FIRST IN-PATIENT EXPERIENCE

 6th November 2014.
 My day started normally enough except for the worsening Rheumatoid Arthritis aches and pains, a growing nodular and skin vasculitis rash and a swollen, painful elbow.
It was my monthly outpatient date with the research nurse  in the Princess Elizabeth Orthopaedic Centre, Rheumatology Departmentat at Royal Devon &Exeter hospital  as part of my treatment with Tocilizumab and the blind trial I was on to assess results of tapering Methotrexate doses. (A powerful drug commonly prescribed to rheumatoid arthritis patients.)
They said the elbow was cellulitis and needed urgent IV antibiotics.
I was admitted to an acute holding ward and a cannula was connected to my good arm.
The 'fun' started here.
My field of vision across the ward took in two beds.
On the right hand side a solid looking extrovert character in his thirties or thereabouts lay on one bed.
The back and top of his head were colored bright orange.
 On the other bed lay a slightly older man, apparently no wallflower either, who from time to time engaged him in conversation.
From the exchanges between the two I gleaned that 'Orange Head'  was apparently a master baker and had been admitted because he heard voices in his head.
I thought there must surely have been other reasons too but they remained elusive.
I'm not sure what the older man's main problems were but it quickly transpired one of them was a severely prolapsed pile, a fact which was declared loudly and almost gleefully to the whole ward,  by  by an aged, bearded consultant who prodded it enthusiastically but far too painfully, aggravating the situation and rendering him incandescent with rage, which forced his bearded tormentor to retreat under a hail of bad language.
He tried  to look as if nothing untoward had happened in front of his accompanying juniors.
Well he would, wouldn't he!
After this outrage against his anatomy had subsided he started to ask quite loudly for an 'armed guard' on his bed in the light of 'Orange Head's' so called voices in the head disclosures.
Suggestions in non too 'sotto voce' tones  that 'Orange head' was a 'two pound note' on account of his bizarre appearance, were also quite worrying, but the master baker never gave us a definitive confirmation of this.
It was difficult to know whether any of this repartee was conducted with genuine  anti-gay sentiment or aggressive intent or was just banter but 'Orange Head' seemed to take it in good humour.
Nevertheless there was a  disconcerting element of the  unknown in the air.
Just to be on the safe side from time to time I added my own efforts at molification in the name of oiling troubled waters.
For various reasons (both arms discomforted, bladder relief, bed shape, and 'stuff going on' I got no sleep that night until just before 6am when I was awoken for my drip after finally dropping off.
It was a horrible night and my thoughts were constantly of home and my wife and family, whether they were alright and what I should be doing, which was definitely not languishing in this place.
I also worried about my wife driving the 30 mile trip to visit but managed to persuade our daughter to accompany her in case of emergencies.
Next day I was transferred to an upstairs ward just when it seemed the exchanges in the two beds opposite were progressing to a more interesting stage of enlightenment.
I could now see three beds opposite.
Opposite me a quiet, stoical man of 68 with diabetes was in danger of losing a foot. Not once did he complain.
Next to him was a middle aged man who had complaining down to a fine art and did nothing but - constantly calling for attention to make some minor adjustment to his bed or pillows etc.
When a nurse removed his plastic non drip cup with spout which he had paid for and was identical to hospital issue his agitation knew no bounds.
'You can't take that, it's mine, I paid for it' etc. This happened several times until eventually they had to put his name on it.
Apparently this patient was suspected of having got his medication wrong or part of it had changed the chemical balance of his blood in a life threatening scenario.
 Notwithstanding, there seemed to be a deal of uncertainty about the cause of his problems.
It was also apparent when they assessed his mental capacity by reason of a long quiz, to which everyone else in the ward was party to, that large parts of his memory were not functioning quite normally.
Either for some obscure reason he was giving wildly inaccurate answers to fundamental questions such as 'what year are we in?'  and correct answers to what seemed trivia or he was genuinely confused.
He was obviously quite ill and for this reason I cannot be too judgementle, but I'm pretty sure that even when well, I would have detested this self-centred, petty, selfish person.
Next to him on that side of the ward and furthest away from me, a large, elderly, bearded fellow was obviously beyond help.
 He lay either in a state of exposed undress after continual contortions to reconfigure his clothing and bodily positions either on the bed or on the floor (where they eventually put down a mattress for him) and made loud animalistic 'noises'.
It was difficult to know whether he was compos-mentis or just didn't want to be there but whatever the case he was a source of constant disquiet.
