Sickened By The NHS Part 10. (Final EXIT!) Monday, Jun 17 2013

A Nurse’s Reply

What do we see, you ask, what do we see?

Yes, we are thinking when looking at thee!

We may seem to be hard when we hurry and fuss,

But there’s many of you, and too few of us.

We would like far more time to sit by you and talk,

To bath you and feed you and help you to walk,

To hear of your lives and the things you have done;

Your childhood, your husband, your daughter, your son.

But time is against us, there’s too much to do –

Patients too many, and nurses too few.

We grieve when we see you so sad and alone,

With nobody near you, no friends of your own.

We feel all your pain, and know of your fear

That nobody cares now your end is-so near.

But nurses are people with feelings as well,

And when we’re together you’ll often hear tell

Of the dearest old Gran in the very end bed,

And the lovely old Dad, and the things that he said.

We speak with compassion and love, and feel sad

When we think of your lives and the joy that you’ve had.

When the time has arrived for you to depart,

You leave us behind with an ache in our heart.

When you sleep the long sleep, no more worry or care,

There are other old people, and we must be there.

Sp please understand if we hurry and fuss –

There are many of you, and too few of us

Liz Hogben

~

He was a child before he was born

Now he is helpless, old and forlorn.

He was a husband, long years ago

He walked with his wife, their cheeks all aglow.

His wife was a mother, she had babes at her breast

Caring for others and giving her best.

He was man, salute him for this

Now he is withered and harder to kiss.

Speak to him gently and nurse him with pride

Now as he waits to sail with the tide.

Ours are the last hands he’ll ever hold

Let him know love now he is old.

Kathy Doyle

~

~Act Thirty~

• To recant what mum was given on the 7th:

• 7-9am mum was given:

2G Ceftriaxone IV

1G Paracetamol Calpol

40mg Furosemide Oral

5mls Carbamazepine Oral

5mg Salbutamol Neb

0.5mg Atrovent Neb

• At 12-2pm mum was given:

500mg Clarithromycin IV

7500units Dalteparin SC

1G Paracetamol Calpol

5mg Salbutamol Neb

0.5mg Atrovent Neb

• At 4-6pm mum was given:

1G Paracetamol Calpol

1000mg Vancomycin IV

• At 5.10pm mum was given:

40mg Furosemide IV

• At 7pm mum was given:

1G Paracetamol IV

• At 10-12pm mum was given:

1G Paracetamol IV

• Now for the 8th!

• At 7-9am mum was given:

1G Paracetamol IV

40mg Furosemide  (Oral but patient couldn’t swallow therefore not given)

5mls Carbamazepine (Oral but patient couldn’t swallow therefore not given)

5mg Salbutamol Neb

0.5mg Atrovent Neb

• On the 8th!

• Notes from the ward manager in Large Writing:

W/R  Sb Dr …..

For 12. IVI’s.

For 20mgs IV Furosemide

General condition very poor.  Daughter has been in attendance all night and morning.

She has been informed of the gravity of mother’s condition.

M………..has been offered the full hospitality of the ward – she has refused.

This is So, So Boring!  And pathetic for an adult to write such drivel!

The truth was that I was offered a cup of tea or coffee, and gratefully said ‘I wouldn’t mind a cup of tea thank you.’

Two nurses (one of which was the disgruntled one earlier) also offered me a mattress in the day/props room if I wished to lie down, and I thanked them politely and told them I was not leaving my mother.

There was absolutely no haughtiness on my part, I merely wished to be with mum!

What if she had opened her eyes again, which she never did!

• The ward manager also wrote in Huge Writing on my mother’s Oral Intake Assessment Chart:

8/2/…N.B.M. Remains Very Unwell.

8/2/… N.B.M. – Unwell. Unable to eat.

• At 11.30 the chart read:

B.P. 139/78, pulse 109, O2 78% on 10L, resp. 26.

The chart has an increase written sideways up 15L 90%.

• At 12-2pm mum was given:

1G Paracetamol IV   (Written by other doctor)

20mg Furosemide IV (Instructed by Consultant)

7500units Dalteparin SC

5mg Salbutamol Neb

0.5mg Atrovent Neb

• On 8/2/… the Consultant came round to ‘explain the gravity also’ and wrote in his doctors notes:

W/R

Very poorly

Creps throughout (R) lung

(L) lung – good air entry

Continue antibiotics

Which antibiotics did he refer to?

The fact that he writes this in plural denotes that he had more than one in mind, therefore which antibiotics were these?

Since FY2 who was Not On Duty on the 7th, signed off the 2G Ceftriaxone after 7-9am, and 500mg Clarithromycin after 12-2pm on the 7th which accords with writing the prescription for 1G Vancomycin in time for the pharmacist to dispense same, (proving that she most certainly was about on the 7th yet wrote No Doctors Notes At all about her Plans) and since this Vancomycin was only to be given every 48 hourly, Which antibiotics was he referring to?

Risk of further PE>>

• Where did this come from?   And When?

• Had there been a PE no-one had written about previously?

risk of recurrence of I.C.H. (Intra. Cerrebrael Haemorrage) => continue anti-coagulation.

=> balance of risk explained daughter + ‘serious’ chest infection.

Not taking oral med.

=> monitor re: LVF => may need IV Furosemide.    Signed by the Consultant.

• At 4-6pm mum was given:

5mg Salbutamol Neb.

5mg Atrovent Neb

FY2 wrote a prescription on the page which she had previously left blank numbered (F) for *20mg Furosemide IV on the 8th, and after this was given at 12-2pm she signed this off?

This * was instructed by the Consultant and written on the ward manager’s notes only!

What if more had been required?

What was the rush?

FY2 also stopped the fluids which were instructed by the Consultant after writing a fluid prescription and giving this once at 12pm!

FY2 was Never diligent about signing off prescriptions before so why now?

FY2 also signed off the prescription above this number (E) after the 1G Paracetamol had been given at 12-2pm!

This necessitated the doctor at 7pm writing a Once Only prescription for 1G Paracetamol IV?

This was despite the fact that when FY2 also informed me about mum’s situation she told me ‘They would keep her comfortable with Morphine!’

I said Morphine? Why Morphine? Is she in pain?

The reply was, ‘The blood clot in her leg, may have or could travel to her lung.’

I asked her why mum could not have Paracetamol instead, and she said ‘it’s possible!’

I also asked her what would happen about fluids since her Venflon had tissued,

Her reply was that ‘they could do a sub-cut,  (Subclavian Cut)  ‘it’s easy!’

‘What is that?’

‘We cut the vein just below her neck at the collarbone and put in a line’.

FY2 was very emphatic that giving my mother fluids ‘wouldn’t do any good’.

Had I known about the bronco-pneumonia I would probably have agreed, but was told Nothing!

I asked, ‘Is there a remote possibility that if my mother was to receive fluids that her throat would be lubricated?’

‘It’s Possible’.

‘Then I’d like that please.’

A Precipice In Front

Wolves Behind

Oscar Wilde

What I did Not Know was the fact that when FY2 was telling me ‘fluids wouldn’t do any good’, that the Consultant had already instructed this to be given and that FY2 had complied by writing a Parenteral Fluid Prescription Sheet to start at 12.oo.

Why was FY2 trying to stop the giving of fluid, as she stopped this after one dose?

• This has echoes of the Liverpool Care Pathway where people are taken off fluids and food to hasten their death!

• A Further Question Arises?

• What was in the IV bag given to my mother by sub-cut and removed at 4pm by a nurse?

• FY2 had stopped the Fluid, the Paracetamol and the Furosemide after 12-2pm!

Unknown to me FY2 wrote a prescription for 2.5mg Morphine, route S/C, indication agitation, Max. Frequency PRN.  (as and when required).

There was no chance of Paracetamol instead! (More Blatant Lies!)

This left nursing staff No Alternative but to give Morphine!

Therefore FY2 signed off the Furosemide prescription after one dose at 12pm, signed off the Paracetamol after the 12-2pm dose, only gave one dose of Fluid at 12pm, and wrote a prescription for Morphine!

FY2 Did Not sign off the Dalteparin after the 12-2pm dose on the 8th!

FY2 Did Not sign off the Vancomycin after the dose on the 7th as it would be due on the 9th and presumably mum would require this if she had lived.

FY2 Did Not sign off the 5mls Carbamazepine Oral on the 8th after 7-9am could not be given (Patient couldn’t swallow as she was in a Coma).

FY2 Did sign off the Furosemide 40mg Oral on the 8th after the 7-9am could not be given.  (Patient couldn’t swallow as she was in a Coma).

FY2 Did Not write another prescription for Furosemide IV to replace the Oral one!

FY2 Did write (at the Consultant’s instruction) a prescription for 20mg Furosemide IV for 12-2pm then signed this off!

Why the rush to sign this off, rather than leave it open?

Another doctor wrote a Once Only prescription for 1G Paracetamol IV on the 7th (which constituted an overdose) and also wrote a regular prescription for 10-12pm on the 7th, 7-9am on the 8th, and 12-2pm on the 8th. 

FY2 then signed this Paracetamol on the 8th after the 12-2pm dose, despite mum lasting until 8.45pm!

Why the rush to sign this off, rather than leave it open?

This meant that mum had No Paracetamol since 12-2pm until she died at 8.45pm?

Yet, FY2 wrote a Morphine prescription in case of distress.

• This was clearly deliberately Pre-meditated!

Since the Doppler after 5pm on the 7th had shown mum to have a clear indication of a Clot, then why would Paracetamol suffice for this by the SHO on the 7th. 

Would mum not require a Morphine prescription (just in case of distress) after the SHO saw the report from the Doppler on the 7th?

Yet this FY2 thought she would require Morphine on the 8th?

• It doesn’t Add Up!

• N.B. Agitation can be caused by many things which do not necessarily require Morphine.

• Patient was showing No Signs of Pain!

• FY2 Review:  (Taken from SHO’s notes).

Sats down to 82% on 60% O2.  (Where did this come from?)

90% on 15L via trauma mask  (Taken from chart at 11.30am)

Sweaty & Clammy.  (Taken from the SHO’s notes)

Cheyne stokes breathing.

Up RR.  Chest with a small sketch.

poor (R) sided entry + creps (L) basal creps.

No signs of failure.

On 12. IV fluids.  (Instructed by the Consultant and written on ward manager’s notes, with a Fluid chart written for this by FY2 to start 12pm – only given once despite writing this for Three times with Dextrose in-between).

Imp/Very unwell 2. infection + – PTEs.

not likely to improve.

‘I have explained this to her daughter.  We are doing as much as we can.  I also explained that at this stage we feel it is best to keep her comfortable and will give her Morphine if agitated.

• She understands this.’

• What a Blatant Lie!

This was the Second occasion this FY2 wrote ‘She Understands This’.

Both occasions resulted in telling me lies!

The first time was when she told me about her proposal to give mum Heparin on the 4th, when she ‘explained’ this as if she was going to give this for the first time.

The second time was this tale about ‘Morphine’ despite my stating that I wished to have mum given Paracetamol and was completely unaware that FY2 had already signed off the Paracetamol Before she told me ‘It’s Possible’!

Also discussed with (Consultant).

Plan:

15 O2.

Keep comfortable with Morphine.

The IV bag was removed at 4pm*** and shortly after this a nurse came in and without even acknowledging mum or I, proceeded to ***remove the urine bag (which was half-filled with deep yellow urine), so presumably any fluid was to either gather in my mother’s bladder, or fall onto the floor, or perhaps onto the blow-up mattress which they had moved her onto; when I asked a male nurse? if they were going to take her bed into the ward  ‘to be nearer the nurses station’ and he said ‘Yes’ (More Lies, but hey it’s just her daughter, so what does it matter!, just tell her any old patronising story) but when the curtain was drawn around her bed I saw the sheets thrown onto the floor and knew they were shifting her about again!  Her poor little body was through the mill.  I was unaware at this time that she was being lifted onto this blow-up mattress!

As for being nearer the nurses station, this was sheer baloney as not one nurse came to see how mum was. 

Not once!

• Nurses notes at 6.30pm:***

Now for S/C fluids as no IV access.***

I am reminded of Shakespeare here who said:

~All The World’s A Stage ~ And It’s People It’s Players~

Only thing is, most people like to watch Stars, not stand-ins feverishly trying to please in order to get more parts!

• How is it possible for an SC to be done at 6.30pm when the IV bag and the urine bag had been removed at 4pm?

Family want to discuss Mrs……..case to date.

• Nurses notes from Communication with Relatives:

Mrs…. daughter and grand-daughter asked staff if they could speak to doctor.  Advised that only ‘covering’ doctor on duty, but they would be paged.  Asked if I could help them in any way.

Asked if getting fluids changed to S/C meant it was ‘like switching off life support’ (my daughter’s reaction).  Explained it was absolutely nothing like that and the only difference would be that sub-cut is less invasive and she would be getting some volume of fluids – only over (possibly) longer times.  Also explained that as condition very poor, IV Paracetamol was discussed and PRN Morphine is possible to control pain.

Was she aware that the Paracetamol prescription had already been signed off?

Asked about oral meds. – explained all discontinued as condition too poor for oral diet. (My daughter’s question) Again explained that medication received very carefully (Did this include the Vancomycin perchance?) and medical staff decide.

This was the (previously disgruntled) nurse who then asked Again:

Explained again that they do not want Mrs….. resusitated.  This has already been discussed and decided by family and medical staff.

Why the constant need to verify this?

This was the Third Time!

Mum died at 8.45pm that night, so the amount of Morphine she had been given must have been sufficient in her body from 2pm – WoW – that must have been some amount – for no distress for Almost Another Seven Hours !

It doesn’t matter that the prescription for Morphine was never signed as the mandatory sheet for Vancomycin was never completed.

Also since mum had been on a Constant bombardment of Paracetamol since she arrived there, are we to expect that after the scenario at the Doppler she could just be taken off this completely after the 12-2pm dose?

