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Archive for July, 2009

I have just had two wonderful days. After a week and a half of working, travelling, supporting and massive sadness I have spent two days back to my ordinary grandmotherly duties of caring for the boys, and it has been so refreshing, they don’t know what has happened. They are not treating me with kid-gloves, discussing the ins and outs of everything, hating the driver, feeling sorry for the driver, planning cremations and memorials, so Nanny has just behaved as Nanny always does, full of life and laughter.

The segway ended at 6.30pm and now I’m back in the twilight zone. The coroner has communicated his findings, cause of death – bronchial pneumonia following massive head injury. The inquest will be opened and adjourned on Tuesday, the coroner hopes to be able to release ‘the body’ after this so then we can schedule the funeral. We have not heard, yet, what the driver will be charged with, if it is ‘causing death’, then his solicitor has the right to demand a second post-mortum and then the coroner cannot release ‘the body’ until the PM has been repeated. What about the rights of the bereaved? This is just prolonging everything, there are too many ‘what ifs’, I don’t like ‘what ifs’ and, where the funeral of her husband is concerned, my Mother dislikes them even more.

My step-father came from a rural background, he had lived all his life in the village on which he had published a history, he was also a mover on the local council so there is to be a memorial service at some point after the funeral, thankfully the movers and groovers, plus the WI, are organising this but our input has been requested. My mother was spouting all these flowery verses, not Ref’s style at all, so I started surfing and found this poem, it is all I want to say  in a nutshell –

 

God saw you getting tired

and a cure was not to be

so he put his arms around you

and whispered,

“Come to Me”

With tearful eyes we watched you

and saw you pass away

and although we love you dearly

we could not make you stay.

A Golden heart stopped beating

hard working hands at rest.

God broke our hearts to prove to us

                                                                                               he only takes the best

 

 

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Good bye

My step-father died early this morning – peacefully. At 5am Sunday morning we were called by the hospital as his condition was deteriorating. We stayed with him until the evening, when we left he was very, very poorly but his condition had not radically altered since our arrival. Keeping vigil around his bed there were times of sadness and tears, moments of silliness and episodes of silence, what is the protocol for behaviour when accompanying a person through their journey to death? Should everyone maintain a respectful silence or was it right that we would joke, encourage Ref to relax and then sing his favorite songs to him? There were also moments of annoyance with those who were caring for him (generally caring very well for him). Why, why take routine bloods from a man who was dying, who wasn’t being given any fluids because of concerns about fluid overload? I asked the extremely junior doctor this, and he replied that they were checking electrolytes. Why? He’s obviously dying. He will be dehydrated. He will have an electrolyte imbalance but does it matter? The doc responded that on Friday the senior doc had requested that the test be done on Sunday. After some verbal badinage (me) and condescending explanations (the doc) he flounced away, without the bloods. Sometimes sense disappears. The results would not affect my stepfathers treatment or condition. The taking of the bloods may have caused Ref more discomfort as his veins had collapsed and, the processing of the bloods at a weekend would had cost the hospital more, for no good reason.

This morning the phone call came just after 6am, my Mum, sister and her fiancee were there 10 minutes before Ref died, I arrived half an hour later. His death had been peaceful, and for that we are all really, really pleased and very grateful to the nurses.

Now the next nightmare begins. There will be a post-mortem, but it will be by a Home Office pathologist as this is now a criminal investigation. Today there has been a call from the coroner; a visit from 2 police officers; a social worker and a bereavement counsellor, plus a visit to the funeral director. Tomorrow the police are meeting with the CPS and then coming back to talk to us and then next week is the preliminary coroner’s inquest. That’s just the official ‘stuff’, there are still all the personal bits and pieces to go through, all those items which continue to epitomise my step-father.

It’s just all so stupid, stupid, unbelievable and ultimately a tragic accident. Taking the dog for a walk one minute, a man reversing, not seeing him, and his life is ended.

Good bye Ref.

