Side Effects

I thought I’d say something about side effects. I’ve mentioned them in passing; usually to show just how well Jenny is coping and how proud I am of her. She is on a huge number of drugs (and I’m so relieved she gets free prescriptions) and the side effects of some of them are something she has to live with.

Let’s start with Steroids. I usually put a list of links at the bottom of these blogs. Most of them take you to a really useful website, Patient.co.uk. There, you will find a full list of side effects in the entry. Jenny’s on Prednisolone. I understand this is to reduce swelling, one of the symptoms of HSP, which can cause problems in the kidneys (and has done in her case). The Steroids come with a whole host of other drugs to relieve the side effects, so she’s also on a mild antibiotic, Septrin, Fluconazole because she is more prone to fungal infections, Calcichews (which is not in Patient.co.uk, unfortunately) and various others.

The Steroids have made her put on weight, which she can afford, being so slim in the first place, and made her face round. Again, she looks fine, although she doesn’t like it. I think the big problem with the Steroids is the mood swings she’s been getting. She was already turning into a bit of a nowty teenager (I’ve put in a glossary for those unfamiliar with the term) but the Steroids have made her really nowty now. She get these amazing highs but she can also get really low and unhappy and she is so stroppy, it’s amazing.

Other members of the family seem to think I’m making excuses for her and she’s just blaming the Steroids but I know that they can make people aggressive (click on this link, for instance, to see what I mean), so I am not surprised.

Another side effect, this time of Prostap SR, is hot flushes, usually associated with the menopause. She has the Prostap to shut down her ovaries to protect them from the course of Cyclophosphamide she is taking. The Cyclops has its own side effects. She tends to feel nauseous and run down after she’s had the treatment. She was also warned that her hair might thin, which would actually have been a benefit, but that never materialised.

Finally, I should mention the cramps she has been getting in her feet and lower legs. We’re pretty sure that these are also a side effect of one of the drugs she has been taking, although I do not know which one is to blame. These can be severe and the effects can last for a few days after the cramping has gone. The cramps can interfere quite badly with her life: she was sent home from College a week or two ago because of cramp and she got cramp in her foot at a gig last week. Fortunately, I was there and so was my car (well, it was nearby) so she didn’t have to come home on the train after having had her foot seize up extremely painfully.

The doctor has prescribed Quinine Sulphate for the cramp. Listed amongst the side effects for it are two rather alarming ones: Coma and Death. Jenny seems to find this funny and, to be honest, so do I. It’s the sort of thing we’ve come to expect.

Links
Prednisolone
Septrin
Fluconazole
Prostap SR
Cyclophosphamide
Quinine Sulphate

Glossary
Nowty

Another Pulse of Cyclophosphamide

I’m a bit tardy writing this blog but I haven’t been online for more than about 5 minutes at a time recently and when I have, I haven’t really done more than check the stats on this site (to quote Jenny’s older sister, Chloe, I’m a bit of a sad cheese when it comes to blogging).

Last Wednesday, Jenny had her 4th pulse of Cyclops. The first three she had in hospital and they were administered intravenously. My sole experience of this was that we waited around for ages, had some sandwiches and then Jenny was given two drips – one to prevent the nausea associated with the treatment and the other was the Cyclops.

Now, however, she’s taking it orally, which means she can take it at home. She needed another injection of Prostap first. The doctor had prescribed this at her last clinic visit, so all she needed to do was to book an appointment with the nurse at our local GP Surgery. Sorry, I’ll correct that. All I needed to do was to book an appointment with the nurse at our local GP Surgery.

That was easier said than done. There was no nurse available on our preferred day, Tuesday. She doesn’t go into college on Tuesdays so it’s best to book things like this for that day. However, they did have a doctor free on the Tuesday so I booked her in. In the morning, I took her into the blood clinic at the hospital to have a blood test because there was no nurse available at the GP Clinic to take the blood on that day and no doctor available early enough.

I then went to work and Jenny took herself off to the doctor in the afternoon to have her injection of Prostap. She was quite annoyed about this too because the doctor injected it into her buttock and Jenny had to drop her pants. This was apparently to save her some pain but she found the injection painful anyway.

She took the Prostap orally that day as well. She has been suffering a little more from nausea than previously but I only found out because she was eating her tea slowly on Thursday and I asked her if it was okay. She said it was fine but was struggling because of the nausea brought on by the Cyclops. She hadn’t complained once.

