By Denis Campbell

Why lie? Why use code words? When the technician said the dye injected in my arm may “feel a bit warm, you may experience a bad taste in your mouth and it might feel like you are passing water but you won’t be,” internal alarm bells sounded but I was strapped to the table and inside the giant whirring tube.

When her disembodied voice came over the speaker saying the dye was now being injected, I braced myself. At first I thought, “OK, there’s the warmth in my arm and I do have a bit of a bitter taste in my mouth, this is not so bad… WHOOAAAAAAAAA!”

A five-alarm fire erupted in my arm and raced up the left carotid artery into every blood vessel of my brain, back down the other side and passed through every chamber of my heart spreading downward into my groin where I was convinced a complete change of clothes would now be required… there was no Depends on this or any planet could possibly contain the growing flood all while being told to hold very still. Riiiiggghhhhhttttt! 

Total elapsed time was no more than 2-3 seconds but the nausea wave was rising rapidly and my vision of perishing because I threw up in my mask whilst strapped and incapacitated in this death machine became a very real fear indeed…

For those just joining this story in Part Three, I had a TIA (Transient Ischaemic Attack) or mini-stroke 2-weeks ago today. The Ignore at Your Peril article talked about how many people ignore these symptoms because they quickly clear yet leave behind lots of forensic data that could be used to prevent an even larger future incident. In my case the specialist recommended a series of scans and a carotid artery sonogram study to help determine the cause and preventative future path.

This was the week I wandered into the absurd world of the NHS appointment scheduling system, conducted without logic or thought and completely in a vacuum. Paper literally is passed from In to Out basket without anyone providing either a central context or asking how is this helping the patient resolve their issue? The patient is the pawn on the board responding to letters and phone calls. Clearly though, unless he or she takes an active personal case management role, at times it seems the left and right hand of this operation do not even know they are part of the same body and it is not anyone’s job to ask if they are.

I read sign after sign on hospital walls saying abusive behaviour would not be tolerated and informing me of the rights of hospital staff without ever seeing one word about the rights of a patient to get a solid comprehensive diagnosis and treatment. 

Instead the poor specialist was reliant on so many parts of the machine coming together in their own time, seeing 30 patients in a single morning (as in the case of the carotid specialist) and hoping it all was there when it was time to review and discuss with the patient. As the pawn, I felt I was spending my time either commuting to and from the hospital on their schedule or acting as the communications adjunct following-up to ensure departments were indeed speaking with each other and the various specialists knew the outcome of the most recent change in the testing regime and was that indeed what they had ordered and… would it be enough for them to make their diagnosis?

And the problem is virtually everyone I came in contact with (OK, I do have a problem with the one entire department as a group taking a 10:30 coffee break together with patients sitting in the waiting room) was treating me with the utmost professionalism and respect while simultaneously seemingly having one arm tied behind their back. And despite knowing more about the various scans than even the specialist, were unable to offer anything in terms of: “looked OK, not sure, etc.”

Now as a business change consultant my first thought was how can such a fundamental communications problem like this exist in an entity taking care of human lives? Were it a business, it would fail because of its inefficiency yet the solution is not that difficult. 

Everyone is doing their job, as designed, very well. What is missing is a basic sense of central relationship command and control (we’ll even leave urgency off the table for now because I have to believe were it life or death, they would act immediately) of a patient’s situation.

On Wednesday I went in for a carotid artery sonogram after waiting to speak with the specialist. The delay with him meant I ran into their coffee break (grumble) and then the technician could not find the left carotid artery easily. So I was already grumpy and she gave me an appointment to come back for the specialist to re-scan on Friday. I trekked back to the specialist area where I saw Mr. Frost to let him know the scan result he expected would probably be delayed. At least I got some Christmas shopping done.

I got home and there was a message from the MRI Group asking me to come in on Friday 90-minutes after my sonogram. I thought OK, at least we have some coordination here. I tried though seven times to get through on the department appointment phone each time reaching a message that did NOT say, “you have reached the MRI department…” So I called the Main Switchboard and they put me through to the same voice saying “welcome to BT Answer 1571…” I left a message saying Friday was fine.

The mail arrived on Thursday with a letter saying my appointment was for the day before, Wednesday. I decided though to trust the phone system and showed up for the sonogram. When I spoke to the main receptionist, she insisted my appointment was (drum roll please…) yesterday and I missed it. I told her the story and, to her credit, she said “leave it with me, go to your sonogram and I will sort it out.” She caught me as I was about to enter the suite and said it was all set for 11:00. 

The sonogram specialist had little luck finding the artery so he wanted to schedule an MRI. I said, “well funny you should say that, I have a head scan scheduled for 11:00, why not do the neck whilst there.” He walked over to MRI and it was sorted.

Got to the MRI and they asked me if I’d ever had any metal placed in my head (insert your joke here). I said “no” but remembered a conversation with the eye surgeon in CA about the lenses he was implanting for my cataracts 15-years ago. There were bits of metal, like tiny fly wheels that helped the lens to stay in place. Now since this was a giant magnet I was about to enter, the thought of my eyes ripping out of my head was something I was not ready to face, the technician agreed and ordered and X-Ray of my eyes to see if there was any metal there.

Given the all clear they strapped me down to the MRI, gave me earplugs and because I was headed for a 35-minute ride in a claustrophobic tube, I was not happy. As they tried to slide me in, my broad shoulders would not collapse enough to fully fit so they were going to have to do a dye CT scan. (Divine providence?)

That brings us full circle. 

The nausea passed, I was sitting up and drinking my third cup of water. I could feel the dye slowly chugging around in my system and after 5 hours in the company of strangers was ready for home and bed. However after drinking copious amounts of water and that interacting to flush the dye out, spent the rest of the afternoon and evening trekking back and forth to the loo. 

Coming in Part Four, the verdict of all these tests and what next?