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My experience of needing surgery between Christmas and New Y...

Posted By antliaki83

"My experience of needing surgery between Christmas and New Year."

About: Fiona Stanley Hospital / Emergency Department St John of God Murdoch Hospital

(as the patient),

If anyone asks for a wise word at the start of a year, here is one you might like to pass along. If you’re going to get sick, don’t do it between Christmas and New Year. I’ve made the mistake of doing so, and oh my, it has been frustrating. I was due to have surgery for a hernia repair, and here I am 3 and a half days later, still waiting, though ready to be wheeled through for surgery should an opening come up.

Let me fill you in a little more.

On Boxing Day I woke to notice a significant swelling that even I could deduce was a hernia. While painful, it didn’t feel desperate, so I waited for our GP to open the next day and went in. After a brief examination, the doctor looked at me as though I had been recklessly irresponsible for having waited so long, and told me to get to the emergency room of the local hospital immediately. “Don’t drive yourself,” he said, “and take a bag – they’ll do surgery and you will be in overnight.”

I dutifully obeyed orders, and within 45 minutes my wife and I were at emergency.

While I don’t like to be critical of our public hospitals, the experience was seriously underwhelming. We were met at the door by a volunteer who asked my name, and then wrote it down inaccurately. I didn’t have the energy to protest. He told me to wait on a red chair – the chair people who need to see a doctor must sit on. There was no inquiry about how ill I was, or if I thought I might be dead in a few minutes, or anything else. Just wait on a red chair until a triage nurse could see me. That happened an hour and a half later. If I had been having a heart attack or a stroke I would have been long dead. Other than jumping up and down and screaming for attention, no one was going to give me any. One person did pass out while we were there, though it turned out she hadn’t come as a patient, but as the support person for someone who was!

When I saw them, the triage nurse asked some essentially superficial questions, and then sent me to an admin clerk. Questions revolved around my private health cover as much as anything. After that there was a further 3 and a half hours wait during which time my temperature and blood pressure was taken. My blood pressure was way, way up, but didn’t seem a cause for concern, nor was I asked what it usually is. 5 hours after arriving at emergency, I got seen by a doctor. And from that point on my criticism of the system ends, because once I actually saw the doctor, I started to be treated really well.

Second bit of advice then… if you have a condition that you could die from, try to make sure it spreads out over at least 5 hours, because going to emergency doesn’t see you getting help before then.

Once seen by the doctor (actually numerous doctors over several hours) and being whisked through a CT Scan, they concluded that surgery could wait until tomorrow, and told me I could eat until midnight (it was then 11pm) but nothing after then. The vending machine (the only food option available at that hour) offered some nice looking sandwiches, but unfortunately didn’t work. I did manage to get it to dispense some nuts and strawberry milk. I slurped the last drop down just before midnight. By 2 am I was admitted to my ward. 3 hours and 40 minutes of sleep followed – when I was woken, observations were taken and I was told to shower and get ready for surgery. They provided some pretty serious anti bacterial soap to use and insisted I use it everywhere. I dutifully obeyed, but my goodness, it does dry your skin out!

After that, various doctors and specialists came by. They explained about the hernia, said the problem is that it is incarcerated and wished me well. Then the first ominous warning. “We’ve classified your surgery as urgent. But you need to understand, urgent is not the same status as an emergency. And this is between Christmas and New Year – we are very short staffed. Every life threatening emergency gets in ahead of you. I am sure you understand why.” Yes, of course I do, and I am glad I am not an emergency. Apparently it could have been, depending on what was trapped in the hernia, but I gather it is none of the really serious stuff. So here I am, 3 days later, showered yet again with that dreadful but really necessary soap, on my third day of fasting, and hoping that today will be the day.

Actually, I am a little more hopeful for surgery at the time of writing this, because yesterday I was shifted to a private hospital, being assured that urgent surgery is more likely to take place in the private system than in the public hospital – certainly if its between Christmas and New Year. Since being first admitted I have been poked and prodded by numerous specialists (painful, every time), have been in four different wards spread between 2 hospitals (and am about to change rooms for a 5th time), been attended to by at least a dozen nurses and multiple junior doctors, and as far as the hernia goes, am still in the same position I was in when I presented to my GP and was told to go immediately to emergency (“and don’t drive yourself!”)

