Breathing

I had nearly reached the Care Home when Good Nurse called me and said the Doctor was there and wanted to speak with me. Rosemarie, he said, was very ill and would no longer swallow her medication or necessary fluids. The choice was to go down the traumatic Hospital route or pass her over to the Palliative Care team to make here as comfortable as possible. 

Glad to have a captive audience I rolled out my questions. It turns out Care Home nurses - even Rapid Response Team nurses, cannot give initial injections of antibiotics, apparently in case there are serious allergic reactions. Nor do they like giving intravenous drips - although subcutaneous drips are ok. 

I am still convinced that the swallowing problem is not terminal yet and she still knows how to swallow if she is not dehydrated, delirious and feverish. I said I was not giving up on Rosemarie and there had to be a solution. It appeared there was. She could be admitted to hospital for the initial injection, then returned as soon as it was known to be safe. The assorted nurses could continue with the course of injections and rehydrate her. Not ideal but close. The doctor said he would arrange it and ring me back.

I was parking when he rang back to say that he had spoken with a consultant at the hospital and the deal was off. The hospital was not prepared to take her under those terms.

I finished the conversation face to face as I came out the lift. We agreed to get the Rapid Response Team to come and rehydrate Rosemarie and see if that was enough to encourage her to swallow the medication.  There was always the ultimate option of hospital but that was truly the last resort.

I went to Rosemarie's room and I was shocked by her condition. She was lying on her back, head tilted back and mouth open, struggling for breath. At times her stomach seemed to spasm in the effort to breathe. 

I let my son and daughter know the situation and sat down to wait. This was a hard time, and I had a very real fear that any breath might be her last. I sat as close as I could, holding her hand and talking to her through an intermittent curtain of tears.

She showed no signs of knowing I was there.

After a while I calmed down as I noticed a pattern. She would have a period of fairly easy, chesty breathing that would become more and more laboured, until there was an explosion of coughing/choking/gasping and she would struggle to swallow the phlegm in her throat. After a tortured eternity she would manage to deal with it and the whole cycle would begin again. 

After about an hour my daughter and her husband arrived with our first grandchild, who Rosemarie is yet to see. Sadly Rosemarie did not open her eyes for the couple of hours that they stayed, and they left about 5 with her still not having seen her granddaughter.

Shortly afterwards the Rapid Response Team arrived with a drip and other gadgets, but most importantly the brought with them the relief that comes when you feel something is at last being done. 

They took her stats, some of which were worrying. BP 100/60, pulse 80, temperature 39.7 and oxygen at 84. They briskly set up the subcutaneous infusion and bustled out, promising to return in 24 hours to replace the bag of fluid.

My son arrived shortly afterwards and we began another long wait. The nurse came in and replaced Rosemarie's heavy duvet with a light sheet, and she seemed instantly more comfortable. 

Over the next few hours her breathing followed the same cycle but my familiarity with it or maybe just my imagination made it seem easier. Her temperature was taken again and had dropped. She seemed to pass from an absorbed cyclical fight for breath to a fitful sleep with regular interruptions. 

As the staff changeover went through its ritual and the Home settled down to its evening calmness I was overwhelmed with tiredness. I took the elephant that was sitting on my head, and drove home with my son. 

I fell asleep still not knowing what I felt.