Locked in a room, when you are 90 and if you have dementia and significant physical and cognitive impairment is horrible. It is cruel and harmful. It is what our older folk have to do, whilst we, the rest are out and about, living it up.
“whistle”… Rover, where are you? Oh, he must be upstairs on the bed, that old dog.
Death – tradition – Jewishness – family – education – self-consciousness
I brought-up Bob when explaining to my colleagues the meaning of ‘happy accident’ – I was being flippant although the context was not.
For the most, this was people showing-off their successes, how many older people they had saved from peril (mostly keeping them out of hospital), how many standard deviations from the mean their intervention had generated and so on.
Although doctors are being battered over the head for not enough F2F appointments, in reality, telephone reviews are much harder than seeing a person in the surgery.
Take away, facial expression, eye contact and body-language and it is far more difficult to know or understand what is going-on.
My mind has been in a Japanese meta-reality rather than on Wong Lane
‘When will I receive my Covid booster?’ Asks patient Annie, 98, unable to leave her house for the past three years.
‘We are working-our way round,’ Says the doctor.
I read this morning about patients waiting 11 (eleven) hours outside of A&E departments.
That doctors and nurses aren’t working hard enough, that the poor are poor from choice, and, that good things come to those who deserve it or who were born lucky.
Occasionally the nurse in attendance might advise the paramedics or the doctors, ‘He was 100 years old, he was very unwell,’
The most significant, particularly for older people (the definition of older is anyone who is older than you) when the effects of ageing can impair balance, coordination, and reflexes.
I popped into Tesco yesterday; there was no pasta on the shelves (no petrol in the pump either).
The PM announced a rise in NI tax this week. I understand this is to offset some of the damage they have done to the NHS over the past decade. Fantastic. (And yes, Whitey is still on the moon).
If you watch the Robin Williams / Oliver Sacks movie/book Awakenings you will see what dopamine can and cannot do to the brain.
No, not the climate, not the uncollected bins, the zero hours, no, not the Shitty White Men travelling on purpose-built spaceships that fly over the filth and poverty of a world falling apart, all of it together.
We want to be associated with the best – the best team, country, organisation.
Others don’t really care.
Some see the whole of the moon.
If their lack of safety is 10 times greater than your perception of safety, are they safe? Are you?
the back wings
Imagine being able to converse with a cat.
That’s what Nakata can do.
Older people falling is often a bad thing.
Anyone who has spent much time in hospital will recognise the phenomenon of the invisible patient.
All resonating, taking me back and creating an atmosphere.
Me and my dog and silence.
Silence is sometimes needed to re-charge.
And yet, Freda is gone and I never really said hello.
What became even funnier was the background I occasionally use of a photo I took in the winter of a cob-web.
Nothing works with Florence, distraction, diversion, joking, cajoling, all the old tropes fail. You have to accept that Florence isn’t eating and leave her alone.
Interestingly, hospital can be the least-safe place for older people, with home being what most want and with far fewer hazards such as the risk of institutionalisation, over-medicalisation, polypharmacy, falls and a host of other healthcare associated ills.
I was recently involved in the care of a patient who developed a pressure ulcer. Behind this seemingly innocuous sentence lurks a whole raft of issues, concerns and aspects of modern healthcare. More surprisingly perhaps, I have spoken with several doctors who believe that pressure ulcers, their care, treatment and avoidance are not a medicalContinue reading “Pressure ulcers (bedsores) & PCHC”
People say there are more bacteria in our gut than cells in our body; I am not sure how true this is – I don’t think I am ready to say I am faeces.
You can still hold hands if someone is wearing rubber gloves; you can still laugh or smile wearing a face mask.
A basic human right – the right to family life has been bolloxed.
People who don’t know things, asking people who know things to tell other people who don’t know things, things.
Often old men and women will seek human contact, particularly when feeling isolated – and when I reciprocate with my gloved hand (that they don’t appear to notice as being anomalously purple or blue) we are able to make contact, to connect.
I met an old man last week, his pants were poking out of his pyjama bottoms. They were the same as mine M&S blue stars; I was going to tell him and everyone else in the room about our shared underwear but, the facemask and the goggles, gown and gloves Got in theContinue reading “Covid, pants and barriers to communication”
I have become victim to the system bias of considering diagnoses and discharge destinations to be of more importance than the person I am discharging.
I know that is so very much the essence of care – understanding the language of interaction. How to approach another, how to speak through gesture, to know what to say and what not.
If this narrative has held together, my point is, we can offer just as good, if not better care, treatment and support for particularly older people in their own homes than is available through high-tech medical interventions.
The colour of our skin is various, the shape of our face, head and hair, yet, our eyes, seem a constant.
He has brown eyes doesn’t mean a thing.
Thanks Jane for allowing me to continue today’s blog; that was about the ways in which Covid has forced a change in my behaviour (likely, yours too) which in turn has led to changes in my brain. It is along the lines of the blog I wrote ages ago after reading a Stephen King bookContinue reading “Covid, my brain and the computer interface”
Serial processing; switching backwards and forwards from concentrating on Word to Outlook to Chrome uses mental energy;
I have always accepted this concept; it has taught me humility.
Out optic blind-spots continuously adapt to provide us with a seamless sense of reality, only becoming real when we reverse into a wall that we didn’t see.
Our growth, our evolution has happened unconsciously, at an intuitive, human level – we have been feeling not thinking, reacting not planning, doing what feels right rather than what we are told is right.
