In hospital with pneumonia, they won't discharge me but I don't quite understand why?

[ediblewoman]

This is a bit long so please bear with me.

I have had an awful cough for six weeks, went to my GP at week 3 who diagnosed viral asthma and prescribed salamol inhaler.

A week later I went back and was given a 7 day course of steroids.

On Boxing Day (300 miles from home at my mum and dad's) I went to the walk in and was fast tracked to A+E, was admitted with pneumonia following a chest x ray. I was on iv antibiotics for the night and day and oxygen. Saturday moved onto oral antibiotics and off oxygen and nebulisers.

Today was hoping to go home but my blood oxygen remains stubonly at 93/94% and my CPR had doubled from admission.

Doctor on ward round didn't see me but decided I should stay in and see the respiratory team tomorrow.

I said I would self discharge if this was just a follow up as it would need to be done in my home town but have been told there are concerns which need to be looked at. The nurse doesn't know what the concerns are (or at least why the blood oxygen and CPR could be worrying) or what the respiratory team might do?

We (me, DH, DS and DD) are supposed to go home tomorrow on the train and I am wondering how likely that is?

Do any of you have any idea what could be wrong or what the respiratory team might say tomorrow?

(Medal if you got this far!)

I'm guessing it's Sunday, it's a junior doctor and the doubling in crp might indicate the infection isn't completely under control?

As far as I'm aware the CRP is an imflammatory marker, so if its doubled you will have a high sepsis score,which,is obviously a bad thing, it could mean that different antibiotics are needed. If fluid is building up on your chest and the O2 levels not rising you may need something like furosemide.

I think I'd stay put. Hope you get well soon x

They need to see your CRP coming down.

even if you are seen in the morning and a decision to discharge is made, by the time you get out of there you are unlikely to make the train.Do you feel up to a long train journey? hope you feel better and escape soon

Pneumonia is very serious and you've not started to bounce back yet!

My knowledge is only gleaned from when I was kept in hospital after giving birth, but CPR is a marker for infection. The fact that it's gone up indicates that you could have an infection, though there are other causes. They can only identify infection conclusively by taking blood samples and seeing what grows, which takes a day or two, so before they've got those results they will want to be cautious.

You aren't yet fit. From those figures I would hazard a guess that the pneumonia hasnt resolved yet. You are also still borderline for needing oxygen.

Trust me if you were fit enough you would have been discharged. This time of year they are desperate for beds. So to answer your question no its not a formality

Btw, just so you know, discharge can take for-bloody-ever in hospital. If they turf you out of the bed and tell you to wait in the lounge, get comfy. I really wouldn't plan on making a particular train tomorrow.

Your O2 sats are too low and your CRP is rising - that's why you've not been discharged.

Asboysrock has already said - if you're fit enough for discharge they'd have discharged you. Hope you feel better soon.

It would be a bad idea to travel whilst still unwell, even if the alternative is inconvenience.

Pneumonia is really not something that you have a swift recovery from. You'll be weak and exhausted for quite some time.

You can't travel tomorrow.

Basically you have not improved with treatment.

CRP indicates infection not under control as could the sats.

Stay put.

Thank you all very much, that all makes sense. I think I knew I was being a bit of a Pollyanna about tomorrow but I just so want to get home. Trust me to get admitted so far from home! At least my mum and dad are lovely and the house they live in big enough to take us without DH feeling like we are imposing too much.

I agree that you need to stay in because you simply aren't well enough to leave. Send dh home with kids tomorrow and once you're fit to leave the hospital get your mum and dad to take you home with them for 24 hours rest before you try the journey yourself.

They aren't confident that you're really on the mend given that your O2 sats aren't improving and your CRP levels are deteriorating. CRP levels should have come down by now (by day 4 they should be around half of the initial level or less) -- that they haven't, and have actually gone up, is a sign of possible complications setting in and they want you in hospital where those can be managed. If I were you I'd assume you won't be going home tomorrow either. And I wouldn't even consider self-discharging.

I was hospitalised in America with pneumonia man years ago when i was there on holiday.
I was in hospital for a week and then wasn't able to fly home to the UK for another week. And when I did eventually fly home I threw up repeatedly in the toilet on the plane.
It took me nearly two months to fully recover from the pneumonia.
Last year I again was rushed to hospital and diagnosed with pneumonia. I was discharged two days later and told to have complete bed rest for at least 7 days. Again it took me several weeks to fully recover.
I understand you want to get home to your own house and your own bed but please don't rush it, take your time and allow your body to recover. You're suffering a very serious illness and travelling while so sick is no fun at all.

Plan for a serious recuperation period. Could you convalesce for a few weeks at your parents' house while your husband wrangles the kids? Is he working OTH as well - he is likely to need some time off?

STAY PUT!
A friend of ours was in a similar position before Christmas last year, she discharged herself despite being warned not to and was them rise back in seriously ill. She was in hospital for just over two weeks and it took until Easter for her to be fit again, she has long lasting effects.
This is serious, plan for your parents to be having you to stay for a little while when you are discharged, if you push yourself to go home it will take ages for u to get fit again.
Please be careful

Oh gosh, I hadn't even thought about recuperating, two months borninastorm, gosh that sounds rotten.

I will suggest to DH he takes the kids home but I think he'll refuse to leave me here (DM and DF are supposed to be away for NYE). He has next week off work but runs his own business so more time off after that will be hard. I might just refuse to think about that right now, DH can work it out!

All the more reason to stay put and get well before you go home. In your head you're in hospital with a cough but everybody else knows you've been properly poorly There is a period of adjustment for you I think. How old are the dc? Do you think your parents or dhs' might be able to come and stay for a little bit when you do get home to help out?

The other thing to think about if the medical staff do want you to stay in is whether they can transfer you to your local hospital. This will be a right faff to arrange but if they think they need you in for a few more days it might be worth pushing for?

Thanks Northern, I think you totally right, bit of cognitive dissonance going on! I think I will ask about a transfer tomorrow if they think I'll be in for more than another couple of days, that's a really good idea.

DC are 6 and 3, I will be calling in favours all over the place for help.

It took dh months to fully recover. If your parents offer to help out with the DC by either you staying put or coming down once they are home please say yes! Dh only has a local office job and after 3 full weeks it was a couple more of part time working before he could cope with a full day for a week. He was previously fit and young and it just wiped him.

Stay in and look after yourself. And everyone's right about recovery time. I ignored feeling a bit ropey a few weeks ago, I had pneumonia but went on to get septic shock, which I started googling when I got home from hospital but stopped because it's too scary. I was in resusc for a few hours, intensive care 2 days and then on a ward, so all in all, in hospital for one week. My CRP began to go in the right direction but they (as in respiratory team, by that point, rather than ICU docs) were determined to see it going carry on going down before discharge - and my temp was doing big spikes at night as well. 4 weeks ago I had never even heard of CRP,. My DCs are 3.5 and 7, and I still feel like crying every time I think about how people rallied round DH and myself. Based on my recent experience your DCs will be more unsettled if you go home and then unfortunately have to return to hospital.

So good luck, but what everyone else says sounds very wise - I do hope tomorrow brings you better news.

Look after yourself. Try not to worry about ykur dh and who ks gokng to look after the kids - let your dh sort that out

Sats of 93/94 is bordering still needing oxygen. Please don't discharge yourself! You've obviously still got an infection if you've got a raised crp so stay where you are and be looked after.