Losing Trach...

2am, Tuesday: "97 Local Close, Nearbury. ?75 year old female, Breathing problems, unable to hear patient properly".

Could be anything really, especially at 2 in the morning. I park the FRU outside the address and remember to leave a space for the ambulance. They're going to be doing the carrying after all... I find the front door open, so knock and walk in. I find Gillian sitting at a table, breathing about 60 times a minute, and a great rasping noise coming from her neck.

Gillian has a surgical tracheostomy. You can read about these here. At least I now know why control couldn't hear her. She's grey, clearly distressed, and tries but fails to tell me what's happened. Her oxygen levels are very low, so I attach an oxygen mask to the trachy site as best I can. Within a minute or so Gillian's oxygen levels begin to improve, and she's breathing a little slower, but she is still very much struggling to breath. Her chest sounds like there's an army marching through it. Her other observations are ok, other than a slight fever. She tells me in two-word sentences that the last time she felt like this she had pneumonia, but it took 3 visits to hospital until it was discovered.

The ambulance arrives after a few minutes, Gillian is feeling a little better, but nevertheless we take the decision that she should be "blued" into hospital. I suspect that she has a chest infection that's turned nasty, and promise her that the hospital will look after her.

2 am, Wednesday: "97 Local Close, Nearbury. ?75 year old female, Breathing problems, unable to hear patient properly". What? What?? I was there 24 hours ago! But back I went, knocked on the door and walked in again. Gillian looked, and smiled as if to say "Oh no! Not you again...!". This time she wasn't quite as grey, but still finding breathing difficult.

"They cleared my trachy site, and sent me home. But I just don't feel right."

We started everything all over again. The observations, the oxygen, the words of comfort. I remember telling Gillian that the hospital would look after her, but I'm not sure they were able to back up my confidence in them, and feel bad for promising something I couldn't really deliver. A different crew turn up this time, I lock up the house, and say goodbye to Gillian.

"See you later" she says back to me.

"I mean this in the nicest possible way, but I hope not..."

Guess I'll have to wait and see.