If I Am For Myself

Who Will Follow Me?

If I am Only for Myself

What Am I?

If Not Now-When?

You may constantly read  in the newspapers or hear on the television about antibiotics being used far too frequently, along with the blame being laid at the door of General Practitioners (GP’s).

Ask yourself:  ‘Who is in charge in Hospital Wards when massive overdoses of antibiotics etc., along with chopping and changing these at a rate of noughts are being handed out like sweets?

  • To recant what mum was given on the 1st.
  • At 7-9am mum was given:

5mg Salbutamol Neb

0.5mg Atrovent Neb

625mg Augmentin PO

500mg Clarithromycin PO

40mg Prednisolone PO

1G Paracetamol Disperse

5mls Carbamazepine PO

  • At 12-2pm she was given:

1G Paracetamol Disperse

5mg Salbutamol Neb

0.5mg Atrovent Neb

  • At 4-6pm she was given:

1G Paracetamol Disperse

625mg Augmentin PO

  • At 10-12pm she was given:

1G Paracetamol Disperse

1.2G Augmentin IV

500mg Clarithromycin IV

40mg Clexane SC

5mls Carbamazepine PO

1 drop Latanoprost ea. eye

~Act Eleven~

On 2nd at 05.00 a nurse wrote ‘Incontinent of urine. IV fluids continue.  Slept well.  Quite abrupt in manner when being attended to.’

How infinitely Petty.  And this is a Nurse???  Imagine writing such a thing, and  precisely for who’s benefit?  What sort of Training do they receive?

N.B. Another Scene set by a choice of words!

Mum wanted to go home and not be in there at all as she thought she was only going to be assessed for occasional oxygen (at my request, not hers) at home if and this is the big word IF she ever needed it!

Always remember, no patient nor relative knows what is being written about them behind their back!  There should be no room for petty comments in a professional organisation. 

In other words, Shit Stirring!

If any one should wonder about these observations, they would only have to read the comments on the ‘Big, Bad daughter’ to realise my observations overall are spot on!

There again, these only occur with cowards; who always go for an easy target, because they wouldn’t dare face someone able for them, and who is an easier target than old, frail human beings, who invariably are too weak or too frightened to say anything, along with constant reinforced messages about their confusion/dementia?

Regardless of their state of being!  What a set-up!

I would and should have taken her home.  If only I had known what was happening!

Lord help those who are open to this form of abuse!

Who Cares? Who Really Cares?

The next nurse was professional as exemplified at 12.35 after the morning dosages!

  • On 2nd at 7-9am mum was given:

1.2G Augmentin IV

20mg Prednisolone Oral

1G Paracetamol Disperse

5mls Carbamazepine PO

  • At 11.45am her blood pressure was 112/58.
  • Her Resp. Rate was 20, and Sats. were 99% on 4L.
  • This was an increase in O2 since the 1st when her Sats. were 92% on 4L.
  • No doctors and No nurses have written these increases in O2 (doubling) which were 2L since 12 noon on the 31st!
  • At 12-2pm mum was given:

1G Paracetamol Disperse

500mg Clarithromycin IV

  • At 12.35pm the professional nurse wrote:

Showered and dressed with assistance this morning.

  • This was after MRSA was discovered in another patient in a bed across from mum!

*Eating and drinking fair amounts.  IV fluids continue as prescribed.
Incontinent of urine.  Mobilising with assistance and zimmer frame. Observations as recorded on chart.

  • Why were the IV fluids continued if mum was drinking fair amounts?
  • N.B. She was mobilising with a zimmer frame and assistance! on the 2nd!

The results from a Microbiology Urine Test taken on 1st arrived on the 2nd:

This was supposed to be a Mid-stream urine test and how they managed that is questionable?   Mum was so doped up and confused she would never be able to hold onto urine to do this!  Also this tells nothing about her condition on the 2nd?

The system is so inefficient It is appalling!

Small number of organisms seen.  No pus cells seen.  No red cells seen.

*No significant growth!

  • On 30th the receiving night nurse in the first Hospital had ticked Incontinent on her form (there is no way of knowing whether this was actual or from the G.P.’s form-again) as she had ‘slept for long periods’.
  • On the 31st at 05.00 mum had not yet passed urine.
  • On 31st (no time noted)  cumulative fluid sheet (which Hospital?) Up to toilet.
  • On 1st the night nurse wrote at 04.30  Incontinent of urine.
  • On 1st another nurse noted Incontinent at 16.40.

I now know that Incontinence in particular really Pisses them off! as will be seen very very shortly!

