The little things

Mr K has been with us for four weeks now. He came in following a fall at home. This was probably mechanical, but routine bloods also showed a marked deterioration in his renal function. So he was investigated (large prostate, slight hydronephrosis) and treated (catheter), all of which took a couple of weeks.

After that came the dreaded 'social' bit. But then a few days later, I noticed that he was over-overloaded: he had pitting oedema to his umbilicus, good-going ascites, and clinically detectable bilateral effusions. This too was investigated. He has an albumin of 18 (normal being over 30), which is a result of his haemochromatosis, although his poor appetite does not help matters. He also has poor cardiac function, also thanks to haemochromatosis. In addition, this had been kept in check with a large dose of diuretics in the community, however in the interests of his renal function, they had all been stopped. Now for the past week and a half, he has been on iv and oral diuretics, and is very slowly losing weight.

But he is absolutely fed-up to the eyeballs of being in hospital. He stopped cracking jokes. His 55th wedding anniversary is next month, and he misses his wife. She does not visit very often - she cannot drive, bus drivers won't wait while she sits down (so she's fallen a few times), and taxis are expensive. He's still a very sweet gentleman, but his unhappiness is obvious.

So one day, I organised a fry-up breakfast. Very simply done: ask the nurse. And while my nurses struggle to remember to do daily weights, and give out once-weekly medications, despite numerous reminders, one mention of getting a fry-up breakfast, and its done!
The change in him that morning was marvellous. He enjoyed his meal for the first time since his admission, turning him back to his happy-jokey self. Never has anything I've done had such a postive effect! And compared to anti-depressants, its safe, very quick acting, and cheap! The only drawback is that it cannot be used more than once a week (for health reasons!).

Its one of the things, we're never taught in med school. Though all the touchy-feely communication stuff has helped, its simple things like this, that I feel, make all the difference.