Did you ever die? Me neither. Unless we believe in reincarnation. But I very nearly did twice. Both times I was in the care of the NHS. The first time was when I was ambulanced into Chelsea and Westminster Hospital years ago, with intense paroxysmal Atrial Fibrillation. That’s when the heart goes mad like a trapped bird in the chest. They shocked me three times. The first, the heart stopped. The second, still stopped. “He’s going blue” my cousin the doctor, who was there, reports them saying. The third the heart started. Hello again.

The second time Death and I met we made love. Just over a week ago in Hammersmith Hospital I was coming out of surgery for the gall bladder operation. In the ward they gave me another shot of Tramadol for the pain and that was so very nice. I was semi-conscious. I could feel myself slipping into the most beautiful glorious warm place. Breathing was getting slower and slower, until it was no longer necessary. This felt right. Everything was sorted. there was nothing that actually mattered. Time to stop breathing. I was very content.

Standing around me, five people who disagreed. The wonderful Dr KS made them inject Naloxone and I re-emerged into this fucking Trump/pain/Tory/NHS Crisis world. Gee thanks. I think.

The point of telling you within the context of this blog is this question: if this had happened in the USA, would they have reacted so quickly and would I be typing this? Yes I know, your default is to say Of Course They Would. I’m not sure.

Shortly after having been admitted to the U of W Hospital in Seattle I was given morphine for the pain. Then, after a couple of scans etc I was alone. I began to shiver. It got worse. It became uncontrollable. I rang for the nurse. A football halfback-type came in, promised me another blanket. Left. Eventually returned with one. Left. Said he would discuss with the doctor. Didn’t, I don’t think. Eventually the shivering subsided.

If I had been suffering from what the Doctor called “Respiratory depression” in that bed in the US, would I be here now? Would I have pressed that call button? No, actually I wouldn’t.

THE SCORE SO FAR:

US: 16             NHS: 19

The winner at this stage is the NHS. Mainly because of the staff: in America it’s all about customer satisfaction and revenue maximisation. Despite the superficially better resources and much bigger man and woman power. In Britain, it’s about maximum care within constraints. And all done with love. No American healthcare professional made any human contact with me – it was all Customer Service. As if to confirm this, Dr KS has just called me to see how I am and give me results of blood tests. She has also read my blogs. Hello.

Back to the story: Let’s see how the NHS score holds up – in Emergency.

PAINLAND 

Painland is a province of the Land of the Living. Yet it has no specific territory. Any living  being can be exiled there for short periods, or long periods, or even for life. Once in Painland, getting out can be horribly difficult.

My visit there (US) with the gallstones was horrible. The visa out  was supposed to be the operation (UK). Three days after the operation when the pain relief wore off I was summoned back. Just above my diaphragm, intermittent sharp hard pain, varying between 7 and 11 on the 1 – 10 pain scale.

Eventually at 1am or so I called NHS 111. Foreigners: this is the NHS Helpline. Every time (I think there have been 3) I called I would speak to a nice doctor or nurse who would say “Go to Emergency” or, “I’m calling an ambulance”. Naturally. They can’t afford to take risks.

But this time there was (still is) the NHS Crisis. So they are obviously instructed not to send anyone to A&E unless there is a life-threatening crisis. “I’ll set up a Home Visit”, nice Dr George said. “They’ll call you.”

A nice woman called. (They are all Nice. Even the NHS organisation which decides on whether medications are to be used by the NHS has the acronym NICE. National Institute for Health and Care Excellence. Uh – where’s the H? https://www.nice.org.uk) “Go to your local out-of hours surgery” she said. “I can’t! George promised me a Home Visit!” “Oh sorry,” she said. “We’ll call you.”

A not nice Doctor in crisis mode called. Tiredly, exasperatedly, he asked me to repeat the whole damn story yet again. I had already repeated it twice to Nice George because he had pressed the wrong key on his computer and deleted everything by mistake. Or something. “Go to A&E at Hammersmith” he said. “There is no A&E at Hammersmith.” I said. “Well go to A&E at Charing Cross then” he said. “Get a cab.”

I didn’t do that. I just took a life-threatening bowel cementing load of pain relief.

SCORE: NHS down 5 points.

They next day was my birthday and to celebrate it the pain came back, booked in, made itself at home and began burrowing away at the diaphragm. I telephoned my NHS GP. and asked to see the Nurse. My idea being, she could look at the dressings and check if there’s anything visibly wrong.”Sure. One hour.”

The walk to the surgery took the pain well above 13/10. I was tearful and ready to scream. A doctor was summoned into the nurse’s room and examined me. She called the Hammersmith,  had to wait 20 minutes to talk to the right person, finally spoke to a surgeon who said, “Send him to Charing Cross A&E. We have to have a referral.” “A&E Charing Cross” she said. “Get a cab.”

SCORE: NHS up 3 points

Oh joy. A Happy Birthday to me.