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Impossible to forecast

My sister and I have decided to ‘take control’ of the visiting step-dad situation. Mum had been refusing to visit if we were not with her, she lives 5 – 10 minutes away from the hospital, as does my sister, I live an hours drive, minimum, away, my sister and I both work. Sister’s work had been very good allowing her huge flexibility, my work, after an initial response indicating that we were busy due to summer holidays so they were not happy to allow me time off, have responded to pressure from my colleagues and told me I don’t have to work this weekend although I did work my shifts during the week. This situation can’t continue though so, yesterday, my sister told Mum that we are risking ‘using up’ any goodwill from our our employers which may make it difficult if Ref’s worsens. That’s a ridiculous way to express things, his condition now is pretty close to not being able to get much worse without him dying, so I suppose that what I mean is if they tell us, again, that there are only hours left before he shuffles off his mortal coil. Thank heavens, Mum seems to have taken this on board and visited last night by herself, it’s me again today though.

Meanwhile, I haven’t seen a Grandchild in a week now, an unheard of situation. I usually care for the twins on Wednesday and Thursday but, due to the grim news on Tuesday indicating that Ref was going to die very shortly, their Daddy had to have one day off and their Auntie had to look after them the other. It’s like ripples emanating out from Ref’s hospital bed, Mum was initially hit by a tsunami, sister and myself experienced a freak wave, we are now all in the ‘perfect storm’ and those around us are in a heavy swell. In this situation the predictions about how events will unfold are even more unreliable than weather forecasts.

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Dying

No ‘ups and downs’ today, just a slow descent to the land of pneumonia. I’m a heartless woman, as my response was ‘Perhaps they should stop his antibiotics’. My sister has been ‘googling’ PVS and has decided that this is where Ref is now, I don’t know, all I do know is, that if this is where he is going to be residing for the rest of his life, then we should not prolong his tenancy.

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Rollercoaster

Yesterday step-father was moved from ITU to the Stroke Ward. All day he had been really responsive, nodding at me in response to questions, giving me a smile when I came out with some pathetic joke and obviously able to understand ‘commands’. The docs had started him on an anti-convulsant, so he was not twitching and they had passed a naso-gastric tube to enable them to feed him. I was on a high, all the previous gloom and doom had seemed over-kill. ITU was unnaturally quiet and the docs were all sitting round chatting so my sister and I went over to them and asked if they could show us the scans and explain the features. First they put up the scans done when he was admitted and they showed us the large bleed and the brain shift, then they put up the second one showing the large area where the brain had swelled and the effect that the swelling had had on the ventricles, one had been squeezed in and displaced, apparently this is bad.

So yesterday, other than my Mother throwing a complete wobbly, all was wonderful. Yes, once I got home and considered the implications of a large degree of brain damage and my step-dads future abilities, I did descend from my cloud 9 but I was still feeling fairly positive, then I saw him today. Non-responsive, pulse-rate of 170 and having difficulty breathing. The consultant spoke to Mum and told her that they had re-scanned today and discovered that Ref has Pulmonary Embolism, they are not going to treat it. We still went out for Mum’ 80th birthday meal, very subdued and some tears, but we did mark the day. Following the meal we returned to Ref, ready to sit with him through the night, and we were greeted by a responsive man, still on oxygen, still rasping as he breathes but back nodding and, occasionally smiling, so we stayed until 9pm and then came home. No one said that this would be easy but this hope, despair pattern is exhausting.

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The long goodbye

Taken from the Highway Code – Do not reverse from a side road into a main road. When using a driveway, reverse in and drive out if you can.

The neurologist visited today and now all the monitors have been taken away, my step-father has been made ‘comfortable’ and our lives have gone into a strange limbo, we are waiting for him to stop breathing, we are saying goodbye. His GCS continues to fall, his brain continues to swell, apparently his death is inevitable, and all because someone reversed out of a driveway.

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Inane chatter

I am proficient now in talking absolute rubbish for hours on end, and it is so depressing. All I want is some sign that he hears me, that he knows I’m there. I don’t expect a conversation, or even a monosyllabic reply, a flicker of something, anything would be wonderful. Redfers GCS has fallen again today, so they did a repeat scan and discovered that there is now brain swelling. I wasn’t there when the Doc discussed the results but, from what my Mum and sister said, he was preparing them for my stepdad not to recover, did he mean he would be in a Persistent Vegetative State or that he is going to die? I wanted to chat to the doc this evening but there was not one anywhere. I have questions, I asked the nurses but they were unable to answer them. If his brain is swelling why aren’t they giving him steroids to slow it down or reduce it? When he starts twitching is he having small fits? Would an EEG be useful?

I’m feeling very down tonight. It doesn’t matter that he is my stepdad, I would feel it about anyone, but knowing the person whose essence is shut away is heartbreaking.

