Friday, 8 August 2008

Starvation

Bob Geldof has it all wrong. Maybe he should have stuck to the Boomtown Rats. Solving starvation in Africa is a laudable goal. I'd favour him doing something a little closer to home, though.

I spent a couple hours on a general hospital ward. It's on a different site so I'm always a little piqued that parking's a nightmare and I can't easily get to see their patients for them, but I was remarkably calm 'cause there were oodles of spaces today. A splendid start, I can at least get to their hospital, hurrah.

I got up on to the ward, along with a colleague (a community mental health nurse who's brilliant). We find the patient's medical notes, sit down, read through them, then weep. Much badness. We find nursing staff who can tell us a bit about the patient, but not much. We find a qualified nurse who can tell us a bit about how the patient's not always taking her tablets and doesn't always eat, but not much more. Ho hum.

We spend time talking with her. Nurses say she can't walk and we'll have to talk to her at her bedside. Oddly, a miracle unfolds. My nursing colleague helps her up and walks her to a parlour and chat for an hour. She suddenly can walk; a miracle!

She used to live alone, in her own home, managing fine. Now she's had confusion (from an infection) that the medics have treated and she's again fine and medically fit for discharge. Has been for 3 weeks. Why is she still on their ward, then, I ask? "But she can't go back home!" Erm, why? "She's not right, she gets confused, she needs to be in care." And my oh my, they're good, better folk than me, 'cause they've made this decision without any discussion with the patient, family, no social work input and no occupational therapy assessment. That ward, must be geniuses, the lot of them.

Rather risk averse, my neighbouring Trust. Patients families complained a lot, they're terrified of being seen to put patients at risk, now nobody can make a decision with an ounce of common sense.

The lady was well. She hated being in hospital. She became depressed in hospital, 4 weeks ago. She was given an antidepressant on our advice (we assessed her then, too) which improved things. Then she stopped taking it regularly at 10.00pm and staff can't offer it at any other time 'cause it's prescribed at 10.00pm and can only be given within 20 minutes of that time.

After speaking with her we spoke to the registrar, Consultant Physician, nursing sister, discharge manager, intermediate care manager, social worker and 'phoned the family. The acute hospital refused to send her home. So, you are forcibly detaining her here against her will under what law? Hmmm, tricky one that. Right, so you're detaining her here unlawfully then, at least we can all honestly agree on that starting point.

3 weeks ago she could have been discharged home with a package of care, but they didn't. Now she's depressed after 3 weeks of incarceration where no treatment or hope or care's been offered and she's fading away. She's lost masses of weight. She's thoroughly disinterested in anything. She spoke perfectly sensibly and rationally to us, presenting with major mood disorder now, but able to articulate her frustrations and deterioration lucidly.

Worse, whilst we were doing all this, she starved.

She, "didn't want breakfast," so this was the first food she'd had all day. Food was brought and placed at the end of her bed, yet she was in an adjacent room. She was told where it was by the same nurse who told me she can't walk. My nursing colleague, in a fit of fury, bollocked the nurse and got a small table from the far end of the ward, brought it for the lady and put the food on it. She enouraged her to eat, which she did. Slowly. Too slowly, since staff came to whisk her food off her just 3 or 4 minutes after she started it. No exaggeration, we were making 'phone calls and documenting it all over 6 pages of notes in the end so we had the times written down. 4 minutes. Hmmm. The food removed, she's nothing further to eat 'til tea time when, again, food will be offered (invariably out of reach) then left then removed.

No wonder she's lost weight.

At a liaison psychiatry conference I'd heard that folk on general hospital wards with dementia die of starvation and I never truly believed it. No nurse would let that happen to their patient, surely? But it does. Sitting at the nursing station and seeing food brought, placed, staff calling out to a patient where it'd been left, leaving them then collecting the food, it's all about the process. Nobody was looking at the anxious and bewildered elderly lady, nobody was seeing her experience of this, nobody was helping her.

Hospital care. Not great care, really. Pretty malign care, if truth be told.

Gets one thinking.

So when she's fretting, and Sir Bob is fretting, shouldn't he be harping on about starvation of vulnerable folk 'pon our own shores, maybe?

16 comments:

Disillusioned said...

What a terribly sad story.
I hope you are able to have some longer term input for this lady. Sounds like she needs the support you would like to be able to give her.

Xavier Emmanuelle said...

Ugh that's terrible! How very sad, and disconcerting.

GrumpyRN said...

Apalling, absolutely apalling. What a terrible indictment of the modern NHS. Please let me grow old and die at home.
It was not always like this.

Azulinebloo said...

This post just reminds me of the need for more training for staff on mental illness (definitely including dementia) and/or more MH nurses on adult wards. The liason nurses can't be everywhere.

What a depressing story. Just glad to know this lady has been spotted, and hopefully not too late.

Bright-eyed said...

Moving and infuriating in equal measure...

I hope something can/is being done for this poor lady. My grandad died earlier this year and thankfully it was at home, without the ignominy suffered by this patient.

Silvawingz said...

I think this type of care is endemic in lot of hospitals be they general or psychiatric - My local psychiatric hospital makes Guantanomo Bay look picturesque and welcoming. The care I got there was abysmal and the therapy was non-existant - My Mum got terrible care in the local general hospital. The Hospice which cared for my Dad when he died however was excellent.

Calavera said...

But wait, I don't get it, on what basis was she kept in the hospital, three weeks ago, once the medics treated her infection? Why was she not sent home then? Because she kept getting confused, even after that?

Dr Grumble said...

Sounds familiar. Getting people fed and mobilised is a constant battle. We need top quality nurses in charge of the wards instead of sending them to replace GPs out in the polyclinics.

Elaine said...

Aaaargh. Disgraceful. This has been going on for so long. It needs someone on the ward (not necessarily a trained nurse, could be a HCA. in fact probably better a HCA) who is designated as being responsible for seeing the patients get their food and eat their food even if they need to be fed.

cb said...

Sad thing is, that none of this surprised me.

Catherine said...

I believe that is one of the worst accounts I have heard in awhile, and that is saying something.

Milk & Two Sugars said...

Something I'll keep in mind at less-great hospitals than the one I'm in now.

The Shrink said...

Ms Bloo, the acute Trust notionally has expertise in mental health care, the PCT gives 'em extra cash for the delivery of high quality mental health services to their patients. Oh, the irony.

Silvawingz it is remarkably variable. I see huge differences in various hospitals, hospices and care homes.

Cal, yeah, they thought she was at times too confused to go home. And my they're clever since they deduced this with no functional or behavioural assessments, no cognitive assessments, no MMSE, no mental state examinations and no documentation of a single risk to self or property or others anywhere. They must just have divine omnipotence or something.

Elaine, agreed, in a good neighbouring hospital HCAs give the consistent patient-centred care. Patients have someone looking after them, there. Infinitely better.

Dr Andrew Brown said...

This is indeed very sad. :-(

verity said...

Sadly, similar things happen all over the place. At a major hospital in a university town, my grandmother was temporarily blind with an eye infection. Food was brought in, placed where she couldn't see it (of course she couldn't see it, she couldn't see anything at the time!) and no-one was there to help her eat it. Fortunately, she was only in there a few days until they stopped eyedropping antibiotics into her every hour 24x daily. So she didn't starve. But it wasn't healthy.

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