Vulnerable
1) Introduction
It
is my contention that humanity believes that it is invulnerable and acts as if its
society will go on forever. However, this is untrue, and it is part of a false
belief. Let’s take Ukraine as an example; in 2012 they hosted the European
football championships. The world was looking up for Ukraine; they were about
to apply for membership of the European Union, and they were looking forward to
joining NATO. In 2022 Russia invaded. This was a disaster for Ukraine in
general and also a disaster for some of its individual citizens, who either
died on the battlefield or were severely wounded. Likewise, thousands of Russian
young men were called up to serve on the battlefield and many were killed or
severely wounded on military service.
History
has countless examples of disasters which destroy lives from natural causes
such as disease and starvation, and from wars, floods, hurricanes and
earthquakes etc. In 1945, few, in Japan, foresaw the nuclear bombing of
Hiroshima and Nagasaki which killed hundreds of thousands in just two strikes.
In 1930’s Europe few expected that over 6 million would be cruelly put to death
in the Holocaust.
It
is quite possible that modern life could drive humans extinct not just from
nuclear war but from climate change. We are not immune. I am going to examine
and contemplate where our vulnerability comes from on a collective and
individual basis, and think about how it affected me personally, especially when
I was hospitalised. I am also going to concentrate on the vulnerability of one
of our national institutions, the NHS and how it went wrong owing to management
vulnerabilities. The NHS example could equally apply to any national institution.
2) Our vulnerability
Human beings have been on the planet for only a short time when compared to geological timescales; we have been on the planet for about 500,000 years at the most. We are an enormously diverse species, but not from a “racial” point of view as there is only one human race; we are almost genetic clones of one another. We share 98.9% of our genes with chimpanzees and more than 99.8 % of our genes with Neanderthals. We interbred with Neanderthal man which in my opinion is not a separate species. Our diversity is more cultural than physical; so, every human being has the same intellectual and economic potential as everyone else. People belong to diverse groups as a result of geographical location and economic power. The western civilisations are lucky because no child is ever born into absolute poverty. No western child is brought up with a sense of vulnerability. However, millions of people in the Third World are born into jeopardy, as they are vulnerable to starvation and changes to the climate and wars. This is especially the case for those unfortunates born into some of the nations in Northeast Africa such as Sudan and Ethiopia. It has not always been like this, for instance advanced civilisations existed in Sudan some centuries ago.
How did humans lose their sense of vulnerability. The use of handmade tools and fire precedes the appearance of human beings, one of our predecessors, Homo Erectus, certainly discovered fire and made quite advanced stone tools. Neanderthals made shelters and clothes to protect themselves from the cold. Human beings developed these tools and other accoutrements of civilisation further. The development of tools, shelter and clothes and the use of fire served to protect us from the elements of extreme weather and the interest of wildlife predators. Human beings learnt to cook food to increase its nutritional potential. Humans were well on their way to developing farming, constructing towns, organising water supplies, and building sewers. They also invented weapons to protect themselves against marauding neighbours. Advanced societies were able to develop medical sciences and medical services all with the purpose of saving and preserving lives. A child brought up in a peaceful society could be assured of a long comfortable life with few exceptions, unless they fell victim to incurable diseases, accidents or individual violence. Is it any wonder that children from certain societies did not grow up with strong senses of vulnerability or fear for the future?
In many parts of the world millions are born into poverty and penury, the causes of which are usually caused by war and the inability of people to migrate when they suffer from climate and weather challenges. The neighbours of the unfortunate limit the number of people who must migrate because of war or starvation, no wonder there is fear and depravity, and prayers to gods that never seem to help them.
In modern times politics have changed and we in the western world have suffered from the worst ravages of war with 20 million people being killed in the first world war and about 50 million being killed in the second world war. Western civilisation has been a victim of its own success in developing weapons. With the use of nuclear or chemical weapons we face Armageddon. However, during the inter-war period the population largely forgot about its own vulnerability, except for when the cold war made it apparent that nuclear war was more than a possibility, especially as atomic bombs had been unleashed upon Japan in 1945, which killed hundreds of thousands.
Our industrial and technological success has, however, backfired on us. The millions of tonnes of carbon dioxide and methane which our factories and oil wells have pumped into the air have heated up the atmosphere to such an extent that there is now almost uncontrollable change to the atmosphere and temperatures of the oceans. Last year every month was on average 1.5 degrees centigrade hotter than the pre-industrial average, this exemplifies why the Paris climate accords of 2015 recommended that we limit global warming to 1.5 degrees centigrade. Last year was an exception but if we are not careful this could become a regular occurrence. The science is clear to be almost incontrovertible; our production of excessive amounts carbon dioxide and methane and their release into the atmosphere represent a danger to all our lives. It is such a danger that our species could almost or completely annihilate itself. Before this happens the people of the third world will be affected the most. If any people remain after this global heating curse they will have to start again, but hopefully they won’t make the same mistakes.
Is it any wonder that young people are protesting strongly about the global heating problem as they see no solution presenting itself on the horizon. They feel frightened and vulnerable, and I ask myself where is the justice of locking them up when they block roads. I have had an easy life and won’t be around to see the worst of the crisis to come, however, the future looks bleak for our youngsters and their successors. Is it any wonder that many of our young people have decided not to have children?
We have been warned, and we are truly vulnerable to what the future holds.
3)
My
vulnerability
I was born in 1951 and was brought up in West Wales in a working-class family. We weren’t rich but my sister and I wanted for nothing, as we had all the food we needed as part of a well-balanced diet. No-one in our community was so poor that they had to visit a food bank, in fact food banks did not exist and it was unimaginable that they ever would. We had a good health service which did its best to serve us well, and the doctor would visit you in your house if you were too ill to get along to the surgery. We went to good schools that were not overcrowded. Although, medical science had not got around to making vaccines for measles, chicken pox, scarlet fever and mumps etc. serious diseases such as smallpox and tuberculosis had all but been eliminated in western society by vaccination. Many children in our neighbourhood, including my sister and I, fell sick with chickenpox and measles etc. but not many were hospitalised owing to them being well nourished and having strong immune systems.