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Still waiting

First I would like to say ‘Thank you’ to everyone who has left kind comments about my step-father’s accident and the resulting injury.

We visited today hoping to see an improvement, however slight, unfortunately his condition today was the same, possibly worse. At least yesterday he did appear to be aware that people were there, today there was zero response to noise or touch. They are using the Glasgow Coma Scale to assess his level of consciousness, being generous it is around 10 by their assessment, when I do it I can’t give him more than 9. Whatever, his condition is stable and the blood has stopped leaking from his ear. He is still in a neck brace, even though a scan has not shown any damage, but the ortho guys are reluctant to remove it until he can tell them if he has any pain, apparently there is a 1% chance that the scan fails to show damage. I had another long chat with the doc on ITU, who is as disappointed as we are that there are no positive signs, but was at pains to emphasise that if there is to be any recovery it may take weeks as opposed to days. I won’t be able to visit now for 4 days, hopefully when I see him again I will feel more positive.

Mum is odd, but there again she is a strange person anyway. She is a retired midwifery tutor who prides herself on, and flaunts, her ability to diagnose, prescribe treatment and take control. (Take this as you will but I have frequently considered that she may have Munchausen by proxy). You would imagine that in this situation a loving wife would be constantly in attendance, not the case here though, slightest opportunity and she’s off and away. Perhaps it’s too difficult, on an ITU, for her to be in control given the one to one nursing and the complexity of the monitors and electrical equipment. Enough of that b******g as on Thursday we will be celebrating her 80th birthday, obviously this will be a rather subdued celebration, in fact it is just going to be my sister and I taking Mum out for a meal, but we do have to mark such a major birthday.

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A waiting game

I’ve spent the majority of today in an ITU as my 87 year old step-father has a serious head injury as a result of being run over by a reversing car. Apparently the car was being reversed off a drive, the driver failed to see my step-dad who was out walking the dog, he thought that something has fallen over in the boot, until his son looked in the mirror and saw a man lying in the road. On admission my step-dad was conscious, but confused and irritable, bleeding from his nose and ears with a laceration on the back of his head. He was then heavily sedated, intubated and a CT scan was undertaken, it showed a large, sub-dural bleed. Following this they shared the image with a centre specialising in head injuries, who confirmed their interpretation but wanted Ref to be woken up so his condition could be assessed before a decision was made regarding transfer. He was ‘woken’ up, he is now conscious, but not responsive but he is breathing unaided. I had a long chat on the phone with the neurosurgeon at the tertiary referral unit, he explained everything and explained that they would rather not operate due to the size of the bleed, apparently that will be as dangerous as leaving the bleed there.

It’s just a waiting game now to see how much brain function, if any, is recovered.

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Over the last two weeks 3 of my women were due to give birth – at home.

A is a 30 year old who was having her first baby. She wanted a homebirth as she is frightened of hospitals.

B is a 31 year old, also having her first baby. B decided on a homebirth after having an entirely normal, ‘easy’ (her words) pregnancy.

C is a 34 year old, she already has a 2 year old who was born in hospital following ‘an awful experience’, with a cascade of intervention and a ‘control freak of a midwife’.

A’s story

At 41 weeks pregnant, with the birthing pool up and waiting in the sitting room, A had a stretch and sweep. The examination discovered that the cervix was central, effacing and 2 cms dilated with baby’s head -2 above the ischial spines. For a few hours afterwards A reported that she was feeling sightly uncomfortable, but then everything settled back down. 2 days later a second stretch and sweep was performed, with very similar findings except that the baby’s head had descended to the level of the spines. A was now 9 days past her due date, so a date was made for an induction of labour when she would be 40 weeks + 12 days.

