Tuesday, October 08, 2013

Stitched up by Nursie

A month and a half ago, I was fortunate enough to have some varicose veins removed on the NHS. They had been causing me discomfort for some time, and occasionally bleeding. When I initially asked my doctor he told me that I could have them removed privately for "very little cost." I asked him how much he meant by very little. He said "about £2000." I didn't bother telling him how hard it would be for me to find that amount of money. But when they bled again I returned to him, and expressed concern about them complicating into DVT. He begrudgingly referred me to a surgeon, who took one look at them and agreed that they should be removed.
I understood how fortunate I had been. I love the NHS. I'll support it at every opportunity, especially now when it seems like people are looking for reasons to make it look bad. And whether or not he did it begrudgingly, my doctor did refer me, thus sparing me lots of discomfort down the line.
At Chelsea and Westminster Hospital I was fortunate to have an excellent surgeon in Dr. Gibbs, and the anaesthetist totally put me at my ease before knocking me out, which is handy considering I freak out at needles. When I awoke, the surgeon was very clear about what was to happen next.
"The operation was a complete success. But you need to make an appointment with your GP in two weeks time. You have three stitches that need to be removed at the surgery. *indicating my groin area* The paper ones on your leg will fall off of their own accord, but if they don't, just pull them off in a couple of weeks. Don't forget to make an appointment with your GP. Keep renewing the dressing in your groin until you have the stitches taken out."
Very clear. He gave me a letter as well, and used highlighter pen over the section saying that some stitches needed to be removed. So I did everything according to his instructions. A week or so after the surgery, I started to develop a rash around the area of the incision in my groin, roughly in the shape of the dressing. I was concerned by this, and treated it very carefully. I thought it might be an allergic reaction to the dressing but since I had never had a surgery wound before, I was concerned. About the rash, and also about how the wound appeared to be constantly open. I had been very active right after the surgery, working on the boats for hours some days, and walking in the park. I was worried that some crap from the Thames had got in it. I was looking forward to having my fears laid to rest, and counting the days until the stitch removal when that would happen.
I had made an appointment with the nurse rather than the doctor for the stitches. My last few flatmates have been nurses so I know that nurses remove stitches - (Tara used to love it. Had she still been here I probably would have got her to do it and this whole sorry nonsense wouldn't have happened). So I rang my surgery and asked if I should see the doctor or the nurse to have stitches removed. They said the nurse. So off I went. I didn't bring the letter from the surgeon, as it said nothing specific.
It's a sunny morning, and I am in a good mood. I am looking forward to getting advice on the rash, and having my mind put at rest about the upturned edges of the wound. I bound into the nurses room:
"Hello! I need to have three stitches removed! I should warn you though, I think I've had a reaction to the dressing, so the skin is raised around the incision wound. It's pretty unpleasant. I'm worried about it to be honest - could you have a look?"
I show her. She gets me to lie down, puts some cream on a cloth, and before I realise what she is doing she jams the cloth into the scabbing, rubbing right over the top of the open wound. This is completely at odds with how gingerly I have been treating it all week. It also hurts and comes with no warning.
"Ow!" She stops. I am instantly really angry - I feel weirdly violated. "What the hell do you think you're doing?" (Not the right way to start this, but I am feeling violated.)
"I have to remove the scabbing so that I can properly see where the stitches are."
"You should have warned me. Also you were going right at the incision wound. Careful of that."
"Yes of course. can I carry on?"
"Yes of course."
She then pokes around for a while. "You have no stitches." 
(Still angry. Still doing myself no favours.) "What are you talking about? I have three - it's probably just that the skin around the wound is raised because of the rash. I definitely have three stitches that need to be removed by you today."
"Do you have your surgeon's letter?"
"No - I left it at home. But all it says is that there are stitches. It doesn't say where or how many. But the surgeon pointed at my groin and said the number three. And that was the main incision so one would assume...
"I can't do anything without the surgeon's letter.
"Well I don't have it. Can you just find the three stitches and remove them? I definitely have three.
"I can't do anything without the surgeons letter."
(So I continue to be a dick.) "God. Ok, fine I'll get the sodding letter and it won't say anything more than what I've told you. It says stitches need to be removed by your GP after 2 weeks. I'm here. It has been 2 weeks. You're not my GP but you're the nurse so that's fine. I can get this bloody letter if you need, but if I get it will you remove the stitches for me?
"I can't do anything without the surgeon's letter.
"Please just get the stitches out.
"The stitches he was referring to are the paper sutures on your leg. I can remove them for you?
"No, God no - I can do that myself. You'll probably take the scab off with them. You really want me to go home and get this letter?"
"I can't do anything without the..."
"Oh for fuck's sake ok fine whatever."

