I’m having a tough time keeping track of everything. So many conversations, so many phone calls. And sometimes the things I’ve been saying over and over to different people and writing down here start repeating on me, coming back to me as if I heard them from someone else.
I touched on The Return yesterday. As we prepared to leave the hospital we learned a valuable lesson that’s worth passing on.
When you are talking to doctors, you are dealing with people who live in an idealized version of the world. It’s important that they are allowed to continue inhabiting this perfect vacuum, because otherwise they could not achieve the depth and breadth of detailed knowledge needed to support the key contribution they make to the medical process. Imagine attempting to fully comprehend the medical history and new clinical data of a human being, assess progress and make a recommendation for next steps, 25 times in the space of just over 3 hours.
But it is a medical process, and although it hinges on the doctors, and without a hinge a door is just a broken wall, the rest of the door is much bigger and heavier, and that’s what you have to put your weight behind to get it to open. It stands to reason that given that cognitive load (and I’m not talking about my door metaphor), there is absolutely no benefit to be derived from loading them up with the process data too.
So when the doctor told us there was no medical reason for mum to remain in the hospital, she was, strictly speaking, correct. But a broader interpretation reveals that her analysis falls a little short of the truth.
More specifically, while on the ward, post-discharge planning is handled by very competent senior nurses. Once discharged, those nurses are no longer involved in the planning process. Moreover, when a person is referred to social services and other community agencies as an inpatient, the case is treated quite differently and with greater priority than if they are referred as an outpatient.
Mandy, the senior nurse who was overseeing mum’s case on the ward, sat us down and explained this to us yesterday afternoon as we were psyching ourselves up to take mum home. I know that we would have gone ahead with discharging mum anyway, but it would be good to have had it spelled out earlier. Although Mandy tried to get the referral through to social services (for example) before we actually left the building, the fact that we were home by the time they saw it was enough to have it reclassified.
As it turned out, I spent quite a lot of time on the phone today, and made a lot of progress. We had a doctor’s visit, got a referral to Macmillan Nursing, and made an appointment to have a home visit from the district nurse tomorrow to talk about regular care visits and potentially useful equipment. I don’t know what kind of equipment that might be. A hydraulic bed or a powered reclining chair would certainly come in handy. We’ll see. We have an “emergency” assessment from social services early next week, who are now treating this as a community referral rather than a hospital referral (or whatever the qualification that inpatient status confers is called). But I think we’re doing OK without them co-ordinating, at least in the short term.