Excellent Care – Not So Excellent Facilities

Today, I am celebrating my first full week post-op. It has been an eventful time and quite the learning experience.

A week ago, I arrived on the pre-op ward early in the morning with my wheelie bag of nighties and clothes, some books, my iPad and my post-surgery aids. Mike was dismissed at the entrance to the ward, on the grounds that it is a small, single-sex area. Although this was not what we expected, it was the best thing for us. Some people – like Mike – are not naturally nurse-y and do not cope too well in the waiting. I was glad that his possible business trip to New York on the day of my op was rescheduled for February so that he could take me to the hospital, but it would not have been good for either of us to have him anxiously hovering by my side before I went in. I told him to go home, but he opted to work in the cafe until he could see me on the ward.

I only had a brief wait on the pre-op ward where I changed into the hospital gown and compression stockings. I was told to put my winter coat, scarf and socks on top to make sure my body temperature stayed in the acceptable zone for surgery. I did not realise there is a minimum body temperature below which your recovery is compromised and your surgery may be delayed or cancelled.

During my wait, I answered several times the questions that were to become the pre-cursor to most of my interactions in the hospital: what is my name, date of birth, procedure (right total hip replacement), allergies, medications.

I was visited by my surgeon’s registrar to discuss risks and to sign the consent form. He was lovely – very reassuring, calm and clear in making sure I understood each risk thoroughly. He explained the preventative measures to be taken during and after surgery (eg antibiotics and blood thinners) and the tests he would perform to make sure my sciatic nerve was not damaged (foot-flexing). He drew a large and artistic arrow and the letters ‘THR’ on my right thigh which was oddly reassuring and took his leave saying he would see me after the surgery.

Minutes later, two nurses appeared to bring me to the anaesthetic room. They informed me I was on the “Enhanced Recovery Programme.” I had never heard this term before and did not know what it meant. Beyond confirming I had attended the pre-op education session and being told that I should be discharged in 2-3 days, there was not time to discuss this any further.

Given the choice of walking or riding, I decided to have a last limp on my dodgy hip to say farewell and to attempt to warm up. We soon arrived, and then everything happened with lightning speed.

The anaesthetist introduced himself as he put a cannula in my right hand. As he taped it in place, he asked if I wanted a spinal or a general anaesthetic. “Spinal, please,” I said, adding that as nice as everyone was, I would prefer not to be chatting or aware of what was happening. “Don’t you worry,” he assured me. “I’m going to give you a good hit of a special mixture called ‘I don’t give a damn,’ and if you seem to be coming round, I will give you some ‘I really don’t give a damn.'” Now you’re talking, I thought. This was a man after my own heart. He was as good as his word – the last thing I recall is him asking me to press my back against his hand as he found the right spot for the spinal.

I did surface briefly during the final stage of the surgery. I was lying on my side and could see the blue towel drapes in my peripheral vision. I could hear my surgeon and his registrar talking and then heard vigorous hammering. I couldn’t feel anything, but I knew that din of panel-beating was going on inside me. A second bout of hammering led me to look for the anaesthetist. “I’m a little too here,” I said. “Don’t worry,” he said, “It’s nearly finished. I’m taking care of this right now.” Seconds later, it was good night, Vienna.

I came to in the recovery room feeling great. I especially enjoyed the ‘Bair Hugger’ – a gorgeous, hot-air filled warming blanket that moulds round your body as it raises your temperature. I would like to be permanently dressed in one of those all winter, please. Bliss.

The recovery room tests were as promised with frequent checks on what feeling I had in my feet. Strangely, the feeling came back in my good leg first, and there was a gap of two checks before I could feel a hand pressing on my operated side. I wish I had been told to expect this beforehand as it made me a bit anxious.

I did not have a long stay in the recovery room and was wheeled off to my new home on Ward 5 before I knew it. For the rest of the afternoon and evening, I felt great. I was sitting up and enjoyed visiting with Mike and Annabel and speaking to friends and family on the phone. I met my bed-bound neighbours and their families.

