My Dad’s a Goldfish – gallstones saga

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This is a long post and is part one of a two-part post. This describes the events which I believe triggered the metamorphosis into the Goldfish.

Saturday, January 20, 2007. Around 9pm, the Step-monster (though the monster title had not yet been entirely conferred at this point) called to say dad had severe stomach pain. The DH went to see him, found him in agony and called NHS 24. A doctor arrived within a couple of hours, thought it might be pancreatitis, gave a morphine injection and agreed it would be quicker for the DH to drive to the hospital rather than wait for an ambulance.

Maybe he arrived at the hospital doors sooner, but the admission process was no quicker. DH phoned with an update about 1am to say junior doctor had been round, had bloods taken, a drip put in and a ‘nil by mouth’ rule in place. Next update was to say dad had vomited but was dozing as the morphine kicked in. DH arrived home sometime after 2am.

Sunday 21 January. No doctors around this afternoon. Wee-sis went in at night. Reported back that dad was very confused.

Monday 22 January. Ultrasound followed by diagnosis of gallstones. The doctor is treating the inflammation and infection with antibiotics and hopes surgery won’t be necessary. If he sticks to a low-fat diet future episodes may be avoided. I hope someone will convince Step-monster of the necessity to put the frying pan and deep fat fryer into retirement. He was dozy when I visited but as he’s had nothing to eat since his evening meal on Saturday, it’s not surprising. The god-like creature called a consultant has not been to see him following the ultrasound so no one would cancel the fasting order. I managed to speak to someone else’s consultant who said he could have a cup of tea. By then the trolley was on its way out of the ward. I chased after it, managing to procure a cup of tepid, stewed brew.

Tuesday 23 January. It’s difficult visiting dad – so hard to find anything to talk about. It’s as if he’s shutting down mentally, living in his own private world. They’re keeping him in until he’s sorted out including eating properly. It might help if they fed him. Still nil by mouth. Apparently they are still considering surgery once the inflammation has cleared.

Wednesday 24 January. Dad’s condition is so bad now that that when they decided to operate after all, the anaesthetist said it wasn’t possible. His kidney function is not good. He has not eaten since last Saturday’s evening meal – well, he’s had two cups of consommé and two bowls of jelly. Other than that it’s sips of water and a drip. Now they’ve inserted a catheter so he doesn’t even get out of bed to go to the loo. They say they don’t want to give him food as that will start the production of bile and possibly worsen the gallbladder condition.

Thursday 25 January. He now has the additional complication of a lung infection. They decide to drain the gallbladder. Excruciatingly painful procedure for him. We are at our wits’ end. Can’t ever find a doctor to talk us through what’s happening. Nurses know nothing – or aren’t allowed to discuss anything.

Friday 26 January. The drain came out during the night so the poor man suffered that painful process for nothing. Today he has swollen up like a balloon – stomach, arms, legs all bloated – kidneys not functioning well…. it’s like everything’s shutting down. He’s been moved to the High Dependency Unit. What a difference! Why can’t they be like that in other wards? Totally different attitude – nurses who introduce themselves to dad, talk to him, joke with him and listen to him. He was already a bit brighter tonight. The doctor even came in to see him after she went off duty.

Saturday 27 January. Spoke too soon. Went in this afternoon. Dad totally out of it – hallucinating, rambling, and with no idea where he was. This wasn’t the usual sense of confusion, which we’ve noticed sometimes when physically he is not well, like last year when he had pneumonia. This was weird. It’s hard to explain. If you heard him you would have thought he was perfectly lucid. He talked about the doctor taking him out in the car to a town not far from where we live, picking up a hitchhiker – a student – described the house where they went, talked about there being a special place inside the car door for the urine container, the noise from the student’s room – on and on he went.

