When will there be Justice in Athens

There will be Justice in Athens

When the One who is Uninjured

is as Indignant as the One who is!

Author Unknown

  • To recant what mum was given on the 4th:
  • At 7-9am she was given:

5mg Salbutamol Neb

0.5mg Atrovent Neb

20mg Prednisolone Oral

5mls Carbamazepine Oral

1G Paracetamol Disperse

2G Ceftriaxone IV

20mg Furosemide Oral

  • At 9am mum was given:

20mg Furosemide IV

5mg Salbutamol Neb

  • At 9.25am mum was given:

20mg Furosemide IV

  • At 9.40am mum was given:

0.5mg Atrovent Neb

  • At 11am mum was given:

20mg Furosemide Susp.

1G Paracetamol Disperse

5mls Carbamazepine Oral

20mg Prednisolone Oral

  • At 12-2pm mum was given:

5mg Salbutamol Neb

0.5mg Atrovent Neb

1G Paracetamol Disperse

500mg Clarithromycin IV

7500units Dalteparin

  • At 2.20pm mum was given:

40mg Furosemide IV

  • At 4-6pm mum was give:

5mg Salbutamol Neb

0.5mg Atrovent Neb

1G Paracetamol Calpol

  • At 10-12pm mum was given:

1G Paracetamol Calpol

5mg Salbutamol Neb

0.5mg Atrovent Neb

500mg Clarithromycin IV

5mls Carbamazepine Oral

1 drop ea. eye Latanoprost

  • Before listing any more of the miseries, I thought I would give you some sustenance for the Spirit, and beautiful to read:
  • ‘It is from an ancient Red Indian burial prayer, from the tiny Makah tribe, ‘and was left behind by murdered Ulster soldier Stephen Cummins’.
  • ‘Stephen sealed the poem in an envelope only to be opened in the event of his death.’

Extracted from THE PEOPLE, March 12, 1989.   By Frank Murphy.

  • ‘Their message of comfort is that death is not to be mourned at the end of everything.’
  • ‘And it has helped the Makahs endure generations of genocide by the white man which has reduced them to 1,100 people living on a tiny reservation in Washington State on the US Pacific coast.’
  • ‘The paleface did not even leave them with their own names.  They forced English ones on the Makah so the bureaucrats could keep the census books tidy.’
  • ‘The prayer was read out at the graveside of screen legend John Wayne in 1979.’
  • ‘It was also included in the memorial service to the five astronauts killed in the 1986 Challenger space shuttle disaster.
  • ‘And the IRA claimed it has also been quoted in newspaper death notices for their own casualties in Ulster.’

Do not stand at my grave and weep,

I am not there, I do not sleep.

I am the thousand winds that blow.

I am diamond glints in snow.

I am the sunlight on ripened grain.

I am gentle autumnal rain.

When you waken in the morning hush,

I am the soft uplifting rush

of quiet birds in circled flight.

I am the soft stars that shine at night.

Do no stand at my grave and cry.

I am not there, I did not die.

Chief Daniel Green from the Tribe said

‘This is an essential idea to grasp for the people of the loved one who are left behind.’

Peace

~Act Twenty Two~

Just another piece of little known information:

  • Around March 2008 there was a new EU funded ALERT project:
  • Early Detection of Adverse Drugs Events.

Even although before launching a new drug to the market, it is tested on thousands of people, a number of recent, highly publicized drug safety issues showed that adverse effects of drugs may be detected too late, when millions of patients have already been exposed.

‘Clinicians are responsible for recognizing and reporting suspected side effects, which are collected in so-called spontaneous reporting systems.  The recently EU funded ALERT project aims to develop an innovative computerized system to detect adverse drug reactions (ADRs) better and faster than spontaneous reporting systems.’

  • Did you notice ‘may be detected too late’ and ‘millions of patients have already been exposed’? Plus ‘a number of recent, highly publicized drug safety issues’?
  • Do you believe this would even have been considered if it had not been for the highly publicized drug safety issues?
  • If clinicians are responsible and Do Not report adverse drug events as in my mum’s case, does that make them also partly responsible in the event of her death?
  • Early in December of 2008 there was:
  • Strengthening pharmacovigilance to reduce adverse effects of medicines.
  • Do you believe this is working, especially given the fact that the IT (computerised system) is not working after spending Billions of pounds?

