Der Prozess

Although the title of Franz Kafka’s story of out-of-control nightmare bureaucracy is translated into English as “The Trial”, the original German does it altogether more justice.  A process that turns its practitioners into cogs in a diabolical machine, and plunges victims into helpless limbo.

I had a medical incident last week.  My eyesight vanished very suddenly, and then came back in bits, with times when I could see half a room or a small area of screen or page while the rest was blank nothingness.  It came with a moderate headache, that was unusual in that it took several days to go away.

I’ve suffered a somewhat similar episode before now.  Back in about November 2007 the loss was a little less sudden, but sufficiently similar that I thought I recognised it.  Back then I was alarmed by it and sought urgent medical attention, only to be told I’d have to wait more than two weeks for a GP appointment – the gatekeeper to our medical system.  No amount of protesting urgency would affect that, but they told me to see an optician instead.  I did, and the optician reassured me there was no immediate need for treatment.  So I left it, and indeed my sight returned over a few weeks.

So it was that this time I was not as alarmed as I might have been, and had no expectations of our NHS.

Rather than repeat last time, I posted a “anyone familiar with these symptoms” question to a forum where I had a hope of good answers.  I got some good responses, but the overwhelming message was to get urgent medical attention.  There was even a suggestion of how to bypass the GP.  So with some trepidation I approached our medical establishment.

The contrast with last time couldn’t have been more stark.  NHS 111 told me to get an urgent appointment.  My GP gave me a same-day appointment, and then an urgent referral to the main regional hospital (which is just half an hour by bus from here).

At this point I made my big mistake.  I went straight to the hospital without even returning home to pack for a spell away from home.  So when they kept me in, I found myself without basic personal stuff, and particularly unhappy in pants and a shirt ever-longer past their wash-by date, and not loose enough for long periods of enforced idleness.  My only little luxury was my ‘phone, and earphones that enabled me listen to radio and (largely) block out the many other noises.  Though with that in such heavy use I was faced with an eternal quest to borrow a charger.

Arriving at the hospital with my GP referral, I was received rapidly, and a man came within minutes to run a couple of routine tests (hey, this is great!)  Once he’d come and gone a couple of times I spotted something of a pattern: attention to me was time-sliced with other things, though I know not whether that might involve another patient, paperwork and red tape, or no more than a cuppa and break.  I needed a drink myself, so after checking with him that I had five minutes to spare, I went to one of the shops near the hospital entrance and got something from the chiller.

So far, so good (though the drink wasn’t).  But that was the end of my being attended to.  As five minutes became five hours and more, I made some vain attempts to find out what the **** was going on.  I checked the time of buses home on my ‘phone, and made a particular effort as the penultimate bus time approached, and again an hour later for the last one.  This pattern of waiting in limbo with ever-rising stress levels turned out to be a foretaste of what was to come, and is overwhelmingly the dominant theme of NHS hospital treatment.  I made a semi-successful effort to get comfy enough to doze in a space too small to lie down: dammit, this is like a night on a bench at a station or airport, only with less luxury and space and more noise.

Sometime around 3 a.m. I was desperate for water and to get up and stretch, so I looked around for anyone I could ask about drinking water.  My first attempt failed: he asked what bed I was in and he’d bring me some, and couldn’t understand when I replied that I didn’t have a bed.  So was I visiting someone?  No, I’m waiting to be attended to, and just need some water.  Aaaargh!  Find another member of nursing staff, one who understands and fills a disposable cup with tapwater from the kitchen.  So now I know where I can get water, and it’s not locked – phew!  I also ask about a bite to eat (having missed my main meal), and get a cheese salad whose fresh (though bland) ingredients made it probably the best food I encountered throughout my stay.

Not long after that, things finally start to happen.  They’ve found me “a bed” (seemingly the NHS’s unit of treatment), and a nurse asks me a bunch of questions and fills a form.  They’re admitting me as a patient.  But the bed is in a ward whose atmosphere is not merely hot and stuffy, it’s positively miasmic.  Ten minutes and I’m sweating and panting, so I get up to reclaim my previous limbo-space in preference.  Only now the ward receptionist denies me that space: it has to be cleaned before morning!  I try to escape outside, but find the ward doors locked against me.  Fortunately a nurse is more sympathetic, and finds me another unofficial (and rather nicer) space where I can curl up on a trolley by an open window.  Sometime between four and five I’m seen there by an actual doctor.

After a couple of hours decent sleep they call me to return to my bed for breakfast.  It’s become quite stormy outside, and the wind is sufficient to provide some air flow even in the ward, so it’s now more bearable.  A bowl of cornflakes and a cup of tea, followed by a lot of sitting around doing nothing.  Lunch, and another moment of tension as not a single meat-free (or even non-meat-centred) option is offered!  Eventually they come back and offer cauliflower cheese, which I accept, with a yoghurt for dessert.  It turned out to be something a little different, and reasonably acceptable (for basic institutional food), though the yoghurt was fearsomely sugary.

