The Heart of the Matter

An unexpected ‘vacation’ in the RVH Cardiovascular Department by Peter Hutchinson

This article covers a short period of time in my life and is a record of what transpired during that time. During a recent hospital stay I recorded my journey and its unexpected consequences, including my thoughts on the National Health Service (NHS) and the excellent service it provided to me. My reflections are also recorded pictorially with a series of sketches.

Background

I attended my GP in early January ‘22 with a thigh problem and took the opportunity to raise the subject of additional concerns such as ankle swelling and shortness of breath upon exercise. Following an examination and an electrocardiograph (ECG) he immediately referred me to the A&E department in the Royal Victoria Hospital (RVH), where I was quickly triaged and thereafter admitted to the Cardiac Care Unit, Ward 5b, from where my twomonth journey through the hospital system began. This period in hospital allowed me, as a patient, to observe closely the daily routine of staff, patients and visitors and also the organisation of the building, its facilities and equipment, and their functioning, both individually and collectively. As an obsessive illustrator of my environment, this hospital stay resulted in many sketches which now illustrate this text.

After a number of medical tests - including echocardiographs, ultrasounds, x-rays, CT scans and finally an angiogram – I underwent a x4 heart bypass operation to replace blocked coronary arteries; now an almost routine procedure in hospitals, but slightly more traumatic for the patient.

I was wheeled down to the operating theatre on my bed, with all my worldly goods stacked around me, robed in a not-so-flattering backless gown, and once in the theatre was transferred to the operating table. The theatre was an enormous space filled with wonderous electronic and technical equipment, including an oversized TV/ monitor screen. I was surrounded by a multiplicity of staff, including nurses, radiographers, anaesthetists and surgeons. Their quiet professionalism made me feel relaxed and I was so fascinated by the space and all that was going on around me that I wished I had my sketch book to record it. Once sedated, I had no further awareness of the next 5/6 hours until I woke up in the Intensive Care Unit (ICU), lying in bed with a dizzying array of tubes and connections attached to the monitors and appliances surrounding me.

The patient care here was one nurse to one patient, with an amazing group of dedicated ICU nurses taking care of my every need. Almost immediately I was offered tea and toast, which was gratefully accepted as I had not eaten that day due to fasting (where would hospitals be without tea and toast !!). Incredibly, I was soon encouraged to get out of bed and stand; three days later I was walking unaided. I left ICU to complete my recovery in Cardiac Surgery Ward 5a. I cannot thank the nursing staff enough for their care and dedication; they were truly remarkable. Back in the ward my recovery continued and about a week later I left hospital to complete my convalescence at home. I am now well on the way to leading a normal life thanks to the coronary bypass operation which has given me a life expectancy of ±20 years - truly remarkable!!

The post-operative care is ongoing with the hospital outpatients’ service monitoring my progress and supporting my recovery in every way possible. I had a slight hiccup some months into recovery when an upset in my heart rhythm resulted in my readmission to hospital. Following successful ablation of abnormal electric pathways in my heart’s conduction system a normal heartbeat was re-established, hopefully finishing my time as an inpatient under the care of the RVH cardiac unit.

The Images

While in hospital I recorded my journey as a travelogue, illustrated by a series of sketches. At the time they were not specifically drawn for any particular reason except to jot down my observations of how a place works: what makes it tick, what makes it unique and gives it its character, what are its flaws and shortcomings? Warts and all, so to speak, as observed mostly from the comfort of my hospital bed/bedside chair, strolling around the ward or along the hospital corridors. What is everyday or “normal” to hospital staff, not thought of as relevant or worth recording at all, can have, to the outsider, a huge impact.

During my stay I gained a unique insight into the hospital’s modus operandi, its many parts and services, and the workload and multiplicity of tasks undertaken by staff.

I created 32 illustrations over an eight-week stay in the RVH Cardiac Surgery Unit. The sketches began in Ward 5b - my first bed before transfer to a side ward. After the operation recovery was in the Intensive Care Unit (ICU), before returning to Ward 5a and recuperation, then, finally, to the ‘departure lounge’ and exit. Whilst I have listed and entitled each sketch chronologically, as they were drawn it became apparent that the longer I stayed, the more the sketches highlighted the different spaces, elements and personnel, allowing me to categorise them as per Appendix One.

