Back in the Gallery, finally, after a fairly momentous week. Last Thursday was a wonderful highlight - I was able to ride on Barry, my beloved exercise bike for the first time in a year. Twelve minutes. So proud. From then on, I was tossed onto a decidedly bumpy ride....
I started to feel an aching back tooth that evening. Exploring with my tongue, the discomfort seemed to be in the rather large chasm on the bottom right of my mouth. I'd had a extraction twelve months ago from that site, so I considered this to be phantom pain from the missing tooth.
Friday night the pain was worse and I was feeling quite under the weather. I resorted to the ever-reliable Panadol and concluded that I would have to ring the dreaded dentist on Monday. The weekend nights were awful. I dug out some Oxycodone, but that just added nausea to the mix. I was producing litres of sticky saliva, my jaw was painful and lymph nodes inflamed.
Monday morning I contacted our faithful dental centre in Northam. They explained they would be unable to do any work on the tooth until the infection was under control through antibiotics. After much thought, we decided to abandon the dentist and go straight to the hospital. By this stage, the pain was terrible and I was exhausted and breathless.
Here is a timeline of my experience at Northam Hospital on Monday afternoon. I have removed all emotion to be totally objective -
- Arrival was around 1.30pm.
- A few patients waiting.
- Triage was undertaken. I have no memory of the nurse identifying himself. I explained my symptoms. I also demonstrated recent bruising from my right heart catheterisation and coronary angiogram on my right arm. Lots of typing.
- I was told to proceed to the next window for administrative details. No chair.
- Instructed to move back to a waiting room chair. No administrative details taken.
- An hour on a plastic chair in the waiting room.
- Taken into the Emergency Department. No wheelchair was offered.
- Another chair in a cubicle. No bed available.
- No information about the toilet.
- No patient bell offered.
- No water.
- One set of observations over four hours.
- I was repeatedly told by the staff how busy the ED was that day.
- My request for a wheelchair or nursing assistance to access the toilet was denied.
- Oxycodone and an antibiotic were delivered to me in a paper cup, along with a black hair. No response from the nurse when I commented.
- Patient band cut off and a script for oral antibiotics given late afternoon.
- We were then ejected at about five-thirty.
I was exhausted by the time we arrived home with the precious antibiotics. I took more pain relief and an antibiotic and went to bed. The night was the worst I'd experienced. We had a doctor's appointment on Wednesday morning. I hoped for better treatment.
Our GP was very kind but limited in his options. He wrote a referral letter to our local hospital for IV antibiotics twice daily, IV fluids and IV pain relief.
Along with the diagnosis of my various conditions over the last eighteen months, I have become panicky and emotional at times of feeling unwell. That's how I was feeling when we arrived at Beverley Hospital.
- Beverley Hospital is operated by two nurses, admin and other casual staff.
- There is no attending doctor.
- I would have stayed on my own for two nights as Michael was not permitted to board.
Trying to make a logical decision became incredibly difficult. I rang my cardiologist's rooms to ask for advice. She was consulting, so a phone-call back was the best we could do. I did not feel safe at our local hospital under their operating circumstances. I had become terrified of this infection and the possibility of sepsis seemed a potentially imminent threat.
Northern Hearts' wonderful receptionist offered me the lifeline. With the referral from our GP, we could attend any Emergency Department. Anywhere. We returned home, packed some stuff and headed for Joondalup Health Campus.
Arriving just before three o'clock, we went into the Emergency Department. My apprehension was through the roof. Would I be taken seriously? Were my fears justified? Would I have to wait ten hours in the waiting room to be seen? What treatment would they offer? Would there be any sort of plan? Could Michael stay with me?
I took a ticket and sat on yet another plastic chair, leaning against Michael. I was utterly spent. Here is a timeline of events at Joondalup Emergency Department -
- Busy waiting room. "Take a number system" - for both patients and visitors. Three Triage stations.
- Called to Triage within fifteen minutes. Vital signs taken. Referral accepted. Questions asked by the triage nurse. My answers given. Much more time taken for this exchange.
- Admitted into the ED within another fifteen minutes. Initially in a wheelchair before being taken to a room within the view of the main observation station, known as the "Flight Deck". An administrative staff member found us and took our details.
