To ask to speak to a doctor ?

[3smallpups]

Not in an aggressive way , just does it seem like a reasonable request ?
my brother has been admitted to hospital with what is clearly alcohol related liver disease. He is in no fit state to advocate for himself , rambling and barely conscious . Having been there for several hours today , there was no sign of a doctor on the ward at all. The head nurse was able to answer some questions but only to say that his bloods were all over the place and he’s waiting for a scan.
i have a medical background and it’s pretty obvious what the diagnosis is, without the scan and I know that there’s lab work that can be done to establish prognosis etc, which hasn’t been done .
i know that basically the only chance of a positive outcome is steroids started early , but I feel they aren’t going to do anything till they have done a scan ( likely not to happen over a bank holiday weekend ) and it will all be too late.
if this was my husband , I’d be laying in the corridor until they found me a doctor to speak to , it’s that important . But I sort of feel
as it’s my brother , I don’t have the authority? But I am his next of kin, our parents are dead and he is divorced .
actually just writing this out makes me realise that I need to stand up for him.

You absolutely need to try for him. He’s lucky to have you fighting his corner. Good luck to you both. 💐

I doubt they’ll be doing nothing.
if he is decompensated they will be trying to treat the reason for it (infection, dehydration, bleed)
with the steroids for alc hep it’s normally based on a GAHs score.
the important thing if it is liver disease is to ensure the bowels are moving. They’ll be plying him with laxatives to try and help with encephalopathy.
Ask to speak to his gastro consultant for the plan, no nurse will be offended by that x

@Antihistamine62 yes, that’s the test, or calculation, I don’t think they have done but needs doing .they aren’t treating it as alcoholic liver disease until they have the scan, no one seems bothered by the fact that he has been drinking 6 bottles of wine a day . He hasn’t eaten anything for two weeks , he always has tremors but now they are terrible, partly due to weakness but also alcohol withdrawal as he has obviously not had a drink since he was admitted yesterday. They are so bad that he physically cannot hold anything or get anything to his mouth to eat or drink. I told the auxiliary nurse this at dinner time, I fed him and held a drink for him but I asked her to please help him if I’m not there as malnutrition and dehydration will not be helped but not having anything in hospital. She said she would but a bit later they came round with the meds and just plonked them on his table. He is barely conscious, can’t sit up and can’t get anything to his mouth but they expected him to take them unaided. I then , very politely, had a word with the head nurse before I left , to reiterate that he cannot even drink by himself, she looked surprised at this and said “ we try to foster independence “
I don’t have much hope that there is stuff going on behind the scenes that I’m not aware of sadly .

I am sorry this has been your experience, as a gastro nurse I am horrified. Everyone in gastro knows nutrition is so important in the care of liver patients.
all the more reason for you to ask to speak to the consultant. He’ll also be likely to go into withdrawal which I would hope they will treat effectively. Speak to the consultant. You probably won’t get one tonight obviously but every hospital should have gastro cover over the weekend due to the complexity of the patients. I hope your brother does well x

Martha's Rule is an option if nobody's listening. Good luck.

Is there any management of your brother’s withdrawal? That to me would seem vital.

No, I don’t think there is, which is one of my main concerns as that will obviously be making things so much worse. It’s ironic as one of the things I’ve wanted to do in the past is kidnap him and lock him in a room to stop drinking, but haven’t as the nhs website is full of dire warnings about alcohol withdrawal .
feels like they have stuck him in a corner to die quietly to be honest .

There will definitely be a Gastroenterologist covering the weekend, they should do a ward round, they would in our Trust (yes even bank holidays). Ask for a chat with the on call, or just to be present when they come. You want your brother flagged as needing a Consultant review, make sure the nurse in charge knows that and documents it.

He’s not on a gastro ward, which may be part of the issue . He’s on the amu, which seems to be a mixed bag . There has not been a physical doctor input since he was admitted on Thursday morning ( at least during visiting hours of 9 to 8 ) . “ he’s on the list “ for a scan seems to mean we don’t need to do anything till that happens .

