A TEACHER WITH a chronic condition has spoken of her experience of spending over 24 hours on a trolley in an emergency department (ED) corridor after being admitted for a life-threatening asthma attack.
Rachel Murray, a 31 year old secondary school teacher living outside of Sligo town, says she is admitted to EDs roughly 4 to 5 times each year for severe bronchial asthma. She was also born with a congenital heart defect, and underwent heart surgery as a child, which means she is immunocompromised.
Rachel was admitted to Sligo University Hospital for four days via the ED, from the 2nd of September to the 5th.
She says she barely slept during that time, which she partially spent on a trolley in a hospital corridor, alongside with eight other patients.
Rachel emphasised that the staff were “incredible” during her stay, and that they gave her great care, but were evidently working in a system under “a lot of pressure”.
Rachel said she received excellent, timely emergency care in an ED’s resuscitation room when she first arrived. Once her airways stabilised the following day, while staff were still uncertain as to whether she had a blood clot or not, she was moved into a busy corridor on a trolley.
In August, 737 patients were admitted to Sligo University Hospital without a bed, according to Irish Nurses and Midwives’ Organisation (INMO) trolley count figures.
This August was the worst for hospital overcrowding across all admitting Irish hospitals since the union began keeping records in 2004.
The average waiting times for people needing admission from EDs in Irish hospitals increased to 11.7 hours, according to estimates published by the Health Service Executive in May.
While Rachel can sometimes manage asthma attacks at home with the help of her primary care team, her family and her partner, sometimes the attacks are acute, and require urgent care.
“I have to monitor my asthma every day, I would make sure when I leave the house that I have my nebulizer with me and my inhaler, and I have an emergency injection for my adrenal deficiency. Daily I struggle with breathlessness, and there is a lot of mucus on my lungs, so I cough a lot,” she explained.
On the Saturday morning of 2 September Rachel was home alone when she realised that her asthma was becoming increasingly severe, as she was struggling to breathe.
“I rang Caredoc and explained my symptoms, and they wanted to ring an ambulance. I told them it was fine, I was home alone but I’d ask my aunt to drive me to the hospital. When my aunt got to the house she took one look at me and said she was ringing the ambulance.
“I was having difficulty speaking, and it felt like no air was reaching the bottom of my lungs. I am very used to having attacks, but usually my parents or partner drive me into the ED.
“Going in on my own in the ambulance, I was frightened. I try not to panic when I am struggling to breath, as it makes it worse, but this time it was especially difficult,” she said.
The Sligo woman said that as soon as she arrived at the hospital she was rushed through to Resus, where she received “speedy care”.
“I was given oxygen through a nebuliser, intravenous magnesium, breathing treatments and strong steroids. After spending that Saturday night in the bay for acute patients, I was moved into a corridor on a trolley on the Sunday morning.
“At that stage, they thought I might have a blood clot, and I was waiting on a scan to find out. The hallway I was in had around eight trolleys back to back. I didn’t ask why I was moved – I know , and that someone else is sicker and more of a priority.
“To be clear – nurses still check up on you in the hallway. It isn’t a case of them not coming near you, they are doing the very best they can,” Rachel emphasised.
The secondary school teacher’s condition went downhill again that Sunday evening, and she was moved back to the acute bay for further treatment.
Then from 12pm on Monday until late Tuesday afternoon, she was placed back at the top of the busy ED corridor on a trolley,
It is not the first time she has waited on a bed for over 24 hours.
“I was at the bend of a corner, near a paediatric section, so there were kids running around, and elderly patients on trolleys in the hall too. One woman kept asking the nurses to make her tea but they had no time. She must have been in her 70s, she had no one with her. She was just sitting up and clutching her gown – it was heartbreaking,” Rachel said.
She got no sleep in the hallway, as the lights were on overnight, and it was loud, with the sounds of babies crying acting as a constant background noise.
“At one point in the hallway, a man who had been waiting for hours for stitches got annoyed with the staff and started shouting: “I’ll stitch myself up! Let me stitch myself up!”.
“It is not an atmosphere anyone could rest and recover in. You feel for the doctors, because there is always another staff member off sick, there is always a ward that can’t be filled because of infection control, and there are inevitably drunk and sometimes abusive people in the midst of all this,” Rachel said.
The secondary school teacher was told on the Tuesday that she was being moved to a ward bed, but was subsequently told that she was being discharged. She didn’t question the sudden change in decision making – she “just wanted to leave.”
“I hadn’t showered or slept in days. We don’t have access to patient toilets or shower facilities, we use the public ones in the ED. They sent me home with a great care plan, but I hadn’t checked the kind of antibiotics I was prescribed, and the particular kind I was given have never been effective for me, but I was able to contact my care team afterwards who are incredible, and got a different prescription,” Rachel said.
During a past hospital stay that also saw Rachel left on a trolley overnight, she made the decision to discharge herself from University Hospital Galway against medical advice.
“The hallway I was on was so busy, and I am immunocompromised. I made the decision that I thought was best for me. It was so chaotic, a drunk man was spitting in the face of staff,” she said.
Though Rachel has heard of hospital’s having ‘winter plans’ in place, she said that over the course of her hospital stays, she has never seen evidence of any plan in place.
“The nurses and doctors are absolutely working to the best of their ability in the circumstances they are in. I don’t know when things will change for them, there is obviously a capacity issue,” she said.
“I will do everything I can to avoid being admitted this winter. The reality is, I don’t know what I will be going in to. My grandmother is 90 years of age, and I dread to think of her being on a hospital corridor, lying on an uncomfortable trolley one day.
“I see older people like that, on their own, trying to find a free plug in the hall that isn’t being used for medical equipment to charge their phone and let someone know how they are doing. It’s a really sad sight,” Rachel said.
She added that she would like to see an alternative pathway being established for patients who have chronic conditions, and need to be admitted via EDs on a regular basis.
“Obviously the most unwell person should get a bed, but I feel like I could be treated in a clinic in a different part of a hospital, and I could end up spending less time in the system overall,” she said.
On Monday, Health Minister Stephen Donnelly is set to meet with medical organisations, HSE management and patient advocates to discuss measures that can be put in place to mitigate the risks of an overcrowding crisis in Irish hospitals this winter.
The INMO is urging the Department to start negotiations with private hospitals now to contract them for extra bed capacity, to avoid hospitals being put under extreme pressure.
They are also expecting a key update on the progress of three promised elective hospitals.
The Journal has contacted Sligo University Hospital for comment.
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