A discursive look at Napoleonic & ECW wargaming, plus a load of old Hooptedoodle on this & that


Thursday, 10 December 2015

Hooptedoodle #201 - Mrs Moore's Rice Pudding


Thirty-something years ago, in a small room off the cancer ward in a big Liverpool hospital, my grandmother – who had been unconscious for some days – was breathing her last, surrounded by her grieving family. There was a knock at the door, and a large Irish auxiliary nurse stuck her head in, wondering if Mrs Moore would care for some rice pudding.

My family has treasured this story for years, and somehow it captures something of my feelings about hospitals – they are filled with caring, earnest people – lovely, vocationally motivated people who strive to help the sick and the infirm – but somehow the sum of their efforts is hamstrung by lack of cohesion – they are defeated by the holes in the system.

This week my mother has been admitted to hospital in Edinburgh. I share this story not because I seek sympathy, nor to lay before you a personal tragedy; I have a sense of inevitable disaster – like a canoe at the top of a waterfall – however much frantic paddling we do, I fear we are going over. Mostly I am bewildered, rather than angry.

A little background – just sufficient for the journey. My mum is 90. When she was a small child she had polio. She recovered well, and she has enjoyed very robust health ever since. However, there can be a long-term issue with polio – the repairs which the body makes to the nervous system are astonishing, but they do not have the same warranty length as the original kit. Eight years ago she started to suffer progressive paralysis of her left leg and her hands. She lives on her own, and she now moves about her home with a Zimmer walker and she has a stair lift. She manages well – she enjoys her books and her memories and her Mozart CDs and (especially) her independence, and she has a daily 2-hour visit from a carer, plus whatever support the family can provide. It works, but it only just works – it would require only a small further deterioration in her mobility to render her situation untenable – a fact which is always at the front of my mind.

Last Sunday she had the second of two minor falls within a space of 10 days, but this time she hurt her knee – some kind of muscle sprain – and could not get up. She phoned me, and I went round there to find her sitting on the floor, in some pain but completely sensible and rational. I could not lift her without causing more pain and possibly further damage, so we rang the NHS 24 service. After an hour on the phone, explaining the situation to a series of listeners – starting from the beginning each time – we were sent an ambulance. The ambulance crew were wonderful – I can’t praise them highly enough.

The next step was a no-brainer – they could attempt to sit my mum back in her armchair, where she would be trapped and helpless until further notice, or they could take her to a hospital in Edinburgh, where her injuries could be checked out.

Some times on this: she fell at 11:30am, the ambulance showed up at about 15:30, she arrived in the Accident & Emergency department at around 16:30; she was examined and sent for an X-Ray, and was eventually admitted to an Orthopaedic Trauma ward at around 23:00. That’s a long day when you’re 90. This is not a complicated case – in emergency terms, she was not a high priority, but it is very obvious that the process consists mostly of hand-offs – by the end of the day I had described the incident and her medical situation to about 7 sets of people – each of whom appeared to be starting again from the beginning. Everyone is waiting – waiting for a porter, waiting for an X-Ray to come back, waiting for a doctor to be available.

The A&E doctor explained that the intention would be to check the extent of my mum’s injuries, get her leg rested and better, and set about fitting her with some kind of leg brace, which would be a big help in avoiding further falls at home.

All good. By the next morning, upstairs in Orthopaedics, her temperature was up a bit, and she appeared to be confused. The charge nurse spoke of a suspected urinary infection, which they would treat with antibiotics, and she checked with me for any known allergies.

On each of the next two days (which brings us to yesterday) Mum was even more confused and more agitated – yesterday she was having actual hallucinations. I have yet to see the same member of staff twice – each day I was told that a urine test had been sent away, and it would take two days for the results to come back. Apparently this is another urine test each day – so we are in full Groundhog Day mode. No antibiotics have been prescribed – the latest suggestion was that they might start them last night, but they’ve been saying that for a couple of days.

We are back to Mrs Moore’s rice pudding. The ward is full of friendly nurses who are kind and enthusiastic, who look after the physical needs of the patients and offer them cups of tea (even the unconscious ones), and measure vitals signs and scribble things on charts. Nobody knows anything.

More worryingly, the very junior doctors I have been able to speak to don’t know anything either. They cannot answer any question which is not covered by the particular page of notes they have open in front of them, they are evasive and – in one instance – incorrectly informed. They are waiting for some other department or some remote authority to do something, to make a decision. They don’t make decisions themselves – decisions might involve blame.

