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Dr Kate Granger, a Specialist Registrar in Geriatric Medicine currently working at Leeds Teaching Hospitals Trust, is terminally ill with cancer. Here, in an intensely moving and personal blog, she views the NHS at work from the patient’s side of the bed:
When I was asked to blog about my experiences as a cancer patient for NHS England I was a little overwhelmed with thoughts of the topics I could pick. After some deliberation I have decided to focus on a very recent episode of care and reflect on that.
To set the context, I have a very rare type of sarcoma. It was diagnosed over two years ago and at that time I was treated with a gruelling course of chemotherapy, which left me very unwell, but did shrink the tumours. I stopped the chemotherapy in January 2012 and have been living an independent, normal life since then including a return to my beloved work as an Elderly Medicine Registrar.
Unfortunately the cancer has recently decided to wake up and I have taken the immensely difficult decision to embark on more palliative chemotherapy.
I have rubbish veins. They weren’t all that great to start off with, took quite a battering in hospital the first time round and have been used so much since. Therefore, to administer the chemotherapy I elected to have, a Portacath inserted.
For non-healthcare professionals this is a line that sits in one of the large vessels in the neck and is accessed via a little port under the skin using a small needle. It means that access to the vein is much easier, more secure and less painful than having multiple attempts on peripheral veins in the arms.
I had my Portacath inserted this week. I had worked myself up into a nervous frenzy about the procedure, as I commonly do when anything invasive happens to me. I arrived at the theatre reception at the specified time with my Mum and here is where I come to the first point I would like to reflect upon:
We were greeted by the theatre clerk. A friendly :“Oh yes you must be Kate! My name is Karen. Please take a seat and I’ll fetch Jay the nurse to do your pre-op assessment.”
All said with a smile and welcoming body posture. Immediately, despite my anxious state I was put at ease. I literally sighed in relief and took a seat.
Introductions might not seem like the most important aspect of care we deliver, but they can really have a huge impact on the psychological state of our patients as demonstrated by this episode. We’ve all sat there and stared at a computer screen or set of notes, refusing to look up to acknowledge the presence of someone who needs our help. But just remembering that patients are in an alien environment and being welcoming can have such a big impact.
I had my pre-operative assessment done by a very jovial staff nurse, who was also thorough and completed the checklist to the letter, making me feel safe.
I was asked to change into a gown again by another very friendly and personable theatre nurse. Everyone was making me feel special, as though I was at the centre of everything that was happening – and that was lovely.
The anaesthetist who was performing the procedure came to consent me. He was affable but had a reassuring air of confidence about him. I was asked to lie down on the theatre table and, like a well-oiled machine, the theatre seemed to spring into action. Monitors, oxygen, drapes all seemed to suddenly appear.
This would have been scary but for the lovely theatre nurse Sue who was sat by my head explaining exactly what was happening. She even put my iPod on for me so I could listen to some relaxing music during the procedure.
This brings me to the next point I would like to stop and reflect upon: Team work.
The theatre team were amazing. Everyone knew their role and the patient was right at the centre of all their actions. As a healthcare professional, observing it was a pleasure to watch. If only we could bottle that essence of ‘team’ and infuse it into other less functional parts of the hospital. They all seemed to be enjoying their jobs and there appeared, looking in on it all, to be no hierarchy. Everyone seemed valued.
The procedure was straightforward and uncomplicated. After about half an hour I was the proud owner of my new Portacath and able to relax in the recovery area, knowing that it had all gone as planned.
This was a good episode of care, maybe even a great episode of care. Why was that? I believe it was because concern for patient safety was combined with concern for patient experience.
This was clearly a safe episode of care. They used the WHO surgical safety checklist. The identity checks were done, they were taking great care with asepsis and surgical technique, everything was documented and I was given very clear aftercare instructions. But they also seemed to care about me, about what I was feeling. The anaesthetist kept asking me if I was doing ok. So did the nurse looking after me. Everything was explained as it happened. I felt valued. I felt like part of the team.
This episode of care I believe was the NHS at its very best. I could have written many blogs about my poor experiences of care but I think we all need to celebrate what an amazing entity the NHS really is and how many amazing episodes of care happen within it every single day.
One of her main clinical interests is Palliative Care in the acute hospital setting and she is currently studying for a University Certificate in Palliative Medicine.
Kate is also a terminally ill cancer patient with a very rare type of sarcoma, which carries a dismal prognosis and is currently having palliative chemotherapy for a recent progression in her disease.
Kate has written books, as well as posting tweets and blogs regularly about her experiences of illness.
She is passionate about Quality Improvement and how she can use her experiences and observations as a patient to make the care delivered in the NHS better.