A Talk With the Specialist

I arrived at the hospital just before 10.00 am to ensure that I was available when the specialist made his rounds. Now Noosa Hospital is different to most hospitals in the area which are either private and one pays your way or public where all is funded by the state. Noosa Hospital was built on 1999 using state funding but then leased to a private company to run. This company in turn receives state funding to run a public facility on their behalf in parallel to their private operation. Margaret is a private patient but due to her late admission on Thursday and the fact that the private facility was full she was placed in a public ward which she is sharing with 3 other ladies. I got to know these quite well as we waited nearly two hours for the specialist to arrive.

The rural nature of Noosa Hospital also means that most specialists don't work at weekends and generally one specialist physician takes over all medical cases, both private and public, from the other specialists over the weekend. This weekend, by chance, it was Margaret's private physician on duty but his rounds followed the following routine. A quick check of all the public patients at about 10.00 am all of whom are in Pavilion D (no wards in Noosa) and then on to Pavilion G, the private wards, to check up on all the other physicians private patients plus his own private patients who he spends more time with. Then finally back to Pavilion D to consult his own private patients temporarily housed there. In this case Margaret. Actually he had assumed that as she was paying full whack she would have been transferred to a private room by now so apologised for the lateness of his visit.

By now Margaret had got herself in a state. She told him that she just wanted to die. He told her that he understood and that her pain and poor state of health would make most people feel that way and that his primary job was to relieve the pain then treat her underlying condition. He explained to her that she would continue to receive morphine while the ribs healed. Then he would ensure that her lungs were clear and functioning, properly and finally he would try and restore the balance of the minerals in her blood which would make her feel better. Then she could go home until the next time. He told us once again that Margaret could expect problems to arise on a regular basis due to her normal body functions being destroyed by the steroids used to control her Chron,s disease over the years and now essential to replace her failed adrenal gland cortisone production.

He asked me to talk with him outside where he explained that the main problems were with the diuretics used to control Margaret's fluid retention. These are necessary to prevent excessive retention affecting her already poor cardiovascular system and leading to congestive heart failure. Her GP and other doctors just prescribe more and more Lasics/Frusimide as required. These reduce the fluid retention but literally leach all of the mineral out of Margaret's body hence the low Sodium levels. He is trying different diuretics to overcome the problem. Without diuretics she is likely to become critically ill. With Lasics she is now in a precarious position. Over the next 10 days he will try and stabilise the situation. We discussed her living at home and he said that she was in danger of falling but this would not be any better in a nursing home and she would be very unhappy there. I had to accept that these things can happen and not feel guilty if and when the next serious fall occurs. Her dementia wasn't too serious as she was aware of what she was doing and functioning at a reasonable level albeit with some peculiar memory loss problems. He also thought that she was suffering steroid induced hallucinations at times due to her medications but reducing these would result in her not functioning at all. She will remain in hospital until she is stable and safe to come home and I am to take advantage of her absence to build up my reserves until she comes home.

I visited her again at dinner time and she was much happier and settled. Two of the other ladies had been chatting to her and made her part of their little community. The other was very old and frail but also quite nice.

I shall visit this morningat 11.00 am.