So that’s it now for a couple of weeks at least. She has a clinic appointment on Monday week and hopefully the bloodtest results will be good again. All her levels, except the protein in her urine, are looking good. Well, they were when she last attended so I’m pretty hopeful. It looks like they have finally brought it under control but it’s taking some pretty aggressive treatment to beat it down. I’m just looking forward to it fizzling out or however it will go.

That is one thing I do know. It will eventually go. It might come back again but then it will go again… And again. There is a consolation amongst all this. I really believe that this has been the making of Jenny. In the last 6 months, she has turned into the most amazing young woman. Her strength of character and her will and determination have really shone through and not just with the disease anymore but in all areas of her life.

I’m proud of her!

A pulse of Cyclophosphamide

Jenny had her third pulse of Cyclophosphamide today. I took the day off work so I could take her into hospital for it and her friend, Jess, accompanied her. We set off at about 10am and dropped her sister off near the town centre and then took her big brother into work. It’s a short drive from where he (and I) work to the hospital and we were there for 11am.

She has to go to the Renal Ward for the treatment so we went up there. She spoke to a nurse, who directed us to the day room. For a very long wait. We had to wait for the Cyclops to come up from the pharmacy. Then a doctor came and asked her for details; it appeared that they had lost her notes. He even wanted to know why she was receiving the treatment and which pulse it was.

Jenny was amused but it was disheartening for me because everything seems to have run so smoothly since her first day in hospital back in March. Now, I was getting a taste of how poor organisation within the NHS can affect patients. At 3pm, they finally started the treatment. She had a drip to prevent nausea and sickness first. That took 40 minutes.

She received that drip in a treatment room, set up for such purposes. While we were in there, one of the Dialysis Nurses, who also arrange the intravenous iron (Venofer) came in and started chatting with Jenny. She asked if Jenny had had the results of her most recent blood tests (taken yesterday). When she found out we hadn’t, she went and got them. They were very heartening indeed. Jenny’s Creatinine and Urea levels were well down again, almost back to the levels they had been at first and her haemoglobin was up. All in all, very good. 

A little later, a nurse asked us to go back into the day room so he could treat a patient in the treatment room. Jenny had to push the drip on its little trolley through to the other room, which is so reminiscent of patients undergoing Chemotherapy. Then again, Cyclops is Chemotherapy, even though Jenny doesn’t have cancer.

We sat in the day room and eventually, the bag attached to the drip ran out. Cyclops is a cytotoxic drug and you need special training to administer it. You also need to wear gloves to prevent it touching the skin and Jenny even saw one person wearing goggles when she had an earlier pulse of it. So we waited for the Cytotoxically trained nurse to come back to hook her up to the Cyclops.

It took about 5 or 10 minutes and this time the drip took an hour. While this had been going on, a gentleman and his wife came in. The man had a chest problem (and a dreadful cough) and was waiting for a bed. He and his wife started chatting to us. He said that they had been there for about 6 hours waiting for a bed. I told him that Jenny had waited hours for a bed when she had been admitted back in March. She told him that she had waited until 9.30pm before she got a bed. She makes a good Job’s comforter.

I carried on chatting with the man and his wife about all sorts of things; the Second World War, Malt Whisky, Real Ale, his service in the armed forces, how easy we have it nowadays (that was my contribution) and loads of other stuff while Jenny chatted to Jess. That way, the final hour passed pleasantly enough.

When the drip was finished, the nurse took out the needle and put a plaster on her arm. We said goodbye to the man and left the ward and the hospital. I sincerely hope he got his bed hours ago. I rather think he’ll only just have got it though.

Links
Cytotoxic Drugs
Iron Infusions
Creatinine

A Landmark in her Progress

We went to the renal clinic yesterday and it looks like the news is good. I’m going to be a little more cautious than I have been before (I thought she was better when she came out of hospital in March but then found out I had been hopelessly optimistic). However, her Creatinine levels are down to 90; they peaked at 172. She didn’t even have to see the Consultant, although he popped in to discuss her Cyclophosphamide treatment briefly.

She mentioned that she has been getting hot flushes recently and suspected that this is due to the Prostap injections she has received. She was right and the doctor told her that the drug had induced an artificial menopause. This is, of course, reversible. As with practically every other irritant, minor or major, associated with the disease and its treatment, she is coping with it remarkably well.

