Treatment in a specialist cancer unit

So you think that the universal public healthcare will guarantee good treatment?

Or that nurses University educated nurses will give you better quality of care?

Well, read this story. You might change your mind…

Peter was diagnosed with leukaemia at the age of 67.

He  did not have private insurance, and was happy to see an oncologist in a large, busy inner city public hospital.

“Private health insurance symbolises everything I hate about America” he announced to his friends. This is Australia mate. We’ve got public health and a fair go for all”.

Over 6 months Peter had regular chemotherapy cycles.  Then some of his stem cells were removed, a high dose chemo given and his own cells were returned to his body.

Peter’s treatment was in a new, modern cancer unit in a large public hospital. There were daily nursing care plans and close medical supervision to monitor patients progress.

Treatment went without a hitch, and Peter eventually went home to recover.

Lifestyle issues ignored

Peter had smoked marijuana as well as tobacco continuously since he was a teenager. He didn’t consider it a health risk, but an alternative lifestyle. Peter was a free thinker, anti establishment and widely read.

He came from a middle class home in Melbourne, attended a private school and lived in Camberwell.

Peter’s father was a chemist. Peter himself spent most of his working life in the pharmacology industry.

“Don’t worry about smoking a bit of dope” he’d laugh, “it’s the pharmacy drugs that will cause you damage”.

Peter had divorced in his 50’s and dated numerous women. He had one daughter studying at university. Peter absolutely doted on her.

Many in his social circle went to private schools and either took drugs or were tolerant of those who do.

Peters medical appointment were strictly about his medications and blood results. His general health or personal lifestyle was never discussed.

None of his medical team talked about smoking, depression after a cancer diagnosis or the side effects of marijuana smoking.

A year after his initial diagnosis, and when there was no sign of cancer cells in his blood, Peter was told he was in remission.

In the years after Peter’s cancer treatment, several of his friends developed advanced cancer.

One was an ex girlfriend who died  in her 50’s from lung cancer, after years of smoking. She was in denial to the end, and kept expecting the Doctors to cure her with a miracle drug.

Peter became obsessed with cancer, talked about it constantly and was convinced he was going to die too.

He continued his lifetime habit of smoking tobacco and marijuana, convinced that no matter what he did, the cancer would return and kill him.

Three years after his initial diagnosis of leukaemia, Peter was told he had lung cancer. He was surprised, but fatalistic.

“It’s a new cancer, completely different to he first one” the Doctors assured him. “The two have nothing in common”.

He was told he needed surgery to remove the tumour. Peter agreed.

This time he was admitted to a general surgical ward, with a wide range of  patients having completely different treatments.

When Peter awoke after the surgery, he discovered that his entire left lung had been removed. The cancer had spread much faster than the Doctors had realised.

Peter was shocked.

“I went to theatre to have a lump removed, and came out with only one lung. How on earth did that happen?”

No explanation was given. Doctors did a quick round in the morning and he only saw nurses when they were putting up antibiotics.

There were no surgical care plans dictating how postoperative patients had to be cared for.

There was no electronic wound management software.

A Poor Discharge

Peters’ surgical site where his lung had been removed, continuously oozed pink, watery fluid.

The nurses never gave it more than a quick glance. They were too busy putting up drugs or typing into their computers. Peter was expected to shower, toilet and feed himself.

"The nurses don’t want to come near me’ Peter complained to friends who visited.I feel like I’m the least important person in the hospital – just the patient who takes people away from their computer screens!”

Peter was discharged five days after his operation. No home care was organised, even though his surgical site was still oozing.

Peter didn’t care. He was just glad to be home.

Medications mixup and readmission with a serious infection

As soon as Peter got home he took out his Dosett box of medications. He noticed that one of his regular medications was missing, a blood pressure pill.

"I must be confused after being in hospital’ he thought to himself."

After several days, he decided to take his pill box to his local chemist and get the pharmacist to check his medications.

His regular pharmacist immediately pointed out that his beta blocker, a pill to slow the heart down and reduce blood pressure was missing. He contacted Peter’s regular Doctor and got the drug back in Peter’s dosette box.

“I could have missed out on my blood pressure tablets” Peter told his friends later. Why don’t the hospitals communicate with the regular pharmacist?"

Peter didn’t realise that there was no interface between pharmacy software, his GP records and the hospitals electronic health records.

Several days after his discharge from hospital, a friend who was also a nurse came around to his house to check on the wound.

She found his wound so wet that the haemoserous ooze had saturated his shirt and was dripping on to his trousers.

