The carer and the Horticulturalist
New Bed 25 is ex-Bed 37
T/F from South West Sydney major Hospital for liver treatment (MISH is a liver Tx center)
The story goes, she was at home the day prior, cleaning the chicken coop and fetilising the yard with dynamic lifter, mowing the lawn.
Had bad abdominal pain and took approx 8 paracetamol in approx 1 hour.
Medical Hx - none
medications - none
Smoking - yes
Drinking - "small nip" of home made macedonean ?wiskey in the morning
Now she's in small ICU, on dialysis, looking as yellow as a member of the Simpsons family. For transplant? Unknown. Plan is to keep going, and hope she gets better.
They did a biopsy of her hip on day 1 in small ICU and she bled and bled and ooozed +++++ (coagulopathy due to poor liver).
Next she had a bleed in her ? rectum that meant blood pooled from her anus - requiring cauterising in IR.
I read as far back as I could in her file. In Juneish of 2021, a friend had phoned police/ambulance as pt was threatening to kill herself, or her father and then herself due to inablity to cope. She was so intoxicated at that time that when the ambulance tried to assess her risk for suicide, they were unable to do a proper assessment.
Supposedly from then on the family rallied support however the Psych who interviewed the family post this new admission is unsure as to the extent of the assistance - and had concerns as to how it got so bad in the first place.
Now she's in small ICU and we are trialing a period of extubation. If she fails, she will be for a tracheostomy.
Psych assessment did a deep dive of the overall picture and interviewed the family(sister and husband) is that she is not a good candidate for Tx due to
-potential low support at home
-alcohol and self harm untreated
I didn't think her sister would accept this answer (and she didn't citing that she had friends who had alcohol dependence who received livers) but Liver Tx explained that the pt would need to be abstinent from alcohol for 6 months prior (damn that's short) which hasn't occured yet - and be off ICU supports (and I assume also, generally well) prior to being on the list.
I wonder where her Dad is now, and who is taking care of him.
I call this a covid related admission to ICU as her family were supportive of putting Dad into a nursing home however, the pt was not.
And I can see why, with limited visitation, family can no longer utilise the nursing home as a "help" - thats what I would do if I ever again put a family member into a nursing home. I would pick one as close to me as possible and then ensure I visited every day, to feed them, to wash their clothes and just generally help out and ensure they got beyond basic care.
But with covid restrictions, this would be all but impossible.
So whilst that may have been the best choice, it was literally unavailable.
Also. BS she isn't an alcoholic. She had at least a 6 months Hx of abdominal pain, bruising etc. and "a small nip" of what is supposedly home made 55% alcohol that is enjoyed by other family members also - her husband admitted she frequently drinks after her father goes to bed, and when she's drunk, phones family members to discuss her anxieties as a carer and the stress she feels with taking care of her father.
The psych seemed concerned that she no longer lived with her husband (no longer co habitating, is how they termed it). From non Western culture, my parents didn't "cohabitate" a bed, or even the same room for a long time prior to my dad going into the nursing home so I don't see that as abnormal.
Then again when Pete wanted to sleep in the other room I did take offence to this (I don't snore. Yes he's a light sleeper. Yes I'm 95kg and pregnant and roll around a lot, but to me it symbols deeper issues). So. Now he starts the night off in the same bed and claims after he pees at midnight has issues falling asleep so goes to sleep in the other room. I don't know if he sneaks off after I've fallen asleep. But it keeps the peace.
The story
Sick from work for last few weeks? months? lives in an apartment in the inner west. Isolated from family due to distance - they live in QLD.
Normally works as a gardener for a council in his area however has become too sick to work in recent weeks. Aged 60s but too young to qualify for a pension.
Was coughing up 1 cup of sputum daily and after a few weeks of feeling unwell, difficulties eating? dihorrea and abdominal pain was on scan found to have a retroperitoneal Ca.
Heavy smoker.
Heavy drinker.
nil other medical Hx, no medications.
They took him to the semi-private across the road to have surgery(his brother told me on the phone on the day of the op, his sister helped him from the car and he was so breathless and could barely walk that they were concerned they would not operate, but no they did it anyway).
When they opened him up, he bled so badly they could not take the tumor, did a liver biopsy instead - as it looked cirrhotic (incidental finding in OT??how did they not see it on scan?)
He was too unstable so they packed him off to ICU, where a few days later - on nightshift, with his very crappy chest (and now fulmittent delirium, albiet, he's the kind that knows he's delirious always asking where he is, and what is going on and why is x y and z, etc.) he coughed so hard he dehissed his wound with large amounts of exudate literally almost spraying out as he coughed. He was an emergency take back to OT the moment the morning list started and he returned 3 hrs later, reintubated.
This was approximately a week ago and now, 1 week + 3 days post my covid leave I'm back and he's still here. Wardable, but did have a peri arrest overnight due to massive nose bleed due to NGT insertion