2 hospital visits
The photo is taken near the main entrance at St Helens hospital, where I had a dermatology appointment this afternoon.
This evening I went to visit Terry who is in hospital with a very nasty condition. Sepsis due to cholangitis. He had cholangitis 13 years ago and was in a bad way then (this is a life-threatening condition) and he was in Whiston Hospital (where he is now and where I was working as a nurse) they needed to do an ERCP to shift the gallstone which was blocking the bile duct and causing the problem but twice the ERCP failed due to swelling (caused by infection) and also to that he has diverticula covering the ampulla that they need to get through to gain access. Thus, they sent him to Broadgreen Hospital as they are the experts in it. The doctor doing it reassured Terry that it won't reoccur as he put in a stent. This sounded great!
Terry was told last year that the stent should have been removed after three months and Terry was never told that or he would have chased it up, naturally. I am not familiar with biliary stents (acute medical ward nurse and stroke unit) but there was no mention of it needing to be removed and the doctor made it sound permanent.
Terry ended up going to A&E on Wednesday evening as the upper abdominal tightness and discomfort he has been struggling with and telling his GP about (for ages) suddenly went far worse and he was in severe pain. I have been wondering for some time if his symptoms were related to his gall bladder and even more so when we were told the stent should have been removed.
I was struggling to get him to go to A&E or anywhere (perhaps looking back he may have been a little confused due to infection or low oxygen) but eventually got him to agree to ringing NHS 111. They said they would send an ambulance for him within half an hour but a paramedic rang him and said to make his own way there. Great, when he was in agony! His respirations were 28 a minute (a bad sign) and he was looking like he might be a little jaundiced and he passed very dark urine which as a former nurse I recognised was full of bile pigments.
In A&E nobody checked his abdomen till he had been there 11 hours. The NHS is broken. Triage nurse asked him questions without even looking at him (facing computer screen, which meant he was not even in her line of sight). How is it you do not get your abdomen checked for 11 hours when you have present with severe abdominal pain?
In the waiting area Terry suddenly looked a lot worse, sweating profusely, clammy and in even more pain so I went for help and the doctor was actually looking at Terry's blood results at the time and said even then he needs admitting and he had not even been examined yet.
He was started on IV fluids and IV antibiotics plus a few other things very quickly and surgeons came to see him as well. Cholangitis does not just affect the gallbladder - infection is immense and spreads to the liver and pancreas, so he has a lot going on.
Tomorrow they are taking him for MRI. His gall bladder needs clearing. They will need to remove it at a later date but can't do that while any infection is present.
I have the awful feeling that what's blocking his bile duct is that stent. If so, it's going to be very difficult to remove after 13 years. The surgeon today was not happy when she found out the stent was left in.
Cutting a very long story to a less long one (!), the ERCP today found something blocking his bile duct but they could not get in to remove it
He is on oxygen as well now because his oxygen levels are down. His temp has gone up a bit yet he is in less pain so probably the antibiotics are kicking in. I haven't had much sleep for worrying about him (sometimes nursing knowledge makes you worry more than if you did not know things). I am really missing him at home.
Sorry to anyone feeling the need to read this epistle but I needed to make a bit of a record and have a rant!
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