THE CRISIS UP CLOSE

Here’s my post from Facebook.

I have just seen the NHS Crisis up close and it’s terrible. Had massive pain and the short story is I ended up in Charing Cross A&E. Everything they say is true – patients everywhere. Trolleys in corridors. Took 5 hours to get dealt with. A churning mass of people, like a railway station made mayhem by multiple train delays, crashes, fires, strikes. Superb staff (except for one sneezing doctor who neither washed his hands nor shielded others from his germs) desperately trying to tend to every variety of illness or accident with kindness and as much efficiency as is possible under impossible circumstances.

When I finally saw the Registrar he said he would like to do scans tomorrow. But there are no beds for me to stay overnight. I said Great! It’s my birthday, I’m outta here see you tomorrow. And as I headed for the door he snatched a phone, someone was having an embolism or something, what can I do? He said, There are no beds!

Hail to the Heroes and Heroines who despite the criminal underfunding of what was the brightest jewel in the British Crown, continue to fight the good fight. And hail to all those who protested in London on Saturday, and to all who support our NHS.

SCORE: NHS down 3 points.

The next day at Charing Cross took a great deal of sitting down. Waiting and waiting. More waiting. As the pain had eased considerably I kept getting the guilt: here there are people who need these scarce resources more than I do.

There were certainly some who needed less. Percentage of Worried Well to Really Sick: no idea. Especially since I had no idea as to which category applies to me.

And to those who say the NHS is overwhelmed by Health Tourism, i.e. foreigners coming to the UK for cheap or free high-quality treatment: there were certainly people in those heaving corridors who spoke little or no English. Some in what your more racist Brexiter would describe as non-British dress. (many of them are more British than you are Mr Farage!) Percentage? Hard to tell who was entitled to NHS care and who wasn’t. My guess would be that the number of Health Tourists is far smaller than Faragists think.

According to Fullfact, “Health tourism costs the NHS around 0.3% of NHS spending” https://fullfact.org/health/health-tourism-whats-cost/

It’s important to note, however, that since October non-EU workers are to be charged £400 per year for healthcare; and NHS services are required to ask for proof of nationality and residence from foreigners. There is a huge amount of resistance to this from NHS staff, many of whom are from non EU countries. And from me too, I have to admit. If someone’s bleeding or dying it is a moral duty to do one’s best to alleviate suffering. Besides, that’s what the Hippocratic Oath says.

It took a day for me to get an Ultrasound scan and an CT scan of my brain (I was very wobbly. As I have AF, it was worth checking if I had suffered a TIA (a mini stroke.). The final conclusion being, dunno. No idea as to the cause of the pain. And today, dear reader, the pain is minor. Each morning at 4am it’s excruciating. Then, painkillers and a little sleep and hope of recovery begins to grow. I think I’ll live. Sigh. At any rate of there’s anything nasty going on in my fundament it’ll show itself sooner or later. Hopefully once the Crisis has passed.

SCORE for EMERGENCY TREATMENT:

NHS: 11          US: 17

Is this fair? The NHS is in Crisis mode, and that’s abnormal. I can assure you: if you have an accident or emergency the NHS is there like an angel. Fast, fully equipped and full of care. And to now, free. However, my experience of emergency care in the US – once I told them I was insured and that my brother the Professor is on the Faculty at that University – was excellent. Initially at least.

PAYING THE PRICE

In the US legend has it that it isn’t long after an accident that you are asked who your insurer is, or how you will pay. That’s coming here. If you have a foreign accent in the UK, certainly you will be asked for ID and how you will pay.

The American nightmare: What if I am ill.  No doubt if you are well employed you may be able to afford good insurance in the US  “A 2015 Employer Health Benefits Survey by the Kaiser Family Foundation found that employer-sponsored family healthcare insurance premiums cost $17,545 annually, and the average worker contributed $1,071 for single coverage and $4,955 for family coverage per year.2 Aug 2016″ https://www.zanebenefits.com/blog/the-cost-of-healthcare-in-america

Of course if you’re not, you can’t. “About 44 million people in this country have no health insurance, and another 38 million have inadequate health insurance. This means that nearly one-third of Americans face each day without the security of knowing that, if and when they need it, medical care is available to them and their families” http://www.pbs.org/healthcarecrisis/uninsured.html

And how much will I pay for my night of emergency treatment in the US if my insurer wriggles out of their obligation?

The total bill for one night and all those scans is, I think $2,140.92. That’s much smaller than I thought it would be. I might have miscalculated or missed something out.

In the UK for one night including surgery, drugs, care, having my life saved, £0.

In the UK for two days of emergency investigations £0.

CONCLUSION AND RECOMMENDATION

Americans, you are crazy. As flawed and underfunded as our NHS is, my final score:

US:

UK:

You tell me.

For the full story on the American experience, see http://jonelkon.com/letter-from-america-part-2-a-rock-in-a-hard-place/