I wouldn't be surprised at all by this neglect unfortunately. I had an ex hemorraging from somewhere in their gastro system. We took evidence in (urgh) and it happened again at the hospital in A&E (loads of blood) and they STILL tried to discharge him. I put my foot down and refused although he wanted to go home, thankfully, because in the night he had a massive hemorrage and almost died, had a 9 hour emergency surgery.

One of the surgeons that had seen him prior to the almost fatal bleed and had said 'I think it's psychosomatic.' was the same one that came to see him in ITU.

You need to contact PALS and/or invoke Martha's law. They need to be managing the withdrawal and he sounss like he's on the wrong ward for this. I am sorry but you probably need to fight for him because if you don't no-one will

Yes use Martha’s law and don’t wait. Waiting due to politeness is not the right thing to do now. They will be writing you off as ‘annoying relative who thinks she knows better than us’ it’s an nhs culture issue sadly. Don’t let them dismiss you

If it's a decent size hospital they probably have an alcohol specialist nursing team if you can get hold of them (via switchboard) or ask the ward to contact them, unfortunately some specialist teams are Mon - Fri. I'd phone or visit this morning, speak to the nurse in charge and be very explicit that your brother is experiencing alcohol withdrawal and so is at risk of X, Y and Z., what are they doing about this?

You know this is the worst thing to do, not just the danger of withdrawal but will increase his drinking levels when you 'let him out'

I feel your frustration. I asked daily to speak to a doctor re my FIL about his heart failure. I'm a doctor and they kept sending the young FY1 doctor who was great but couldn't answer all my questions as she didn't have the level of experience.
Once the palliative care team got involved it was much better but I had to fight for that. Things tended to get left and some staff really didn't know what they were doing.
Actually the best staff were the care assistants.

@3smallpups ask if they’ve followed the CIWA protocol for alcohol withdrawal and say you would like it written in his notes that you are very concerned about his alcohol withdrawal and are requesting a medical review. Once they have to write it they will
want to cover their backs I’m sure.
Definitely push for a review and raise your concerns, bank holiday or no bank holiday weekend.

Obviously I have no intention of actually doing that , for many reasons , was just pointing out that as a lay person , even I know the issues of alcohol withdrawal.

Shocking.
I had a similiar situation with my father. Not an alcohol disease. There wasn’t a doctor to be found. I could buy a pasta salad and even a chicken leg in the huge airport style lounge downstairs. But in a hospital it was bereft of any staff to actually crack on with medical care. He was in terrible pain and it took me ages walking around to find anyone.
While I was with him a man in the bed opposite called for a nurse. She came and said ‘ I cannot understand you’. And walked away. Some nurse. I went over and said what is it ? He pointed to the floor. He had dropped a pencil he had been using for his crossword. Then he pointed to the water. I poured him a cup.
He was so grateful.
The state of some hospitals is shocking.

Thanks all
will bear all that in mind
he has a close friend with him this morning to make sure he gets food and fluids , I’m taking over later ( live two hours away which doesn’t help )
plan to ask to speak to a doctor on arrival and if no joy will 100 pc escalate if needed
have also equipped friend with a list of questions to ask if by any chance a doctor turns up this morning .

At the very least I’d expect him to already be on chlordiazepoxide, Pabrinex and lactulose. Has he been given any of this? Pabrinex is a bright yellow liquid given IV, chlordiazepoxide is oral capsules (from memory they are very brightly coloured, but it varies) and lactulose is a liquid.

AMU isn’t such a bad place for him to be; I was an AMU nurse for a few years and looked after many people with decompensated cirrhosis, which is what is probably what is happening to your brother. There will (or should) be a doctor that covers AMU full-time and can update you on his care. The nursing team can refer him to the drug and alcohol liaison service, if there is one in your Trust. He also needs to be under the care of the dietetics team as proper nutrition is crucial for his recovery, the nurses should also be able to complete a referral for this.

I would ask the nurse looking after your brother when the daily ward round is happening as that will be when you get to meet and speak to the consultant and juniors involved in his care and find out exactly what is happening.

I hope he recovers

Good luck @3smallpups you're doing the right thing

Insist on seeing someone.