Belfast City Hospital to the Children’s Hospice

Belfast City Hospital to the Children’s Hospice

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I love this photo of Leah.

Sometimes when I look back over everything that I’ve written in this blog about the care that Leah and I received during her illness, I worry that I haven’t said enough about all of the good care that we experienced.

I worry especially that I haven’t said enough regarding the many excellent staff that looked after us in Belfast City Hospital.

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There are a few possible reasons for this:

Our first impressions of the City Hospital were very negative and I think that this in some ways coloured my subsequent perceptions.

Secondly, I always struggled with what I considered to be the lack of age appropriate care in an age appropriate environment in Belfast, for our fifteen year old daughter.

Thirdly, my emotions were in tatters during the two and a half weeks that Leah was dying in ICU in the City Hospital and that obviously coloured the lens through which I interpreted everything.

When Leah was in Bristol Children’s Hospital and developed complications post transplant, she was prescribed pain relief in the form of  tramadol and oramorph – a derivative of morphine. I was slightly alarmed at this and had visions of my daughter becoming a junkie!

The doctor reassured me however and explained that a bone marrow transplant had very severe effects on the body and initially all of her pain receptors would be in a state of heightened awareness, so that any pain that she experienced would feel quite severe and needed to be treated as such.

This actually made sense to me. I noticed that Leah had also become quite “sound sensitive” and couldn’t cope with any noise – even a dripping tap drove her crazy.

Well, whenever Leah was dying in ICU, I reflected back on this and compared it to how I was now feeling emotionally.

I felt as if all of my emotional pain receptors were in a state of heightened awareness.

During Leah’s final weeks, there were three things that I desperately wanted from the hospital staff:

1) To be allowed to remain at my ill daughter’s bedside continuously.
2) To be kept fully informed of her medical condition and their treatment decisions.
3) For any staff that came in contact with me to show kindness and an awareness of my needs as Leah’s Mummy.

When what was happening to me did not meet the above criteria, my emotional pain transmitters started firing and at times this felt unbearably painful.

However, when all of the above criteria were being met, I felt calmer and I found it much easier to cope.

I have to say, that most of the staff were very kind.

Those that got it right for us got it very right.

We had got off to a shaky start (at the time of diagnosis) with our haematology consultant, but Leah & I quickly put that behind us when we discovered how kind and caring he really was and is.

Our TYA (Teenage and Young Adult ) Cancer Nurse Specialist and our Clic Sargent Social Worker were there for us every step of the way and they were an enormous source of support to both of us. I don’t know how we would ever have managed without the two of them.

Most of the nurses were incredibly kind and caring, I wish that I could name them all and thank them individually.

There was two women who regularly cleaned the hospital during the night. They always had a smile and a kind word for me – they will never know how much this helped.

Sometimes, when a doctor wanted to talk to me, I was taken into the ICU office and two or three other members of staff piled in and watched while the doctor was talking to me. I detested this audience.

I was never told good news, so here I was, being told things about my daughter’s medical condition and life expectancy, that no parent ever wants to hear, struggling to maintain my dignity, while all of these pairs of eyes were fixed on me.

I would like to have been asked who I wanted to accompany me to meet with the doctor. I would most likely have chosen my TYA cancer nurse specialist, if she was available.

On another occasion, one of our favourite consultants was on duty, a young man who never failed to treat Leah and I with respect and compassion. When he wanted to speak to me, he “smuggled” me out of ICU and down a corridor and through another unit and into what looked like a store cupboard, far away from inquisitive eyes.

There, he gently, falteringly, explained to me that he really didn’t think that Leah was going to survive. Oh how I appreciated the respect that this doctor showed to me and his compassion. No, I didn’t want to hear what he was telling me, but it was so much easier to hear, when the information was delivered in a context that showed an understanding of my needs.

The day that Leah was being admitted to ICU it was the lovely consultant from Cork who assessed her, admitted her to ICU, then broke the news to me that my daughter was possibly going to die.