This afternoon only one staff nurse was on duty. He was talking to another patient’s family and pointedly ignoring me. Finally, apologising for interrupting, I explained my concerns. He said: “Oh, they all get confused.” I said this kind of confusion was really not normal (is there a normal confusion?) but he shrugged off my worries. I left the ward, burst into tears and phoned the DH, crying hysterically that they were killing my father.

When DH phoned the ward the staff nurse downplayed our concerns. DH asked him to call a doctor and nurse got really shirty saying he didn’t have time to call for doctors every 5 minutes. DH went to the hospital and found a duty doctor who took a message to one of the doctors who is on dad’s team. She had been in surgery and it was after 10pm when she went to see dad. She had to sedate him because he was by then so agitated he was trying to remove the drip and his catheter so he could leave the hospital.

28 January 2007. Dad not so confused and temperature down so looks like infections are clearing. The doctor who finally saw him last night said she thought the mental side was taking a couple of days to catch up with the physical decline and so, although he was physically improving, mentally he was still when he was at his weakest. He was moved back to ward 6. Hopefully tomorrow we’ll see a further improvement but he’s still to have the drain put into the gallbladder again. He’s still not allowed to eat although he won’t be having surgery.

29 January 2007. After eight days of starvation they finally gave dad some food.

To be continued…

 

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My Dad’s aGoldfish – Has he ever had gout – part two

cropped-goldfish-87-1254566814ncva1.jpgThe consultant who diagnosed gout told us they wouldn’t usually admit someone with gout. Unfortunately he couldn’t allow us to take the Goldfish home at that point as he was well through being processed into the system and, because it was Friday night he wouldn’t be discharged until Monday.

Our offer to come in to help the Goldfish eat his meals was accepted though they said not to bother coming in for breakfast as they had enough staff. The DH went in on the Saturday to help with lunch.

He returned, spitting nails. He’d arrived shortly before 11.30 and found the Goldfish in the ward we did not want him in. Not only that, he’d had no breakfast and nothing to drink. When the DH asked a nurse about his medication she’d smiled, saying: “Oh, he was sleeping so peacefully. Thought it best just to let him sleep.” He succeeded in getting the Goldfish transferred to another ward – though his lunch disappeared during the move.

We kept thinking about the wonderful nurse who had spent so much time gathering information on how we deal with the Goldfish when he’s in one of his ‘sleep-mode’ days, ensuring he gets his meds and food. The poor woman could have knocked off work at her usual time because everything she recorded was ignored.

I recorded in my diary that evening: “I’m on a downer about everything right now: the Goldfish being in hospital, not doing any writing, our lives being totally disrupted. Everything sucks right now.”

The staff on the new ward started the medication for the gout and when I went in next day the Goldfish was sitting up, wide awake and very alert. Yay for steroids! The pain was greatly reduced. We looked at magazines while waiting for his lunch to arrive. It was lovely to see him smiling. He ate well – mince and potatoes followed by apple tart and custard. He was still on excellent form and with a good appetite in the evening.

Diary entry: “The Goldfish is bright and cheerful and should be home tomorrow. Not a bad day all round.”

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I only just found this photo, which has nothing to do with the post about gout. It’s  from two months earlier when the Goldfish celebrated his birthday in hospital.

My Dad’s a Goldfish – Home at last

cropped-goldfish-87-1254566814ncva1.jpgThree weeks after his seizure, the Goldfish was discharged from hospital. I had a busy day before he came home, tidying the house, shopping for food, buying a sofa so that when he is in his recliner chair we can be sitting close to him both for reasons of togetherness and hearing, paid his bills and cooked dinner. I also had to contact the various care agencies who provide care services to make sure the Goldfish was back on all their rotas.

The Goldfish was delighted to be home though he asked, almost at once where the step-monster had gone and when would she be back. It’s been a while since he asked about her and can only think coming back home jogged something in his memory. We did our usual muttering about how she’d gone to see her sister. How could we tell him she’d left him?

