You can open the capsules
The email arrived last week.
It was on the heels of the panic relating to Strep A.
Nationally, there has been a scare.
The information that two years ago just as many children died from the same infection was overlooked.
Every sore throat in every child has resulted in a trip to the GP or A&E.
We worry about the after-effects of Covid on our children’s immunities.
Antibiotics or not.
I don’t want to downplay the worry parents have been experiencing
Or the tragedy of the children who have died.
Have been selling the story.
If it bleeds it leads
Goes the mantra.
The greater the tragedy the more
people will tune-in and turn on.
The country has run out of Amoxicillin.
The yellowy liquid you will remember as a child.
Banana or strawberry flavour.
The people in power
Who we long ago stopped trusting
‘There are plenty of antibiotics, it is a matter of logistics’
No one believes them.
We live in a world that has gone beyond post-truth
Everyone for themselves.
We are diminished,
We pull-on our Oodies and go to bed early
To save on heating.
We limit our mileage,
As the country is shrinking.
First the downsizing of Brexit and now the death throes.
‘Don’t be such a pessimist’
I am told.
My patient was chesty.
His breathing rate had increased.
His heart rate was up, oxygen levels down.
He is an old man who has dementia.
He is nursed in bed and struggles to swallow.
One option would be,
‘His time has come, let’s keep him comfortable,’
An hour later I was told the chemist had run out of Amoxil syrup,
All he can swallow.
I reconsidered and prescribed Clarithromycin.
I was in luck,
Or perhaps he was.
In the medical journals they are advising doctors to guide parents to open Amoxycillin capsules and sprinkle them on food or mix with a drink to help the tots who are too small for pills and tablets.
Another patient this week was struggling.
He has deteriorated after falling down a flight of stairs.
He is in his 80’s.
The family were asked whether the call was urgent,
Whether they really needed an ambulance,
Whether he could wait.
They covered him with a duvet
(Fortunately, he has a wife or he’d likely have died.)
They turned-on the radiator,
Repositioning his feet to avoid burns.
After five hours the ambulance arrived
Then a wait to get into A&E
Wait to be seen once on a stretcher.
Sixteen hours later he was in a hospital bed,
Scans of his brain and spines having ruled-out a fracture or a bleed.
He was, in the parlance of 21st century healthcare a ‘Cat 3’
I’d never heard of the categories before this year.
It is how the ambulance service triages our calls.
Cat, or category one, is a blue light, when you have collapsed and aren’t breathing.
If you are lucky, a person on a motorbike will arrive promptly, defibrillator at the ready. If you are less fortunate you will wait.
The target is to arrive within eight minutes.
Recently only five per cent of calls have reached the victim within that time.
In the stochastic language of healthcare, ‘time is brain’ and, by eight minutes following a cardiac arrest, for the average person, the brain is well-into the process of its death, good CPR will help.
My patient was Cat 3 or maybe 4, this is, ‘non-urgent, get to them when you can.’ This is frequently, commonly, an older person who has fallen, broken hip or not.
The ageing tsunami has been approaching this country for decades and yet we haven’t prepared. Like the pandemic, it was coming, it was inevitable and yet, everyone chose to do other things.
The numbers of doctors training to specialise in the healthcare of older people (the discipline that helps maintain independence, reduces falls downstairs and avoids category threes and fours) is understaffed and diminished, it doesn’t feature adequately in the training of doctors or nurses and the system is, fractured.
NHS doctors, nurses, and therapists are retiring at a faster rate than they can be appointed. Retirement ceremonies have become passe.
By this week my patient was home although his wife was struggling. She is providing 24/7 nursing care. He is in bed, he can’t walk, she is solely tending to his continence, nutrition, hydration, washing, dressing and emotional needs.
There is no care.
That is, domiciliary care. The young (often) men and women (oftener) who visit to support the old and diminished at their homes.
Nationally, there are thousands of people trapped in hospital, they used to be called ‘bed-blockers’ before that term was outlawed. They are ready for home yet there is no support in the community.
My patient was somehow sent home without this care, hence his wife, in crisis. I found myself negotiating between a social worker and my patient’s wife, ‘How much money do you have in your bank?’ I was asked to ask. A moment of exquisite anguish and we are talking savings accounts.
Like my patient and his wife, domiciliary care is in crisis. There are not enough people willing to take-on this physically and emotionally demanding role on a zero-hours, minimum wage basis. Better to work for Lidl or Aldi, you often hear.
And, if you decide to take such a job, there will be no holiday pay, no travelling expenses, no on the job training or progression. You will work and work and if unlucky, people will complain.
Where are all the carers? They are either servicing Reece-Moog’s castle or have returned to Romania or Poland. Brexit was the nail in that coffin, thank you.
‘Bloody hell,’ you say, ‘This is depressing.’
And don’t get me started on the war in Ukraine (fascinating Podcast available here which explains America’s role in all that has happened – transpires, the aspiration to get rich on arms exports through participation in NATO plays a major role in the crisis) or even the protesters I dodged yesterday outside Waitrose as I popped-in to purchase some Christmas chocolates, ‘Ban Israeli dates,’ they shouted, in Yorkshire middle-class English. I wanted to scream. Instead, I bought two packets of Medjoul.
Perhaps I am over-sensitive,
I should rest,
Read a good book
(Tomorrow and Tomorrow and Tomorrow, Gabrielle Zevin is fantastic).
Or get back to the water.
Yesterday I swam in a frozen lake.
The first time in my life (one degree centigrade).
Not recommended for the weak of heart.
Such was my zeal,
I front-crawled into a sheet of ice,
Lacerating my cheek.
Where do we go from here?
The doyen of historical podcasts describes society’s rise and fall with the image of a flight of stairs,
The ascent is people trudging up in clogs and heavy work-boots, the toil, the sweat, and struggle of our ancestors as they establish the wealth or fortune on which our society (if you are lucky and live in the developed world) versus the velvet slippers that walk down as things fall-apart, as the deterioration, the softening of too many luxuries takes away our forefathers grit.
We are sliding fast.
How to stop this descent?
Somehow ‘Vote Labour’ doesn’t seem adequate,
Not that we will have the chance for another two years,
By then where will we be?
How far will the wrecking have gone?
Eat organic, walk to work, turn-down the heating, avoid airlines, don’t buy certain categories of dates or Bamba or Bisli, none of this will get you very far.
I suspect the only response can be mass protest and a general strike, like the nurses and the rail workers, postmen, paramedics, schoolteachers, and colleagues.
And yet, it doesn’t seem that anyone is noticing.
The media aren’t interested.
Not enough blood, you think.
The protests too small to make the evening news.
We worry about the World Cup, ignoring the Qatari abuses of human rights and equality, looking the other way, ‘I’ll buy those Jordanian dates instead,’ you say, a balm to your confused conscience.
I’ll Tweet my way out, you think. And no, that won’t get you anywhere, will not make any difference (Musk will see to that).
The nihilist in me is emerging.
Perhaps I need some more ice.
Cold water in my face or down my back.
That’ll do it.