Day Three

Day Three in what is becoming known ironically as the Big Mother House

My Mother is very unwell, she remains paralysed and drowsy, has a chest infection – could that be due to her being left lying flat during her first night in hospital? – and is on a brightly lit, noisy and busy ward with considerable footfall past her bed. Her worst nightmare.

When I arrived on the ward yesterday the doctor -not one doctor has yet  introduced themselves – introduced himself and said he wanted to discuss resuscitation. The first time he has spoken to me he wants to talk about letting my Mother die. He seems surprised that, as I have only just arrived, I want to check my Mothers charts and see her first. Her charts are not there, so a nurse finds them for me. The chart I had asked for – see yesterdays post –  is in the file, but has been used as a tick chart – there is nothing to show who has done (or not done) what, no signatures, no description of intervention, no accountability or audit trail. It is, to nick a Monty Python phrase, a dead chart, deceased, useless, an ex-chart. It is almost exactly what I had asked them to avoid and is a lovely example of an Arse Covering Exercise – one that demonstrates nothing at all except that they want to demonstrate something.

This doctor and the one I refer to as The Kind Nurse (singular) who we met in Emergency and who works on the Stroke Unit take me to a room for privacy: after a while we find an empty room, albeit one that people will continually enter and peer into while we discuss allowing my Mother to die. I suspect, as this has been a challenge, that I would not have been afforded this courtesy if I had not become one of Those Families who appear in the notes under unflattering pseudonyms with the whiff of litigation following them. I believe that my Mothers quality of life would be crap if she failed and had to be re-sussed, and one of her fears was being dependent on others. However, although I am in  agreement with a Do Not Resuscitate policy, it occurs to me that we should, in fact, have a Best Interest meeting as this hinges on mental capacity. I am in such internal turmoil that I fail to raise this in the discussion – my primary aim is to ensure that my Mother does not suffer more than necessary. On return home I doubt this, and will raise it the following day on the ward. I will let you know what happens.

I ask the Kind Nurse if we can talk about the nursing my Mother is receiving. He says that he knows I have some issues (so – clearly, time in handover to discuss this, but not to discuss nursing detail or distribute tasks. Curious.) He says the Modern Matron will be in soon and it would be a good opportunity to talk then, when we are all together. Cool – I can wait.

Modern Matron arrives with Kind Nurse. I know her! A lifetime ago I worked in the same hospital in a different role. She is nice! She has good manners and understands stuff and her nursing practice was always superb. But I recall she is weak with staff and not a born leader, I recall the group she had to manage back then and how she failed to control the most assertive ones or manage out the weaker ones. A curates egg, then.

She and Kind Nurse say they understand my issues and want to help. I explain, carefully, that I do not intend to be critical of individuals, unless I have to, or of nurses generally, and my intention is to secure the appropriate nursing care for my Mother, as well as some reassurance and an audit trail for me. Matron tells me (I am getting used to this) that they were short staffed and busy and it was unusual. Given that a bank holiday is not a secret or a surprise I am unclear why it is not possible to have plans  B, C, D and E in place – as I demonstrate to people when I am upskilling organisations as part of my business – but I say simply that I understand. And I do – I have been in their position exactly and I fully appreciate the challenges. But I do not care if they are challenged, I care only that they sort it out and nurse my Mother properly. It is not my job to manage their work for them. I explain that in kind and calm terms. Matron seems to think that if she tells me that they are actually routinely 4 or 5 patients over their quota, have increased their workload by 66% by introducing a new Thrombolytic technique,  and are running three to four nurses short on each shift, that I will feel reassured and sympathetic. Well, no. If you have been foolish enough to accept too many patients, to offer a new service before making plans and provision for service delivery, and have failed to recruit or marshall sufficient bank and agency staff, that speaks to me about not only your practice but the hospital management. This kind of super-inefficiency puts lives at risk and impacts to a high degree on personal safety. So, no, I do not sympathise. I want nursing action. I feel rotten about it because I like this woman, and this guy – they are nice people. But the fact is they are colluding with abysmal patient care, appalling and unacceptable hospital management, and the risking of all the patients personal safety as well as the registration of their nurses who will be culpable when this is exposed. Which appears to be now.

