My recent fall at Central Station – that sparked two hospitals stays, two operations and eight weeks in a leg brace – was a wake-up call. What I discovered about Emergency medicine was illuminating, to say the least. Here is the first instalment.
One Bad Idea After Another
Playing tourist with Sydney’s Light Rail for the first time, when the destination was a train departing Central at a fixed time – 4.20 – was a bad idea. As I discovered, the Circular Quay service didn’t return to Central, it went off to Randwick. In a panic, I got off at the next station, Moore Park, thinking I had plenty of time to hoof it to Central. I didn’t.
It had been drizzling all day and the paths up to Central were slippery with rain and wet leaves.
In a nutshell, I was running too fast to check where my feet were going. Next thing I knew, I was on the ground, with three helpful Central Station medical staff trying to lever me onto a bench, so they could check me out and patch me up.
They suggested I go to Emergency at St Vincents, but my heart was set on a home-cooked dinner and a comfortable bed. I accepted their copious spare dressings and antiseptic wipes, and waited for the next train to Shellharbour. It was a long wait, but not as long as the night that followed.
Looking Like I was Mugged
I didn’t realise I had blood seeping from my face, hands and left knee.
I must have looked like I’d just been mugged because people kept coming over offering to help me. Crammed into a train full of commuters feeling sore and miserable, the two-hour trip was interminable.
Tracey’s face, when she picked me up from the station, was a study, so I knew my face must have been a horror.
Although I’d called and said I’d had an accident, I’d been a bit light on detail. Clearly this was more than a scratch and Shellharbour Emergency was the only option, so I kissed my home-cooked dinner goodbye.
Luckily, Tracey had prepared a picnic of gourmet sandwiches and two cold beers on ice. Naughty for sure, but handy as it was another three hours before I was seen by a doctor. We were like a couple of kids having a smoke out the back but, as it turned out, the funny side kept us going.
By 10pm, the knee had been bathed in non-sterile saline, stitched up and dressed, the unsmiling doctor giving no antibiotic and sending me home. At the time, Tracey and I were in disbelief, thinking we’d imagined this. We hadn’t.
Three days later my left leg was twice the size of my right, the skin tight and shiny, and it was torture to put weight on. Clearly it was infected.
Back To Hospital Times Two
After another trip to Emergency at Shellharbour, an Ultrasound and much head-scratching and discussion, I was off to Emergency at Wollongong Hospital, awaiting someone to interpret the result and take the next steps. All up, we were waiting in or moving between hospital emergency departments for 13 hours. It was surreal.
At the end of that day, we discovered things were worse than we thought.
Sure, the knee was infected, but as a bonus, I now had an MRSA infection – or Golden Staph as it’s affectionately called. It’s the worst bug to get in hospital because it’s resistant to most antibiotics. I couldn’t be sure, but the shoddy patch-up at Shellharbour seemed a likely cause.
The MRSA news also meant that the Infectious Diseases people had to be involved. At least that put some urgency into it, as they wanted me fixed up and out of there before I could infect anyone.
Bad Reaction To Bactrim
It was time for op number one: cutting open the knee, scraping away all the infected tissue, making the wound twice the size of the original and needing twice as many stitches. Now it was a real injury, needing a leg brace, so I couldn’t move the knee or disturb the stitches. It was supposed to be on for just a week. Hah!
Because of the Golden Staph, they gave me a broad spectrum antibiotic, an old-era stalwart called Bactrim, a sulphonamide drug which can cause liver damage. They discharged me, telling me to look out for side effects and have a blood test in a few days.
They were right: I ended up with jaundice and GGT levels (a liver enzyme) of 1779 against a normal range of 5-50 U/L. I had a flashback to when I contracted hepatitis as a 16-year-old in Germany, and wondered if there was a link. Later, I’d find out this result was a warning.
The blood result had my GP apoplectic, urging me to return to Wollongong Emergency immediately.
Another reason was that the wound hadn’t healed. Eight days after surgery, the two sides were still 7mm apart, the skin on both sides was mushy and the stitches hadn’t taken. Tracey and I had never seen anything like it. My GP said it was a ‘post operative complication’. I would have used another word.
Definition of Insanity
Now it was time for round two on the knee.
We couldn’t see how doing the same procedure again would change the outcome. That definition of insanity came to mind – doing the same thing and expecting a different outcome – but the surgeon said he had no choice, so nor did we.
So there I was, back in Wollongong Hospital, with a surgeon making an even bigger hole in my left knee, cutting back even more tissue and adding even more stitches.
The wound was now three times its original size and the leg brace non-negotiable. We’d been told it would be day surgery and Tracey would be taking me home later that day. Hah! It turned out to be eight days.
Local Area Health Or Field Hospital?
After op two, I ended up in the ‘surgical short stay ward’, where I soon realised I was prisoner in a system unchanged since my last hospital stay decades ago. It occurred to me that prisoners were actually better off. At least they had decent food, regular sleep and exercise.
Exercise wasn’t easy – with my left leg in a brace tight enough to stop the knee bending and stop the infernal contraption falling down every time I stood up. Even walking was difficult. The surgeon had also attached a suction pump to the wound to assist wound healing, apparently. That turned me into a prisoner with a ball and chain. This thing had to go everywhere with me – including to the toilet, shower and bed.
There were a few dozen cubicles on the ‘surgical short stay’ ward, each about three metres by three metres in size, separated by paper curtains. I could hear the guy in the next cube breathe and the one on the other side snore. One night there was one screaming.
At first, the flimsy walls reminded me of scout camp when I was a kid in Germany. That had been fun and we didn’t need earplugs to sleep, because we were tuckered out from running around all day.