Every time the curtains were pulled and a nurse examined him words to the effect of 'that's not nice' or ' we don't do that' could be heard from the unfortunates who attended this patient's 'needs.
God knows what he was doing to elicit these reactions but it obviously 'wasn't nice'.
He was late removed by his family to the relief of everyone. I had the sense of a look of quiet satisfaction in his facial contortions as they wheeled him out, apparently oblivious to his surroundings or any of us.
In the beds next to mine, thankfully were two 'normal' patients, an elderly West Country man,  and next to him a young family man.
We (and the infected foot patient opposite) exchanged comments on subjects such as the weather and sport in a friendly enough way.
The boredom was excruciating and only relieved by the visit of my wife and daughter for an hour or so until it was time to leave.
Again that night I got little sleep before the 6am wake up call for the same reasons as before plus a couple of additional reasons.
The late admission on the night shift of a middle aged man with a urine infection and an elderly lady in an adjoining room saw to that.
The urine infection patient was put on a drip but was beside himself with pain, weeping and calling out for help. He was obviously in the deepest of distress and I genuinely felt sorry for him to the point where I asked the night nurses  if anything more could be done to help him not only for his own sake but ours who were being kept awake while all this was going on.
The few staff on nights seemed unfazed by his condition and gave the impression they thought they'd done all they could in the absence of any doctors. They probably had.
Meanwhile the unfortunate man continued his pleading for help and several times, dragging his drip behind him painfully exited the ward presumably for the toilet facilities, only to be ushered gently back by the night staff.
For a time I had wondered whether there was a maternity unit nearby as there was continual howling and screaming coming from somewhere. At first I thought it was the poor fellow with the urine infection but it continued after he returned to the ward, so that ruled him out.
Even so it was a huge relief when things eventually settled down and whatever meds this man was on finally lessened his agony.
The high pitched, croaking, screams and howls of pain and demented outrage carried on from elsewhere though, for what seemed an eternity and turned out to be from an old lady in a nearby room. Among the utterances I could make out words to the effect 'I've been brought here against my will' - 'I want to go home' and many more versions all in a peculiar, animal like howl that was extremely unsettling.
Eventually she must have succumbed to sheer exhaustion, died or been moved because it went quiet in time for my 6am shot.
On Saturday my third day, just when I was beginning to wonder about my sanity, I was told I may be allowed to be discharged, probably around visiting time, subject to confirmation from the bug analysts that I had the right antibiotics.
I arranged for my wife to pick me up but the confirmation hadn't arrived by visiting time and she was now waiting in the car near the hospital for my call so I could be picked up at the main entrance to save time rather than using park and ride.
By now I had already decided to leave with or without antibiotics which I felt could be prescribed by my GP. I was not going to let her drive the 30 miles home in the dark on her own and so I justified my position with the declaration that 'I'd rather lose an arm than my missus.'
 I suspect the sense that my head was about to explode with the boredom, and being incarcerated somewhere I didn't want to be, might have had something to do with it too.
After this things happened quickly. I suddenly had that confirmation and efforts were made to obtain my antibiotics from other wards as the pharmacy was closed. The shortfall I could get from my GP.
I almost ran to the front entrance where my wife collected me in the car. (I say 'almost ran' more in the mental context than physical).
  On the journey home I had never been so happy to see the outside world.
I also reflected on the fact that my first in-patient experience had been mercifully short, the food had been excellent and the staff wonderful except perhaps in the mind of one patient who considered his prolapsed pile was treated somewhat disrespectfully.
I wondered how I'd cope with longer incarcerations as so many others have to, perhaps with somewhat less tolerant or caring staff, a less digestible menu, and if humanly possible a more disruptive set of fellow bed-mates, but it didn't bear too much close scrutiny.
It gave me an uncomfortable insight into my own limitations in imposed and unwanted circumstances outside my usual routine of life. The omens were not good.
 Suffice to say 'It just wasn't my bag.'
My experience reinforced my conviction of one thing above all though.
The NHS is a fantastic institution, probably unique in the world and one we must always treasure with one proviso.
Like many public institutions, (the police included of which I was once one in London) the day only has 16 hours.
The nightmares start in the dark hours and in these dark hours the front line staff don't seem as well supported by higher qualified doctors as they should be.
I don't know whether this is somehow designed to keep staff turnover to a minimum by reducing unsocial hours or whether it is a genuine shortage of doctors.
Either way it seems that the night duty staff face difficulties they ought not to and the system for whatever reason lets them down.
I rest my case.