The Hillington Hospital Nightmare of Dr. Paul Marik

I laugh so hard when Paul tells this London hospital story. But it wasn't so funny for him. Enjoy his powerful complaint letter to the UK's National Health Service. Audio version by Paul Marik!

Years ago, Dr. Paul Marik got suddenly and severely ill when he was attending a medical conference in London. He was brought to Hillington Hospital within UK’s National Health Service (NHS). What happened next is a comedy of hospital mis-steps that is almost unimaginable. To describe Paul’s marathon stay in the emergency department as a dystopian nightmare would be a completely fair description.

When Paul told me this story for the first time, I was laugh-crying so hard because the way he told it was hilarious (if any of you know or have met Paul, he has an amazing sense of humor). But it wasn’t funny back then because he suffered a great deal. When he got back to the U.S, he decided to write a letter to the head of the NHS. Both the written letter and the audio version are included below (I got him to read the letter below word-for-word, but he had to do it in a serious tone given he was reading a professionally written letter). You have to hang out with him to get him to tell it in his more typical, spontaneous, comedic delivery. Enjoy.

The Failure of NHS: A Personal Experience.

Paul E Marik, MD, FCCM, FCCP

This paper describes my unfortunate encounter with the National Health System (NHS) in Central London on a cold and dreary winter day in February of 2018.  I had flown to London from the USA spending over 12 hours travelling to attend a meeting.

While sitting at the conference table, I remember turning my head to better visualize the screen, suddenly developing intense vertigo with the room turning, rotating and whirling about me. This was accompanied by a feeling of intense nausea and disorientation. Although unsteady on my feet, I left the room thinking that I was having a vasovagal attack and needed to sit down on the floor. I had difficulty sitting and so decided to lay down. The symptoms did not improve.  I had broken into a cold sweat, developed projectile vomiting and had a sense of “impending doom” (I thought I was about to die). I had no chest pain or shortness of breath.

My colleagues, recognizing that something bad was happening called 999 (London’s emergency phone number). The operator informed them that it would take “at least 4 hours for an ambulance to arrive and that was no guarantee.” This should have been a warning that I was in great trouble. With no other option, my colleagues wheeled me to a car, placed me in the back seat, and drove me to the nearest hospital. The car journey, which took about 10 minutes, intensified my vertigo and I developed severe and uncontrollable projectile vomiting; I probably aspirated at that time.  

We pulled up to the emergency entrance of the Accident and Emergency (A&E) Department of the hospital (a teaching hospital affiliated with the Imperial College of London). With no response from the A&E staff, my colleagues found a wheel chair and wheeled me into the A&E department. After much discussion, I was placed on a gurney and wheeled into the emergency section of A&E where I was seen by the A&E doctor. I was disorientated for time and place and had difficulty remembering my home address. I was placed on a cardiac monitor; my blood pressure was 140/90 mmHg, my pulse was in the low 50’s, and my arterial oxygen saturation fluctuated between 86 and 88%.

            After taking a brief history and performing a cursory examination (H&P) that consisted only of asking me to show my teeth, clench my fists and shrug my shoulders despite my complaints of vertigo, confusion and disorientation, the A&E doctor decided that I had Meniere’s disease.  I was treated with ondansetron with some improvement in my symptoms.  A normal electrocardiogram and troponins excluded an acute myocardial infarction. Due to hypoxemia, he told me he was going to do a blood gas analysis. He attempted with much difficulty to get a left radial arterial blood sample. Despite much poking and prodding, and knowing that this was a painful procedure, I was surprised that I did not feel a thing.

Due to the persistent hypoxemia, my colleague suggested that I might have had a pulmonary embolus (PE). The A&E doctor seemed puzzled by this suggestion and argued that I had no risk factors or features of a PE. After much discussion, he agreed to perform a d-Dimer test. This came back markedly elevated (1305 ug/L- ULN 275 ug/L). After a discussion with someone on the medicine team the A&E doctor told me that computerized tomographic pulmonary angiograms (CTPA) could not be performed at night and that I would need to be admitted to the medicine team to have a CTPA performed.  