That is unless it was known that the Vancomycin dose had done the trick and put her into a Coma, then if ‘Agitated’ there was always the convenient top-ups of regular Morphine which, when given sufficiently will stop the heart!

• At 8.45pm Mum Passed Away!

• Within seconds a yellow palor (like someone painting her) passed across her entire face and body!
• The Jaundice swept over her like a wave!
• The speed this was exceptional!

The fact of the Jaundice is the only slight comfort I have in knowing I was right in not allowing mum to be resusitated, as she would have been in agony, and the only recourse would have been lots of Morphine, which may not have been sufficient by that time.

The fact that I was put in the position of deciding to allow my own mother to die because of taking her into that place shall never be excused.  I Do Not take  any comfort in the fact that all of this was deliberately brought about, and I talked my mother into going there initially!

I sat with mum to be sure she was gone and put my head out of the curtain, where two females were changing a bed at the farthest away corner while talking non-stop to each other – eventually responded to my saying ‘nurse’.

Another FY2 was sent for and she was so gentle and kind toward my mum talking to her as though she could hear her (possibly just in case she could).  She did various tests and said time of death 9pm which I corrected at 8.45pm.  She acknowledged this with sympathy and left us both alone.

This FY2 was asked to certify death!

-No breath sound one minute.

-No respiratory effort one minute.

-No pulse one minute.

-Pupil fixed and dilated.

Time of Death:  8.45pm

Cause of Death: Bronchopneumonia.

• Nurses notes:

Patient died at 8.45pm.  Doctor notified.

Daughter will collect Death Certificates today.

Disgruntled nurses notes again from Communication with Relatives:

Mrs………….  died at 20-45hrs.

Her daughter was in attendance.

Following Mrs…….. death the daughter said that she didn’t want her mother to go down to the Mortuary.

She wanted to take her mother’s body home with her.  Myself and S/r ……….. explained that this was not possible.

The daughter then said she wanted an undertaker to take her mother to the chapel of rest right away.

I did not say ‘right away’, I merely thought that they would not want mum staying in the ward with other patients; understandably; and I wanted mum to go somewhere nicer than a mortuary!

S/r……. explained that it would be unlikely that an undertaker would be willing to come out at that time of night.

Eventually after telephoning an undertaker from the ward Mrs…….. daughter was satisfied that her mother would go to the mortuary.

Daughter and friend in attendance at this time.

I asked if mum could go home with me, or if a Funeral Parlour could be contacted, but was told that was not possible because she would have to remain there until the doctor certified her death in the morning.

The two nurses told me ‘the Mortuary was a nice place’!

Can you believe this?

FY2 notes:

8/2/…..  Death Certificate Issued.

Cause of Death   

1a –  Bronchopneumonia                                      

1b – Pulmonary Embolism

FY2  Could not know that mum died of a Pulmonary Embolism as there was no way of telling it had moved from the Femoral Artery.

Only a Post Mortem examination would show this for certain!  It possibly never moved, especially with Morphine numbing the body, and no movement from mum at all apart from breathing with the Trauma Mask!

Since two doctors are required to sign this Why was this not seen?

• I did not know at that time that doctors are paid to sign Death Certificates!

That’s Terrific!

So the people purported to be looking after you get paid by you when you die!

Mum had been sitting watching a film on Television the night I noticed her heart racing a bit when she retired for the night, and if it had not been for my stupidity in asking that G.P. about occasional oxygen -if and when she required it for occasional use – my mother would have been safe at home, and when her turn came to leave, she would have been able to die in her own bed.

• Certainly Not by Involuntary Euthanasia-so don’t fool yourself as this is exactly what happened.

Do Not Be Like Me! 

Do Not Trust Blindly! 

Ask Questions All The Time!

Get The Right Answers!

I’ll be back in two or three weeks with Curtain!

One Response »

 

Sickened By The NHS Part 9. (3rd Part of Final D-Day). Friday, Jun 14 2013

Look Closer

What do you see, nurses, what do you see?

Are you thinking when you are looking at me,

A crabbit old woman, not very wise,

Uncertain of habit, with far-away eyes,

Who dribbles her food and makes no reply,

When you say in a loud voice, “I do wish you’d try”,

Who seems not to notice the things that you do,

And forever is losing a stocking or shoe,

Who, quite unresisting, lets you do as you will,

With bathing and feeding, the long day to fill?

Is that what you’re thinking, is that what you see?

Then open your eyes, you’re not looking at me,

I’ll tell you who I am as I sit here so still,

As I move at your bidding, as I eat at your will,

I’m a small child of ten with a father and mother,

Brothers and sisters, who love one another,

A young girl of sixteen with wings on her feet,

Dreaming that soon a true lover she’ll meet;

A bride now at twenty – my heart gives a leap,

Remembering the vows that I promised to keep;

At twenty-five now I have young of my own,

Who need me to build a secure, happy home;

A woman of thirty, my young now grow fast,

Bound to each other with ties that should last;

At forty my young sons will soon all be gone,

But my man stays beside me to see I don’t mourn;

At fifty once more babies play round my knee,

Again we know children, my loved one and me.

~

Dark days are upon me, my husband is dead,

I look at the future, I shudder with dread,

For my young are all busy with young of their own,

And I think of the years and the love that I’ve known,

I’m an old woman now and nature is cruel,

‘Tis her jest to make old age look like a fool.

The body it crumbles, grace and vigour depart,

There is a stone where I once had a heart.

But inside this old carcase a young girl still dwells,

And now and again my battered heart swells.

I remember the joys, I remember the pain,

And I’m loving and living life over again.

~

I think of the years all too few – gone too fast,

And accept the stark fact that nothing can last.

So open your eyes, nurses, open and see,

Not a crabbit old woman, look closer –see ME.

Phyllis McCormack

~

~Act Twenty Nine~

• At 5pm the nurses notes read:

Signed by the Staff Nurse who had given mum the Vancomycin.

(Attended at 16.05).   17.00 Patient returned from X-Ray following Doppler.

On return at 17.00 patient was Almost Unresponsive.

Pulse 88.

B.P. 113/76.

O2 Sats 24%.

No Charts were written for the above!

+Trauma mask commenced.

O2 Sats improved to 92%.

Medical Staff informed.

Blood gases taken.

Furosemide 40mg given IV (given at 17.10 prescribed by the emergency doctor).

N.B. My mother at 11.10am had tolerated O2 continuously at 4.L.

Yet when she was taken to the Doppler she was not on O2?

• Mum had been at the Doppler for 1 Hour. (This should take approximateley 15 minutes.)?

• A doctor was urgently called in from another ward .

ATSP re. low Sats. + very unwell.

Returned from X-Ray department – clammy + low responsiveness  low Sats.

87 female – cognitive impairment.

COPD.

LVH.

Elevated B.P.

Epilepsy*

(*Taken from FY2’s Admission Document, which misled the Consultant and started all of this downward spiral). (Also this *was from a stroke years before!)

Admitted 31.1… – LRTI – not improved despite IV Augmentin and IV Ceftriaxone.

• Why no mention of all the other drugs, especially the *IV Vancomycin given one hour before this emergency doctor’s arrival; *which was written on page One of the prescriptions instead of the current page Four; and given Before the Doppler?  Therefore once again another doctor only read the previous notes, as the prescriptions would have shown the rest including the Vancomycin, and having seen this the ‘Blank’ separate form would also have been noticed , hopefully!
  

Developed Pulmonary Oedema 4.2… (Developed this before the 4th, but FY2 wrote on 4th ‘New Since Admission’ making it appear it happened on the 4th!)

CXR – wedge shaped opacity and Dalteparin started.  (Started on 4th and Taken from doctors notes/prescription)

• Where are the other notes with regard to Heparin etc. stopped and started?

Doppler US legs today confirmed DVT and likely PE’s?

O/E  B.P. 120/67, p 110,  Sats. 80% initially  T  ?

• The emergency doctor would be unaware that the nurses notes stated: as there was No Chart written for 5pm B.P 113/76, pulse 88, O2 Sats 24% Off Oxygen.

• Where does 80% initially come from as they were 24% at 5pm, then improved after the trauma mask commenced, to 92%.
  

-> 92% on 15L* O2, B.M 9.8.

• The staff nurse must have Verbalised the 15L ->*

Chest RR 28down A/E bibasally

harsh breath sounds (L) base.

CVS  Hs1 +11 + 0

mild pitting oedema

JVP

GCS – e3/m5/v4 12/15

ECG SR ? (cannot read writing!)

ABG pm 15L O2

• The following Arterial Results noted by the SHO111 were  Analyzed by FY2 @ 17.03!

• Why was FY2 analyzing this sample with the Results @ 17.03 when mum had been wheeled back into the ward @ 17.00?
• How was it possible to take bloods in the ward after 17.00 and have the analyzed Results @ 17.03 from the Lab?
• Why the Delay when mum was almost unresponsive @ 24% oxygen when wheeled back to the ward?
• Why was she wheeled back to the ward without any Oxygen?
• Why if FY2 took this sample during the Doppler did she not accompany her patient back to the ward?
• Why did FY2 not give any O2?
• What was FY2 doing at the Doppler in the first place when she was Not On Duty?
• Why did FY2 analyze this Arterial blood?
• What happened at that Doppler?
• Especially, given the fact that a procedure which normally takes 15minutes, took mum from 4pm until 5pm?
• Why was mum at the Doppler for an Hour?

He 56.8

pCO2 9.4

pO2 8.3

BE 20

Bic 31.1

• Why did the SHO111 not wonder where these Arterial Blood Results had transpired from since she was the doctor called in that emergency?
• Did she know that FY2 was with mum at the Doppler?
• Even if FY2 had been nearby and been called by the X-ray department to an emergency and she took bloods to see what was happening, this would not excuse her for not giving her patient oxygen at the very least! 
• This would also not excuse No Notes written as a report!

Imp 1) DVT + likely PE’s?

11) LRTI not especially ? abx.

111) degree of pulmonary oedema.

Plan: 5.05pm

IV Furosemide

Paracetamol cal.

IV Vancomycin * 

• ( This * was already given, therefore did the SHO111 Plan this for the next 48hrs?)
  

• This SHO111 copied prescriptions and notes, already written by FY2 before the 7th.  

• Did she not notice the ‘Special Instructions for Vancomycin which had been ignored as there were No Doctors Notes written that day prior to her own?
  

MRSA Screen

• Staphylococcus aureaus (MRSA) is a gram positive bacteria that causes a variety of infections including pneumonia.  This gram positive bacteria becomes pathogenic when there is damage or injury to the skin, giving bacteria systemic access to the organs and tissues.  Those most at risk include individuals with a weakened immune system.
• Look at the numerous injections in mum’s stomach and wrists and hands!
• Elastic stockings never entered into the frame!

LET Next-of Kin know of deterioration.

If this SHO111 had not written this would I have been told at all until too late?

I Do Not believe I would have been called without this SHO111 instruction to do so!

N.B. ~This  SHO111 in her professional capacity wrote:

5.05pm PLAN:

IV Vancomycin   (which she took from the prescription written by FY2 )

• Why did SHO111 Not Observe that this had already been given by the Staff Nurse and therefore conclude that since mum was at the Doppler from 4-5pm, that she was given this Before the Doppler and at a far too fast rate which was extremely dangerous? 

Plus Not Given over 120 minutes!

• At 5.10 mum was given:

40mg Furosemide IV

• The ward manager who had telephoned me to come in, and who had expected that I had gone visiting a former patient, wrote her report of almost three pages about Me at 5pm, at precisely the same time of 5pm that my mother returned to the ward ‘Almost Unresponsive’.

• At 6.30pm Nurses notes: 

(The same nurse who gave the Vancomycin).

• N.B. There is no mention in these nurses notes about the 1000mg Vancomycin she had given despite initialing them as given.  Not even IV as recorded!

Radiographer attended for X-ray patient’s chest, patient’s daughter refused to have this carried out.

medical staff informed.

• At 7.30 the SHO-On-Call wrote my reasons for this as you will read below*.

• The emergency SHO111 took an Arterial sample which was analyzed @ 18.48.

Results:

cH            47.7up

pCO2       10.4up.up

pO2          10down

Na+          146up

K+            4.3

Cl              103

Ca++       1.19

Hct          42

Glu          9.4up

Lac          1.4

tHb          12.8

O2Hb      82.8down

COHb      1.8up

MetHb    1.0down

HHb        4.5

sO2          95.4

BE(B)      10.9

HCO3(c) 40.2up.up

Biochemistry Results:

*Collected  17.01.

*Received 18.56.

*Report Issued on the 8th at 09.26!

Sodium *146

Potassium 4.3

Chloride 99

Urea *12.4

Creatinine 85

eGFR>60

Glucose *8.2   What caused the rise in this from 10am until 5.01?

CRP *461

Bilirubin 6

AST *53

ALT *210

GAMMA-GT *551

Alk. Phos *442

Protein 62

Albumin *21

Globulins *41

They were Collected at *17.01 but

Not Received until 18.56. 

Why the delay?

 *A Further Overdose

• At 7pm mum was given:

*1G Paracetamol IV given

Nebulizers given

Attempted to reduce O2 therapy and give humidified O2 but saturation dropped to 84%.

Re-commenced on trauma mask at 10L.

*Another doubling up of Paracetamol from the previous dose before 4pm!

7.10pm Temperature 38.2!

7.10pm

The 40mg Furosemide IV was also given (written on the SHO111 Plan at 5.05pm).

• 7.30 SH-On-Call:

Above handed over – background noted – discussed patient’s condition with daughter.

Concern how unwell she is -clearly very upset with condition/situation.  Feels that condition much worse by treatment in hospital.

“Never should have made her come in!”

Explained that we are treating a combination of problems – infection/possible PTE/possible LVF (Lower Ventricular Hypertrophy).

Understands that we feel that if Mrs……condition does not respond to treatment, that there are no other interventions that we think would be appropriate.

