#ThingsThatMatter
My experience of NZ Health and ACC. “Under the Covers: six days in Waikato Hospital, New Zealand”
SUMMARY (thanks niece!)
TL:DR
Sharon’s a speed demon and the medical professionals and ACC staff that helped along the way were delightful.
Plus some stuff about other patients in the middle…
😉
😎
SATURDAY
In a rush to complete some chores on the lifestyle block, I was driving our fabulous Massey Fergusson 35 at some speed around the paddocks (funny, been reading British authors and nearly typed “fields”) to mow an area suitable for working my horse and fix other ongoing access issues. In true “it only happens to Sharon” style I miscalculated the speed and turning capability of Wee Fergie and found myself desperately trying to disengage from a fence line. Seven wire, post and batten fencing to be exact, with a high-power PTO (must look that up) driven “slasher” mower designed to cut through foliage the size of said batons, but Not wire and posts.
Clutching desperately at the steering wheel in one last effort to avoid absolute catastrophe, I find Wee Fergie coming to a halt, partially within the fence but in alignment with the strainer post. Luckily for me the “Wee” and the “35” allow Fergie to stall at this point, as I find my right wrist at an unnatural angle and (based on previous experience resulting from a long and unsuccessful lifetime riding and falling off horses) know there are seconds before the visual image will be followed be the physical pain of the injury.
In the initial impact assessment (split second) before my brain interprets the pain, I decide to straighten the limb -with a dim hope it might be dislocated and able to “pop” back into line. (Again, based on previous experience with injury, I believe dislocated limbs better reset ASAP. Sad what you know because of following your passion.)
First try fails when the wrist immediately flops afterwards, leaving me to realise “broken then, not bent” and decide it’s still better straight than sitting at 90 degrees. So, I straighten it again, and rest it across my body (suddenly the flabby tummy gained over the last few months feels like a comfy resting place as I hold the injured limb across it with my good hand).
So then. Self-first aid underway, I assess the scene looking for ways to prevent further harm to me or others, and limit my actions to turning the key on poor Wee Fergie to the off position before grabbing my mobile phone and heading to a safe seating area before shock sets in and I risk fainting.
So initial assessment and triage complete, I decide to first call the ambulance (I was working alone, in the country), then brave the wrath of Husband #1 (first and only, for the past 27 years) with the realisation that he will TOTALLY expect the horse to be the cause of the injury. This is to be expected based on my history of falls/fails, but in this one instance totally unfair. I also know Husband #1 is on duty as a Station Officer, Brown Watch, and unable to assist this low-level emergency, so I use an incident briefing approach to deliver the message with an outcome based action plan.
With the ambulance despatch delegated to the call centre, I take a breath before making the call. Husband #1 (H#1) sounds very sceptical of my story, but accepts my assessment “I’ve broken my wrist. I’ve called the ambulance. No, I can’t drive myself, I’ve broken my wrist.” And we hang up to make our next priority calls.
While I arrange with a close friend and neighbour to secure the property, H#1 has called our daughter (again only one, I have issues with counting past that) and she is on her way to me as said neighbours husband arrives and assists with everything from shutting down the air compressor and locking the shed to locating an ice pack. He even carries my handbag to the ambulance for me. I tell daughter number one to meet me at Anglesea Clinic.
St John despatch must be having a good day for resource availability as the ambulance arrives quickly and I am soon viewing the countryside from the back-trolley bed.
I ask for a sling and am surprised this doesn’t seem to be in common use, as neither attending officers are familiar with applying one. However, with sling in place, some pain relief and a 20-minute drive to Anglesea Clinic, I can walk into the surgery via the back door. St John information has arrived before we did, along with my daughter who called me as I was entering the ambulance at which time I asked her to meet me at Anglesea. This has allowed for an immediate place in the que.
X-ray taken, the radiologist comments “ouch” when looking at the first plate. I reply that four-letter words were applied, one of which might have been “ouch”.
I am sympathetically moved from X-ray back to the doctor through the short cut, and the doctor confirms my arm is broken. We are to move to the hospital and consult with orthopaedics as to treatment.
This all sounds a logical and effective response to my accident, so far…
Luckily my daughter is there to transfer me to the hospital, and she drops me at A&E for further assessment. Again, my information has arrived before me and the registration and assessment are reasonably quick. I find myself in an exam room having a procedural anaesthetic explained to me before being knocked out long enough for the arm to be straightened and placed in a full arm splint. This is designed to stabilise the bones until surgery can be scheduled. As it is Saturday I am informed surgery is likely to be next week, though it is mentioned that if I can be made comfortable I may be sent home until surgery is scheduled.