The next pulse of Cyclops (that’s what they call it anyway) is booked for 21st August, a little later than preferred but she has a busy social life and will be visiting a friend in East Sussex the week earlier when she should receive it.

She needed all her drugs except the Iron and Calcichews prescribed again and for the first time, she was unable to find her list in her bag. I’m sure that by now, she has rewritten it, but the doctor had to check the hospital notes to write the prescription out.

Then we went for the usual round of collecting prescriptions, booking her next clinic appointment and having blood taken. When her turn came up to go to have her blood taken, she told me she didn’t need me to go in with her. Considering that the first time she had blood taken, she had to lie down and was terrified and as recently as June, was gripping my hand while it was done, I think that’s marvellous.

Links:
Prostap SR
Creatinine
Cyclophosphamide

Sorry…

I’ve deleted the page HSP Jenny. She’s a bonny girl, I know (I’m her mother so I’m bound to be biassed) but I’m a little disturbed about the number of views the page is getting. Silly me for creating it. Back to normal blogging next time.

Recent Developments

We have been on holiday for the past two weeks and we got back last Saturday. Before we went, Jenny was given the first of a course of Cyclophosphamide to suppress her immune system and thereby prevent damage to her kidneys. This is a form of Chemotherapy and is administered by an intravenous drip. Jenny was given a low dose of the drug so it does not have the same debilitating effects generally associated with Chemotherapy. She has had to have her ovaries “put to sleep” to minimise the chances of her fertility being affected and she was given two pills to take to combat the mild nausea that would follow.

She is a remarkable girl and I was never aware of any nausea. She didn’t mention it, although she felt run down for a few days. The doctor also gave her a note so that if her condition worsened while we were away, we could take her to the local Accident and Emergency and she could present it there. Fortunately, we didn’t need it.

So we went away and had a good time for two weeks. We overdid things a couple of days – went walking too far – so she got tired and the rash on her legs got a bit worse but on the whole she was fine. One of my high points was her on the beach going for swim in her bikini even though it was freezing; she can be determined at times and even shamed me, the world’s biggest wuss, into the sea. She wasn’t worried about the rash on her legs and, to be honest, it was not too obvious. I have changed the photo (solarised of course) on the side bar because she looks so fabulous in swimwear.

After the two weeks we came home and we’ve quickly got back into the habit of visits to the clinic (Monday) and treatments (today).

On Monday, I took her to the clinic. She had a list of questions for the Consultant written down on a piece of paper. She asked them and he answered them. Then he said that he wanted her to have the next Cyclophosphamide drip today when she was to come in for her final Iron Infusion (giving Iron Supplements by intravenous drip), so he arranged that with the pharmacist. The blood test results from two and a bit weeks previously showed an improvement and she had noticed that the protein in her urine had dropped too.

I was at work today and she got her Dad to drop her and a friend, to keep her company, at the hospital for the treatments. He then came home and she texted him when she was ready for collection.

As she got out of the car, she caught her fingernail in the car door and ripped it out a little (sorry if you’re squeamish). She took herself straight to A & E, where they patched her up, and she still made it for the Iron Infusion appointment with 5 minutes to spare. She got the nurse to use the “magic cream”, to numb her a little before they put the drip in. She’s so organised: she keeps everything she needs, with a list of drugs she is taking and various other useful pieces of paper, in a folder and takes it with her.

She is also becoming a world authority on Henoch Schonlein Purpura. I’m so proud of her!

Links:
Cyclophosphamide
Topical Anaesthetics

Discharge from hospital and the aftermath

The day after her biopsy, Jenny was discharged from hospital. I went into work that day (the first time that week) and her father went to collect her. She was supposed to be discharged at 11 that morning but they had to wait for the drugs she had been prescribed:

Ramipril to lower her blood pressure to take the stress off her kidneys and lower the amount of protein in her urine.
Ferrous Sulphate to replace the iron she had lost.

to come up from Pharmacy and she didn’t leave until mid-afternoon.

When I got home from work that day, her rash was pretty bad and her joints were swollen but she was home and in reasonable spirits.

The following day, Friday, I went to work again and when I got home, there was a marked improvement. Her joints and feet were back to normal size and the rash had faded considerably. She was looking much, much better and I genuinely believed she was on the mend.

I took her shopping on Saturday because she was positively stir-crazy but we overdid it and the rash and swollen joints came back with a vengeance. This was not going to be as easy as I had thought.

