- Does your experience of A&E match mine?
- Napoleons descendants were our saviours.
- Never say that I don’t cover the complete story…
Tony is a really good friend, and a good drinking mate to boot My wife describes us as being as ‘thick as thieves’ in reference to our close friendship, rather than our mental capacity. And it’s true, we have been through school, sixth form and university together so there is not a lot of secrecy between us.
A few weeks ago he developed really bad back pain, the sort of thing that immediately takes your breath away and leaves you completely immobilised.
His wife called me to ask for some help to get him to hospital as there was no way he was going to make it alone.
When I got to him he was bent over on the kitchen floor, hands of knees with his breathing coming in short sharp gasps. I knew this would be no easy task, and after at least 40 minutes of gentle coaxing he was in the back of the car, more lying than sitting and squealing at every start, stop and bump in the road.
On arriving at the A&E department we were met with a sea of waiting patients in various states of distress and blood soaked bandages… all life was there!
The triage nurse took a few details and told us to take a seat and wait, which we did… for nearly six hours… and in an A&E department with a groaning seventeen stone man beside you, that’s almost a lifetime!
I really feel for the staff, especially the nurses who were whizzing round like dervishes and getting dogs abuse from the increasingly angry mob for their trouble. But, you can understand the frustration from those who were in genuine need.
Anyway, we finally got to see the doctor who asked a few pertinent questions like “how did it happen?” and “where does it hurt?” and the slightly more interesting “have you lost any sensation in the saddle area?”
The main concern for these type of presentations is that the lower part of the spinal cord becomes squashed and as a result the patient risks loosing control of bowel and bladder functions due to a condition known as Cauda Equina… the horses tail, a description of what the spinal cord looks like in the lower back apparently!
Having satisfied himself that Tony was in no imminent risk of loosing his lower half functions much of our young house doctors interest waned, and he prodded his patient with a pin, tapped his knees with a hammer and declared him ‘suffering from a muscle spasm’ which might take 2-3 weeks to clear up.
The whole consultation lasted no more than 10 minutes… after waiting for a third of a day!
A prescription for pain killers later and we are gently ushering Tony back to the car and home, via a chemist for the horse strength analgesics which he so clearly needed.
The drug of choice was Co-Codamol, a combination of paracetamol and the morphine derived codeine. We fired the required dose into Tony and awaited the beneficial effects.
We didn’t get what we expected…
Within a few minutes Tony was racked with convulsions as he fought to contain his stomach contents, a battle which, alas, he lost in a spectacular fashion.
Over the course of the next few hours this pantomime repeated itself at every allotted pill taking time – the net result of which was that he was getting no pain relief at all as he couldn’t keep the medicine down.
I phoned the pharmacist who told me that vomiting was a common side effect from the drug, and that eating little and often would help. It didn’t and Tony spent a very uncomfortable night.
The old enemy comes to the rescue
By morning Tony was in a worse state than before we took him to hospital, what with being sick at one end and constipated at the other. Two more unhelpful conditions for back pain there cannot be.
The act of straining increases abdominal pressure and actually makes the pain WORSE.
As I walked to the paper shop that morning I pondered how I might help my old buddy.
I collected my daily bundle of newspapers and magazines and bumped into Terri, our French neighbour who was out with her dog, and the conversation turned to Tony’s predicament.
“Eet’s easy” she said on learning of the impact of the Co-Codamol, “Ee needs to put it in the ozzer vey!”
Forgive me for trying to recreate the French accent here, but I thought it added to the dramatic effect of what she said.
“Just a minute madam, are you suggesting he puts pills where the sun doesn’t shine?”
As it turns out, she wasn’t suggesting anything of the sort, but was making the very valid point that much of the rest of Europe uses pain killing suppositories rather than oral ones as we do here.
In fact, there is so much evidence to show that pain killers given by the rectal route are much more effective as they are taken into the blood stream quicker, and generate fewer adverse reactions than the mouth route.
It’s a strange quirk of the British medical fraternity that suppositories are rarely used, and over 98% of pain relief is delivered via oral routes for self-treating patients.
Could the British resolve be a hindrance to getting pain relief? – well for Tony it certainly was.
His wife spoke to his GP who changed his prescription to a Diclofenac suppository and within 30 minutes his pain had reduced, the sickness disappeared and he found solace in blissful, healing sleep.
So, I guess we all need to rethink our approach to controlling pain and maybe consider taking a more European approach… despite Brexit!
Yours, as always
Ray