My cousins and I felt that life couldn’t be better as we used the countryside and local beaches as our playground. We had no portable ‘phones and couldn’t contact our parents when we went out to play. We would often go to the beach and climb up vertical cliffs without a care in the world. If our parents knew that we were doing this climbing, we would have been banned even though we never fell off.
At no time in my young life did I feel vulnerable until the Cuban missile crisis, in 1962, and the threat of nuclear war. I can remember that the US had blockaded Cuba to prevent ballistic missiles and nuclear warheads from being delivered to the island by the Soviet Union, which was dominated by Russia. The Russians were retaliating against the US who were deploying their nuclear weapons in Turkey, and this was seen by Russia as a direct threat. Russian ships were rapidly advancing towards the blockade; US warships had been ordered to sink the Russian missile carriers if they got too close. Fortunately, the Russians thought twice and backed down by ordering their ships to alter course. If a nuclear attack had come to pass then Britain would have had 8 minutes warning, so not too much time to say goodbye to your loved ones and your friends. Every day we were sent school with my mother saying: “don’t worry there won’t be a war”. However, I could see the harrowed look on her face that she may never see her kids again; she couldn’t hide her feelings. After the crisis was over
, life returned to normal and our worries were over, but the possibility of nuclear Armageddon still remained on all our minds.
Medical Ideology is such that many doctors and health professionals seem to be of the opinion that we can all live forever if we listen to their advice; regarding diet, getting the right sort of exercise, being the correct weight, not smoking or drinking alcohol and being vaccinated and wearing masks when you have got a cold or the flu or other sorts of respiratory disease. This is of course not true, eventually you are going to die, to make way for others. You could easily die anyway from an accident or heat stroke or falling off a cliff.
Would you want to live a long time if you could only drink water and feed off lettuces and turnips? Nature has arranged it this way; we will all be victims of the second law of thermodynamics, eventually, when our organs run out of the energy to maintain a highly organised body. We age and cannot turn back the clock.
Spare a thought for Dr Michael Mosely the famous medical journalist who taught us how to live well and maintain a healthy body. He made the mistake of walking home from the beach alone at midday during excessive temperatures on a Greek island in the summer. He had no water and was found dead at the bottom of a slope near a restaurant. He was probably overcome by heat exhaustion; he was a healthy man who was going to live happily and healthily to a great age. One unfortunate misjudgement killed him: there was no doctor around to save him. Doctor Mosley knew that to lead a full and satisfying life you must take risks every now and then even if they prove fatal.
Medical ideology has a profound effect on the way we are treated by doctors and other health professional, which I was to find out when I had my own medical emergency.
I have been aware in the later years of my life that I must look after my health by eating well and getting plenty of exercise. I have been running 5 km three times a week and walking for an hour on the remaining days. I made sure that much of my running and walking was uphill to make my heart work. I have not been overweight. I felt healthy and invincible and invulnerable. So, imagine my shock when I contracted a nasty chest infection and type 2 diabetes at the same time. I was laid low and hospitalised. I felt very weak. Initially, I visited my local GP when I noticed my symptoms. She did not seem to be interested; she did not check my blood sugar but sent me for blood tests. This was crazy. My mother contracted type 1 diabetes during the 1960s. The doctor was able to diagnose her condition almost straight away from her description of the symptoms, he did a blood test immediately in his surgery. They started treatment of her condition almost immediately.
Conventional medical wisdom suggests that if you are not overweight and get plenty of exercise and don’t eat too much sugary foods then you are unlikely to contract Type 2 diabetes. I often wonder why I ended up with this affliction when many of those around me do not get any exercise are overweight and eat whatever they like. I suspect that genetics has got something to do with this as many of my cousins on my mother’s side of the family suffer too. Also, the inflammation caused by the lung abscess might have had something to do with matters. Of course, I have got no proof of why I was vulnerable and neither have the doctors.
Today a general practitioner (GP) would not be able to diagnose Type 1 diabetes from a patients’ description of the symptoms. I doubt if a GP would be able to recognise a child with chicken pox rather than measles as they would send off for blood tests. I often wonder why we bother having a GP service as most people end up in the emergency department of a hospital if they are ill whether the condition is serious or not. Once, I cut myself badly, and ‘phoned the GP, the receptionist said the doctor could see me in two weeks’ time, but I could have bled to death by then, so off I trotted to the emergency department to be given stitches. In the 1960s the doctor could have stitched you up and stopped the bleeding almost immediately. How times have changed but without a first line of defence we are increasingly becoming vulnerable because of delays and over-burdened hospitals.
As I said before, in late May 2024, I contracted two medical conditions: a chest abscess which caused a pleural effusion, and diabetes, I became increasingly weak. After seeing the GP I was not happy with the fact that the diagnosis was left so late, and I was so weak that I could not pick myself up after a fall. We had to ‘phone the emergency services. One day I had severe back pain, so severe that I thought I was having a heart attack. We ‘phoned the emergency services who came quickly. On my way to hospital, the pain relieved itself and I guessed that the pain was caused by a muscle spasm. Nevertheless, the doctors insisted on giving me a chest Xray and other tests. The Xray showed up an abscess and its associated infected fluid on my chest, but one of the doctors thought that the infection would clear itself with antibiotics. I could not feel any symptoms of the infection, there was no panting, coughing or pain when I left the hospital. I continued to feel weak, but the hospital did not test me for diabetes or pre-diabetes. I was discharged after a multitude of tests and after a number of hours in the emergency ward. I still felt weak, and the antibiotics were ruining my sense of taste, so I stopped taking them early with the approval of my GP. My weakness prevented me exercising, and one day I started to feel a bad cough and such weakness that we phoned the emergency services again. This time the hospital tested me for diabetes and, also, gave me a CT scan which revealed that the pleural effusion had got worse. I found myself in a medical ward being treated for diabetes with insulin, and a pleural effusion with antibiotics. At last, I was diagnosed with diabetes. Initially both the GP and the hospital had missed testing me for the affliction even though I described my symptoms to them.
