I thirst

There is a horrendous story in today’s papers about a young man who died in a London hospital from dehydration. Throughout a catalogue of disasters and omissions by the hospital, the 22 year old even dialed 999 to try and get the police to get him a drink of water. It is a horrible, horrible story and one which resonates with me too. My father, who has multi-infarct dementia, has been admitted to hospital several times in the past few years with dehydration. The care-home where he lives often ‘forget’ to give him water to drink and as a result he starts to become seriously unwell, fits and eventually is admitted to hospital. Although he is given coffee at certain points of the day and juice with his meal, he has to be prompted to drink it. He forgets to drink what is in front of him.

It is not a huge care issue – to prompt someone to drink. Without the prompting he just forgets. It is not like dealing with incontinence or wandering or shouting which many others in the home do. All it takes is for a member of staff to remind him to drink whenever they pass him. And to make sure that he has a drink beside him all the time. That’s not a big care issue in my books. We’ve even had it written into his Care Plan because for a while there were so many temporary staff nobody knew about it.  But still I will visit and find him with no drink beside him.  He has a catheter so it is important that he drinks plenty fluids. There’s barely a month goes by without him being on antibiotics because of an infection with that and I wonder if drinking more might just help.

We used to always take drinks in for him when we visited but were told we didn’t need to because they would provide it. And sometimes they do. But not always. He has gout too and what is one of the causes of gout recurring? Dehydration. It just seems such a simple thing but somehow it doesn’t always get done.

And hospitals are not excluded from this either. For when he is admitted and is given a drip it sometimes takes 4 days to rehydrate him. Then when he is taken off the drip the problem starts all over again. Water jugs out of reach, full cups of coffee removed because they are cold but nobody thinks that this means he hasn’t drunk anything.

You’d think it was such a simple thing. We are not a developing country; water is freely available. But time and time again I visit people in hospital suffering from dehydration. It is just so preventable and so simple really. Their needs are few. They thirst. Just give them a drink.

Greeting St Joseph and all dads

Today is St Joseph’s day and we prayed for all fathers this morning.

Got me thinking about my own dad. Not a teach-your-child-carpentry kind of dad. Carpentry or DIY was not one of dad’s gifts. But he did teach me how to do the cryptic crossword in the Scotsman and was even known to phone at 7am to ask if I’d finished it and did I know what 3 Down was. He also taught me how to hold my drink, which was terribly important in my hedonistic youth. He taught me the importance of good communication in business and how to mix with people from all sorts of backgrounds. He passed on his ear for music and his wide feet and curly hair.

Now that he has vascular dementia he teaches me patience. He teaches me the Sacrament of the Present Moment. For when I visit now, there is no exuberant conversation from him, no jokes, no plans for the future – just silence. No chats, no questions, no enquiries on how we’re doing, no news from the rest of the family. Of course I can ask those questions but there is really no point for he can’t remember and gets a bit anxious. So it is all a bit one-sided as I tell him what we’ve been up to, give him all our news and then we sit back in companiable silence. We enjoy each other’s presence and enjoy that moment. We have a smoke and we watch whatever is on the loud TV in the smoking lounge. Sometimes I pick up his Scotsman and we have a go at the crossword. Sometimes he even gets the answers to the clues for the cryptic part of his brain still seems to work. But mostly we just sit.

One great thing about growing old is that nothing is going to lead to anything. Everything is of the moment.

Joseph Campbell

Hospital Success Story

Readers may remember that some time ago I had cause to complain to the local hospital after my father was admitted with a suspected heart attack.  Hygiene, lack of ‘old fashioned’ nursing, and other issues were raised.  The Patient Liaison Manager did get in touch and offered to meet with me to discuss the matter and that meeting was today. I met with a manager from A&E and Combined Assessment of Lothian hospitals, someone high up in A&E or Nursing, and someone from Patient Liaison.

I just want to let you know that the meeting was a great success. All the issues had been addressed and I was pleased that they had taken it all so seriously.  A&E staff are even getting further training in working with people who have dementia.  No excuses were given – just hands held up and apologies made that they are trying to make sure it doesn’t happen again.  The grotty floor has even been replaced!

They also stressed that they were pleased to get my letter and to meet and discuss it too.  It had allowed staff to see how they were perceived by patients and relatives and I was told they were horrified.

So, to those who said I shouldn’t have written and that I was a thoughtless daughter, can I merely say that the hospital did not feel the same. In future if you have any concerns you should speak to the Duty Care Manager at the time or write to Patient Liaison as I did. They are always looking at ways to improve.

