What surprised me most about my experience in the John Radcliffe hospital was the anger it inspired in other doctors. "You have to sue," one trauma doctor friend said. "You must write to your member of parliament," a local GP insisted. "You must write to the press." He even thought we needed to adopt something of America's litigious culture to improve the situation. "It's third world!" he said. "Nothing will change unless patients are prepared to complain."
I hadn't expected this from the professionals. For me, as for many people, the virtue of the NHS was an article of faith. I still had an image of valiant doctors and angelic nurses fighting together an ordered campaign against the odds. I cling to this image still. But a week in the orthopaedic/trauma ward of the John Radcliffe makes you painfully aware of the human reality of chronic underfunding. You feel that you are lying somewhere near the bottom of a downward path, where the lines of command and control are breaking down. In your worst moments, it seems that all that survives is the sweet talk of care.
I flew into chaos the moment I arrived by helicopter having fallen from an eight foot ladder on an island in the Thames. Although the paramedics had efficiently radioed ahead to tell the hospital that the helicopter was for logistical reasons rather than resuscitatory, the message had not got through to the trauma team, which had been dragged from other operations to greet me. They vanished in understandable irritation when they saw that I was conscious, instructing the radiographer to x-ray my back.
I saw my spine emerge on a light box attached to the far wall. As I lay there trying to decipher its ominous message, the kindly radiographer kept leaving her job to ask me whether a doctor had seen it yet. Eventually, she pulled the x-rays off the wall and strode out of the room to find someone herself.
The doctor she brought told me that I had fractured a vertebra but I would probably be discharged and advised to take bed rest. In the end, I lay in hospital for six days, waiting for a full torso brace to be fitted and then another five in the Nuffield orthopaedic centre where I had a new brace fitted because the first did not fit. Apparently, the John Radcliffe reverted to making back braces out of unwieldy fibreglass instead of thermo-plastic after the machine for heating the plastic broke and was replaced by one that was too small.
Like others in my ward, I lay for the first 23 hours on a trolley in a corridor in casualty, watching stretchers rolling in. Without a bell and without my friend, who had gone home expecting me to be discharged, I spent an increasingly frantic night trying to get more pain-relief. People were passing but my voice was too small to attract their attention. In their state of overwork, they seemed to adopt a kind of closed look, trying, like waiters in a busy bar, not to catch your eye. I managed to get five people to stop in the space of several hours. After the fifth had said, with swift sympathy like the rest, that he would see what he could do and disappeared, I was desperate. An innocent junior doctor got my explosion: "I've been in pain for hours. I've been told I can have morphine and I can't get anyone to give it to me."
I got my morphine and while I had the nurse's attention, I asked about my hand which was hurting even more than my back. I thought the intravenous line in the back of my hand was causing the pain. The nurse wasn't convinced. She said I had probably hurt it during my fall and showed me the bruises up my arm. But she already had another patient to attend to. I felt I'd had my ration of care. Six weeks later, when the pain was still there, my GP sent me for an x-ray. I had, in fact, broken my hand. Now, three months later, the plaster has been removed and my hand hasn't healed. I will probably have to have an operation.
It is not surprising that such mistakes are made. One nurse I spoke to told me that the John Radcliffe has only a third of staff required. I thought I'd misunderstood her and that she meant that they were understaffed by a third. "No," she said. "We are down by 60%."
The strongest impression I got from my week in the JR was of the destructiveness of chronic underfunding. You felt you were way down a line in which doctors and nurses had been coping with too many people for too long. From the moment of admission you acquired a new persona - you were "a patient": your needs were familiar but impossible to meet adequately, you would therefore be demanding and need placating. What was interesting was how quickly we adopted the role: how quickly the bond between patient and nurse deteriorated into a sense of "them and us". Each time a nurse entered the ward we all sought her attention, not knowing when we were next going to get help.
Indeed, we very quickly sussed the prisoners' dilemma. Everyone rang their bell for me when I was about to vomit, lying flat on my back unable to move and in danger of choking. We all rang our bells when one of us was left painfully stranded on the com mode. After a particularly bad night, during which the 94-year-old woman in the bed next to me had been crying in pain on the bedpan for ages and was then chastised for not having used it, I said to one nurse who had a sense of humour: "Sometimes this feels like a prison."
I kept thinking of something Brian Keenan wrote about his experience as a hostage in Lebanon. According to him, the physical torture was never as bad as the torture of uncertainty. I had found that difficult to believe. But in my ward, the times that people broke down were not when we were in agony but when we were rendered powerless in the face of apparent chance. The woman in the bed next to me was starved all day for an operation and then told, after dinner had passed, that it had been cancelled. She was halfway through breakfast next day when, without warning, the trolley arrived to take her to theatre. They had forgotten to put "Nil by mouth" on the end of her bed. On many occasions, my cup of tea was left beyond my reach. No one had time to help me eat or to work out what I could eat by myself. Eventually, my family brought in food which they fed me and stored in the hospital fridge.
On the fifth day, somebody noticed that I hadn't been given aspirin since my accident despite a danger of blood-clotting. I still had not got my brace. The nurses' reassurances began to seem frighteningly disconnected from reality. Two days running I had been told I would be taken to the plaster room. At lunch-time the nurse would go to find out what was happening. Then the shift would change and I wouldn't hear what she had been able to find and the day would come to an end.
Finally, on the sixth day there was a bus crash outside Oxford and the ward was told to clear 15 beds. I still did not have my brace. The nurses said I'd be more comfortable in the Nuffield - it was a specialist hospital and I'd have a private room because I might be carrying bacteria from JR. I wasn't convinced. Fortunately, as the management was organising my transfer, the consultant appeared and told them that I could not be moved without a brace. That was the necessary spur. Two women arrived from the plaster room, smiling and stressed. As they pushed my bed along it emerged that they had been spending a significant part of the week wheeling patients around the hospital as there weren't enough porters.
It felt like dangerous chaos. Doctors were doing the work of nurses and nurses were doing the portering. For six days I took a precious bed and four people to turn me every few hours because I wasn't fitted with a brace. It was clear that this was no longer a simple question of injection of funds. I had the impression that the hospital had been in this state for so long that the whole culture of care was crumbling, that its efficacy was more often determined by chance, and that it will now take a lot more than money to turn things around.