Matron asks Kind Nurse what charts are in place, as I have said I am not happy with them. He tells her there is now, as I have asked, a chart in place for nursing interventions. Technically true, but a massive and whopping exaggeration. I ask if we can actually show Matron, please. He is irritated (but still kind) and goes to fetch them. Matron recognises what I am talking about and they have a little chat about how to improve the charts. I can see that, unless I create a chart that does what it says on the tin, it isn’t going to happen, but I let them have their chat. Their conclusion is that I am right and the charts will be adapted to make them fit for purpose (and I am left wondering why it hasn’t happened previously….) and they will tinker on the computer with them. There is a minor sub-conversation between them about who is capable, but that is not really resolved. I think it will be me. I am on  it in my head already and will bring it in tomorrow. Kind Nurse returns to the (short staffed and busy, I know the form) ward, and we conclude the session with a bit of chat about how our respective kids are, and how tough it is to be a Matron especially when the other Matron is off sick for 12 weeks and she has to suck up the extra work. I wonder how they would fare in the Real World and toy with the idea of inviting them to shadow me, but realise it is a fantasy, and would in any case probably kill them. But bearing that in mind and depending on the outcome of this, I may re-visit the decision……………..

To my great relief I can see that, in practice, my Mother has had some nursing attention – the Blue nurse roundly draws my attention to the fact that Mother is clean and has had her hair brushed and plaited. (Is it that unusual that she needs to trumpet it?) Matron – she is a nice, kind woman after all, and I know that and like her and feel bad about not trusting her – has arranged for a ripple mattress, which should have already been in place frankly, as part of the nursing care of an immobile patient. But I am grateful even if I should not have to be. Disappointingly, later on I have to draw attention to the fact that my Mother needs suction as she is drowning.

That is something that strikes me so forcibly I am almost winded: I am grateful when these people halfway manage to do the jobs for which I pay them. After I have made a quiet, polite, but clearly potentially litigious fuss. And they have my Mothers life in  their hands.


4 Comments on “Day Three”

  1. Andrea Evans says:

    Am still following this with interest…and a huge amount of empathy.
    Have they not heard of a 48 hour plan of care which requires absolutely no tinkering on the computer?
    Cannot believe the first discussion involves a DNAR!
    What you have written as the Matron’s explanation about staffing levels etc is so common in our hospital as well. We are forced to take patients even though we may not be equipped for them and if we are lucky get offered one extra member of staff for the ward. I say forced and mean it. The decisions as to whom we take onto the ward are generated from management above the matrons level. We frequently get more wandering patients than we can handle but cannot stop it. The only way forward that I see is to get “them upstairs” to realise that the ground level cannot cope and the patients are suffering for it. Good staff leave their posts to go elsewhere when they cannot take the frustration any more or, they just roll over and stop objecting. I think every day of how things could be changed and am aiming to try and do something about it over the next year but it is definitely a Herculian challenge for everyone.
    I hope your mother’s condition will start improving – there are no crystal balls available when it comes to Stroke patients but sometimes amazing things happen as you know. Wishing you and your mother all the best for 2011.

    • Andrea, your comments are so refreshing and a huge support at this difficult time. I sincerely appreciate your emails and comments and am grateful for your continued following of the tale and your good wishes. I wish you all that you wish yourself for 2011, and thanks again.

  2. Chris Precious says:

    It is a very sad reflection that we are now at the stage where we can be slightly appeased by a slight show of attention after having been deemed to be potential ‘trouble-makers’. The poor use of charts is symptomatic of the overall haphazard approach to record keeping endemic throughout the NHS. I recall my son being taken in for a nights observation, having not eaten or drunk following a bout of sickness. He was seen by a doctor at six-thirty in the evening and given some calpol and a drink. The next time we saw a nurse was at about ten-thirty when I went looking for a blanket. For the rest of the night I found him drinks and encouraged him to sip them and at about six the following morning I found an orderly and persuaded them to allow me to make him some toast in a staff room. At seven that morning a nurse appeared who was delighted to find that I had been making my own notes throughout the night and then proceeded to copy them on to a chart, omitting my comments on the levels of care. Had we been at home he would have been better cared for and had more rest.

    Thank you for the honesty of your blog and the courage you show in sharing these difficult times, and decisions, with us. Let us hope that changes can be made soon to improve the appalling standards that are becoming so commonplace in the NHS and that we no longer have to be “grateful” when they are compelled to provide third rate service.

    • Chris, how often have people in the last few days shared with me their own painful horror stories of “care” in the NHS? I am so sorry you have also suffered in the system. I call it a “system” and it calls itself an “organisation” but neither word rings true. My experience is that it is a chaotic random huddle of people tied together with a loose and unravelling string of directives without sanctions, rules without structure, and unwitting cruelty in the place of thought. I cannot help my honesty in this blog – it has to be said and I am happy to say it. I will not give this one up – I have had enough of this burden called the NHS in which expectations are not met sufficiently to warrant the drain on the public funds. Let us be clear, though: this is not about throwing money at the NHS, it is about managing it properly, leading the services, modelling and enabling good practice and cutting out bad practice and bad people like tumours.

      Chris – thank you. Your thoughts are so helpful and supportive. We are batting on the same side and it is good to know.

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