Looking Glass Wards - Part four

Continues...

We were yet to visit these realities.  My only concern at this stage was an ambulance transfer, settling Carolie back into the Canberra hospital domain and continuing on the path to an ill-defined recovery.    

On the day of the transfer, I set out early to ensure all was in readiness for her arrival. As with most aspects of the journey, departure and arrival times were unclear.  The ambulance left later than expected; with transfer speeds conservative for someone with a tracheostomy.  I rang the designated ward many times, driving the duty managers to distraction.  They had as much idea as me on expected arrival times. 

I had expected they would have radio contact with the ambulance and be able to check on schedules.  By 4pm, the ambulance had not arrived. It was another nerve-racking wait, but I was more track-hardened on this occasion and took most of the uncertainty in my stride.

Eventually, one of my regular phone calls extracted the awaited news of Carolie’s arrival.  The trip had gone without incident.  Ensconced in a single room with a large plate glass window adjacent to the nursing station, close monitoring was now possible.  The room was airy and had an unfettered view of nearby surrounds. 

The standard of accommodation met my expectation of what was necessary to keep her safe in transition from the tracheostomy.  I never felt that in Sydney, once she left the ICU.  My anxiety level diminished. I knew we were in a new grind, but fears of cross-infection and inadequate monitoring tapered off.   

The nurse to patient ratio was probably no different, but the operational culture felt more focussed and ‘sympathetic’ - reinforced quickly as I came to know a few of the nurses rostered to manage Carolie’s stay.  They were another multicultural potpourri of empathetic nurses.  Some were young and inexperienced, and did not have the aura of technical competence exuding from the Sydney ICU cohort, but they were friendly and happy to oblige my determined ‘briefing’ of each of them.

My experience in the Sydney ward had convinced me that care protocols did not necessarily transfer in tandem with patients.  I was more alert in Canberra. I discovered nurses were giving Carolie 1000mg of Paracetamol as a routine prophylactic.  In the Sydney ICU, she had a dramatic response to the common analgesic, such that it dropped her blood pressure precipitously.  An adjustment to her care regime acknowledged this atypical response - to reduce fever 500mg would suffice.  This necessary diversion from the usual approach to prophylactic care was lost in conveyance.  I had to insist on several occasions that her formal management regime reflect the smaller dosage requirement.    

Another incident was more serious.  Towards the end of her period of intensive care, Carolie developed a deep-seated bacterial infection in the area of the cranial suture line.  Blood cultures revealed at least two organisms – Staphylococcus Aureus and Klebsiella Oxytocae – were present.   

Staphylococcus Aureus 

Klebsiella Oxytocae

A neurosurgeon told me such cranial infections were common because of contact with foreign objects inserted during treatment, such as the EVD. Bone matter infections do not always respond to long-term antibiotics, requiring further surgical intervention to remove the infected tissue.  Antibiotics are the first line of defence and I did not think much more about it. In the overall scheme of things at the time, it was a lower order concern. 

A small dark tissue mass marked the discharge point at the site of the second EVD, which retained a stitch, unbeknown to ward nurses and me.  The presence of this stitch was lost in patient transfer.  It remained in situ in the Sydney ward and for many days in Canberra. 
  

After almost a week had passed in Canberra, Carolie was becoming febrile off and on.  Seepage at the discharge point alerted nurses to a possible ongoing problem.  The stitch was uncovered and removed and further culture tests ordered.  Whether the failure to remove the stitch much earlier contributed to the bacterial infection is unclear, but it cannot have helped.  The cranial infection persisted and its treatment came under the purview of infectious diseases specialists.  Long-term antibiotic treatment of this infection continued for over two years.

Speech pathologists were still to the fore, continuing the cuff deflation regime in preparation for removal of the tracheostomy.  Her left side remained unresponsive, while the right was showing limited mobility.  Reviews by a rehabilitation specialist, physiotherapist, dietician and occupational therapist mapped her recovery regime toward full-blown rehabilitation therapy.   

Carolie remained under the over-arching purview of the neurosurgical team.  I settled in for another long haul and gradually came to grips with this new staging post.  

To be continued...