My treatment in the medical ward improved matters for me enormously. My diabetes was being controlled well and I was not feeling any symptoms of my pleural effusion: no cough and no pain. I had an oxygen tube attached to me, but my wife spotted that I did not need oxygen as the measurements were so good. We took off the tube and I could breathe just as easily without it. One of the doctors noticed that my oxygen tube was missing but my wife soon put him right and the doctor agreed that I did not need supplemental oxygen. When the nurses queried why my oxygen tube was not attached, I said that the Doctor had approved its removal. No-one after that insisted that I took supplemental oxygen. My wife was looking after my interests very well especially as I did not have the will to “fight back” and question what the medics were doing. The medics were also reluctant to believe that I felt no symptoms from the abscess and the pleural effusion but of course the problem was showing up on the scans.
After a couple of days, I was transferred to a respiratory ward, which had its depressing moments and some funny ones. I was by far the “fittest “of the other patients in my treatment ward. I did not require oxygen, and I was not in pain. One visitor remarked why I was in in hospital as I was breathing easily and did not have any of the severe pain that her husband had. I assured her that I was not malingering and that I was being tested and monitored for potential surgery.
I also saw some sad moments. One of my fellow patients became so weak that he was about to die, the nursing staff wheeled him off to another ward to pass away. Worse, I accidently saw another patient die in front of me with his family there to see his last breath. The curtains around the beds do not assure absolute privacy and it seems that this unfortunate patient drew his last breath with me accidentally seeing it when I woke up from a slumber. Probably, the hospital did not have enough spare capacity to ensure a dignified and private death elsewhere in the hospital. This did not do much good for my morale.
My treatment in the hospital was variable. Everything is institutionalised and things must be done according to a check list. They checked my blood pressure umpteen times during the day so much so that I was able to predict what it would be. Luckily it was never too high. They even woke me up in the middle of the night.
They also tested me for blood glucose levels. For me this was more important as sometimes it was too high, and I needed an extra shot of insulin. The hospital food was ok, but it was difficult for me to judge how much carbohydrate I was eating. It was also inconvenient to go for a brisk walk to reduce the blood glucose level. Which is something I do now.
Every time they tested my blood they measured my temperature, but one day when it was very hot in the hospital my temperature read 38 degrees. It was too high, so I had to be given an extra shot of antibiotics in case I had an infection. I made the case that I was already being injected with massive amounts of antibiotics for my chest infection, and my temperature wasn’t that high. It cut no ice; an elevated temperature meant that the antibiotic box had to be ticked.
Everyday a “nurse”, dressed in red, came round to take a blood sample, thoughts of Dracula went through my head, but I kept my mouth shut. One day she came round while I was eating breakfast, so I asked her to come back later. She insisted that she had to take my blood there and then. I asked if she would like it if I came to her house brandishing a needle to take her blood while she was eating her Weetabix: she came back later. I had upset the box-ticking routine of the schedule. The next day she tried it on again, but this time I reminded her that the UK is still a free country, and I had the right to refuse treatment and the right to get dressed and leave the hospital if I wanted. She had to alter her routine, because of me but probably had to ask permission first. I’m grateful that she did not change her gentle touch.
I had another run in with a nurse who was meant to be training me how to test my blood and inject myself and to train my wife as a contingency. She was rather brusque with me. The nurse showed up late, so my wife went off to see a friend who was in another ward. The nurse insisted that I ‘phone my wife to come back to the ward, I told her to get lost and to turn up on time and that my wife was not there for the hospital’s convenience. The training was postponed. I had already practised using the “pen needle” and had injected myself a few times with a general nurse around to supervise; he also showed me how to use an ordinary syringe if I needed to.
I also made my feelings known to the doctors when they attempted to do “keyhole” type surgery to drain my abscess and the pleural effusion. After examining my chest by ultra-sound, they decided that the procedure would be too difficult for them. I was prepared for what was about to happen. I had words with them that their organisation was a bit haphazard, and they had no contingency plans. They took this criticism quite well.
After several days of discussions amongst the doctors, they decided to attempt a “keyhole” procedure again to drain the abscess and the effusion. This time the doctor doing the procedure felt that the abscess was not well placed, and too small to attempt a draining operation, but gave me the “all clear” but not to my face. I found out from the nurses the following morning that I had been given the “all clear”; this was disputed by some of the other doctors treating me who were asking for advice from other respiratory experts. In the meantime, I was elated and told my family and friends that I was well on my way to recovery. Imagine how I felt when the “all clear” was rescinded, I wasn’t happy and the doctor who pulled out of the procedure was asked to come and apologise to me. The upshot was that I would continue with the antibiotic treatment at home and would be given another CT scan after a month or so. I would be going home immediately or so I thought.
The nurses were training me to use the insulin pen as I would be prescribed this as part of my diabetes treatment. However, no-one was prepared to approve my departure until they could find a diabetic nurse to support me for the first week or so at home while I got used to injecting myself. I felt that I could do the testing and injection without supervision. I was thinking of discharging myself, which is my right, but my wife persuaded me not to. I decided to stay in the hospital for another 2 days, I was fed up with this as I had already spent 15 days lounging around in a hospital bed, however, it turned out to be the best thing. The doctors and nurses treated me very well and I felt that caution was really the best approach. I really have nothing but admiration for them. The lack of resources for the hospital and NHS bureaucracy were getting in the way of their work. None of the problems with the health service can really be laid at the feet of the medical staff. Without such dedicated staff I hate to think what would have happened during the Covid 19 crisis, tens of thousands more would have died. The nurses and doctors are heroes, and it should be noted that most of them are not from the UK; if we did not have medical staff from overseas then the NHS would collapse completely. I asked the foreign nurses, that I got on well with, and who were prepared to talk, why they didn’t head off to richer countries like Australia and the US - just like many of their British colleagues. The response was that they like working and being in the UK and felt some loyalty towards Britain. It’s a pity that some politicians and their followers don’t reciprocate this loyalty. I owe the medical staff a big hug.
