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2007 - June 22nd - Friday

POSTOPERATIVE DAY THREE

JH finally got into bed at 11pm . . ..  During the night/early hours of the following morning JH got up to PU three times; although the blue folders and pots of hand gel did get knocked off the bed ends rather frequently by passers-by, JH was not the culprit of causing this added disturbance.  Although Hussein had kindly assessed her ‘bowel anxieties’, and brought a commode to the bedside (for a different bodily function, than the previous night), the commode did not get used during the night (this would have undoubtedly caused embarrassing disturbances!).  A fairly early hour found JH sat on the loo feeling distinctly wobbly, and woozy-headed, and her arms and legs went numb – which sensation she had experienced before, but now considered her said sensation to be exacerbated by becoming an analgesic junkie: JH did get looked at rather anxiously by another patient washing her hands. 


 

At this point, Ray Trevitt arrived and – upon enquiry – told JH that she would probably require analgesics for at least another month – and that perhaps the tramadol (being taken orally after discontinuation of the PCA) was ‘the problem’.  Kathy said that she was giving up – in other words she had surrendered to not maintaining the stiff upper lip during the night – to the Doctor who then prescribed PCA for her very severe back pain.  Ray Trevitt said that it was ‘their fault’ that Kathy had been over-infused with fluid, thereby exacerbating her problems, as they did not have a body-weight on which to base careful monitoring of Kathy’s fluid requirements: this admission is another example of exemplary professionalism.

JH had the usual visitations: obs were done; a different lady pharmacist came to see her; the lady from Patientline came and fixed the console.  Professor Yaqoob berated, in loud tones, the stout black lady who wanted to go home; he said that she needed to have ‘something out’; obviously, he knew his patient well, and she realised that whatever he said, went, although she continued to weep unhappily.  Professor progressed round the Ward, sitting on beds, - including JH’s – Florence Nightingale must have been turning in her grave!  JH observed, as did the Professor, that she had forgotten to measure her urine (since her urine was no longer draining into a bag), the first lot of which had been admixed with suppositories in any case:  we both agreed that Doctors and Nurses make the worst patients – to which JH added ‘Psychiatrists’ and to which the Prof countered – ‘were they not Artists?’  There was discussion between JH, the Professor, and his entourage, about JH’s pain management: to something suggested by the Registrar, the Professor countered with the comment that such-and-such would ‘severely constipate her’; the Professor then suggested Fentanyl skin patches, which JH thought was a brilliant idea – to which the Prof countered that he had to earn his title – Professor!  {JH has no doubt that he does that 100 times a day.}  Lunch was not memorable, even though ordered off a menu; JH thought that she remembered having a Satsuma for pudding: in any event, JH was unable to relish her food throughout the day – which fact was more to do with her post-operative collywobbles than the fare that was offered.  A fifth, and last, anticoagulant injection was received; apparently yesterday’s injection had been erroneously omitted: in any event JH seems to recollect walking about in her TED stockings throughout her stay, and being told she could take them home with her! 

A very young lady, who wore a name label inscribed ‘Yvonne’ and ‘Volunteer’, visited: Yvonne was regaled with JH’s ‘story’; Yvonne asked if there was anything she could do for this chatty patient; at first JH could not think of anything but – upon being asked if she could help with hair washing – Yvonne said that she would have to ask permission and at the moment, Moses, the Nursing Team Leader was not around so JH said that she would wait (after all, she had no choice but to do that in any case).  In the interim, Grace became rather concerned that a well-endowed large Mama was sitting exhibiting her boobs to all passers-by; JH does not recollect exactly how Grace got this message over but it was either by proclamation (to all passers-by) or by slightly nearer sympathetic advice to cover them up: in any event no offence was caused either by the exhibition or by the advice being received. 

Also just in this interim, Mary rang JH on the Ward phone: the Staff were always amenable to a non-mobile-owners speaking to callers, if the old-fashioned patient could be found easily, but on this occasion the Ward Clerk did politely interrupt the start of JH’s conversation with a request for her to come off the phone ASAP, as the other extension to the Ward was broken down and so JH was using the Ward’s only means of telecommunication!  So JH rapidly explained to Mary, put the receiver down, and went to get some change for the payphone in the day room.  Yvonne and JH met ‘in transit’ and JH explained that there had been a change of plan – from hair washing to telephoning; Yvonne asked if JH needed escorting to the phone – which JH did not.  Mary was working in the Oxfam Shop in Tavistock, the phone number for which JH thought she had in her ‘phone book’, but she did not.  JH could not think of a directory enquiries number to phone from a Solitaire payphone, so she found a mutual friend, Laura J's number: Laura had just been discharged home from Hospital after 2 week stay – having had a pleural effusion drained – into the care of a friend who was staying with her; between them they found the Oxfam Shop number for Callington in their local directory.  JH’s first attempt to phone this shop failed, but her second attempt was more successful, as JH fed 40p into the machine very rapidly; the ladies in the shop quickly provided the correct phone number, and JH got through to Mary immediately.  However . . . less success was experienced when trying to make other phone calls by pressing the ‘next call’ key – to make full use of the 20 minutes paid for by the minimum charge: on retrospect, JH should have trammelled with a Patientline console to make phone calls for more or less the same price but less hassle - perhaps! 

