Listen to the family
5 voices: RN, Clare Conway (patient’s daughter), Mr Brown (patient), Dr Maxwell (JMO),
Dr Shore (VMO)
Scene i
Background noise of busy ED
Clare (patient’s daughter) (talking to RN at front desk):
I don’t know if I’ve overreacted by coming to the Emergency Department at this time of
night, but I’m really worried about Dad. Just over the last day or so, he’s become very
confused – he’s not himself at all. I know there’s something not right… and I was worried
about what might happen if he got worse in the night…
RN:
Not a problem – it’s best that we see your dad if you’re concerned. If you’ll just fill out these
forms… a doctor will be with you shortly.
Clare:
It asks here about medications – I’ve brought his Webster pack in so the doctor can see
exactly what he’s taking at the moment…
RN:
OK, I’ll just put it over here for now for safe keeping. Don’t forget to mention it to the
doctor.
Scene ii
Junior medical officer (Dr Maxwell):
So, Mr Brown, you haven’t been feeling quite yourself?
Mr Brown:
I think I know you – I’ve been an ambulance officer here at King Edward Hospital for years,
you know. You would be Dr Prentice, I think…
Dr Maxwell:
No, Mr Brown, I’m Dr Maxwell, and this is Glendale Hospital. Let me start by checking you
over, and we’ll get some blood tests underway. (to Clare) And you are…?
Clare:
Oh, I’m Clare Conway – Mr Brown’s my father…
Dr Maxwell:
And does Mr Brown live with you, Mrs Conway?
Clare:
No, my husband and I have just moved Dad up here from Sydney. He’s in a self care unit at
the retirement village. It’s been a big change, but he wasn’t really managing on his own in
Sydney. But he has always been quite alert – and now suddenly he’s started behaving really
oddly. Particularly over the last day or so, since we’ve moved him into the unit... he seems
to be getting more and more confused... He doesn’t seem to remember who we are, or
where he is…
Dr Maxwell:
Well, as I said, I’m going to get some blood tests done, and I also need to know about his
past medical history, and any medications he’s taking. You say he’s just shifted up from
Sydney? Who was his GP in Sydney? I’ll call the practice and get a health summary sent
through.
Clare:
It was the Delta Street practice at Eastlands – and Dr Irvine was his GP. Here’s their card
with the number on it. Oh, and doctor – I brought Dad’s Webster pack in with me, so you
could check his pills. I gave it to the nurse at the front desk in Emergency when we came in.
Dr Maxwell:
Thank you, Mrs Conway – I’ll get this health summary information request under way now,
and we’ll take some blood samples. You’ll have a little time to wait while we get this sorted,
but we’ll be as quick as we can. In the meantime, just try and relax and get comfortable, Mr
Brown.
Scene ii
Dr Maxwell (talking to VMO on the phone):
Dr Shore, I’m sorry to bother you so late at night, but I have a patient here that I’d like
discuss with you. He’s an elderly gentleman just recently moved here to Glendale, and his
daughter’s brought him in because his mental state has significantly deteriorated, and he’s
become quite confused…. Yes, I’ve done basic bloods – his sodium levels are way down –
only 125. Everything else seems normal…. Yes, I have his health history from his Sydney GP,
and I’ve charted his usual medications… He’s supposed to be taking a thiazide diuretic,
Frusemide, Slow K and Lanoxin. Oh, and some Panadol Osteo for back pain….So you’re
suggesting I cut out the diuretic? And limit his fluids to 1800 mL? OK, I’ll get him admitted
now. No, it will have to be the surgical ward – apparently there aren’t any beds in the
medical ward… And you’ll see him in the morning? Thank you very much. What? Oh yes, it’s
been absolutely hectic – in fact, I’ve just been paged to assist at an emergency C-section.
But I’ll get Mr Brown’s admission sorted before I go up to theatre…
Scene iii
VMO (Dr Shore):
So how are you feeling this morning, Mr Brown?
Mr Brown:
Oh, Dr Prentice, it’s good to catch up with you again. I thought I saw you at dinner last night,
but perhaps I was mistaken… To tell you the truth, I ‘m not feeling very well at all. It’s my
heart, you know. It’s thudding and thumping and feels like it’s about to stop at any moment.
And I feel quite groggy… You weren’t here last night, were you?
Dr Shore:
No, I wasn’t here last night, Mr Brown. Now let me just take a look at your chart. (Speaking
quietly to herself) Hmmm… Well, the sodium levels are normalising – that’s good. But the
rest of these obs aren’t great. I wonder why you’re showing signs of bradycardia and
hypotension? Dr Markwell didn’t say anything about those being present when you were
admitted. I think we should transfer you to the medical ward – we’ll set up some cardiac
monitoring and telemetry… And I’d like to have a chat with your daughter…
Scene iii
Dr Shore: Good morning, Mrs Conway. I’m Dr Shore, the visiting medical officer. Dr
Markwell asked me to pop in and take a look at your dad this morning. How do you think he
seems today?
Clare: Oh, Dr Shore – I’m so glad to see you! I’m really worried about Dad. He doesn’t seem
to be improving at all. He’s still very confused. And now he says he’s not feeling very well –
And I’m worried about all the pills he seems to be taking. It’s a lot more than he took before
he came into hospital. Has more medication been prescribed for him?
Dr Shore: No – we’ve really just been following the medication list we got from his GP in
Sydney, with a little adjustment to some of the levels.
Clare: Well, I don’t understand it. He’s taking things I’ve never seen him take before. How
can that be?
Dr Shore: Mrs Conway, I see in your dad’s notes that you brought his Webster pack with him
to Emergency. It would have come up with all his other things when they brought him to the
ward. I think we need to locate that Webster pack and take a closer look at what’s in it.
Scene iv
Dr Shore: Well, Mrs Conway, I can see immediately that there is almost no resemblance
between the medication list we’ve received from your dad’s GP in Sydney and what’s in this
Webster pack. Are you SURE this is his latest medication pack?
Clare: I’m positive, Dr Shore – we brought everything out of his unit. This was the only kind
of Webster pack he had. And I know this is all his tablets. He just takes them straight from
here. He doesn’t have any other pill bottles or packs anywhere. The pack was to make it
easy for him to remember to take everything he needed.
Dr Shore: Well, there are certainly some major discrepancies here, and that may explain
your father’s lack of improvement...