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2007 - June 18th - Monday

ADMISSION TO PAULIN WARD

After sleeping very well, JH woke up a bit before her alarm clock rang – but at least she had remembered to bring it.  She had just showered, and then opened a door to a knock: Ruth had come to take away the sheets, as she quite thought that JH was scheduled to have her operation this morning!  As JH was not – she was able to eat toast and bran flakes for her breakfast – before walking over to Paulin Ward.  Ruth was very happy for JH to come and stay again in JHH, when JH returned to the RLH for her 6/52 Surgical FU appointment.


 

JH reached the Ward at 10.00am, and met Kathy just going in the door; Kathy was carrying a towel and washing things, so JH (wrongly, as it turned out) thought Kathy had just had a shower.  JH reported to Marilyn, the Ward Clerk – having been told to by the Registrar who had recognised JH from clinic, perhaps, or Devonshire Ward; JH was asked to wait in the day room, as no bed was yet available.  Kathy came along with shortbread biscuits but (yet again) drinks could not be had without asking the Nurse to ‘serve’ them (through the kitchen hatch opening onto the day room), and – as yet – JH had no ‘Named Nurse’, because she had no bed!  Never mind, JH had her own barley water, which she had scrounged from JHH and diluted in her water bottle, and she just happened to arrive with the Hospital Shop’s trolley from which she bought her own supplies of barley water and a carton of Ribena.  Kathy went off to be ‘attended to’ by a nurse, but left her mobile behind – so it rang once or twice, but did not get answered immediately: in any case, JH did not know how to.  After Kathy had retrieved her messages – one from Ralph, and one from Lorraine, we finally got a drink of coffee at about 11.15am.  JH was concerned to hear Kathy coughing rather a lot but, as Kathy explained again, this is all to do with her fluid balance when she is coming up to having her dialysis session. 

A gentleman, who had come to have a third renal biopsy, was by this time sharing the day room with us.  His procedure was to be done using the bigger ultrasound machine in the X-ray Department, as two attempts made in the ward – presumably using the mobile machine – had failed.  This gentleman’s story was most interesting: his mother had given him a kidney 21 years ago, and it had lasted that long, but 7/12 ago he had had another transplant from a deceased donor, which was a perfect match apparently, but his creatinine had risen to 150 – whereas it should be about 100.  This gentleman is now 56 years old, and his mother is a healthy 73-year old.  He continued his story by telling us that, unfortunately, his bowel had been perforated because of adhesions he had developed after having an appendicectomy at the age of 16 years. (JH is not quite sure as to whether this setback occurred during this gentleman’s first, or second transplant operation; she also noted that she had had an appendicectomy at the age of 7, but that her left kidney would be removed, ie, the opposite side to her adhesions which remained after 59 years!).  Of course, Kathy was alarmed by hearing this tale - she has to go over such stories in her mind, especially bad ones, and express her apprehensions; however, there is no doubt that JH is just as frightened at the thought of having a major operation as Kathy must be – but JH is well to start with.  The gentleman had to wait until 2.00pm for a bed to be found for him prior to him going to the X-ray Department for the biopsy to be performed at +/-3.00pm. 

In the meanwhile JH had eaten meat lasagne for lunch, followed by some tinned fruit and custard (the latter JH usually preferring to cream); Kathy had sandwiches and apple pie; JH asked for a jug of water, which she hoped would be delivered after the lady had finished serving but, finally, JH drank her Ribena, and then filled her water bottle from the hand basin by the toilets!
 
During the course of the afternoon, several people came to talk to JH.  Ray Trevitt called up: he undertook to phone up Sara Stacey, in Derriford, to let her know about JH’s welfare after surgery; if he got no reply from Sara’s extension, he would phone Lyn Headon.  The on-duty SHO, Dr Schatz who is German, came to insert a venflon cannula into a vein on the back of JH’s right hand (as JH is left-handed); she also took lots of blood specimens from a vein in JH’s anticubital fossa (inside of elbow) – as blood was not ‘available’ from the venflon.  Subsequently JH kept catching the venflon on her clothes, or whatever, so the Student Nurse kindly wrapped a cotton bandage round it, which stopped the cannula from getting caught up.  Whilst taking blood, the SHO remarked on JH’s blotchy skin but JH explained that, as she had got older, that was what had happened; furthermore, she had had eczema in her elbow and knee creases when younger.

Mr Chawdhery, and the lady Registrar whom JH had met during her surgical appointment, tracked JH down to the day room.  These two Professionals were ‘courtesy itself’ in their conversation with JH: JH was approached with a smile; she received an apology for the long wait for a bed to be available; she was called ‘Miss’!  They obviously appreciated that, although JH had worked for the NHS for 40 years – and so had a certain understanding of the techniques, medical jargon, and all the rest of the implications of the situation into which she had placed herself quite voluntarily – that she was as frightened as the next person (as the saying goes).  JH was asked if she had any particular concerns/questions to ask: JH stated that being a person ‘on her own’ she was very concerned about the loss of her personal autonomy, but that she realised that that was ‘how things would be’ in an acute hospital ward.  Furthermore, JH expressed her concerns about her bowels: she had already stated that she had a diagnosis of IBS, and that she felt very uncomfortable (and became very anxious – which made the ‘situation’ worse) if she was not ‘in command’ of her bowels: it was not hospital policy to give patients anything to evacuate their bowels before major surgery (at a distance from the rectum – JH assumes) but we decided between us that JH could be prescribed to give herself suppositories pre operatively in the morning (as JH would not be allowed to eat any breakfast which would promote her gastro-colic reflex!).  JH also discussed her discharge into Mary Andrews’s care, and that Mary would be escorting JH home on the train on Monday next, 25th June; Mr Chawdhery explained that, usually, Donors are discharged within 3 or 4 days of surgery but that it would be an understanding between us that JH could retain a bed for a further two or three nights.  JH was fully aware that she was, in fact, occupying an ‘acute bed’ which might be required by someone else; however the nights preceding her discharge would fall over the weekend when, presumably, elective surgery would not be planned for; whenever JH subsequently mentioned the arrangements for her discharge home, to other clinicians, this plan was accepted without question.

