ER LÍKIÐ EKKI FARIÐ?

Skrifað um November 10, 2017 · in Almennt · 1,596 Comments

 

Um þessar mundir er ár liðið frá andláti konu minnar, Sólveigar Aðalbjargar Sveinsdóttur, (2.6.1948-15.11.2016). Það var á vordögum 2013, sem hún fann fyrir einkennum, sem síðar kom í ljós, að var upphaf að ólæknandi MND-sjúkdómi og myndi smám saman fara versnandi og leiða til dauða á þremur til fimm árum.

Hér verður ekki sagt frá, hve skelfilegt það var að standa frammi fyrir slíkum dómi. Á hinn bóginn þurftum við á mikilli aðstoð og ýmiss konar hjálparmeðulum að halda í löngum veikindum. Þar kom fjölmargt okkur svo mjög á óvart, að undrun má sæta. Það skal þó tekið skýrt fram, að flestir, sem við þurftum að eiga samskipti við, sýndu okkur hlýju og samhug, en engu að síður fór margt á annan veg en æskilegt má telja.

Það voru einkum fimm aðilar, sem komu að málum.

Í fyrsta lagi var það Heimahjúkrun Reykjavíkur, en tvær konur komu klukkan tíu að morgni og tíu að kvöldi Sólveigu til aðstoðar. Þessar konur unnu frábært starf og verður þeim aldrei nógsamlega þakkað fyrir dugnað, hlýju og aðhlynningu.

Í öðru lagi MND-teymi Landspítala, þar sem voru læknir, tveir hjúkrunarfræðingar, næringarráðgjafi og iðjuþjálfi. Því miður voru samskipti við teymið ekki hnökralaus, eins og vikið verður að síðar.

Í þriðja lagi Heimahlynning Landspítalans. Hjúkrunarfræðingur kom einu sinni í viku. Þar bar ein manneskja eins og gull af eyri og því miður hugnaðist Sólveigu ekki afskiptasemi sumra í þeim tíu manna hópi, sem skiptust á að koma.

Í fjórða lagi þurftum við að eiga ýmislegt undir Sjúkratryggingum Íslands (SÍ).

Í fimmta og síðasta lagi var sjúkraþjálfari, sem kom tvisvar í viku og vann ómetanlegt starf, bæði við að þjálfa Sólveigu og ráðleggja okkur, hvað bezt væri að gera hverju sinni.

 

LYFTUR

Í október 2014 var ljóst, að Sólveig þyrfti lyftu utandyra við íbúð okkar, sem við höfðum búið í frá 1978. Við ræddum það á fundi með MND-teymi Landspítalans og var sagt, að það yrði athugað. Á næsta fundi í lok janúar 2015 ítrekuðum við þá ósk. Okkur var þá tjáð, að sótt hefði verið um og neitun borizt frá Sjúkratryggingum Íslands (SÍ) í nóvember. Þetta kom okkur í opna skjöldu. Í ljós kom, að SÍ hafði sent neitun í svo nefnda „gátt” til Sólveigar, sem var henni algjör nýlunda og ókunn. (Sagt var síðar, að SÍ sendi bréf, ef gátt væri ekki opnuð, en það barst aldrei.)

Okkur var boðið að kæra þessa niðurstöðu, en þar sem sótt var um án þess að láta okkur vita, vissum við ekkert, hvað stóð í umsókninni, og því erfitt að kæra þann úrskurð. Þetta var líkast því, að við værum ómálga börn, sem hefðum ekkert að segja um umsóknina. Eftir nokkur bréfaskipti fengum við að sjá umsóknina og úrskurður var kærður. Stuttu seinna fékk eg símtal frá SÍ, þar sem fram kom, að ekki yrði fallizt á beiðni okkar um útilyftu, þar sem a) aðgengi væri ekki gott í íbúðinni, b) þröskuldar væru til trafala, c) eldhús væri lítið, d) baðherbergi alltof lítið, e) ekki væri rými fyrir rafmagnsstól, f) við hefðum ekki reynt að selja íbúðina og g) lyftan sinnti ekki frumþörfum (hvað svo sem það merkir). – Vitaskuld mótmæltum við þessu, enda algjörlega órökstutt. En það sem vakti furðu okkar var, að þessar upplýsingar um íbúðina voru komnar frá MND-teymi Landspítalans, sem sótti um lyftu í nafni Sólveigar.

Sem betur fer eigum við væna fjölskyldu og voldugan hóp vina. Meðal þeirra eru hönnuðir, iðnaðarmenn, verkfræðingar og arkitektar, sem var gott að leita ráða hjá. Þeir töldu ekkert því til fyrirstöðu að búa þarna áfram. Það var einfalt verk að rífa þröskulda burt, í eldhúsi voru sæti fyrir 5, en nú vorum við bara tvö, svo að auðvelt var að rýma þar til. Til þess að fullvissa okkur um, að nægt rými væri fyrir rafmagnsstól fengum við einn slíkan að láni frá Stoð, og það sýndi sig, að komast mátti greiðlega um alla íbúðina. Þá vorum við tilbúin að breyta baðherbergi, ef þess gerðist þörf. – En þetta dugði ekki, SÍ varð ekki haggað. Því var ekki annað í boði en að kaupa sjálf lyftu.