But that could all end in a few hours if I do get to surgery tonight. But my private specialist has warned me that though my chances are greatly improved by now being at a private hospital, I shouldn’t bank on it happening. But he did say I could eat until noon today, so that is a major consolation. It’s now 2pm, so fasting has commenced. Technically I’m booked in for 6pm, but am told 8pm is more likely. And we shall see what happens.

My takeaways… well beyond my tongue in cheek comments, here are a few more serious ones.

1. I have private health insurance. Spare a thought for those who don’t… those who have to wait until the urgent morphs into an emergency, often with life long (or death long) consequences. We all need to work towards a more just world.

2. I have genuinely tried to tap into mindfully noting the moment, and spotting God in it. In other words, even though this isn’t the way I’d planned to spend my days off between Christmas and New Year, I know that God never takes a break, and that it’s up to me to spot the God moments. And they have been there. I have been mindful that the love of my life has been with me all this time, sitting on seriously uncomfortable hospital chairs, doing her best to be supportive. She has been at the hospital from early morning until evening. My note to self – she is really extraordinary. If the roles were reversed, I would struggle to match her commitment. Thank you Lord for my wife, and for this little reminder of how astonishing she is. There have been other moments as well. Not being able to get to a church service on Sunday, I listened to some worship music. There was a period of about 10 minutes when I felt as though I was in God’s own presence. Truly wonderful, awesome, sobering. If only for those two experience, it has all been worth it.

3. Though much has been frustrating, I have met some astonishing people. The system might be wanting, but the people working in it aren’t. I am grateful for them.

4. Once told surgery is not happening on a particular day (I usually get the news around 4 pm), my wife and I have taken a slow walk outside. There is a long term rehabilitation ward within the precinct. I’ve observed several of the patients there – most of them wheel chair bound for the rest of their days, some of them so young. I’ve noted the banter between them, and the look on the faces of some of their carers. There are so many worlds out there. Worlds where little has gone to plan, and where heavy loads are carried for decades. I don’t know what to say. Life is not tidy or fair, but somewhere in the midst is God. And it is not that God makes everything better, but that God journeys with us. That’s the one benefit of getting sick between Christmas and New Year. You can’t forget the Christmas part of it. For God is with us… And sometimes you have exceptional experiences of God’s presence, and they are more than enough, even if they only last 10 minutes. And that’s true, in hospital, or out.

Well, it’s now early afternoon. My surgery hasn’t been cancelled yet… so who knows. Perhaps tonight.

A very happy New Year to you. Nice chatting…

PS I’m now writing a couple of days later. Yes, the surgery did happen. I am so grateful to my specialist Dr Leigh for making sure it happened and for being exceptional in his follow up afterwards. Turned out to be a little more complicated than expected due to a fair amount of bleeding, but else all is good. I’m home now. I never expected when I set off to my GP for a “it’s best to be cautious” visit, that a four day and 2 hour adventure lay ahead. Now for the recovery. Apparently I’m allowed a little walking, no driving and lots of mooching around in week 1. Interesting! What should I mooch about?

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Responses

Response from Nyrene Jackson, Acting Executive Director, Fiona Stanley Fremantle Hospitals Group 2 months ago
Nyrene Jackson
Acting Executive Director,
Fiona Stanley Fremantle Hospitals Group

Submitted on 13/01/2025 at 1:57 PM
Published on Care Opinion at 3:21 PM

picture of Nyrene Jackson

Dear antliaki83,

I am sorry to hear about your recent experience at Fiona Stanley Hospital, in particular the concerns you held with the triage process in the Emergency Department upon arrival.

Our ED does at times like all public hospitals, have significant demand that will impact our ability to see patients as quickly as we would like. Our ED team are constantly mindful of how to best prioritise and stream patients, whilst recognising that prolonged wait times can be frustrating, particularly whilst you are unwell or in pain and discomfort.

