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Too little, too late?
Friday was a busy day, clinic first, lasting until 1pm, and then visits. The first visit was to a lady, P, who had her baby 11 days ago. A visit had been requested for Tuesday as my job-share had concerns about the woman's emotional state, I had a day off and the other members of my team hadn't picked it up. When I first arrived all appeared well. P was fit, had no problems to report and baby was thriving and breastfeeding brilliantly and her parents were staying and doing all the chores around the house. Since I hadn't seen P since the birth I sat and had a chat with her about how it had all gone, I was going to discharge her, as our conversation went on I became concerned. They had encountered problems becoming pregnant and had eventually conceived with IVF, P kept returning to this saying that emotionally she felt she had been ignored. Then she went on to say that everyone was ignoring her, not listening to what she had to say, apparently the Health Visitor had called and she had 'only talked to her husband'. At that point her husband came in, first impressions, control freak, which he readily agreed with. He described how P wasn't sleeping, I had to say that she didn't appear tired but I wasn't there all the time, so all together we worked out a plan to try and ensure that P had enough rest. I left them, promising that I would visit on Monday. When I got back to the office I made a note on her visit slip that I had concerns about her mental state and had left relevant phone numbers with the family.
I start at lunch time on a Monday, go straight to a clinic, do home visits until 6.30pm and then return to the hospital to facilitate a parentcraft class, so in the morning I phoned the office for my visits. On Sunnday P's husband had phoned the hospital requesting that P be admitted so that we could look after the baby and she could have a rest, he was told we don't offer that service but that a midwife would visit. By the time a midwife visited he had called the on-call Doctors service, a Doctor had visited but decided that all was well. Later the midwife had called round, she had decided that there wasn't a problem, and anyway I was visiting the next day. Prior to my phoning for my visits this midwife had also spoken to our manager, P was now 14 days postnatal, to say that we shouldn't still be visiting, I was told to discharge her.
I decided to visit before my clinic, I was feeling quite concerned about the situation. When I arrived I was greeted by P who told me that someone special was coming round at 1.30, I told her that was me (!) but she seemed really confused. I suggested that we see if her Mum knew who was supposed to be coming and have a cup of coffee and a chat, that's when the 'fun' really started. Mum didn't know who she was expecting but said that P and her husband had visited their G.P that morning, and he had prescribed antibiotics as he thought she may have an infection. Now I know that infections can cause people to hallucinate and be disorientated but by now P was exhibiting all the signs of puerperal psychosis, disorientated, distressed, paranoid and suffering from insomnia. Then Mum in law entered the room and the emnity between the Grandparents became apparent, thinly veiled insults were exchanged, P and I sat there, onlookers at a slanging match. P's husband appeared, at first a truce was declared whilst he encouraged P to talk about what was worrying her. P described how she knew that she still had to give birth, to another baby. When she had IVF they had used two embryo's, only one had implanted, but P was now waiting for the second embryo to be born. Her husband left the room, extremely distressed, I asked P if I could go with him and look round the garden, she was happy for this. Poor man was crying, we sat and had a chat and I outlined what my concerns were, would he object to a psychiatric opinion, he was more than happy for this. I then returned and had a few sharp words with the waring factions and set off, late, for my clinic.
When I got to clinic the G.P was there, I told him how concerned I was, that I suspected, and had documented, that I felt it could be puerperal psychosis and I would be requesting an urgent psychiatric assessment. He nodded and said he would get back to me, 5 minutes later it had been arranged, thank you, thank you.
P is now in our local psychiatric unit, without baby. We no longer have a Mother and Baby unit, another cost-cutting measure, so the one thing P was coping well with has been stopped. Mum in law is looking after baby, and he is being bottlefed, P is out of the loop. On the one hand I am patting myself on the back for getting P the help she needs, on the other I am feeling really guilty for splitting up Mum and baby. I just wonder what would have happened if we had acted earlier?
Yesterday I also discharged my little teenager who gave baby up for adoption. She seems to be doing really well, her stitches are now replaced and are healing nicely and she has enrolled in evening classes, I just wonder if it is really all-behind her.