That was March 31st this year and I have learned so much about the nature of the illness in the 3½ months since. HSP clears up spontaneously in the end. Sometimes it takes weeks, sometimes months and sometimes it will take years. It can come back as well but it tends not to be so severe as the first time.

HSP is basically the inflammation of the blood vessels. They become weak because they are swollen and bleed… into the skin (hence the rash), into the joints (hence the arthritis), into the stomach (stomach ache) and in the kidneys. There are other effects but I am not familiar with them because Jenny has not suffered them.

The rash has been Jenny’s constant companion since March. Sometimes it is bad, spreads to her arms, practically covers her lower legs and she gets lesions (the skin is broken); sometimes it is not so bad and it looks like pale freckles. The arthritis has not been particularly bad since the early days and the stomach ache has come and gone but not with the severity that she experienced at first.

The main area of concern is her kidneys. The doctors have kept an eye on her kidney function during regular Renal Clinic appointments. At first, they were doing fine and the biopsy result came back normal but a few weeks ago, her Creatinine levels shot up.

Creatinine is a good indicator of kidney function. It is a breakdown product of Creatine Phosphate in muscle and is filtered by the kidney. This means its levels in the blood show how much the kidney is filtering out. The doctor decided to put Jenny back on Steroids. Steroids have loads of side effects and he prescribed drugs to deal with them too:

A mild anti-biotic because she is now more prone to infection.
An anti-fungal because she is now more prone to fungal infection.
Calcium chews because the steroids are attacking her bones.

She is also on anti-cholesterol medication because losing protein into the urine results in higher levels of cholesterol. She has to take 16 pills a day, some of them enormous. She is getting better but it is proving a long winded process.

Links
Creatinine
Steroids

The Biopsy

On the Wednesday, Jenny had a biopsy of her kidney. All the blood results had come back normal but there were blood and protein in her urine and the Consultant, Dr C, wanted to be able to check her kidneys properly to make sure they were not being damaged by the disease.

Before the biopsy, the doctors did their rounds of the ward. One of the doctors was accompanied by some medical students and he asked me if they could look at Jenny’s rash because it was such a good example of a purpuric rash. I had no problem with that and neither did Jenny, so the two students, both young women, examined the rash and then pressed down on it to see if it blanched under pressure. I offered the use of a glass (knowing the drill for checking to see if your child has meningitis) but there was no need really.

The doctor asked the students if they could hazard a diagnosis and it was frankly gratifying when one of them volunteered “Henoch Schonlein Purpura?” It not, after all, a particularly well known disease and I felt an almost maternal pride in her for getting it right.

Sometime after that, Jenny was taken to the treatment room to have the biopsy. The doctor asked Dr C if the two medical students could sit in on it but he said no, he didn’t want to have the room crowded. Instead, I went in with Jenny and Dr C, the man who was going to check the biopsy and a student nurse.

First Jenny had a scan on her kidneys. I was fascinated. I had had scans for all three of my children so I remember what they were like. The image on the computer screen was fantastic and her kidneys would not have looked out of place on a mixed grill. Jenny had to lie on her front with her stomach propped up by two or three pillows. She’s a very slim girl and that was the only way to get the kidneys into a position where they could do the scan and biopsy.

After that, she had a local anaesthetic to prepare her (i.e. numb her) for the biopsy. I’ve never had one of these injections but I’ve heard they’re very painful. Jenny was by now very nervous and I don’t think that helped at all. She held my hand with one hand and the student nurse’s hand with the other. As Dr C injected her, she nearly broke my fingers, poor lass. She has assured me since that it hurt like hell.

Once the area was numb (and he checked by dabbing her back with a needle), he made a small incision through her skin and muscle into the kidney and took the first sample. Unfortunately, that was not a good sample so he had to take another and then another. The third one was fine and we later found out that the kidneys were still in good shape. Dr C said that doing the biopsy was difficult because she was in such good shape.

After that, she was moved back to the bay and she had to spend the next six hours flat on her back, drinking as much fluid as she possibly could. If she needed a pee, she would have to go in a bed pan. The nurses had to check her blood pressure every 15 minutes at first and then at longer intervals. I watched the monitor nervously, worrying in case her blood pressure dipped significantly. I helped her drink by giving her a drink through a straw at regular and extremely frequent intervals.

