My mum had a scheduled home visit with her palliative doctor on Tuesday. It’s always only Dr Rose. This time there was Dr Carmen, who recently joined Beacon Hospital. And, nurse Ruth. She was present to do my mum’s blood test. A once every three-month arrangement.

Dr Rose’s home visit routine starts with questions about how my mum has been/is feeling. If my mum’s in a cheeky mood, her response would be as ‘the/her’ doctor she should know. Instead, she explained that walking from the bed/sofa to the bathroom made her breathing difficult. She also had/has occasional headaches and phlegm. 

Dr Rose checked my mum’s vital signs. Mainly, the blood oxygen saturation level and pressure. The oximeter registered 70.  Second try. 70 again. Third try. 68. Finger malfunction. Dr Rose thought maybe my mum’s arthritic finger was resisting/halting the reading. She tried the toe. Too large. I offered my oximeter. Same reading. No improvement. Through all these, my mum was chatting away. Both doctors looked concerned. Anyone else would be gasping for air. Not my mum. Dr Rose did a clinical examination.

Concurrently, nurse Ruth was ready to take blood. Without notice, she tugged at my mum’s arm. Dr Carmen caught my mum’s incredulous expression, and immediately alerted her. Nurse Ruth promptly described to my mum the procedure required to take blood. At that point, my mum, in jest and in fluent English, (yes, her English improves several notches in certain situations) said to Dr Rose that she must provide better training for her staff/colleague. She also gently told off nurse Ruth for being too familiar. Nurse Ruth had apparently touched her arm like a family member would when greeting her up close. All four of us – Dr Rose, Dr Carmen, nurse Ruth and me – were in stitches. We were bowled over by my mum’s cheekiness, who was still clocking a stubborn 70 on the oximeter. Actually, nurse Ruth does know my mum well. She has taken blood many times over the years. Short term memory is not one of my mum’s stronger points.

What does a persistently low blood oxygen saturation level mean for my mum, I asked? Dr Rose explained it could result in pulmonary embolism or pulmonary edema. Neither is good. At that juncture, my mum coughed, and it sounded chesty. There was almost an aha moment from the two doctors. Why? Maybe phlegm in the lungs caused the unexplainably low reading. I liked their theory. It was better than the other two diagnoses. But … my mum hadn’t/didn’t produce phlegm all week. Her sputum was mainly frothy and runny. Nevertheless, Dr Rose suggested a sputum sample. I agreed. After a long wait, my mum managed a half-hearted globule of phlegm.

The care plan for the week was to administer 3% saline nebulizer, thrice daily. Combivent when needed. Fluimicil one tablet, twice daily. And, Bisolvan one tablet, thrice daily.  Dr Rose advised that I monitor the symptoms clinically. If suggestive, to start on antibiotics. The last instruction bothered me.

I got the blood test result on Wednesday. My mum had borderline high inflammation. All other readings were generally normal. Dr Rose again advised me to monitor symptoms clinically. If suggestive, to start on antibiotics. Again, the last instruction bothered me. My mum’s saturation level was over 90.

On Thursday, I texted to check on the sputum culture test result. Four considerations were buzzing in my head. One. My mum was not producing yellow phlegm but her blood test indicated inflammation. Two. She was responding well to the extra medication. Three. She was on an antibiotics regime just last January. Four. The sputum result was still pending. I consulted Dr Rose. She advised to wait for the sputum test result before initiating antibiotics. Yay.

Friday. Sputum result in. Normal. The instruction was to continue watching my mum clinically. If needed, start antibiotics. ‘Might be in early stage so not enough to detect.’ I got the text just after 1pm. My clinical observation told me there was no need for antibiotics as the extra medicines kept the phlegm at bay, and improved the saturation level to 93-95. Yes, there was some laboured breathing after exertion but that was normal. By late Friday, the sentence, ‘Might be in early stage so not enough to detect’ was all consuming. After enough conversations in my head, I caved. What if my clinical observation was wrong? What if I had missed something? What if..? At 10.30pm, I gave my mum the antibiotics. I felt a sense of relief. I texted Dr Rose, and updated her on the antibiotics status. Yes, after 10.30pm on Friday night.

I am responsible for my mum’s wellbeing. The antibiotics conundrum plagued me since Tuesday. The decision, to start or not to start, weighed heavily on me.

I honestly don’t know how/what I’ll do when more critical decisions have to made.