Sunday, October 01, 2006

The NHS actually works (sometimes)

The other week an old lady left hospital, walking alone, to stay with her daughter. Not an unusual story you may think, but this old lady had quite a story to tell.

Several months ago I was on call and was asked to come to the Emergency Department to help deal with the victim of a Road Traffic Accident (RTA). The sole victim was an elderly woman whose car had hit a tree at around 60 mph. She had multiple injuries, with a punctured lung, fractured femur and large scalp wound, and her blood pressure was very low despite aggressive resuscitation with blood and fluids. Although it was not clear where the bleeding was, her abdomen was distending rapidly and the surgeons thought she might have internal injuries.

She was taken to theatre rapidly and her abdomen opened. No bleeding point was found, but she continued to require large volumes of blood to maintain her blood pressure. At several points her heart nearly stopped, and her lungs were not getting enough blood to pick up sufficient oxygen. She was, to put it mildly, in a bad way.
There was some collective head scratching as to where the bleeding was, when her chest drain bottle (tube sited to treat the punctured lung) suddenly filled with blood. The cardiothoracic surgeons were called and the lady’s chest opened, where the bleeding vessels were found and tied off.

By the end of this operation this lady had received 27 units of blood, around 4-5 times her circulating volume, as well as litres of fluid and other substances including platelets and clotting factors.

Having been stableised she was transferred to Intensive Care, although no one held out much hope. Such massive trauma combined with a prolonged and major operation would be a challenge for a far younger patient, let alone someone of this age.

But, confounding our expectations, she continued to improve and came back to theatre several times for further operations to fix her broken bones. Eventually she was able to be weaned off the ventilator and was transferred to a normal ward, where I would see her from time to time. She made slow progress, and had some memory impairment but was otherwise remarkably intact.

Two weeks ago she left hospital, and will stay with her daughter. She may never live independently again. But she has regained much of her quality of life. Worth the money? I think so.


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