Latest news with #anaesthetist
The Guardian
6 days ago
- Health
- The Guardian
When Odie the cavoodle needed emergency surgery, the veterinary staff showed why they are the unsung heroes of healthcare
Speaking on a panel with me, a paediatric anaesthetist says that every time she takes a patient into theatre, she says to the parent, 'I will take good care of your child'. Somehow, just imagining this solemn promise makes me tearful although I don't even know that a variation of these words is headed my way. For the past week, our cavoodle Odie has been vomiting. The vet's diagnosis of 'it could be a stomach bug or lymphoma' is not exactly reassuring but, admittedly, the patient is wagging its tail. Two days later, our suspicion rises. The receptionist suggests I bring him in 'now' for tests. I guiltily decline, loath to cancel my patients who have waited months to see me. Later, we go for an ultrasound and, as Odie burrows into my arms, his little heart thumps. Noticing his apprehension (and mine), the technician kneels, fusses over him before drawing him away. As I swallow the bill shock, I learn that Odie has swallowed something causing gastric obstruction. The waiting room has emptied but the vet does me the courtesy of asking me inside to advise that he will need emergency surgery. After texting the kids, I rush him to the animal hospital. In the rear view, he looks tired and innocent, and I feel remorseful. How did we fail him? The receptionist greets me with a fine-tuned amount of care and compassion. She neither indulges me nor fawns over my dog. This is not the time to tell me he is cute. Odie and I are nodding off when the duty vet calls us. Soon, she has me marvelling at her ability to be professional without patronising. She explains that I have a choice between attempting to retrieve the foreign body via a gastroscopy or moving straight to open surgery. Why not pick the less invasive option first, I ask, instinctively thinking about my patients. 'Because if it fails, your cost doubles and some people can't afford it.' This one-line informed financial consent hits the mark – but nauseous at the idea of cutting open Odie's tiny abdomen, I opt for a gastroscopy and hope for the best. I ask the vet if I should wait only to be gently advised that the procedure requires prepping for hydration and sedation. Having sent countless patients for a gastroscopy, I feel stupid. A friendly nurse appears. Odie likes her, licks her and follows her to 'the dog ward', leaving me to pay the hefty deposit. This reminds me of my patients whose pension would foreclose this luxury on behalf of a pet that is often their sole companion. 'Before you leave, do you want to see Odie?' the receptionist asks. I have decision fatigue – and say no, unconvincingly explaining that I don't want to get his hopes up. 'As you like,' she says. Recognising the politest of signals to guard against future regret, I stop at the door. 'Do you think I should see him?' 'Yeah.' The nurse brings out a still happy-looking Odie. I stroke his head, telling him (and me) that we are lucky to be in able hands. Meanwhile, my own hands feel awfully empty without dog or leash. My remedy to ward off the tears is to play loud Bollywood music and, while incongruous, it stops the sadness from invading my heart. At home, after answering my kids' questions with 'we don't know' and 'we can't say', I fall into an exhausted sleep. After midnight, an apologetic, frustrated vet calls to say that the gastroscopy was unsuccessful. She could see a twig-like object but couldn't budge it. So I consent to an exploratory laparotomy, a term for opening up the abdomen that I have explained to many patients suffering from conditions that don't involve a swallowed twig. A kindly surgeon assures me of the routine nature of the procedure. Eyeing the 'for resuscitation' box, I hope so. The offender turns out to be the seed pod of a sweetgum tree. Odie comes home, a little dopey and nonplussed as to what the fuss is all about. As an oncologist, I am used to being compared (unfavourably) to vets. In the depth of their disappointments, patients and families will lament that they wouldn't treat an animal 'like that'. Of course, the human condition and human expectations are complicated, but I will say that vets and their staff might just be the unsung heroes of healthcare. They protect the interests of those who can't even speak for themselves, comfortable both with curing and, when the suffering gets too much, palliating. All this without fanfare but with compassion and humility. What I will remember most is their empathy, which felt natural and unforced. They instinctively understood that they were treating two patients – me and my dog – and tailored their touch and talk accordingly. Alas, we don't do this nearly well enough in medicine. The barrage of bureaucracy no doubt hardens us but, if we let our empathy dissipate, we will be the lesser for it. As for Odie, his wound is healing and he is inhaling our love. Considering the drama, I have a good mind to never again let him off leash. But, to be honest, at the first whiff of his eagerness to sniff at every blade of grass and inspect every dog's behind, I will relent and, before I can exclaim 'Don't eat that!', we will be back to our normal ways. Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is Every Word Matters: Writing to Engage the Public
