Machines Not Working Properly

Good Nurse phoned at 8.23 to tell me that the fax had arrived, she had taken the blood from Rosemarie and it was all ready to go. Five minutes later I was in the car heading towards the Care Home. The traffic melted away before me and I arrived twenty minutes later.

The test request and the blood sample were put in an envelope marked Pathology Dept. I asked for their number of the dept so I could give them a call on the way and check where in the hospital they were. It didn't immediately strike me as the sort of place visitors would commonly go to. I was given a number. I got back in the car and headed off to the Mayday Hospital as was, or as we should now call it: Croydon University Hospital.

I found a parking space on  the road outside and went to the machine to get a ticket. I started to get an inkling that things might not be going as smoothly as the evaporating traffic had hinted.

The notice said: 80p for 30 minutes, £1.60 for an hour. I checked my pockets (I hardly seem to use cash any more) - three pound coins and a few coppers. Fair enough. Half an hour should be plenty. I put a pound in and pressed the green button, not expecting any change. I looked at my watch. 9.15. I picked up the printed ticket. It read TICKET EXPIRES 09.25. I looked at my watch again. Yes, definitely 9.15. I looked at my phone. 9.16 now. 

There was nothing for it. I put my last two pound coins in the machine. I checked my watch. 9.16. I printed the ticket. EXPIRES 11.12. What?

I made my way to Hospital Reception, realising I hadn't actually phoned ahead. Three polite and apparently eager people waited at the counter. What could they do to help me? They could tell me where the Pathology Department was. Why did I want to go there?  I explained I was dropping off a blood sample for urgent testing. Ah. I didn't want Pathology I wanted the Walk In Blood Test department. No I didn't think so - the envelope was clearly marked Pathology. 

No further help was forthcoming. The location of Pathology was obviously a state secret and they very generously told me where they thought I should go and where the nurse would be very happy to help me. I thought about this for a moment and decided to give them the benefit of the doubt. I could always ask someone else. 

I easily found the almost entirely empty room that led to a row of cubicles with people already being bled. There was no friendly nurse in sight, just a prominent ticket dispensing machine and a large notice telling me to take a ticket. I waited for someone to appear. After a couple of minutes a nurse appeared from the cubicle corridor.

I opened my mouth.

"18 and 19", she said, before I could say anything. There was a shriek of joy from behind me from two people who had just moments before entered the room and taken a ticket each. In a blaze of happiness they leapt past me and were marched away by the nurse. 

I shut my mouth.

A couple of minutes later a door opened further along the room and a nurse entered. My determination to speak was apparently obvious because she stopped and asked if she could help.

I explained that I had some blood to be tested urgently and had been trying to deliver it to Pathology but Reception had insisted I bring it here instead.

She opened the envelope and swiftly perused the contents. "Leave it with me."

"It's urgent."

"I will take it upstairs right away."

I waited. She didn't move.

"I will take it upstairs right away."

I gave up, thanked her and made my way back to the car.

A Worm Of Doubt was eating me all the way home. As soon as I got in I phoned the number I had been given for Pathology, to check that the blood had arrived. Completely different department. 

I looked up the number of the hospital and went through the mandatory button pushing exercise you have to suffer in order to speak with anyone these days. I got through to Pathology and politely explained that I wanted to check that the blood I had handed in half an hour earlier at Phlebotomy (as it was correctly called) had indeed been brought up 'right away'. She asked me for the necessary identifying details (name, date of birth etc.) and looked it up on her computer.

Of course it hadn't.

But wait! Was I sure it had an URGENT sticker on it? I tried to picture it. I certainly did not recall any colourful eye catching label so confessed I probably thought not. 

"In that case, it wouldn't come here anyway. If it is not marked as urgent, GP requests for blood tests are sent to a different hospital."

I felt the blood singing in my ears. Which hospital? St. George's. When does it get taken there (expecting the answer "At the end of the day")?