Agrees that should ? Rx but that Mrs…..should not be for resucitation in the event of a cardio-respiratory arrest…..

By now every instinct in me knew that if mum had to go through this sort of trauma she could have been in agony if they had to revive her from a collapse, as I did not feel her frail little frame could take a pounding.

I beat myself up about agreeing to this for years until  discovered the amount of poisons being given to her and exactly what this FY2 had done from the beginning!

Nevertheless I still feel that I was made a party to ending this needless torture because that is what it was – Needless!

Not only was I responsible for talking her into going there; at the behest of that G.P. about her heart of all things; but I was party to ‘pulling the plug on my own mother’ albeit extremely reluctantly, and only because of the condition she had now been reduced to!

Note:*

Patient’s daughter initially not keen for CXR-moving patient about too much.

Now having explained this further she is happy for this to go ahead, therefore reason for delay…….. was that she would have this in her bed, with little movement……….Patient on 10L O2 SPO2-90% SPO2 quickly downward off O2 between changing masks.

Chest reviewed- some wheeze in addition to ? creps at base without nebs.  Patient flushed, feels warm, mouth dry.

Great!

Report ABG on 10L.. PO2 10.0, PCO2 10.4 up, cH 47.7 up, HCO3 40.2 up, ->???

These were all taken from the Arterial Sample Results at 6.48pm.

(P) ? current Rx – change to humidified O2. try to reduce further but need to maintain SPO2.

-IV Paracetamol (given at 7pm).

CXR reg. nebs.

Review later.

Not for resusitation in the course of cardiac arrest.

I wonder if the ward manager read this as she Did Not write in her own notes from the ‘meeting’ at that time I wanted mum to be resusitated?

7.2…..

Note patient better ? nebs – SPO2 95% on 8L.

Awaiting CXR  (Attended 7.26).

Daughter to stay in with patient overnight if possible.

Will speak to medical staff?  SHO11.

CXR Results: 7.2…..

*This report has mum at 89 instead of 87 and while this may appear a trifle incidental it illustrates a further example of the carelessness in the NHS.

There was an ECG report with another persons name on plus another nutrition sheet with someone else’s name scored through and mum’s written above!

There are other charts wrongly completed, such as SIPS of fluid on the 8th when mum was in a Coma!

*There is now very extensive consolidation involving the right hemothorax together with a small amount of pleural fluid in keeping with severe infection.

7.2…..

CXR Reviewed:

Patchy opacification of whole of (R) lung.

Ab? bibasal effusion.

Most likely cause – infection -??aspiration???  Despite SALT Report?

Note patient’s daughter concerned re. LMWH Rx given patients previous history of intracerebrael haemorrhage in 200..?

*Please discuss more.

*No Discussion about this Ever Took Place!

• N.B. The same staff nurse who gave the Vancomycin, and was at the ‘meeting’ was nowhere to be seen; when I arrived after the phone call from the ward manager who wrote her three pages of notes on Me at 5pm then left before I arrived;  and had written nurses notes at 3.20pm, 5pm, 6.20pm and 7.10pm (as according to the ward manager she was on back shift!)

• Therefore this staff nurse was writing her notes at 5pm about my mother, at the same time that the ward manager was writing her notes about ME, so who was with my mother until the emergency doctor arrived at 5.05pm?

Yet No Charts were completed after 12.00 for B.P., pulse.

The 24% should have been written etc.

These Charts would show the effects which erupted from the Vancomycin IV which this staff nurse had given mum.

*Can Vancomycin hydrochloride cause Hyperclycaemia?

*Age of people who have Hyperglycaemia when taking Vancomycin hydrochloride.

0-1       =    6.67%.

2-29    =   0.00%.

30-49 =   6.67.

60 +    = 66.67%.

Top co-used drugs for these people include Prednisolone, Furosemide, Corticosteroids, Salbutamol and Ipratropium All of which can cause Hyperglycaemia (High Blood Sugar)!

N.B. This only flagged up after the 5.03 Arterial Blood Sample showed elevated Glucose!

Conversely, Clarithromycin can cause Hypoglycaemia (Low Blood Sugar).

Great, isn’t it?  If you manage to survive it all That Is!

On September 4th 2012 a post-marketing study showed that 2,158 people reported to have side effects when taking Vancomycin hydrochloride.

Common side effects of hydrochloride include fever, sepsis, hypotension, renal failure acute condition.

• The Department of Haematology Results:
• Date of Sample 07.02….@ 19/..?
• Date of Report 07.02…@  20/..?
• *05.02…  FBC.  No Clinical Details Provided.
• PLEASE SUPPLY RELEVANT CLINICAL DETAILS.

WBC 24.27

Hb 13.0

Plts 357

WOW!

• At 10-12pm mum was given:

1G Paracetamol IV

• At 11pm another nurse wrote:

……..remains fairly settled in upright position.

O2 therapy continues and has been around 90-92%.

IV Antibiotics as charted.       Which? When?

Daughter present.

….has been talking at times.

This was misinterpreted as mum had opened her eyes and looked at me and I said to her  “Hi, Young One”.   She closed her eyes again!

1am. Required an increase in her O2 to 10L. to lifting her O2 up from 83-94% and has remained at that level.

Urinary volumes were 12% at 2am.

More settled, breathing less laboured with the O2 improvement.

6a.m.. Required again -O2 still around 95%.

But 4% urinary output much less at this time.

Positional change -other (R) side, skin slightly red.

IV Antibiotics and IV Paracetamol as charted.    Which ones?

Temp. now settled.

More settled now.

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Sickened By The NHS Part 9. (2nd Part of Final D-Day). Monday, Jun 10 2013

IF

• IF You can keep your head while all about you

are losing theirs and blaming it on you,

If you can trust yourself when all men doubt you,

But make allowance for their doubting too,

If you can wait and not be tired by waiting,

Or being lied about, don’t deal in lies,

Or being hated don’t give way to hating,

And yet don’t look too good, or talk too wise.

• IF You can dream-and not make dreams your master,

If you can think-and not make thoughts your aim,

If you can meet with Triumph and Disaster,

And treat those two imposters just the same,

If you can bear to hear the truth you’ve spoken,

Twisted by knaves to make a trap for fools,

Or watch the things you gave your life to broken,

And stoop and build’em up with worn-out tools.

• IF you can make one heap of all your winnings,

And risk it on one turn of pitch-and-toss,

And lose, and start again at your beginnings,

And never breathe a word about your loss,

If you can force your heart and nerve and sinew,

To serve your turn long after they are gone,

And so hold on when there is nothing in you,

Except the will which says to them ‘Hold on’.

• IF you can talk with crowds and keep your virtue,

Or walk with Kings-nor lose the common touch,

If neither foes nor loving friends can hurt you,

If all men count with you, but none too much,

If you can fill the unforgiving minute,

With sixty seconds’ worth of distance run,

Yours is the Earth and everything in it,

And-which is more-you’ll be a man my son!

Rudyard Kipling

~Act Twenty Seven~

• ~ Part 1 of this Act ended with~

‘She Did Not mention the fact that my mother was being taken for a Doppler while I was wasting my time with her!’

‘The fact was that this ‘meeting’ lasted from 20 minutes to four until 15 minutes to five!’

Not Once, was there mention of my mother being taken for a ‘Doppler’ test – while we were having this conversation!

During visiting hours?

Presumably another nurse did not take mum for a Doppler without the Ward Manager’s knowledge therefore why did she not mention to me that mum was going for this at 4 o’clock?

Why did the Ward Manager tell me that mum was going to be weighed at 4 o’clock?  After all, she had consulted her notes before stating this therefore she must have known about the Doppler as she was in Full Charge of that ward!

Did FY2 know that mum was going to the Doppler at 4 o’clock?

Who knew and When did they know?

Why was mum at the Doppler for almost One Hour?

In fact, I hurried out of that room back to mum to give her the banana and ricicles; which had been delayed due to the milk which I had brought with me turning sour and had to be bought afresh in the local shop nearby; and my friend had gone to buy this.

It was in that shop that FY2was seen yet was Not on Duty That Day?

• Mum never received her food that day, and never received any food ever again!

• Mum and I never spoke to each other again!

I almost fainted as her bed was completely empty!

I was informed that she had been taken for a Doppler at 4 o’clock.

I waited until 10 minutes to five feeling guilty about staying after visiting hours, thinking the other patients may soon be having their dinner or being attended to by nurses?

My friend mentioned that we were going to visit a previous patient ( one who had witnessed my mother’s extremely bad night from the 3rd/4th!).

I reluctantly left to go back home, in order to return after eating, and was just in the house when the phone rang between 5pm and 5.30pm!

This was to tell me that mum had returned from the ‘Doppler’ in a bad way!

• Remember, mum was waiting for fresh milk to eat her ricicles before that meeting!

This ward manager also said in a very bold and aggressively challenging voice, (which was the entire opposite of her attitude from her notes which sound so accommodating)

‘I thought you were going visiting!’

‘Not Me!’ 

• Did she actually think I would not be in to take this call?

We turned around and flew out the door again, but the traffic at tea-time was terrible for a short journey normally by car.

I ran into that ward to find mum with a face like a balloon, and she just stared constantly into my eyes as if trying to tell me what was happening to her.

I knew in an instant!

The Anaphylactoid Symptoms were plain to see even for a fool, and mum looked absolutely alarmed.

I took off my coat and sat down and not All the Hounds of Hell itself Would Have Moved Me from Mum’s Side!

The ward manager had Gone Home!

The staff nurse who had been at the meeting was nowhere to be seen?

• The details of the Doppler report was:

Attended 07/02/.. 16.15pm.

US LEG:

*Suboptimal limited examination due to patient condition.*

Was there an initial proposal for some other type of examination?

• N.B. My mother was fine if not doped before I went in for this talk.

• Why was she in this *Condition when she Arrived at the Doppler?*

• Who booked the Doppler for 4pm visiting hours on the 7th?

• The Consultant instructed this to the ward manager on the 5th, therefore she must have booked this, yet she told me at the meeting that she was going to weigh my mother at 4pm on the 7th?

*Echogenic matter present in the left common femoral and superficial femoral veins.

Spontaneous venous flow is present in the right common femoral and superficial veins.

IMPRESSION:

Thrombus present in the left leg vein to the level of the left common femoral vein.

• Now, for the bit to make you sit up and take notice!

• A word of Warning folks, you will Really need All of your concentration to absorb the following!

~Act Twenty Eight~

On 7th FY2 had written a prescription for 1G Vancomycin IV to be given at 4-6pm.

FY2 wrote this prescription on a ‘blank’ box number ‘D’ which had three other prescriptions dated the 4th, Four Pages Back!

This  box D was initially left ‘blank’ along with another full sheet E,F,G,H by FY2 when she wrote the new sheets on the 4th?  She then completed prescriptions on J,K,L,M,N,P,R.

In not using S which was at the end of the prescription sheet, anyone looking at the current prescriptions would not notice that this 1G Vancomycin IV had been written on D.

Plus the fact that 2G Ceftriaxone IV was also given on the 7th at 7-9am, along with 500mg Clarithromycin IV which was given at 12-2pm, and then the Vancomycin !

Why would anyone want to go back Four pages to a blank space to complete a prescription instead of using the next one in sequence?

This meant that this was being dispensed by the pharmacist BEFORE I went into the meeting.

This meant it had been written at the latest between 3-3.30pm in order for him to dispense it, as he was dispensing when I was there.

This means that FY2 had written this prescription for 1G Vancomycin IV (a drug of last resort) BEFORE mum went to the Doppler!

THE QUESTION ARISES?

• On the 5th at his previous visit the Consultant had written – continue antibiotics 2 days => review.
• He would not be in until the 8th therefore would not know about the Vancomycin given on the 7th until it had Been Given!

Do you think he would have been aware of the fact that the Vancomycin had been given far too quickly?

It’s not difficult to see where Major Problems can arise when the ‘Main Man’ is not in the picture!

• There were No Doctors Notes written on the 6th.
• FY2 was Not On Duty on the 6th.

Now here is a strange thing:

• When I telephoned the Nutritional Support Sister on the 6th, she contacted the ward sister, dietitian, and another ward sister Plus FY2? yet she was Not On Duty that day, in fact no-one was?

• There were No Doctors Notes written on the 7th.
• FY2 was Not On Duty on the 7th.
• When did FY2 write this,  (I had asked to speak to the ‘doctor’ and was told she was not available that day) as she was only seen in the local shop and was Not On Duty in the ward that day?
• Even if she had been in the ward that morning, Why were there No Doctors Notes regarding such an important change in Drugs etc.
• FY2 decided to give this extremely potent drug of last resort without consulting any other Senior doctor or the Consultant!

How do I know this?

Because she always wrote any other doctor’s instructions in her notes!

It helped to fill in blank pages, didn’t it?

• As she had written this prescription in time for the pharmacist to dispense it early afternoon, Why did FY2 write it Before mum took badly at the Doppler?

• Ah, but wait until you hear about the Doppler and FY2!

• The next day of the 8th FY2 told me that there was nothing more they could do for mum and that she was giving her a drug of ‘Last Resort’, which was this Vancomycin (which mum had Already Been Given on the 7th which precipitated her Dying on the 8th!). There was No mention that it had been given Before the Doppler on the 7th and that it had been given far too quickly!
• Once again, FY2 implied that this was to be given to mum that day, with no mention that it had already been given the day before!  Exactly the same as on the 4th scenario with the Heparin!

This Gets Worse!

• The pharmacist wrote a separate sheet for this drug called:

ANTIBIOTIC RECORDING CHART

VANCOMYCIN

Please record the administration and sample times below.  his enables samples to be accurately interpreted to avoid treatment failure or toxicity to the patient.

Date: 07/02.

Drug: Vancomycin. Dose: 1000mg. Time of administration or start of infusion. Time infusion complete. Given by. Sample date. Sample time.

Guess What!

The Staff Nurse who was in the meeting with us, GAVE mum this 1G Vancomycin IV and initialled this as given!

