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2007 - May 3rd - Thursday

JH woke up feeling really refreshed just before her alarm went off at 7.30am.  JH had a shower and then, having remembered NOT to eat or drink, JH walked over to reach the X-ray Department at 8.25am.  The Department was somewhat deserted; the receptionist directed JH to waiting room B; the cleaners were going about their business – and JH moved round with them: JH was shortly collected by a Nurse, also called Vicky, and taken to a curtained bay.  JH had omitted to bring a dressing gown and slippers – as instructed on the appointment letter – so, after completely undressing, JH was given two hospital gowns, so that she could wear one with the tapes at the back and the other with the tapes at the front – so that her bottom did not show; JH was reminded to take off her watch and remove her earrings. 


 

A radiologist – who did introduce himself but whose name JH promptly forgot – inserted a cannula into JH’s right antecubital fossa – just in case.  Dr Hussein, the Registrar who was going to carry out the procedure, then came along and ‘consented’ JH; Dr Hussein mentioned all the potential risks of the procedure, and also mentioned that he preferred to access the RIGHT femoral artery.  At some point, JH asked to go to the toilet – in actual fact, the cleaner had been cleaning the toilet in the waiting room – so JH was guided back by Vicky, through a short cut, to ‘go’.  Vicky noted that JH did not have anyone accompanying her, so JH explained that Ray Trevitt, from the Renal Outpatients Department, was planning to come over, when summoned, to escort JH to James Hora Home.

JH was then escorted into the Angiography Suite and asked to climb onto the X ray table; the room was full of people; JH said that she was not, as a rule, very comfortable lying flat on her back and so a pillow was placed under her knees – after a nurse asked Dr Hussein if this was OK; JH had a cuff placed on her left arm for blood pressure and pulse monitoring, and a clip placed on a finger - which was a new experience and puzzled JH until she realised that it was for pO2 monitoring; Dr Hussein explained what he was doing throughout the procedure; JH’s right groin was exposed and she was draped ‘all over’ – there was obviously a hole with adhesive edges in the drapes just over the groin; first of all Dr H injected local anaesthetic into JH’s right groin; subsequently he inserted a cannula (presumably with a trochar which was removed but, as JH was lying so flat she could not see – not to mention the large X-ray machine in her field of vision) and through which he inserted a fine catheter for the injection of the dye up into the aorta at the level from which the renal arteries branch off.  JH had difficulty in seeing the monitoring screens over the edge of the drapes so Dr Hussein brushed aside the drapes on her behalf; Dr H then had to change his gloves and gown – for which breach of sterility JH apologised as being her ‘fault’!  Dr Hussein asked JH if she had had a hysterectomy – because he saw clips on the X-ray of JH’s pelvic cavity – but JH said ‘No’, and explained that the clips were for her ‘fertility control’!  JH was asked several times if she was feeling OK, had any pain, etc, etc, but - other than a vague ache in her groin – she had no complaints. 

When Dr H removed the catheter and then the drapes, he asked JH if undergoing the procedure was as bad as she had expected to which JH replied that she had been very apprehensive about her irritable bowel being irritated at NOT being emptied following the normal gastro-colic reflex being experienced after breakfast - although she had managed to ‘go’ a bit in spite of having none; Dr H countered that what he had done was nothing to do with her bowels – so JH said she realised that, but she was worried about needing to ‘go’ in the middle of the procedure!

JH was then asked to shimmy sideways onto a trolley - being careful to remain recumbent and not wave/bend her right leg at the thigh; JH was taken back to the Recovery Room where she was – as she had been told – to lie flat {recumbent} for two hours.  At one point JH endeavoured to use a slipper bedpan whilst lying flat – but this was an impossible feat as JH was ‘not allowed’ to raise her head, or move her right leg, in case she dislodged the clot in her groin: in any event, ‘fluids’ were not allowed until she sat up a bit.  Dr Hussein came at about 10.15am to remove the cannula – and thereafter pressed hard in JH’s groin for 10 min; neither JH or Dr H had a watch handy to time this exactly, so Dr H enlisted the calling-power of the Nurse sat at the Nurses Station!  JH asked Dr H why he preferred to perform the procedure in the right groin to which he rejoined that it was simply because he is right-handed [– no doubt a left-handed ‘Operator’ would request the imaging staff to put his/her stool on the left side of the patient in the Angiography Department]. 

Whilst JH was reclining for two hours, she started her ‘collection’ of Nationalities, ie, the Home Countries of the Staff who were attending to her – more on this Theme is to follow.  Ray Trevitt came over to see JH: he left his extension number – so that he could be contacted when JH was ready to go over to JHH - on a piece of paper which JH subsequently suggested was kept at the Nurses Station; Ray said that he needed to leave the Hospital at 5.00pm, because he had a child to pick up; JH was then informed that Ray had two older children (who were capable of looking after themselves) and a Spouse.
 