He has come home still with a catheter in place. While he was in the infirmary we had asked nurses repeatedly about this and why it had never been removed – not once – to see if he was able to pass urine without it. Finally tracked down the doctor who seemed genuinely surprised to hear the catheter had not been removed and wrote a note to this to be done. His instruction was ignored.

At the community hospital, I tried again and was initially told they’d give him a day or two to settle in first. Maybe I should have insisted they did it on the first day but I let it go. It was several days before they finally removed it and it was back in place before I went in to visit. They said he hadn’t passed urine. I tried pointing out that he could go for hours without having a pee, even when taking his water tablets, and I didn’t think they had left it out for long enough. The matter, as far as they were concerned, was now closed.

Now we had to be even more vigilant in making sure the Goldfish drank enough to prevent urinary tract infections and we had to learn how to deal with urine bags and night bags and all the rest of it. Oh, and how to get his elastic stockings on while keeping the catheter in place.

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About to do battle with the elastic stockings

It was lovely to have him home and see his obvious enjoyment of being back in familiar surroundings. The Goldfish went to bed happily around 11pm – and slept all night. Joy! And was more than ready for his breakfast next morning with his number one care assistant.

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Tucking into breakfast

My Dad’s A Goldfish – in hospital (still)

cropped-goldfish-87-1254566814ncva1.jpgThe Goldfish had been in the infirmary for almost two weeks when he was transferred to the community hospital for ‘rehab’ before coming home. During his time in the infirmary following the seizure, he had recovered from two bouts of pneumonia, had had other seizures we were not told initially about and after so long in bed had lost his mobility.

The first time we went in he was sitting in a chair beside his bed. On the notice board above his bed it said he couldn’t walk unaided and he must have two people helping him with his walking frame. The Goldfish obviously hadn’t read this and several times had attempted to get up and walk.

He was transferred on his birthday so we arrived with cake, cards, including one from the young lad with a collapsed lung who’d been in the bed opposite the Goldfish in the infirmary and gifts, Although he had no idea it was his birthday, and the news that he had reached the age of 88 didn’t seem to mean anything to him, the Goldfish was happy to tuck into his chocolate cake. He choked a few times but this in no way put him off.

Next time I went in the Goldfish had caused a bit of a panic when they’d lost him. Maybe he had read the notice and thought: “I’ll show you who can’t walk.” He’d borrowed another patient’s walker and taken himself off to explore – or maybe he thought he was going home. What worried the staff most was that they had left a door open and feared he might have got outside. They found him sitting alone in the physiotherapy department and escorted him back to his chair. Then, they fitted an alarm – an electronic tag at his age! It was a wire attached to a box gadget which sat on the bed. If he stood up and moved away the wire would slide off the item of clothing to which it had been attached setting the alarm off. A nurse would appear before he had the chance to go walkabout.

On my next visit – we went several times a day during visiting hours and at meal times to make sure he was fed – the Goldfish decided he was coming with me. He stood up and I watched for the wire to unclip itself as he moved forward. However, he picked up the box and slipped it in his pocket so the wire remained connected. I swear he winked at me.

Next time I discovered him down a corridor, sitting in a wheelchair he’d ‘borrowed’. He used it the way Fred Flintstone drove his car – feet going as fast as he could make them. “Hello, dear,” he said when he saw me, big beam on his face, eyes twinkling. Those moments of utter lucidity and clarity are astonishing and precious.

My Dad’s A Goldfish – It’s not just me!

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The Goldfish in his chair enjoying a visit from a neighbour’s cat.

I’m interrupting the chronology of the Goldfish’s lengthy stay in hospital to share some words from the chief nursing officer in Scotland, Professor Fiona McQueen.

Often I feel I am a grumpy old woman, always complaining about nursing staff (and often some doctors and care agency staff) who don’t listen, are not professional and seem to have little or no understanding of patient care. I was delighted, therefore, to read first in the newspaper and then on her blog that it’s not just me. Someone a lot higher up the food chain has also noticed, publicly commented and expressed a desire to see things change.