On Wednesday morning 15th January ’14 when we were in an end of life situation and Leah’s medical condition was rapidly deteriorating, the consultant from Cork, who always treated Leah and I with such dignity and respect, was mercifully once again on duty.

This incredibly compassionate man uttered the words that I will never forget “I’m off tomorrow morning – I will use this time to transfer your daughter to the N.I. Children’s Hospice.”

48hrs prior to this I had been told that under no circumstances could our daughter be transferred to the Children’s Hospice for her end of life care, as she was on a ventilator and too ill to be moved. I had found this very distressing as, if our daughter was going to die, we did not want her to die in critical care or even in an acute hospital setting.

When I was pregnant I was encouraged to write a “birth plan“. www.nhs.co.uk states “Use your birth plan as an opportunity to explain the things that really matter to you. However, remember to be flexible and recognise that things don’t always go to plan.”

Well, when Leah was dying I wanted a “death plan” – it was going to be my last act of love for my dying child. Of course, the “politically correct” term for this is an “end of life care plan”.

We have a large extended family who all needed the opportunity to say goodbye to Leah and she herself just loved big family get-togethers. No ICU anywhere could possibly have accommodated all of us. Least of all the ICU in Belfast City Hospital which does not even have a ‘relatives room‘ on site.

The Children’s Hospice was the only place that could accommodate our family’s needs and provide the type of end of life care that I wanted for Leah.

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No, I didn’t want our daughter to die, of course I didn’t, but I thank God for all of the kindnesses that we experienced through it all, for the many people who touched our hearts along the way.

Leah was looked after by eight different consultants during her time in ICU, they all provided excellent medical care. They all cared about my daughter and they did everything humanly possible to save her life.

However, for me it was very special that the same kind, caring consultant from Cork (my hometown) who took Leah into ICU on the 27th December 2013, was the very same consultant who took her out of it and brought her to the N.I. Children’s Hospice on the 16th January 2014.

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Peace Restored

Peace Restored

In the early hours of Thursday morning the 16th January 2014, I left Leah’s room in ICU and walked back through the winding hospital corridors, to my room in the Cancer Centre, for one last time.

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I knew exactly what lay ahead for us as a family that day.

My entire body felt like lead. Walking along those corridors felt like trying to propel my limbs through deep water.

Leah had been on a ventilator for two weeks and she had been unconscious for the past four days.

I was already missing her terribly. When she was awake on the ventilator, she had found creative ways to communicate.

All of the tests had confirmed that Leah’s body was now “broken beyond repair”.

Leah’s CT scan images had been scrutinised by the top experts in both Belfast City Hospital and Bristol Children’s Hospital.

Two of the consultants in Belfast had sat surfing the internet until midnight, searching for any potential remedy that hadn’t already been tried.

Hundreds of churches and thousands of people, all over the world, had been praying.

Nevertheless, it was now abundantly clear, that Leah’s story was only going to have one ending.

At 8.30am that morning, an emergency ambulance was booked to transfer Leah and myself, along with three ICU staff, to the N.I. Children’s Hospice, where all of our loved ones would be waiting.

There Leah’s life support would be withdrawn and we would say our final goodbyes.

I packed my bags and sat on my bed.

I felt numb, empty, desolate.

I lifted my iPad and clicked on Facebook.

There I discovered that Leah’s friend Matthew had put together a beautiful YouTube video, of various photos of  Leah taken over the past year, interspersed with inspirational messages and backed with the song “It is well” by Hillsong.

I could scarcely breathe as I watched and listened:

“But Lord it’s for Thee
For Thy coming we wait
The sky not the grave is our goal
Oh trump of the angel!
Oh voice of the Lord!
Blessed hope
Blessed rest of my soul!

It is well with my soul
It is well
It is well with my soul

You are the Rock
On which I stand
By Your grace it is well
My hope is sure
In Christ my savior
It is well with my soul”

A peace flooded through me.

I knew without a shadow of a doubt, that it was well with my daughter’s soul.

I slept for a few hours then.

In the morning I left that room for the last time.