The Guardian, Wednesday May 31 2006:

‘The NHS’s multi-billion pound IT system is between two and two and a half years behind schedule, the government minister in charge admitted yesterday, as a survey of doctors found 85% backed calls for an inquiry into the scheme.’

‘Lord Warner also conceded that the overall cost is likely to be nearer £20bn over the next ten years than the widely quoted figure of £6.2bn. etc.’

  • Can you imagine what that sort of money could do for the NHS?
  • On the 5th at 03.35 the nurses notes were:

Slept only for short periods

IV AB as prescribed- this can only refer to the 500mg Clarithromycin IV given the night previously at 10-12pm, Unless there was another Verbal one?

O2 therapy via nasal canulae.

Nebulisers as prescribed

Catheter patient – draining

All care given

*At 07.00 B.P. was 170/74, pulse 90, O2 78% on 4L, resp. 18.

Sedation Score 1 (for the first time!)

  • At 7-9am mum was given:

40mg Prednisolone Oral

2G Ceftriaxone IV

1G Paracetamol Disperse

40mg Furosemide Oral

5mls Carbamazepine Oral

5mg Salbutamol Neb.

0.5mg Atrovent Neb.

  • FY2 Review:

N.B. This must have been written after 11am! as the Chart for Sats and B.P. were taken then.

Patient says she feels fine today.

Can you begin to imagine her state of fear?  I most definately can!

O/E in bed.  looks a little pale.  Chesty cough.

Sats 94% on4L O2 via nasal canula.  Taken from Chart @ 11.00.

RR – 18

B.P. 124/60  Pulse 94bpm.

N.B. * No mention of the 07.00 Details above e.g. B.P. 170/74 which the nurse took!

  • Let’s Not Draw Attention to That!
  • Because if we don’t draw attention to it no-one else (doctors or consultants etc.) will see it and wonder what happened over the weekend to cause it!
  • After all she was ‘Not very unwell’ when she arrived!
  • FY2 Notes continue:

Urine output low overnight but reasonable since – 80-100ml/hr.

Still has bilateral pitting oedema up to thighs.  JVP <—>

Received 2 x 40mg Furosemide yesterday + 40mg orally this am.

N.B. Mum actually received 2 x 20mg Oral + 2 x 20mg IV Furosemide yesterday + 40mg Oral this 7-9am.

  • FY2 Notes continue:
  • Chest poor air entry
  • no air entry L base –>as per yesterday
  • dull to percussion
  • Imp/- Pulmonary oedema most likely cause of ‘drop’ in sats yesterday

I think she is still overloaded today

– PTE unlikely

– chest infection not resolving despite Abx

  • Plan:

bloods today    These were taken @ 14.46 but did not arrive at the bio. lab. until 19.05!

If Ues ok – further IV Furosemide

D/W  Dr…..(Consultant in charge of ward) on today’s ward round

Re – Stopping Dalteparin?**

Changing Antibiotics? ***

FY2 asked another doctor yesterday about Starting Dalteparin**

The antibiotics were Not changed but:-

  • FY2 Stopped Prednisolone?
  • No Notes exist about stopping this!
  • Why?

FY2 said to me yesterday ‘I don’t know exactly what is going on’?

This must be the understatement of the year, actually of the decade!

You could take out the word ‘exactly’!

There again, FY2 should know what exactly was going on, since she was the cause of most of it!

I have met some inadequate people in my life, but Never someone of this caliber, and I would Never have imagined this going on in a hospital where peoples’ health and their very lives are at stake!

This is someone who is ‘Supposed’ to have six and a half years of education in medicine?

Not counting one and a half years in a hospital, possibly with the elderly?

This Truly Beggars Belief!