Here, there was no exercise, and earplugs were no use. I wondered if this setup was copied from Red Cross field hospitals in refugee camps in Syria, rather than boy scout camps in the 1950s. It didn’t feel very much like 21st century Australia.
The Penny Dropped
I realised later that, because I’d entered the system through Emergency, the rules were different.
I couldn’t choose my bed, my ward, my food, my doctor and I couldn’t get out without permission. Just like prison, I’d imagine. If I did get out of here, I’d be on my own, medical speaking.
If the wound became infected again and I went to my GP, he’d send me back to Emergency – as he’d already done twice. If I attempted to see a specialist wound clinic, they’d send me back to Emergency, too. All routes led to the same place.
Then, the penny dropped.
Private hospitals don’t have emergency departments for a reason. They’re not designed for the unexpected; they’re designed for scheduled things like knee replacements. If you have an accident, ‘Accident & Emergency’ is where you’ll end up, whether you like it or not. One clear lesson from this saga is: avoid all accidents.
Visitors The Only Spot of Colour
This was a colourless, air-conditioned camp with no natural light, where night and day blurred into one. My only bearings and colour came from visitors.
Tracey visited with three meals a day. She even tried cooking dinner with my recipes, which was a bit ambitious for someone who doesn’t cook. Even so, the results were paradise compared to what passed for healthy food in this prison.
The chilled fruit with probiotic Filmjolk yoghurt and hot coffee for brekkie and gourmet, soy-lin sough-dough sandwiches for lunch were heaven.
She also brought colourful T-shirts and bedding which she arranged for pics for the kids, so I looked better than I felt. (You can see the T-shirt overlays in the pics.)
The other spot of colour was when my kids rediscovered their father and decided to visit all at once.
I wasn’t too keen at first, because my flimsy cubicle didn’t have room for one chair, less alone three, but it worked out in the end. They arrived bearing cheeses and 85% cocoa Lindt chocolate. We found a place outside and spread out the bounty. The kids have been in touch a lot since then, which I love.
Convoy Thrown In
Back in my cubicle, lights were mostly turned off around 9.30pm but, as I discovered, that didn’t mean sleep.
It meant nurses changing shifts, entailing 15 minutes of loud conversations and raucous laughter. Mercifully, once they caught up on the latest gossip, things quietened down a bit. Hasn’t anyone told them that ill people need their sleep?
‘Peace at last’, I thought one night as I tried to catch some fitful rest.
About 1 am that was shattered by a loud rushing noise. It sounded like noisy traffic on the street but it was a conga line of nurses pushing creaky trolleys with computers mounted on top of top of them.
‘Looks like we have ourselves a convoy’, I thought, drowsy with lack of sleep. ‘Yes, ain’t she a beautiful sight? Yeah, breaker one-nine, this here’s the Rubber Duck, you got a copy on me, Pig Pen, c’mon? I’m about to put the hammer down.’
The nurse pushed into my cubicle with her trolley, brandishing a blood pressure cuff. ‘They took my blood pressure just a few hours ago,’ I protested feebly. A faint nod but no change. ‘Ain’t nothin’ gonna get in our way, Ten Four, good buddy,’ her grim face seemed to say. Unsurprisingly, the readings were unchanged.
When she left, I was wide awake and stayed that way until the bustling convey finally moved off again. ‘It was the dark of the moon on the sixth of June, and we got a little ol’ convoy rockin’ through the night …’
I started to drift off but the convoy was back, ‘rocking through the night – ain’t she a beautiful sight?’ It was vampire hour, and the nurse was taking blood from the catheter in my left arm. ‘Why couldn’t this have been taken with blood pressures?’ I wondered. When she was finished with me, I crashed out from sheer exhaustion.
By the way, here in the Illawarra, convoys are a big deal, and I don’t mean the hospital ones.
Each year a local radio station, i98FM, organises a major fund-raiser where drivers of hundreds of trucks big and small, splendid and decrepit, pay to drive in convoy from Helenburgh in the North to Albion Park in the South. It’s huge, raising over AUD500,000, and clogging the sides of the motorway and feeder roads with thousands of flag-waving locals. It’s another world.
Tractors, Too?
Being in hospital here is another world, too. I woke up again when the main lights came on suddenly.
Through my sore eyes I saw some maniac driving what looked like a tractor across the floor.
As I tried to make sense of the nightmare, I realised it was a cleaner on the dawn shift. He wasn’t part of no convoy, he didn’t have no CB radio on his rig and he wasn’t hauling pigs. His two mates were just crashing around, emptying rubbish bins. I closed my eyes and tried to drift into semi-sleep.
Over the ensuing days, I was so exhausted, I was drifting off night and day, but never enough to get any real sleep. I was depressed, delirious half the time and wondering ‘how could this be a place of healing?’
Lessons
No sleep and no exercise were just two parts of it.
The third was food. One dietician told me he was happy with it – food with no nutritional or healing value from my viewpoint – white bread sandwiches filled with cheese that tasted like plastic, flavoured milk to wash them down and tea for later, served with sweet biscuits. I lost 6kg while in hospital, even with Tracey bringing me real food each day. I shudder to think of the result had she not. I began to ask myself: ‘Are they trying to kill me?’
Lying in a hospital bed gives you lots of time to think., especially when sleep is out of the question.
That simple slip at Central upended my world for two month. Once I was inside that prison, I lost all control – over time, over space, over decisions about me. Tracey’s life was turned upside down, too.
It was scalding experience, one I plan not to repeat. Next time, the train can leave without me. Safety will come first.
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