Wednesday, December 8, 2010

I've been working on this very VERY long post for ages. This happened in mid-October...

Speaking of Mary Harney and Healthcare...I have been meaning to share our recent experiences with seeking medical attention for my mother-in-law last month. It's incidents like these that remind me that Ireland is not where I will be growing old. As many friends as I've made, and for all the positive things that make my life enjoyable here, I know that I will be going back to the US for my winter years. And there's pretty much one major reason for that: the Healthcare system here is absolutely terrifying, especially if you are old, disabled, or alone.

Joyce is 80 years old. She was last in the hospital while Mark and I were away. She hadn't been well since before Christmas, but has a real reluctance to go to the doctor because the waiting time is between two to six hours. If you have an appointment, the doctor will likely not even walk into the building until two hours after your scheduled time. And then he'll see the six or seven patients ahead of you, not to mention make and receive telephone calls and take queries from the secretaries during appointments. When Mark and I first moved to Dublin, we signed up for this practice, not knowing where else to go. After each having two very bad experiences, we switched. When we suggested that his parents do the same, they responded that they'd been going there for over 40 years, and sure, they wouldn't want to make anyone feel bad by switching. So their answer to this problem is to simply go to the doctor as seldom as possible, no matter what kind of agony they are in.

In July, Joyce had been admitted to the Mater Hospital for fluid around her heart. She was in a hallway, waiting for three days for a room. At the time, I didn't think much of this, although it was disturbing, but my mental picture was of a patient in an American-style hospital, on a proper bed, and while I thought jesus, that's horrible, I didn't linger on it too long in my mind.

When she was discharged, Joyce was given a prescription for a water tablet, to be taken daily, to keep her fluid down. However no one seems to have explained to her the consequences of not taking this pill. Since going to the doctor meant a two to six hour wait, she wasn't likely to go for a follow-up appointment. I mean, logistically, if you're on a pill that makes you want to urinate all the time, are you really going to go to a place where you'll have to sit in a waiting room for several hours? No. You get frustrated, and not understanding why you're on this medication in the first place, you stop taking it. Or at least, she did.

So we noticed she wasn't well -- she seemed to have a cold, and a cough, and was not herself at all. But there's a fine line when you're caring for the elderly between taking control of them and letting them have some autonomy. We respected her wish not to see the doctor. But when we found out she was coughing up blood, Mark quickly went into action. We called the doctor, and they promised to make a house call within two hours. So far, so good. We called over to Joyce, where she complained that she had been sweating through her bedclothes during the night, and was still coughing up the blood. She said she was going to call the doctor in the evening, though we couldn't figure out why she wanted to wait. About an hour before the doctor was due, we casually let her know that we'd already set the plan in motion, and the doctor was on her way. We figured that she would examine Joyce, give her an anti-biotic, some cough syrup, and we could all sleep better that night.

The doctor sailed in, asked a couple of questions, listened to Joyce's lungs, made a phone call, then informed us that since she takes Warfarin (a blood thinner), and she was coughing up blood, she'd have to go to the A&E (Emergency Room). She asked if we wanted her to order an ambulance. We said no. But this was a big mistake, we were to learn later -- a big mistake that we will never make again.

Not wanting her to be too anxious, we assured Joyce that she'd be in and out of the hospital -- no need to pack a bag! And we called a taxi, giving her only a half hour to get some things together. She was very nervous about going, but we tried to remain upbeat.

The taxi dropped us off at the hospital at about quarter past three in the afternoon. We checked in, and had a seat in the crowded waiting room, which was filled with wooden chairs, all facing a small television perched on the wall. It played Sky news. For those who don't know, Sky news is possibly the worst news channel ever invented. It picks out the same five crappy news stories and repeats them over, and over, and over. The big story that day was about Wayne Rooney, this hotshot soccer player, who was threatening to quit. Stupidly, we didn't bring books or ipods or anything that might distract us. And even if we had, we would have felt bad using them while Joyce quietly suffered beside us. Within the first two hours, we were called into a little room, where a nurse took Joyce's vitals and asked some questions about why she was referred to the Emergency Room (A&E). He examined her, and then it was back out into the main waiting room. So far so good, we thought.

Behind us, sat a blind man, accompanied by a woman. You couldn't guess what was wrong with him -- he sat quietly in his seat, occasionally making his way to the rest room. Sometimes he would remark on how long he'd been waiting, but by that time, we were all in the same boat, so we all commiserated. At one point, a middle aged man came in with his very frail father. It choked me up a little to see someone so vulnerable in such a place. But luckily he was taken in right away.