So my mother, who hurt herself, painfully but not too seriously, 4 days ago, is now becoming very ill with something which was not a problem when she was admitted. She will certainly not be getting home any time soon, and I have a very bad feeling that she has just become another faceless dementia victim, who will be expected to die and free up a hospital bed. That, I believe, is the correct procedure. It will be nobody’s fault, and no-one will know how it could have happened, and the latest urine test results will arrive back on the charge nurse’s desk two days later.

If no antibiotics have started by this evening I am seriously going to rattle someone’s teeth. Who is in charge of killing off the elderly patients in these places? – that might be the person to speak to.


9 comments:

  1. I'll just say I have a bit of experience in this area. What you should do is be there for the team's morning rounds, this will be before visitors' hours so you'll need to slip into the ward- not too hard. Then have a written list of questions and get the team to answer it when they round. If there's anything pending (e.g. urine results) get the name and contact details for one of the junior docs (ask for the PGY1 or 2) and tell them you'll contact them that afternoon for the results. They're busy, but they will help you out.

    Best wishes, let me know if this works or you need any other advice.

    Barks

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  2. I am often glad that I abandoned the big (ok medium) city for rural life near a good but small hospital where it wouldn't take long to cycle through all the staff.

    2 years ago when we took my (now late) mom-in-law in to emerg it was my first experience (for which I am thankful) as a walk in (my only other experience was being wheeled in from an ambulance and I wasn't really paying attention). I was pleasantly surprised that the 91 yr old Joan was spotted and jumped ahead in the queue by staff supported by various in waiting customrrs. My wife only had to repeat her diagnosis about 3 times before they did a quick test which confirmed her diagnosis (dog groomer but.....), applied meds, and 2 hours later we were heading home. I was extremely impressed.

    My own brief experience after being shipped off to Halifax was more of being wheeled here and there for something or other and never being allowed to see the same person twice. The highlight was being there for morning rounds and having them draw the curtains then proceding to discuss we. I finally learned abit but had to restrain an amused guffaw and stifle an urge to call out "I can still hear you!"

    Any way, best wishes for your grandmom and you.

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  3. I am sorry to hear this Tony. It does make me wonder, in one of her last books, Children of Men, if P.D. James was on the mark when she invented a government-administered euthanasia program for the elderly called "Quietus".
    In November, while my wife Kay was getting chemotherapy, the night after one of her treatments she began to leak fluid out of the subcutaneous port then installed in her side. Since the chemo drugs are quite toxic, this was alarming. We went to Emergency, where the staff were equally alarmed. After three hours waiting, we were given a supply of absorbent bandages and some gauze tape to get us through the night until we could go back to Oncology in the morning. The ER doc, a kindly and harried fellow, told us that the drugs were "quite nasty" but we already knew that from observing the precautions taken in the chemo ward. In the morning we went to Oncology and were told that the ER staff should have consulted the on-call oncologist. Except, no one in ER seemed to know that there was an on-call oncologist. As you say, no one knows anything. It all makes me hope that when it's my time to fall off the twig, I get hit quickly and comprehensively by a large truck.
    Keeping you and your mum in prayer.

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  4. I wish you and your family the best, my friend.

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  5. Experience with my missus after her experiment with gravity (7 months ago - still no decision on whether surgery is essential/desirable) dictates that hospitals are no places for sick people. The doctors and nurses are great, caring and hard-working; it's the administrators who are foisted upon both them and us that cause the ructions. We have opened a book on which notes are most likely to get lost, the handwritten or the computer-input ones. All the best for you and your mum, mate.

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  6. Thanks for supportive comments and emails - advice appreciated.

    On Day 4, the antibiotics are underway. My mother is less distressed, and the confusion is less extreme - certainly less offensive. Apparently the hospital have a policy of cutting down on the quantity of antibiotics they dish out - they try to avoid the risk of patients and/or viruses becoming resistant to them. My mum is 90 - it does occur to me that she is unlikely to develop a resistance to anything in the time she has left. I am not a doctor, of course.

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    Replies
    1. Tony, sorry to hear about your mum (and you) going through the mill. God knows what the answer is to this sort of 'merry-go-round' that we get in hospitals. Good to see she's finally getting the treatment she needs.

      Re; antibiotic resistance, I think they are worried about drug resistant strains infecting the general population. I understood the policy now was to prescribe it less frequently but when they do to give such a high dosage not enough 'bugs' survive to evolve.

      All very logical but I guess you're wondering why did it take the hospital so long to conclude the you mum needed antibiotics.

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    2. Hi Chris - the antibiotics are now running, but the late start means that my mum became very ill in the interim - she is now getting oxygen, regular bloodtests and scans to check for pneumonia - she looks like a pincushion - battered and bruised. If I stuck that many needles and probes into an old lady they would put me in prison.

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