After lunch they take me off for a scan.  They want to put me in a bloomin’ wheelchair (gotta make work for porters), but I decline, and eventually they let me walk, accompanied by a nurse[*].  Getting back I’m just in time to listen to the last of Ayckbourn’s Norman Conquest plays, which I’ve been enjoying on the radio over the past couple of weeks.  But the storm outside has abated and it’s getting impossibly stuffy again, so once again I go to complain about being detained in such a place.  I badly need a change of clothes, and a charger for the ‘phone, and my toothbrush, etcetera.  Plus, I have strong reasons to want to be back home.  Can’t I just come back by appointment for further tests they want to do?  No chance, we don’t do that.  Well, at least go home to pack a few changes of clothes?  Nope.  But there’s news: they’re moving me to another ward.  The Short Stay Ward should be a bit nicer and more peaceful for me.

It is indeed an improvement.  This time I get a bed by the window, and they’re happy for me to open it.  I wonder about my fellow-inmates, and am immensely encouraged when the patient in the next bed enthusiastically says yes please to opening the window.  So it’s gone from being a place of active torment to a mere place of detention.  I negotiate some time off: I can’t go home, but I can walk around the outside of the hospital for some fresh air and activity, and they’ll ‘phone me if I’m wanted for any more tests.  Outside is a great maze of roads with no green space, and every promising-looking path just brings me to another car park after a few metres, yet it’s still a lot better than being stuck inside doing nothing.  Even food is more relaxed in this ward: there’s a menu, whose options are the same as before, with a few more.  That evening my comfort is further improved by a “patient kit” with toothbrush, soap and towel so I can shower and clean up, and NHS one-size-fits-none pyjamas.

So now my life is the life of the ward, and I’m talking to staff and other patients.  I can see how all the staff are cogs in a huge machine, with their various responses to it and to patients who don’t see themselves as mere widgets on a production line.  Most of them try hard to introduce an element of humanity where possible, and some are very good at it.  I can actually feel marginally useful myself when I’m able to do some small thing for patients less able than myself (of whom there are several).  I have a twinge of regret when I can see I’m not qualified to help when one of the nurses is struggling through a bad headache.

The highlights of the next day are a session with the eye specialist and an MRI scan[*].  And another futile argument about going home, with a glimmer of hope when they tell me just one more test and it’ll be … soon … about ten next morning … aaargh, another night!  I take the plunge and buy Private Eye to see how the eyes will fare[*] and to give myself some entertainment other than just the ‘phone.  It’s too hard to read in the ward light, but next morning I have bright daylight and can read it cover-to-cover.

I’ve been getting into a routine with the catering staff: what do you want for (next meal) … nothing, I’m going home …  Turns out I’m in a pattern the caterers know all-too-well from thousands of patients caught up in this limbo, so they get used to this exchange and generally know best.  I try the only other veggie option, but the so-called curry is utterly disgusting.  And amongst the sweets, only the fresh fruit isn’t smothered in ten times more sugar than a supermarket equivalent.  So that’s a lot of cauliflower&broccoli meals.  They’re smaller than I’d eat at home, but with ***-all physical or mental activity I feel quite full on them.

Next day, ten o’clock passes, the whole morning passes, the whole day passes, my rage and blood pressure are rising.  WTF are they keeping me in for?  This total limbo is truly Kafkaesque, and of course the ward staff I have contact with are not the people who can influence anything.  It’s not just my time, either: they’re supposed to be short of those precious beds, so why are they tying one up with a patient who could perfectly well go home and come back in the morning, or some other time by appointment?  Talking to other patients, I’m far from the only one!

The following morning they finally send me for that test I was expecting.  For a bit of ritual humiliation, a jobsworth porter insists on putting me in a wheelchair: aaargh!  But the test itself is somewhat interesting to a technologist: that’s some impressive medical imaging kit!  I comment on it and mention having worked as a developer on scientific imaging systems, and get into a brief chat that might even have been interesting over a pint if I’d met the man socially.

Afterwards they tell me there’s one more test … aaargh, still in limbo!  But that happens in the early afternoon, so now I can finally await my discharge (the caterers of course know better).  This time, at last, I’m right, though the caterers are also right in that it isn’t until after hospital evening mealtime I’m released.  Four days to the hour after my arrival I wish my ward-mates good luck, and bid farewell to them and to the staff who are around.  It’s a bit late to walk home, so I overcome my embarrassment at clothes so far past their wash-by date and get on the bus home.


[*] Errata are marked thus.  The time I was accompanied by a nurse was when I went to the eye specialist, and that was probably because she put some quite painful stuff in my eyes which might have left me wanting nursing attention.  I had completely forgotten the eye specialist when I first wrote the piece.  There may be more errors, as my memory of the timing and order of some of the tests is unclear.

Posted on April 3, 2015, in nhs. Bookmark the permalink. 2 Comments.

  1. Only just saw this little tale.

    Yeah, the “keeping you in, tying up a bed, until they’re ready to do their test” thing is incredibly frustrating. The only mitigation is – I’m pretty sure they know it’s frustrating, and they’ve probably made at least some bona-fide effort to work out a way round it, but haven’t managed it. Conversely, imagine how frustrating it’d be to turn up for an appointment, only to be told that something urgent had come up and the specialist couldn’t see you today, how’s tomorrow looking…?

    Good luck with the eyes.

  2. vet, after a couple of days it’s very clear. Even if I had had to wait around all day, I could have been waiting in clean, comfortable clothes, I could have brought something with me to read or do, I could have got a decent evening meal and my proper pint of tea at breakfast. Not to mention the least of the little luxuries: my own bathroom and bed.

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