Monday 15 August 2016

Protocols and Procedures - PFFT!

I suppose this had to happen at some stage. For the first time, and hopefully the last time, I was underwhelmed by events at Joondalup Health Campus last Thursday and Friday.

Michael's angiogram was booked for the morning list on Friday. We were planning on travelling to the Big Smoke on Thursday after closing the Gallery. Staying with the kids in Banksia Grove for two nights and motoring back to Beverley on Saturday. That didn't sound too onerous.

Except the hospital kept chasing us to see the anaesthetist and attend the pre-operative clinic on Thursday. Eventually, we caved into the pressure and adjusted our departure time. The wondrous Poppy Juillerat offered to Gallery sit at the eleventh hour. Using logic and reason to back up her argument that we should let her loose in the Gallery, we gratefully accepted.

The pre-operative clinic involved seeing a nurse, who already had accessed Michael's file. All his previous history, including his surgical notes from the Mount Hospital, were in her hands. We then moved onto the anaesthetist. This perfectly nice chap asked us some questions, ordered some blood tests and agreed that of course, I could stay with Michael in the Day Procedure Unit before he went off to be stabbed in the thigh. Apparently, this was as close to a Royal Dispensation as I could get.

Our admission time changed from 7.45am to 6.30am to 6am. Awesome. And it was still only a Cattle Call. We duly arrived, registered, sat and waited, completed paperwork, sat and waited and then we were escorted, en masse with two other patients up to the Day Procedure Unit.

First almost international incident. What? I wanted to enter the unit with Michael? Who had given me such authorisation? When I answered "the anaesthetist", I was grudgingly allowed into the inner sanctum.

Usual cubicle with bed and chair. The groovy gown. Which Michael is always incredibly self-conscious about wearing, so he asked me to loosely do up the ties. Just as well I was there because our nurse was not present to help him.

We listened to confusion being openly discussed in our hearing. Did Michael need the pressure stockings or not? Did they need to put a cannula in his arm? Or not? After the well-oiled machine of H4, the Day Unit was a bit of a letdown.

The piece de resistance by our nurse. She needed to shave him Down There. Now. Drop your dacks, Michael. She started with the electric razor. Then "Ooh you are hairy!" was announced to the universe.

I watched Michael mentally disintegrating before my eyes. So I offered to take over. She obviously had lots of other more important tasks. "Oh, would you?" No problem, I replied. And Michael might feel more comfortable with me shaving him.

She gratefully left. I completed the job.  Second almost international incident. I asked Michael if he wanted me to go with him to the Holding Bay. He answered in the affirmative. I had to receive the Blessing of the unseen Ward Co-ordinator in order to do so.

On our way up with the very pleasant young orderly, I asked Michael again if he wished my presence. Particularly, after all the Fuss I was causing. He nodded emphatically. I kissed him goodbye when they arrived to take him in. Apparently, I would be phoned when he was finished.

I headed in the direction of the cafe and enjoyed breakfast and four cups of tea. I caught up online matters for an hour of so. About 10 o'clock, I returned to the Unit to inquire about Michael's location. At the exact moment I was asking the reception staff about Michael's status, I noticed the ever so friendly sign instructing me not to ask about a patient. I was supposed to wait to be Rung.

The reception staff duly answered my question. He was Still In. I found out later he was actually Out, twiddling his thumbs and bored out of his brain lying flat on his back in the Unit. They had allowed him to have a sandwich and a coffee. There had been no anaesthetic, except for a local. And no anaesthetist. Which begged the question about the rings we had jumped through at the pre-operative clinic the previous day.

Thinking he was still in the Cath Lab, I imagined that the surgeon must be tackling Michael's arteries. So I went off to purchase some new joggers, an extra shirt for the Gallery and some DVDs. I met Callum at the shopping centre as I had inadvertently knicked his wallet that morning. After turning his house upside down, he had rung me and requested that I look in my bag for his missing wallet...oops.

We returned to the hospital after 12 noon. Now I was becoming seriously worried. I was about to ask, again, against protocol, of Michael's condition. Before I could make a complete idiot of myself, Michael texted me to say he was dressed, sitting in a lounge and waiting for discharge in about another half hour. I texted back to ask if he wanted company. Yes.

Third international incident. Could I join him in the Unit? A blank look was the initial response. Then "No, he hasn't been discharged". I repeated my request, to be told I could join him Shortly.

So, we began texting each other. He was climbing the walls. So was I. Nothing was happening. I was tempted to engage the doors in combat but decided to cool my heels for the Duration.

The doors finally opened and Michael and the discharge nurse ushered me into a room for me to sign his discharge paperwork as his Guardian. We were officially given our Get Out of Jail Free card.

We were both shattered. After grabbing a bite of lunch, we returned to Callum and Bron's house  for an afternoon kip. Our spirits were further restored by the kids shouting us dinner at the Mullaloo Beach Hotel, Callum's work venue.

The amount of time Michael had spent having the angiogram was, perhaps, half an hour, an hour at the most. He spent seven hours in total in the hospital, mostly on his own. Now I am not criticising the Unit on his care. He came out alive. That was the important outcome. However, he and every other patient in the Unit could have been treated somewhat differently, if they so chose.

Hospitals are scary places. Even if you are a grown-up. And hospitals are undignified and embarrassing. Michael was mortified to have to seek help from a nurse to use a bottle. This was something I've done for him, but nobody else has. And the comments about his hairiness on the Unit just about caused him to disappear into himself.

As far as I could tell, there was no medical reason for carers or supporters to be excluded from the Unit. There was a chair in each cubicle. I was helpful, particularly for Michael's emotional well-being. And when he was waiting for discharge, what was the rationale for keeping him in the Unit Lounge on his own? Michael observed that the nurses did not appear to be run off their feet. In fact, he mostly heard the general chit chat of the nurses' outside lives.

I am happy to stand corrected if there is a legitimate and compelling medical reason for isolating patients in the Day Unit, some of whom may wish their partner or parent or supporter with them. Michael is one of those who is excruciatingly unsettled by hospitals. He does not want others to perform intimate functions for him - he wants me there. And as long as I believe that protocols and procedures are the only justification for the Day Procedure Unit policies, I will continue to accompany him into such places.


A familiar view of Joondalup Private Hospital...


Michael's anxiety is ever present...


and he feels vulnerable and embarrassed 



as do most patients. So give us a break.




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