Although I was connected to a PCA – a machine that administered 1ml of morphine intravenously when I pressed a green button – I did not feel the need for pain relief. I gave a few, experimental presses throughout the evening when I thought I sensed the start of a background ache. All in all, I felt so well that I thought, “This is a doddle. What’s the big deal?”

Morphine Is Not My Friend

That smug sense of comfort evaporated at 3am when I was woken by extreme pain all over my right leg. I felt like I had fallen off a cliff. I pressed that green button. I tried to distract myself during the 5-minute intervals before I could press the button again. It was agony. I started to time the interval on my iPhone stopwatch as I simply could not imagine that 5 minutes could take quite so long.

In desperation I pressed the nurse’s call button. I explained I was in great pain and the morphine did not seem to be working. The nurse looked at the PCA which showed that in 12 hours I had only made 9 presses and that I needed to be patient while the pain relief built up to take effect.

I pressed that button with fervour every time I spotted that the green light was illuminated. Eventually, the pain became bearable, but the side effects of the morphine were incredible drowsiness (the sort where you conk out mid-sentence) and constant sickness. I spent all of the morning and early afternoon in a fog of sleep and sickness. I became a popular subject for monitoring as my respiration and blood pressure rates dropped significantly.

The highlight of my day was a visit from the physios who asked if I would like to have a go at getting out of bed and standing. Truth be told, this was not top of my wish list at that exact moment, but I am a compliant soul, and I knew that getting moving quickly after surgery was in my own best interests. “I’ll give it a go,” I answered. This was met with exclamations of delight and approval. The three physios were so encouraging and wonderful. They explained how to get my legs to the side of the bed safely. This took a lot of effort, but there I was sitting up with legs dangling. We paused so everyone could admire my slippers and I could let the room stop spinning.

My slippers - approved by Annabel and much admired by physios and nurses

My slippers – approved by Annabel and much admired by physios and nurses

Then I stood up and was amazed to find that it really was true that my new hip was safe to bear my weight. I was instructed on how to coordinate stepping forward with using my crutches and managed three steps forward and three back. I was told I had done very well but looked quite dizzy so that was probably enough for day one. I celebrated by getting back into bed, throwing up and dozing.

By the way, this experience was instructive in explaining how post-op patients stay on their backs when asleep – at least in the early days. That operated leg weighs a ton and is as immovable as granite. The chance of accidentally turning on your side appeared to me to be nil.

By the evening, I managed to perk up a bit with the help of an anti-nausea tablet and enjoyed a visit from my brother-in-law, a wonderful fellow who brought holiday pictures and M&S chocolates! I was looking forward to a good night’s sleep, but, unfortunately, it turned out to be a wild night on Ward 5.

Morphine Was No One Else’s Friend Either

From my bed-bound vantage-point, I had not experienced all of Ward 5. I could see that it was a huge, old-fashioned ward with beds arranged in three long rows (two rows along the outer walls and a row in the middle of the space. I was almost opposite the nurse’s station in bed 3 and looking across to the far wall, I could see the sign for bed 25. That’s a lot of people in one ward.

Every bed was occupied with a mixture of hip and knee replacement patients at various stages. I’d learned from my bed 4 neighbour that she had been in for 8 days since her hip surgery. My bed 2 neighbour was also a hip replacement patient who had been in for some time. She was physically doing well and was able to walk around the ward with a zimmer frame, but she was also confused and not always aware that she was in hospital.

The ward closely resembles a busy train station in terms of bustle, noise, fluorescent lighting and general aesthetics. There is very little space between beds, and the only privacy measure is to pull a flimsy curtain around a bed. This still means every patient is audible though not visible. There is a constant hubbub as the nursing and catering teams dispense medications, vitals checks, food and drink, sick buckets and commodes on a constant basis. Even at night, this activity continues unabated with only one set of the most glaring lights turned off at around 11.30pm. With patients, staff and visitors all talking, the din is quite overwhelming. Needless to say, Ward 5 does not provide a restful environment.

I dropped off to sleep when the big light was finally switched off, despite the continuing burble of conversation among patients and nurses including a long grumble about sluices not working properly.

