Thursday, December 7

How we got here.

As mentioned previously, the NHS appears not to be to blame, for once, for the situation my rather excellent wife Vic currently finds herself in. That's not to say, however, that mistakes haven't been made. And lots of them.

To recap, we just had a baby girl, Daisy May Kynaston Reeves, born on the 27th of October 2006, and utterly excellent. For a few days afterwards, all seemed well apart from the usual fatigue and pain that affects anyone who's recently had surgery, be it caesarian or otherwise. Then the fatigue got dramatically worse, Vic got out of breath, her pulse went through the roof, and she was readmitted to hospital with what turned out to be pulmonary embolisms in both lungs — that's blood clots to you and me. She was put on blood-thinners to destroy the clots, but not before her lungs had been damaged. They are expected to take some months to repair themselves.

She was readmitted again a couple of days after she was next discharged, this time coughing up blood. This can be a normal side-effect of being on Warfarin (the blood-thinning drug and, incidentally, rat-poison), but it's the kind of thing you need to check up on anyway. She stayed in another week.

Vic currently has enough strength to climb stairs once or maybe twice a day. She's on a terrible cocktail of drugs: Warfarin for the blood, iron tablets because it turns out she's anaemic, antibiotics for the infections that took advantage of her damaged lungs by moving into them, Cyclazine to stop her throwing all the other drugs up (it doesn't work, though: it's an anti-nausea drug that causes Vic extreme vomiting — go figure), and sleeping pills. Plus the usual insulin and thyroxine that she'd be on anyway. A few of these drugs aren't compatible with each other, so the doses need to be carefully staggered through the day. It's all a bit of a nightmare.

I was rather surprised to realise that Daisy is six weeks old tomorrow. It doesn't seem like she's been around six weeks, because, of course, all our time has been spent thinking about Vic. That's not to say we don't dote on her — she's lying beside me, creating spectacular smells, as I write this — but that time that we had hoped to be spending exclusively on our child is instead... well, not. These things happen.

Anyway, I happened to re-read this post the other day, about the things we were worrying about prior to Vic going into hospital to have the baby. It was interesting to compare our worst-case-scenario worries to what ended up happening.

I have quite a few things to point out now, and I'm not sure it's possible to assemble them into any sort of coherent essay, so here are some observations, in no particular order.

As I mentioned before, Vic's diabetic consultant is rather excellent — one of the best in Northern Ireland, I understand. After the delivery, he visited Vic and expressed his anger that she had been allowed to go through induced labour for so long (seventeen hours or thirty-one hours, depending how you measure it) before the obstetricians finally releneted and gave her a C-section. It transpires that a lot of inductions — most of them, he says — fail these days. He believes that diabetic patients are better off given an elective C-section with no attempted induction first, and that's what he wants for his patients. Unfortunately, in matters of birth, he gets overruled by the Royal College of Midwives, who want everyone to do it the "natural" way.

(The Royal College of Midwives appear not to have understood the Theory of Evolution, then. We don't do things the natural way: we use medicine instead, because it's better. This decision was made thousands of years ago, and it's no good arguing about it now because we already live with its consequences. The natural way is for babies who are too large for their mothers to deliver to die, or for their mothers to die, or both. Natural selection then ensures that very few such babies ever exist. But we don't let such babies die; we use caesarians and other medicinal techniques to save them, allowing them to survive and breed and pass on their big-baby genes. An insistence on doing things the natural way when it comes to birth is, therefore, ignorant and silly. Quite apart from anything else, Vic is diabetic, so the natural way is for her not to give birth at all, but to have died a few years ago instead. But I digress.)

I mentioned here the disgusting trend in British medicine whereby the GMC want doctors not to even tell their patients that treatments exist if those treatments aren't available on the NHS. And that's what happened here. Good though he is, this is Vic's diabetic consultant's one big mistake. It's no good to us for him to tell us afterwards that his recommendation is elective C-section and that inductions tend to fail. He may have lost his fight with the RCM in this hospital, but we still have the option of forking out to go to a different, private, one. The reason we didn't do so was that it really looked like Vic was getting the best care from the best doctors. Had her diabetic consultant told us what his real recommendation was before the event, we would at least have made whatever decision we made on the basis of correct information.

That mistake may well be partly due to the structure of the NHS, but it strikes me that it's more to do with the structure of a hospital and the nature of doctors' and midwives' egos. Every hospital, NHS or private, has policies, and its staff are expected to obey policy even when they disagree with it. That's what's happened here.

Due to her thrombophilia, Vic was on Clexane, another blood-thinner, for the entire pregnancy. She was also given a few huge doses of the stuff the first time she was readmitted with the embolisms. At that time, she was referred to a haemotologist (a blood specialist), who pretty much immediately decided that she had been given far too small a dose. It's another of those things that makes perfect sense in retrospect: of course you should see a haemotologist if you're being given a drug that changes the nature of your blood. But Vic wasn't until after everything had gone wrong. The thinking seemes to have been that Clexane is a treatment for recurrent miscarriage, therefore it's perfectly OK for obstetricians to prescribe it. In fact, well, yes, Clexane is a treatment for recurrent miscarriage, but it is also and more importantly a blood-thinner. In retrospect, it seems wrong that a blood-thinner is being prescribed without any consultation with the hospital's resident blood specialist. What the haemotologist pointed out was that the amount of blood-thinner you should be on varies with the amount of blood you have, and you have a hell of a lot more blood than usual in the late stages of pregnancy. Again, obvious in retrospect — but not so obvious that the obstetricians thought of it.

So, again, we have an error made as a result of doctors' egos. The two obstetricians treating Vic are known to be bloody good in their field. They're the kind of doctors you'd want to see if you went private. There is no reason to suppose that going private would have avoided this problem.

On the other hand, Vic went to see her GP today, and discovered that the following things are not in her medical notes: the fact that she had a CT scan, the results of that scan; the fact that she'd seen a pulmonory specialist, and his name. That's just sloppy, and I have no doubt that the ineffectiveness of bloody NHS bureaucracy is to blame. And it's not a minor thing: considering Vic's condition, there is a good chance of her needing urgent medical care from one day to the next. For her notes to be incomplete — for them not even to mention the name of one of the senior consultants who's been dealing with her case and knows a lot about it that no-one else knows — is appalling and dangerous.

Finally, despite what I said about the official policies of the Royal College of Midwives, I would like to say that the midwives themselves have been consistently brilliant. In fact, they've been the best, most professional, most observant, most caring, most informative, most reliable medical staff we've come across in the last few weeks. At least round these parts, the midwives are more consistently competent than the nurses and most of the doctors. Whatever the diabetic consultant's argument may be with the RCM leadership, the midwives in the delivery suite were excellent and had nothing against caesarians. There was no preaching about the "natural" way; rather, there was a sensible and realistic recognition that induction isn't natural, and neither's diabetes. Later, it was a visiting midwife who noticed that Vic's breathing and pulse were wrong and sent her back to hospital, thereby saving her life. I'm grateful for that.

That's all for now. Daisy needs to be depolluted.