Tears of frustration
Today is a day off but I had asked to be kept up to date on my woman with ?puerperal psychosis, so here comes the latest in this tragic tale of buck passing in this modern health care system, including me.
The local psychiatric unit only admitted P to their respite care facility after much wrangling, initially referring her to A & E as they had doubts about whether she was psychiatrically ill, . In the middle of the night she 'absconded' and was found by the police wandering the streets in her nightie. They returned her to the unit, where she attempted to 'abscond' again, so she has been sectioned under the Mental Health Act, no idea which section she is being detained under. At some point during all this P believes that she has given birth to the second baby and so is now worried about where both her babies are. When my colleague phoned me to let me know what was going on I felt huge anger and frustration. Angry, as I believe that we have all let P, and her family down, in a major way, frustration because none of the mechanisms supposed to work together in this type of scenario have worked at all. I question if I should have acted on Friday, if I had would I have got anywhere? P was only showing emotional disturbance then, certainly there was no delusion concerning other babies, her paranoia was limited to people ignoring her, it had not moved on then to people trying to harm her or organisations working against her, so given the reluctance by people to act once she was displaying these signs I feel I probably wouldn't have 'got' anywhere.
Yesterday, when speaking to her husband I was close to tears. Today I have shed tears, tears of frustration and anger.
Healthy lot
Nasty tummy bug today, courtesy of Amy's Mummy.
Jack's Mummy had her scan yesterday, baby growing well, placenta growing where it should. Jack's Daddy is recovering slowly at home. The nurses are visiting everyday and packing the wound which does seem to be healing slowly and oozing less.
Last week Hubby and I attended our local hospital to have our routine blood tests, him for his cholesterol, me for my routine thyroid plus some more specific ones for arthritis. After our hours wait, not much fun with a husband who has been starving since the evening before and an Amy who, like all toddlers has little tolerance of boring surroundings, plus decides that filling her nappy is a good way to pass some of the time. Of course silly Nanny had not taken a change as we were 'only nipping down there and at 8.30 in the morning the queue won't be that long.' Two days ago my G.P surgery phoned and, with her mouth full of some foodstuff and masticating away, the receptionist told me that I shouldn't worry and asked that I make a routine appointment to discuss my results. Alright then, when is there an appointment? 'Thursday'. That's good, I thought, only 2 days away, 'a week on Thursday, she clarified'. I made some comment about the waiting list to see my G.P being nearly as long as that to see a Consultant, I think she laughed, but she may have been choaking on her elevenses. I asked if she was also going to phone Hubby, apparently they don't want to see him. Now I'm wondering if there is a problem, and if so, what? Hopefully it's just that my medication needs adjusting, I certainly have long enough to come up with some terrifying possibilities. It's great being a hypochondriac!
Ghost cats
Havn't blogged about my two feral cats for some time, possibly because they are nearly 'normal' now.
Flo, the black one, is still quite reluctant to involve himself in too much human interaction, except when food time draws near, and then he is constantly trying to trip me up, winding around my legs, and jumping up and crashing into my thighs. He is the more playful of the two, chasing his tail, knocking small toys under furniture but totally ignores attempts at human involvement.
Billy, the black and white one, has decided that I am a friend. I am allowed to pick him up and stroke him, if he comes in and I am not around he looks for me and if I am behind a closed door he will claw at the carpet until I open it. An unfortunate, destructive, arguement causing habit but one that I can't seem to stop him doing. The time he always serches out contact is when I'm at my desk, then he stands on his hind legs, front paws on my legs and cries to be picked up. Once on my knee he goes into a frenzy of purring and padding, quite distracting but after the early months of being ignored, or run away from, very rewarding.
Both the cats are very wary of Jack and Amy, which is sad really as the babes love them, after the usual first words Bo and Illy were the next words that Amy mastered. I was thinking that once they were not quite so noisy and intent on chasing the cats Flo and Billy would stop avoiding the house when the Grandchildren were about, with another baby arriving after Christmas though I don't think that will happen.
Question Time last night - Anne Widdecombe, love the woman.