They don’t teach you about this in carer school – how best to manage an acute, chronic condition on a weekend when frontline health services are either unavailable or greatly reduced?

If you’re eating, you may wish to look away now.

MW has an issue with her bowel, i.e. it doesn’t function properly at all.  Her MS-affected nervous system causes her intestine and bowel not to move correctly and the medication she takes to counteract pain – opioids, etc – list constipation as a side effect.  It’s touching cloth…sorry, touch and go as to whether I enrol her into Constipates Anonymous, where she can say “Hello, my name is [redacted] and it’s been 14 days since my last significant stool”.

I’m not taking this lightly.  I’m trying to make light of a situation that, frankly, is making me fucking seethe.

You see, she takes a lot of medication to deal with her bowel problem.  Oral softeners and laxatives by the shovelful.  None of which seem to have made any difference at all.  In the last few days, community nurses have given an enema and a suppository.  No effect.  Last Friday, the nurse team asked for a stronger enema to be prescribed.  I had to go out, leaving MW in the capable hands of the carers, expecting to return home to a card from the chemist asking me to pick up the item the following morning.  Got home.  No card.  Hmmm…..fair enough.  I’ll just go to the chemist in the morning and see if they’ve had a prescription faxed through.

Later that night, I get a message from the carers telling me that the GP rang while I was out and spoke to MW.  Bear in mind that this is MW’s named GP and that MW has little understanding of conversations or memory.  And that this GP – who has access to her full medical history – should be fully aware of this.  I ask MW about the call and, sure enough, I was met with a blank look.  From what the carers know, a prescription was sent to a chemist which I should pick up.  So I did.  Yet another oral laxative.

Long story short – I’m sitting here on a Sunday night, waiting for an ambulance to take MW to hospital on the recommendation of an out of hours GP.  MW still hasn’t shit.  It’s making her extremely sleepy – more so than usual.  I rang 111 (non-emergency out-of-hours NHS line) at 3pm.  I’ve been triaged twice, explained the situation to a nurse for half an hour, gone through the whole bloody thing again for a further half hour to a doctor and told that MW should be taken to hospital for an X-ray to see if there’s a blockage.  An ambulance has been requested.  MW has been waiting in her wheelchair for five hours.  Not as comfortable as she’d be in her recliner chair or bed.  I’m expecting a third call apologising for the delay and telling me that the ambulance service is under extreme pressure due to emergency calls.  Fair enough.  I get that they’re underfunded and overstretched.  But my main concern is that even if the ambulance arrives right this second, MW is going to have to wait for another 2-3 hours in A&E before being seen by a doctor.  There’s little prospect of an X-ray being carried out tonight.  The GP already told me that there’s no bed available for her to be admitted.  So, in effect, she’s going to go into a 15th day of no bowel movement.

The thing about this is that it’s not trivial.  Any exacerbation of one symptom has a knock-on effect on everything else MS-related.  Particularly fatigue.  That’s the beauty of a condition that affects the entire nervous system.  Something seemingly innocuous can have a severe knock-on effect on everything else MS-related, e.g. fatigue, breathing, regurgitation of food/liquid and subsequent choking/aspiration.

There’s no guidance for carers on what to do in these situations.  We make it up as we go along and hope to fuck that we don’t make a mess of things.  It’s a matter of trust.  And I’m running low on healthcare professionals that I *can* trust.