  • At 12-2pm mum was given:

500mg Clarithromycin IV

7500units Dalteparin SC

1G Paracetamol Disperse

5mg Salbutamol Neb

0.5mg Atrovent Neb

  • At 02.30 the Nurses notes were:

Bedbathed this morning

Eating and drinking small amounts

Catheter patient and draining good amounts.  Different from FY2?

Bowels inactive  Oh Great – now she can hold onto all the toxins/poisons from these meds!

Remains in bed    Why was that?

Observations stable as charted

Sats 94% on 4L via nasal canula  This was @ 11am

Nebs given as prescribed IV ABx. continue

Furosemide 40mg given  This was @ 7-9am

Settled day

N.B. Absolutely No Blood Tests other than the two Arterial ones were taken on the 4th, with FY2 using the results from the blood tests taken @ 9am on the 3rd to write her report on the 4th!

~Act Twenty Three~

On the 5th the bloods  which were taken at 14.46 were not received by biochemistry until 19.05?

Yet on the 5th the bloods hours arrived at the Haematology at 15.00? with the results reported shortly afterward and were:

WBC 13.98, Hb 11.1, Plts 286.

*05.02.0?  FBC: No Clinical Details Provided.

*PLEASE SUPPLY RELEVANT CLINICAL DETAILS.

*THE ABOVE REQUEST WOULD BE REPEATED CONTINUALLY UNTIL MUM’S DEATH!

*NO RELEVANT CLINICAL DETAILS WERE EVER SUPPLIED!

  • Now watch this very carefully!
  • Remember the delay of 4 Hrs. 19 Mins. in the bloods arriving at the Biochemistry Laboratory not being received until 19.05 resulting in the Lab. giving the results on the 6th the next day?
  • FY2 did however receive the Haematology results around 15.00hours shortly after the Lab received the bloods, with the First of Many requests to supply relevant clinical details.
  • So, Why were the bloods held back from the Biochemistry Lab until it was too late to process them on the 5th?
  • Even more important is the fact that when these same results arrived FY2 knew there would be No Doctors on Duty the Next Day to read these results!

N.B. The biochemistry lab. with the Liver Test Results would not be received until the 6th @9.26am.

Guess What?

When FY2 Was NOT ON DUTY!

When No Doctor/Consultant was on duty on that ward!

  • *Mum’s Liver Test Results from the 5th were:

Normal Range

  • *296                    AST<40
  • *313                    ALT<50
  • *373                    Gamma-GT<55
  • *5                        Bilirubin 3-22
  • *310                    Alk.Phos. 40-150
  • *52                     Protein 60-80
  • *19                     Albumin 32-45
  • *33                     Normal Globulins 23-38

So, FY2 thought ‘she was overloaded today’, but no more Furosemide was given?

  • On the 5th the Consultant wrote his notes:

A little brighter

Dull + downward A/E (air entry)  L base

Continue antibiotics for 2 days –> review**

CRP checked today**

  • When was mum a little brighter from, as the Consultant had Not seen her since the 1st?
  • Did he know that FY2 had stopped Prednisolone on the 5th After 7-9am as no notes exist?
  • **Did he know that CRP’s were Not Checked Today, only bloods taken with the delay in supplying these to the Bio. Lab. until it was too late to process that day?
  • **Did he know that when he stated ‘continue antibiotics’ was he referring to the 500mg Clarithromycin plus 2G Ceftriaxone, and was he aware of the near disaster this latter had caused?
  • Did he even see the old prescription for Ceftriaxone dated 2nd to be given on the 3rd at 7-9am, 12 extra, plus 12mid. extra, plus 7-9am on 4th?
  • Or? did he only see the nice new prescriptions written by FY2 on the 4th for both Clarithromycin and with Ceftriaxone showing 7-9am crossed as given on 4th?

A strange thing happened on the way to the Circus!