Me, and rage: when I walk into a lamp post, my instant reaction is rage. Rage at the lamp post. That bloody lamp post how dare it hit me! This is always my first reaction to unexpected pain. I kick out at it. But also she unexpectedly caused me pain in a really intimate area, where I had invested a lot of concern. I really didn't want to have a septic groin. So I was angry, needlessly and stupidly angry. And I was doing myself no favours. And then she tapped into my pet hate - people being officious and stating the rules in the absence of common sense. Nothing makes me angrier than the whole "It was in the terms and conditions when you signed up for X". I get like Michael Douglas in Falling Down when they won't serve him breakfast.
I was still fuming when I got back into the surgery clutching the letter. I marched up to the reception brandishing it.
"I need to make an appointment with the doctor. Your nurse is an incompetent." (The nurse is, of course, in earshot. I'm really not interested in doing myself any favours here.) 
But they fit me in - brilliantly. I think the nurse has had enough of me. The doctor, however, is not particularly interested in giving creedence to the fact that I know I have three stitches in me. He is more concerned with closing ranks with the nurse. In fact he barely looks at the wound, and tells me I have no stitches. I'm calmer now. I say I do. He says I don't. I tell him he is going to send me away with stitches in my wound.
He shrugs. "If you do have stitches that aren't removed then your body will reject them. The worst that can happen is that you'll get an abscess.
"Great. Well, I'll see you when I get the abscess.
"Do you want the nurse to remove your paper sutures?
"I'm not letting her anywhere near me. Look, please - the surgeon told me I have stitches that need to be removed. Why would he do that if I didn't?"
"I used to be a surgeon. Stitches that need to be removed have a bobble on them. I can't see anything like that in your wound."
So I go home. That evening, I carefully take off the paper sutures on my leg and discover TWO BLUE STITCHES WITH BOBBLES ON THEM in one of the wounds on my leg. My leg! dammit I thought it was my groin. That was where the surgeon indicated. My leg? Now I look like a twat. I poke around looking for a third, but to no avail. "Weird," I think. "I wonder where I got the number three from." I go in the next day, and ask the nurse to remove them. We are courteous to one another. I ask her if she might look for a third stitch. She says there are only two. I feel like I have been a dick. I apologise to her for my behaviour the previous day. I am annoyed with myself - I was sure the surgeon was indicating my groin. Why would he have done that if there was nothing to remove there? Either way, I should have been more calm and then we would have probably found the stitches in the first appointment and there wouldn't have had to be so much bad karma floating around. The nurse does not apologise back. She uses my apology to explain how I was wrong.
"If you had told me they were in your leg...!"
I respond - "Well, yes. But in the end, I'm the patient here."
Weeks pass. As for the wound in my groin, it remains open. Constantly weeping. I am cleaning it carefully and regularly and trying to stop it from going septic and wondering when it's going to heal. Operation scars are a new thing to me, and they don't seem to work like normal cuts and bruises, I think. I know there isn't a stitch in it, but I wish the flesh wasn't turned up like that. I worry it might scar. I assume I am being too active, but I can't bear not to be. It's a constant background worry, but I try not to let it get in the way.
A month later I am dancing in my kilt at a wedding, when I feel the half closed wound open yet again. IDIOT! Why am I dancing when I know this wound isn't healing properly? Especially considering I've been cancelling shifts on the boats, worrying that being on a speedboat won't help the healing process one little bit. I don't want to go to my doctor. I've already wasted their time, besides they'd just talk down to me and tell me it was normal for that sort of wound. I ignore it, but it keeps bothering me.
At home the next evening I decide to get some light on it and shortsightedly peer and poke at it. My eyesight is not good at the best of times. My lenses are a very old prescription and I lost my glasses on holiday so I only have sunglasses without them. But oh my God what is this? Stitches! Two knotty bobbles either end of a ligature running the length of the wound. I get a really close look and realise that the weeping is coming from the holes where at the top and bottom where it punches through the skin. That night I hardly sleep at all. The next morning I am at my GP as the surgery opens, and thankfully the nurse has a slot first thing. By this stage I am not interested in "I told you so." although I am very glad that I was not delusional. I just want the damn thing out of my body. There is already some scar tissue that there wouldn't have been if it had been taken out when I first came in, but nobody tends to see me naked - although I have stood on stage stripped to the bollocks. But I'd never need to look perfect - I'm no porn star. 
So I say to her "I need to have a stitch removed from my groin.
She knows me. "Another one?
"No, the same one as before. It's been there for a month now keeping the wound open.
She takes a look. Then, quite astonishingly, she gets a large pair of big blue tweezers. I calmly think they are some sort of cutter, until - again with no warning and no sense - she actually yanks the top knot upwards, trying to pull the bottom knot through the wound and out the other side. I am getting deja vu here. This great big knot slides wetly into the hole in my skin and then jams on scar tissue as it travels through the wound.
"Ow! What the hell do you think you're doing?" (Again) 
"I have to pull it out.
"Well, yes, God, but there's a bloody great knot on the bottom - surely you should cut it off before pulling it through the wound?
"There wasn't a knot on the bottom." 
"Of course there was a bloody knot on the bottom. I looked at it really closely."
"There wasn't a knot on the bottom."