 This meant that this drug had been given Before the meeting!

This meant that this drug had been given to mum at ‘A Rate of Noughts‘  Before she went to the Doppler!

A Quick Exit!

The Staff Nurse completely ignored this Antibiotic Recording Chart and left it blank!

Despite the pharmacist writing on the Prescription under:

Additional Instructions/ Comments/Pharmacy:

48 hourly.

Give Over 120 Minutes!

 

• At 4-6pm mum was given:

1 Paracetamol Calpol

1000mg Vancomycin IV

Conflicting Drugs:

Vancomycin Indications:

Is indicated for the treatment of serious, life-threatening infections by Gram-positive bacteria  (So FY2 finally discovered which bacteria it was?) which are unresponsive to other less toxic antibiotics.  It acts by inhibiting proper cell wall synthesis in Gram-positive bacteria.  Most Gram-positive bacteria are intrinsically resistant to Vancomycin because their outer membrane is impermeable to large glycopeptide molecules.

It is Not active against Gram-negative bacteria.  (So FY2 was certain this was not Gram-negative?)

• Strange thing is. Where are the results showing the Bacteria?

In particular, Vancomycin should Not be used to treat methillin-sensitive Staphylococcus aureus because it is inferior to penicillins such as nafcillin.

Adverse Effects:

Local pain, which may be severe and/or thrombophlebitis.

Anaphylaxis, Superinfection, Thrombocytopaenia.

It has traditionally been considered a nephrotoxic and ototoxic drug!

Caution in elderly patients!

It should be noted that the total systemic and renal clearance of Vancomycin are reduced in the elderly!

• IV may cause nausea, take as directed with food, small, frequent meals, frequent mouth care.

• Report immediately any chills, pain, swelling!

Vancomycin does not readily diffuse across normal meninges into the spinal fluid, but, when the meninges are inflamed, penetration into the spinal fluid occurs!

• Rapid bolus administration (e.g. Over Several Minutes) may be associated with exaggerated hypotension including shock and rarely, cardiac arrest!

Vancomycin is Ototoxic to the auditory portion of the eight cranial nerve.  This means hearing loss is possible from taking Vancomycin and is more common with I.V.

Mum always had terrific hearing!

Vancomycin IV is processed by the kidney.  Patients with no fluid restrictions should maintain adequate fluid intake to ‘flush’ the kidney and reduce the likelihood of overloading and damaging the organ.

The ward manager had written after 3pm in HUGE writing:

N.B.M – General Condition -very poor

So, that takes care of adequate fluid to ‘flush’ the kidney!

And FY2 knew all of this before giving it to mum?

While on treatment, two kidney markers, BUN and Creatinine, as well as Vancomycin drug levels, are monitored in the blood.  An increase in the levels of these markers correlates with a decline in kidney function, and a reduction in the dose is indicated to restore and preserve kidney function.  Also as kidney function declines, urine output decreases, causing dehydration and increase in thirst.  Nephrotoxicity.

Prescribing Vancomycin in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.

Side Effects:

Decreased B.P., increased heart rate and flushing, usually when IV is given too fast!

Shortness of breath or difficulty breathing may occur while on Vancomycin IV therapy, especially with the first dose.

What sort of imbecile would put my mother on this?

Acquired microbial resistance to Vancomycin is a growing problem, particularly within ‘health care’  facilities such as hospitals!

Say That Again?

N.B. There is some suspicion that agricultural use of Avoparcin, another similar glycopeptide antibiotic, has contributed to the emergence of Vancomycin-resistant organisms.

Incompatible with:

*Ceftriaxone  2G was given to mum at 7-9am!

*Heparin         7500units given at 12-2pm!

May cause neutropaenia; use caution with Carbamazepine.

*5mls Carbamazepine given at 7-9am!

IV Induced Anaphylaxis has been reported

These signs and symptoms should be assessed immediately (One Hour Late!) and Vancomycin Stopped until hypersensitivity to Vancomycin is excluded as the cause of these symptoms.

• N.B. There is No Specific Therapy for Overdose with Vancomycin!

Another Drug with No Antidote?

Something very questionable here!

Subsequent reviews of accumulated case reports of Vancomycin-related nephrotoxicity found that many of the patients had also received other known nephrotoxins, particularly aminoglycosides.

Vancomycin can also be given orally, but this method is very expensive!   (Not that mum could have had this as she was now in a Coma!)

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Sickened By The NHS Part 9. (1st Part of Final D-Day). Friday, Jun 7 2013

A Nurse’s Oath,

The Florence Nightingale Pledge

I solemnly pledge myself before God and in the presence of this assembly,

to pass my life in purity and to practice my profession faithfully.

I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug.

I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling.

With loyalty will I endeavour to aid the physician in his work, and devote myself to the welfare of those committed to my care.

• To recant what mum was given on the 6th:

• At 7-9am mum was given:

2G Ceftriaxone IV

40mg Furosemide Oral

1G Paracetamol Disperse

5mls Carbamazepine Oral

5mg Salbutamol Neb

0.5mg Atrovent Neb

• At 12-2pm mum was given:

500mg Clarithromycin IV

7500units Dalteparin SC

1G Paracetamol Calpol

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:

1G Paracetamol Calpol

500mg Clarithromycin IV*

5mg Salbutamol Neb

0.5mg Atrovent Neb

5mls Carbamazepine Oral

1 drop Latanoprost ea. eye

~Act Twenty Five~

• On the 7th at 05.00 the nurses notes were:

Settled and slept well.

4% catheter volumes

Bedrest maintained.

• At 06.00 the Charts read:

*B.P. 129/71, No pulse recorded, O2 98% 4L, resp. 20.

This *was Not written on any nurses notes!

• At 7-9am mum was given:

2G Ceftriaxone IV

40mg Furosemide Oral

1G Paracetamol Calpol

5mls Carbamazepine Oral

5mg Salbutamol Neb

0.5mg Atrovent Neb

• Nurse’s notes on Oral Intake Chart on the 7th.
• (The chart which Commenced on the 6th!)

cornflakes – choking on breakfast.

N.B.M. -> SLT (Speech and Language Therapy) review 2pm.

Below this was written in huge letters by the ward manager!

• N.B.M.-General Condition – very poor

• At 09.00 the Charts read:

*B.P. 159/85, pulse 92? (there is another dot at 148 on Chart)?, O2 98% on 4L, resp. 20.

This * was Not written on any nurses notes!

• On the 7th the  Biochemistry results from the bloods taken at:
• Collected @10.00
• Received a@ 11.46,
• Report issued on the 8th @09.26:-

Sodium *146

Potassium 4.3

Chloride 98

Urea *11.3

Creatinine 78

eGFR >60  (est. Glomerular Filtration Rate)

CRP *396

Bilirubin 4

AST *46

ALT *185

Gamma-GT *476

Alk. Phos. *384

Protein *50

Albumin *17

Globulins 33

Absolutely Sickeningly Inhuman!

• At 11.10 the nurses notes were:

Bed bath given

Nil by mouth as patient appears to be aspirating. (Choking on food/drink)

Water swallow tests carried out.  Patient gurgling and choking thereafter.

Referred to SALT for swallowing assessment.

Catheter patient and on 4 hourly volumes

Remains on bed rest

MEWS -> 3

Recordings to be monitored ODS

O2 therapy tolerated continuously on 4L

• The Department of Haematology results were:-
• Date of sample ?
• Date of Report 07.02… @ 12.27.
• *05.02..     FBC:  No clinical Details Provided.
• PLEASE SUPPLY RELEVANT CLINICAL DETAILS.

WBC 16.42

Hb 11.2

Plts 268

• At 12.00 the Charts read:

*B.P. 128/91, pulse 100, O2 91% on 4L, resp.24.

This* was Not written on any nurses notes!

• In fact NO MORE CHARTS would be completed AT ALL until 1.30am on the 8th!

Why Bother?

There again, What wouldn’t be seen?

• At 12-2pm mum was given:

500mg Clarithromycin IV

1G Paracetamol Calpol

7500units Dalteparin SC

5mg Salbutamol Neb

0.5mg Atrovent Neb

• At 14.30 the Salt (Speech and Language Therapist) wrote:

Swallow Ax consistent coughing up fluids/puree but due to high effort an difficulty co-ordinating respiratory/swallowing as chest signs less typical of aspirating pneumonia.

Advise:  Very small sips of normal fluids and very soft moist diet.  Monitor chest and for signs of patient distress.

• Salt wrote on notes:

Speech and Language Therapy (SALT)

ATSP by N. staff who were concerned that patient is having swallowing difficulty.  Assessed for normal fluids + puree.  Tends to ‘dump’ and consistent rattly cough post swallow and some SOB. chest status in Not Typical of aspiration but difficulties co-ordinating breathing and swallowing may be contributing to cough/SOB/huge effort, all of which are denied by patient.

How absolutely desperate mum must have been to get out of there!

This absolutely breaks my heart!

Advise:  continue to small sips of normal fluids and a very soft, moist diet but monitor for changes in chest status or high patient distress.  SLT11.

• Nurses notes on Oral Intake Assessment Chart:
• 3pm forticreme  – 30mls.
• water – sips.

Was I ever informed of this or of any problem regarding my mother?

You guessed correctly!

No!

It’s All A Big Secret!

For Them To Know and Us To Stay In Ignorance

of What is Going On!

~After All, They have the Stage all to themselves, and we are only bit-players!~

~Act Twenty Six~

• At 15.20 the nurses notes were:

Patients daughter requested a nurse attend to mother’s swollen Right hand.

(A bandage was wound around a couple of times and it was cutting off the blood supply with her hand turning blue).

I …………responded immediately to the request, and left to fetch scissors to cut this.

Mrs……… hand was indeed swollen due to her Venflon having tissued.

They talk to people like fools.  This was clearly because of the bandage cutting into her wrist!  The venflon was tissued alright but this was not the cause of the hand turning blue!

I informed Mrs……….daughter of this and informed the medical staff.

Who were the medical staff?

Why was this not observed by the nursing/medical staff?

Mrs……..daughter was extremely disgruntled intimating that the nurses are extremely cruel ‘torturing her mother’.

Everyone knows that use of words which are edited cleverly can be used to appear to mean something other than what is stated, and this was indeed the case, when I remarked that this was cruel!  This nurse managed; to add to the damage already written regarding myself; to enhance a picture of a very hostile relative, and nothing could be further from the truth.

I most certainly Did Not receive the information or assistance I so craved, right from my mother entering that ward, and Did in Fact receive hostility from the Ward Manager right from the start!

This person set the scene for unhelpfulness, hostility from day one, and lack of help from a nurse whom I had approached, along with obviously telling nursing staff that I was against them when this was Not True!

I was against indifference, and neglect, and the lack of communication or indeed any information which Never transpired!

As I said before,  ‘This Hogwash Does Not Wash With Me!’

There followed Over one hour and fifteen minutes meeting in a day room with the ward manager and this nurse.

What a naughty girl I was to suggest any mal-treatment of my mum.

Bad Daughter.

Over One hour and fifteen minutes which should have been spent with my mum!

Over One hour and fifteen minutes which should have been spent on care for the patients.

• The subsequent handwritten report of what had transpired at the meeting consisted of three full pages; to add to the other five written all about ME!

• This totalled Eight pages.
• All the nurses notes written about my mum added to Eight in total! 
• Surely there is something wrong somewhere when a ward which is short staffed has a ward manager and nurses writing up mainly petty and untrue remarks. 
• What about the time this takes? 
• No wonder the records are in such a shambolic state. 
• Every single one!
• Plus open to a great deal of abuse because of this shambles in organisation, or should I say non-organisation!

Dear ‘O’ Dear.

A shambles if ever there was one.

Report:

‘Myself and nurse… asked what her concerns were.’

(1) Mother’s Venflon had tissued.

(2) The doctors and nurses have no communication.

This was because I was sent from FY2 to the ward manager who in turn would send me back to FY2 without any solutions!

(3) Every task is compartmentalised.

(4) One occasion her mother’s legs were not covered.  One occasion?

She was kept in bed and Catheterised after this.

(5) Staff had been ‘fiesty’ towards her.

(6) She did not believe the food chart completed by staff.

This was in response to my stating that day that my mother’s teeth were falling out of her mouth and she had lost weight:

‘She’s Not Lost Weight!’  ‘What weight is she?’ Looking through her papers on her lap she said ‘We’re weighing her today’. ‘What time?’        ‘Four O’clock!’

Details:

‘Mrs….. venflon had tissued and her hand was swollen actually her skin was stretched and shiny like a balloon and blue)……. claims she came in and saw it before staff had seen it and if she hadn’t then staff would never have found it.’

What a load of bunkum.

I actually said it could have been dangerous to my mother if no found in time before more harm was done.

In any case did she not require this?

‘I explained that tissued venflons were very common.  I explained the reason why and told her that the staff are in and out of the patient’s rooms all day and especially when they are acutely unwell.’

So That was why No other Chart Observations were recorded for the rest of that day after 12.00hours!’

‘and it would have been discovered the next time we attended to Mrs….’

Now, given the fact that no nurses usually attended patients during visiting hours, this would mean that mum would have sat like that for at least an hour and a half!

‘I stated that while I actually didn’t feel the need to discuss my professional relationship I told her that the doctors and nurses communicated all day regarding patient care and that she was wrong in her opinion.’

This verifies what I said regarding ‘not feeling the need to communicate to relatives’. They may communicate to each other, for what it is worth, but they certainly Do Not communicate with a patient, relative or carer especially one who has a Legal and Binding Power of Attorney.’

Got it in One!  Because that Is The Prevailing Attitude.

Patients are here for us to do what We like and they do Not say Boo!

That is Why they are called Patients!

We are Not here to explain to Anyone whatsoever!

Relatives are a nuisance and an obstruction to this process and are tolerated begrudgingly!

So, when they communicate all day, is that when doctors are Not Off Duty?

