Five Days in a Derry ED, Two in a Chair: A Salutary Tale

Author KEN THATCHER writes about his recent trip through the badlands of the NHS and how how he was forced to endure a 120-hour wait in Altnagelvin Hospital's Emergency Department before finally getting a bed on a ward

'We were a band of mostly elderly people trying to squeeze as much comfort as possible from a hard chair, praying for a moment of sleep which never came'

TO BEGIN, a bit of background. I am no stranger to our NHS and am a firm advocate of it, Having suffered from Crohn’s Disease for the last thirty plus years I am quite familiar with how the system works, I have experienced a flare-up of my symptoms for several months which had necessitated visits to my GP, the Out of Hours doctors and when needs must to the Accident and Emergency Department. By the last weekend of October, Halloween, my symptoms had become entirely unbearable. I was no longer counting the number of visits I was making to the facilities but the number of toilet rolls I was using in a day.

On the Friday I visited my GP who knows me well. He was sufficiently concerned to phone my consultant at Altnagelvin who arranged to have me seen at my next infusion visit the following Tuesday in four days’ time. This happened and my medication was changed and a follow-up arranged. By the weekend things had become worse.

On Sunday morning I could no longer contain myself, before ten o’clock I had visited the toilet no less than twenty times. I phoned the Out of Hours doctor and got an appointment for 12.15. I saw the doctor on duty who gave me a very thorough examination and concluded very rapidly that my condition was above his paygrade, and the sensible course of action was to go to the ED . 

I was swiftly transported by wheelchair to the ED, arriving at about 1pm to begin my adventure. From the Waiting Area I was swiftly taken to Triage where I had bloods taken, a medical history given and then returned whence I had come. Sometime later I was triaged as appropriate for further examination and brought back into the inner sanctum where I was transferred from the care of a nurse and was seen by a doctor. Time had also passed, but you expect that in ED. I was becoming well versed in the recounting of my ailment and so when I spoke to my second doctor, he decided I was worthy of a canula and further investigation. By this point time had become irrelevant. My long-suffering wife decided she needed a break and a breath of fresh air and went home bristly.  It was by now 6pm, Six hours in ED. My wife returned from home only marginally refreshed.

Inexorably time moved on. We all know how hospitals operate; at key moments some tasks are no longer possible. As we approached one of these deadlines my wife sought out one of the more senior doctors and demanded to know what the plan was. There was a plan of sorts. I had been admitted, was in the system and wheels would turn. And so began the slow grind of finding an appropriate spot to spend the night.

My wife went home for some well-deserved rest. Myself and three or four others tried to find an appropriate spot to spend the night. We found ourselves at a particularly awkward intersection in an area called Minors. There was considerable badinage as we tried to keep each other’s spirits up. Even on a Sunday night we hoped, maybe prayed that something, anything, might happen.

Before I continue, I should familiarise you with the layout of the ED. In the waiting area there are two toilets, in the nearby Triage area there was one toilet. As one progressed into the building there were  undoubtedly more but were hard to find. I’m sure that the facilities satisfied all building regulations, but do they take account of people like me. People with Crohn’s or similar diseases of the bowel? Let me tell you I think not. The long and the short of it is this; no matter what lengthy expedition I undertake I now protect myself with disposable pull-up underpants, just in case. As my sojourn in the ED rolled inexorably on so did the feral matter in my bowel. As I walked briskly towards the toilet a person nimbly stepped in front of me and nipped into the WC closing the door firmly in my face. Things were beginning to trundle or more likely to flow. I strode as best I could to the next facility, perhaps twenty metre or so away. Calamity, occupied. I hobbled back, hips clenched, towards my original destination and gained access. Disaster, I could no longer hold. The inevitable happened. My only source of protection, my pull-ups, were now out of commission, I adjusted my dress, disposed of the pull-ups and left. Once again, I reclaimed my chair. By good fortune I was wearing a dressing gown, long enough to cover any mishaps. 

My little group tried to console one another by reflecting on our good fortune on having been admitted with the expectation of treatment and a bed, eventually. The night wore on. Once again, I had trouser issues which I resolved in the toilet by various scrapings and rubbings.

Suddenly a nurse appeared. I was on the move at last. We set off up unknown corridors, I dreamed of stretching out on a nice clean bed, even a trolley would do. We crunched to a halt. My reverie interrupted, I found myself confronted with some of the patients I had seen earlier on the outer periphery of the department. My chair was parked up against the wall, but at least I had moved. As I gathered information from my fellow sitters, I realised that we had penetrated the inner sanctum and whats more we were being fed, shaky plates balanced on shaky knees with measured portions of pasta bake. We were a band of mostly elderly people trying to squeeze as much comfort as possible from a hard chair, praying for a moment of sleep which never came, In the course of the night I had the misfortune to witness the stress caused by lack of sleep. Voices were raised, tempers flared, fuelled by tiredness and a lack of hope, family groups disintegrated.

Dawn doesn’t break in the ED, they simply turn the lights on

Day two dawns

Somewhere in my head I have a notion that I had seen a senior doctor who had  found my condition serious and stated that when a bed became available I would be taken straight to a ward. Knowing what I do about hospitals, I thought it unlikely that wards would discharge patients first thing on Monday so I braced myself for a wait. In the meantime, we all ate a healthy breakfast of pancakes and tea. My insides were beginning to calm down , presumably thanks to the medication which I was being given.

