Finding a cure for the trolley epidemic

Patricia Feehily


Patricia Feehily

Finding a cure for the trolley epidemic

UNIVERSITY Hospital Limerick has for some time now been one of the worst effected centres in the country’s annual hospital overcrowding crisis.

Now, if you don’t mind me saying this, I told you so, several years ago when the HSE first started dismantling services in Nenagh and Ennis hospitals. I’d like to be able to claim the gift of prophecy now but the thing is, everyone else was more or less saying the same thing at the time – that Limerick wouldn’t be able to contain us.

It wasn’t that we were more delicate or genetically less able to withstand an epidemic. It was just that the Mid-West Regional Hospital, as it was known at the time, was already straining at the bit.

But we were all dismissed as a bunch of paranoid parochials out to sabotage the plan to provide ‘centres of excellence’ just because they weren’t earmarked for our own backyards. Admittedly, there might have been some truth in the paranoia claim partly because of there being such intense rivalry on the hurling field at the time. Some of us were afraid that if push came to shove in the Emergency Department at the Regional, Limerick people would get priority and the rest of us would be consigned to trolleys and there would be little we could do about it apart from claiming Limerick descent.

That was irrational, of course, but nothing at all seemed rational back then – no more than now. I’m glad to see that some patients are now being rescued from the trolleys in the Limerick ED and being transferred out to Nenagh and Ennis Hospitals to enjoy – if I can use that word – a much more comfortable hospital stay. What puzzles me, however, is why they had to go through the trolley crisis in Limerick at all. Why couldn’t they have been referred initially to Nenagh and Ennis and assessed in those hospitals to ascertain if they needed a ‘centre of excellence’.

Which brings me to the point of what I really want to say this week, and that is to call for the restoration of GP home visits and home treatments. Others have been calling for this for the past couple of years but as far as I know their requests have fallen on deaf ears. I don’t know how GPs themselves would feel about it, but most of them stopped doing regular house calls when their payments were cut, and really, I wouldn’t blame them. Certainly nobody sends for a doctor in the middle of the night anymore unless there is a real crisis, and even then they must contact an out-of-hours doctors’ co-operative which is very impersonal and nearly as off-putting as the prospect of a trolley in the Regional.

Every village worth its salt had a resident GP when I was young. Now, they don’t even have a post office. When you sent for the doctor, he or she, as the case might have been, came to the house, emergency or no emergency and often in the middle of the night, to assess the situation and provide the appropriate treatment. The service was prompt, humane, efficient and very reassuring. And despite the social esteem which the doctor commanded in the parish, we wouldn’t have expected anything less than this extraordinary service.

I say ‘extraordinary’, because I have no idea how one man or one woman could have manned a whole territory 24 hours a day without collapsing or, at least, complaining. But that’s how it was – most of the time. Our own doctor was reported to have exploded once when called to the bedside of an elderly man living in a remote hilly corner of the parish at 3am. He drove up the rough road in his VW Beetle and found the patient sitting up at the kitchen table eating a boiled egg, having undergone a miraculous recovery shortly after the messenger had been dispatched to the clinic. There were very few phones in the parish in those days. The incident, however, was a source of mirth in the locality for years afterwards and even the doctor looked back on it later with amusement.

Right now, in certain parts of the US, doctors are abandoning their clinics in favour of house calls and home treatments. In fact groups of GPs are dedicating themselves specifically to calling to see and treat their patients in their own homes, or, in the case of elderly patients, in nursing homes. If the trend caught on here I think it would help to alleviate the queues in the hospital emergency departments, as well as assuring sick people that they were being looked after, with the doctor calling every day if necessary.

When I was nine years old, I contracted pleurisy and was very ill for at least two months, but I wasn’t hospitalised. The local doctor was sent for when my parents realised that it was serious and for once, I wasn’t putting on a show. He diagnosed the problem and treated me at home, calling twice a day for nearly a week. If it were now, I’d be on a trolley in the Regional, waiting for a bed.

The trouble with us all is that we have become far too institutionalised. We all believe that the only answer to all our aches and pains is a hospital bed in a centre of excellence, even though at times we’d be just as well off in our own beds getting the appropriate treatment from a qualified medic doing his or her rounds, or answering a call for help.

This is primary care at its most basic and we’ve forgotten what it was like. My mother always kept a separate drawer of bed linen for fear a doctor might have to be called at short notice. It was a small price to have to pay for a health service that thankfully met all our needs.