In the evening, Jenny was moved to another bay because her bed (or the space it was in) was needed for a patient who was coming up from the Critical Care Unit. As they wheeled her away, I smiled and waved at the old lady opposite. She smiled and waved back. It was strange because we had not exchanged any words at all but I really didn’t like to go without any acknowledgement of her existence.

We made sure that Jenny’s new television was activated and then we went home. She was due to be discharged the following day. I was going to go back to work and my husband would bring her home.

Links:
Renal Biopsy
Purpuric Rash

The Renal Ward

I went back to the hospital early the next morning. I didn’t want to leave Jenny on her own for too long and the doctor had mentioned giving her a biopsy on her kidney so I wanted to be with her for that.

She was a little better; the swellings had subsided and she was much more comfortable after a night’s rest but the rash was as bad as ever. I kept her company on the ward for as long as possible but she was very bored so we decided to go for a walk. I asked the nurse if a porter could bring a wheelchair up to the ward so we could go and get a coffee and go to the hospital shop.

A little while later a porter arrived with the chair and I helped Jenny onto it. Now, I don’t know if any of my readers (a very small number, I know) have ever tried to push somebody in a hospital wheelchair but I would strongly recommend you to try it if you haven’t already. It’s great fun. The chairs are designed to go off course at the slightest thing, especially if there is a wall, a doctor or a fellow patient in the way.

Taking Jenny to the lifts was a very interesting experience for the two of us because I really had not got the hang of it and the wheelchair went in every direction apart from forwards. Going down in the lift was also an experience because, although I didn’t need to push the wheelchair, I am very uncomfortable indeed in lifts. Then I had to push her along the main corridor to the main entrance, where I would be able to buy her a coffee and we would be able to have a look round the shop.

The wheelchair would insist on banging into the walls (thus explaining their battered appearance) and I spent most of the journey giggling. A few people told me to turn round and pull the chair but I prefer to see where I am going and I quickly reverted to going forward and bashing into walls.

I parked Jenny up near the coffee shop and went and got us both a coffee and something to eat (we both have bottomless pits for stomachs). Then we went to the shop. I think they should have designed the shop so that novices can wheel hospital wheelchairs around it. There was not that much space and I was far more wary of banging into goods than into walls. There were also far too many corners and not enough room to manoeuvre. Still, I managed to do it without breaking anything.

At one point a lady asked if Jenny has Psoriasis. The rash on her legs was in full view and was particularly livid at the time. I explained that Jenny has HSP and how the rash had formed. She was particularly sympathetic and said that she has Psoriasis and showed me her rash. We talked very briefly about it and she disabused me of some of my misconceptions about Psoriasis. All my knowledge about the disease comes from an interview with Dennis Potter that I read a few years ago.

After that we stocked up on necessaries: sweets, biscuits, crisps and fizzy pop. The hospital could supply Jenny with healthy food after all. On our way back up the main corridor, somebody suggested I pull the wheelchair and walk backwards for about the fifth time that day. A passing ambulance man told me to keep going the way I was and said that it is far safer to push the wheelchair as she could fall out if I pulled it. I felt vindicated.

I took her back up to the ward and we spent the rest of the day in companiable boredom. There were 3 other people in the bay, all considerably older than Jenny. Next to her was very confused woman, who I think had Alzheimer’s Dementia. She was very hard work for the nurses but it is understandable. She was receiving medical treatment and having various procedures and she clearly didn’t know what was going on. It must have been very difficult for her. She was much, much calmer when her husband visited her, which would have a knock on effect on the whole bay.

Opposite Jenny was another elderly lady. She was no trouble at all and would sit in bed or in her chair for hours on end, saying nothing. When she did speak, it was very quietly indeed. I took a big shine to her, possibly because of the contrast with Jenny’s neighbour.

The other lady in the bay was an Asian lady. She did not speak very much English, which meant that the nurses sometimes had difficulty explaining what they were doing. Fortunately, some of the doctors were able to speak to her in her own language and she had plenty of visitors who were able to translate for her. Her visitors were great because Jenny’s neighbour didn’t always receive visits and the Asian lady’s visitors would go over to her to check she was alright and to give her some companionship. 

Sometime during the day, a lady from Patientline came round the ward and got Jenny’s television and phone working. The television was free because Jenny is only 16. This provided her with another source of entertainment and we would able to telephone her. She would not be able to ring us, though, because there was only a very limited amount of free time available and thereafter she (or rather, we) would have to pay.