"Your wound is infected’ she told him bluntly. ‘Get in the car. We are going to the Emergency Department. Right now!"

In the Emergency Department a nurse took the dressing down and poked it. Immediately, pus shot across the room and hit the wall.

The Emergency nurse was horrified and said she had never seen a surgical wound this badly infected.

Peter was immediately admitted, and sent back to the same ward he had been discharged from.

The Consequences of Septicemia

By the time Peter was readmitted to the hospital, all the paperwork was done and a bed found on the same ward he was discharged from, he was hallucinating.

"I’m a Zulu king! My tribe are under attack’ he yelled at the ward nurses. ‘This is the final battle. It’s war!"

His daughter had to talk on the phone, to calm him down.

"Dad, I’m not African, neither are you. We are both Australian."

The next day Peter was taken to theatre, his wound washed out and a vacuum dressing applied, to continuously suction out the infected exudate.

After his wound swab results came back, his antibiotics were changed.

The hallucinations continued, in a different form.

Peter sat in his hospital bed pointing out huge spiders crawling up the hospital walls.

“Look at the size of that one’ he said to his visitors. ‘It’s disappeared into a crack in the wall. But there are others. They are huge hairy and ugly. This room must be sitting on a spiders nest!”

Finally the infection was brought under control and the hallucinations stopped. Peter just lay exhausted on his bed, pale, unable to even wash himself.

His friend who was a nurse came to see him. She found Peter lying unshaven on his hospital bed. His lunch tray had been left beside the bed untouched. Peter had no idea it was there.

Meanwhile, the hospital nurses were tapping on their computers, just outside his room.

She sat him up, took the lid off his meal and made him eat.

Then she shaved him.

Peter was really grateful. But as his friend pointed out this was just ‘basic nursing care’.

A Dirty Ward

Word spread around Peter’s friends and they started bringing in meals for him to eat, or making sure he sat up for hospital meals.

They quietly removed the urine bottles left sitting on his bedside tables.

They also gathered up the rubbish of empty syringes and 10 ml saline containers used to flush his drip, left lying on bedside tables, and put them in the bin.

Peter’s visitors noticed that other patients in the ward were also left alone, neglected and grubby.

Meanwhile, the hospital nurses could be seen clustering around mobile computers or sitting at the nurses station.

Peter’s friends started to help out other patients in the ward, offering them food and drink.

Ongoing Chaos

Peter was told he would go back to theatre to have another washout and have his VAC dressing changed. However his surgery kept getting canceled.

For five days in a row he was told different things by different doctors and nurses.

“Your going to theatre today.”

“Theatre has been cancelled.”

“You need to fast.”

“Stop fasting.”

“Your should have been given an early morning breakfast then fasted.”

“Here are a couple of sandwiches, no more fasting.”

'The left hand doesn’t know what the right hand is doing’ complained Peter. ‘Every time someone talks to you, they tell you something different. In the meantime, I’m left starving.'

Peter also complained about waking up continuously during the night. He became desperate for a proper sleep.

“The nurses are having a party every night, it’s so loud. You can hear them all laughing at the nurses station. Meanwhile the machines are left to beep continuously. The poor old patient is just forgotten. What sort of a hospital is this? One where patients don’t matter.”

Hospitals Need Reform, not More Money

When Peter recovered he asked his friend the nurse what had gone wrong.

“The errors are so stupid, that’s what I can’t understand. How can people leave out the heart tablet I’ve been taking for years? Or send me home with an infected wound? Or tell someone they are going to theatre five days in a row then keep cancelling?”

Peter’s nurse friend told him that these errors are the symptom of stress the health system is under.

“Do hospitals need more money?” asked Peter. “Should we all be lobbying the government to contribute more to healthcare? "No" said his nurse friend. "Hospitals don’t need more money. They need reform."

The nurse went on to explain that hospitals are now overwhelmed with elderly, frail patients, who have multiple chronic conditions. They would be safer with GP led treatments and home care.

“Well why is the nursing care so bad?” asked Peter. “Frankly I’m shocked”.

His friend told him that a lot of nurses are coming out of university with $30,000 worth of debt and high expectations of a career in healthcare. They don’t know how to assess a wound or wash someone. When they realise how basic nursing really is, many just leave in disgust and do another degree.

“Meanwhile, the kind of people who did hospital based nurse training in the past, simply can’t afford to go to university. I honestly thought the health system in this country was wonderful” said Peter. "I believed passionately in public healthcare. Now I see it’s full of stupid errors and bad nursing care”

© Wikihospitals June 2019