At 11am on the scheduled day A, tearfully, made her way to the maternity unit. On admission a cardiotocograph (CTG) was performed to assess the wellbeing of baby. Once it was demonstrated that baby was doing okay a vaginal examination was performed, a Bishops Score estimated and a prostin pessary inserted, it was 1pm. Following a second CTG A went for a walk and tried to relax, nothing was happening. At 7pm the whole procedure was repeated, her partner and Mother stayed with her until 10pm and then left (hospital policy) to await a phonecall. By 2am A was experiencing regular contractions but was coping well using a TENs machine and wobbling on an activity ball. 6am saw A no longer coping with contractions, a vaginal examination discovered that the cervix was now 6ms dilated and baby’s head was now -1 below the ischial spines, an artificial rupture of membranes was performed and A as given pethidine.  At 10am a vaginal examination was performed, hospital guidelines indicate that 4 hourly vaginal examinations should be performed during induction of labour to assess progress, at this time the findings were the same as 4 hours previously. A was very upset by the lack of progress, despite regular contractions, and when told that the next move would be to start a syntocinon infusion she requested an epidural, after an hours wait for the anaesthetist, he was in theatre, an epidural was sited and then the synto was started. 3pm, a vaginal examination by a doctor estimated that the cervix was now 9cms dilated but he detected that baby was trying to come out with it’s back to Mum’s back, direct occipito-posterior, he also believed that baby’s head was not tucked down with it’s chin on it’s chest, instead it’s head was deflexed. He decided that baby was not going to succeed in being born vaginally and so A gave birth to her baby boy, weighing 8lbs 12ozs, by caesarian section.

B’s story   

41 weeks pregnant and the super, heated, filtering birthing pool had been inflated and filled for a week. A stretch and sweep was performed and the findings suggested that labour was not imminent, the cervix was posterior, long and only 1cm dilated, baby’s head was -3 above the spines. An induction was scheduled for 2 days later and all started as with A. The first prostin worked wonders though and 6 hours after it was inserted B was taken to labour ward to have her waters broken (ARM). Within the hour her contractions had started and her TENs was pulsing away, 5 hours later, after much marching, she gave birth to her son who weighed in at 8lbs 10z and 6 hours later they went home.

C’s story

At nearly 36 weeks I couldn’t be sure that baby was coming head first so A went to hospital for a scan, baby was head down so her homebirth was booked. 4 days later A experienced sharp pain in her uterus so self-referred to the maternity unit where they performed a CTG. The doctor who reviewed it felt that it was non-reactive and believed that baby was small-for-dates so, as a result of these two findings, suspected intra-uterine growth retardation (IUGR), an USS and doppler was arranged for 2 days later. C was on tenterhooks. The scan and doppler were performed, plus a repeat CTG, and all was reassuring, baby wasn’t huge but was estimated to currently weigh about 5lbs 8ozs. C was now 37 weeks pregnant, it was all systems go for a homebirth and so…..the pool was inflated.

2 days later and C experienced a few trickles of fluid.  A community midwife visited, performed a speculum examination to try and assess if her membranes had broken, they had, and a vaginal swab was taken to exclude the presence of infection. The following morning the on-call midwife contacted C, there were no contractions and the membranes had now been ruptured for nearly 24 hours so C was asked to make her way into the maternity unit for augmentation of labour by syntocinon infusion plus the administration of intravenous antibiotics as once the membranes have broken there is a risk of infection to the baby. C refused, but did agree to attend the hospital a have a CTG to check that baby was okay. The risk of prolonged rupture of membranes was explained to C, but she opted to return home and await events.

36 hours after her membranes had first started leaking C’s contractions started. She contacted the on-call midwife who came round to assess the situation. It was 4am and when C was examined the midwife found that the cervix was 2cms dilated and long, C was advised that labour was not yet established. The midwife stayed for an hour and, believing that C was only in early labour, went back to bed. C was finding the contractions difficult to cope with so had a warm bath. Within half an hour she decided that, if this was early labour and that there were still hours to go (as the midwife had told her), then there was no way she could do it without an epidural so she, her husband and their 2 year-old son set off for the hospital, 20 minutes away. Halfway there C realised that baby was coming, quickly and told her husband to pull over. He told her to hang on as they were nearly there, with that C felt the baby’s head being born so screamed at her other half to stop, NOW! He did, and their son, weighing 5lbs 7ozs, was born in a lay-by. An ambulance took C and baby to hospital for a quick check over, all was well, and 4 hours later they were driving back past the lay-by where baby entered the world.

Why write about these 3 births. Well, all were booked homebirths, but not one actually gave birth at home. None of the examinations before labour gave any indications of when, or if, labour might start. In fact the examination which appeared to give the most positive sign of readiness to labour was A, who ended up with a caesarian section. What does this show?  That there are no rules, patterns or predictive measures as far as labour and birth is concerned and that birthing pools are very popular!

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