The Guardian
6 days ago
- Health
- The Guardian
When Odie the cavoodle needed emergency surgery, the veterinary staff showed why they are the unsung heroes of healthcare
Speaking on a panel with me, a paediatric anaesthetist says that every time she takes a patient into theatre, she says to the parent, 'I will take good care of your child'. Somehow, just imagining this solemn promise makes me tearful although I don't even know that a variation of these words is headed my way. For the past week, our cavoodle Odie has been vomiting. The vet's diagnosis of 'it could be a stomach bug or lymphoma' is not exactly reassuring but, admittedly, the patient is wagging its tail. Two days later, our suspicion rises. The receptionist suggests I bring him in 'now' for tests. I guiltily decline, loath to cancel my patients who have waited months to see me. Later, we go for an ultrasound and, as Odie burrows into my arms, his little heart thumps. Noticing his apprehension (and mine), the technician kneels, fusses over him before drawing him away. As I swallow the bill shock, I learn that Odie has swallowed something causing gastric obstruction. The waiting room has emptied but the vet does me the courtesy of asking me inside to advise that he will need emergency surgery. After texting the kids, I rush him to the animal hospital. In the rear view, he looks tired and innocent, and I feel remorseful. How did we fail him? The receptionist greets me with a fine-tuned amount of care and compassion. She neither indulges me nor fawns over my dog. This is not the time to tell me he is cute. Odie and I are nodding off when the duty vet calls us. Soon, she has me marvelling at her ability to be professional without patronising. She explains that I have a choice between attempting to retrieve the foreign body via a gastroscopy or moving straight to open surgery. Why not pick the less invasive option first, I ask, instinctively thinking about my patients. 'Because if it fails, your cost doubles and some people can't afford it.' This one-line informed financial consent hits the mark – but nauseous at the idea of cutting open Odie's tiny abdomen, I opt for a gastroscopy and hope for the best. I ask the vet if I should wait only to be gently advised that the procedure requires prepping for hydration and sedation. Having sent countless patients for a gastroscopy, I feel stupid. A friendly nurse appears. Odie likes her, licks her and follows her to 'the dog ward', leaving me to pay the hefty deposit. This reminds me of my patients whose pension would foreclose this luxury on behalf of a pet that is often their sole companion. 'Before you leave, do you want to see Odie?' the receptionist asks. I have decision fatigue – and say no, unconvincingly explaining that I don't want to get his hopes up. 'As you like,' she says. Recognising the politest of signals to guard against future regret, I stop at the door. 'Do you think I should see him?' 'Yeah.' The nurse brings out a still happy-looking Odie. I stroke his head, telling him (and me) that we are lucky to be in able hands. Meanwhile, my own hands feel awfully empty without dog or leash. My remedy to ward off the tears is to play loud Bollywood music and, while incongruous, it stops the sadness from invading my heart. At home, after answering my kids' questions with 'we don't know' and 'we can't say', I fall into an exhausted sleep. After midnight, an apologetic, frustrated vet calls to say that the gastroscopy was unsuccessful. She could see a twig-like object but couldn't budge it. So I consent to an exploratory laparotomy, a term for opening up the abdomen that I have explained to many patients suffering from conditions that don't involve a swallowed twig. A kindly surgeon assures me of the routine nature of the procedure. Eyeing the 'for resuscitation' box, I hope so. The offender turns out to be the seed pod of a sweetgum tree. Odie comes home, a little dopey and nonplussed as to what the fuss is all about. As an oncologist, I am used to being compared (unfavourably) to vets. In the depth of their disappointments, patients and families will lament that they wouldn't treat an animal 'like that'. Of course, the human condition and human expectations are complicated, but I will say that vets and their staff might just be the unsung heroes of healthcare. They protect the interests of those who can't even speak for themselves, comfortable both with curing and, when the suffering gets too much, palliating. All this without fanfare but with compassion and humility. What I will remember most is their empathy, which felt natural and unforced. They instinctively understood that they were treating two patients – me and my dog – and tailored their touch and talk accordingly. Alas, we don't do this nearly well enough in medicine. The barrage of bureaucracy no doubt hardens us but, if we let our empathy dissipate, we will be the lesser for it. As for Odie, his wound is healing and he is inhaling our love. Considering the drama, I have a good mind to never again let him off leash. But, to be honest, at the first whiff of his eagerness to sniff at every blade of grass and inspect every dog's behind, I will relent and, before I can exclaim 'Don't eat that!', we will be back to our normal ways. Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is Every Word Matters: Writing to Engage the Public
