Thursday, December 03, 2009

Putting it All Together

My mother has somehow banged her broken shoulder again, and with it some ribs and her neck's hurting too.

The most worrying thing is that she doesn't know how she did it. "I think I did it on my way to bed," she said.

So tonight she's sleeping in the downstairs bedroom so she doesn't have to go up the stairs. She thinks that having one arm in a sling is unbalancing her.

Hmmmmm. Possibly. But, although she says she just banged her shoulder, there were no witnesses so perhaps she actually fell again.

Perhaps she tripped. And perhaps she tripped the first time, when she broke the shoulder.

But perhaps she fell the first time because of a sudden loss of blood pressure - certainly, when she collapsed in the cafe after her first fall, her blood pressure was very low. And perhaps it's just happened again, at home. They did try to keep her in hospital a bit longer to monitor it but of course she wouldn't have it and insisted on coming home.

But just before she collapsed in the cafe, she became very unresponsive - I talked to her, her eyes were open but she just didn't register anything.

Perhaps this was because of the low blood pressure. But - - and here's my most worrying thought - perhaps it was because of a TIA (or transient ischaemic attack, meaning a small stroke). After all, she had a big stroke when she was sixty-eight. And perhaps, when she banged her arm this second time, she had another one.

There's another thing, too. When she had the original fall, on the steps of Park Hotel in Tenby a month ago, she banged her head and cut her nose and it all bled a lot.

But any possible head injury had no medical attention at all, because my mother was yelling her head off and trying to discharge herself from the hospital. But what if a head injury was a contributory factor in the yelling her head off? Certainly, she's had occasional such moments in the past but never so much or so often.

I rang the Intermediate Care Team and they have arranged for Mum to have another X-ray in the hospital tomorrow, to see if she's done any more damage to the shoulder, and I'm going to take her.

I will take advantage of the fact that she's lost one of her hearing aids in the hospital to try to tell a fuller story and to voice all my worries about her.

But, at the moment, because my mother was so difficult to deal with when she was in hospital, it doesn't seem to me as if there's anyone except me who's trying to put the whole picture together.

And, of course, my mother's not usually difficult - she's extremely warm, kind and sweet-natured. She is, however, claustrophobic, and she hates hospitals. What if this claustrophobic-and-hates-hospitals theory might be covering up something else going on?

But tomorrow it's the X-ray department. Will they be willing to listen to this story? And if they are, will they want to keep Mum in for observation? And if so, what happens then? The nurse who booked the X-ray said that Mum became extremely upset and angry at the mere thought of visiting the hospital, though when I saw Mum later she seemed fine about it as she'd realised she was only going to Outpatients.

Now look, I know that I have, perhaps, more knowledge of medicine than many people, even though I have no medical training, because I've done so many medical roleplays on so many subjects. And I speak fluent Doctor, because I've worked with them such a lot.

But really, it shouldn't be down to me, in any way, should it? Surely somebody should be asking some questions about what's going on and trying to put it all together? I just have a feeling that by the end of tomorrow's visit all that will have happened will be some more X-rays added to her file and a little note that says "Daughter thinks she's a bit confused".



Blogger Silverback said...

It shouldn't be, but I believe it IS down to you and you WILL probably return tomorrow with just more x-rays to add to her ever growing file. Well not you personally but they'll go to her doc.

With the NHS, most of us do what we're told as the doctors 'know best' but if someone like your mum doesn't want treatment for whatever reason, there isn't much they can do.

But you must tell someone about this sequence of events and sadly I doubt you'll get a chance tomorrow unless you do so when your mum is actually having the x-ray. The problem will then be convincing your mum to have hospital tests when she just wants to go home.

Apart from slipping something into her sweet sherry and then strapping her to a bed, I don't have an answer for that one !

Sounds like a great roleplay scenario for the future though.

4:08 am  
Anonymous ruth said...

Unfortunately I agree with Silverback, I think it is down to you to give all the information because, even if it is asked for, it's unlikely that your mum will map it out as needed.

However, the person who needs to hear the information is a consultant, not a house officer (unless they are a particularly on the ball SHO). A consultant will then have a duty of care meaning they can't discharge, or rather will have to admit, your mum until appropriate tests have been done. If they don't do the tests and subsequently your fears are proved to have been founded they could face clinical negligence proceedings. If in doubt contact hospital clinical manager.

It's not fair but it is down to you to put it all together. Medics could ask the questions but they won't get the answers from your mum. She is lucky to have you.

7:08 am  
Anonymous Anonymous said...

Yes, I have come to realise that only the patient, and/or their immediate relatives, holds all the knowledge on their condition. Isn't that one of the things medical students are taught: when in doubt, ask the patient.

You may be frustrated to find that your mother's visit to X-ray will only be a glancing interaction with the medical system.

If you get no joy with Ruth's suggestion, you could try re-entering the system vie someone who may be more interested in your mother's overall condition: her GP. S/he may also have her notes/letters from the hospital etc. S/he could then refer her to the consultant most specific to her condition.

I wish you luck and will be thinking of you.

9:03 am  
Blogger Jennyta said...

Unfortunately it does seem that one has to be very persistent when dealing with the NHS these day, psrticularly as, with elderly patients, they seem to give up all too easily. My ex sister-in-law is currently in hospital following a stroke and I hear that they have stopped physio on her affected arm because she is 'awkward and unco-operative'. The more I hear about hospital experiences from my clients, the more I dread the day when either of us may have to be hospitalised!

12:39 pm  
Blogger Debby said...

I was so sorry to hear about your Mum's new injury last night late when Ian told me.

I know things are a LOT different there than here. So, my suggestions might not help.

I was my father's care giver as you know. I went to each and every appointment with him as he lied to the docs. Question 1. Have you had any heart problems Mr. Ellis? Dad: no. Me: He's had 2 heart attacks and a triple bypass. Doc: Are you allergic to anything? Dad: no. Me: He's allergic to sulfa drugs. Dad: that was a long time ago and I don't even remember what happened. Me: your balls swelled up, blistered, and cracked open. Dad: oh yes, that wasn't nice. Doc: Have you had any surgeries? Dad: no. Me: He's had a triple bypass, a pace maker, 3 knee operations, a hernia operation, shall we go on??? Dad: well those don't count. Me: sighhhhh

Difference of course was that my Dad was compliant to my wishes. He wouldn't listen to my brothers, the docs, but he'd do anything I told him I thought he should do. He also hated hospitals and it was a miracle I could get him to go.

Anyway...squeaky wheel here gets the grease. If I hadn't gone in and told the docs everything, over and over, and insisted on tests and further treatment, he'd have been brushed under the carpet. You need to make the doctors understand the whole picture. After they hear it, you need them to repeat it to you. They pretend they're listning sometimes and are not. Even with the NHS you have the right to tell the whole story. Your Mum isn't going to do it, it's up to you. Use your stern school teacher look to get attention...rap on the table, raise your whatever it takes.

If your Mum yells, you might need to yell louder. Ask her if she wants to die. Tell her if this isn't taken care of she's going to be put in a nursing home. Tough love. Tell her she's acting like a spoiled child. Might not get through, but it might. It's hard to be tough with our parents, but sometimes you have to.

Huge hugs to you my friend. It's a tough time you're going through right now.

12:48 pm  

Post a Comment

<< Home