Mary informed the patient that:- JH’s ticket could be upgraded to a first class ticket – which would ‘qualify’ her for assisted travel; she would be met at Paddington and transported to the platform by wheelchair (in actual fact an electric buggy which JH had already noticed being manoeuvred skilfully around the Station); she would be met by a member of staff with a wheelchair at Plymouth Station and taken to the waiting taxi; zero hour was 1400/2.00pm at which time it was necessary to depart from the RLH in time to catch the 1506 train; Mary planned to leave some things at the patient’s house prior to coming back to London to collect the patient, so the latter gave number 62’s landline number to Mary, so that she could gain access to number 64; Mary would be staying with Frances, Mary Haddock’s daughter - who lives nearer to the RLH than her mother - on the Sunday night before escorting the patient home on Monday 25th June.  Subsequent to the business conversation . . . the patient – with a bit of a struggle – had a full wash, and washed her hair!  Then . . . with frequent ‘straining-at-stool’ attempts, the patient was rewarded – in excess - so by the evening she was feeling somewhat less pregnant (if that is possible for someone who has ‘only’ done Midwifery Training and never experienced having a baby?)!

During the morning JH had removed a very full vomit bowl from the bed-table of the beshawled Indian lady now occupying the opposite bed, taken the bowl to the sluice, mentioned how sick the patient was to a nurse, and replaced the bowl with an unused bowl off her own table.  [JH thought that this poorly lady had peritonitis as a sequelae of treatment for her kidney problem with continuous ambulatory peritoneal dialysis {CAPD}.]  In the evening this patient’s visitors – one of her daughters, and a young grandson – came over to thank JH for being so kind; JH did state that she had been a nurse (which could be considered gratuitous information, as anyone can extend a hand of kindness to those feeling more retched than themselves); apparently the patient had realised this but spoke no English even though she understood a fair amount.  JH told these visitors how attractive all the ladies looked – young and old – in their saris and shawls, and also mentioned being delighted to observe other large extended families visiting; and of course the men and boys always looked smart and well groomed.  This daughter explained (without rancour) that their family were in actual fact Hindus, not Moslems (she was wearing a pretty blouse and smart skirt); JH told them that she had been baptised into the Church of England, and was a volunteer at the PCFCD but that – in practice – she was really a heckler: JH asked the young man if he knew what ‘heckler’ meant, which he did not so JH explained – even though he looked somewhat shy almost to the point of embarrassment, he kept his composure.  [Will he remember this eccentric lady, and does he know what eccentric means, JH wonders.]

Lorraine came, together with her friend Paula - who has nephrotic syndrome, and whom JH had met previously at one of the family picnics in Greenwich Park - to visit Kathy.  Lorraine also came bearing a cup of MacDonald’s tea which did the trick (ie, whatever trick it was supposed to do – the paper cup being at least twice the size of the hospital’s disposable cups).  Eventually . . . JH was hardly ‘keeping up’: her tea tasted like sawdust; breaded fish, and chips, and peas, had to be washed down with copious drinks of water; she had to ‘dash out’ before finishing her meal and left a note ‘not finished’ written on her menu.  When Ralph visited, he brought with him another packet of Andrex flushable wipes, the right thing requested by JH; JH had walked passed Kathy so often clutching her packet of Andrex, that Kathy was also supplied with a packet – as a suitable addition to her personal hygiene requirements.  Also more get-well cards arrived, either by visiting ‘courier’ or by post.

JH enquired about her dressing which had not, as yet, been renewed: Moses and the Student Nurse arrived and, whilst the procedure was being done, Moses’s mobile went off; Moses looked at his mobile phone and remarked that his brother had sent him a text, whereupon JH pointed to the notice on the wall above the head of her bed ‘mobile phones are not to be used keep them turned off’!  The Student Nurse was most amused at this patient’s to-the-point pointing.  A different pharmacist called.  JH did not see a phlebotomist today.  JH asked the Night Nurse if she could omit giving JH her last dose of paracetamol but the Nurse was busy just then; however, she came back and apologised for not listening to what JH had to say: the latter explained that she had kept her 6 o’clock dose of paracetamol and taken it later and now, on Ray Trevitt’s advice, was refusing any more doses.  Ray had also told JH that he would not be around over the coming weekend, but would be available anytime for chats about analgesisia and/or any other concerns via telecom as necessary. Also some discussion took place with JH about taking OxyNorm (not oxymoron as written by JH in her manuscript diary) which, apparently, is an analgesic which is recommended for use in patients who cannot tolerate morphine.  And it was decided that JH would take only one laxative, lactulose – the senakot being omitted.  JH listened to Any Questions on her radio, and subsequently spent the evening up until 10.45pm writing her Donation Diary.



 
 
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