Which days are ‘all day?’

(3) I do not know what …means by this.     I don’t imagine she would!

(4) …….states that on one occasion when she came in her mother’s legs were cold and uncovered.

This was the day mum was sitting ‘frozen’ in the ‘dayroom’ with the ‘props’ after having had a shower when the MRSA beds were being steamed, an she had No bedsocks on or feet propped up and her limbs once again were frozen!

She was also staring into space.  Being drugged can cause this but so can hypothermia!

‘I apologised for this unreservedly but I did say that the staff did their very best to deliver the highest standard of care at all times but on some occasion – things got missed.

(5) Again, I apologised for any ‘perceived’ nastiness, and said I would address this with the staff.

Unbelievable, another excuse to blame the daughter for badmouthing the staff when it was herself who instigated everything!

‘In defense of the staff……talks over you constantly, and interrupts you when trying to answer her.’

This was a new thing for me and the reasoning was because I was tired of either receiving no proper answers or a pat answer such as ‘it’s common for swelling feet and limbs to occur with steroids’.  ‘It’s common for Venflons to tissue!’.

Maybe it’s time for these to Stop being so Common?

These are real live human beings we are talking about here, not some robotic pieces of metal who are being programmed to die!

First Do No Harm!

Why was mum on so Many Steroids?

plus ‘her venflon had tissued’ with no redress to the effects on my mother!

‘As documented above – (this must have been on some of the other sheets written about ME, because I’m Soooo important?)  she has been ill-mannered on several occasion.’

This is completely untrue but considering the caliber of my accusers I shall let you, The Readers, be the Judge!

(6) ‘…..refused to believe the entries on the food chart, as she said her mother wasn’t swallowing well…

The ward manager herself told me that my mother had a sore throat days ago!

…I went into extensive detail re.  this i.e. thin fluids can be not tolerated, while thicker consistencies are easier to swallow.

I covered stage 1 & 11 fluids Textured A-E diets.  Assured her that the nurses do not routinely lie about patients intake.’

I did not accuse nurses of lying.  I stated that I did not believe mum had been eating well, and was told that a nurse had fed her chicken pie and I immediately wondered how she could chew and swallow this with her teeth falling out of her mouth.

Remember, I knew nothing at all about the SALT or any problems, all I saw were her teeth falling out!

This was my conversation but obviously it has been mis-stated as per usual from this source.

This ward manager adamantly and forcefully attempted to convince me ‘She’s Not Lost Weight!’ when clearly this was untrue.

In fact mum lost half a stone in just over a week’s stay in that establishment.

‘I explained fully, thoroughly and sympathetically all the answers to her queries.   I was professional and courteous despite….  provocative attitude, and the wild accusations being verbalised.’

This all sounds so professional and even nice, doesn’t it folks?

• She Did Not write that I had apologised if I offended anyone, and she and the nurse accepted my apology!
• She Did Not write that when she mentioned about the MRSA problem that she told me they actually had a major problem with C. Difficile.
• (I am still unsure whether she was sharing a problem she had, and which I at the time felt sympathy for her predicament, or if this was something else for me to worry about and she was allowing me to? But I shall err on the side of the sympathy vote meantime, rather than appear paranoid.)
• With the sheer unadulterated and obscene amounts of drugs given to elderly and infirm patients (and also to elderly in nursing homes ) with All of the Endless Authorities turning blind eyes to this, along with chopping and changing these at a rate of noughts I am not in the least surprised.

Talk about inviting Trouble!

Trouble must be a constant visitor to the NHS!

• She Did Not write that she told me they were short staffed, and that I had shown an appreciation for this.
• She Did Not write that she agreed the meals were cold.
• She most certainly Did Not write that she asked me ‘If I wanted my mother resuscitated ‘ should this be necessary and that I had at this time most vehemently said ‘Yes!’

‘She must have pretended to write as I saw her motioning this!’

‘Also it is noticeable to me now that she asked this at this meeting, as the events which followed were particularly ugly!’

Co-incidence?

There is No Such Thing in the Universe.

This merely suffices to fill a gap which many cannot explain otherwise.

• She Did Not write that she told me ‘Don’t worry about her not eating.’  You can go three weeks without food! and that my mother had been fed by one of the nurses and while she did not normally feel the need to explain herself nevertheless she would try to explain that my mother’s condition warranted that she take drinks which are of a custard-like consistency to enable her to swallow without choking, and that she was receiving these.

Would this fact not be of some importance for a daughter to know about?

• She omitted to mention that I had taken in Fortisip on the First Day of mum’s arrival in that place and she had placed this in her fridge!  Such was her aggressive manner to me that day, that she obviously forgot!

• What she failed to mention was the fact that my mother had been Choking on breakfast NBM SALT Reveiw 2pm that same morning, had only drank Forticreme 30mls and had sips of water at 3pm, accompanied by the fact that it was only ‘After’ my telephone calls to the Consultant’s Secretary and Dietitian? the day before that ‘One of the nurses had fed her’ and by all accounts this was the only day she had done so, apart from the choking incident that morning, yet her extremely defensive and aggressive manner belied the fact that her words did not match the facts, that for two days my mother’s teeth kept dropping down and I wondered how it was possible to eat Chicken Pie?

• She Did Not mention the fact that my mother was being taken for a Doppler while I was wasting my time with her!

This discussion lasted over one hour and fifteen minutes.

The fact was that it lasted from 20minutes to Four until 15 minutes to Five.

Watch This Space!

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Sickened By The NHS Part 8. Friday, May 31 2013

• ‘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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Sickened By The NHS Part 6. (1st Part of D-Day.) Tuesday, May 28 2013

If I have failed to do a thoughtful deed,

or turned my back on anyone in need,

If I’ve ignored the clouds in someone’s skies.

Or missed the chance to wipe another’s eyes,

If I have spoken words of bitterness,

If I have failed or faltered, more or less,

If I’ve forgotten the golden rule some way,

Please bring tomorrow’s dawning, so I may,

Make up for all I’ve left undone today!

Author Unknown

‘I wish to apologise for the confusion in posting Part 7 before Part 6 (here) as for some reason the date for Part 6 was scheduled for 6 June?’

I am greatly indebted to the kind person who advised me to give a short overview at the beginning of my blog entitled ‘Death By Trust!

Thank you so very much, as I had missed this opportunity and am very grateful for your advice, which I have carried out forthwith!

This must singularly stand out as the most traumatic work I have ever undertaken.  Words fail to describe the gnawing agony I feel inside, so it is my fervent prayer that someone, somewhere will read this as an expert in this Field.

To ignore it would be to ignore all our future’s purpose, as it is completely futile to plan for any future Life while this type of behaviour goes unreported and unpunished.

This has already been underway for far too long, beginning with the elderly, then babies and now the in-betweeners.

It is only a matter of time until with DNA studies and Genetics throwing up the potentials for no insurance, therefore no medical intervention.

Surely you do not imagine that all this verbosity around Gene Therapy and Stem Cells is all for our Benefit?

All new things in medicine have been ‘tried out’ on the minions (and soldiers in the field) then if proven effective used on the wealthy.  It is not possible to charge fortunes to help the wealthy and not produce some benefits as they will come back and bite them on the Ass, or worse Sue them for every penny possible.

Millions of people died in Two World Wars, Not for King, Not for Country per se but to protect those they loved from harm.

In allowing this type of heinous behaviour to go unchallenged we make a mockery of everything that Life itself stands for, and everything that Millions of people died for.

Do you imagine they saw that their own sacrifice of Life would be totally meaningless, when their loved ones were to be put on a scrap heap and not only allowed to die, in some cases horrifically, but actually being deliberately killed off, under a pretense that ‘it is for the best.’

The best for whom?

The Truth is much uglier than this.

What type of future is there for the young generation?

Years ago in Michael Anderson’s film Logan’s Run with the Late Sir Peter Ustinov, and Michael York playing a ‘Sandman’ who rebels.  It depicts a Dystopic Ageist Society in which both population and the consumption of resources are maintained in equilibrium by requiring the death of everyone reaching a certain age, which is 21 to the day.

And you thought this was just a film.

As Dylan Thomas wrote

Rage Rage at the Dying of The Light!

The following gives me an acute stab in the gut, and tears me apart every single time, when I read the many hundreds of articles which write of the following:

• An article in the Telegraph by Laura Donnelly and Alastair Jamieson dated 15 Oct 2011 tells of  ‘Elderly patients condemned to early death by Secret use of ‘Do Not Resuscitate orders’.

These are routinely being applied without the knowledge of the patient or their relatives.

‘A charity for the elderly said the disclosures were evidence of ‘euthanasia by the backdoor,’ with potentially-lethal notices being placed on the files of patients simply because they were old and frail!’

I don’t know about you, but in my book this is tantamount to murder because it is premeditated, against people’s Human Rights to Live and under :

Article 3 of The Universal Declaration of Human Rights

• Everyone has the Right to Life, Liberty and security of person.

These matters should be dealt with in the Criminal Law Courts!

When I first began to research this abomination I said to a friend ‘I am going to have to be very careful, in case I frighten the shit out of anyone to the extent they will be afraid to go into Hospital.’

This no longer applies!  Having read the facts of what can happen when you do so, I am sad to say ‘you ought to have the shit frightened out of you so that you

‘Take Action against a Sea of Troubles and by Opposing End Them!’

• It is Time for the people of this entire Country to become outraged at this and  stand up to be counted!

• If they don’t then they Are Next in Line.  There is nothing more certain.

The only thing necessary for evil to succeed is for Good Men to stand and do Nothing!

Hundreds of people have already been unlawfully killed in this way every single year, with Many, Many More Hundreds of Thousands of Relatives and Loved Ones still suffering as a consequence of these ill treatments and deaths.  To the extent that this suffering shall entail until their own demise!

• Under the auspices of the Liverpool Care Pathway; which no doubt when used with compassion without starvation or liquid withdrawal; as in the Marie Curie principal; the alleviation of terrible suffering with attending compassion would hardly be objected, only and once no alternative has been established.

Today this is not the case, in many Hospitals, as under this Permitted and  Actively Encouraged and Government Funded Umbrella to assist them to meet target quotas,  people are being unlawfully killed off, simply because they are old, and no longer of any use to the ‘System’!

• No money in it you see!

I have one Word of warning to give:

• Thou Shalt Not Kill

I can also warn that every single person involved in any one of these crimes against humanity Shall Pay with their own Soul, whenever the slightest doubt exists as to whether this is used in selflessness or selfishness.

Only those individuals will know themselves at this moment in time, but Time has a way of unearthing everything that was hidden, and it shall be so in Time, of this I am assured!

This is a most awesome undertaking and is not for the selfish being to have in his hands, so how do the people who have thought this up decide who is fit and who is not?

The sad answer is they don’t, and they have not.

• This scenario has been rolled out into the Community for Nurses to administer where they see fit – After A Twelve Week Course!

• One nurse who cares stated, that knowing some of her colleagues, and also knowing that some old people can be a bit awkward especially in their own home which is their own fortress, so to speak, that she is worried sick about this as she can imagine a person who is intolerant going into an elderly persons home where they live alone and just because she takes a dislike to the old man or woman, puts them on the Liverpool Care Pathway, which in these circumstances would mean no food or water, Hey but plenty of Drugs!

Easy Peasy Victim! and Plenty More out there!

Who would see this happening?

No one apart from the poor victim, because there are not enough staff to go around as it is, so do you imagine someone is going to follow up and check this?

It is now being rolled out for babies also, incidentally!

• Who’s Next?

Without the Umbrella of The Liverpool ‘Care’ Pathway all sorts of underhand abuse would never take place in Hospitals today, as the perpetrators would be too afraid of being caught.  But caught they shall be.

I tell you in Truth!

All That is Hidden Shall Be Revealed!

 

This is the opposite of Love for One Another

or To Treat Your Neighbour as You Wish To Be Treated!

Roll up folks!  Whose first for the Starvation trail?  What about some Dehydration?  Or perhaps a goodly dose of Morphine and you’ll forget Aaaall About It? 

Just think, you can even have this when there is next to nothing wrong with you, especially after you Volunteer to come into the parlour now because you are a little bit breathless.  We will soon sort you OUT! 

The bit you don’t know is that you will be sorted OUT in a COFFIN!

And all because they thought it was HIDDEN!

What is that saying?  Your sins have a way of finding you out!

We are allowed to mess ourselves up All We Like.

But – We Get The Bill!

We are Not Allowed to do the same to Others!

Or – We Get The Bill!

• To recant what mum was given on the 3rd:
• At 7-9am mum was given:

2G Ceftriaxone IV

20mg Prednisolone Oral

1G Paracetamol Disperse

5mls Carbamazepine Oral

• At 12-2pm mum was given:

2G Ceftriaxone IV

1G Paracetamol Disperse

500mg Clarithromycin IV

• At 4-6pm mum was given:

1G Paracetamol Disperse

• At 7.30pm the other FY2’s 20mg Furosemide was Not given and Not initialled!

• At 10-12pm mum was given:

500mg Clarithromycin IV

1G Paracetamol Disperse

5mls Carbamazepine Oral

1 Drop Latanoprost ea. eye

• At 12.00 Mid. mum was given:

2G Ceftriaxone IV

• You aint seen nothing yet!

~Act Nineteen~

On 4th at 04.00 the sister of the disgruntled nurse wrote:

Slept for short spells.  Up to commode.  Also incontinent of urine.  Transfers with 1-2 nurses.  *Observations as charted.  IV fluids continue 10hrly. IV anti bx as prescribed. (This could only be the 12mid. 2G Ceftriaxone).

I haven’t a clue what these *Observations are as the first time for these was noted at 08.30 after all hell broke loose!

At 04.30 (same nurse as above) Climbed out of bed, sat on commode pulling Venflon in the process.

Very bad! tut tut.  

• Big bother!

• Where were the ‘nurses’ who were meant to assist her?

• What were they doing apart from watching her pull this?

