The mystery....solved?

Back to the mystery lady.
When morning came, she had more tests, including a CT scan of her brain, which showed atrophy* - which is to be expected in a lady of her years. She also had an abdominal x-ray - which was the only test to show something (other than the blood tests, which just confused me even more, and did not really indicate where the problem lay). As I was saying, her abdominal film showed that she had faeces in her rectum.
Thats a normal place to have faeces and its certainly normal to have faeces. But in her case, her rectum was rather large. And she must be impacted**, because she is passing watery stool, and vomiting faeculent*** fluid. Poor thing.
Were she not so ill, she would have been vigourously de-faecified with the strongest enemas known to man. But given her condition, its not such a good idea. So we are going on a slowly-slowly approach with the enemas.
Her condition is more stable today than it was yesterday - where she had the Portsmouth sign**** for most of the day. And she is more awake today - there were periods yesterday where she didnt respond to painful (and I mean painful) stimuli - which is understandable given how ill she is.
If I were able to make big decisions (ie more important than whether to do bloods or not), I would have said that this lady was dying and that maybe she should be treated conservatively. But my senior was very keen that we carry on, considering how much work we had been doing on her: in terms of all the investigations and for instance, now because she has fluids going in one arm and antibiotics in the other, her routine bloods are taken from her femoral vein - which is more invasive than the usual venous bloods taken from the arm). And today looking at her condition, I suppose he is right, because she has perked up - albeit very slightly.
So instead of putting her on the Liverpool Care Pathway*****, we are giving her fluids and antibiotics, and hoping that her condition will improve over the weekend. However, she has been deteriorating for weeks on the ward and prior to her admission was deteriorating at home, so what are the chances of her improving enough to go home, before becoming prey to the illnesses that float around the wards??
I have issues with doing something just because we can: just because we have the ability to do this fancy blood test and that fancy scan, does it mean we should? and will it alter management?? While a lot of the time this is taken into consideration, there are times when I wonder why the patient is being put through our attempts to 'care' for them.
But to speak up for doing things even when the attempt seems futile, you may remember the gentleman who had the massive bleed last week this time. He has regained full use of his left hand! and compared to the right there is only a very small difference in strenght.
So on that, I shall leave you for this week....I can't believe how quickly it has flown by!




*atrophy = shrunken - normal in elderly people.
**impacted - hard stool, ultra hard to shift. A very common cause of confusion/falls/deterioration etc in the elderly.
***faeculent - vomit that smells of faeces.
****portsmouth sign - where the heart rate is higher than the systolic blood pressure - very bad sign - it means that the heart is working very very hard, but is still not managing to maintain a decent output.
*****liverpool care pathway - a set of guidelines which is used for the management of patients who are dying, or from whom treatment has been withdrawn as it is felt to be futile. It means that patients are kept painfree and have an 'easy' death.