Normally the staff on that ward in the Cancer Centre were friendly and welcoming to me, but they must have been very busy, for as I slipped in and out that morning, nobody spoke to me or seemed to notice me.

I felt alone and invisible.

At 7.20am as I stepped into an empty lift to head down to ICU, feeling very alone and vulnerable, I heard a text coming in on my phone.

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It was a work colleague from a previous job – her act of kindness in texting me at that exact moment was precisely what I needed.

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The remainder of that day is described in my blog post How Could We Ever Have Let Her Die In An Unplanned Kind Of A Way

This is the YouTube video that I watched that night:

 

Leah’s birthday in ICU

Leah’s birthday in ICU

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This was Leah with her Dad on her 16th birthday on the 31st December 2013.

There was no party, no cake, we didn’t even sing “Happy Birthday”.

Leah was exhausted from the effort of trying to breathe. She struggled to even keep her eyes open.

I kissed her and told her how precious she was and how much we all loved her. I said that we’d have a big party when she got home.

This is what I wrote on our Facebook blog @ 8am that morning:

“Leah’s oxygen levels & breathing remained stable over night. They are alternating 1hr of the face mask CPAP with 3hrs using the nasal prongs. Leah prefers the nasal prongs. We both got a few hours sleep. Thanks for all your prayers & supportive messages. Visiting is of course restricted in ICU & many of you live far away but modern technology brings your loving support directly into Leah’s room.”

Lots of people sent birthday wishes by text, facebook, card or email. All of these were read out to Leah.

On Thursday 2nd January ’14 Leah went on a ventilator. By Friday this had helped her body so much that she was awake and keen to communicate.

Photography was strictly forbidden in ICU but like many young (and not so young) people, Leah loved taking selfies.

On the morning of the 3rd January, when Leah was using her iPad, she pulled my head down beside hers and ‘click’ – there it was, we’d broken one of the rules of ICU.

It was usually quite difficult for Leah to type, as the medication that she was on blurred her vision.

Not on this occasion – Leah uploaded the photo to Facebook and typed out:
Didn’t exactly plan my sweet 16 birthday or the New Year to be like this but thanks to everyone whose been praying. I love you mummy ❤ 🙂

Such precious beautiful words.

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A time to be born and a time to die

A time to be born and a time to die

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In Bristol Children’s Hospital the cleaning staff always knocked and asked our permission before entering Leah’s room to clean it. If we indicated that it wasn’t a good time they would go away and came back later. If Leah and I were snuggled up together in her hospital bed watching a DVD then the nursing staff often apologized for intruding. Shortly after Leah was admitted to the Bone Marrow Transplant Unit there I was quite taken aback when our very senior haematology consultant even apologized for disturbing us when he came to see Leah!

However once Leah became an adult (i.e. over 16) and was in the adult ICU in Belfast City Hospital, there were times when I felt like the intruder. Now I was the person on the outside knocking and asking permission to enter. I hadn’t changed but the environment had changed, policies and procedures had changed, and my heart was breaking.

In Bristol when Leah was ill I provided all her personal care, showered her, dressed her, changed her bed linen etc. The nurses administered her medication, worked the pumps, nasogastric feeds etc. It never occurred to me that it would be so different when we returned to adult services in N.I..

On Thursday morning 2nd January I could see that Leah’s oxygen levels were dropping and that she was finding it increasingly difficult to breathe. I knew that putting her on a ventilator was the likely next step. I was asked to leave the ICU for doctor’s rounds so I went and had breakfast in the hospital cafe – I liked their warm and frothy cinnamon milk.

Shortly after my return to Leah’s side-room the consultant on duty called me into a separate room. He explained that Leah was critically ill and that they would have to put her on a ventilator to help her breathe. He said that this would entail giving her a general anesthetic & keeping her fully sedated for at least the first 24hrs or maybe more.

He said that because she was so ill she might not even survive the process of being put on the ventilator. He also said that she needed some essential blood products before being ventilated in order to reduce the risk of death and these weren’t available yet so it would be 1-2 hrs before they could go ahead with the procedure. I knew that this unfortunate delay could further increase the threat to her life.