Hospital shambles

I spent about 6 hours yesterday sitting in A&E of the Royal Infirmary with my dad from 6am to 12noon.

Not once did anyone use the antibacterial handwash in his bay. Not once. But then it was empty so they wouldn’t have had much joy anyway. I did ask a few folk if they’d give me a new one but no joy.

Dad was hooked up to 15 minute blood pressure which was taken automatically, along with his oxygen level and resps. From time to time a nurse had to come in and write these figures down. Most of the time they didn’t say a word to my Dad. No “How are you?” No “I’m just taking a note of this for your file.” No “Everything is looking fine, don’t worry.” No “Can you get you anything?” No nursing. Just note-taking.

At around 8am Dad decided it was breakfast time.  I asked a nurse if it was okay to get him a coffee from the machine in the waiting room. “No,” she replied, “we’ll get it. Just give me a minute.”  An hour later I asked the same nurse if he could get a drink as he suffers from dehydration occasionally and is diabetic.  “Here’s a cup of water.”  At 10am I asked a nurse who had come to write things down again if they ever got breakfast in this place.  (For I’m pretty sure all the nurses did.) “Only if they are well enough to eat and drink,” was the reply.  “Well, he is,” I said. “<Sigh> Alright, I’ll get someone to get it for him. Toast ok? Coffee?”  A young smiley nurse brought it to us 10 minutes later. I didn’t see anyone else being offered anything and not all of them were on death’s door. Far from it, as far as I could see. No wonder they are ill.

The doctor was called away 3 times in the course of speaking to us. I have no complaint about that. There were other sick people. He always came back, sometimes after an hour, and apologised. (Dad thought he was too young to be a consultant!)

Dad was to be kept in for observation for it may have been a heart attack but there were no beds.  We were told we’d just have to wait.  But then someone came in who was quite poorly so dad was put out of his cubicle and parked beside the nurses bay in the corridor.  He was meant to be on oxygen but the nurse who was going to get some portable oxygen never returned.

In the course of our time there I watched nurses deal with a drug overdose patient hand-cuffed to 2 policemen. They wore gloves while dealing with her but then would come out and answer the phone while wearing the gloves. What about the next person who picks up with phone without gloves?

I saw lots of things. What I didn’t see was nursing. What I didn’t see was caring.

Is that too harsh?  Were they busy? Yes, I’d say they were kept pretty busy.  But how much longer would it have taken to talk while doing the blood-taking, or the ECG, or pillow plumping – oh sorry, I forgot, there were no pillows. A shortage.  I didn’t see hand-holding, reassuring arms round shoulders, listening. Too busy to listen perhaps? A listening shortage.  I saw nurses deal with a patient and go back to the computer screens and stand and click the mouse until the next task. Filling in on-line forms? Possibly. But most of the time they didn’t type anything, just stood and swirled the mouse around while looking about – but never catching a relative’s eye.

I realise that emergency medicine is different from ward nursing. But I don’t accept that they are too busy to talk and reassure. And I don’t accept that a system can’t be put in place that someone makes breakfast for those in the emergency ward. For they were not all emergencies, as far as I could see.

Bring back Matron. Not to swish around checking the nurses are all working. No, a Matron who walks round the beds asking the patients if everything is okay.

Memory test

Spent yesterday in hospital with my dad. He was in for a routine procedure in the morning and they happened to notice that his kidneys were failing. The careworker who was with him went off duty at 2pm so we got the call to go in and sit with him because they were keeping him in.

Dad has multi-infarct dementia so has trouble with his memory. He also has a tendency to confabulate which means that if he doesn’t know the answer to a question he will make it up. He does this exceedingly well. I think a lifetime in marketing and advertising means that he has a very vivid imagination and he can spin a good tale. So, its always good if we are there with him because otherwise he can be very convincing.

Amongst the many questions he was asked yesterday was the memory test. Do you know where you are? His answer was the Deaconess Hospital – which closed down years ago. Do you know what day it is? He got that right because we had just told him when he told me he was going to come and hear me preach tomorrow. Who is the Prime Minister? Maggie Thatcher… and then a pause as he sorted out in his head that that was wrong. He knew it wasn’t Tony Blair but poor old GB didn’t surface to his memory. Counting back from 20 was a little haphazard to say the least. And ‘do you know who I am?’ brought the reply ‘well, we haven’t formally been introduced’.  So all in all, I think he did very well.

Let’s hope he’s still there this morning and hasn’t wandered off, drips attached, looking for a place to have a sly ciggie. And what do you take to someone in hospital who has been told no chocs and no fruit because his potassium is so high?