In her New Year blog post Professor McQueen gives examples of the kind of bad practices she has witnessed during 2015 and writes: “I expect registered nurses to speak to all patients and their families with unconditional positive regard and never again will a registered nurse say to a patient, ‘if you wet the bed we’ll call you pishy-pants

“At all times I want nurses and midwives to put their patients first. No skipping off for a break when relatives need to speak to you or, worse, when patients should be having their meals served.”

As you might expect there has been a fair amount of outrage at her words from nursing staff and from their union. Gordon McKay, a registered nurse and chairman of Unison in NHS Ayrshire says: “My experience is that nurses work unpaid, way beyond their contracted hours to provide world-class care rather than ‘nipping off for breaks’ as is claimed, and that nurses speak to patients and relatives with the greatest of respect and kindness…”

Well, Mr McKay, threatening to call a patient pishy-pants is neither respectful nor kind.

The outraged ones don’t seem to have noticed Fiona McQueen also says: “I have met some outstanding nurses and midwives and hear of examples of care being delivered that is so good it’s breath taking.”

This is something many of us on this and other blogs have discussed and we’ve all said that there are nurses (and carers) who are wonderful and do a fantastic job – but they should not be the exception to the rule. I am sure many good nurses must be cheering (even if they have to cheer in private) with relief at Fiona McQueen’s words. How disheartening it must be to see colleagues bring your profession into disrepute.

Professor June Andrews, a registered nurse and director of the Dementia Services Development Centre at Stirling University has given her support to the chief nursing officer’s words. She says: “As a hard-working nurse, knowing that other nurses and midwives who, not for want of resources but because of attitude, bring down the profession, I would be glad to have them outed.”

The day after the story appeared in a national newspaper Fiona McQueen issued an apology saying she had not intended to offend hardworking nurses. I don’t think it IS the hardworking nurses who will be offended and I salute Professor McQueen for telling it as it is and for wanting all nursing staff to work together to eradicate bad practice.

You can read Fiona McQueen’s blog post here.

My Dad’s A Goldfish – Jelly

In the great trifle debate, I’m not an advocate of jelly being included. In fact, I’m not really a jelly person. I’m sure I ate it at parties when I was a small child, possibly may even have liked it but other than a vague memory of mashing ice cream into red jelly, turning it into a pink swirl, I don’t really remember.

My mother made a kind of milk jelly with evaporated milk and I do recall eating cubes of undiluted jelly as a teenager. We’d heard or read somewhere the gelatine it contained was good for making our nails grow strong.

As an adult I have never felt the need to eat the wibbly-wobbly stuff and would never choose it on a menu – even if it did have champagne in it or liqueur soaked raspberries. I am beginning to worry though, if the time will come – when I’m in my dotage – if I will be forced to eat the stuff again?

The reason I am worrying about this is because I’ve noticed a marked tendency for nurses to order it for the Goldfish. Like me, the Goldfish would never choose jelly for pudding. His choice would be apple pie and custard, sticky toffee pudding, syrup sponge or, if it’s a cold sweet then he’d go for banoffee pie (his favourite) or a rich chocolate mousse. Okay, I know those are not all options on a hospital menu but the sponge puddings and apple pie are. Jelly ALWAYS is.

For some reason during this hospital stay it’s been impossible to fill in the menu for the Goldfish, which means the poor man has been presented with jelly on several occasions. He doesn’t eat it.

Me: “Would you like me to fill in dad’s menu card?”

Nurse: “Already done.”

Me: “How is his appetite? Is he eating better?”

Nurse: “Well, he didn’t eat his pudding.”

Me: “What was it?”

Nurse: “Jelly and ice cream. Nice and easy for him.”

Me: “But he doesn’t like jelly.”

Nurse: “He said that was what he wanted.”

Me: “It’s in the notes we brought in for you and in the notes they made on admission for likes and dislikes.”