The Independent
22-07-2025
- Health
- The Independent
Ask any Black woman – we get second-class NHS treatment
When I gave birth for the first time, my concerns were dismissed by my medical care providers. I put it down to my age, as I was only 18 at the time, rather than my skin colour. But as a new survey finds that a quarter of Black women experience discrimination in the NHS – how, in particular, on maternity wards, Black mothers are denied the pain relief, such as epidurals, routinely given to our white counterparts, and that we are up to four times more likely to die in childbirth – I'm not so sure. I'd wager that every Black mother I know has her own little NHS horror story. I remember a midwife telling me that I was putting on too much weight, and asking sarcastically if I had ever heard of salad. I already felt bad about myself, as I'd developed cankles for the first time. When I was later diagnosed with edema, which led to pre-eclampsia, my labour had to be induced several days early. Looking back, I didn't receive a lot of pain relief, even though I was in so much pain, I kicked the footboard at the bottom of the bed clean off. I was so traumatised by the experience that I never had another natural childbirth again, both other times opting for an elective C-section. The second time I gave birth, five years later, I had planned to have a general anaesthetic. I didn't want to be awake for any of it. Two hours before the operation, I had a visit from a member of the medical team who asked if I minded having an epidural instead, because the anaesthetist wanted to go home, and it was only me keeping him there. I felt horrible refusing, and spent the final two hours of my pregnancy scared that they would 'accidentally' give me too much medication, and I would die on the operating table. I still can't believe the maternity unit had the audacity to put that amount of pressure on me – but it seems I'm not alone. According to a survey of more than 1,000 Black and mixed-race women by Five X More – a grassroots women's health organisation which takes its name from the statistic that Black women are five times more likely to die during childbirth that their white counterparts – half of all Black women did not receive pain relief when they requested it. It all seems to stem from a misplaced – and let's call it what it is: racist – mindset among midwives and doctors that 'strong Black women' simply don't need as much help as other patients. I mean, our ancestors were happy pushing out their progeny without modern medicine – they gave birth on their own, while standing up, didn't they? Wouldn't we prefer to just get on with it without gas and air? A friend of mine, who is now a senior cardiologist, told me: 'At med school in the 90s, we were taught that Black women had a higher pain threshold during labour, so they didn't usually ask for pain relief.' There have long been serious concerns in the Black community about the treatment Black women receive during maternal health care. It was the subject of a Dispatches documentary in 2021, presented by Rochelle Hulme. The myth of the 'strong black woman' is also partly a legacy of slavery. Medical historians point a finger at Dr J Marion Sims, the 19th-century physician who became known as the 'father of modern gynecology', having invented the vaginal speculum – but whose pioneering surgical techniques were practiced on enslaved women. His statue in Central Park was pulled down in 2018. Even more shocking to me is that medical racism within the NHS doesn't just exist in maternity care, I believe it's pervasive across the entire service. I know a woman who has been battling the NHS – and been belittled by it – ever since she was a girl, when she was diagnosed with a chronic autoimmune disease that causes muscle weakness and tiredness. 'I used to fall asleep in lessons, but was told by teachers there was nothing wrong with me, that I was attention-seeking, that I was a liar and fake. At 11, I was diagnosed with Myasthenia gravis, symptoms for which I had shown since the age of 4.' Today, she needs regular plasma transfusions, so spends a lot of time receiving medical care. 'I've had so many bad experiences, panic attacks thinking I was going to die,' she tells me, 'and yet white people with the same condition tell me they have not suffered.' Once, while having antibiotics administered intravenously, she was left unable to speak – yet her nurses ignored her obvious distress. 'All I could do was point to the cannula and whisper 'Out…'. When two policemen walked past, they pointed and laughed at me, acting as though I was a mental health patient. The nurses joined in laughing and joking.' I know that the plural of anecdote isn't data, but Black people do have a rougher ride at the hands of our medical profession. Certainly, health campaigns for conditions that disproportionately affect the Black community, such as sickle cell anaemia and prostate cancer, don't seem to get the same profile as others. When it comes to ensuring the NHS is more attuned to the needs of Black patients, I won't hold my breath – because if I did, they might just leave me to suffocate.