Hooray I was back at home, in late June 2024, but I had lost a lot of weight and strength whilst being in the hospital. On my first day at home a nurse arrived on time in the morning to make sure I was testing my blood and injecting myself properly. She wasn’t a fully specialist diabetic nurse, but she gave me a lot of useful tips and guidance, I was happy that she was there and so was my wife. It made me feel more confident and happier that I could live with the diabetic condition. I had visits from nurses for a week but only one of them was a specialist diabetic nurse. She noticed that I was using the wrong type of needle in my injection pen. I was using a safety needle which prevents people assisting you from accidently injecting themselves, I should have been using a longer needle which penetrates deeper into the tissues, and which is much more unlikely to accidently slip out and spill insulin all over your stomach. I was then able to inform the non-specialist nurses that they had got it wrong; and so had the hospital which trained me on the safety needle. My wife had a go at learning how to inject me, just in case but every day I have to inject myself as she is reluctant to inflict pain on me. The insulin pen needles are so fine that I do not feel them penetrating my skin, so I must watch what I am doing. I don’t find watching the needle going in terrifying, but some people do, so they have to have someone do the injection for them. As soon as I got home, I started exercising to improve my strength by going for walks: it was amazing how quickly I recovered. I am also doing some weight training to improve the strength in my arms. When I got home from hospital, I could hardly move myself around in bed. I am a lot stronger now. It took about six weeks to improve my strength. I lost about 12 kilograms in hospital as lying around sees your muscles wasting away. Instead of 70 plus kg I am now 63 kg. My wife and the diabetic nurses want me to put on weight. However, 63 kg is the ideal weight for a man of my height, and I am having the devil’s own job putting on weight on a diabetes diet. When I was in my twenties, I was this weight, so I feel a little bit rejuvenated. I am not deliberately going to stuff my face and risk high blood glucose levels to put on a few kgs. I am not putting on muscle weight, but my muscles are tauter and that is why I am stronger. I have had to buy better fitting clothes, but this is a small price to pay for being the ideal weight.
In the meantime, I was being treated for the abscess on my lung and the resulting pleural effusion with strong antibiotics which adversely affected my sense of taste which has not recovered, even after two months of stopping to take them. The respiratory specialists were still debating whether to give me keyhole surgery to drain my abscess and its resulting pleural effusion but a CT scan in August revealed that the abscess had shrunk considerably, and the effusion was getting better. They decided to leave things alone until my next scan in late October, the anti-biotics seem to have down the trick. I don’t feel any effects from the abscess, I don’t cough, I don’t lose my breath when I walk or jog briskly uphill and I don’t feel any pain when I breathe deeply. Originally my abscess grew to 14 centimetres, but the antibiotics reduced this to 7 centimetres, my body then reduced the abscess to just a scar on its own. I think the exercise routines did the trick. Hopefully, my lungs have recovered sufficiently to not require any more treatment. I am still concerned that the effusion could come back if I get infected with a dangerous strain of Staphylococcus Aureus again. S. Aureus is responsible for lots of the MRSA in hospital, it is all over the skin on our bodies. I was unlucky to get a dangerous strain getting into my lungs. Anyone could catch this strain. I consider myself to be unlucky. However, I congratulate the doctors for getting the treatment right as I did not require intrusive keyhole surgery to drain the pus. My lungs feel good now and I am able to exercise with no trouble.
I was also unlucky to get Type 2 diabetes as I wasn’t overweight, and I used to get plenty of exercise, and I didn’t put sugar in my tea etc. But many of my cousins have type 2 and my mother contracted type 1, so it runs in the family. It is my belief that the abscess on my lung contributed to my contracting diabetes or sped up its appearance. I am probably pre-disposed genetically to the condition. I am trying to manage the condition as best I can with a mixture of medication, diet, weight control and plenty of exercise. My dietician says that I am manging my blood glucose impeccably and the ultimate plan was to wean me off insulin completely. Initially I was on 22 units of Humulin per day but I was soon down to 8 units and then 6 . As of November 2024, I am no longer using insulin, the diabetes is being managed with drugs, exercise and diet My exercise routine consists of daily squats and sit ups and weights, and at least 10 minutes going up and down the stairs at home. The stairs routine is excellent for my heart and blood pressure and can be used to control; my blood glucose, I can increase the time climbing the stairs when it is raining hard and I don’t want to go out, there is no need for expensive and cumbersome equipment. You should try it. My treatment for diabetes has been very good and I am feeling less vulnerable. I can make trips overseas. I can drive now without having to test myself as the risk of me having hypoglycaemia is greatly reduced. I feel almost normal now, but even if I am able to greatly reduce the medication, I shall have to watch my diet and get plenty of exercise every day for the rest of my life. Since I left hospital in late June, I have eaten just one teaspoon full of ice cream and a small portion of a croissant shared with my wife. I do not eat white bread or anything much with free sugar. I have not had a sip of beer. I only drink a couple of glasses of red wine a week: red wine unlike milk hardly contains any carbohydrate. Now, I am more vulnerable to get infections and heart problems etc. but the hospital and diabetes clinic medics have saved my life and if I am careful my health risks are well contained. Well done the NHS and my wife for all her support.