- Seen by multiple nurses and a doctor. Examination of my mouth.
- Cannula inserted and bloods taken.
- CAT scan of my jaw.
- IV antibiotics begun. IV panadol given.
- Moved to an adjoining Pod, just at one end of the main Flight Deck. Small nurses station opposite my cubicle with all files for that part of the ED.
- Patient bell given.
- Michael identified as a visitor and my husband. Steps taken for him to remain with me.
- Sandwiches, tea and water provided through the night.
- Breakfast tray, tea and coffee in the morning.
- My plan updated by ED doctors as results came in.
- Antibiotics and pain relief given as charted.
- Seen by morning ED doctor to prepare for discharge.
- Advice about timing of my dental visit, a discharge summary and drugs all given. Encouragement to seek medical attention if symptoms worsened.
- Discharge twenty hours after admission at 11am.
That is the sequence of events in each Emergency Department in two hospitals - one country, one metro. Joondalup Hospital and its Emergency Department in particular, often seem to attract unfavourable publicity when patient treatment goes terribly wrong.
This is as it should be.
But who gives this hospital and this ED the kudos it deserves when a patient such as myself receives outstanding care and attention? Because good reviews rarely make a newsworthy story...
Joondalup Emergency Department is a place that beggars belief. Its size, its staff, its patients, its security and its visitors are a huge living machine. Overseeing the entirety is the Flight Deck. The ED is divided into different areas with multiple teams attending those areas. The PA is ever present. The lights never turn off. The noise can be deafening. There are phones that cause the staff's blood to run cold when they ring.
Yes, there are patients being looked after by ambos in the hallways. Yes, there are people on stretchers being given IVs inside the ED. Yes, there are police present with patients who may be of dubious character. Yes, the stuff struggle to move patients out of the ambulances into the ED and out of the ED onto a ward. Joondalup Hospital is frequently at capacity.
What I also discovered is that the Joondalup ED is a profound snapshot of humanity. Patients may wander in and out of their cubicles. Visitors may wander around, looking for their friend or relative or the toilet. The nursing staff do not wander - they move with purpose and speed. The doctors spend their time examining the patients, performing tests, chasing results and formulating plans.
Behind our curtains in our cubicle, I listened to conversations floating in from outside...
"It's the beginning of creation" - from whom I assume was an elderly lady.
"Help! Help! Help! I want to go home!' - from a woman whose family members then soothed her.
"I think we need to get you back on your heart monitor" - from a nurse.
"She's seventeen weeks pregnant and is bearing down" - two nurses painting a miserable picture.
Michael moved in and out of the ED over the long afternoon and evening. He watched nurses on breaks sitting in their cars to take a break. He observed the ramping of patients waiting to be admitted out of ambulances, being cared by the ambulance officers as the ED was packed. He saw patients being moved as beds inside became available. He was my eyes and ears all night.
I would like to thank the Joondalup Emergency Department for their compassionate care and treatment over twenty momentous hours. I can't fault their professionalism, their attention to detail and their devotion to the plan to get me better and get me out of there.
There was also the little touches of humour to cheer up the patients. A nurse wearing bright pink socks. A doctor from the Purple Team dressed entirely in... purple! Every staff member wore a name badge, often colourful statements to illustrate their individual personalities. Every staff member, regardless of which Team they were officially attached, would chase up patients' needs or questions or fears.
They all defused fear, pain, confusion and anger as if this was second nature. I saw no judgement, no criticism, no dismissal, of any patient or family member. I witnessed defusing of difficult situations, reassurances that patients were receiving the best care possible and always working towards getting patients out of there - either into the hospital or home.
I suspect Northam Hospital ED staff thought I was a time-waster or a drug addict looking for meds. I am waiting to hear for a plausible explanation, having contacted WACHS (Western Australia Country Health Service) and the Health Minister.
Australians are constantly being asked to live and work in the regions. All very well if you are young and fit. Not so great when you are staring down the barrel of age. This situation has to change.
Where will I go when (not if) I have another health crisis? Joondalup Health Campus has my full support..
My recommendation to the Northam ED staff - go and spend a shift at Joondalup ED and take away some strategies for a better environment for both patients and staff.
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