Irish Times
16-07-2025
- Health
- Irish Times
Inside the insourcing industry: The multimillion euro business within our public hospitals
In a presentation to a conference on the future of healthcare a couple of years ago, an anaesthetist from Cork urged that 'innovative thinking' was needed to tackle the perennial problem of patients waiting long periods for hospital treatment. This involved 'thinking up something new or to think about something old in a new way'. Ken Walsh told the Health Summit conference that in the regular health system there were roadblocks to progress on dealing with the waiting list, such as staff availability, sick leave, absenteeism, pay and funding issues, as well as restrictions under the European Working Time directive. READ MORE However, he suggested there was an alternative that would incentivise staff to work additional hours within the limits of European employment laws. The overall concept was relatively straightforward. With a growing and ageing population, demand for care was likely to surge and the ability of the public system to cope was limited. The State had been outsourcing patients on long waiting lists to private hospitals for years. But what about spare capacity in public hospitals? These had highly trained staff and expensive equipment, largely funded by the exchequer. But routine or non-urgent care was primarily a Monday-Friday, regular working hours operation. Unlocking unused capacity at night-time and weekends could allow tens of thousands more patients to be treated. Hospitals already offered regular overtime to staff. But this new 'third party' insourcing would mean private companies putting together teams of doctors and staff who would be paid premium rates to work in their public hospitals, outside of core hours. This 'third party insourcing' may have proved effective in getting more patients treated but it was also highly lucrative for those involved. And behind the scenes, it generated strong concerns about potential conflicts of interest, perverse incentives and governance and oversight shortcomings. [ Waiting list initiative suspended at Naas after concerns consultants paid directly Opens in new window ] Around teatime on Friday of last week, the Health Service Executive sent a report to an Oireachtas committee on how much such insourcing companies had been paid. Over 27 months to March 2025 three had, between them, received more than €70 million. One, EHF 29 Limited, received €54.636 million. Official filings showed it was largely owned by two doctors, Ken Walsh and Clodagh Ryan. Accounts for 2023 show that EHF 29 Limited had recorded an annual profit of €2.39 million. The company declined to comment this week but its website sets out the scale of its operations. It had carried out more than 70 waiting list projects in 22 acute public hospitals. From a small start in 2020 it assisted in the provision of treatment for 5,500 patients in 2021, 46,000 in 2022 and approximately 79,000 in 2023. Its accounts for 2023 say that the average monthly number of people employed, including directors, was 576. Among projects on which it has worked are day case surgery at St James's in Dublin, vascular surgery at Cork University Hospital, plastic surgery in Galway, breast clinics in Galway and Letterkenny, endoscopies in Ennis, Limerick and Wexford, and a pathology initiative in Waterford. It is understood as part of its operations, it recruits 'suitably qualified staff' from the HSE. Another company, Rosata Recruitment, received €10.3 million in the 27 months to March. This company's accounts list Ronan Corrigan as director and its report for 2023 said it had a monthly average of 29 doctors employed. It reported profits close to €500,000 for that year. The company says it has been 'providing a wide range of insourced surgical/outpatient/diagnostic/endoscopy waiting list initiatives since 2020″. The HSE said another firm, Totally Healthcare, received €5.9 million in the 27 months for insourcing projects. The company says it works with hospitals across the United Kingdom and Ireland. Last year, it announced a 12-month insourcing contract for oral and maxillofacial outpatient and day surgery cases with HSE hospitals in the west of Ireland. [ HSE paid one firm €54m over 27 months for services to tackle waiting lists in public hospitals Opens in new window ] 'All procedures will be delivered during weekends when hospital facilities are not otherwise in use', it said. Sinn Féin health spokesman David Cullinane described the HSE funding report as 'staggering' and warned that insourcing presented risks. However, it was official policy. And while supporters of the idea, such as Dr Walsh in Cork, may have had a vision, it could not have been implemented without political backing. Governments for years had struggled with waiting lists. Taoiseach Micheál Martin as minister for health 20 years ago had established the National Treatment Purchase Fund to buy care for those waiting longest. But after the Covid-19 pandemic there were serious problems. In February 2022 