In relation to a few of the issues you have highlighted I can advise that our front of ED volunteers are only there to welcome visitors/patients and provide guidance on where to go in terms of waiting for triage, clerking and visiting. They are not trained to make any assessment of a patient’s clinical situation and therefore do not ask questions regarding symptoms. We would expect the triage nurse to request support to assess for prioritisation of triage order if there are large numbers of patients waiting in the red chairs; I can only apologise if this did not occur during on this occasion.

All of our ED Triage nurses are trained to undertake a brief initial assessment which can include obtaining vital signs such as temperature, blood pressure, pulse and respiration rate, and ask a series of other clinical questions. While it may appear that their questions are superficial, they are selected to provide the information required to prioritise patients presenting with time sensitive conditions. There is also always a waiting room nurse circulating, tasked with taking observations and escalating care as needed. From your feedback I can see that the waiting room nurse did attend to you.

I am sorry that you had to wait for an extended period of time to get access to the department and assessment by a doctor. Unfortunately, as outlined in your feedback the period between Christmas and New Year was extremely busy for the ED, with one day receiving a record number of ambulances. While the team attempt to see all patients within a time allocated to their triage score, access to the department is impacted by the acuity of patients arriving by foot and by ambulance.

I can completely understand with your frustrations waiting for surgery as well as having your procedure cancelled to accommodate emergency cases. This is a situation I can assure you we strive to avoid at all costs and only reschedule as a last option.

I am glad to read however that you have since had your procedure completed and I wish you all the best with a speedy recovery.

Kind regards,

Nyrene Jackson

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Update posted by antliaki83 (the patient)

Dear Nyrene

Thanks you for taking the trouble to reply to my story. I recognise the seniority of your role, and appreciate the demands on your time. Once again, thank you.

I wrote up my experience for a blog which I host, and someone who read it suggested I post it on Care Opinion as well - which is why it reads as it does. However, a fundamental principle in writing a readable blog is that you shouldn't let too much detail get in the way of the account, and that's a principle I followed in writing the account up, and the team at Care Opinion helped me to make a few very minor adjustments to ensure it was suitably anonymous.

However, as this account has come to your attention, I would like to clarify a few points which your reply simply does not address.

You apologise for the frustration I experienced at ED at Fiona Stanley. Yes, it was frustrating, but my far more serious point is that what happened was dangerous - very dangerous. When someone walks through the doors at ED they are essentially saying "I think there is something fairly seriously wrong and I need help." As they step through those doors they are saying, "You are the experts, you know what needs to happen." It's an extraordinary trust that the public is placing in the team. And my experience of walking through those doors is that no one - let me repeat - no one, asked a single question about how I was or why I was there, for one and a half hours. You know as well as I do that there are many, many conditions where you don't have the luxury of that amount of time. If that's how the system works, the consequences are sometimes going to be fatal - it is only a matter of time.

So frustrating, yes, but much more importantly, shockingly dangerous, in my opinion. It must be taken seriously.

You say that there would have been a triage nurse who would have asked for assistance in prioritising those in the red chairs if it had seemed necessary. Sorry, don't know who you are talking about. I didn't see anyone walking around checking on those in the red chairs. As you know, the ED reception, while one area, is divided into two sections, red chairs and then you are moved to the others once you have seen a triage nurse and admin - yes, a nurse did walk around the other section periodically, but certainly didn't check into anyone in the red chairs in the time I was there. There was absolutely no way anyone could know why I was there as the only information you had on me for the first hour and a half was my name (Incorrectly spelt), which had been taken by a volunteer.

You might say that if something had been seriously wrong it would soon have become obvious - perhaps, but in my account I mentioned that someone did actually collapse while we were there (in the post triage section). The response was not reassuring. They were an elderly person - ironically, not a patient but a carer for someone who was. They just slowly keeled over. As they did, I, like most, thought "well now the room will spring into action and help will come." Not at all. It slowly dawned on us that though this was the emergency room we (the patients) would have to go and find help for this person - which a few then did. Help did not come fast. When it did, it involved suggesting the person lie still on the ground for a short while, then sit up, and then have some water. I think the conclusion was that they were probably dehydrated (definitely a hazard when you are kept waiting for hours and hours) - and that was that. If that's what happens to people who enter the room well, I think what is happening to those who enter it already very unwell...

