"My husband's experience following a fall"

This story is from my perspective as carer for my husband, who is in his late 70s and has dementia and mobility issues.

Early in the new year my husband had two separate falls, a few nights apart. A week later he complained of severe lower back pain and was urinary incontinent overnight. His GP advised paracetamol. A few days later he coughed up some blood, I took him to A&E, he was admitted because his blood tests showed some abnormalities.

He was kept in hospital for four nights, during which time my only contact with a doctor was a junior doctor, who didn't know my husband and hadn't read his notes. On discharge a more senior doctor spoke to me, I asked about the back pain and continuing urinary incontinence, they said they were not aware of it but would consult a colleague. As I was wheeling my husband off the ward another doctor approached and said because of pain and incontinence they were concerned he might have prostate cancer, but as he was desperate to leave to take him home and they would check with a senior colleague and call me, which they did, saying come back or call GP if issues continued, which they did.

Hospital reablement phoned after my husband's discharge, said they would send someone to see us, but I heard no more.  

My husband's GP said prostate cancer unlikely because a PSA test a few months earlier was clear. A prostate enlargement exam was booked, but he was unable to stand. I queried the ongoing back pain and incontinence, the GP said it might be cauda equina syndrome, requiring urgent MRI, which they actioned.

I was so worried overnight, having Googled CES, I took my husband to A&E the following morning. A&E doctors were sceptical about CES, not keen to do more than a standing X-ray, but he couldn't stand unaided, so they agreed (somewhat reluctantly I felt) to do a CT scan. This showed he had sustained a recent small spinal fracture, at least we now knew the cause of the back pain.

It was a kind, understanding doctor who told us result of the scan, and seeing how weak my husband was said they would admit my husband for inpatient care until he improved. My husband smokes a pipe, very much likes his own space, and was desperate to be back home. As he did not need medical treatment as such, I knew bringing him home was best for him. Doctor advised I should look into more home care support, which I agreed was needed.

Then followed five quite awful days of my husband being doubly incontinent day and night, requiring change of bedding every day, daily clothes change more than once, he was partly on codeine for the pain, but it made him so tired he couldn't stand at times, his legs gave out often and it took two of us to hold him up. He couldn't be left alone he was too weak. When these episodes were happening he looked so distressed, but once in his chair he recovered his mental energy and was straight back to his pipe, Sudoku and watching TV, much more relaxed than he would have been in hospital and I knew it was the right thing to bring him home.

The hospital called four days after A&E visit to say his urine sample showed a UTI, and prescribed antibiotics through the GP. I believe he had acquired a bug too as he had an episode of D&V one night.

We were assigned an Admiral Nurse last summer and I emailed them to explain the last few days. The nurse phoned within a short time and visited the following day, making a direct call  to the reablement team and being an understanding support to me.

Reablement OT and physio arrived within a couple of days and assessed my husband as needing a hospital bed, commode and extra raised toilet seats. They were lovely and helpful.

The hospital bed arrived within a few days, it was difficult to get my head around this new normal for us, but I know it was needed and it has made my husband's home care much easier. The team have returned to do a follow-up, and physio will be visiting too I believe.

It is so good to see my husband beginning to look properly better for the first time in weeks, his back pain reducing, his mobility slowly improving.

Some further observations as a dementia carer of these recent weeks engaging with different aspects of the NHS: the understanding in hospital of my husband's dementia was mixed, one duty nurse said they weren't aware of it, but equally other nurses were excellent, caring and patient with his dementia issues; I asked every day to speak to a ward doctor, or for them to call my mobile, knowing my husband would not be able to remember context, it was only at discharge that I did speak to a doctor; I believe some hospitals have a blue bracelet system identifying people as living with dementia, this would have helped a lot. Our Admiral Nurse is absolutely brilliant, I believe they should be a part of all NHS community care.

Now feedback re another patient, compassion and privacy. At one point on a ward, it was impossible not to overhear a patient being told their cancer scan results, that it was untreatable, terminal, and they had two months to live. All delivered I feel in a fairly matter of fact way, without any loved one alongside. I felt so sad for them and the way this news was delivered I had to fight back the tears. Who would want to be told like this?

My summary is of people trying to do their best, in a system which is creaking under the strain.