• Let’s blame it on the ‘confused’, ‘doped up, incontinent elderly patient’.  ‘Why Not?

• After all they cannot tell anyone, and they don’t know we’re writing this shit about them to make out they are to blame!

•  To blame for harming themselves?

Confused at times!

  Imagine that! 

Both nurses knew the above situation Yet:

• *No nurse attended mum from 04.30 until 08.30.

• Why?

N.B. The sister of the disgruntled nurse had been on duty on the 3rd from 7-9am when she gave the first 2G Ceftriaxone, until 10-12pm when she gave the 500mg Clarithromycin, plus possibly the 12Mid. dose of 2G Ceftriaxone –and was on duty the next morning at 04.00 until her last notes at 04.30, possibly until 08.30am!!!

How many hours is that?

This same nursing sister gave mum Saline with dextrose plus KCI 20mmol, and she had Saline with dextrose plus KCI 20mmol at 05.50.

• At 7-9am mum was given:

2G Ceftriaxone IV

20mg Prednisolone Oral

20mg Furosemide Oral

1G Paracetamol Disperse

5mls Carbamazepine Oral

5mg Salbutamol Neb

0.5mg Atrovent Neb

• At 08.30 the nurse/assistant wrote:

• *Found to be pale and lyspnotic.

• At 08.30 Sats 50% off O2.  4(6)? Litres O2 administered – Sats up 77%.
• What happened to cause this?

B.. 140/60 pulse 119. Resp. 24.

*There is No Chart written for Sats 50%., or the 4L of O2 given!

This was written only on nurse’s notes!

• At 08.30 another FY2 was called in as mum’s Sats. were 75% (77% on Chart!) on 4L O2.

She took an Arterial sample which was analyzed at 8.48am and took down various observations from FY2’s previous notes along with:

Known COPD. L base pneumonia?

Creps L base.  Patient sitting up.  Gross ankle oedema.  Sats improved 86% on 5L O2.

Her PCO2 was up 7.1 and her PO2 was down 6.5 – taken from the Arterial sample results.

Plan:

Given at 9am: Furosemide 20mg IV.    (A Once Only prescription was written.)

N.B. There was no observation between 04.30 and 08.30am when mum was found pale and lyspnotic, Yet at 7-9am 20mg Prednisolone Oral, 2G Ceftriaxone IV, 1G Paracetamol Disperse, 5mls Carbamazepine Oral were all given by the same nurse who gave the 20mg Furosemide at 9am when the emergency FY2 wrote a Once Only prescription.

If mum took unwell after the further 4th dose of 2G Ceftriaxone along with the other drugs, or before these?

• Where are the nurses notes?

• Also why was the missed dose of Furosemide the day before not noticed as it had been written above the emergency FY2’s Furosemide on the 4th?
• Did anyone eventually question this missed dose?

At 9am 5mg Salbutamol Neb given. By the emergency FY2.

• No Once Only prescription was written by the emergency FY2?

• How do nurses know to give this? Are these verbal instructions which lead to errors?

• Mum had been on O2 every day so When was this stopped and Why?
• Verbalisation again?

• More to the point Who stopped this and Where are the instructions to do so?
• A nurse/assistant wrote at 08.30, BP 140/60 Pulse 119, Resp 24.
• Then the Salbutamol Nebuliser was given at 09.00 after the FY2’s instructions.
• The same  nurse wrote at 09.00, Sats 86% in her notes  (which was actually 08.45 onthe Chart)   BP 123/80 pulse 107 (which was 111) with no resp. rate or Litres of O2 written on chart.
• The pulse of 107 was at 09.35!
• At 09.35 the chart shows Sats 88% on 4L, resp. rate 24, and BP 142/70, pulse 107. written by the same nurse as above but timed for 09.40 on her notes (with pulse written 109).
• At 09.40 the Sats were 87% on 6L, resp rate 24, BP131/79?, pulse 101! But these were not written in the nurses notes!

FY2 arrived around 9am?

Shortly afterward and timed between 9am and 10.22 FY2 wrote her Review:

87 i. COPD.

pneumonia (Did she take this from the other FY2’s question on her emergency notes at 08.30am?)

On Ceftriaxone + Clarithromycin.

Note above – Sats down this am. currently 85/90% on 28%? – (taken from chart at 9.35am). – After Salbutamol + 20mg Furosemide.

PO2 6.5 PCO2 7.1  (These figures were taken from the emergency Arterial sample results at 8.48am).

N.B.  These 8.48am results were Before the Salbutamol and 20mg Furosemide were given at 9am!

• Therefore the figures which FY2 had taken from the report @ 8.48am were before the above Nebs + Furosemide @ 9am were given, so they could not indicate any change from these.
• In fact after drugs there was an improvement which showed up in FY2’s Arterial sample at 10.22am.
• This report by FY2 is both erroneous and pointless.  It could  (at a glance) provide any other member of the medical staff with information detrimental to the patient’s well-being by the suggestion that the Salbutamol and Furosemide had affected these results!

• *Patient has no complaints!
• My mother must have been so frightened after having had a horrendous night and would say this in the hope that she could get out of there!
• She had just had a horrendous night and I had been telephoned to come in by the nursing staff who phoned to tell me mum  had a bad night, but another patient across from mum told me the truth!

Munch’s Scream again!

FY2 notes continue:

Chest – poor air entry,  scattered wheeze, L base – no breath sounds, dull to percussion.

At 09.40 ECG sinus rythm – 100bpm. No acute changes. Inverted T waves V1-V3 – Not New.

On IV fluids recently due to poor fluid intake.

• On 2nd the nurse had noted ‘eating and drinking fair amounts’, so when was the poor fluid intake?

Bilateral pitting ankle oedema –

What about the swelling up to her stomach?

New since admission.

You bet it was and then some!

Imp/? worsening pneumonia –

When did this start as this was never mentioned as a possibility?

Stupid question, when was anything ever mentioned as a possibility?

LVF (Left Ventricular Hypertrophy)

N.B. The report from the Chest x-ray:*

FY2 notes continue:

Plan:

Bloods.*

• FY2 only took a further Arterial sample which was analysed at 10.22am!
• Sats 94%  PO2 10.0, PCO2 6.9, H+ 36.8, HCO3 34.5.  On 35% O2.These were taken from the results of the Arterial blood sample which FY2 took at 10.22am.

• No Haematology Test on the 4th!

• No Biochemistry Test on the 4th!

At 9.25am a Further 20mg Furosemide – A Once Only Prescription was written.

CXR

Catheter

*The nurse/assistant who wrote all of the charts ‘inserted’ this catheter and who wrote in her notes at 9am that mum had refused Oral Furosemide, and had ticked the box for Easy insertion which I shall Never Believe .

In fact I believe Catheterisation to be an assault on the person unless they were completely immobilised and unable to use even a commode or a bedpan! This is most often a convenience for the nursing staff, and I have listened to patients ( both male and female and have heard a male ‘doctor’ snigger at the woman) screaming at some of the dummies who do this to them!

• This procedure incidentally, which is routinely carried out, can and does cause Urethral infections plus ongoing actual damage to this area, and the sheer unadulterated arrogance which permits this should also be questioned in a Court of Law!

• Incidentally, Who is going to do anything about this?

• Is there anyone out there interested in this subject?

This Catheter must have been done before FY2’s arrival as this would Not be a priority, so a nurse/assistant did this Before a doctor gave permission! It was not possible to do this then write nurses notes at 9am when the emergency FY2 was trying to help mum.

That solved the urine incontinence!

This was also the day that mum was confined to bed, never to rise again!

I shall Never forgive myself for entrusting her to these beings?

Never, Ever!

FY2 Notes continue:

Try to increase O2 to 35%. Re-check ABG’s.

Atrovent Nebuliser

• At 9.40am 0.5mg Atrovent given.  FY2 wrote No Once Only prescription.

• How do nurses know to give this?
• Verbalisation again which give rise to errors as illustrated below?

THIRD OVERDOSE!

Salbutamol+Atrovent

• Have you noted that mum was given at 7-9am:
• 5mg Salbutamol Neb
• 0.5mg Atrovent Neb
• Now she has been given 5mg Salbutamol Neb at 9am. (By emergency FY2).
• Plus 0.5mg Atrovent Neb at 9.40am. (By FY2).

• What is much more important is the fact that the 9am Salbutamol of 5mg and the 0.5mg Atrovent at 9.40am Should have been administered Together!
• Allied by the fact that Atrovent should Not be Overdosed.
• Both of the above are Dangerous!

• What sort of Calibre are we seeing here?

FY2 Notes continue:

Increase Prednisolone to 40mg* (on 20mg currently).

This prescription* was written to be started on the 5th!

FY2 wrote a Once Only prescription for 20mg Furosemide at 9.25am!

FY2 gave an extra dose 2omg of Prednisolone at 11am on the 4th!

FY2 wrote 11 on the normal prescription at 11am for a further 20mg Prednisolone (instructing this extra dose time).

FY2 also wrote a Once Only prescription for this 20mg Prednisolone at 11am?

FY2 wrote 11 on the normal prescription at 11am for a further 20mg Furosemide (instructing this extra dose time).

FY2 wrote No doctors notes written for this further 20mg Furosemide at 11am

FY2 wrote No Once Only prescription for this further 20mg Furosemide at 11am.

FY2 wrote 11 on the normal prescription for a further 1G Paracetamol at 11am (instructing this extra dose time).

FY2 wrote No Once Only prescription for this further 1G Paracetamol at 11am?

FY2 wrote 11 on the normal prescription for a further 5mls Carbamazepine at 11am (instructing this extra dose time).

FY2 wrote No Once Only prescription for this further 5mls Carbamazepine at 11am?

The only time that Once Only prescriptions are written by FY2 are:

The 9.25am 20mg Furosemide (which is actually written in a misleading fashion as the actual increase to 40mg prescription was dated for the 5th!) therefore no mention is written in doctors notes particularly indicating a 20mg increase on the 4th!

The only other one written is the 20mg Prednisolone for 11am. This is also mentioned in her notes!

• All of the other extra doses at 11am did Not have Once Only prescriptions And:
• They were Not written in the doctors notes!
• Therefore it is highly unlikely that any Consultant or other doctor including other FY2’s would be unaware that these other 11am doses were given!
• The only way of knowing this would be to examine the prescription sheets which would be highly unlikely for a Consultant in particular.

N.B. Both Paracetamol and Carbmazepine helps to dose elderly people !

It’s enough to Make you spit!

Nurses notes are:

Further Stat dose Furosemide 40mg IV.

FY2 Wrote notes for further Furosemide at 14.20 – Dr… had suggested this dose!

FY2 wrote a Once Only prescription for further 40mg Furosemide at 14.20.

 

FY2 Notes continue:

Keep on IV Ceftriaxone

Absolutely! After 4 doses of 2G within 24hours = 8G,

Why Not? Especially after having had a horrendous night!

Just keep taking the medicine!

It’s nothing if not obscene!

CXR Results: report states 10.22: but X-ray time is 10.11.

Chest (4.2…)

*The heart is not enlarged and the mediastinum was unremarkable. Extensive bilateral upper zone fibrocalcareous changes again noted which is unchanged compared with 30.01…  A relatively small left sided pleural effusion is again noted and this is essentially unchanged.  This might be secondary to infection.

Plan:

To continue 35% O2.

Hold off IV fluids just now.

*Await blood results.  Remember only the Arterial was taken!

*These blood results could only possibly refer to the bloods which FY2 had verbalised? to a nurse to take the day before, as FY2 had already written up her own Arterial sample results taken @ 10.22am.

These could only reveal mum’s state from the day before and had nothing to do with her condition on that 4th!

Monitor Sats.

Note patient has not had Clexane for 2 days.

More garbage!

And plenty more to follow!

Like the blood results taken from the 3rd which FY2 lists as though they were applicable that day, which by the 4th and Hell night would not relate to mum’s condition after all the 2G doses of Ceftriaxone.

Plus the details of Clexane.

After all, this is only the 1st part of the date of the 4th.

Just wait until the 5th when I recant all of the drugs from the 4th and you will find it hard to swallow!

And Then Some!

Time out folks!  Time for a cuppa!

One Response »

 

Sickened By The NHS Part 7. Friday, May 24 2013

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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Sickened By The NHS Part 6. (3rd Part of D-Day.) Friday, May 17 2013

Tis a Tale Told by Many

Full of Sound and Fury

Signifying Nothing!

William Shakespeare

This is the final of Part 6. which is the calendar date of the 4th!

It is so long and protracted simply because of the Colossal amount of Drugs which were given to my mum on that one day, after the Huge amounts of 2G Ceftriaxone the previous day!

~Act Twenty Two~

• FY2 also mentioned to me at our ‘talk’ on 4th at 13.00pm that she was going to send mum for a Doppler to check for clots!

• FY2 Did Not write about this in her notes.

• In fact it was the Consultant who ordered this Doppler the next day on the 5th?

• Why? if FY2 suggested it on the 4th, did she delay?

• N.B. Mum was Not sent for the Doppler until the 7th when this entire episode plus another, became a major factor in her death!

• FY2 Did Not write in her notes that I asked her if mum had blood clots and her reply was  ‘No, I don’t think so, it’s just a precaution!’

• If it was just a precaution then Why was the Clexane stopped at all on the 2nd?

• N.B. The prescription for Clexane was already written and dispensed at 12-2pm.

• This meant that FY2 had already written this prescription Before 13.00 when she spoke to me as though she was including me in permission to give this?
• Not only that, but this was also Before ‘Discussing the case with Dr. …….. whether to give Dalteparin (Clexane had been written on her notes and scored through)?

• N.B. FY2 wrote No Notes whatsoever stating that Heparin was stopped on the 2nd, therefore any other doctor reading these notes would be completely unaware of this.

This must have been another verbal instruction to a nurse not to give these, while failing to sign off the prescription sheet?

• Wow – That’s some amount of verbalism in that ward!

