• ‘The time has come’, the Walrus said,

‘To talk of many things:

of shoes-and ships-and sealing wax-

Of cabbages-and kings-

And why the sea is boiling hot-

and whether pigs have wings.’

  • ‘A loaf of bread,’ the Walrus said,

‘Is what we chiefly need:

Pepper and vinegar besides

Are very good indeed-

Now if you’re ready, Oysters dear,

We can begin to feed.’

  • ‘But not on us!’ the Oysters cried,

Turning a little blue.

‘After such kindness, that would be

A dismal thing to do!’

‘The night is fine,’ the Walrus said

‘Do you admire the view?’

  • ‘It seems a shame,’ the Walrus said,

‘To play them such a trick,

After we’ve brought them out so far,

And made them trot so quick!’

The Carpenter said nothing but

‘The butter’s spread too thick!’

  • ‘I weep for you,’ the Walrus said

‘I deeply sympathize.’

With sobs and tears he sorted out

Those of the largest size,

Holding his pocket-handkerchief

Before his streaming eyes.

  • ‘O, Oysters,’ said the Carpenter,

‘You’ve had a pleasant run!

Shall we be trotting home again?’

But answer came there none-

And this was scarcely odd, because

They’d eaten every one.

Lewis Carroll

~From Through the Looking Glass and What Alice Found There~

  • To recant what mum was given on the 5th:
  • At 7-9am she was given:

2G Ceftriaxone IV

40mg Furosemide Oral

40mg Prednisolone Oral

1G Paracetamol Disperse

5mls Carbamazepine Oral

5mg Salbutamol Neb

0.5mg Atrovent Neb

  • At 12-2pm mum was given:

1G Paracetamol Disperse

500mg Clarithromycin IV

7500 units Dalteparin  SC

5mg Salbutamol Neb

0.5mg Atrovent Neb

  • At 4-6pm mum was given:

1G Paracetamol Calpol

5mg Salbutamol Neb

0.5mg Atrovent Neb

  • 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

~Act Twenty Four~

*No doctors Notes were written on the 6th!

*No Consultants Notes were written on the 6th!

*No doctor WAS ON DUTYon that ward on the 6th!

In fact, there are only nurses notes.

Plus the Consultant Secretary’s Notes which were written because of my phone call!

Plus a sheet written by the Nutritional Support Sister, re., the above phone call.

  • On the 6th at 05.00 the nurses notes were:

Slept Fairly well.

IV AntiB. as prescribed.

O2 Therapy & Nebs. as Tolerated.

Catheter Patient.

  • At 10.00 the Charts read:

*B.P. 139/84, pulse 98, O2 95% on 4L, resp. 18.

This * was Not written on any nurses notes!

  • At 11.00 mum was given:

Fortisip – all 200mls

  • Heaven knows the flavour she was given?

Nurses notes at 11.50:

Bedbathed this morning.

Eating and drinking small amounts referred to dietitian.*

Catheter patient and draining good amounts.

Remain in bed.

Observation as Charted. * (This was the one and only mention of Obs. Charted).

O2 via nasal canula 4L – continue IV Bx . Nebs given as prescribed.

  • On the 6th mum was given:
  • At 7-9am mum had:

2G Ceftriaxone IV

40mg Furosemide Oral

1G Paracetamol Calpol

5mls Carbamazepine Oral

5mg Salbutamol Neb

0.5mg Atrovent Neb

  • The Biochemistry results from the bloods
  • Taken on the 5th Collected @ 14.46  (Yesterday)
  • Received on the 5th @ 19.05,
  • Report Issued on 6th @ 09.26:-

Sodium 143

Potassium 3.8

Chloride 97

Urea *10.8

Creatinine 73

est. Glomerular Filtration Rate >60

CRP *254

Bilirubin 5

AST *296

ALT *313

Gamma-GT *373

Alk. Phos. *310

Protein *52

Albumin *19

Globulins 33

  • Wow, what a fantastic result for the liver!  Don’t you think?
  • The Department of Haematology results were:-
  • Date of sample 06.02…..
  • Date of Report 06.02…..
  • *05.02.     FBC:  No clinical details provided.
  • *PLEASE SUPPLY RELEVANT CLINICAL DETAILS.