  • The extra 12am plus 12mid. doses of Ceftriaxone given on 3rd/4th, plus the extra 11am Carbamazepine on 4th, plus the extra 11am Paracetamol on 4th, plus the extra 11am Prednisolone on 4th, plus the extra 11am Furosemide on 4th were All written on the Old Prescription Sheets .
  • All of the above drugs were written on new prescriptions on the 4th (to begin a new week).
  • Therefore None of these extra doses would be seen by the Consultant or any other doctor on the 5th, when assessing the patient/or what had transpired!
  • Also the extra 11am Furosemide was written on a prescription sheet dated 4th only, and FY2 added 5mg Salbutamol dated 4th, plus 0.5mg Atrovent dated 4th, plus 40mg Prednisolone dated 4th but x out.
  • None of these above prescriptions were signed off.  The Nebs. were given at 7-9am plus 12-2pm then stopped, even although these were circled four times? Therefore FY2 replaced these prescriptions dated 4th (**but written on the 2nd before she went off duty) with new ones dated 4th after 12pm?
  • No one would observe that these 7-9am plus 12-2pm Nebs. had to be written on the 2nd, And the 11am extra Furosemide would not be seen!
  • **Now Go Figure This!
  • **FY2 had to have written both of these Nebuliser prescriptions on the 2nd dated for the 4th, before going off duty until the 4th, as they were circled and given at 7-9am, BEFORE she arrived at 9 -9.25am on the 4th! Resulting in the double doses of Salbutamol from the emergency FY2 at 9am, plus Atrovent from FY2 at 9.40am!
  • Mum had NO nebulisersafter the last dose @ 12-2pm on the 1st!
  • These were clearly Not written as PRN (as required) just in case mum may have required them, but these were definate prescriptions to be given!
  • **Why did FY2 write these two prescriptions on the 2nd for Nebulisers in advance, BEFORE SHE KNEW WHETHER MUM WOULD REQUIRE ANY? Especially since she had Not Had Any since the 1st?
  • Why did FY2 Anticipate these Nebulisers would be required?
  • N.B. A point to illustrate is that this FY2 had a ‘habit’ of leaving blank spaces on prescriptions. i.e. she wrote these two nebs. plus Prednisolone on A,B,C – left blank D (which she returned to on the 7th, and wait until you hear about that one!) left blank E,F,G,H – then completed J,K,L,M,N,P,R – left blank S.
  • She then wrote the above Salbutamo 7-9am + 12-2pm and Atrovent 7-9am + 12-2pm prescriptions on AA,BB, plus *40mg Prednisolone oral 7-9am on CC which *she cancelled for the 4th AND also wrote an identical prescription for *40mg Prednisolone oral 7-9am on M (the new ones which she wrote on the 4th.) and also *cancelled this?

This *coincides of course with the extra 11am’s not being seen again as this filled up this entire prescription sheet!

  • Above AA,BB,CC, was Y- which must have also been left blank as the helpful FY2 on the 3rd had written a prescription for 20mg Furosemide for 7-9am to be given on the 4th which was given at this time!
  • This same prescription Y was utilised by FY2 to give mum the extra dose of 20mg at 11am!
  • At first glance it almost appears that since the Y Furosemide was dated 3rd, then FY2’s Salbutamol and Atrovent dated 4th would follow on.
  • This is impossible as both of these had been given at 7-9am BEFORE FY2’s arrival.

Also, as a long shot, had she written these at 9am – cutting it neat so to speak – then there would have been no requirement for the Emergency FY2 on the 4th to give Salbutamol at 9am, or for that matter for FY2 herself to have written a prescription for Atrovent at 9.40am!

  • The nurses notes were:

S/B Dr……..

WZ?  – for Doppler U/S of legs

Continue Fragmin (Dalteparin) + IV ABx

  • The Consultant obviously did not agree with FY2’s suggestion to stop Dalteparin!
  • At 4-6pm mum was given:

1G Paracetamol Disperse

5mg Salbutamol Neb

0.5mg Atrovent Neb

  • At 20.30 mum’s B.P. was 111/56, pulse 100, O2 95% on 4L, resp. 18.
  • No nurses notes on these and No doctors notes on these!
  • At 10-12pm mum was given:

500mg Clarithromycin IV

1G Paracetamol Disperse

5mls Carbamazepine Oral

5mg Salbutamol Neb

0.5mg Atrovent Neb

1 drop Latanoprost ea. eye

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