One of the junior doctors that I met in the hospital told me exactly what is wrong with the health service while we waited for me to go into the radiation room to have a CT scan. I wasn’t getting special treatment by having a doctor to sit next to me all to myself. The hospital did not have enough porters to take me to the scan in a wheelchair, however, my consultant had noticed that I was able to walk quite easily as she had seen me getting exercise by pacing up and down my ward corridor. She asked me if I could walk to the radiation room and of course I said yes. The junior doctor was asked to accompany me to ensure my safety. As we were waiting for my scan, I asked my doctor what he thought was wrong with the health service and he hit the nails on their heads:
Not enough finance,
Not enough staff,
Bed blocking, whereby recovered patients are kept in the hospital wards rather than being sent home because there is no-one to look after them,
Accident and Emergency forced to do General Practitioners’ work,
Poor information recording and disparate patient records,
Duplication of bureaucratic work,
There are badly trained General Practitioners, who cannot tell a case of measles from a case of chicken pox,
General Practitioners send patients off to a local clinic for their tests rather than taking blood samples etc. in the surgery, and then despatching the sample for testing,
The general attitude is that patients should have to put up with waiting rather than being treated promptly,
Managerial deficiency- and that is authority without responsibility- as senior management are not truly held to account by the government.
There is more to work to do to help members of the public look after themselves not just by exercising and dieting. The government is not doing their bit to ensure that members of the public - and the health service- are not worked too hard or stressed at work.
Probably the worse of the problems is that of managerial accountability, whilst I was in hospital a third-party contractor had a computer outage; they were responsible for the patient testing procedures. As a result of this outage the testing of blood samples etc. was delayed by weeks. No-one in the hospital hierarchy took responsibility for this. It was a failure of due diligence and a lack of contingency planning on the part of both the health service and the third-party contractors. There is no doubt some patients’ treatment would have been delayed to their detriment, and some could have lost their lives. No-one to my knowledge was sacked, and no apology was given. The government should have told the health service trust directors to come around the wards and apologise to the medical staff and their patients.
I could recount numerous examples of the above. I, myself, was a bed blocker. My departure from hospital was delayed by two days as they could not find a diabetic nurse to supervise me for my first two days at home.
Of course, there is a solution, but it is down to the government and the senior management to organise the health service for success rather than failure. They can start by ensuring that managerial authority goes along with responsibility – they really are Siamese twins. This would improve the organisation of the health service immeasurably.
Then they can continue by providing realistic care in the community to ease the bed blocking. Recovered patients should not be hanging around in hospital; lone patients should be supported at home when they have recovered.
Modern computers now have enough processing capacity to initiate an IT system which has just one record for each patient to reduce duplication of effort and improve information keeping. This would improve efficiency no end.
General Practice should be re-organised and staffed to ensure GPs are able and willing to do much of the routine work of accident and emergency, such as treating cut fingers, childhood coughs and sneezes, testing for diabetes in the surgery, improved measurement of blood pressure. There are countless things that GPs could do to relieve the work of the accident and emergency department. There could be more use made of paramedics to do some of the routine work that accident and emergency have to do now - like treating minor cuts, bleeding noses, sprained ankles and minor burns etc.
I have learnt my lesson that I am not invulnerable, and that if I am to maintain a healthy and happy life for the limited years that I have left, then I must keep my weight as it is. I am now at the ideal weight for my height, and this is key to controlling, cholesterol, blood glucose, healthy joints, and mobility. It will also reduce the risk of heart and circulation problems. I will not live forever, like everyone else, and one day my body will really start to fail but I might as well try to keep as healthy as possible until that day comes.
4)
Medical
Ideology and public health
Medical Ideology is such that many doctors and health professionals seem to be of the opinion that we can all live forever if we listen to their advice; regarding diet, getting the right sort of exercise, being the correct weight, not smoking or drinking alcohol and being vaccinated and wearing masks when you have got a cold or the flu or other sorts of respiratory disease. This is of course not true, eventually you are going to die, to make way for others. You could easily die anyway from an accident or heat stroke or falling off a cliff.
Would you want to live a long time if you could only drink water and feed off lettuces and turnips? Nature has arranged it this way; we will all be victims of the second law of thermodynamics, eventually, when our organs run out of the energy to maintain a highly organised body. We age and cannot turn back the clock.
Spare a thought for Dr Michael Mosely the famous medical journalist who taught us how to live well and maintain a healthy body. He made the mistake of walking home from the beach alone at midday during excessive temperatures on a Greek island in the summer. He had no water and was found dead at the bottom of a slope near a restaurant. He was probably overcome by heat exhaustion; he was a healthy man who was going to live happily and healthily to a great age. One unfortunate misjudgement killed him: there was no doctor around to save him. Doctor Mosley knew that to lead a full and satisfying life you must take risks every now and then even if they prove fatal.
Medical ideology has a profound effect on the way we are treated by doctors and other health professional, which I was to find out when I had my own medical emergency.
5) My Health and what happened to me
I have been aware in the later years of my life that I must look after my health by eating well and getting plenty of exercise. I have been running 5 km three times a week and walking for an hour on the remaining days. I made sure that much of my running and walking was uphill to make my heart work. I have not been overweight. I felt healthy and invincible and invulnerable. So, imagine my shock when I contracted a nasty chest infection and type 2 diabetes at the same time. I was laid low and hospitalised. I felt very weak. Initially, I visited my local GP when I noticed my symptoms. She did not seem to be interested; she did not check my blood sugar but sent me for blood tests. This was crazy. My mother contracted type 1 diabetes during the 1960s. The doctor was able to diagnose her condition almost straight away from her description of the symptoms, he did a blood test immediately in his surgery. They started treatment of her condition almost immediately.
Conventional medical wisdom suggests that if you are not overweight and get plenty of exercise and don’t eat too much sugary foods then you are unlikely to contract Type 2 diabetes. I often wonder why I ended up with this affliction when many of those around me do not get any exercise are overweight and eat whatever they like. I suspect that genetics has got something to do with this as many of my cousins on my mother’s side of the family suffer too. Also, the inflammation caused by the lung abscess might have had something to do with matters. Of course, I have got no proof of why I was vulnerable and neither have the doctors.