Around 8am the ED began to come to life and all of a sudden there were doctors everywhere, reviewing the patients who had accumulated overnight. I kept looking for a familiar face. About 9am I made inquiries and was assured that doctors from Gastroenterology were on their way. I overheard a conversation and guessed that this was the person to whom I should speak. I was informed that my name was on their list and that I would be seen in the course of time. Being well brought up, I knew to defer to doctors, that they knew best. I resumed my seat but, all the while , keeping an eagle eye on the doctors. Suddenly I was approached by yet another doctor from the Gastro department. They couldn’t find a room to afford me some privacy so, if I didn’t mind being seen in the corridor, in the public gaze, then I could tell my story. I was by now, well-rehearsed in the relating of my symptoms to which the doctor listened politely, then, pointing out that the doctor from the night before had had no authority to promise me a bed, said he would be back after he had seen other patients. I felt I had done my best and retreated to try to find some sleep.

Sleep eluded me. The rest of the morning was spent waiting for lunch to arrive which it duly did. Pasta Bake. There was much chat among our little band but no one came and no patients left for pastures new. In the afternoon a doctor arrived and tried to persuade me that I could be treated at home. I explained that that had already been tried the month previously and here I was back with the same problem. I needed to be seen and treated. As the afternoon wore on I realised that I had not had an opportunity to wash or brush my teeth, there were no facilities for such. My long-suffering wife arrived with a change of clothing and a toothbrush, that was the highlight of the afternoon.

The day wore on without any sign of movement. Our little band remained constant. Nurses passed amongst us from time to time but no one moved out and no one arrived. Any questions we had elicited the same response. There were no available beds, the wards were full. Tea-time came and went. My only consolation was that there was a toilet nearby and my innards were calming somewhat. Tea and toast came about eight o’clock and that was it for the night. We were still about five or six souls living in hope.

And so we faced into our second night in the ED still without any significant sleep. I think it was about this stage that I began to have hallucinations. At one stage I believed that I was playing a part in a drama which had been laid  on for our entertainment, at another stage I thought that one of my fellow patients was being held against their will and I began to hatch a plot to facilitate their escape. This would involve violence and the use of my walking stick, as luck would have it my natural bent for cowardice won the day and I did nothing. I dread to think what the various nurses with whom I shared these thoughts made of me. The night wore on and I managed to avoid making a spectacle of myself. Nurses came and went giving me the appropriate  medication and  as dawn broke I gathered my wits once more. Come to think of it, dawn doesn’t break in the ED, they simply turn the lights on.

Eventually I was pushed into my allocated space. I was still in the ED and my space was a small square no bigger than the trolley, immediately outside a toilet and adjacent to a heavily used pathway between departments. My wife was horrified, I was too far gone to care.

At last breakfast arrived with the welcome cup of tea and pancakes. The ED began to stir and we braced ourselves for the day ahead. Doctors came and went. I recall speaking to one of the consultants who was familiar with my complaint, that gave me some hope. The day wore on, nothing happened. After lunch my wife returned with more fresh clothing, I had not had a proper wash for seventy two hours, I’m sure I had  developed a bit of an odour. Sometime in the late afternoon there was a breakthrough. Rumours of free bedspaces swept through our little band, Our number began to dwindle, I remained unmoved. Suddenly a senior member of staff arrived, space had been found for the three remaining patients. My spirit soared and once again I began to dream of lying down, of sleeping. A nurse appeared with a trolley to transport me to a place of comfort. My wife was with me to help get me sorted, I was pushed on the trolley for a minute or two then we came to a halt. Things began to get a little weird. I thought I was outside waiting for an extension to the hospital to be completed before I could get my space for a bed. Even worse, I thought for some reason I had been put into a Tesco trolley to travel to  my destination. Eventually I was pushed into my allocated space. I was still in the ED and my space was a small square no bigger than the trolley, immediately outside a toilet and adjacent to a heavily used pathway between departments. My wife was horrified, I was too far gone to care. Fortune was on my side, a consultant whom I had seen earlier happened to pass by. My wife nabbed her and in no uncertain terms told her what she thought of my circumstances. The doctor was in complete agreement with my wife and was very sympathetic but unable to do anything. 

Suddenly the nurse accompanying me spotted an opportunity and myself and the trolley were whisked towards a vacant space just opposite the nurses ‘  station.  At last, after two nights on a chair, a space to call my own. Who would have thought a cubicle could  have fell so grand. Progress had been made.

You might have thought so but, Tuesday night came and went. Being at the nurses’ station might have  sounded interesting, but it was busy. Everything and everybody passed that way, all that lay between me and them was a curtain. But sure we were on the move. Treatment for my complaint seemed to be working and the sense of urgency was declining. All I had to do was wait, and wait and wait. And wait I did, Wednesday became Wednesday night. 

At one o’clock on Thursday morning I was shaken awake. Once again I didn’t know where I was  I thought there was a fire and the ward was being evacuated but I was finally on the move, off to a proper bed in a proper ward and the promise of a proper sleep. I had been in the ED for more than one hundred and twenty hours.

I woke early as you do in hospital and began the day with a long-awaited shower. A doctor came and explained how they intended to treat me and I lay back to enjoy hospital routine. In the afternoon, and not for the first time, I experienced the dubious  pleasures of a sigmoidoscopy, Three days later I was discharged with a plan, a fistful of drugs and a hope for improvement.

To conclude. In my five days on a chair and on a trolley in ED I never experienced a cross word from any member of staff. I was always treated with respect although the understanding of the Crohn’s sufferer could be improved as might the understanding of the anxiety and urgency that they experience. During my stay I watched the staff as they went about their business. They never strolled to a task they strode. They were efficient and quick, remained patient and were I believe doing their very best in trying circumstances.

Eight days as a guest of the WHSST,  hopefully never to be repeated but , being a bit of a polyglot, 'Qui sait?’ or ‘Que sera, sera.’

KEN THATCHER is currently working on the second volume of his memoirs, the sequel to The Wife Sister's Wee Boy, (published by Colmcille Press in 2023).