Close to home, yet so far away

The twists and turns of the past 2 weeks have brought much contemplation. And none more than my dear Dad being admitted to hospital with fevers and diarrhoea 10 days ago. Thankfully he tested covid negative, and there would have been virtually no way that the virus would have contemplated reaching the front door of my parents' house with the meticulous and regular sanitising that my Mum has been doing, largely, and heroically, to keep my vulnerable COPD dad in his late 70's from contracting it.

He had complained of feeling tired the Friday night, then was late to rise on the Saturday too, and I knew something was up. He sounded fine when I called him, but by evening I found out he had been in bed all that day when Mum told me he had had a bad gut. All these highly out of character. I facetimed him and got Mum to give him the thermometer in bed, and waited while he took it. 38.8..his oxygen sats were 81 (while we know he runs at sats in his mid to late 80's sometimes in each day since he has willingly complied with 3 times a day checking and reporting to me, they have never been this low), and he had diarrhoea, all very worrying for covid was my immediate thought, knowing what this diagnosis could mean for him. I asked them to call NHS 111, take paracetamol, drink fluids, and let me know. I assured them that on on any other occasion I would have given this advice and not involved 111...but we are in the midst of a global covid pandemic and this was a necessity.

He was advised,, his temperature responded, and I had a fretful night wondering how he would be. My parents may be no more than unmarried housemates on paper, but they do still care and look out for one another as they did when they were married, and my Mum wouldn't let anything go unnoticed. NHS 111 were excellent. They called back at 5am while dad was sleeping, then again later that morning, and despite my Dad sounding well and chirpy, he omitted to tell them his oxygen sats level (I found out later from my mum), they saw through it and based on his fevers and diarrhoea they advised that he got assessed at the hospital. My Dad has 3 phobias I have learnt over recent years: going to hospital (he told me the night before that he wouldn't be going, hence perhaps the tactical omission of the oxygen sats I'm sure), going on oxygen, and having any walking aids, all of which have been explained to him may be in the offing at some point. And here he was, having been convinced by the lady on the phone, I assume to have been a doctor, and packing a bag to head in. He would have a full respiratory work up, and covid swabs, a chest xray, and anything else they would deem necessary in the current climate. He was warned that someone would collect him from the car in full PPE, and that Mum or anyone couldn't visit. I know he was nervous, but we all were, and I promptly contacted both of my brothers. And through all this, the most trusted opinions I took from my most trusted and oldest medical school pals, who are sisters to me, who are always "on call" as we all are to each other 24-7, and to have two of the best GPs I know advising me and my family and supporting us with their own experiences right now was invaluable.

Mum was of course amazing as always, trying to arrange his commuications with his less than useless mobile phone, his ipad, his chargers, and something to keep him from boredom-his crossword book. I managed to see him every day at least once on facetime and he was absolutely cheery in there! Bournemouth hospital have looked after him before; with his 5 star stay in a side room, the whole 4 days of his admission were only marred by the ongoing fevers and diarrhoea, the "terrible" coffee, and the pressurising by a Care of the Elderly consultant who was pushing him for her to document a Do Not Resucitate decision, while he was well , soon to be discharged, and on his own in this discussion with her. He said he felt bullied-a sad moment when I hear this happening in my own profession to make anyone let alone vulnerable patients feel this way. And he stuck his ground that he wanted to talk to his family about it. So after a fretful afternoon thinking about this at work, and sharing with my colleagues the best way to broach this issue with Dad and the family, it was my two "sisters" who both said there was no rush to make this decision while Dad was about to be discharged, and that once we chatted as a family these issues of documenting agreed resuscitation status should his heart stop, could be done with his GP. I didnt' know about the RESPECT protocol which is implemented in the community, and nor it seems did my hospital colleagues, but it was worth Dad and all the family reading about it. This was a relief to all, especially Dad, who was discharged after 4 days without a question about it from the morning consultant on the rounds on his last morning.

I had in fact had a conversation on face time with him on what was his last night in hospital that day, about what the decsion about resuscitation status meant, and I realised that this was all of a sudden too close to home for me. I put on my doctor head myself, discussing the whats and wherefores in a gentle and non-directional way, and yet realised afterwards, as I have on many other occasions over medical matters with my family, that my own coping mechanism is to remove my emotion from it and deliver the advice and explanation as though I were talking to a patient. But then it grabs you afterwards. And by then I was already feeling far away, not able to be there, no able to visit him, to have this discussion face to face, my mum couldn't visit him, and it upset me to think he might be feeling lonely, and my thoughts went to those poor patients whose fate was worse at this time, and that succumbing to their illnesses, whether covid related or not, without their loved ones, must have been excrutiating for all involved. I just couldn't imagine this for my own.

But I was pleased to know that Dad was actually on good form, and joking with the doctors and nurses ("the thai nurse with the mad hair" made his days), chatting to the Nigerian doctors about his own years in Nigeria, the constant traffic into his room for observations, and his best bit was rediscovering jacket potatoes! And all this while the poor man was battling through campylobacter gastroenteritis ie food poisoning, which had been the cause of this whole episode!

The final issue was that of home oxygen based on his chronically low oxygen sats The team visited him to discuss what home oxygen would entail, and all of us sure that this would be an incidental side-gain from this hospital admission, even though it was not respiratory related (his chest xray was clear on admission to hospital so they were sure he didn't have covid from the get-go), he was told before he left that he wouldn't in fact be needing it after all just now-so this was another relief. As Dad's COPD has been stable for so long, they said this would only be revisited if he deteriorated at any time with his chest. He didn't have single whiff of oxygen during his entire stay in hospital, so this was as a good a sign of stability as any.

So covid and its risks had taken on a new meaning for us as a family, to have Dad admitted to hospital at this time, thankfully with an unrelated problem, but I have also thought in the past week about patients' mindsets at this time: we know that patients have resisted hospital admission despite being unwell, on account of fear of catching covid in hospital, and sadly we know that this resistance has cost lives. My Dad may well have resisted going to hospital (although not if my mum had anything to do with it!), and there is a good chance that without his iv antibiotics, fluids, and regular input with investigations and assessments by the medics, that he may have deteriorated at home, and then where would we be? Equally we know that many patients needing hospital care haven't been able to receive it on account of the risk fo covid infection being too high for them. Again, these situations have tested medics, patients and their families, in ways that we may have not had opportunity to process as yet, but we know that we are dealing with a time in our generation that we will never forget.