My poor demented Dad was rushed into hospital at the weekend. We’ve had a hellish week. And all because of his bowels.
There’s nothing to be gained by being squeamish about bowels. Use all the euphemisms you like, but don’t ignore them and keep them regular. Once a day? Once a week? Or longer? Is there a Guinness record? I’d be interested to know.
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Even with a good diet – and Dad’s has plenty of the three Fs ; fruit, fibre and fluids – the necessary muscles become weak in extreme old age and without help constipation is almost inevitable. And so it was that on Saturday morning - after a night of Dad being sick and his chest developing an ominous rattle - a very charming NHS 24 emergency doctor came to the house.
He gave Dad an enema and me a prescription for antibiotics - a precaution against pneumonia which the doctor said wasn’t there yet, but was more than likely "in the post". The doctor put on his jacket to leave and just as he was saying goodbye, Dad vomited up a dark coloured liquid.
"Is that blood?" I asked, assuming that was the worst it could be.
"No" said the doctor, "that’s faeces".
The Victoria Infirmary hasn’t much changed since I was there 36 years ago to have my tonsils out. A & E can’t even run to a hot drinks vending machine, the lifts don’t work and the loos have that blue light which makes it hard for junkies to see their veins and they can’t so easily inject themselves.
The receiving staff made all sorts of assumptions about Dad because he was a) old, and b) had dementia. They shouted at him because they thought he was deaf (he isn’t) and they talked about him to me as if he wasn’t there (which to be fair, was the case in most practical senses). They assumed he ate like a bird when the opposite is true; Dad has a monumental appetite and food is one of his few remaining pleasures. The X-rays confirmed that Dad was literally full to bursting.
I called my friend Carolyn - a very senior nurse who has given up her job in Newcastle to look after her Mum, also with dementia. We were friends when we were growing up; Carolyn taught me how to smoke (‘just keep persevering, you’ll get it in the end’, she would say. Of course neither of us smokes now) and we have become each others' support group. She brought coffee for me and helped the very junior admissions doctor take bloods from Dad (‘I think this is his first ever job!’ she said, far more sweetly than I would have done if I’d known), while I sat in another cubicle with my head out of the window trying not to faint.
Dad was diagnosed with Diverticulitis and put on three lots of intravenous antibiotics, fluids and oxygen. His constipation - the original cause of all of this - would have to wait until the infection had subsided and in the meantime he was to have Nil by Mouth.
Dad’s GP used to joke about the two things that occupied the minds of his older patients more than anything else. ‘Bowels and spectacles!’ he would say, ‘Bowels and spectacles!’
I now remember with fondness the early stages of Dad’s dementia when the most frequently recurring - and frustrating - conversations were about his glasses. Happy days!
The consultant on Dad’s ward at the Victoria kept saying to me that Dad was a “very old chap, you know”, by way of the answer to anything I asked him.
“All his diagnostic results are improving” he told me.
“If only he was a car!” I said, “but he’s not. And he’s worse now than he was on Sunday. How do you account for that?”
“Well, he is A Very. Old. Chap, you know".
I wonder if they dare say that about Prince Philip when he goes to hospital. He’s the same age as Dad and he is deaf!
And as for Dad still not having had a bowel movement, the consultant was ‘entirely unconcerned’, claiming that it was possible for someone to go for six months without moving their bowels, and then muttering something about there being a pathological component.
While I was at the hospital last night I watched another patient, distraught by news of a death in his family and befuddled by dementia, try to leave the ward. The nurses rolled their eyes and one said “we don’t have the staff to deal with this!”
They were paging the on-duty doctor who eventually turned up and admitted he had his pager switched off. But then felt he was too junior to make a decision anyway so he paged someone else, who the nurses had already established was no longer in the building.
Their solution was to call the police and have this man arrested. Although they didn’t actually get round to doing that. And all the while the only people offering any kind of comfort or support to this man were the other patients, as they struggled with their own wounds, and drips and catheters.
The junior doctor eventually phoned the man’s wife to say he was sorry to hear about the death and to tell her that her husband was being very difficult, and he just wanted to be able to say to the man that he’d spoken to his wife in the hope that would calm him down. So he’d spoken to her now, so he could say that. OK?
When I eventually had the chance to talk to the staff nurse I told her, with some pride, that I’d managed to get Dad to eat two squares of Cadbury’s Dairy Milk. She looked puzzled.
“I’m just telling you in case he’s sick again and you think it’s more faecal vomiting”. I said.
“Faecal vomiting?” she said. “I don’t know anything about that. That’s not in his notes.”
I left the hospital feeling that it could go either way. I wanted to hope for the best and to believe that all the signs were of improvement, but the voice that said “he’s a very old chap”, in brackets (“you surely couldn’t complain if he died now. At his age!” ) kept me awake most of the night.
But there’s better news today. As of this morning I have managed to enlist the help of a nurse who is a ‘dementia champion’ and I am now able to go to the ward at any time to help Dad. So I gave him lunch and helped him to drink – he won’t ask and prompting isn’t always enough. Sometimes you have to hold the cup and put it to his lips and not let go. It can take a while, but today he was very thirsty and drank well.
His infection is indeed subsiding, he is re-hydrated, he doesn’t need the oxygen and he’s on oral antibiotics.
When I asked him if he wanted to come home he said “yes, very much indeed”.
The only unresolved bit is the bowels. Dad still hasn’t had a bowel movement, (it’s now day 13), but he’s eating again and as the consultant won’t give him laxatives, what will happen? Surely there are only three possibilities: a spontaneous bowel movement (how long are we to wait?), a perforated bowel or more faecal vomiting.