Ah, every hour. The hospital has a busy Phlebotomy Department and a testing lab but all non urgent tests are sent by courier somewhere else, every hour. 

But it must have gone with the 9.30 batch. Or at least the 10.30 batch. It had to be there soon. There should not be a problem getting the results today should there?

Just after 11.30 the phone rang. It was Good Nurse - maybe the results were back already.

They weren't. Rosemarie had suffered another seizure.

Everything went dark for a moment.

She had bitten her tongue quite badly and had been very distressed. She had been given 10 mg Diazepam as a suppository and was now sleeping.

The doctor (the one I spoke to yesterday) had been called and was expected early afternoon. 

When I arrived Rosemarie was lying asleep in recovery position on the bed. She looked exhausted. Her lips were swollen where she must have been biting them. She looked very small and very frail.

Our friend Phil, who usually visits her on Wednesdays, was sitting with her, looking worried. She said Rosemarie looked a lot better than she did when she arrived - she had been really frightened at how ill she looked.

We sat there for some time, talking in low voices and looking at the small, sad figure on the bed. Every now and then her eyes would flutter open and she would look around her like a frightened child, and either Phil or I would go over to her and stroke her arm, hold her hand, and try to comfort her. She would make some low, soft noise and her eyes would close again.

Shortly after 2 the doctor arrived accompanied by Good Nurse and, for a brief period, the Care Home Manager.

The doctor was pleasant, intelligent, patient and thorough. She started by announcing that she had already made out an open ended prescription for saline should it be needed (she had presumably heard about the problems of supply previously). She examined Rosemarie and said she could detect 'crackling' in her lungs and so was likely still infected. Good Nurse said she had just started her on the next course of Amoxycillin.

We talked at some length about the Clonazepam. According to the doctor, any change in the dosage of medication of this type, up or down, can cause problems that result in seizures. She suggested, and I agreed, that we should not restart the Clonazepam unless there was no alternative, and even then it should be in liquid form at a much lower dose. It was generally agreed that the risk of another seizure was outweighed by the increased chance of her taking food and drink if she was more alert.

I felt guilty about the almost casual way I make these decisions for her now. I think I have learned that thinking too much about them paralyses me with indecision. Being her legal guardian means making decisions, not avoiding them.

The other, invisible person in the discussion was my favourite Neurologist, whom Good Nurse had phoned more than once during the day, I assume, and whose opinions and recommendations she kept introducing with absolutely no opposition. 

The discussion ran out of steam after a while because we couldn't decide the main things until we had the results of the tests. She said that Rosemarie's last recorded sodium level (before she had the drip) was 157  mmol/L, and the safe, 'usual' level was under 145. She said if it had gone down at all she would recommend starting the saline again. 

She left promising to call as soon as she had the results.

So 5.30 came and went (when the lab was supposed to close), as did 6, when the doctor's surgery was supposed to close. No news. Rosemarie woke up though and I had no problem giving her 100 ml of juice before she became drowsy again.

Shortly after 6 Good Nurse arrived and said the doctor had rung her and said she had been in touch with the lab and humma humma humma. I didn't really get the communication. Something about them still doing testing but the level was about the same (?). Anyway, the main thing was the doctor had spoken to the Rapid Response Team and told (convinced?) them to come and set up a drip tonight - one litre over 24 hours.

The District Nurses duly arrived just before 7 ('sometime after 6') and briskly set up the drip, but treating Rosemarie with a warm and caring consideration that absolutely stole my heart. They had even brought a spare bag with them.

So some machines did not work properly today. Croydon parking machines have their own special mathematics. I deliver a blood sample to the 'designated' hospital before most people would have finished the Starbuck's coffee they bought on their way to work, but the test is still not complete by the end of the day. 

But other things do work. Traffic dissolves, antagonists become partners, and the invisible Neurologist hovers like the ghost of Obi Wan Kenobi watching over us all...