I was fortunate to be supported through my experience by my wife, a now retired nurse with 50 years of nursing experience. She was my main protection and probably the reason I was not kept waiting even longer than the hour and a half - because after we had waited about an hour and 20 minutes she got up to ask what was going on and to express concern at the complete lack of attention given to those arriving. She got to speak to a person who I recall said to her with the utmost seriousness, please complain. It's the only way anything will happen. There is nothing I can do about it, but we all know the system is broken. And then they said it again, please complain, I mean it, please do complain. Nothing will happen otherwise. 10 minutes after this, I was seen. I don't know if I had jumped the queue or would have been seen then anyway.

That is clearly not good... I tried to stress in my original post that I have absolutely no complaint against any individual staff member. As with any group, some stood out more than others, but all were polite, pleasant and genuinely seemed to be doing their best. But the system was letting them down. It's not OK to set staff up to fail - and while I can't speak for other days at ED, I can only say that on the day I was there, ED was so inadequately staffed that the only rational conclusion, in my opinion, was that staff were set up to fail. I accept that it was the tricky period between Christmas and New Year - but realistically, they come around every year, and a better plan needs to be in place. It's a totally predictable period. And leadership must plan for those predictable times, just as it must also plan for less predictable periods.

Beneath this, I imagine the cry might be for better funding of the sector, and clearly in your role you have to act as an advocate for improved funding and staffing levels. I am sure this advocacy is warranted, but please don't miss how much money and staff time was wasted by the way my case was handled. You know the daily bed cost per patient - well basically I simply had to hang around as a patient at Fiona Stanley for three days before I transferred to a private hospital - and if the staff who advised me to go private are accurate - if I hadn't done that, the chances that I would still have been waiting in another 3 days were unacceptably high. So I paid the private hospital excess and moved. The economics of this are unacceptable - a worrying waste of taxpayer money because of a seemingly broken system.

Anyway, this is turning out to be more negative than I intended it to be. Please hear me when I say that my basic concern is not the frustration I experienced, but that I felt the system as it operated that day (the only day I have to judge it on) was dangerous. I don't believe it can be shrugged off.

I wish you well in your role. I note that you are the "acting" Executive Director. I know nothing about your tenure and the comment that follows is in absolutely no way intended to be personal, but I am worried by how many people are in "acting" positions. If by any chance this is read by someone more senior than yourself, I worry that part of the problem with the current health care system is that we are keeping far, far too many people on "acting" contracts which makes it near impossible for them to bring about the change so obviously required. You need some certainty of tenure to be a genuine change agent.

Once again, thanks for the time you have taken to read this. I hope that in some way it can help lead to a safer system.

Response from Nyrene Jackson, Acting Executive Director, Fiona Stanley Fremantle Hospitals Group 2 months ago
Nyrene Jackson
Acting Executive Director,
Fiona Stanley Fremantle Hospitals Group

Submitted on 15/01/2025 at 5:44 PM
Published on Care Opinion at 5:56 PM

picture of Nyrene Jackson

Dear antliaki83,

I was deeply sorry to read of your experience and acknowledge the impact that has had on you.

Without knowing your details, it is difficult for me to elaborate further on our processes from what I have already provided in my initial response. I would appreciate the opportunity to complete a review of the care provided to you in our Emergency Department to allow me to provide an informed response to your concerns. I would encourage you to contact our Patient and Family Liaison Service on (08) 6152 4013 or via email fshfeedback@heath.wa.gov.au so an investigation can be undertaken.

The FSFHG strives to deliver the best care in a timely manner, and I would like to again reiterate my sincere apologies that this was not your experience with our service. I can assure you that all feedback is treated seriously and can lead to improvements in the care we provide.

Kind Regards

Nyrene Jackson

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