Accuse Not Nature

She Hath done Her Part

But do Thou Thine

John Milton (1608-1674)

  • To recant what mum was given on the 31st:
  • At 7-9am mum was given:

2.5mg Salbutamol Neb

0.5mg Atrovent Neb

625mg Augmentin PO

1.2G Augmentin IV

500mg Clarithromycin PO

40mg Prednisolone PO

5mls Carbamazepine PO

  • At 12.2pm she was given:

2.5mg Salbutamol Neb

0.5mg Atrovent Neb

  • At 12.35pm she was given:

1G Paracetamol PO

  • At 4-6pm she was given:

625mg Augmentin PO

5mg Salbutamol Neb

0.5mg Atrovent Neb

  • At 10-12pm she was given:

1G Paracetamol Disperse

625mg Augmentin PO

500mg Clarithromycin PO

40mg Clexane SC

5mls Carbamazepine PO

5mg Salbutamol Neb

0.5mg Atrovent Neb

1 drop Latanoprost ea. eye

  • It is said that writing things which have disturbed you can be cathartic but this is certainly not the case in my experience of my mum’s ‘treatment’.  It is far too horrendous to cleanse those responsible, or for me to find solace.
  • I truly hope everyone who has any forensic/detective/medical experience is reading this blog, and I would appreciate any observations!

~Act Eight~

  • On 1st at 4.30am a night nurse observed that mum had slept well.  IV infusion continues, incontinent of urine.

At 10am her test was sent to the Biochemistry Lab. which returned the results at 13.26, and showed that her CRP (inflammation markers) were 316 ~ (remember they were 188 in the other Hospital) ~ and her Urea was 13.0.

Yesterday 31st her CRP was 283 with Urea 10.9.

  • At 7am her blood pressure was 113/60.
  • At 7am mum was given:

1G Paracetamol Disperse

625mg Augmentin PO

500mg Clarithromycin PO

40mg Prednisolone PO

5mg Salbutamol Neb

0.5mg Atrovent Neb

5mls Carbamazepine PO

  • At 11.50 her blood pressure was 111/57.
  • At 12-2pm mum was given:

1G Paracetamol Disperse

5mg Salbutamol Neb

0.5mg Atrovent Neb

~Act Nine~

  • What happened next is beyond comprehension.
  • This FY2 knew mum had been transferred from another Hospital.
  • She copied down the initial findings carried out in that Hospital
  • On completing the Admission Report she stated wholly erroneous facts.

1.  She left blank the part of the form which asks where the patient was admitted from (which should be ‘Home’.

2.  She wrote that mum had been transferred from home (which should be ‘Other Hospital’s Name’.

3.  The way the boxes were printed in sequence is:

A:

Date of Admission: 30/01/07

Date of Transfer:      31/01/07

Admitted From:

Transferred From:  Home

G.P.: Name taken from previous hospital’s nursing notes.

Consultant:  FY2‘s Consultant

B:

In listing these wrongly, the Consultant would read:

  • Home, then G.P. which was completely erroneous.

This should read:

  • Other Hospital’s name, then G.P.

The Consultant’s visit recorded:

Feels a little better this am, signs at (L) base persist.

  • Continue antibiotics.

N.B. No instructions to change these. (which occurred the next day).

No instructions to decrease the Prednisolone (which occurred the next day).

  • *Check medications with G.P.
  • * This was never done! There are no records whatsoever of this check having been done or its outcome, nor could there be!
  • A.  Because the medications he referred to were on the list written by his own FY2 (which she took from the first hospital FY2’s notes listing drugs which she had prescribed) and Not the G.P.
  • B.  Further when the Consultant had written on the 31st ‘Continue as above’, he therefore must have assumed from this Admission Document that the list of Medications he was ‘continuing’ came from the G.P. as it was written that mum was Transferred from Home!
  • C.   This meant that mum (unknowingly by FY2′s Consultant that the Medications he referred to and instructed to ‘continue’) was kept on a list of drugs which had been prescribed by an A&E FY2, and not her G.P.
  • D.  The outcome for the ‘check medications with G.P.’ would never be done for the reasons stated above, but also by the time of his next visit on the 5th, mum’s medications had been changed at a rate of naughts to a degree that:
  • 1) Almost all of these original medications had been changed.
  • 2) The Consultant would be unlikely to remember his instruction about the medications and expect an answer to be written (which never occurred) on his next visit.
  • 3) Mum had taken extremely unwell on the penultimate 3rd/4th overnight preceding his next visit, necessitating other changes in medications.
  • 4) Six pages had been written mainly by the FY2 plus an emergency doctor, between his last notes and the 5th.

Previous notes – not available.

  • The Consultant also gave instructions to the Ward Manager:
  • Nebulisers stopped.  Inhalers re-started.
  • FY2 signed off the prescription for the inhalers, wrote 2 puffs of Salbutamol INH and scored through this ~ without initiating any at all?

Mum never received any inhaler at all.

  • In fact No Salbutamol/Atrovent or Inhalers were ever given to mum until 4th after an extremely bad incident!
  • As was usual FY2 copied the Bio. Test:

Note CRP up – 316 (237, 188) Urea up 13.00

WCC 12.74 static.   Creat. 85 (76).