Today a general practitioner (GP) would not be able to diagnose Type 1 diabetes from a patients’ description of the symptoms. I doubt if a GP would be able to recognise a child with chicken pox rather than measles as they would send off for blood tests. I often wonder why we bother having a GP service as most people end up in the emergency department of a hospital if they are ill whether the condition is serious or not. Once, I cut myself badly, and ‘phoned the GP, the receptionist said the doctor could see me in two weeks’ time, but I could have bled to death by then, so off I trotted to the emergency department to be given stitches. In the 1960s the doctor could have stitched you up and stopped the bleeding almost immediately. How times have changed but without a first line of defence we are increasingly becoming vulnerable because of delays and over-burdened hospitals.
As I said before, in late May 2024, I contracted two medical conditions: a chest abscess which caused a pleural effusion, and diabetes, I became increasingly weak. After seeing the GP I was not happy with the fact that the diagnosis was left so late, and I was so weak that I could not pick myself up after a fall. We had to ‘phone the emergency services. One day I had severe back pain, so severe that I thought I was having a heart attack. We ‘phoned the emergency services who came quickly. On my way to hospital, the pain relieved itself and I guessed that the pain was caused by a muscle spasm. Nevertheless, the doctors insisted on giving me a chest Xray and other tests. The Xray showed up an abscess and its associated infected fluid on my chest, but one of the doctors thought that the infection would clear itself with antibiotics. I could not feel any symptoms of the infection, there was no panting, coughing or pain when I left the hospital. I continued to feel weak, but the hospital did not test me for diabetes or pre-diabetes. I was discharged after a multitude of tests and after a number of hours in the emergency ward. I still felt weak, and the antibiotics were ruining my sense of taste, so I stopped taking them early with the approval of my GP. My weakness prevented me exercising, and one day I started to feel a bad cough and such weakness that we phoned the emergency services again. This time the hospital tested me for diabetes and, also, gave me a CT scan which revealed that the pleural effusion had got worse. I found myself in a medical ward being treated for diabetes with insulin, and a pleural effusion with antibiotics. At last, I was diagnosed with diabetes. Initially both the GP and the hospital had missed testing me for the affliction even though I described my symptoms to them.
6) In the hospital
My treatment in the medical ward improved matters for me enormously. My diabetes was being controlled well and I was not feeling any symptoms of my pleural effusion: no cough and no pain. I had an oxygen tube attached to me, but my wife spotted that I did not need oxygen as the measurements were so good. We took off the tube and I could breathe just as easily without it. One of the doctors noticed that my oxygen tube was missing but my wife soon put him right and the doctor agreed that I did not need supplemental oxygen. When the nurses queried why my oxygen tube was not attached, I said that the Doctor had approved its removal. No-one after that insisted that I took supplemental oxygen. My wife was looking after my interests very well especially as I did not have the will to “fight back” and question what the medics were doing. The medics were also reluctant to believe that I felt no symptoms from the abscess and the pleural effusion but of course the problem was showing up on the scans.
After a couple of days, I was transferred to a respiratory ward, which had its depressing moments and some funny ones. I was by far the “fittest “of the other patients in my treatment ward. I did not require oxygen, and I was not in pain. One visitor remarked why I was in in hospital as I was breathing easily and did not have any of the severe pain that her husband had. I assured her that I was not malingering and that I was being tested and monitored for potential surgery.
I also saw some sad moments. One of my fellow patients became so weak that he was about to die, the nursing staff wheeled him off to another ward to pass away. Worse, I accidently saw another patient die in front of me with his family there to see his last breath. The curtains around the beds do not assure absolute privacy and it seems that this unfortunate patient drew his last breath with me accidentally seeing it when I woke up from a slumber. Probably, the hospital did not have enough spare capacity to ensure a dignified and private death elsewhere in the hospital. This did not do much good for my morale.
My treatment in the hospital was variable. Everything is institutionalised and things must be done according to a check list. They checked my blood pressure umpteen times during the day so much so that I was able to predict what it would be. Luckily it was never too high. They even woke me up in the middle of the night.
They also tested me for blood glucose levels. For me this was more important as sometimes it was too high, and I needed an extra shot of insulin. The hospital food was ok, but it was difficult for me to judge how much carbohydrate I was eating. It was also inconvenient to go for a brisk walk to reduce the blood glucose level. Which is something I do now.
Every time they tested my blood they measured my temperature, but one day when it was very hot in the hospital my temperature read 38 degrees. It was too high, so I had to be given an extra shot of antibiotics in case I had an infection. I made the case that I was already being injected with massive amounts of antibiotics for my chest infection, and my temperature wasn’t that high. It cut no ice; an elevated temperature meant that the antibiotic box had to be ticked.
Everyday a “nurse”, dressed in red, came round to take a blood sample, thoughts of Dracula went through my head, but I kept my mouth shut. One day she came round while I was eating breakfast, so I asked her to come back later. She insisted that she had to take my blood there and then. I asked if she would like it if I came to her house brandishing a needle to take her blood while she was eating her Weetabix: she came back later. I had upset the box-ticking routine of the schedule. The next day she tried it on again, but this time I reminded her that the UK is still a free country, and I had the right to refuse treatment and the right to get dressed and leave the hospital if I wanted. She had to alter her routine, because of me but probably had to ask permission first. I’m grateful that she did not change her gentle touch.
I had another run in with a nurse who was meant to be training me how to test my blood and inject myself and to train my wife as a contingency. She was rather brusque with me. The nurse showed up late, so my wife went off to see a friend who was in another ward. The nurse insisted that I ‘phone my wife to come back to the ward, I told her to get lost and to turn up on time and that my wife was not there for the hospital’s convenience. The training was postponed. I had already practised using the “pen needle” and had injected myself a few times with a general nurse around to supervise; he also showed me how to use an ordinary syringe if I needed to.
