and on most evenings.

A hospital occupational therapist, she broadened her skills by helping with my "personal cares" and with my hoisting.

At least twice a day, plastic slates were slid under me and clipped on to a metal structure. This frame would then be hoisted by a small electric crane to allow for washing, the circulation of air, toileting and to minimise the risk of pressure sores.

This time-consuming process was repeated about 60 times and Shona became adept at it. The ward, for orthopaedic accidents, was always busy and Shona's assistance as an "honorary nurse" was appreciated by hectic staff.

My three children were regular visitors and my son astutely noted that, stuck side-by-side in hospital, we had more chance to talk than we would normally.

The first night in ED remains blurry and, looking back, I marvel at the effectiveness of low technology.

Because the accident twisted my pelvis to an alarming tilt, also breaking it in two places, the surgeon in ED seems to have wrenched it back close to level and knotted a strong sheet around my middle.

The sheet remained in place, like a cast, for about 10 days, although when the swelling subsided it became quite loose.

Apparently, I was given the equivalent of one of those date-rape drugs for that "operation", remaining conscious but remembering nothing.

I do, though, recall X-rays and CT scans and being wheeled to a single room opposite the nurses' station in ward 3B.

I had my oxygen mask, drip and each 30 minutes over Saturday night my nurse would check my blood pressure, temperature and "sats", the oxygen level in my blood.

By this stage, my body temperature had been carefully raised over several hours from about 34degC to normal, my racing heart was easing back and my sunken blood pressure was climbing.

A few days, later I was given two units of blood to replace some of what was lost.

Fear of tissue and organ damage persisted and on the Tuesday after the accident, when my "sats" slipped temporarily and alarmingly for some unknown reason (a lung blood clot was suspected), I was back for another scan.

One night early on, a vivid and scary drug trip had me shaking my head at why some voluntarily seek such experiences.

And, despite anti-spasming drugs, I would groan in agony when pain periodically ripped through my right side.

In between times, various chemicals, including those administered through a personal hand pump, did their analgesic jobs and I was reasonably comfortable as long as I wasn't moved.

They say, however, you can find humour in almost anything.

And so it was when my boss, the squeamish editor, was leaving after a brief visit. He was just going out of the room when a bolt of pain struck me and caused an involuntary moan of misery.

I'm not sure what was whiter - his face or the hospital sheets.

Improvement was rapid and I knew I must be well on the mend when I was shifted after two weeks from the nurses station hub to the far corner of the ward.

The oxygen mask had soon been replaced by nasal prongs and then just "pure" hospital air. The drip was extracted after several days and the catheter after about two weeks.

The spasms died down and the stronger opiate-based drugs were withdrawn earlier than expected.

A hospital conundrum for those prone in bed like I was is this: Do you miss having a shower or sitting on a toilet more?

Excruciating constipation had set in by this time and the answer was easy, not that sitting would have made much difference.

Finally, the dam burst effectively, only to be replaced by matters too loose. Then it was back to the agonies of a sore stomach and trying to pass what seemed like rocks.

Shona tells me I became obsessed with the problem, not surprisingly, and was unabashed in telling every poor visitor about these particular agonies.

For someone who had been fizzing with fitness, it was disheartened to watch muscles atrophy and feel ligaments stiffen. So when I finally "mobilised" on to a frame I creaked only a few feeble, tentative shuffles - a frightening preview of what it will be like to be very old and very frail.

The first shower, down the ward via wheelchair, was unforgettable but not for the faint hearted. Steamed and heated, I returned to undertake my transfer to bed only to briefly collapse.

Usually, when I rang the nurses' bell in the busy ward for non-urgent assistance, I might have to wait 20 minutes or more. That's just the way it is on a busy ward.

This time, after the bell was given the three emergency blasts, my room was full of helpers within seconds.

My dizzy moment proved to be a false alarm - no stroke or heart attack - but the response was gratifying.

Hospital food, mostly, was perfectly reasonable considering the challenge of preparation en masse; much better than in many other hospitals, I'm told.

I couldn't help, though, feel sympathy for the cooks. Because so many patients are unable to eat properly, they must know much of their effort ends up as waste.

It was the delivery of food that provided the first of what to my critical eye was a failing. In this case it was potentially perilous.

•I was supposed to be on liquids for the first few days because of the danger of blocked bowels or other internal damage.

But a normal dinner was delivered as a matter of course. Happily, I was alert enough not to eat it.

•Inadequate communication about whether I would be flown to Christchurch for orthopaedic surgery caused me unnecessary anxiety.

I, fretful about my long-term prognosis, was told my X-rays would go North for a recommendation which I assumed would be made promptly.

The X-rays were not sent until about three days after my accident and then there were delays in Christchurch.

Only when my wife rang her uncle, a retired orthopaedic surgeon, in Christchurch, did I learn that these delays did not matter at all.

Any operation wouldn't take place until I was over the worst of the initial trauma.

The medical staff had not thought to tell me this specifically. As it happens, the decision was made to treat me conservatively.

The break at the front left, which is not in the way and has not been sore, will just stay broken, while the split bone just to the right of my spine - the one that has given me much discomfort - has healed with time.

•While I hadn't asked the right questions about Christchurch, I was wide-awake in another instance.

Several days after going off the drip, I asked why I was still swallowing potassium tablets. "Whoops, we could have stopped those days ago," was the response, not that the extra pills did any harm.

Once a drug is "charted", it can easily just carry on, and I was attentive to the end of a course of antibiotics taken after signs of catheter pus.

•The most spectacular failure concerns me less than, I've no doubt, many others; an Emergency Department clinical sheet of mine was found on the street outside the hospital by a hospital staff member and handed in to the patient affairs office.

What a surprise in early July to receive an official Otago District Health Board letter setting out the incident, a summary of its investigation and reports that the cause could not be ascertained.

Although somebody bungled somewhere and somehow, this type of mistake does not cause physical harm.

While occurrences as blatant as that should never happen, our society's cult of privacy is at times overdone.

Secrecy encourages corruption and can, in some circumstances, undermine care and health in a small nation which is, after all, like an overgrown village.

•Although I was advised about the plugging up effects of the "oxy" drugs, I'm disappointed no-one told me the pain killer tramadol has similar, if not so acute, properties.

When I went home, constipation again plagued me but, given my high-fibre diet, I couldn't understand why. I also hadn't been prescribed additional laxatives.

Yet, for all that, the big things seemed to go right.

And I, too, work in an at times mad-rush industry where perfection is sought and never achieved.

Hospitals are complex and dozens of staff are involved in your care. I can now advise them there's a touch of numbness in my left thigh as nerves take their time to heal.

I'm also sometimes aware of a dull ache at the back when I sit for too long. But I've some of my fitness back and am close to "normal".

Overall, while I can't comment on everyone in 3B - and certainly not those in other parts of the hospital - I am most impressed and most grateful.

In fact, a primary reason for me writing this article - constructive comments, I hope, and all - is to publicly thank the staff of the orthopaedic trauma ward for their professionalism, their hard work, their skills and their good cheer.

 

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