WBC 13.83

Hb 11

Plts 260

On 6th the Biochemistry results from bloods taken at:

  • Collected @ 10.00
  • Received @ 13.41
  • Report issued @ 16.25

Why Rush!

After All, Who was going to Read these Two Biochemistry reports plus the Haematology report to see whether everything was good or bad?

Absolutely No-One!

Sodium 144

Potassium 4.1

Chloride 97

Urea *11.2

Creatinine 76

est. Glomerular filtration Rate >60

CRP *316

  • Wow! What a fantastic dose of inflammation there and getting worse between the 5th and the 6th!
  • Plus the bonus of No Doctors on Duty!
  • How’s that for a No- Show?
  • At 12-2pm mum was given:

500mg Clarithromycin IV

7500 units Dalteparin SC

1G Paracetamol Calpol

5mg Salbutamol Neb

0.5mg Atrovent Neb

Oral Intake Assessment Chart:

  • N.B. The 6th and the following day the 7th were the Only days an Oral Intake Assessment Chart was completed:  (apart from a comment on the 8th by the Ward Manager)!

Does this make sense when someone is on IV drips plus Furosemide to suck the fluids out?

  • 12.30pm

Mince & pots. – All.

ice cream jelly – 1/2 portion.  (What flavour?)

milk – 100mls.

  • Do you wonder why she was given *Fortisip at 11.00?

I made several telephone calls in my attempt to find out who was in charge of Nutrition for Patients in this Hospital!  Eventually I spoke to the Nutritional Support Sister.  I then spoke to Mrs…(the Consultant’s Secretary) who gave me a number to speak to Dr…..(Consultant) on the 8th @ 11.45!

Remember this was the 6th!

Notes from the Consultant’s Secretary:

12.45pm Phone call from patient’s daughter this morning to inform me that her mother who was weighing less than six stones ( mum actually weighed six and a half) before admission, is wasting away because she is not eating enough.

  • This woman may or may not have got her facts wrong, but again it appears slanted to make the relative sound ridiculous.  This was not written in a concerned way regarding the fact that mum was not eating enough in that place!
  • I advised daughter to raise her concerns with the Ward sister and Dr…..(Consultant) and ask to speak with the dietitian.
  • I said to daughter that I would inform ward sister an dietitian that she had called me. – Spoke to sister….and Dr…FY2? – Where was she today? (written as FY1?).  I spoke to dietitian…..
  • Wait for this!
  • …who informs me that due to staff shortages…
  • ‘There is No Dietetic Cover to the Medicine For The Elderly Wards’.
  • She advises that patient continues to be encouraged with oral diet and supplements which the ward are already giving her.
  • The ward obviously told her this!
  • The oral diet of *Fortisip was after I telephoned that morning!
  • What about the mince and potatoes 15 minutes earlier?
  • Was she choking on these?
  • …I have informed Nutritional Support Sister, sister…and sister…ward manager of this.
  • The First Nutrition Risk Score Chart was completed on the 2nd.
  • The Second Nutrition Risk Score Chart was completed on the 6th.
  • None were completed for the 31st, 1st, 2nd, 3rd, 4th, 5th, 7th, 8th!

BODY WEIGHT   Normal (O)2/2   Recent unintentional weight loss (3) 6/2.

APPETITE   Poor – leaving half meals and fluids (3)  2/2 + 6/2.

ABILITY TO EAT AND DRINK   No difficulties, eat  drink independently *PROMPT PATIENT (0). 2/2.

Requires assistance with eating and drinking  (2) 6/2.

*No PROMPT WRITTEN ON 6/2!

SKIN CONDITION   Healthy (O) 2/2.

*Some Red Pressure Areas (2) 6/2.*

GUT FUNCTION   Normal (O) 2/2 + 6/2.

MEDICAL CONDITION  Mild infection  (2) 2/2   Mild infection (2) 6/2.

  • MILD INFECTION~ DEAD TWO DAYS LATER!

A Pressure Sore Risk Assessment doctor’s form was completed in the First Hospital on 30th.

A Pressure Sore Risk Assessment was completed by the disgruntled nurse on the 2/2!

A Pressure Sore Risk Assessment was completed by the ward manager on 6/2!

  • Under~ SKIN TYPE-VISUAL RISK AREAS:

Tissue paper dry/oedematous clammy (temp.) Up.

This was ticked (1) for 30th, 2nd, 6th!