So much for restorative sleep. At about 2.30am, Ward 5 became a madhouse. All at the same time, a new patient at the far end of the ward began shouting about going home, calling the police, having the staff arrested for kidnapping; another new patient, two beds away from me in bed 1, began plaintively shouting, “Help me. Somebody please help me,” which she repeated at top volume without a break; my neighbour in bed 2 announced she was just getting up to make her husband a nice cup of tea; and someone in the middle row fainted and fell.

Over the next several hours, the two shouters seemed to be in a competition to cause maximum disturbance. The poor staff ran between the beds of the shouters and wanderers trying to keep everyone safe while still trying to meet the routine needs of the other 20+ inmates. I’ve never witnessed anything quite like it.

It is incredibly eerie and disturbing to hear someone repeatedly shouting for help in the wee, small hours, particularly if you are bed-bound. Moaning Myrtle, as I named her to myself, had great stamina in sharing her repertoire of: “Help me. Somebody please help me. Ooh me knee. Ooh the pain. I can’t breathe. I’m frightened,” which she belted out for more than seven hours without a break.

Initially, I was very concerned for her. I caught the eye of one of the nurses at about 4.30 and asked if anything could be done. She assured me that the patient in question was being looked after but was not pressing her morphine button often enough. She said the other patients were also affected by morphine which was causing drowsiness, ravings, confusion and sickness.

I confess that once I witnessed Myrtle verbally abusing the day nurses who arrived at 8am when they tried to help her, my sympathies went out the window, and I just wanted her to pipe down! She was apologetic the next day, confessing she thought morphine was terrible stuff.

Despite the disturbed night, I managed to get out of bed, walk around, go to the toilet and get rid of the PCA. I promised the physios that if they would persuade the nurse to remove the cannula in my hand, I would walk the whole ward and take the stairs test. It was incredibly painful to use crutches with that needle in my hand, and I was thrilled when the nurse agreed. I was told that subject to various tests (walking, stairs, OT, blood tests and X-ray), I would be discharged the next day.

Once I was mobile, I was able to experience every aspect of Ward 5. Sorry about this, but I feel compelled to comment on the toilets. There were just four toilets for 25 patients. Each toilet had a commode frame over it to raise the height of the seat but which also covered the flush mechanism. In practice, the height was set wrong for a number of patients and, to put it delicately, they frequently missed. On most visits there were puddles all over the floor. In addition, there was nowhere safe to put crutches, and mine fell into the puddles more than once.

I found it astonishing that a hospital absolutely at the cutting edge of surgical practice and with an enviable record of performance on infection prevention had such primitive facilities. I found this aspect of my stay really awful. Surely it’s not beyond the wit of man to install toilets with an adjustable seat height, an accessible flush mechanism and a bin like the one below which I use to keep crutches from falling over?

Excellent tip from the education day - put your crutches in a tall bin by the bed and toilet. Surprised not to see  this on Ward 5.

Excellent tip from the education day – put your crutches in a tall bin by the bed and toilet. Surprised not to see this on Ward 5.

As a Non-Executive Director of an NHS Trust, I and my Board colleagues are always interested to understand the patient experience. It occurs to me that there is no substitute for direct experience, and I think all Directors (Executive and Non-Executive) should be encouraged to spend a night on a typical ward to appreciate what it’s really like for patients. From this experience, I have no doubt that many practical quick wins would be identified that would really enhance the patient experience.

When I was discharged, I was given a feedback card and asked if I would recommend Ward 5 to others. I found the tick box (with choices ranging from definitely would to definitely would not recommend) and small comment box a bit inadequate to sum up my experience. I received top notch surgery and excellent care from all the clinical and allied health professional teams. I found all the domestic and catering staff incredibly kind and helpful. That said, I felt the ward was too huge, too noisy, too bright, too unmanageable and too outdated to provide a good environment for rest and recovery.

Unlike many of my fellow patients who had stays of 10+ days, I was extremely fortunate to get sprung on day 3 and was eager to say thank you and goodbye!