  • N.B. CRP was 283 on 31st, Not 237!

Abs. stable, No change in clinical condition.  ~ Really!

Currently on Oral Aug + Clarithromycin

Plan:

IV Augmentin + Clarithromycin

MSSU – ticked

  • *Despite FY2’s Plan another doctor had written the prescriptions for 500mg Clarithromycin IV, scored through this circled 4 x day, and re-wrote a prescription for 500mg Clarithromycin IV to begin 10-12pm.  Plus 1.2G IV Augmentin to begin 10-12pm.

~Act Ten~

At visiting time on the 1st mum was sitting on a chair with her back to the only open window which had a curtain pulled across it. 

Unknown to me at the time of course was the fact that they even suspected pneumonia as a possibility, which was not a fact then, but would you place a frail old lady in front of the only open window about two feet away if she had?

Her little body felt like a block of ice and she only had on a cotton gown.  No vest.  No dressing gown.  No bed socks.  No stool to put her feet on.  I went to fetch a stool and there was only one for the entire ward (rooms) of 26 beds, because both of her feet were badly swollen.  Never in her life had she looked like this.

I was livid and disgusted and in order to thaw her out I helped her onto the top of the bed covers with the pillows and bed propped upright, put her dressing gown and her bedsocks on, and wrapped a blanket around her legs and feet, because I couldn’t rub them warm as they were so swollen.

 I even said to her “I’m just putting you on top of the bed mum, so that the nurse’s won’t think I’m encroaching on their territory”.  There was such a display of hostility by then that I did not want them taking their moods out on mum because of my stealing their thunder!  Especially the Ward Manager’s as she had enough thunder on her demeanor for a bolt of lightening!

  • Talk about a Culture of Fear!

Mum said she needed the toilet and I rushed to the Ward Manager’s desk to ask a nurse for a chair/commode, as I had seen this done for another patient.

A nurse who had been sitting sideways on a chair with others around the desk of the Ward Manager, rose up and with a smile began to walk towards me.  She was beckoned from ‘someone’ behind the desk, spoken to and when she turned again to me her face was deadpan.

This nurse accompanied me silently to mum and helped her to the toilet (which I could have done in the first place).  I stood outside and left the door ajar to give her privacy, but heard the nurse telling mum to ‘press the buzzer when you’re finished.  She then ‘hurried’ away and I went in to help mum.  It was then that I saw how ‘Doped To The Hilt’ mum was.  Absolutely horrified, I spent some time trying to get mum to turn to me as she was facing a side wall and couldn’t understand me at all.  She was oblivious of my words  ‘turn towards me mum’, and I had to squeeze into this narrow toilet to turn her and guide her towards me but she could barely walk.  She actually walked like Frankenstein as her little feet and legs were so swollen.

I tried to find this nurse, whom I never saw again therefore presumably she was one of the Agency Nurses who worked one day’?  ‘She had gone off duty’!

  • Agency Nurses earn the same for one day that the full time ones earn in a week.
  • Makes Sense?

Despite the fact that the first F2 had written ‘Syrup’ on mum’s prescription and the notes which the Ward Manager could not miss, along with the fact that I had informed her about mum having difficulty swallowing tablets; when I told her about the liquid Carbamazepine; the day before, this was completely and callously ignored, as I found a Large pink tablet (Augmentin)? in mum’s dressing gown pocket plus another large Half-tablet (Clarithromycin possibly from the day before) on mum’s sheets when I escorted her back from the toilet.

Fearing mum may not have the medication she required ~ Am I a Fool, or Am I a Fool? I rushed to tell this Ward Manager and to re-affirm that mum‘ Could Not Swallow Tablets‘.

She was completely dismissive when I said “I’ve swallowed half- tablets this size and they scrape my throat, and I can swallow tablets”.

She replied “I’ve swallowed tablets like this and they don’t scrape My throat”, in an extremely defensive manner verging on aggression.  I may as well have approached a Rottweiler.  Fortunately I am not in the least afraid of dogs.

  • This coming from a person in charge of a Ward For The Elderly!  If that is an example of the way she treats relatives, how does she treat patients?
  • * Here was the necessity to change the two prescriptions for Augmentin and Clarithromycin from PO to IV by the other doctor!
  • Too late after the damage had been done!
  • At 4.40 another nurse noted:

Washed and dressed with assistance. Eating and drinking well.  Incontinent.  Mobile with assistance.  Abs. stable, IV fluids continue.

  • This is rather late for a patient to be washed and dressed?
  • If she was eating and drinking well (no records of this food or drink, in fact none until the 6th when I had a run-in with the Ward Manager) why was she still on IV fluids?
  • This would ensure her incontinence, allied with ? did anyone help her to the toilet again or the elusive commode?
  • At 10pm her blood pressure was 127/52.
  • At 4-6pm mum was given:

625mg Augmentin PO (still a tablet)!

1G Paracetamol Disperse

  • At 10-12pm mum was given:

1G Paracetamol Disperse

1.2G Augmentin IV

500mg Clarithromycin IV

40mg Clexane SC

5mls Carbamazepine PO

1 drop ea. eye Lantanoprost

More to come in a couple of weeks.

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