The NHS and its Band of Mighty Warriors

How to describe the hospital - the complexity of the building fabric, its multiplicity of parts, the amazing range of technical equipment, its staff, their tasks and personal contribution - is virtually impossible. This article is a tribute to all the men and women - from the porters and cleaners through to consultants and the surgical team, including students, probationers, part-time and auxiliary staff at every level - who looked after me. The value, respect and dignty shown to me and each and every patient, at all times, was wonderful to see and experience. The way in which each patient was treated with such care made a profound impact on me, my family and friends, and will remain with me for a long time after my discharge.

I could make comment about some inadequacies and shortfalls in the system, too, possibly due to underfunding and inadequate staffing levels. The RVH is like a big juggernaut, or better still, a giant oil tanker: difficult to stop or change direction and costly to run (a bottomless pit?), but for all its faults we are blessed to have it. Our NHS is a national treasure, the envy of others and needed now more than ever and should therefore be treated accordingly. You have given me a future to look forward to, one that would not be there without your help.

Conclusion & Reflection

I feel a bit strange writing this article retrospectively, after being discharged from hospital almost five months ago, wondering did it really happen - a surreal experience - or was it all in my imagination? Certainly it was very real when I was there, especially entering the operating theatre, and my time in ICU recovering from the operation, but some bits are a bit of a blur, especially the long wait pre-operation when hours turned into days, then weeks. Getting Covid-19 and consequent isolation put back the operation, which didn’t help physically or mentally, but much of the delay was also due to lack of operating time and staffing problems.

Whilst I was only in ICU just over three days, it left the strongest impact- the 24/7 care by nurses on 12-hour shifts, tending to my every need; my utter dependence on their care has left a lasting impression. I fell in love with all of them, but offers of marriage failed to appear - strange (silly old romantic fool that I am!!).

When the day came to leave hospital I entered the discharge lounge, and panicked, not realising that I had become institutionalised after so long in hospital. As a few staff members said goodbye and a porter shovelled me into his chariot, piling me high with my accumulated baggage, I looked back expecting tears and wailing at my departure – instead, my bed was already being stripped, sanitised and made ready for the next person sitting patiently in the wings. A showstopper if ever there was one - curtain down,

Nurses and auxiliaries changing & sanitising bed for next arrival lights off - and that is how it should be; just one of the audience but what a performance they put on!! 

My Request to Each and Every One of You

At some time in your life you will inevitably cross paths with the NHS in one of its many guises; it is there to look after each and every one of us hour by hour, day by day, weekly, yearly, for the whole of our lives. It is therefore crucial that the services it provides have the necessary funding needed to keep doing what they do so well. Now this is where you come in: you can help fill the gap in funding required for everything from everyday running expenses to high-end research projects, health promotion campaigns etc….etc….etc….

Peter Hutchinson

PLEASE GIVE GENEROUSLY

NHS: Always there when you need it most Arts Care - Belfast www.artscare.co.uk/donate-1

Footnote/observations - this in no way is meant to be critical of the hospital and its workings - just some personal thoughts and views on the hospital fabric as an observant patient.

1.Circulation spaces - at least 7 no. levels of corridors, banks of lifts, stairwells & landings. I was amazed by the length and width of the main corridors: almost 100m long, v wide with acres of glazing. Stairwells - and banks of elevators/lifts: spacious compared to the spaces allocated to the wards and ancillary facilities which appeared cramped and were always cluttered with medical equipment, trollies etc.

2.Medical Equipment Mobile - it is amazing how many pieces of equipment are on wheels - beds, tea and food trolleys, medicine cabinets, blood pressure equipment, drips, ECG & X-ray units, bedlinen & medical file units. But best are the porters’ chairs [chariots] that transport patients everywhere by an army of porters.

3.Medical Equipment/fixed to walls - In wards the multiplicity of medical devices inc. monitors, oxygen supply, patients’ buzzers, even to raise/lower matresses - number of conduits, plugs; the mileage of hidden cables, tubes and pipework necessary to run the system is mind blowing! Each bed had 2 multi-functional ’robotic arms’ that could be manipilated/rotated and carried a multiplicity of medical equipment to each patient’s bed during their stay/ recovery - they were the Sampson & Goliath of the hospital - scary stuff!!

4 Sustainability & Recycling - whilst I understood the overarching need for safety and hygiene, especially in light of the recent pandemic, I was perturbed by the almost complete lack of reuse and recycling of any used medical equipment and vestments. Very difficult to change overnight but I would love to see it being addressed sooner rather than later to reduce the need for incineration or adding to landfill.