Thursday, 18 January 2007

Love Potion No.9

Return to the hospital to see the boy and relieve the wife. He's no better and she's knackered. A night in hospital beckons.

Came to the local hospital after work. Was a difficult day at work. Computer screen a bit fuzzy from lack of sleep. Even copious amounts of coffee didn't help.

The boy's condition didn't seem to have changed that much from when I left to go to work. High temperature and heart rate only controlled for short periods by regular paracetamol. He still needs to have extra oxygen or his saturations fall too low. He looks weary and fed up. He's on an intravenous antibiotic and an oral antibiotic (on which more later).

But essentially the doctors don't have a clue what's wrong with him. Their diagnosis can be likened to a medical shrug of the shoulders. Doesn't seem to be a chest infection. No other obvious source of infection. Might be viral, in which case the antibiotics are not worth much - except as a prophylactic against secondary infections. A monitored wait and see policy.

And so to the oral antibiotic issue. When I was young there weren't many oral antibiotics - there seemed to be only two as I recall. A liquidy strawberry one and a milky banana one. You were rarely considered ill enough for the banana one and kept getting fobbed off with the strawberry one. But I digress. Now there are a range of liquids and tablets. As the boy has a G tube, the doctors always prescribe a liquid. But they forget or don't think to take into account that he has a jejunostomy inside the G tube. This means that the actual dimensions of each is quite small even though externally it looks like a quite significant tube. And most modern oral antibiotics are suspensions of enteric coated granules, not liquids. The granules act like silt, even when heavily diluted in water. And so can block the tube.

Despite our concern, the nurse brings us the oral antibiotic swearing blind that she's looked at it and it's a liquid. Mistrustfully I take it, dilute it and start to administer. Two mls go down before the tube blocks and it spurts back over my hand and the boy. Rub my hand to clean it off and there is the white powder of the granules. Grumpily get the nurse for another way to give him the antibiotic and a G tube introducer to try and unblock the tube. End up working on the tube as if its merely a smaller version of my kithen sink. Eventually, manage to clear most of it through a combination of the introducer and drawing back with a syringe. The boy is very patient as my face becomes as pink as his from the effort.

The nurse returns. She's found, at our suggestion, a tablet form which she's crushed and disolved in water. We ask if she's checked the packet to see if it talks about granules. She's sure it doesn't. Being suspicious we wait to see if there's sediment. Which of course there is - tablets have enteric granules too these days. So I try gingerly to administer it but to no avail. They are out of alternatives on the ward and we will have to ask the doctors and pharmacy in the morning.

Decide that he's too unstable for us both to be at home. The wife has dealt with him all day so I offer to do it. A sorry sandwich, a packet of crisps and bed.

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