In the evening, Jenny had visitors: her dad and older sister, Chloe, came to visit. I went home and had some tea first and then we all came back together. Jenny was in a far better frame of mind than the day before and was much more comfortable physically. We all went home a little earlier, leaving Jenny watching her television.

Links:
Psoriasis
Dennis Potter
Alzheimer’s Dementia
Patientline

Jenny and The Medical Assessment Unit

We got to the hospital at about 10.30. I really hate going into places I don’t know well and I felt very awkward indeed. Somebody, possibly an ancillary, pointed us in the direction of the Day Room and we went there and a sister called Sharon asked us to sit down. She booked Jenny in and asked us to sit down. A little later, she took Jenny’s details, measured her blood pressure, pulse and temperature and then sent her back to sit with me. She said that a doctor would see Jenny a bit later.

We were in for a long wait but I had made sure we had come prepared and we both had books to read. Fairly early on, I noticed a male nurse working in a room across from the Day Room and he looked extremely familiar. I quickly identified him as my former manager from work. He came over to us and said Hello. It was really good to see him again and possibly the best thing about seeing him was how well he looks now. We had a quick chat but he had work to do and had to go on his way.

The Day Room gradually filled up during the morning. Some people came in on foot, some in wheelchairs and some were brought in by ambulance staff and paramedics. I got chatting to one gentleman, who had had a hip replacement a week or so earlier. It appeared that there may have been some kind of complication. He found walking difficult but fancied a Mars Bar, so I went to the vending machine for him. He spent much of the rest of his stay there singing my praises and telling people I was an angel. I do respond well to flattery! 

There was also a girl there, about 18 or 19, and my heart went out to her. She looked as though she had been beaten up. She also had deep slashes down both forearms so I assumed she was a self-harmer. She had been hooked up to a drip and spent some of her time walking around with it. She sat down in the Day Room at one point for a rest but then started talking. I quickly realised she was talking to voices in her head. My brother-in-law is schizophrenic and hears voices too. I felt so sorry for her; when she wanted to sleep, they would start talking to her. She was getting annoyed with them. Unfortunately, Jenny got scared of her. I reassured Jenny as well as I could but she was not comfortable until the girl had gone.

People were assessed by clinical priority so some had to wait longer than others. Jenny had a relatively short wait before she was seen by a doctor. The doctor examined her, asked questions and took some blood for testing. She used a much larger needle than Jenny was happy about and took a reasonably large amount of blood. Poor Jenny.

We were both given lunch at dinnertime. We had already been treated to a cup of tea. I don’t know why but tea always seems to taste nice in hospitals. They can drown it in milk and not leave it to brew any time but it still tastes good. Anywhere else, I would hate it.

In the late afternoon, Jenny was examined by more doctors, including the one who had seen her in the morning. One of the doctors works in the Renal Unit and he wanted the Renal Consultant to see Jenny. The blood results had come back normal but there were blood and protein in her urine, which was not a good sign.

Jenny had been sat in a chair all this time and her feet had swollen really badly. She was uncomfortable and now was frightened too. She began to cry because she was so worried. I think the strain must have taken a toll on me too because seeing her like that started me off too. I couldn’t reassure her because there was nothing to reassure me and I’m a hopeless liar.

Suddenly, we were surrounded by nurses and sisters. They were able to reassure her (and make her laugh too) and that had a knock on effect on me. The sister who had booked her into the unit told her that a very nice kidney doctor (the one who had seen her already), who was very sweet and looked just like a chipmunk (and who happened to be standing behind her taking it all in) was going to get the Renal Consultant to see her.

She did get to see the Consultant and he was fantastic. He confirmed the diagnosis of Henoch Schonlein Purpura and told her they were going to get her a bed on the Renal Ward because one of the main concerns with the disease is the effect it has on the kidneys. He also told her that he wanted to take a biopsy of one of her kidneys to see how much they had been affected so far. He warned her that she would surrounded by old people in the Renal Ward (and he was right, she was).

She went back to her chair to wait for the bed and while we were waiting, her Dad and older sister came in to wait with us. Some time later, she was taken up to the Renal Ward and put in bed. Thereafter, her mood improved considerably, although her feet were badly swollen now and the rash had got much, much worse. I left her at about 11pm after I had shown her how to buzz for a nurse if she needed the toilet. She was no longer able to walk without assistance.