At this time, I was moved to another room at the back of the A&E department. After about 4 hours, my disorientation and confusion began to clear and I began to appreciate the gravity of my situation. I asked the nursing staff when the medicine team would see me; she responded that she had not seen the team for hours and that I should be patient.  

After waiting several more hours, I again enquired as to the status of the medicine team and was told that they had arrived in the A&E but there were many patients ahead of me. After waiting for about 10 hours, the medical registrar finally arrived. He did a very quick H&P (no neurological examination) and told me I would have to wait to be seen by his attending.

About two hours later the attending arrived, and she too did a very brief H&P. She told me she was unable to order a CTPA and that I needed to be seen by a pulmonary doctor. Sometime later, the pulmonary doctor arrived. She auscultated my lungs and told me she could order the CTPA but there was no guarantee that it would be done that day. I explained my situation and pleaded with her to get the test done as soon as possible.

After waiting for about 3 more hours the CTPA was completed and I was told that the result would be available within one hour.  I was wheeled back to the A&E and placed in different room; I was moved twice again eventually being deposited in the plaster (casting) room with broken plumbing and lighting. I was once again totally ignored by the nursing staff.

After waiting for about 4 hours, I asked the nurse when I could expect the results. I was told that only the medicine team could give me the results, that they were busy, and that they would get to me sometime that day or the next.  The nursing staff was extremely harsh and unwilling to help. After being held captive in the A&E department for close to 20 hours and having received very little to eat or drink I realized that I was in big trouble.

I wanted to sign myself out of the hospital but was reluctant to fly home without knowing if I had had a PE.  At this time, I went to the central station in the A&E. I introduced myself to two doctors and explained my situation pleading with them to get my results. I was told that only my medicine team could do that but they would see what they could do. So, I went back to room 23 (the plaster room) and waited; no response. I tried to get the attention of some of the nurses and other doctors who were in the passageway, but was ignored.  

Eventually, I was able to get the attention of a young doctor who was the first healthcare provider to listen to me and show compassion and concern. She tried to contact my team but they were “unavailable” and could not be reached; apparently they were no longer on call, were not in the hospital and would only return the next day.  She was kind enough to print out all my records (which included my CTPA report indicating I had not had a major PE) and advised me to “get the hell out this hospital and sign myself out.” 

This is exactly what I did… I  got dressed and walked out the hospital without signing a thing. When I landed at John F Kennedy (JFK) airport in New York, I kissed the ground, happy to be home (and alive). After undergoing a number of screening tests at home, the most likely diagnosis was benign paroxysmal positional vertigo. The cause of my hypoxia was likely due to aspiration pneumonitis (the CTPA was negative but did demonstrate patchy basal infiltrates).

There are a number of reasons for recounting my experience, which is unlikely to be an isolated event in the United Kingdom. Furthermore, having practiced medicine for over 35 years in various settings and countries gives me the unique insight as to what a patient should expect in a situation similar to mine. Clearly, the system failed. While I recognize that A & E departments tend to be chaotic, they provide a point of entry into the health system and need to provide both safe and efficient care.

With cuts in National Health System (NHS) funding, a recent report demonstrated clear evidence of health systems failures, which included “ambulance call-out times and waiting times in A&E”.[1,2]  The hospital experience can be a terrifying one, however, we clinicians may have underestimated just how terrifying it can actually be. Health care providers need to engage with patients, act in a professional manner and be caring and compassionate. I felt dehumanized, helpless and abandoned.  

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Notice this occurred a few years before the pandemic. Reading Paul’s letter in the wake of my recent posts on the proximate cause of the catastrophic non-care delivered to the UK care home residents in Spring of 2020 is unsettling. I might have to re-think the idea that spontaneous mass euthanasia by U.K care providers is inconceivable. Whoa.

References

1.   Hiam L, Dorling D, Harrison D et al. Why has mortality in England and Wales been increasing? An iterative demographic analysis. J R Soc Med 2017; 110:153-62.

   2.   O'Dowd A. NHS cuts have played part in rise in excess deaths, study claims. BMJ 2017; 456:j875.

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