As daylight waned and darkness descended on Dublin, the crowd in the A&E changed considerably. The zombies started to come out. Sure, there was your usual: car accident victims, a woman who looked like she was going to have a heart attack, etc. Then there was the dude who looked like he'd been in a bar brawl, and the guy who had pissed his track pants, who kept wandering around the waiting room, trying to get into other parts of the hospital. He kept grabbing at his tongue with his fingers. A guy walked in wearing a nice pinstriped suit, carrying a Dunnes Stores bag. I figured that he was there to bring provisions for a patient. So I was quite surprised when he sat down in the waiting room and began a sing-along with a drunk guy in a wheelchair. I managed to use my cell phone to record their rendition of "Leaving on a Jet Plane:" The bar brawl guy was NOT happy with them, and I thought he was going to lose it, but he managed to keep it together, more or less.

Another man came in, still with the plastic bracelet from his visit the previous day. He was trying to get admitted. Of course, I don't know what his story was but he was shouting, so the whole place knew why he was there, and it was heartbreaking: he said he'd been there every day for the past three days, apparently, but he didn't remember because he has dementia. He has dementia because, he shouted, he has "full blown AIDS." He also shouted that they could call the cops, he would be quite happy to go to Mount Joy (the prison across the street from the hospital), as he'd spent the last 30 years there and at least he'd have a roof over his head. The guy needed help, and it was difficult to see someone so sick begging for treatment. I'm not sure what happened in the end, if he was admitted or not. He was so confused, but at least knew why he was confused, and was able to try to advocate for himself, but it felt so hopeless. As he shouted in the waiting room, you couldn't help but to envisage the trajectory of this man's life.

Poor Joyce took it all in stride, even though she must have been in agony sitting in those chairs, sick as she was. It was more than TEN HOURS before she was called into the interior waiting area. When you walked through the door, it was filled with people in trolleys (hospital beds are called trolleys here) and chairs. Joyce was brought into an examining area, where she waited on an examining table for the rest of the night and into the next day. On a table. That she was too small and frail to hop on and off of (she is less than five feet tall). At one point, she set up a bed for herself on the floor, but she was ordered to get off the floor and back onto the table, but seeing as she couldn't get onto it, she sat in a chair. At some point, someone gave her a pillow, but she has such severe osteoporosis that the pillow was really no use to her. After nearly 24 hours, she was moved to a proper hospital bed, within the same waiting area. But still the bed was too high, so mostly she sat in the chair. They gave her an x-ray and determined that she had a bad case of pneumonia. But there was no bed available in the hospital. Our poor blind friend was across the way, in a trolly, waiting to be treated as well.

The real kicker was this: Joyce was standing next to her trolly, with her back to the curtain, brushing her teeth at the sink, and someone made off with her handbag. She was literally four feet away, and they nabbed it. Luckily, it had almost nothing in it but socks, underwear, and her bus pass. Still, the idea that someone would steal from a sick old lady made us all feel a bit angry and depressed. But finally, after two and a half days, she was admitted to a short term ward. This was essentially a large room with about seven or eight beds in it, and two bathrooms to share among them. Since Joyce was on a heavy dose of diuretics, this was a big problem. I won't go into the details. But in this room, women and men of all ages and circumstances were being treated. One guy across from her was vomiting and having diarrhea all night long. And I don't mean in the bathroom. A couple of nights later, an old woman with dementia thought Joyce was her daughter, and kept hovering over her bed, trying to take her shoes, and shouting at her. Basically, it was the worst conditions possible to try and recover from pneumonia in. We could see Joyce getting discouraged, wondering when she could go home. However the visiting hours were only between 2 - 4 and 6 - 8, so we couldn't hang around to make her feel better. We brought her magazines and treats, but I'm not sure how well it helped to pass the time.

Mark deserves best son of the year award for hassling the doctors and managing her care. He worked tirelessly with the doctors and nurses to make sure they knew all of his mother's conditions, and that they treated all of them. He also did an amazing job explaining it all to his parents in a way they could understand (to say they have a mistrust of medicine is an understatement). All in all, Joyce was in the hospital for *twelve* days.

When she came home, we had a bit of a surprise for her. While she was in the hospital, we had gone out and purchased (well, his dad paid) a washer/dryer unit and had it installed in their kitchen. If you can believe it, they've been hand washing their laundry for 80 years....with NO HOT WATER. They boil water in the kettle. Insanity! So we knocked out a cabinet, then went to IKEA and bought a new one to put on the other side, installed that (three trips to IKEA because they kept giving me the wrong drawer), and then cleaned the place up a bit. I'm not sure they're using it, but at least it's there if they choose to.

So October entailed a lot of running around. But it reminded us both of why we're here. Honestly I'm not sure Joyce would have made such a good recovery if we had not intervened. And it was just nice to be useful and to contribute to our family's quality of life. You know, the stuff life is all about, I suppose.

However, the experience also opened my eyes to how healthcare really works in this country. It doesn't. At times it felt as though we were in a developing country. The whole system was chaotic and, to be frank, unsafe. It made me wonder why hospitals aren't being constantly sued for malpractice here. But that's a question for another day. We were just really happy to have Joyce home, safe and sound.

1 comment:

  1. I'll remember this post when I'm complaining here in the States! So sorry you had to go through all of that, and I hope Joyce is feeling better!