At somewhere around 12.00md the attendant Nurse started to gradually raise up the head of the bed so that, after a period of 20 minutes or so, JH was sitting up high enough to be able to have a drink: she had two plastic mugfuls of squash – of which the Nurse found a bottle at the Nurses Station, but which JH had to explain how to dilute.  During this hour of gradually rising up in the world, JH did manage to PU into a bedpan!  Also, JH was brought a packed lunch by a lady who identified herself as the Co-ordinator: JH ate tuna sandwiches, a small yoghurt, a banana, and a small cake, for her lunch (and breakfast).  After 3 hours, JH dangled her legs over the edge of the bed for about 10 minutes, and then carefully lowered herself into a chair (under supervision) where she sat for about 20 minutes - continuing to read The Prisoner of Zenda - with a blanket over her knees and her jacket over her shoulders.

Throughout the Morning, JH observed other patients arriving: ‘next door’ sat an elderly - possibly Indian – gentleman who was with his son; however, it was thought necessary for ‘legal reasons’ to obtain an interpreter to explain to the patient that he was going to have some sort of procedure to do with his failing kidneys.  ‘Opposite’ JH a, probably Caucasian, elderly gentleman was admitted for – as explained by the Radiologist – the insertion of a little umbrella into one of his vessels in order to prevent clots breaking off, whilst he was having something more elaborate done, and causing an embolus.

At about 1.20pm JH started to yawn a lot – which she thought was rather a ‘poor show’ as she had been lying about all morning – then she was aware that the Nurse attending to the Caucasian gentleman was all misty; the mistiness increased and JH weakly raised her arm and called to the Nurse, suggesting that JH needed to lie down!  The Team arrived: JH was lowered to the floor on her blanket; a lady Consultant Radiologist – who identified herself but whose name JH cannot remember – asked JH to grip her hands, and asked JH to raise each leg independently off the floor; JH performed these tasks; JH was then asked if she had ever fainted, to which JH replied ‘No’ but that she had felt very woozy some forty years ago when standing to attention in front of a Matron at Bart’s Hospital (JH forgot about the times she had food poisoning but, in any case, then, she was able to reach the prone position herself - at this present moment she had not thought of moving herself about, because of the strict protocol with regards to her gradual progress towards standing upright and walking).  JH felt very sick and vomited a little, and was then given a some water to rinse out her mouth but which she spat out onto her pillow [missing the disposable vomit bowl/kidney dish(!)]; the Staff Nurse placed an incontinence pad under JH’s head; at some point JH was also given some i/v anti-emetic.

JH remained on the floor for about an hour – as far as she can remember – and was amazingly comfortable: Vicky, whom – it had been pointed out - was 7-months pregnant, then got down on her knees to perform an ECG on JH; One of the Nurses informed JH that her, ie, JH’s, pulse had dropped to 31, and that her blood pressure had fallen;  furthermore, when there was some discussion about it, the Nursing Staff felt sure that JH had lost consciousness when ‘your head fell back with your mouth open’ although JH was of the opinion that she became very woozy but just remained aware of what was going on. ‘Fluids’ in the nature of a litre of saline had been running into the cannula in JH’s right arm since her initial collapse.  JH was lying very close to the curtains next to the Indian gentleman but, no doubt, he was busy with his own affairs. 

The lady Radiologist came and asked JH how she was feeling but – on ‘surfacing’ a little from her rest on the floor – JH felt dreadfully sick and vomited up the rest of her packed lunch; furthermore she farted noisily – which made her feel much better – and also thought that she had been incontinent of urine!  The Radiologist had, by this time, ascertained that JH had been planning to stay at JHH that night and so was, now, strongly of the opinion that a hospital bed must be found for JH instead; JH said that Ray Trevitt’s phone extension number should be on the desk.  Ray came over to see JH lying on the floor and said that this sort of behaviour was ‘typical’ of a Nurse!  JH anxiously told Ray about her GP noticing that JH was having ectopic beats (when JH had visited her GP, because of her slow pulse, on 3 November 2006); JH further explained that she had had bloods done and 2 ECGs in Plymouth, since then, and everything had been normal; JH hoped that the odd ectopic beat would not be a reason to tell her that she would be an unsuitable donor for Kathy; Ray assured her that this would not preclude her donating a kidney.
 
The Team arrived, in due course, to raise JH to her feet whilst the chair was quickly pushed under her bum; after a few minutes, as nothing untoward happened, JH gingerly stood up and then climbed back onto the trolley.  JH asked the Staff Nurse if there was a puddle of urine on the floor – which there wasn’t! JH was informed that she would be taken to the Renal Ward: two Nurses from the Ward arrived but awaited the arrival of two porters; the friendly SHO had been asked JH how she was feeling several times and, furthermore, once she was back on the trolley, had asked JH about her past medical history, etc, etc; subsequently he wrote busily in JH’s notes at the desk.  JH then felt needs must use a bedpan and, having almost given up, managed to ‘go’ just as the Nurses came in to relieve her of the bedpan – which was just as well as, by this time, JH had received the litre of saline.  One of the Nurses, and JH, noted that, after the elderly Indian gentleman had had his procedure performed, he could speak reasonably fluent English but, of course, no recriminations were made about the wait for an interpreter beforehand.

