Today's situation of too few staff, too many patients has become the norm. Denise Deegan reports
In 1989, I was a young nurse at the beginning of my career when health cutbacks were introduced. Suddenly, we were understaffed and seriously overworked. Patient care suffered enormously. Neither dignity nor privacy was guaranteed, even for the dying. "Frustrating" does not do justice to the situation we found ourselves in. I wasn't the only person to leave the profession.
A recent visit to a Dublin A&E has made me realise that healthcare workers are still battling the same equation - too few staff, too many patients. There is one significant difference, though, since the late 1980s. Nobody is using short-term phraseology anymore. "Cutbacks" are no longer being sold to us the same way an injection might - a quick prick and it'll all be over. No.
Today's situation, we are told, is the norm. And we have to put up with it on the basis that we should not be in casualty unless we are on our last legs. If only reality slotted conveniently into the tiny gap provided by the theory.
My mother recently took ill at five in the afternoon. A GP who is a family friend was with us in 10 minutes. He advised immediate hospital investigation. At that time of day, he apologised, there was no way round it - we would have to go through casualty. I can see now why he apologised.
After a wait of 20 minutes in A&E, a nurse carried out preliminary observations and took a medical history. She then warned us to expect a further wait of an hour or two to see a doctor. We settled in, in front of the television. Liz Bonnin was photographing tigers somewhere or other. After that, we tried to concentrate on No Frontiers. Then EastEnders, Fair City, The News No doctor. Prime Time, still nothing. I went to check that they had our name. "You'll be next," a nurse told us. We were - two hours later. Only next, actually meant, next out of the waiting room, but at the end of another list of patients waiting to be seen in casualty. My mother was asked to lie up on a trolley in a corridor. After standing beside her for half an hour, I followed the example of most waiting relatives and found a spot on the trolley to perch on. Other trolleys began to line up on either side of us. It was hard to know where to look. I didn't want the man in my direct line of vision with the blood-soaked bandage to think I was staring. Behind him, a man was removing his shirt and having electrodes attached to his chest. The only options were the wall on my direct right or the curtained area on my left, behind which were seriously ill (and often visible) patients. I became intimately acquainted with my mother's face and my own lap.
Plugging my ears with my fingers might have made me appear rude or mad. So I settled for learning the medical history of all our neighbours as well as the logistics of running casualty. A nurse explained to a nearby patient that he needed to be admitted but that there were no beds available on the wards. A section of A&E had been set aside. He would have a bed there for the night.
Three thoughts crossed my mind. One: this must be the norm if staff members are so prepared for it. Two: are extra nurses and doctors allocated to look after patients who are supposed to be admitted but can't be? Three: Not the most secure place in the world to spend the night.
There seemed to be only two doctors on duty. And they were needed for the serious cases. Exclusively. For hours. Everyone else had to wait. And wait. I longed for another doctor to be allocated to keep things moving, dealing solely with non-life-or-death cases. I dreamt of an efficient supermarket scenario with extra staff called to the registers when queues started to form. Would it be too simplistic to apply the same principle to casualty?
I struggled with my sense of humour. And lost. It was two in the morning, almost eight hours after we had arrived, before a doctor finally saw my mother. He apologised for something that was out of his control. Our humour improved. An outsider might have been forgiven for thinking all's well that ends well. Well, luckily yes for us - for others it can be a lot worse; spending spending a day or even more waiting on a trolley.
But what would have happened if my mother's condition had been steadily worsening while she was waiting? What would have happened if I had not brought her medication with us? What would have happened if she had picked up MRSA or developed a clot from lying rigidly in one position for so long? I appreciate that these are deliberately bleak scenarios. Unfortunately, they do occur. In one of the wealthiest economies in the world, it is not good enough to provide such obviously inadequate emergency services on the basis that GPs should be our first port of call. GPs go off duty. GPs refer us to A&E. And what warrants an emergency anyway?
A sudden, excruciating pain would probably bring most of us to casualty. But what about more subtle and often more serious symptoms - sudden, unexplained memory loss or visual disturbances? Are there going to be seriously ill people who talk themselves out of medical help on the basis that they don't want to wait and wait and wait?