Plus it must have been verbalised to the ‘disgruntled’ nurse on the 2nd as she gave the last dose at 10-12pm when FY2 went off duty that night!

• Perhaps they have Super Memories for All their patients!

~SIXTH OVERDOSE~

Paracetamol:

• N.B. Mum was given 1G Paracetamol at 7-9am, plus 1G Paracetamol at *11am, plus 1G Paracetamol at *12-2pm.

• This was 2G in less than 3 hours!

A further 1G was given at 4-6pm, plus 1G at 10-12pm.

• This would Total 5 Grams of Paracetamol within 14-16 hours, or 3 G’s within 6 hours!

Paracetamol is metabolised primarily in the liver.

In a normal dose of 1G four times a day, one-third of patients may have an increase in their liver function tests to *Three Times the normal value.

Here is a Preview Below of mum’s Liver Test Results on the 5th!

Normal AST <40.                Mum’s *296.

Normal ALT <50.                Mum’s  *313.

Normal Gamma-GT. <55.  Mum’s *373.

Normal Bilirubin 3-22.       Mum’s *5.

Normal Alk. Phos. 40-150. Mum’s *310.

Normal Protein 60-80.        Mum’s *52.

Normal Albumin 32-45.      Mum’s *19.

Normal Globulins 23-38.     Mum’s *33.

Toxicity can occur even with chronic ingestion of doses as low as 4G a day, and DEATH WITH AS LITTLE AS 6G A DAY!

Concomitant use of other drugs that induce CYP enzymes such as Carbamazepine have also been reported as risk factors!

OVERDOSE SYMPTOMS:  Nausea, upset stomach, Diaorrhea, convulsions, Coma, appetite loss, vomiting, Confusion, General Malaise, Jaundice, Coagulation Defects, cardiomyopathy, Sweating.

*Mum would have every single one of these in Red before she died!

Evidence of liver toxicity may develop in one to four days.

• Spot On!   She Died Four Days Later!

In severe cases it may be evident in 12 hours.  Laboratory studies may show evidence of massive hepatic necrosis (that is the Liver dying!) with elevated large potential for overdose and toxicity.

Individuals that have overdosed on Paracetamol in general, have not specific symptoms for the first 24 hours although nausea, vomiting and diaphoresis may occur initially, these symptoms, in general resolve after several hours.

After resolution of these symptoms, *Individuals tend to feel better, and may believe that the worst is over.

*Patient has No complaints.  Still feels O.K.  (From FY2 Notes above.)

• Did this not match perfectly?

If a toxic overdose was absorbed, after this brief feeling of relative wellness, the individual develops overt Liver Failure.  In massive overdoses, coma and metabolic acidosis may occur prior to hepatic failure.

Without timely treatment, overdose can lead to Liver Failure and Death within days!

Intravenous acetylcysteine (Parvolex/Acetadote) is used as a continuous intravenous infusion over 20 hours (total 300mg/kg).  Recommended administration involves infusion of a 150mg/kg loading dose over 15 mins. followed by a 50mg/kg infusion over 4 hours, the last 100mg/kg are infused over the remaining 16 hours of the protocol.

Once it has been determined that a potentially-toxic overdose has occurred, acetylcysteine is continued for the entire regimen, even after the Paracetamol level becomes undetectable in the blood.

If hepatic failure develops, acetylcysteine should be continued beyond the standard doses until hepatic function improves or until the patient has a liver transplant.

Acetylcysteine was Never given!

• Can you guess Why?

PROGNOSIS:  The mortality rate from Paracetamol Overdose increases two days after ingestion, reaches a maximum on day Four!

• Strange how FY2 was Off Duty two days later, And her appearance coincided again on day Four!

• On day Four mum’s Jaundice appeared immediately when she died!

• N.B. On 5th (Next Day when the results of the above Liver Function Tests arrived) the Department of Haematology Started Daily Requests:

• FBC: No clinical details provided.

• PLEASE SUPPLY CLINICAL DETAILS!

• This request would be repeated on the 6th, the 7th and once again on the 7th after 8pm!

• Clearly the Laboratory Technician knew something was amiss!

• No Clinical Details were ever provided to the Haematology Department!

• No further nurses or doctors notes for B.P., Oxygen Saturation, Respiratory, or Pulse were recorded from the Chart which were:
  

Next, along came lunch and mum and the other ladies were hungry, but this is no magician’s feat.  The aluminium lids were removed to reveal roast beef.

• Mum looked constantly at her plate as I cut this up into small pieces to feed her.  Her hand was shaking.

• Can you begin to imagine how torturous this was for her, and for me feeling helpless to help?

All the other ladies complained that it was cold. 

• Mum was eating it without a murmur and I had no idea it was cold until then!

The nurse/assistant who brought these told everyone quite casually ‘This often happens.  It takes the food 15 minutes to get here’!

• I gave mum some potatoes and rice pudding which she ate starvingly.

The roast beef was returned by all ladies.

• Mum was still hungry!

By the afternoon visiting time mum looked absolutely exhausted and I asked the nurse about moving her about when they washed her as I felt this was sapping any energy she had.

• Remember I had No idea about this chemical cosh she was receiving!

The nurse whom I had spoken to then wrote copious notes abut me in reference to my appeal above.  She also wrote that I had told FY2 that mum had not been cleaned properly.

I can see how Shit-stirring happens in this ward, as I was not referring to anyone but the one nurse who had abandoned mum in the toilet, previously, then went home. (The one with the mud on her trainers!)

The pity of it was that this particular nurse had done an excellent job of caring with mum!

• At 13.15pm written by the nurse/assistant:

‘Daughter asked who was …..floor manager.  I told her…..advised her that it was…..and gave her his address.  I enquired was there anything the ward manager could help with tomorrow, but she said she wanted to complain ‘fire alarm being noisy and had gone on too long’.  She thinks it should be changed to a light system.’

Now for The Truth Once More!

The fire alarm went off around 12.30 and this was in the corridor facing mum’s ward door.  I said ‘That’s terrible, what a racket’!  She said it was up to the hospital and I asked who the manager responsible was.  She gave me his name, and still speaking casually I suggested it would be better if the alarm was cut shorter, maybe intermittent with flashing intermittent lights.

It finally stopped about three quarters of an hour later and by then I had a headache, never mind about the elderly patients who were unwell.

Deepak Prasher of UCL on BBC2 9.4.8 quoted ‘Noise Causes Stress’!

The staff appeared resigned to this along with the fact that only one plumber was available in the hospital and the sink required fixing for three weeks.

I used this sink to clean mum’s teeth in running water!

• The other nurse on duty, who had written about my complaining, wrote:

‘Patient’s daughter called me and stated she wanted a saline drip put up on her mother as she was *sweating. I explained to her that this was not beneficial to her mother as she was overloaded and needed IV Furosemide earlier in the day.’

‘She was not happy with my explanation.’

• Oh my, another opportunity to make the relative out to be a baddie!

• Having told the facts so far, and picturing what I had to contend with on behalf of my mother, do you see the real picture emerging?

Ask yourself one question.

• Whose benefits are these copious notes written about relatives for?

• N.B. *Sweating is one of the symptoms of Paracetamol Overdose!

Ask yourself.   

Was I the Only person who saw this?

Mum Never, Ever sweated!  She was one of those people who generally find it difficult to break sweat-   a Redhead.

N.B. Methyl/Prednisolone:

Serum levels may be increased by Clarithromycin – Monitor!

Carbamazepine:

Serum levels may be increased by Clarithromycin – Monitor!

CYP3A4 Inducers Carbamazepine may decrease the level/effect of Clarithromycin.

Furosemide may enhance the nephrotoxicity (kidneys) of Cephalosporins – Ceftriaxone.

*Comcomitant administration of single doses of Clarithromycin + Carbamazepine are shown to result in increased plasma concentrations of Carbamazepine.

*Mum was given both of these on the 30th, 31st, 1st, 2nd, 3rd, 4th, 5th, 6th and 7th!

• At 14.00 her B.P. was 135/82, pulse 102, Sats. 87% on 6L O2, resp., 24.

These were Not written on any nurse’s notes.

These were Not written on FY2’s notes.

• At 2.20pm mum was given:

40mg Furosemide IV.

• At 4-6pm mum was given:

1G Paracetamol Calpol

5mg Salbutamol Neb.

0.5mg Atrovent Neb.

• At 22.00 her B.P. was 154/90, pulse 101, Sats., 98% on 2L O2, resp., 18.

These were Not written on any nursing notes.

These were Not written on FY2’s notes.

• At 10-12pm mum was given:

1G Paracetamol Calpol

500mg Clarithromycin IV

5mls Carbamazepine Oral

5mg Salbutamol Neb.

0.5mg Atrovent Neb.

1 Drop ea. eye Latanoprost

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Sickened By The NHS Part 6. (2nd Part of D-Day.) Monday, May 13 2013

Oh What a Tangled Web We Weave

When First We Practice To Deceive.

Sir Walter Scott

Ready for more garbage?

I understand that you may find this very long which it is, but if you persevere you will learn much about the workings of an NHS hospital ward and the drugs which were given to my mum in profusion, despite her not being too unwell, which was confirmed by Two Consultants. 

You will also learn in-depth about the effects of these said drugs, and hopefully you can put this information to good use!

Thank you for reading this – My Mum’s Story!

~Act Twenty~

FOURTH OVERDOSE!

Clexane+Dalteparin

• N.B. The last Clexane was given 10-12pm on the 2nd, therefore 2 days + 10-12pm on 4th.  This was before lunch time on the 4th!

• Who authorised stopping Clexane  and Why?
• There is no signature on the prescription to close it!
• How did nursing staff know to stop prescribing it?

• Verbalisation again like some game of Russian Roulette?

• Why was it stopped the night before FY2 was starting mum on Huge doses of 2G Ceftriaxone the following day?

At the time FY2 wrote this early on the  morning of the 4th mum had her *Last dose of Clexane at 10-12pm on the 2nd, therefore it was Not 2 Full days!

*Two full days are required between Clexane and Dalteparin!

Dalteparin – N.B. Clexane is Not interchangeable with other low molecular weight heparin (LMWH) products.

Dalteparin is Not superior to unfractionated Heparin in preventing blood clots.

Careful attention should be paid to elderly patients below 45kg.

• *Mum was below this!

Moderate risk patients 20mg.

High risk patients: 40mg.

Do Not have this medicine if/Drug Disease Contraindications.

Cerebrovascular Haemorrhage – Yes!

You have a problem with bruising easily.  – Yes!

Call your doctor at once if you have easy bruising!

• What doctor?
• This wouldn’t happen to be the ‘same’ one who prescribed Clexane by any chance?

A different site should be used for each injection to prevent the development of massive haematoma!

Can you imagine the state of her stomach?

You are underweight –  Yes!

And becoming more so each day!

• Patients over 60years may have higher serum levels and clinical response as compared to younger;

• Lower doses may be required!

• Elderly patients may be more sensitive to the effects of this medication!

You are taking Prednisolone – Yes!

You are taking Furosemide – Yes!

PRECAUTION:  INCREASED RISK OF HAEMORRAGE, ESP., FEMALES.

ADVERSE EFFECTS:  Most Frequent:  Heparin-Induced Thrombocytopaenia is the most drug-induced thrombocytopaenia because of its high frequency and association with arterial thrombosis!

Drug induced immune thrombocytopaenia is a condition in which the use of drugs leads to the formation of antibodies against clot-forming cells in the platelets.  These antibodies can cause a low platelet count, which makes it more likely.

ADVERSE REACTIONS:  Dilution of serum electrolytes, overhydration, (this medication contains sodium) hypokalaemia.

• Did you ever hear anything more mad than this?

• Pump this shit into a frail little lady, Overhydrate her, and then suck the liquid out of her with Furosemide.
• Oops too plump looking today, time for a little mummification!

• Do you absolutely believe they really know what they’re doing?
• Because I don’t!

Local: Thrombosis.

Respiratory: Pulmonary Oedema.

Overdosage: Toxcology Symptoms – Hypokalaemia.

HEPATIC:  Elevated Liver enzymes (AST/ALT)

• Wait until you see the results on the 5th!

Seek immediate medical attention if these allergic reactions occur!  Trouble breathing, confusion, swelling, severe dizziness, pain or swelling in one or both legs, speech or balance.

• Well now, let’s see?  What in the shit did not happen from the above list?
• Was any of it flagged up?
• Guess?

• The elderly may be at greater risk for bleeding while using this drug.

• Unbelievable!

Anaphylactoid reactions.  Adrenal insufficiency.

Monitor/Modify:  Diuretics, potassium sparing – Furosemide!Cephalosporins – Ceftriaxone!

• Ceftriaxone on 3rd: 2G 7-9am, 2G 12noon, 2G 12mid., plus 2G 7-9am on 4th!

PRECAUTIONS:  A preservative (benzyl alcohol has been associated with toxicity) in this product or in the liquid used to mix this product (dilutent) can infrequently cause serious problems   SOMETIMES DEATH!

• N.B. This is not to mention that Sodium Heparin is from Porcine (Pig) Intestinal Mucosa!

*Patients with heparin-induced thrombocytopaenia, a serious adverse effect of heparin mediated by platelet activating heparin-dependent antibodies (with or without thrombosis) require alternative anticoagulation because of their extreme risk of new thromboembolic complications.

• Remember FY2 suspected ‘is there a possibility of a P.E’,  in her notes but told me the opposite and that it was merely a precaution!

• Could this have been because she took mum off this for the entire day previous when she started the Ceftriaxone mega doses, then asked another doctor about ‘starting’ Clexane or Dalteparin the next day of the 4th, which was about 10 hours too soon?

• What about the effect of this crossover of the two different heparins still in mum’s body?

• Would the human body not be almost guaranteed to try to make the blood capable of clotting once more when an anti-clotting agent was withdrawn?