The porters arrived and JH was taken to Devonshire Ward(!)  JH was about to shimmy over onto a bed but one of the porters suggested that JH be provided with an electric bed – as the brakes on the one already in JH’s space did not seem to be adequate – and the two beds were quickly swapped round.  It was, by now, about 5.30pm and JH leaned back and relaxed: she observed (on the bed label) that the lady in the bed opposite was called Estella; Estella and the lady to JH’s left conversed easily together; opposite this lady was a very ill-looking young man, probably from the Indian subcontinent.  A lady come round to offer JH something to eat: JH explained that she had fainted away and been sick after her angiogram, but felt that she ought to make the effort to eat something; the lady gave JH some rice, a chunk of chicken, and some mixed veg, and also some fruit sponge and custard – which JH was very apprehensive about eating – but the lady encouragingly advised JH to eat what she could because, otherwise, the food would be thrown away in any case!  The savoury meal was very dry but JH had been given a small jug of water and so ate the meal slowly (only leaving a little of the rice); needless to say JH managed to force down all the sponge and custard; after this JH had a cup of hot water with milk in (as she does at home in order to ‘avoid’ caffeine in the evenings) - as she was advised not to have an all-milk drink by the lady serving - said lady thought that this might make JH feel sick again. 

After this JH got out her wind-up radio and ear phones, which she had put in her bag ‘just in case’ on her way out of JHH {fortunately none of JH’s possessions seemed to have got mislaid although there was a bit of a search for her specs which got whipped off and laid on the bedside trolley when she collapsed}. JH relaxed and listened to The Archers and Front Row, felt warmer after eating something, had a headache, and found the electric bed very comfortable.  JH sat on the edge of the bed and rang the bell to ask a Nurse to accompany her to the toilet – as JH had been instructed to do; however, JH was, by this time, feeling very confident that she was not going to fall in a heap!  After JH had introduced herself to the two lady patients in the four-bedded Bay - Joan E and Estella (Surname not remembered) - JH spent the rest of the evening sitting reading her book in the elegant gowns.  JH had seen the young man’s attractive wife and two young daughters – dressed in beautiful saris - come and visit him; he also had a delivery of some Sainsbury’s bags of ‘supplies’ brought up by a porter later in the evening.

One of the nurses who escorted JH from the Imaging Department was a Philippino Student Nurse on placement; she poked an electronic thermometer {with a disposable ear piece} into JH’s ear, whilst the Staff Nurse was chatting to JH; JH was taken rather by surprise, upon which the Staff Nurse advised the Student to explain to the patient what she was about to do – no doubt said Student Nurse has never clapped eyes on the old-fashioned glass clinical thermometer which JH used many years ago and poked under the patient's tongue!  In any event this exchange was all very good humoured.  JH also had her blood pressure and pulse recorded at intervals, although she was not attached to any monitors whilst on the Ward. 

As usual, JH asked the next SHO she saw about his ‘ethnic aetiology’; in response JH was encouraged to visit Bombay as England was ‘going to the dogs’ (or some such) over the last 20 years or so, and it would be best to get out whilst the going was good!  JH mentioned that her father had sent letters to her mother from Bombay whilst he was in India during the War; said SHO asked if JH still had those letters and JH explained that she was expecting her sister to return them to her very shortly and she would ‘show’ them to him if an opportunity arose; therefore, JH asked this gentleman to write his name in JH’s Aide-Mémoire – Dr Ranjit Shail - to which was added a phone number!

Dr Hussein, from the Angiography Suite, also popped in to see JH – as he had been informed that JH had fainted in his Department; JH said she had heard the words ‘vaso-vagal attack’ banded about amongst the Staff and Dr H said – that WAS a faint! 

Staff Nurse asked JH several times if JH wanted her to phone anybody up: JH explained that her sister lived in Germany and that, as JH was now recovered, that there was really no need to be ringing round; JH had been told by Ray that he had phoned up the Wardens in JHH to tell them that I would not be staying in the Home that night.  The Staff Nurse and I decided that it was not very relevant to have my Solicitor down as my Next of Kin – should anyone need to be telephoned in the middle of the night; after a search, Staff Nurse found JH’s photocopied Living Will Chapter at the rear of the RLH’s notes; subsequently, JH’s two Attorney’s, Su Watson and Sharon Lambert, were written down as being JH’s ‘Next of Kin’ – Su’s name being first on the List.  In any event, JH was surprised and pleased when Staff Nurse came and told her that Ann had rung up: apparently Ann had rung JHH and been told that JH had been admitted to Devonshire Ward for observation overnight – which was just as JH’s big sister would expect, of course.

JH settled down to go to sleep at about 11.00pm: one of the Nurses had switched off the lights in the bay shortly before this, and JH drew the screens round herself to keep out the lights shining down the corridor – JH had already seen that each bed had a ‘do not disturb’ notice hanging by the curtains which the patient could hang up when they wished to ‘sport the oak’.  JH felt rather hot during the night, but must have slept because the time went by quickly; she had a headache when first lying down, but this had gone by the morning; unfortunately the noise from the fan in the ventilation system was more noticeable when trying to sleep, and there was a slight tinkling noise as if something was caught in the outlet.



 
 
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