I challenge any Piss Artist to have this constant flow of saline water in your veins and not feel an overwhelming urge to urinate, but no chance if you are waiting for assistance, especially if you are so doped up dizzy (don’t forget the constant reinforcement of ‘Confused’ which they themselves wrote frequently which set another ongoing idea), never mind the amounts of drugs/Paracetamol on an old frail lady who was completely unused to these effects which did indeed make her confused, but let’s cash in on this anyway as it may come in handy later if questioned, and the zimmer is at a far wall!

They completely and utterly miss the Humanity part of loved ones knowing what’s what, and who could give a lot of information about a patient. 

Or there again do they Really? 

Now That Is The Question!

~Act Twelve~

  • N.B. On 1st the FY2 signed off the 40mg Prednisolone and wrote another prescription for 20mg.
  • She did not write this at all in her doctors notes.
  • Therefore the Consultant or any other doctor would never know about this unless they checked the prescriptions.
  • Why would they do this, as the format is to read the previous doctors notes, with perhaps an addition of a Biochemistry or Haematology test report?
  • Remember on the 1st the Consultant left no changes for either the Antibiotics or Prednisolone.
  • He expected the medications to be checked with the G.P.
  • Impossible!
  • The Consultant would not see mum again until his next visit on the 5th!

~Act Thirteen~

On the 2nd a Nutrition Risk Score Chart was completed:

  • Normal-No weight loss!
  • Appetite poor-leaving half meals and fluids.
  • Yet the nurse at *12.35 stated eating and drinking fair amounts?
  • Ability to eat and drink-Prompt.   (Sleepy and dizzy with all the medications)
  • Medical condition-Mild infection. (Therefore this Nutritional Risk was done after the results of the Urine test came through).

How could she eat and drink fair amounts – Yet -leave half meals and fluids?

Which was it?

~Act Fourteen~

  • On the 2nd a Physiotherapy Assessment could Not be carried out as ‘Patient appeared confused.’
  • Contact NOK.

Was I ever Contacted?

Guess?

~Act Fifteen~

  • Bed Rail Assessment:

1st Assessment.

  • Confused.
  • Extremely restricted (sitting in a chair)
  • Nocturnal incontinence.
  • Risk of Falls.

N.B. These were all circled by the same nurse who thought mum was ‘abrupt in manner’!

  • No bed rails were put up! (Risk of Falls)? (Confused)?

What was that about?

  • No more Assessment would be done on mum after 1st Assessment?

~Act Sixteen~

  •  FY2 Notes:

WCC (up). 13.71 (12.74) (Taken from Microbiology Test.)

  • FY2 Failed to Note that Potassium was NA H.  It was 4.0 on the 1st.

CRP remains 316

Patient Unchanged.

  • Yet her WCC was raised.

B.P. 112/58 (taken from nursing chart)

Pulse 85 (FY2)

RR. (Resp Rate) 20 (taken from nursing chart)

Sats 99% on 2L (taken from nursing chart) Wrong. This was 4L!

Ho-Hum just another lack of observations?

  • *Plan:
  • No mention in FY2’s notes of stopping 40mg Clexane (Heparin) after 10-12pm dose that night of the 2nd?
  • Yet *no one signed this off, so how did they know to stop this?
  • This must have been another verbal instruction from FY2?
  • To whom?
  • Yet another doctor signed off the Augmentin after 10-12pm but *did not sign off the Clexane?
  • Did this doctor not know about the Clexane being stopped?
  • After all, they were dispensed at the same time of 10-12pm and were next to each other on the same Prescription sheet?

Would the patient not require Heparin (to prevent blood clots forming) more so after being given a large dose of another antibiotic (in fact three large doses the next day when she would have No Heparin at all?)

Change Augmentin for IV Ceftriaxone.

Check bloods over W/E.

  • Three things to note:

1) This was the start of changing drugs and with huge amounts before the others had any chance to work.

2) FY2 Stopped the Heparin that night and at the same time wrote a prescription for 2G Ceftriaxone to be given 3 times the next day!

3) FY2 wrote ‘Patient Unchanged’.

  • Therefore Why Change drugs at all?
  • The Consultant had stated ‘Continue antibiotics’ (Believing these had been given by the G.P.)
  • He did not say Change antibiotics tomorrow or the next day!
  • Why did FY2 not ‘Continue the Antibiotics the Consultant instructed?’
  • Who was she referring to when she wrote check blood over W/E as she would not be in the next day?
  • Therefore she must have left instructions verbally with the nursing staff to take bloods the next day, as
  • No mention of bloods being taken or instructions to do so in nursing notes!
  • A nurse took these bloods before/after the dose of:  2G (Grams) Ceftriaxone, with the Lab. receiving these at 9am.