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8 Responses to Excellent Care – Not So Excellent Facilities

  1. Andrea says:

    As I am two weeks away from having a THR I have read this account with rather mixed feelings! I was looking forward to the post op PCA option but as i am utterly phobic about vomiting, I wonder whether it is such a good idea – does morphine make everyone sick? I am not overly anxious about the procedure itself (ha, who am I kidding!) but am wondering about your thoughts on new hip bonding. It seems a strange thought to know that pieces of yourself that you know and love will be removed and replaced by an ‘alien’ in the form of the implant. DId it take you long to grow to love your new joint? I look forward to your thoughts…..

    • Dear Andrea
      Thank you for your comments and questions. I would suggest you discuss the pain relief options with your clinical team. It’s definitely worth finding out what the options might be and letting them know about your concerns. Unfortunately, all the patients who had morphine in my vicinity were sick at some stage – I’m sorry to report that and wish it were not the case. I understand your anxiety about new hip bonding and felt worried about this before my surgery, too. I can honestly say, it did not feel alien at all, and once I was able to be up and about, I felt very fond of my new hip and very grateful to be pain free! Good luck with your surgery and recovery – I hope it will be a great success and that you will love your new hip very soon!
      Best wishes
      Sue

      • Andrea says:

        Thank you Sue for your reply. I will definitely talk to the relevant people about pain relief, they already have me flagged up as emetophobic … I am working hard on the positive thoughts towards the new hip and its reassuring to know your view. Best wishes.

      • I am now day nine post op and doing well .. and I wasn’t sick – ditched the codeine asap afterwards though. I have posted a report of my op and early post op phase on the Arthritis care forum (I think you recommended the site) if it is of interest. Didnt want to hijack your blog by posting the link here, but please feel free to share it if you are so minded. Best wishes. Andrea

  2. Paul Downes says:

    My experience was unlike yours, my left hip was replaced in December 2013 and after 6 weeks great and has been fine, this was in Basildon Hospital (at the time under special measures. My treatment, food, after care fantastic.
    But due to having a spinal fusion done in the previous year (successfully) I decided a direct anterior approach would eliminate the need to sleep on my back for 6 weeks.
    Biggest mistake of my 66 year life in October 2014 is was admitted to The Royal Orthopaedic Hospital Birmingham under the care of Mr C McBryde discharged after 4 days and 4 days later the pain was unbearable.
    Four weeks post op I was seen in clinic but no diagnosis was offered apart from the discovery of a 7cm hematoma on my hip joint. Returning home the pain was not controlled by Tramadol and was told to go to a local hospital for an X-Ray.
    The X-Ray revealed the stem had sunk and the pain was due to micro movement in the femur, I was referred to my local hospital (as urgent) it took five weeks to see me, I paid privately for a consultant to send me for an MRI, had nerve conduction studies, CT scan Ultrasound, pain management.
    During this time it has been like treading on glass, so far the hospital that did the operation has given me a clinic date of the 25th March ,5 months after the op with no suggested date for revision surgery.
    I find it unbelievable that this can happen and no noe seems to care other than me, I now have a pronounced limp where my leg is shorter, a dead upper thigh area.
    All this whereas I was very fit playing golf twice a week , active walker, and confined to minor excursions from home.
    I accept that operations go wrong but how you put it right is the answer, clearly The Royal Orthpaedic dont seem to think so.
    Prior to this my faith in the NHS was unshakeable now it is destroyed
    Paul Downes

    • Dear Paul
      Oh dear. I am very sorry to read about your experiences and what a terrible time you have had. As I am not medically qualified, I cannot comment on the specifics of your situation, but as an empathetic lay person, I am just so sorry that you have not been able to resume your active lifestyle post-op and have been living with pain. I do hope your situation has improved since you posted your comment. Apologies for the delay in replying.
      Best wishes
      Sue

  3. I agree with your observations about general wards. My bed was in a ward separated into four bed bays. The problem was with orthopaedic patients with dementia. the nursing staff were on constant patrols to prevent them interfering with equipment some of it attached to patients! My eventual move to the private wing (day three to five) was a relief.

    • Hi Norman
      Yes, looking after patients with dementia on a general ward is a significant challenge for all the clinical staff. Hope your recovery has gone smoothly and that all is well. Thanks for commenting.
      Best wishes
      Sue

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