I also made my feelings known to the doctors when they attempted to do “keyhole” type surgery to drain my abscess and the pleural effusion. After examining my chest by ultra-sound, they decided that the procedure would be too difficult for them. I was prepared for what was about to happen. I had words with them that their organisation was a bit haphazard, and they had no contingency plans. They took this criticism quite well.
After several days of discussions amongst the doctors, they decided to attempt a “keyhole” procedure again to drain the abscess and the effusion. This time the doctor doing the procedure felt that the abscess was not well placed, and too small to attempt a draining operation, but gave me the “all clear” but not to my face. I found out from the nurses the following morning that I had been given the “all clear”; this was disputed by some of the other doctors treating me who were asking for advice from other respiratory experts. In the meantime, I was elated and told my family and friends that I was well on my way to recovery. Imagine how I felt when the “all clear” was rescinded, I wasn’t happy and the doctor who pulled out of the procedure was asked to come and apologise to me. The upshot was that I would continue with the antibiotic treatment at home and would be given another CT scan after a month or so. I would be going home immediately or so I thought.
The nurses were training me to use the insulin pen as I would be prescribed this as part of my diabetes treatment. However, no-one was prepared to approve my departure until they could find a diabetic nurse to support me for the first week or so at home while I got used to injecting myself. I felt that I could do the testing and injection without supervision. I was thinking of discharging myself, which is my right, but my wife persuaded me not to. I decided to stay in the hospital for another 2 days, I was fed up with this as I had already spent 15 days lounging around in a hospital bed, however, it turned out to be the best thing. The doctors and nurses treated me very well and I felt that caution was really the best approach. I really have nothing but admiration for them. The lack of resources for the hospital and NHS bureaucracy were getting in the way of their work. None of the problems with the health service can really be laid at the feet of the medical staff. Without such dedicated staff I hate to think what would have happened during the Covid 19 crisis, tens of thousands more would have died. The nurses and doctors are heroes, and it should be noted that most of them are not from the UK; if we did not have medical staff from overseas then the NHS would collapse completely. I asked the foreign nurses, that I got on well with, and who were prepared to talk, why they didn’t head off to richer countries like Australia and the US - just like many of their British colleagues. The response was that they like working and being in the UK and felt some loyalty towards Britain. It’s a pity that some politicians and their followers don’t reciprocate this loyalty. I owe the medical staff a big hug.
7) Post-hospital treatment.
Hooray I was back at home, in late June 2024, but I had lost a lot of weight and strength whilst being in the hospital. On my first day at home a nurse arrived on time in the morning to make sure I was testing my blood and injecting myself properly. She wasn’t a fully specialist diabetic nurse, but she gave me a lot of useful tips and guidance, I was happy that she was there and so was my wife. It made me feel more confident and happier that I could live with the diabetic condition. I had visits from nurses for a week but only one of them was a specialist diabetic nurse. She noticed that I was using the wrong type of needle in my injection pen. I was using a safety needle which prevents people assisting you from accidently injecting themselves, I should have been using a longer needle which penetrates deeper into the tissues, and which is much more unlikely to accidently slip out and spill insulin all over your stomach. I was then able to inform the non-specialist nurses that they had got it wrong; and so had the hospital which trained me on the safety needle. My wife had a go at learning how to inject me, just in case but every day I have to inject myself as she is reluctant to inflict pain on me. The insulin pen needles are so fine that I do not feel them penetrating my skin, so I must watch what I am doing. I don’t find watching the needle going in terrifying, but some people do, so they have to have someone do the injection for them. As soon as I got home, I started exercising to improve my strength by going for walks: it was amazing how quickly I recovered. I am also doing some weight training to improve the strength in my arms. When I got home from hospital, I could hardly move myself around in bed. I am a lot stronger now. It took about six weeks to improve my strength. I lost about 12 kilograms in hospital as lying around sees your muscles wasting away. Instead of 70 plus kg I am now 63 kg. My wife and the diabetic nurses want me to put on weight. However, 63 kg is the ideal weight for a man of my height, and I am having the devil’s own job putting on weight on a diabetes diet. When I was in my twenties, I was this weight, so I feel a little bit rejuvenated. I am not deliberately going to stuff my face and risk high blood glucose levels to put on a few kgs. I am not putting on muscle weight, but my muscles are tauter and that is why I am stronger. I have had to buy better fitting clothes, but this is a small price to pay for being the ideal weight.
In the meantime, I was being treated for the abscess on my lung and the resulting pleural effusion with strong antibiotics which adversely affected my sense of taste which has not recovered, even after two months of stopping to take them. The respiratory specialists were still debating whether to give me keyhole surgery to drain my abscess and its resulting pleural effusion but a CT scan in August revealed that the abscess had shrunk considerably, and the effusion was getting better. They decided to leave things alone until my next scan in late October, the anti-biotics seem to have down the trick. I don’t feel any effects from the abscess, I don’t cough, I don’t lose my breath when I walk or jog briskly uphill and I don’t feel any pain when I breathe deeply. Originally my abscess grew to 14 centimetres, but the antibiotics reduced this to 7 centimetres, my body then reduced the abscess to just a scar on its own. I think the exercise routines did the trick. Hopefully, my lungs have recovered sufficiently to not require any more treatment. I am still concerned that the effusion could come back if I get infected with a dangerous strain of Staphylococcus Aureus again. S. Aureus is responsible for lots of the MRSA in hospital, it is all over the skin on our bodies. I was unlucky to get a dangerous strain getting into my lungs. Anyone could catch this strain. I consider myself to be unlucky. However, I congratulate the doctors for getting the treatment right as I did not require intrusive keyhole surgery to drain the pus. My lungs feel good now and I am able to exercise with no trouble.