1) FY2 left a prescription for this 2G in time for the pharmacist to dispense this on the afternoon of the 2nd, as this was to begin at 7-9am on the 3rd (when she knew she would be off duty at the end of the 2nd)?

2) This prescription consisted of 2G Ceftriaxone to be given 3 times on a day that FY2 was off and in fact no doctor on duty on that Ward that day! (weekend skeleton staff).

3) Another doctor signed off the Augmentin after the last dose at 10-12pm on the 2nd.

4) This other doctor Did Not sign off the Clexane after the last dose at 10-12pm on the 2nd.  *No one did!

  •  As for ‘Patient Unchanged’ All three Platelets, Haemoglobin and White Blood Cells had risen on the 2nd thanks to the constant increases and changes which would be a sign to double check on the 4th after FY2 arrived following an emergency doctor who had been called to mum.
  • N.B. No anti-clotting factor (Clexane) would be in mum’s system when this new and huge intake of 6 Grams of Ceftriaxone were being given.

When I spoke to FY2 in passing she mentioned casually that she was thinking of changing mum’s antibiotics. 

This was the only thing I knew at this point in time!

  • Of what earthly use would these bloods be when FY2 Knew she was not on duty until the day following?
  • Why have a nurse take these at all knowing no-one was there to read the results or to respond to them?
  • Had something serious been flagged up who was going to deal with this?

The results would not arrive until the 4th, so too bad if they were really needed.

  • Ah, but wait and read what happened with these results on the 4th!

These bloods as you will see were taken in all probability before the 2G Ceftriaxone, as after the three doses amounting to 6G of this, allied with the withdrawal of the Heparin, ‘mum had a very bad night’!

Can you imagine the torture on this little body of all these Drugs chopping and changing, with increasing amounts, lots of Paracetamol and Carbamazepine which kept her sedated and confused, Incontinence, Hunger, Dry throat, Anti-Blood Clotting factors started and stopped (just imagine what the body is going through), large doses of Steroids into a six and a half to seven stone lady, Fear and Confusion as to what is happening to her, and to Confound it all, her daughter kept in the dark about it all?

  • Does not the medical profession tell us to complete the full course of antibiotics in case of building up resistance, otherwise the body has not had time to replicate it?

~Act Seventeen~

  • Now for the real starter for Ten! 
  • Another sequence of events which the Consultant and/or other doctors would be extremely unlikely to observe, especially given that by the time they saw mum she had taken a large turn for the worse!

Can you see Why by now?

If not, you soon Shall!

Remember the *FY2 Plan:

Change Augmentin to IV Ceftriaxone!

By now her Prednisolone had been halved on the 2nd, and her Augmentin increased from 625mg to 1.2G IV.on the 1st.  Now the Clexane (Heparin) was to stop at the end of the 2nd, and the Augmentin; which had been increased on the 1st was to stop at the end of the 2nd; and she was to be given 6G Ceftriaxone to start 7-9am on the 3rd!

Before treatment with Ceftriaxone (Rocephin) appropriate specimens should be isolated for Causative organism and for determination of its susceptibility to the drug.

Ceftriaxone has broad spectrum activity against Gram Positive and Gram Negative bacteria.

  • So the actual bacteria (Causative organism) was never identified? but this covers all bases! This may have been understandable if the patient had been ‘Very Unwell’ but to pitch in and give such huge amounts of a substance to a little ‘malnourished elderly frail lady’ is inexcusable, and in fact rather Sinister!

Adverse reactions:

  • Allergic pneumonitis, anaemia, dizziness, headache, jaundice, thrombocytopeania, flushing, sweating, chills, bronchospasm, angiodema, seizure etc.  Trouble breathing, fast/pounding heartbeat, persistent sore throat, easy bruising or bleeding!

Really?

Transient elevations of Serum Creatinine have been observed.

Elevated Liver Transaminases.

Watch this space!

Caution if Seizure Disorder.

A Cerebral Haemorrage doesn’t count then?

Observe for symptoms of Anaphylaxis!

  • This would indeed occur but in a most Sinister way later on!

I now have extreme misgivings about this symptom being blatant in this drug – which was given in such a huge amount – especially under the circumstances in which it was delivered and especially since mum had had a cerebral haemorrage?

  • N.B. In the case of Overdosage there is No Specific Antidote?  For 6G?

IMAGINE THAT!

  • Either this FY2 was ignorant of these facts in which case she should have conferred with a superior and not have written prescriptions with such a low calibre base of knowledge.
  • Or she knew precisely about them and chose to dispense them anyway.

WHY?

Effects on mental status:

Delusion, Depersonalisation with Cephalosporin.