JH went to sit by Kathy, who had had a lie down – and so JH was munching K’s marshmallows when the gentleman Registrar, whom she had also met before, came to ‘consent’ JH - in other words - explain again about the removal of JH’s left kidney, ask JH again if she had any unanswered questions, or any unexpressed concerns, and, finally, to ask JH to sign the consent form to be given anaesthesia, and have her kidney whipped out!  JH was told that the RLH’s donors are important, and JH felt she was – in spite of her (almost) overwhelming apprehensions, which she had not expressed to the Registrar but which he tacitly understood without being told.

A bed was found for JH at +/-3.00pm.  JH needed to dash out to the toilet before getting ensconced on the bed behind the screens so that the SHO could ‘clerk’ JH and, on the way, met Ralph arriving – in spite of Kathy giving him strict instructions not to, as he was really weary.  Just then the Domestic Lady delivered a jug of water to JH – who noticed that Kathy had a jug twice the size of JH’s; also, the Nursing Assistant gave JH (who had missed the tea trolley) a much-needed cup of tea.  The SHO had managed to clerk JH succinctly – in spite of JH’s constant interpolation of things forgotten about her own health - and there were no language misinterpretations which were not of JH’s own making!  Next, JH’s Admitting Nurse came to fill in all the Kardex documents - such as JH’s care plan, based on JH’s assertion of her usual competence with her ‘activities of daily living’ {it was noted that JH had an upstairs toilet at home}; also baseline observations were made and recorded - with regards to JH’s ‘vital signs’.  All this interrogation – but done in a very friendly manner – took ¾ of an hour!
 
For her supper, JH had chicken with mixed veg and roast parsnips (another of JH’s favourites), and jelly.  JH was just listening to the Archers on her walkman, when she was asked to go down to A&E X-ray Department, in the basement, for a chest X-ray.  Here, were large contraptions which looked rather like giant triffids: the Radiographer sitting at Reception explained to JH that the ventilation system had broken down before Christmas and so the Staff had been told that, because the new hospital being built would be opening in 2010, the system would not be repaired: however . . . this ‘would not do’ for the Staff so temporary Heath-Robinson triffids appeared following their protestations1.  JH also had an ECG done by her third-year Student Nurse; a lead was missing from the first machine she attempted to use (JH had heard of this happening before somewhere!).  Nasal swabs were taken, after which JH was instructed to use a tube of anti-MRSA cream 3 x daily until the cultures came back.  A pharmacist came to visit JH; JH explained that she was not on any pre-operative medications.  And then . . . whilst the Nurse was taking JH’s blood pressure an entourage of Clinicians were in the Ward and so JH’s blood pressure was reported to be VERY HIGH; Dr Schatz observed that ‘. . . this lady is a bit exited!’; JH anxiously asked if there was a cut off point – with regards to the donor’s B/P being high – at which the donor could no longer donate!  In any event, after a brief discussion between the Clinicians, JH was given a shot of something through her venflon, and when the Nurse checked JH’s blood pressure later on, JH’s B/P was normal.  Whew!  In a quiet moment Dr Schatz told JH that ‘ . . . you’re too hard on yourself’ - which kind remark made JH realise that this professional lady also realised, too, that JH was just as frightened as the next person.

JH arrived in the Ward, quite deliberately wearing a Turgwe Hippo Trust T-shirt, which also had ‘Zimbabwe’ screen-printed on the back; two Zimbabwean Nurses – one of whom was Dan, the Charge Nurse - were intrigued to read the name of their Country on JH’s back, and so JH had to explain that she fostered Abe, a Hippo at Hippo Haven.  Several times, JH and/or Kathy were asked, by fellow patients, about the family relationship between us both: we both received friendly encouragement on our pre-operative night; and an Indian lady sat next to a Mauritian lady near Kathy’s bed was most concerned about Kathy not having returned from her dialysis, in the Hambury Unit (next to Devonshire Ward), by 10.30pm:- in any case, Kathy’s bed would be moved into a 4-bedded critical care bay next door.  JH wrote up her Donation Diary until about 11.30pm.  JH had already discovered that she was unable to switch off the Patientline console above her bed, although she had located the on/off switch; she turned the screen towards the wall, but the light emanating therefrom reflected off the light-coloured walls – so JH hung her dressing gown over the console.  JH heard a faint tinkling noise emanating from the earphones dangling from a console above a patient’s head: said patient was engrossed in reading a book - this lady was quite happy for JH to switch off her console.

JH was just going to settle down in bed when the Bedlam Night began: it was apparent that an unfortunate patient was being taken to Theatre for an operation at somewhere around midnight; the porters arrived with a trolley, but the patient was not quite prepared to be conveyed away.  The porters did wait outside on the veranda, so that exchanges of interjections between the Ward Staff and themselves were a bit less audible – perhaps.   On one of JH’s trips to the toilet during the night, JH sadly observed that a patient had had an ‘accident’ - whilst opening of the bowels – and missed the pan. JH told the Night Staff, but realised that the ordure would not be cleared up until the early morning, when the Domestic Staff arrived: no doubt this stalwart Team were aware that such accidents will happen to very distressed patients who, by the very nature of their malady, will have bowels which are in uproar one way or another.

1The new Hospital opened in 2012.
 



 
 
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