Maria and Helena O'Dwyer taking a break from looking after their father in UHL where Zone A of the A&E department has a maximum capacity of 22 patients. Last Wednesday night, there were 52 patients in there with just three nurses allocated.

The most unwell thing in Ireland is our health system. In 2022, when technical and medical advances can do much to improve our health and wellbeing outcomes, the systemic and repeated failures of our national health system have resulted in a care crisis. 

Daily updates on trolley tallies and waiting list numbers make for dismal reading — we all hear those numbers and secretly hope that our loved ones won’t ever be part of that count. 

For our family, that fear became a reality when our father ended up in A&E at University Hospital Limerick last week. What unfolded over the 54-hour wait for admission to the hospital was symptomatic of the chaos and callousness that now defines HSE services.

Our father required admission to oncology last Monday for an infection. His consultant apologetically informed him that, because of Covid, admission could only happen by going through the A&E department. As he was due to start radiotherapy the next morning, he was assured quick admission as somebody with cancer "could not be left in A&E". 

The next morning, and after a few hours in A&E, he was brought to radiotherapy only to be returned to a trolley on a very busy corridor in... A&E. After many frantic phone calls, he was moved off the corridor and into a side room/bay because of the intervention of a brilliant patient advocate. 

Ironically, dad felt guilty moving into that area because of the 12 other patients, most of whom were elderly, lying on trolleys in the corridor in just that one section of A&E.  Fast forward 50-plus hours and he was still in that observation side room, having been brought and returned from two radiotherapy sessions. 

The idea of undergoing such intensive treatment and being returned (twice!) to the bedlam that is the emergency department at UHL sounds like a piece of badly written fiction. But it isn’t. 

A disjointed system of communication, a skewed definition of risk and the absolute abandonment of any sense of compassion have made this the reality for patients unlucky enough to need its services. While a tome could be written about our recent experience, some particular areas need to be highlighted.

To provide context about what a typical night in UHL A&E appears to look like, the initial waiting area was as busy as you would expect an A&E to be. That is an illusion though because once you are brought through for triage, the real waiting and overcrowding begin. 

The minister for health’s visit to Limerick on February 17 must have been akin to tidying the house before visitors call. It might seem orderly, but the dirty laundry and mess is just stashed away, out of sight. 

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We were in Zone B, a small L-shaped area where all bays were full and the number of trolleys on the corridor in that confined space ranged from nine to 12 during our two days there. Next door, 

Zone A has a maximum capacity of 22 patients. Last Wednesday night, there were 52 patients in there with just three nurses allocated. That kind of overcrowding can only ever result in substandard care.

Clinical and support staff in UHL, like most hospitals in Ireland, are overburdened and overwhelmed. They endeavour to show kindness and compassion but it’s hard to give what you don’t receive. 

They seem entirely quashed by layers of bureaucracy, management and rules that leave little space – and certainly no time – to worry about the dignity of patients. ‘Duty of care’ doesn’t just mean keeping someone alive. It’s a moral and legal obligation to ensure their safety and wellbeing. That includes dignity. 

To see an older man on a trolley being told (for all to hear) that he has cirrhosis of the liver and watching him struggle to understand that diagnosis — while all alone — was heart-wrenching. We noticed another man becoming increasingly distressed. When asked, he told us that he calls his sister every evening. 

His glasses had been lost in his transfer to the trolley, so he couldn’t see his phone to call her and was worried she would be anxious. Such a simple fix to something that caused such distress to an elderly man, on his own. If 30 seconds could have been spared to check on him, hours of stress would have been prevented. 

Another gentleman quietly clutched his rosary beads and flinched every time his trolley was accidentally banged as staff tried to manoeuvre equipment or yet another trolley past him. 

Exposed bodies under half-tied hospital gowns and clinical conversations on open corridors compromise dignity. It is not okay, yet we seem to have accepted it as an inherent part of health care in Ireland.

