Drips and Buffers

Yesterday the routine hit the buffers.

I thought we had established that we were going to rehydrate Rosemarie using the drip as the major contributor. What this fails to take into account is that the saline is actually prescribed by her GP, and usually only one or two days at a time. The Home has to phone up and request a repeat prescription, but because of the fact that it is a group practice it is not always the same GP and different GPs have different opinions on what to do. Her designated GP was on holiday yesterday, and the GP who took the decision wanted to limit Rosemarie to one more bag of saline and then review it Thursday when her GP was back.

Not good but I thought I could live with that, until Good Nurse came in at supper time and told me she had just received a call from the doctor and Rosemarie was not getting any saline at all. The doctor had spoken to the Rapid Response Team, who were of the opinion that she had already had in excess of what was advisable. That was it. No more information.

I tried to call the doctor but had to leave a message with the receptionist, asking that I be called back as a matter of urgency.

I occupied myself getting Rosemarie to take 200 ml juice and 3/4 tub of Nutilis. Baby steps but in the right direction.

I was just about to leave when my phone rang. It was the doctor, sounding a lot more polite and reasonable than I had imagined her and we proceeded to have my favourite kind of Educational Conversation.

It is probably a fault but I find it frustrating to be given decisions/conclusions without knowing the reasons, particularly when it concerns something or someone I care about. I don't consider myself stupid and I have never had problems understanding any of these medical issues once a few details have been explained to me. 

And so it proved. The argument wasn't as simple as I had thought it to be (which I expected). Saline does contain some sodium and whereas intravenous delivery is reliable and predictable subcutaneous delivery is a lot more unpredictable, and for that reason they prefer to monitor the sodium levels after every few litres of saline, and Rosemarie had indeed gone considerably beyond the normal testing point. 

The doctor understood my concern but pointed out that if the saline had been doing her good she should be somewhat rehydrated and could probably cope easily without saline for 24 hours. If the saline was causing her problems we should stop it anyway. In any case we needed to find out by doing a blood test (which I had actually been advocating for several days).

So she would fax through a blood test form first thing in the morning, Good Nurse would draw the blood, and I agreed to run it to the hospital early morning (the scheduled courier only called in the afternoon) so the test results would be available same day. Rapid Response would be on standby to race in with some saline if the test results supported that decision. 

I felt relieved. My biggest worry had been that people were making decisions on faulty data, and that didn't seem to be the case.

I sat by Rosemarie stroking her arm and trying to reassure her. She was sleepy after the effort of eating and drinking and her eyes kept closing. I told her that she was doing fine and needed to have more fluid and start eating some food. I said everyone was doing all they could and she had to hang in there. 

I stroked her hair and kissed her on the forehead, and drove home hoping it was true.