Thursday 14 December 2017

Tallaght Hospital: State inquiry about its A&E department

In the week when a coroner condemned Tallaght Hospital as a 'very dangerous' place to fall ill and a State inquiry about its A&E department began, cardiac patient Treacy Hogan endured a soul-destroying night in a corridor. This is his searing despatch from ...

Hogan outside
Treacy Hogan outside Tallaght Hospital

The chap in front, the top of whose head came perilously close to my feet, was a taxi driver and I was glad he was there. His good company was badly needed in what turned out to be my long day's journey into the night at Tallaght Hospital's Accident and Emergency Unit.

You get slightly delirious after a few hours of waiting and watching the comings and goings of the busiest emergency department in the country. There were some very sick people on the corridor and some downright nuisances; time-wasters clearly suffering the ill-effects of alcohol or drugs.

The very sick on the trolleys in front of me had no link-up to oxygen, no monitors or any life-saving equipment in the event of cardiac arrest.

The corridor also had to be a breeding ground for infectious bacteria, as some patients with suspected TB are frequently rolled on to the corridor to join the endless queue of the desperate. A man could go on to the corridor with a broken arm and come out with TB, I thought. Jesus wept!

My new friend, the taxi driver, spoke to me over his right shoulder throughout the night, creating the surreal effect of sitting in the back of a taxi, stuck in traffic. He wasn't a happy camper. His trolley was outside the hospital kitchen. Which wouldn't necessarily have been a big deal except that he was put on a 24-hour fast in order to undergo a certain procedure.

No one, myself included, was particularly hungry despite our proximity to the kitchen. Another patient spent the night and most of the next morning vomiting into a silver bowl.

Like most people I tried to see the funny side in the most appalling situations, probably as a result of watching too many episodes of M*A*S*H, the television series about a mobile hospital unit during the Korean war.

But the sheer obscenity of having dozens of patients -- young, old, vulnerable; many clearly very ill -- lying on a row of trolleys snaking along several corridors quickly drained any remaining one-liners for the passing doctors and nurses.

The ambiance resembled more a scene from an old war movie, rather than one of former Health Minister Mary Harney's so-called Centres of Excellence. A very elderly man tried to eat his supper with all the dignity of a stray dog. Others had McDonald's takeaways sent in to them.

In the end, I spent more than eight hours on a cubicle bed followed by another 14 on a trolley in Tallaght's dangerously overcrowded A&E department.

The unit is now at the centre of a storm following the death of a patient in a so-called virtual ward, AKA lying on a trolley in a corridor, and the investigation into safety and care launched by HIQA, the State's health safety watchdog.

First an acknowledgment. Three years ago, a cardiac team led by Dr David Moore saved my life at Tallaght Hospital after the condition was picked up by Maynooth GP Dr Christy O'Rourke. I probably had about 24 hours to live before they inserted a stent in one of my arteries and kept me upright for a while longer.

My recent trip to Tallaght A&E concerned a suspected bout of angina, related to the heart condition.

Here's how it works. The clerical staff, nurses and doctors in the unit are superb professionals working flat out in a facility clearly not capable of handling the demand placed on it.

There's much talk about reeling in the pay of public-sector workers. Generally I feel the public sector should suffer the same pain as the rest of us. But not nurses and doctors -- double their pay and numbers, I say.

I was seen by triage nurses within minutes of arrival. They determined that I should be subjected to a battery of tests to determine the extent of my condition. I was then despatched back into the waiting room where up to 40 others were waiting in line.

I didn't have to wait long before I was called through into the A&E proper and put into a cell-like cubicle where every possible test under the sun was carried out. No complaints. The triage system of access to care on the basis of need was working. The young doctor who attended me throughout the evening could not have been more helpful and professional, but he was being swamped by an avalanche of patients, and I've no doubt he was working flat out all day long, and probably well into the night.

It was soon clear to me that many people presenting for treatment should not have been there. Drunks shouting abuse at nurses have no place in the emergency room, and had the effect of intimidating the many respectable elderly people beside me who should have been entitled to some dignity in their hour of need. "There are people here who should not be here," one nurse whispered to me. "You should be here."

Dignity, however, goes out the window, once you get the call to arms, and march the short distance from treatment room, down the corridor adjoining the packed emergency room, to take your place on an assigned trolley.

"Sorry about this, Mr Hogan, we have no beds, and you are about to have what we call The Mary Harney experience," said a member of staff.

As I strolled past the seemingly endless line of trolleys, any shred of remaining humanity ebbed away as I thought, "oh no, not beside your man, please. Anywhere else. He wouldn't be too bad. Oh no, she's puking. Not the junkie."

And so it continues, past the moaning old man, the crying old lady. "Sweet Jesus, this is awful. I'm not going to be able to hack it here."

And so I eventually found my spot, which turned out to be the last trolley in the line, located just at the entrance to the children's A&E department.

The sound of children crying and screaming filled the night behind me. In front, it was a constant cacophony of puking and moans, punctuated by snoring echoing down the corridor. At least someone was able to sleep through this waking nightmare.

A crash victim and the drunk driver who caused the crash both arrived on the scene together, the latter escorted by several gardai. There was a commotion when the driver unsuccessfully tried to escape down the corridor.

And in the middle of all this chaos, a funny moment in the early hours of the morning after I had finally managed to doze off for a few minutes. I was wakened by a gentle tap on the shoulder.

A smiling member of the clerical staff armed with a clipboard asked me if I would like to sign my VHI private health insurance form, and I dutifully complied, thinking: "If this is first class, I'd hate to be on a trolley in economy section."

I think the condition of an elderly man a few trolleys ahead worsened a few hours later as there was a bit of a kerfuffle and he was taken away. I don't know if he died. I hope he made it. The nurses and doctors made checks on my condition, and I'm presuming everyone else.

The overriding impression I was left with was twofold: this is a disgraceful way to treat ill people. It is downright dangerous. How can patients be safely treated in these third-world conditions? You work all your life, you pay taxes and PRSI, and you end up on a trolley in some god-forsaken bend in an unattended corridor.

And those dedicated, overworked and underpaid nurses and doctors in Tallaght's A&E for whom I have nothing but the highest praise, admiration and gratitude, should not be expected to work in these conditions, let alone make life-or-death calls for acutely ill patients lying on trolleys or sitting on chairs in badly-lit corridors without any proper medical facilities and surrounded by drunks and drug addicts.

As the second or third shift came on duty -- you lose all sense of time -- I was eventually called up to a bed on ward. Bloody luxury, but there remained a sense of betrayal for my friend the taxi driver, who was still on a trolley. I hope you made it up, pal.

When I got home I looked up an account of life in a field hospital in France in 1916 during World War One and found: "An exhausted major was standing in the midst of a jumble of groaning bodies, dressing wounds, giving injections and making recommendations in a calm voice."

It sure sounded familiar.

Indo Review

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