How UHL interpret risk is mind-boggling. Porters, for example, can’t take patients outside in wheelchairs to get to the Oncology Department from A&E. Staying inside the building, it’s a nine to 12-minute journey, involving many busy corridors and a lift. 

Going outside, it’s a four-minute journey that provides patients with some much-needed fresh air and breathing space, after hours cooped up in A&E. In addition to supporting patient wellbeing, the outside journey also more than halves the time each porter spends getting there, which frees them up for other patients quicker. 

Logistical common sense, however, is no match for HSE risk assessment prowess. There are two ‘bumps’ (small ramps) that seemingly pose a risk to patient health and safety, so journeys between departments must remain inside the building. An interesting take when you consider that trolleys line both sides of every corridor in each of the A&E zones. 

For anybody who has the misfortune to go into cardiac arrest while on a corridor, their journey to the resuscitation unit is entirely dependent on how fast the poor porters can play trolley Tetris. Every time they want to bring a patient in or out of A&E zones, they have to move around all of the other trolleys. 

The fact that a person’s survival could come down to how close a trolley is located to the exit door shouts risk much louder than an easily fixed ‘bump’.

The lowest point of the entire debacle at UHL came in our need to both bring and administer dad’s own feeding equipment to A&E. As part of cancer treatment, he had a feeding tube inserted into his stomach. 

This procedure was done in the Mercy Hospital in Cork, which had luckily discharged him with sufficient supplies of pharmaceutical-grade liquid food. While undergoing treatment, these 1500 calorie bags are his only form of sustenance over 10-hour periods. 

Once it became apparent that the stay in A&E was going to be longer than anticipated, we requested a dietitian as we assumed that the hospital would need to manage the feeding regime as part of his overall treatment. After the fifth request to speak with a dietitian, we were informed that this resource is not available to A&E. 

We drove to our parents' home, collected all of the equipment and food supply, set it up beside his bed in A&E and took it in turns to do shifts to monitor feeding. Neither of us is a clinician. Our father, an incredibly independent and proud man, was too unwell to manage the process himself. 

BYO to a hospital really does beggar belief. You have to wonder what would have happened had dad presented to A&E alone, like so many of the other patients on trolleys. Would he have been left without sustenance until admitted to a ward (54 hours and three rounds of radiotherapy later), dependent on the availability of a dietitian? That isn’t health care, that’s a horror show.

The ‘not in my contract’ curse

While doctors, nurses, cleaners, catering staff and porters were constantly on the move, imagine what could happen if a ‘plus one’ was added on to the contracts of the significant number of office and administration staff in UHL. 

One simple addition to every person’s to-do list would surely support better efficiency and morale? Simple things like checking one area each once a day to see if people on their own have access to a phone charger. 

It’s not rocket science – it’s leveraging existing resources to bring some basic level of compassion back into healthcare.

Finally, communication in UHL appears to be a complex calamity. While patients are asked the same questions over and over again, answers to their questions are as rare as the disposable cups that you would expect to find beside water fountains in a hospital. 

Departments seem incapable of talking to each other and the only unhelpful staff we encountered were those behind administrative hatches, who threw out the standard line ‘I can’t help you with that’ like infuriating confetti. 

A senior clinician, frustrated by our father’s experience, suggested that we post about it on social media as ‘public bad press’ may lead to movement. And they were right. Ten minutes after posting on Twitter, a public response was made apologising for the (then) 45-hour wait. 

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A private message was then received from the hospital’s Twitter account, asking for a contact phone number for follow up. We provided a number – nobody from UHL ever called or followed up.

UHL is staffed by amazingly dedicated people and blighted by systems failure. We wrote this article to give a voice to the many older and vulnerable people we met on trolleys, and to the staff who can’t openly challenge the HSE machine. 

The irony is that the people who are part of that machine – the layers of senior managers and ball-passing decision-makers – don’t seem to realise that one day they may find themselves on a trolley in UHL. They will then learn that this really is no country for old men.

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