"There was. It was bigger than the one on the top. You've just yanked it into the wound!" 
"There wasn't a knot. It's just a bit of scab, like this." *she shows me a bit of scab, as if that explained everything* She is world weary in tone now, fed up of this delusional idiot, patronising. I am really trying hard to remain measured. I will not allow another atmosphere like last time. Despite her protestations she starts digging in the hole into which she has pulled the knot, sticking the unsterilised blue plastic tweezers right into the wound, trying to pull the knot back the way it came. Which implies that she might realise she's made a mistake.
"Stop a second. Look, the only reason I came back to you was so it was on my record that there WAS a stitch in my groin. I could have cut it and taken it out myself. I wish I had now. I almost did because I was scared you'd do something like this. This is unbelievable.
"Wait here."
"No it's fine let's just get this done."
"No - wait here. If you are calling my competence into question I have to get the doctor."
She leaves the room, and comes back with a doctor - a different doctor from the first time, thankfully. 
The nurse tells the doctor that I am kicking up a fuss because I think there is a knot on the end of the stitch she is pulling through my wound, whereas I am mistaken and it is just a bit of scab. I tell the doctor how she has just unnecessarily pulled a great big bobble halfway into my wound and ask her if she thinks it's better to try and pull it back the way it came and cut it off, or to just get it all the way through now. The doctor - this one - takes a tiny bit of time to understand the problem and the history of the problem. She appears willing to listen. The nurse however is using her talking to an idiot voice "There was a little bit of scab on the bottom of the stitch and you are saying it is a knot. There is no knot." I am totally past caring. "Please," I say to the doctor. "Just get it out. I don't care how much it hurts. I don't want it in me any more." The nurse types something on the computer and asks the doctor to look at it. I assume it's something about me. It doesn't matter. Nevertheless, carefully and slowly thank god, the doctor manages to pull the stitch all the way through. It hurts because there IS a bloody great bobble on the end. The doctor shows it to me. It's the larger of the two knots. The nurse is now silent and withdrawn, looking at the screen where she has written something. The doctor apologises, even though she has done nothing but good. The nurse says nothing. I thank the doctor for her apology and make a note to myself that if I ever need to come back I should come on a Tuesday.
Now what upsets me about this whole episode is that - apart from the final doctor - nobody ever appeared to think that what I had to say about my own body and what was wrong with it had any relevance. As someone that lives in my body all the time, surely my opinion is worth something? But both the first doctor and the nurse were unwilling to accept what I had to say, in the matter of the surgeon's letter, and in the matter of my own pain and understanding of my healing process. In fact they didn't ask me any questions or seek to understand anything. I very quickly lost my faith in the nurse, and I never have qualms about making it clear to people when that happens. But on the first visit I felt so talked down to, that had I not found the stitch in my groin, I would have been very unwilling to go back to the doctor unless I was puking blood. Also I had an allergic reaction to a dressing. No interest was taken about that - surely it could be useful to have on file for future reference?
It is this kind of episode, taken in isolation, that allows for those who are looking for the cracks to attack the NHS. And it was so needless. I was moody, but lots of sick people are moody. I made matters far worse for myself but shouldn't they treat the disease not the patient?
We make our opinions based on our experience. It is easy to go from the particular to the general. Someone on twitter asked me "How is it the NHS at fault when it is only 1 doctor?" If I was punched by a Chelsea fan I could be forgiven for thinking that all Chelsea fans are bastards. It may be irrational, but it is often how we work. Nonetheless, this was to do with the NHS, but not the fault of the NHS - the hospital was fantastic. My nurse, and the aftercare just sucked.
But is this slipshod aftercare endemic? I am healthy, outspoken and determined. I avoided infection (thus far) and had enough basic knowledge to get things fixed for myself eventually, even if I put up with an open wound for too long as I didn't know how a surgical wound might behave. But someone more afraid than me or more vulnerable than me might well have ended up in a far worse situation a few months from now with a septic groin. All I lost was a couple of shifts at work and a bit of confidence. Someone else could have lost their willy. The attitude of both the first doctor and the nurse was from the same dangerously flawed standpoint: "I am knowledgeable and qualified. This person is not. Therefore I am right, and this person is wrong." With internet self-diagnosis everybody thinks they have cancer if they have a lump on their tongue, but surely this is not enough to dismiss everything the patient has to say for themselves?

I suppose I'm disappointed. I want to believe that the NHS is fantastic, even as Nye Bevan spins in his grave at what's happening to it. I think I will continue to believe in it. But if the wolves were closing in on me, and I worked in healthcare, I would do everything in my power to prove the detractors wrong and provide the best possible service. More and more I am considering - if my career ever takes a turn for the better - getting health insurance. In ten years time I fear that the wonderful experience I had with the surgeon - which cannot be overlooked in all this - would be impossible for anybody. In that sense I was extremely fortunate. But if I ever end up in front of that nurse again I will scream and run away, even if she has already accidentally amputated my legs.

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