Imagine the harm done to those people previously ‘living well’ with dementia who for six weeks have had a dramatic reduction in visitors and day-centre attendances; even the bitter-sweet routine trips to GP surgeries or hospitals have been done away with.
‘Will my mum be recorded within the statistics?’
I haven’t been asked that yet.
All we can do in the Time of Covid is to do our best and act in good faith.
We have closed schools which has reduced transmission; we can’t close care homes.
You wouldn’t send someone into the centre of Fukushima wearing a plastic flimsy? Well, the UK has allowed that to happen.
Well, if nothing (but everything) has changed, what is the big deal about DNACPR and ACP; what is new?
This will all soon be over and we can get back to huddling, cuddling or whatever.
How do we cope with Covid when we want to minimise clinical examination?
There is still plenty of bread, flour and beans in the UK.
Fear of doing the wrong thing is a fundamental of quality improvement. If you are afraid to act because people might call you out or think you stupid, you won’t do anything, and the quality won’t improve. It won’t necessarily deteriorate either, yet, in times of radical change, that is worse.
Getting rid of the routine allows people to focus on what is important. (Bruce Lee said this in the 60’s – ‘Hack away the un-essential’)
Ever been breathless at three in the morning? Do you have any strategies to sort yourself out, particularly when to begin you have a bad chest?
Sometimes eight or nine relatives would pack into these airless spaces to spend the last hours and minutes with their mum or dad;
…designed for maximum efficiency of staff and outcomes, not necessarily for the comfort or dignity of patients – we erect a thin curtain between beds and pretend it is sound-proof, for example.
You will note this is the opposite of ‘There is no bus to Upton, you are 93, you have dementia, you are in hospital’ approach, which is likely only to worsen the anxiety.
Ensure independence, autonomy and the right care and support for people living with dementia (and, yes, older people in general) and the NHS will be fine.
What struck me was the similarity between bad leadership as described in the 256th US Army Air Squadron and… you guessed it, the NHS.
(Admittedly there are no bombing runs in most UK hospitals)
For today, I hope to keep popping out, spending quality time with patients, understanding what is important to them, their preferences, hopes, fears and aspirations, and supporting them to stay outside acute care.
Many are the result of an acute deterioration in the health of an older person, who, terrified of being admitted to hospital calls their GP. Many patients do not want to be admitted; they want to stay at home and recover.
..when you see society deteriorating, when there is so much potential for improvement, that is surely depressing; when you see vibrant doctors and nurses forced into early retirement because the work has become too much, that is bad; when you know that people have and will die because of cuts, what could be worse?
You see, The Plan says that more will be invested into community care, yet, the cumbersome nature of the NHS, again, the upside-down system of health and social care has resulted in lots or organisation and reorganisation but little transformational thought, little concept of how we can do things differently.
It is never good to start something with an obscure medical acronym; ‘Chronic Obstructive Pulmonary Disease’ is however a bit of a mouthful and I suspect for many, even those who have the condition it doesn’t explain much more.
Maybe we should call it ‘hospital check-out’, to get away from the nonsense of fitness, when many of the people described are actually quite sick and are often even dying, it is just that their death need not require a bed on a hospital ward.
Consequently, significant numbers of very frail and older people are transferred to local Emergency Departments following either trivial head injuries or when a head injury is only suspected but not witnessed.
A patient with a headache is more likely to receive paracetamol from a GP, a CT scan from a General Physician and an MRI from the specialist.
Who is more effective?
Mostly, my approach is to consider that we, that is the community services (those outside the acute hospital) can and do support a far broader range of patients than people realise and, when working well together, can care for a significant proportion of the people who otherwise arrive at the door of A&E.
I have a patient Who cannot read or write. I have not yet Determined the reasons why; Whether circumstance situation or something else. Nevertheless, He struggles with many activities that you or I would find Straightforward. When I was explaining to him the other day About the dosing of Paracetamol, I realisedContinue reading “In the darkness we wait.”
First, I wanted to mention Neprilysin (and its inhibitor) as it seems to me to be such a cunning piece of high-tech science it should reach this blog. Then I’ll get to the cardiologists!
I will not go into more detail about this but suffice it to say, this is congruent with my values and probably my purpose.
He was treated with antibiotics and returned to the care home 48 hours later. During his stay he fell twice on the ward; there was an incident with a member of staff which led to him receiving intramuscular Lorazepam.
This morning I had a brief discussion with one of our patients; she is on the cusp of her 65th birthday. And, for those involved in the administration of the flu vaccine, this is a thing. Under 65s get one vaccine and overs another. Why would this be? At first, my assumption was that asContinue reading “Influenza”
You see, nowadays, in order to study medicine, you have to be little short of an academic wunderkind.
An army of carers support our old, frail and vulnerable.
Many receive minimum wage.
Many also work to zero hours contracts.
No sick leave, no training, no holiday pay.
In life, there are those who work and act quickly; my mum would say, ‘chick-chak’ which I think is a derivation of Hebrew meaning, ‘promptly, without messing about,’ and, those who tend to dilly-dally.
Just to mention – a normal blood test does not mean that there is nothing seriously wrong – this part is the ‘art’ of the clinician.
If when you stand-up you become light-headed or dizzy, or, even worse, you collapse or lose consciousness, this is something to address.
In the olden days, over 65 was considered old.
Now, when I meet someone who is 75, I consider them young.