I asked the doctor if I could stay and hold her hand until the general anaesthetic had been administered and she had gone to sleep. He replied that this wasn’t possible as he had equipment to set up and I would be in his way. He continued talking, explaining other aspects of her situation, but I couldn’t concentrate. My stomach was churning. My child was possibly going to die. He was going to put her to sleep and I couldn’t be there to provide reassurance and comfort until the anaesthetic took effect. The last face my child would see would be his face and not mine.

I wanted back in to see Leah, knowing that every moment was precious, but right now my breakfast was threatening to make a reappearance and there was no relative’s toilet in ICU. I excused myself and made my way through the convoluted set of corridors until I reached the public toilets in the hospital foyer.

Thankfully the disabled toilets were available – I didn’t want an audience. I locked the door and gripped the sink as the walls spun round me. I closed my eyes and tried to slow my breathing. This was awful – just awful.

About 20min later I had finally regained my composure and could return to my daughter. I sat and read to her and prayed with her and we listened to her favourite Christian music on her iPad. Due to some difficulty in sourcing the very specific blood products Leah needed, it was a couple of hours before the doctor came and put us out of the room. During this time of waiting, Leah’s oxygen levels continued dropping and the machine that was monitoring her stats was frequently alarming. I wondered at one stage if Leah was going to live long enough to even go on the ventilator.

The Bible says in Ecclesiastes 3:2 “There is a time to be born and a time to die” and thankfully this was not Leah’s time to die.
On Monday 13th January Leah’s oxygen levels were again dropping and she was again finding breathing difficult although this time round she was already on a ventilator and she was awake.

Thankfully a different consultant was on duty – one who didn’t mind me being with my child & giving her comfort while he worked through the crisis. He tried many different approaches to help her with her breathing difficulties until the only option left was to fully anaesthetise her for the last time. While all of this was happening I comforted her by holding her hand and stroking her head. The last face that Leah saw before going to sleep was mine and it was a face so filled with love for my daughter.

Leah remained fully anaesthetised until she was transferred to the N.I. Children’s Hospice on Thursday 16th January to spend her final moments in peace and dignity surrounded by the love of our large extended family and a few very close friends.
It’s so hard to explain how in the midst of the terrible sadness of my daughter’s death I still feel an incredible sense of God’s perfect timing.
Another song that Leah and I loved comes to mind, it’s “Sovereign Over Us” by Aaron Keys
There is strength within the sorrow, There is beauty in our tears
You meet us in our mourning, With a love that casts out fear”

As Leah’s Mummy I must consider all possible options

As Leah’s Mummy I must consider all possible options

Leah had her CT scan of her lungs this morning and it showed a significant deterioration since the CT scan done just over two weeks ago when she was already very ill.
The doctors are not hopeful that she will recover.
It is good to continue to hope and pray for a miracle.
However as Leah’s Mummy I must consider all possible options.
Today I have been talking to some professional people who can give advice and guidance regarding end of life care should this be what lies ahead for us.
In an end of life situation ideally I wouldn’t want things to “just happen” – I would like there to be a plan so that there can be dignity for both Leah and for our extended family.
If we don’t need any of these plans it will be wonderful.
In the meantime Leah will be kept fully sedated because the mode of ventilation she currently requires would be uncomfortable for her if she was awake.
The Drs have no new treatment options and will continue with her current treatment plan unless or until she recovers or deteriorates further.
God is in every tomorrow,
Therefore I live for today,
Certain of finding at sunrise,
Guidance and strength for the way;
Power for each moment of weakness,
Hope for each moment of pain,
Comfort for every sorrow,
Sunshine and joy after rain.”
Leah takes a selfie

Leah takes a selfie

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Visitors are not allowed to take photos in ICU but Leah took this “selfie” this morning.

She is very awake but comfortable & making very determined efforts to communicate via her iPad but it’s complicated by the fact that the muscle relaxants have made her vision a bit blurry.