• Strange thing is, this was the same day FY2 re-started mum on this alternative heparin, so why did she suspect this BEFORE the 7500units of Dalteparin were administered at 12-2pm, as she ‘proposed’ giving this when she spoke to me at 1pm?
  

• No Antidote is available.

Wow!

Bleeding complications are the most important adverse effects.

• With a cerebrovascular stroke already, Plus a further ischaemic attack?

Thrombosis is a common and potentially serious complication of immune-mediated heparin-induced thrombocytopaenia!

Really?

The risks of total minor bleeding with LMWH, were significantly higher than the risk with pneumatic compression stockings. (in a meta-analysis.

• FY2 Notes:

Wedge shaped opacity?

Oedematous legs.

No chest pain.

Is there a possibility of P.E?

For treatment dose Clexane? Dalteparin?

• Plan:

Give treatment dose Clexane to management. This was changed to: Add treatment dose of Dalteparin to management.

I will discuss the case with Dr ………. on call.  signed  FY2.

Dr ………. suggests 40mg IV Furosemide at 2.20.

• FY2 wrote a One Only prescription for this.

At 10.52am the biochemistry results (Bloods taken by a nurse on 3rd at 9am Before most of the 2G’s Ceftriaxone were in mum’s body, if any?

No Nebulisers, Clexane stopped, No diuretics, so a lovely concentrated amount of drugs would be in her system on the 3rd After the blood tests?

• Does this make sense?

• Now for another eye opener!

• FY2 then proceeded to write Blood Results:

From the results at 11.51am.

*WCC 14.71

*Hb 12.0

*Plts 297

• Remember the notes from the 2nd stating Plan Bloods?

Which could only have been verbalised to a nurse to take these bloods on the 3rd!

• Well the Haematology results above were taken from these bloods which a nurse took on the 3rd! With the results dated 4th @ 11.51am.

• Before mum had a Terrible Night!

*CRP 301

*Na 138

*Urea 11.9

*Creat. 75

• The Biochemistry results above were taken from these same bloods which a nurse took on the 3rd!  With the results dated 4th @ 10.52am.

• FY2 Notes continue:

CRP 301 – Same  (This was actually down from 316 on 1st and 316 on 2nd but FY2 wrote ‘Same’?)

• Ah, but remember this was being written as though these figures were from the 4th and not the 3rd when the bloods were actually taken.
• Before mum took ill overnight 3rd/4th!

Na (Sodium) 138

Urea 11.9 – down.

Creat. 75 (No notes that this was down from 80 on the 2nd?)

Inflammation markers not improving.

Really?

What about the CRP at 301?

Is this not an improvement from 316?

• FY2 did Not note that mum’s Potassium was NA H on these results from the 3rd, which were exactly the same as the test results on the 2nd, even although on the 2nd she added KCI 20mmol given at 00.00 on 2nd  by the sister of the disgruntled nurse, (over ten  hours later after the results came through).
• FY2 also added KCI 20mmol to 3rd date on the chart which was never signed as given?
• FY2 also altered this chart from 6 hourly to10 hourly on the 3rd, without writing a new chart!

• FY2 took None on the 4th at all, apart from the Arterial sample and this was after the emergency FY2 had already taken one at 9am!

• Would it not make sense to to take both of these After the extreme reaction the night before which required an emergency doctor plus a phone call to her daughter to come to the Hospital?

• Ah, but then all of this Shit would have shown up and there would be questions from the Laboratory Technician!

• Ah, good point.  Just wait until tomorrow the 5th!

Of Much more significance is the fact that All of the above figures were lower than the 1st and 2nd figures, so Before all that Shit was put into mum on the 3rd and more on the 4th she was gaining ground!

• At 11am mum was given:

20mg Furosemide Susp.

1G Paracetamol Disperse

20mg Prednisolone Oral

5mls Carbamazepine Oral

• At 12-2pm mum was given:

7500 units of Dalteparin (Fragmin) SC

• Ten Hours Too Soon!

N.B. The average weight is 4500 daltons.

500mg Clarithromycin IV

1G Paracetamol Disperse

5mg Salbutamol Neb

0.5mg Atrovent Neb

~Act Twenty One~

FIFTH OVERDOSE!

Mum was given 5mls Carbamazepine at 7-9am, 5mls at 11am and 5mls at 10-12pm.

This is 15mls within 5 hours, and especially 10mls within 1 hour!

It is recommended to start a lower dose of the suspension since this will produce higher peak levels than the same dose given as a tablet.

You don’t say!

• Before taking Carbamazepine be sure to mention if you are taking Paracetamol, anticoagulants (Furosemide), Clarithromycin.

• Carbamazepine levels are elevated when taken with Clarithromycin.

• Carbamazepine may cause syndrome of inappropriate anti-diuretic hormone (Furosemide).

• In addition it has been linked to serious adverse cognitive anomalies, including EEG slowing, and cell apoptosis.  It is CYP450 inducer and may increase clearance of many drugs, decreasing their blood levels.

• Aplastic Anaemia has been reported in association with Carbamazepine.  Although reports of transient or persistent platelet or white blood cell counts are not uncommon in association with Carbamazepine, data are not available to estimate accurately their incidence or outcome.

• No systematic studies in geriatric patients have been conducted!

Good Idea!  And Guess What?

There is No Specific Antidote!

Now is that Brilliant or is that Brilliant?

So, not only did FY2 dispense this in a cavalier fashion, do you think the G.P. knew about the Carbamazepine Aplastic Anaemia association?

• Carbamazepine can lower the blood cells that help your body fight infections, and can make it easier for you to bleed from an injury, or get sick from being around others who are ill!

You Couldn’t Make It Up!!!

• It should be taken with meals?

• In the morning 7-9am? and 10-12pm?   No Chance!

• It should NOT be administered simultaneously with other liquid medications!

• What about the 1G’s of Paracetamol Disperse?

• It induces hepatic (liver) CYP activity and causes decreased levels of Prednisolone.

• Baseline and Periodic eye examinations are recommended since many phenothiazines and related drugs have been shown to cause eye changes.

Was mum or I ever told of this?

You Guessed! 

• No!

SIDE EFFECTS:  Abnormalitites in Liver Function Tests, Jaundice, Oedema, Thromboembolism, congestive heart failure, Dyspneo, Pneumonia, Confusion, Fatigue, blurred vision, Visual hallucinations, Speech Disturbances, abnormal Involuntary movements, etc. etc. etc.

OVERDOSE SYMPTOMS:  Fast Heartbeat, Tremors, nausea, Shallow Breathing, Swelling of Ankles or Feet, Dry Mouth, joint or muscle pain, leg cramps, feeling light-headed or fainting? headaches and migraines, etc. etc. etc.

• Every one of these in Red happened to my mum in that hospital ward!

As for the rest I shall never know what else affected her on that ward!

What about the G.P. Oedema, dyspnoic, Confusion?

• Plus – Avoid cold or allergy medicine!

• Piriton doesn’t count then?

• Fever and sore throat should be reported immediately to a physician even if mild!

• They are joking of course if they mean our very own FY2!!

• The ward manager told me she had a sore throat, and I saw her fevered!

This was the reason for changing the horse pills for IV, because they insisted, despite my telling she could not swallow tablets hence the requirement for liquid Carbamazepine, on giving her huge tablets; some halved in two and still large with jagged edges; to swallow until her little throat couldn’t take it any more!

• Do you think they cared?

• Nurses notes:

Daughter now in attendance.  Spoken to by FY2. IV Antibiotics as prescribed.

2G Ceftriaxone?  Catheter nurse signed this. Chest X-Ray.

Commenced on Fragmin 7500.

On IV fluids, recently due to poor oral intake.

• This is absolute garbage, as endless amounts of people who have had an elderly person in a British Hospital will be able to vouch that food and drink are left on trays outwith the reach of the person.  This may not apply to every Hospital and I pray not but it applies to a Hell of a lot of them!  Chance would be a fine thing!

• More FY2 Notes:

Urine dipstick negative.

Still feels O.K.  (After all she was put through!)

• This beggars belief!

• If only she had not been continually doped and could have told me what was happening!

When I was phoned on the 4th around 9.20am-9.30am I was told ‘Your mother’s had a bad night’.

I flew into that Hospital as fast as I could (A taxi at the corner of my road,  and I was there in about twenty minutes).

• FY2 told me ‘I do not know exactly what is going on, but her infection does not seem to be improving and she possibly has fluid on her lungs.‘

• FY2 wrote in her notes that I thought my mother should not sit in the chair or mobilise to the toilet.

I had deliberately brought mum’s short dressing gown in case she tripped on her long one going to the toilet, and it was only when I saw her in that toilet; where the nurse had left her alone and I tried to steer her from facing a wall and to face me in order to guide her out; that I asked for a commode and for no other reason.

She was so doped up even then that she could not understand what I was saying, and for these beings, each and every last one who knew she was on All of these sheer amounts of drugs which even I could not fail to be confused with, to dare to continue to write that mum was confused is verging on Demonic!

She was never Confused since making a remarkable recovery after her stroke years before,  and only very slightly at home, until she arrived in that place.

• What A Liar!

• No,No,No! Not on my Watch do you tell all this garbage in my name and think to get away with it!

• FY2 also wrote I wanted my mother kept in bed.

I never suggested anything of the kind.    I never ever thought to want her kept in bed. 

Why on Earth would I want her in bed?

I wanted her desperately to get out of there! Strengthened and walking out or even in a wheelchair if she was still a bit weak!

• Remember this is written on doctors notes and completely unknown to people, so they write what they like, and who is going to know?

The truth was that I was unhappy with my mother sitting in front of the only open window in the ward about a meter away, frozen to the bone with only a thin cotton nightdress on, no bed-socks, dressing gown or even her own nightdress, and her feet; like ice in her slippers; swelling worse every single day.

When I tried to warm mum I could not rub her little limbs so put her on top of her bed the day before and said to her ‘I don’t want these nurses thinking I’m intruding or stealing their thunder (this describes the ward manager precisely) so I’m just putting you on top of the bed covers mum with your blanket around your legs to try to thaw them out, and put her dressing gown over her shoulders and chest, with her socks on. 

Mum nodded in agreement to this!

• FY2 ‘I stated *that as she is unwell today she will be kept in bed, but that on this ward we like to mobilise people as much as possible if they are well in order to further rehabilitation.’

Rehabilitation for What?

How is a patient like this expected to mobilise when they are drugged up to the hilt, and staring into space?

I would have been overjoyed to see her up and moving around!

• N.B. FY2 stated*’that as she is unwell today she will be kept in bed’.

• This appears to state that this is temporary, yet mum was catheterised at the same time, so when was this temporary event supposed to end?

• Sounds Good, Dinnit?

• FY2 ‘I also explained that ankle oedema is common in patients and that we have been keeping her legs elevated’!

• Never!  In her dreams!

• I can absolutely believe that ankle oedema is common when patients are pumped full of Steroids!
• Did FY2 mention to me about mum having been given Steroids?
• You Guessed!
• No!

I was the one who had to go looking for a stool for her feet which were swelling, and in fact when she sat on top of the covers I gave this stool to another lady across from mum who had been sitting in a chair with her feet down and swelling grossly (I realise now that she and others in that ward were so intimidated and frightened and that they also knew the score about getting into bed).

• Ah, but this is one way of getting back at the relatives and to hell with the patients.

• Make out as much as possible that these relatives are disruptive; instead of helpful; and write a case against them just in case they should ever decide to spit back!

• As stated before, this will Never wash with this daughter!

• Not a chance in Hell even if it freezes!

Waken Up folks, and smell the roses, not the dung you have been dished for too long, with a measure of chemicals added to lure you into thinking it is the real thing!

If you do so then you will realise that you ought to examine just how much the ‘System’ has brainwashed you into being a little submissive sheep, following all the others to their deaths – Dutifully I may add!

• FY2’s next load of garbage ( I honestly do not know how this female sleeps at night with all her lies and cunning!).

• ‘I have explained the rationale behind giving LMWH (Low Molecular Weight Heparin) to the patient’s daughter.’

• Now get this one folks!

• She UNDERSTANDS THIS and SEEMS HAPPY with it?????

This is pure conjecture to allay the fact that I knew nothing of the previous Heparin, along with all the other Drugs, and to suck me into her plan of making it appear as if I was in full agreement!  Talk about trying to pass the buck!  The fact is I was anything but happy with it but what would I choose? I most certainly did not know what this stuff was made from!

• Nothing could be further from the Truth!

She said this in a manner suggesting this was a new procedure and omitted to mention that my mother had already been on Clexane until the 2nd!

When I asked the name of this drug she ‘mumbled’  ‘Rocephin’ in such a low pitch I had to ask her twice.  Such was her usual reluctance to tell the daughter anything at all!

• I also witnessed another side to this individual, later on; which was normally kept well in check by her; and this behaviour was anything but pretty.

Had she revealed the details regarding the Heparin dose previously, I would undoubtedly have wanted to know why this had been stopped, and why the proposal was being made to start a Heparin (even of a different type) once more?

She already knew I was interested in the drugs being given to my mother as I had questioned her before on this matter; although I usually got a murmur below her breath, and a shake of the head;.  In fact this was a common occurrence and par for the course for FY2!

My mother did not even take aspirin before or after her stroke some years previously and her system was pretty clean, so anything would hit her strongly.

As for the Heparin, it is dangerous to mix the two types, and a mandatory time elapse is necessary!

When questioned about the efficacy FY2 reassured me saying ‘ I don’t believe she has a D.V.T.  It’s merely a precaution.’

• Yet, on her notes written before our meeting she wrote ‘Is there a possibility of P.E.?

• She never even mentioned Pneumonia!

• Something strange occurred also. 

• WhenFY2wrote in her notes about our conversation, she not only separated these; which could be explainable; But she added the time of 13.00hrs, although our conversation took place much earlier?

• Other than this particular time when FY2 ‘spoke to me’ In every single doctors notes there are No Times written whatsoever.

• This was the only Time?   
• Why?

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