I come fully awake while being moved into recovery to await transport up to the orthopaedics ward.
On arrival in orthopaedics I am placed in a room of six. All the beds are occupied. In respect of the privacy of the patients I shall refer to them by first initial only.
Patient H is elderly and having difficulty communicating. She reminds me of my mother in the last visits to her before she passed, in that she seems surprised every time she sees someone, and unable to understand where or why she is here.
Patient A is in traction, with weights constantly dragging her down the bed as they attempt to prepare her for a second surgery.
Patient G has had a hip replacement and at the time of my arrival is restricted in her mobility.
Patient P has had back surgery and is also restricted to her bed.
(It is fair to say how wonderful it was to see these two ladies progress from bed bound to mobility and freedom. Recovery of their independence was critical in their confidence, and I wish them both a happy home life with their mended bodies.)
Patient B is awaiting surgery on her broken ankle. it turns out B has been in hospital 8 days, scheduled on “nil by mouth” for surgery four times only to have surgery cancelled. B has a fixator (I think that is the correct term) framework of rods and bolts holding the leg stable externally. The rods appear goldish in colour and the bolt ends are a festive green. While B may not appreciate my description, I continue to refer to it as her Christmas tree during our time together.
B and I are both placed on nil by mouth for Sunday morning, which I find pleasantly reassuring.
DAY TWO
Hah! How naive am I! By lunchtime Sunday I am free to eat, as theatre are unable to schedule my surgery that day. I do ask about options for using private health insurance, but am told accidents must be dealt with in the public health system, under ACC.
B is left all day waiting with no food, but ends up with a fifth day of surgery unaccomplished.
WAIT DAY THREE
All my roommates remain for the second night. G has much improved her mobility and independence. As her pain decreases, it appears she and I are alike in our outlook on life, in that we take every opportunity to enjoy the moment. Poor A and P are dragged along with us on our verbal ribbing, while B remains amused but more reserved. Frankly she is the voice of reason and is the room, and I am grateful to both G for the humour and B for the empathy and understanding.
B and I are again on standby, nil by mouth, for Monday.
My arm has settled by now, and I am feeling a bit of a fraud amongst such serious conditions. When the surgeon visits later today to cancel again, I even question him as to the option of resting at home. It seems to me that tying up valuable hospital real-estate in the form of my bed could be better placed. I am advised that if I am not present I will have no opportunity at all for surgery.
B again remains on nil by mouth for most of the day.
H has been moved to “rehab” today. I hope for the best outcome for her, but have no point of contact to follow up.
Into her space in the room is wheeled Patient L, a delightful lady recovering from scheduled surgery to repair an existing knee replacement. L comes accompanied by Husband J, and the nationality is well known to me, so I anticipate a bit of gentle ribbing will ensue while are in such confined quarters. Husband J does not fail us, and the banter in the room remains light, even if a little more politically correct!
P is also more mobile today, which is pleasing to see, as I understand she will be returning to an independent dwelling, though on a property shared with working family members.
When surgery is finally cancelled for B, Husband J is incensed on our be halves and suggests many ways ACC could improve their level of service.
WAIT DAY FOUR
B and I are again on standby, but having heard the emergency helicopters again last night we are limiting our expectations.
This time B is cancelled before lunch, and I am left on nil by mouth until the evening meal. Today I find a nurse with time to put me in a sling, which improves my ability to be independent even more than before. With the limb supported I can walk around a lot more and find myself trying to aid the comfort of others by doing trivial things. One constant need was the retrieval of call buttons, bed controls and even morphine pump buttons. These were constantly being put out of reach of the reach of the restricted mobility of my roommates.
I have by this time become resolute that something MUST BE DONE to repair the broken health system. Understanding how slow Governments are to apply change, I reach out to the recently appointed Minister of Health, the Rt Hon David Clark, by email. I know he cannot, and should not affect operational (excuse the pun) matters within the health system, but offer my case as a point of reference for him to affect much needed change in service delivery. This is a battle worth fighting, and we (the public) must stand and be counted to influence change.
