A mammoth undertaking

By Gillian

Chris had a dose of palliative radiotherapy yesterday afternoon, on the L1 vertebra where he has a tumour. That’s about at the level of his diaphragm, so the radiation went right through his digestive system from back to front. The beneficial effects of the radiation continue for about 6 weeks. However, the unpleasant side effects started almost immediately – in this case within 20 minutes.

I was driving us home from Cheltenham, and had to pull over into a layby four times to allow Chris to throw up – copiously. Fortunately, we now keep  a sick-bowl in the car in case of such emergencies. When we got home, he was no better, and vomited a total of ten times in four hours. He was in quite a lot of back pain too, but couldn’t even keep water down to allow him to take either his pain-killers or indeed his anti-emetics.

I decided enough was enough and phoned the chemotherapy help line at Cheltenham (even though the problem was clearly due to radiotherapy – they are very helpful and I reckoned they would be able to tell me if these symptoms were normal or whether Chris needed treatment). The nurse on the phone-line said that it sounded very much as though Chris had got into a vicious cycle of vomiting, and that he urgently needed an anti-emetic injection to break the loop. He suggested that I phone my out-of-hours GP service, and say that I’d spoken to the helpline who advised that I get someone out to the house to sort Chris out.

Up until now I’ve never needed to call our GP out-of-hours, so I didn’t know what to expect. I was put through to a receptionist and had tell him the story from scratch. Fortunately, I was able to also tell him that we did in fact have some doses of Chris’s anti-emetic medicine in injectable form, prescribed for him by the palliative care consultant in Worcester, in case of just such an emergency. However, it was no use to us, as we didn’t have a syringe or needle.

The receptionist decided that, since we knew what the problem was and already had the prescribed medicine for it, we didn’t actually need to be seen by one of the out-of-hours GPs. Instead, he referred me to the Out-of-hours District Nurse team. I was a bit wary about being handed on from one team to another, in case I got lost in the cracks, but I needn’t have been. Within fifteen minutes, the receptionist for the out-of-hours nursing team phoned me back. I had to go through the whole story again, and she agreed that it was indeed something that her team could do. Five minutes later, the duty district nurse herself phoned to ask for exact directions to the house, and was here within a further ten minutes. From first calling the chemotherapy help-line to having a nurse in the house checking Chris over was well under an hour. Not bad!

Of course, that would have been far too easy. There was one final hurdle to overcome. We had the anti-emetic drug in injectable form in a box clearly labelled with Chris’s name and dispensed by Worcester hospital. But it appears that the Malvern and Worcester IT systems don’t talk to each other as  there was no record on the Malvern system of the prescription. And without a specific instruction from a doctor, the nurse was not actually allowed to give Chris the injection that everyone agreed he needed!  Fortunately she was a very pragmatic, no-nonsense person, and she wasn’t going to let a poor IT system interfere with her job. So she phoned the out-of-hours doctor herself, got put through to the duty GP, explained the situation and what she was going to do, and got a verbal go-ahead. Then she jabbed Chris with the injection that she had  already prepared, and that was it – except of course for the ten minutes of paperwork she had to fill in, detailing case notes and treatment. The vomiting eased, and by midnight he was able to take and keep down his pain-killers so that he could get a reasonable night’s sleep.

That wasn’t the end of the story. This morning Chris was phoned first by our GP who said that he would prescribe both anti-emetics and pain killers in injectable form, and also give us the appropriate paperwork to permit a district nurse to use them. Then the nurse herself phoned to say that, when we picked up that prescription we should also collect a “just in case” box from the surgery, containing needles and syringes etc so that we would be better equipped next time. I hope that “next time” is a good long way off, but it is good to see the back-up that’s available.

One reads in the newspapers dreadful stories about out-of-hours services going horribly wrong. But when we needed it yesterday it worked very well indeed, albeit with a pragmatic work-around, and I have nothing but praise for the professional way the medical team dealt with the situation.