Nurse: “I asked him what he wanted and he said he wanted jelly.”

Me: “No, you asked him if he wanted jelly and he nodded. He has dementia. If you asked him what he wanted he wouldn’t remember the list of choices and be able to decide. He can’t make choices but he is still the polite, eager-to-please gentleman he always was and so he will nod in agreement to whatever you ask or suggest.”

She scrawls NO JELLY!! on the board above the Goldfish’s bed and vanishes down the ward, no doubt swearing about stroppy family members who seem to think they know best.

My Dad’s a Goldfish – Hospital continued

Day 2: I visited the Goldfish in the afternoon but he was asleep, looking very peaceful and did not wake up. The nurse I spoke to said he’d eaten lunch and had been “very happy and cheerful earlier”. I wanted to believe her.

DH went in the evening. The Goldfish was asleep. He woke, grunted something unintelligible and went back to sleep. DH returned to report that staff is disappointed with the lack of progress the Goldfish has made and a doctor had ordered the drip, which had been stopped when he seemed to be doing well in the morning, to be put back in again. The doctor also wants an MRI scan to be done.

Day 4: The Goldfish was so much better – astonishingly so. He was sitting up, bright and alert, delighted with the chocolate and biscuits I brought. Anyone seeing him would wonder why he was in hospital! They were even talking about him coming home soon – which is worrying as he hasn’t yet been out of bed. And he still has the catheter in.

Day 5: The Goldfish wasn’t quite so bright today. He is still in the admissions ward as no bed has become available in either of the two wards to which he could be admitted. They are no longer talking about sending him home. I learned today about the power an occupational therapist (OT) can wield.

The OT is concerned about his mobility. He hasn’t been out of bed since his arrival in hospital and she wants to see him walking before allowing him to be discharged. He won’t be discharged within the next two or three days – which will bring us to a weekend, unless he comes home on the Friday. I noticed the pain chart records the Goldfish is not in pain. I ask how they know this because I know his arthritic hip is very painful. The nurse said they ask him if he is in any pain. I point out he has dementia and she huffs at me.

Day 6: The Goldfish was finally transferred to a ward but is not doing well. DH, in an attempt to stop me pissing everyone off with my sarcastic questioning of their care of the Goldfish volunteered to talk to the staff. He is the most diplomatic, Wee-sis comes next in the diplomacy ranking – I come nowhere.

DH came home fuming. “The nurses,” he said, “know everything. They won’t listen or accept what anyone else can tell them about the patient in their care. They know.” Usually he can find something positive to say, but not tonight. No scan done. Catheter still in place. I just feel so depressed. The Goldfish very poorly.

Day 7: I went in this afternoon and found the Goldfish really not well – despite being assured he was “comfortable” and had had “a settled night” before I went in to see him. He was struggling for breath. Time for diplomacy was over. I pressed the buzzer for a nurse and insisted there was something seriously wrong and I wanted a doctor to see him. She pulled the curtains, insisting I step outside while she and another nurse examined him. They called for a doctor.

A junior doctor arrived and invited me to join him INSIDE the curtains while he examined the Goldfish. He has pneumonia. Antibiotics and a drip sent for. The doctor was lovely – talked us through what he was doing and why. I smiled to myself when he got in a bit of a fankle with the syringe of blood he’d taken and asked me to hang on to it while he attended to the drip. I suspect a nurse should have been there but we got on fine without one.

Day 8: The Goldfish much better again and eating well. He is one tough cookie. I have no idea what gives him the strength to fight back so hard – but fight back he does. We had a chance to speak to a doctor. He said the seizures are part of the dementia and they will put the Goldfish on an epilepsy drug. We discovered during the course of the conversation the Goldfish had had more than one seizure since admission – but no one had told us. The MRI is now not considered necessary. The doctor made a note that the catheter should be removed.

Fingers crossed we’ve turned a corner.