At this point of my story I must commend those working at the coal face of the hospital. Surgical teams, catering, cleaning, laundry, and especially the nurses are overworked and under resourced. We are relying heavily on foreign nationals to deliver these services, as the working conditions are below New Zealand standards.
Before Husband J departs for the day, he bets me a bottle of wine I will get my surgery. I’m a little concerned if he wins, as I anticipate he and L have a more cultured palate than I, and the wine he might choose will be a good one! However, the health system comes to my rescue on this at least, as my surgery is cancelled in time for dinner.
SURGERY DAY
B was told yesterday that she would be first on the list for today, and my midnight medication also came with similar news. I am glad that B and I had different surgical teams, it would have been awful to be competing for resources.
I have the night nurse plastic bag my arm at 05:45 to be certain of having showered as early as possible. I have been managing my own personal care throughout, except for the plastic bagging.
B and I are both prepared and rolled to theatre prep before 07:30.
I spot B in one of the waiting cubicles as I head for a nervous pee. The area is filling up fast and we both have our fingers crossed for no acute cases needing theatre today.
My anaesthetic team are good fun, I even find someone able to talk me under with chatter around tractors. Gotta love Waikato! I choose a nerve block to assist with pain before, during and after surgery. This is anticipated to last 12 hours.
Recovery is a little rough, but I don’t recall much until I am fit to suck the ice block offered here. Wheeled up to my room, I am left with a nerve blocked arm, which feels as though they have done a full limb replacement and given me a dead mans arm. I have no ability to control the dead weight my arm has become, and again forced to ask for a sling. This time I am given the spongy strap model which sits around the arm in two points of contact. There is NO elevation, and this comes back to bite me when the nerve block finally wears off approximately 16 hours after surgery. Lying in bed during the night shift I repeatedly call for pain relief until the nurse finally cuts through the soft upper bandaging (the arm is supported only by a splint, strapped in place with bandages). The relief is instant, and later that night the same nurse gently rebandages it and raises it in a towel pinned to the over bed lifting bar. I am finally able to sleep, and by morning the swelling has moved from the injured lower arm to my elbow area.
G is also discharged today, and P continues to work on her mobility.
ONE DAY AFTER SURGERY
My goal for today is to control the pain enough to get home. I still feel a fraud for holding a hospital bed up for 5 days, but know I need to be self-sufficient on my departure. We organise for Husband Number 1 to collect me at 17:00, which gives me all day to ensure everybody involved in my release has time to do their part. I have noted during G’s processing that the many parts of the hospital wheel do not always work cohesively. B is also in recovery, but having had a much more complicated surgery than I it is sensible for B to take an extra day.
I tick off surgical team, physio tips, occupational therapist advice and equipment, ACC release assistance requests and pain medication prescriptions before having the nurse rebandage the arm, which is now a nearly normal size.
Husband Number 1 arrives, and I depart, hiding the bottle of Italian wine which Husband J has given me in honour of his debts.
FIVE DAYS AFTER SURGERY
Still no more than an automatic reply from Minister of Health, I decide to place an official information request for statistics with ACC. This proves an EASI task from their website. Further research shows yet another Minister, this time Minister Iain Lees holds the portfolio. In My Humble Opinion (IMHO) the lack of coordination between NZ Ministries delivering similar services is an ongoing issue. (Don’t even get me started on Emergency Services!)
I also phone today for confirmation of an appointment at the Fracture Clinic. The surgeon had wanted to see me in one week, but the earliest they can schedule is 15 days post-surgery date. Sigh!
SIX DAYS AFTER SURGERY
Having been managing pain on minimal medication, I find my sleep disrupted by pain and heat in the bandaged arm. I wake to some swelling. And spend the day sorting a trip to my GP, and requesting ACC assistance with a taxi. I am also visited today by home help, as arranged by ACC. I congratulate the service delivery and empathy of the staff at ACC. With the help of them and the GP staff, I am on antibiotics before the end of the day.
EIGHT DAYS AFTER SURGERY
I have a call from ACC to clarify my information request. Again, the staff are efficient, effective and empathetic. (HAH! – a new 3E’s, for those of you used to Civil Defence speak!
NOW 24 DAYS POST INJURY, 19 POST SURGERY
ACC has transferred my request to each of the 20 DHBS. 9 have acknowledged receipt.
No surprises that Waikato DHB is on the missing list.
And still no response from the office of the Minister of Health, MP for Dunedin North.