She says that being on the ventilator is easier than when she was struggling to breathe. Leah’s oxygen levels have continued to improve & I am hugely relieved as they certainly weren’t looking so good yesterday, either before or after she went on the ventilator.

I try to choose my words carefully when writing on this Journey page, I’m too tired and befuddled to remember all the ICU consultants names so I have secretly given them nicknames – today we have Mr Happy – they haven’t all been allocated complimentary titles!

Thank you to those who asked – I slept reasonably well last night & feel fairly well rested. I have use of the lovely room in the Cancer Centre over the weekend if I want it.

Leah used her iPad to put this photo on her Facebook page and underneath she wrote the words “Didn’t exactly plan my sweet 16 birthday or the New Year to be like this but thanks to everyone whose been praying. I love you mummy “

 

Leah is now fully ventilated

Leah is now fully ventilated

Doc has been out to say that the procedure has been successful.
Leah is now on a ventilator & fully sedated.
The ventilator will do the breathing for her while we wait for the treatment to work.
They have also taken samples from her lungs to test for bacteria, viruses and fungi just to be absolutely sure that they have her on the right treatments.
After a day or two they will reduce the sedation so that she can be more aware of her surroundings while she is on the ventilator.
Doc says that patients usually adjust quite quickly to being on a ventilator & cope reasonably well with it.

 

Does this man have kids?

Does this man have kids?

Just before 2pm they put Nic and me out of the room so that they could start the process of putting Leah on the ventilator.

The Doc wouldn’t let me stay with Leah until they administered the anesthetic that would put her to sleep because he said that he needed space to set up his equipment and I would be in his way – does this man have kids?

We left Leah awake and cuddling “Duckie” & “Bristol Gromit”. I thought my heart was going to break saying goodbye to her but I had to hide my emotions for Leah’s sake.

They said that they will call us back in about an hour. Nic, Leah & I have spent the last couple of hours listening to Leah’s favourite praise & worship music on YouTube; mostly Rend Collective Experiment & especially “My Lighthouse” – verse 2 goes

“In the silence, You won’t let go
In my questions, Your truth will hold
Your great love will lead me through
You are my peace in the troubled sea
You are my peace in the troubled sea.”

We also read from Rainbows for Rainy Days written by Catherine Campbell and Streams in the Desert.

Never Once Have We Ever Walked Alone

Never Once Have We Ever Walked Alone

Our night was punctuated by dropping oxygen levels, Drs visits, nebulisers & retching.

Leah’s going on a ventilator around 12 or 1pm today and the biggest risk to her life will be during the process of installing the ventilator equipment in her body.

Once it’s up and running everything should be ok.

When Leah was 3 years old she came home from Good News Club and said that she had asked Jesus to forgive her sins & live in her heart as Lord & Saviour.
Since then Leah has sought to love and serve God with all her heart.
In April ’13 when Leah was diagnosed she said two things “God has a plan for my life” & “Mummy, we have to see the bigger picture”.
After the Dr had called me out of the room last Saturday to give me his “your daughter might not survive talk” Leah typed on her iPad “What did the Dr say” I answered her truthfully & in simple terms. She nodded her head & shed a single tear but showed no fear then or since.
Leah knows the truth of the Bible verse “To live is Christ, to die is gain.”
Of course Leah wants to live and I want – more than words can express – for my child to live, but it’s also hard to see your child suffer so very much.
I know that 100s maybe 1000s are praying for her healing and this is what I want, but I have to trust her in the hands of the one she loves & Who died on the cross for her & for us all.
“Never once have we ever walked alone”
Start of non invasive cpap

Start of non invasive cpap

I am very much appreciating everyone’s prayers & words of encouragement thank you.
Leah’s breathing is currently being assisted by something called “non invasive cpap”.
Drs have told us that a ventilator may eventually become necessary.
So far there has not been a significant response to the various treatments being used and this is worrying.
Leah’s own immune system also needs to be able to fight this infection but her immune system is seriously weakened due to her transplant.
This is a very challenging time & much prayer is needed & I know from your messages & texts that very many people are praying for us right now – thank you so much from the bottom of our hearts.