Hospital 1

Last Tuesday Rosemarie started to show signs of another infection: listlessness, temperature, lots of phlegm in her throat, and reluctance to eat. By Thursday Good Nurse and I were starting to get worried: three days without food and, more worryingly, almost no fluid intake.

This thickened liquid idea was not really working. The recommended consistency is similar to that of thick custard or thick yoghurt. It is almost impossible to drink; you have to sort of 'bite' some from the tilted beaker. I had some success feeding her with a spoon, but allowing for the wait to check she has finished swallowing, it can take over an hour of patient work to get her to drink 200 ml. And that is if she cooperates. If the thickener is added to water the resulting liquid looks and tastes like wallpaper paste. I always try to mix cranberry or orange juice - something with a bit of taste - but I am certain a lot of the care staff just mix up water. It is no surprise to me she doesn't want to drink.

The doctor had been called Wednesday but didn't turn up. Called again Thursday and didn't turn up. By Thursday night Rosemarie was seriously dehydrated and Good Nurse strongly advised - and I reluctantly agreed - that she needed to be in hospital. She promised to chase up the doctor Friday morning and insist on a visit even if it was from a locum.

I didn't get a lot of sleep Thursday night. There have been too many examples of residents with chest infections going off to hospital and not coming back. Despite my recent positive experience with the X-ray I lay in the dark with worry chewing at my gut. It was almost a relief when the alarm went off. 

I spoke to Good Nurse at about 10 and she told me she had spoken to Rosemarie's doctor and he would visit her at 1230. He was of the opinion she should be in hospital but wanted to see her for himself. Later she rang back to say he wouldn't be there but was ordering the ambulance for 1230.

I threw some things in a bag and jumped in the car. At 1200, as I arrived at the Care Home, Good Nurse rang again to tell me a locum doctor had turned up and had ordered the ambulance. It arrived 10 minutes later, and after half an hour of fiddling with paperwork and one of the paramedics examining Rosemarie, we were off to A&E at King's (my strongly requested choice)

Rosemarie didn't doze this time but was quiet and remote: since the chest infections there have been many more of these eerily calm times, and I can't help but feel that another part of her is disappearing. The eyes stare blankly, she does not respond to me calling her name, stroking her arm or any other attempt at stimulus. I sat next to her in the ambulance and tried to speak soothing and reassuring words but she totally ignored me as if I was on another planet.

She was like this during the journey, the booking in, the multiple blood pressure readings, the EEG, and unbelievably, the insertion of a cannula. In its own way it felt more distressing than if she had been agitated and frightened. 

I started the process of telling her story repeatedly that I remember clearly from last time. A succession of nurses and doctors coming in, asking questions, making notes (in the case of nurses usually on their hands). Most carried stethoscopes and listened intently to Rosemarie's chest and none of them could hear the noises heard by the locum doctor or the paramedic. They set up a saline drip and plugged her into some oxygen and passed in and out of the cubicle in the usual slightly frantic, barely controlled chaos of A&E.

Just before 5 a porter arrived and took her for an X-ray. I went with her but was not allowed in this time so I had to kick my heels in the corridor for 10 minutes till the porter reappeared with her and we returned to the cubicle. 

I find the nurses either to be chatty and pleasant or sullen and resentful. I had been fortunate enough to click with a couple of the former, one of whom brought me a cup of tea (my first of the day) just after we got back from X-ray, and also kept me vaguely up to date during the long empty hours of waiting.

The plan appeared to be to get Rosemarie into a ward, settled, so they could continue to do tests. Almost immediately she returned to tell me that the plan had changed and they wanted to do a CT scan because they were worried about her lack of speech...

I wasn't sure whether the nurse had misunderstood the plan (unlikely) or the hospital had misunderstood Rosemarie's situation. I enlightened the nurse and she disappeared into the crowd with a worried look on her face. 

Just after 7 a doctor arrived and pronounced that the CT scan had been postponed and that the priority was to get Rosemarie rehydrated and reduce her sodium levels. She would definitely stay overnight and possibly till monday depending on the results of the tests.

We had quite a lengthy conversation about Rosemarie's condition and particularly about the trade off between preventing aspiration by using the thickener and risking dehydration by.... using thickener. It was clear there was no answer to this problem but these honest talks are in some strange way empowering. 

It was now about 7.30 and Rosemarie had been lying on the hard cubicle trolley for six hours and she was beginning to twist slowly and move her legs restlessly. I tried to comfort and reassure her but she ignored me.

Just as the plan had been sorted out and we were looking forward to getting her to a more comfortable bed, everything slowed down for the shift change.

Just after 8 the doctor returned with a consultant and basically said the same things all over again, but more briskly this time. 

Time slowed to a crawl. 

Rosemarie's friend Celia arrived. It was nice to have someone to talk to at last. 

The nice nurse was replaced by a sullen woman who resisted all my attempts to form some kind of relationship. She took Rosemarie's blood pressure. I asked what it was (as I had done throughout the day). Her answer was to rudely enquire if I had any idea what the numbers would mean, and what it should be, the clear implication being that I would be too stupid to understand if she told me. When I told her what it had been throughout the day, what an acceptable range was and at what level it was considered dangerous, she harrumphed and refused to speak to me. Later, Rosemarie's drip ran out and the alarm began to sound. I told the nurse when she was walking past the cubicle. She sighed heavily and wordlessly flicked the alarm off. She didn't replace the drip for half an hour. 

Finally, at 10.30, nine hours after admission,  a porter arrived with the paperwork to move her to a ward. Long brisk walk through empty echoing corridors then into the dim hushed ward full of the noises of people trying to get to sleep. 

Rosemarie looked exhausted, very vulnerable and somehow very small in the hospital bed. It was nearly 11 by the time she was settled, and we were briskly hustled out of the ward.

Long empty corridors again, waiting for a bus in the dark rain, and the unexpected bustle of Brixton at nearly midnight on a Friday, the damp pavements full of excited people looking for parties, small groups of teenagers all talking at once, and pairs of heavily made up girls wandering around who must have been almost fifteen.