  • *No mention of some red pressure areas as above on 6/2*
  • Under~ CONTINENCE OCCASIONALLY INCONTINENCE:

This was ticked (1) for 30th, 2nd, 6th!

  • NO Box was ticked for CATHETER on 6th by the ward manager!
  • Under~APPETITE:

Poor.

This was ticked (1) for 30th, 2nd, 6th!

  • N.B. This Appetite was completed by the same ward manager, who told me the next day ‘She’s Not Lost Weight!’  most vehemently, and that she had been eating well, including chicken pie etc!
  • N.B. The First Oral Intake Assessment Chart was written on 6/2!
  • 11.00 Fortisip   All   200mls.  (Which flavour)

12.30 Mince, Potatoes.   All

Ice Cream, Jelly. 1/2 portion.   (Which flavour?)

Milk  100mls.

5.30 Soup  All

Chicken Pie, Potatoes.  1/2 portion.

Tea  Sips.

  • This would be mum’s Last Supper, unknown to either her or me!
  • At 14.30pm The Charts Read:

*B.P. 119/74, Pulse 101, O2 94% on 4L, resp. 20.

This * was Not written on any nurses notes!

  • At 4-6pm mum was given:

1G Paracetamol Calpol

5mg Salbutamol Neb

0.5mg Atrovent Neb

  • At the second visiting time I took mum in a small bowl of rice crispies, milk and a banana ans she ate these like a starved person, never taking her eyes off the food.
  • A cup of cold tea with a little taken out of it was sitting on the trolley table across the bottom of the bed, -out of reach – and not for the first time.
  • Mum ate the banana out of the peeled skin and said “I like a banana”. “I know you do, and I’ll bring you more tomorrow”.
  • She then drank the rest of the milk.
  • Remember, I knew nothing of the problem with swallowing? Or Gagging?
  • In fact I knew next to nothing of the deeds in that place, where as far as I am concerned my mum was tortured to death!

Nevertheless mum ate these happily without a problem!

What does that tell you?

  • At 18.00 The Charts Read:

*B.P. 117/62, pulse 101, O2 94% on 4L, resp. 20.

This * was Not written on any nurses notes!

  • At 10-12pm mum was given:

1G Paracetamol Calpol

500mg Clarithromycin IV *
N.B. This *was initialled as given in both the box for 10-12pm, PLUS ‘other time’ but this May have been because of a signature error. It is difficult to decipher!

5mg Salbutamol Neb

0.5mg Atrovent Neb

5mls Carbamazepine Oral

1 drop Latanoprost ea. eye

  • At 22.00 The Charts Read:

*B.P. 136/90, pulse 90, 2 95% on 4L, resp. 20.

This * was Not written on any nurses notes!

  • N.B. NO DOCTORS saw any of the above Charts, because NO-ONE was IN That day!

On both that day and the day previous mum turned her head to ‘stare’ after me going out of the door after the first visiting hour, and she looked so utterly forlorn and sad.

She had been put in the furthest bed from the door, next to the window.

There was a long narrow window beside the doorway (which you could use if the door was closed) and I used to look though this on my way out.

I jumped back into the doorway saying ‘See, I’m still here!’

Mum gave a dazed smile and I said, ‘I won’t be long till I’m back’ (for the next visiting time).

Mum always had the brightest smile and since arriving at this place she became more like a baby with hives – Without the Joy!

I could sense her despair, (as she knew what was occurring which I Did Not!) as she sat ‘Dutifully’ (frightened) or been Dazed (doped) which is the main reason why she was unable to communicate what was happening to her. I now realise that the ‘fear factor’ was the main reason why no-one would say Boo in that ward!

  • This I deem to be a Major Problem and one which relatives would be most vehemently advise to watch for as it is not always because someone is unwell!  I know this Too Late for my Mum!
  • I Bid You to Watch Very, Very Carefully, and at the least suspicion of anything at all going wrong, Then But In!
  • How often do we read of the Elderly being doped in Nursing Homes.
  • They should be jailed!

Oh, If only I had known a fraction of this!

It Truly would have been a case of ‘Woe Betide Those Who Do These Deeds,’ but then any steps I would have taken would have paled against what is to befall these people.

  • ‘I Bid Ye To Love One Another.’
  • ‘And To Treat Your Neighbour As You Yourself Would Be Treated’.

 

 

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