I was also unlucky to get Type 2 diabetes as I wasn’t overweight, and I used to get plenty of exercise, and I didn’t put sugar in my tea etc. But many of my cousins have type 2 and my mother contracted type 1, so it runs in the family. It is my belief that the abscess on my lung contributed to my contracting diabetes or sped up its appearance. I am probably pre-disposed genetically to the condition. I am trying to manage the condition as best I can with a mixture of medication, diet, weight control and plenty of exercise. My dietician says that I am manging my blood glucose impeccably and the ultimate plan was to wean me off insulin completely. Initially I was on 22 units of Humulin per day but I was soon down to 8 units and then 6 . As of November 2024, I am no longer using insulin, the diabetes is being managed with drugs, exercise and diet My exercise routine consists of daily squats and sit ups and weights, and at least 10 minutes going up and down the stairs at home. The stairs routine is excellent for my heart and blood pressure and can be used to control; my blood glucose, I can increase the time climbing the stairs when it is raining hard and I don’t want to go out, there is no need for expensive and cumbersome equipment. You should try it. My treatment for diabetes has been very good and I am feeling less vulnerable. I can make trips overseas. I can drive now without having to test myself as the risk of me having hypoglycaemia is greatly reduced. I feel almost normal now, but even if I am able to greatly reduce the medication, I shall have to watch my diet and get plenty of exercise every day for the rest of my life. Since I left hospital in late June, I have eaten just one teaspoon full of ice cream and a small portion of a croissant shared with my wife. I do not eat white bread or anything much with free sugar. I have not had a sip of beer. I only drink a couple of glasses of red wine a week: red wine unlike milk hardly contains any carbohydrate. Now, I am more vulnerable to get infections and heart problems etc. but the hospital and diabetes clinic medics have saved my life and if I am careful my health risks are well contained. Well done the NHS and my wife for all her support.
8) Vulnerability of the health service and what’s wrong with it
One of the junior doctors that I met in the hospital told me exactly what is wrong with the health service while we waited for me to go into the radiation room to have a CT scan. I wasn’t getting special treatment by having a doctor to sit next to me all to myself. The hospital did not have enough porters to take me to the scan in a wheelchair, however, my consultant had noticed that I was able to walk quite easily as she had seen me getting exercise by pacing up and down my ward corridor. She asked me if I could walk to the radiation room and of course I said yes. The junior doctor was asked to accompany me to ensure my safety. As we were waiting for my scan, I asked my doctor what he thought was wrong with the health service and he hit the nails on their heads:
Not enough finance,
Not enough staff,
Bed blocking, whereby recovered patients are kept in the hospital wards rather than being sent home because there is no-one to look after them,
Accident and Emergency forced to do General Practitioners’ work,
Poor information recording and disparate patient records,
Duplication of bureaucratic work,
There are badly trained General Practitioners, who cannot tell a case of measles from a case of chicken pox,
General Practitioners send patients off to a local clinic for their tests rather than taking blood samples etc. in the surgery, and then despatching the sample for testing,
The general attitude is that patients should have to put up with waiting rather than being treated promptly,
Managerial deficiency- and that is authority without responsibility- as senior management are not truly held to account by the government.
There is more to work to do to help members of the public look after themselves not just by exercising and dieting. The government is not doing their bit to ensure that members of the public - and the health service- are not worked too hard or stressed at work.
Probably the worse of the problems is that of managerial accountability, whilst I was in hospital a third-party contractor had a computer outage; they were responsible for the patient testing procedures. As a result of this outage the testing of blood samples etc. was delayed by weeks. No-one in the hospital hierarchy took responsibility for this. It was a failure of due diligence and a lack of contingency planning on the part of both the health service and the third-party contractors. There is no doubt some patients’ treatment would have been delayed to their detriment, and some could have lost their lives. No-one to my knowledge was sacked, and no apology was given. The government should have told the health service trust directors to come around the wards and apologise to the medical staff and their patients.
I could recount numerous examples of the above. I, myself, was a bed blocker. My departure from hospital was delayed by two days as they could not find a diabetic nurse to supervise me for my first two days at home.
9) Is there a solution?
Of course, there is a solution, but it is down to the government and the senior management to organise the health service for success rather than failure. They can start by ensuring that managerial authority goes along with responsibility – they really are Siamese twins. This would improve the organisation of the health service immeasurably.
Then they can continue by providing realistic care in the community to ease the bed blocking. Recovered patients should not be hanging around in hospital; lone patients should be supported at home when they have recovered.
Modern computers now have enough processing capacity to initiate an IT system which has just one record for each patient to reduce duplication of effort and improve information keeping. This would improve efficiency no end.
General Practice should be re-organised and staffed to ensure GPs are able and willing to do much of the routine work of accident and emergency, such as treating cut fingers, childhood coughs and sneezes, testing for diabetes in the surgery, improved measurement of blood pressure. There are countless things that GPs could do to relieve the work of the accident and emergency department. There could be more use made of paramedics to do some of the routine work that accident and emergency have to do now - like treating minor cuts, bleeding noses, sprained ankles and minor burns etc.
10) Where do I go from here?
I have learnt my lesson that I am not invulnerable, and that if I am to maintain a healthy and happy life for the limited years that I have left, then I must keep my weight as it is. I am now at the ideal weight for my height, and this is key to controlling, cholesterol, blood glucose, healthy joints, and mobility. It will also reduce the risk of heart and circulation problems. I will not live forever, like everyone else, and one day my body will really start to fail but I might as well try to keep as healthy as possible until that day comes.
11) Where do we go from here?
12) Conclusion
My story is not much different from that of most people; we really are always vulnerable to infections and adverse medical conditions like diabetes. The health service is just about hanging on for dear life, but we must fund it properly and it is down to the government and senior management to ensure that it is organised to give us the best care possible. We could start by improving the front-end primary care service to relieve the burden on the hospitals. Also, we should be prepared to fund care in the community to further relieve the burden on the hospitals. We are all vulnerable, but we deserve a better health service to help get us back to full health when things go wrong. We ignore all this at our peril.
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