By giving this to the elderly they can never tell what they think is happening to them, but plenty of people can write that they are ‘Confused’!

How Convenient!

May rarely cause Neutropenia.  Use with caution with Carbamazepine!

What was that I asked about this FY2 and her knowledge base?

  • Ceftriaxone:  Sodium contents: 83mg per Ceftriaxone 1G.
  • Antibiotics should be administered with Caution to any patient who has demonstrated Some form of allergy.

Was mum not treated for Asthma by the G.P?

When I arrived at vising time mum’s bed was empty and I discovered she was in a day (props) room across the corridor.  She was sitting in a chair, in her Dressing Gown and Slippers.  No Bedsocks,  her feet down, No Footstool and both her legs and feet were swollen with the skin so tight and shiny and bluish pink!

A female? told me there was a patient with MRSA in mum’s room and that mum had her hair washed and a shower.  Mum nodded but did not say anything, as she leaned forward with her arms on the chair for support.  She was so obviously doped.  Again her limbs were as cold as ice.

Caring?

Shit!

I spoke to a woman ‘steam cleaning’ the ward and commented that ‘they were certainly thorough’.  I also asked her if patients would go back to the same bed, ‘which I anxiously wanted for mum’ and she told me to ask a nurse.

By now it was becoming apparently clear that whatever ‘The boss had said’ that I was to be treated with the outward appearance of civility and be given the least assistance/information apart from designated answers, which did not concern me personally, but worried me enormously for mum’s sake.

I spoke to a nurse,  whose name I had asked the day before, for mum to know who was attending to her, and highlighted a compliment on her name and accent which I admired, to help mum to remember her.

I asked her about the swelling in mum’s foot extending up her leg and this was the first time I was made aware of mum being on Steroids:

Unknown to me this nurse had written up adverse notes about me:

‘Daughter not happy that patient’s legs are swollen and her shin is discoloured.  I advised that as her mother is immobile and septic that the patient would tend to have lower leg oedema.  I also advised her that patient is on Steroids and her skin would be fragile.  Spoke to FY2 on 2 occasions regarding same’.

  • Remember mum was ‘mobilising with a zimmer frame and assistance’!  so how could she be immobile at the same time?

Obviously FY2 discussed my conversation with this nurse regarding my mother’s continually swelling limbs but nothing was done or said to me or my mum!

I also asked FY2 the name of the new drug she proposed to give my mother (for my notes) and after some hesitation and deliberation she mumbled ‘Rocephin’ so that I had to ask her twice.

This same nurse whom I had complimented also wrote:
‘The room which the patient was in was being cleaned due to MRSA and daughter did not want her mother returned to the Ward.  She was advised re. I.C. policy and she also spoke to the domestic.  Patients daughter was carrying a small notebook and was taking down everyone’s names.’

I had only spoken to the ‘domestic’ and decided it was futile to ask anyone else. I desperately wanted mum to go back to her own bed, and as for the Ward?   

It never entered my head that she would not go back to the same Ward!  Why would it, when she had such a long wait initially for a bed in the other Hospital?

I was never advised about Policy from anyone unless this was covered under the auspices of ‘ask a nurse’?  There again I was supposed to ‘also’ have spoken to a domestic who was actually the only one I had spoken to. 

At that point in time I was only primarily concerned with anything I could glean regarding my mother’s state, and only began taking names down later as there was a never- ending sea of faces with little continuity!

I wonder what this paranoia is all about?

In hindsight, why would she be particularly concerned if I had been writing down names?

For all intents and purposes I could have been writing down a list for my mother’s requirements.

After all, my first exposure to their routine was when mum was found sitting with her back to the open window, and I opened the cupboard to fetch her Dressing gown etc, only to discover all of her used bed clothes in a plastic bag at the bottom of this cupboard.  No one had said a word about soiled clothing being stored there and had I not seen these for myself they could have still been there for a longer period.  Such was the sheer lack of communication!  I also noted that the bar of soap which I had supplied, and which was gentle for fragile skin, had been left untouched along with her face cloth!

MRSA?  Soiled clothing stuck in bags for perhaps days? Unknown to relatives?

Furthermore, I had no idea whatsoever the name of this foreign nurse, as on the afternoon of the 2nd I had no cause or particular desire to know the names of any member of staff.

Hardly a prerequisite of someone anxious about their loved one!

  • At 4-6pm mum was given:

1G Paracetamol Disperse

1.2G Augmentin IV

  • At 10-12pm mum was given:

1G Paracetamol Disperse

1.2G Augmenin IV

500mg Clarithromycin IV

40mg Clexane SC

5mls Carbamazepine PO

1 drop Latanoprost ea. eye

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