the then minister for health Stephen Donnelly said months of disruption during the pandemic had left more than 730,000 queuing for treatment. The year before, Donnelly had introduced a short-term plan from September to December, which, he said, had provided care to an additional 40,000 people. After Covid, Donnelly now had more money at his disposal than any of his predecessors and he now effectively turbocharged the drive on waiting lists. Initially, in 2022, he launched a €350 million plan, which became a permanent feature in subsequent years. Overall, the sums involved in tackling waiting lists were vast. Over four years, about €1.6 billion was provided. Some of this allowed the HSE to directly hire more staff, more went to the National Treatment Purchase Fund to buy treatment in private hospitals. But significant amounts went on insourcing arrangements. Although regular overtime continued, third-party insourcing became increasingly common. The framework on which this worked was a dynamic purchasing system introduced by the HSE. This allowed hospitals operating a non-recurring initiative to conduct a mini-competition open to providers on the dynamic purchasing system. A multimillion-euro private industry was about to develop inside the country's public hospital system. [ The Irish Times view on hospital waiting lists: Straining to stand still Opens in new window ] There were concerns about insourcing from early on. But they were mainly behind the scenes. Officially, the initiatives were working, particularly in bringing down the length of time people had to wait. Donnelly told the Cabinet last November that since September 2021, there had been a 58.5 per cent reduction in the number of patients waiting over 12 months, equating to over 169,000 people. But in the background, there were concerns. In recent weeks, The Irish Times received documents which suggested that within Children's Health Ireland (CHI), the group that runs children's hospitals in Dublin, there had been particular unease about insourcing. CHI paid €5.66 million to EHF 29 between 2023 and March 2025. It ceased insourcing initiatives in June. However, some in the health system maintain that concerns existed more widely and the documents represented attempts to rehabilitate the image of CHI in the wake of recent controversies. But nonetheless, CHI seems to have pursued its concerns about insourcing, albeit in private, including a meeting with the Health Service Executive in June 2023. Children's Health Ireland said in a statement that its board 'raised concerns regarding the concept of insourcing and the potential conflict of interest for staff, with HSE colleagues on several occasions'. [ Almost €100m spent on companies that use HSE facilities and staff to cut waiting lists after hours Opens in new window ] The HSE said that in 2023, a meeting was convened between it and Children's Health Ireland representatives, including members of the CHI board, to discuss the provision and use of insourcing. 'CHI expressed concerns at the meeting, which were shared by the HSE. It was agreed that insourcing was necessary as a short-term measure to address waiting list backlogs,' the HSE said in a statement. Children's Health Ireland said it reiterated its concerns on foot of a HSE memorandum (on insourcing) issued in February 2024 but agreed to continue with the initiative 'in view of the challenges to patient waiting times and with HSE assurance'. The HSE did not say whether it had alerted its board or the Department of Health to the concerns raised by Children's Health Ireland. However, within the HSE internal auditors began looking at insourcing arrangements in 2023 and early 2024. In September 2024 The Irish Times reported auditors had found that two companies which received more than €1.5 million between them at University Hospital Limerick without a competitive procurement process were owned or part-owned by employees. Over recent weeks more controversies emerged involving CHI, Beaumont Hospital and Naas in Kildare. [ Beaumont Hospital has NTPF waiting list funding suspended Opens in new window ] At the end of June HSE chief Bernard Gloster urged Minister for Health Jennifer Carroll MacNeill to phase out insourcing within a year. He said 83 serving or former health staff were acting as directors in 148 companies providing insourcing and outsourcing arrangements. Carroll MacNeill is expected to decide on the future of the multimillion-euro insourcing industry within the next few weeks.
Daily Mail
27-06-2025
- Health
- Daily Mail
We wanted a baby so they could act as a transplant donor for our seriously ill daughter, reveals MINA HOLLAND. It was a minefield... but what happened next will make you believe in miracles
When the moment comes for the anaesthetist to place the mask over my little boy's face, I falter. While I've witnessed my daughter, Vida, go through the same thing on multiple occasions, her medical condition means invasive hospital procedures are necessary to keep her alive, making it easier to fight my protective instinct.
