So two strapping young ambos arrive with the full emergency resus ambulance and they found their reportedly semi-comatose patient to be awake and now fully responsive. No longer hallucinating and seemingly perfectly normal. But they did confirm the low oxygen saturation level and high temp so, despite mutterings about the doctor's competence, rehydrated Philip, administered oxygen and whatever else their protocol demanded (ignoring the doctor's instructions to "just get him to hospital"), then took him to Calvary while I drove the 3 km there in my car.
At this stage there were two competing possible diagnoses - infection, and the side effects of too much opioid. Each could explain Philip's symptoms and probably the ambos see more drug overdoses so that was their favoured diagnosis. It was certainly possible, given the amount of pain yesterday and the on-demand pain relief in the form of liquid hydromorphone which Philip had had six doses of yesterday.
Once in ED we had to repeat the full history, again, and the full medication schedule, again, to a young Irish registrar, Lindsay and the nurses. They took blood and urine samples and set up intravenous antibiotic. Philip was starving by this time, having missed dinner and only having had a tiny lunch smoothie. He had to wait for an hour until after taking his empty-stomach Tarceva but at the tail end of the day the only food available was a stale and unappetising sandwich which he found inedible anyway. I went home at about 10.15 pm and later that night Philip was transferred to MAPU,
Today, Thursday morning, he was given an ultrasound of the right leg, two brain CT scans, two CT scans of the torso, upper and lower, and a bladder scan, I think by ultrasound. He was not permitted to use the heat-wheat packs which gave pain relief to the leg and foot for 'safety' reasons - whether this was for patient safety or the nursing staff was not clear. They were afraid of burning, or spontaneous combustion, or something.
Before coming to the hospital I had a lengthy discussion with the pharmacist as to Philip's medication history. Again. It has been reported that Minister Ley is determined to bring the medical profession into the digital age and it can't come soon enough.
For hours in the hospital I was trying to speak to the nurse or preferably the doctor in charge of Philip's care but they were quite impossible to track down. Until finally some action when the team leader discovered that Philip's meds, which I had brought in, were sitting in an open box on his bedside chest. They included morphine which The Rules said were to be kept under lock and key. Panic! Outrage! Near hysteria! But it got some action when I threatened to administer a dose of pain relief to Philip myself. (Mind you, he had had three occasions of diarrhoea while I was there and I gave him Gastro-Stop. The nurses had not been the slightest bit interested.)
Looking back I realise I missed a golden opportunity to make a fortune flogging the morphine-based meds to other patients. I just don't have that criminal entrepreneurship. Sigh.
After I'd returned home a phone call from Philip produced an unexpected third diagnosis which explained his recently-developing leg pain: Dr Jun tells him that the ultrasound had revealed clots in the leg. The doctors now have to have a confab about what is to be done. In one sense it is good news, I think, as at least the pain does not seem to be coming from a new cancer growth. Will keep you posted as to developments.
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