Við lyftukaup kom tvennt til álita. Annars vegar kaupa nýja lyftu eða hins vegar að falast eftir gamalli lyftu hjá SÍ, sem lá þar í geymslu ónotuð. Um helmings-munur var á kostnaði. Þrátt fyrir ítrekaðar fyrirspurnir til SÍ gekk seint og illa að fá svar við því, hvort lyftan væri föl eða ekki. Það þurfti hvorki meira né minna en 14 símhringingar um miðjan marz 2015. Loks kom svar og urðum við að greiða lyftufyrirtæki, sem hafði milligöngu um kaupin, rúmar 400 þúsund krónur fyrirfram til þess að lyftan fengist sett upp. Það má skjóta því hér inn, að eg skrifaði bréf til um tuttugu manna í „stjórn-kerfinu” og bað þá um að hreyfa við málinu á „æðstu stöðum”, en hvort það virkaði eða ekki er mér ekki kunnugt, en jákvætt svar barst fljótt þar á eftir að við mættum kaupa lyftuna.

SÍ stóð fast á sínu og neitaði að taka þátt í kostnaði. Við kærðum þá ákvörðun til úrskurðarnefndar almannatrygginga og svo fór að nefndin dæmdi okkur í vil, en þó ekki fyrr en síðla í ágúst. Okkur var gert að greiða 10% af uppsetningu lyftunnar, sem kostaði rúmar 400 þúsund krónur; (verkfræðingur, sem spurður var álits, taldi 150-200 þúsund hámark;) og einnig kostnað við að tengja rafmagn. Þar kom reikningur að upphæð rúmar 60 þúsund krónur, sem við neituðum að borga, og var hann lækkaður í krónur 12 þúsund, enda þurfti aðeins að bora eitt gat í vegg og leggja þar snúru.

Hefðum við beðið eftir úrskurði nefndarinnar án þess að aðhafast nokkuð, hefði Sólveig verið fangi á eigin heimili hátt í níu mánuði.

Að því kom, að nauðsynlegt var að fá lyftu inni á baðherbergi. Þar þráaðist SÍ við í rúma sex mánuði vegna þess, að þeir töldu baðherbergi of lítið. Eg sendi teikningu af íbúðinni og þó að þar mætti lesa að herbergið væri 140 cm á breidd, las starfsmaður þar, að það væri aðeins 90 cm og ekkert rúm fyrir lyftu. Það var ekki fyrr en við fengum til liðs við okkur verkfræðing, sem er sérfræðingur í lyftum, að SÍ féllst á að greiða fyrir því að lyfta yrði sett upp og tók þetta ferli um hálft ár.

sjukratr

HJÓLASTÓLAR

Snemma þurfti Sólveig á hjólastól að halda. Eitt sinn, þegar hún beið eftir að máta hjólastól, spurði hjúkrunarfræðingur hana: „Kvíðir þú fyrir að fara í hjólastól?” „Ég veit alveg, hvað það er,” sagði Sólveig, „ein bezta vinkona mín, sem er nýlátin [Elín Snædal], var bundin við hjólastól og ég skottaðist oft með hana.” – Hjólastól fékk Sólveig frá SÍ, stóran og þungan. Eitt sinn fórum við einhverra erinda í Stoð, og þar kom starfsmaður, rak augun í stólinn, og spurði: „Þú ert í allt of stórum hjólastól, þessi er fyrir 100 kg karlmann; hvar fékkst þú hann?” Við sögðum sem var, að SÍ hafði látið okkur hann í té. Við gerðum okkur þetta ekki ljóst, en var sagt, að það væri alvanalegt, að menn fengju bara það, sem til væri á lager hjá SÍ. – En úr þessu var þó bætt og fékkst nettur stóll, sem var þægilegur í meðförum.

 

Óhjákvæmilegt var annað en að fá sérstakan hjólastól til að fara á salerni. Það var starfsmaður Heimahlynningar, sem sótti um hann. Í umsókn stendur, að dyr inn á baðherbergi væru svo mjóar, að venjulegur stóll kæmist ekki þar inn. Í forundran spurði eg viðkomandi starfsmann, hvernig stæði á því, að hann segði það í umsókn, sem væri ekki sannleikanum samkvæmt. Hann svaraði því til, að það væri oft gert að lýsa vondum aðstæðum, svo að umsókn væri afgreidd fljótar en ella.

 

Að því kom, að Sólveig þurfti rafmagnsstól. SÍ lagðist ekki á móti því, þó að enn væri þar á bæ andstaða við útilyftu. Það var því nokkur ráðgáta, hvernig ætti að koma stólnum inn og út úr húsi án útilyftu.

Frá fyrsta degi sagði Sólveig, að það færi illa um hana í stólnum og hún gæti ekki setið í honum. Hjúkrunarfræðingur frá Heimahlynningu sagði, að það væri þekkt, að MND-sjúklingar þráist við að nýta sér hjálpartæki í fyrstu og hún þyrfti bara að venjast stólnum smám saman. Leið nú nokkur tími og ekki undi Sólveig sér í honum. Þar kom, að við báðum starfsmann hjá Stoð um að koma og líta á gripinn. Hann sá um leið, að hvorki sessa né bak hentaði Sólveigu og spurði, hver hefði eiginlega pantað þessa hluti. Við því áttum við ekkert svar. Hann sagðist þurfa að panta aðrar gerðir, sem féllu betur að líkama Sólveigar og tæki það um þrjár vikur. Eftir það sat Sólveig nær alla daga í stólnum og leið vel.

 

SAMSKIPTI VIÐ STARFSFÓLK

Það er eðlilegt, þegar engin von er gefin, leiti menn allra leiða til þess að ná einhverjum bata. Svo var með Sólveigu, að hún vildi prófa að fara í magnesium-sprautur til Hallgríms Magnússonar í Hveragerði. Eitt sinn í heimsókn hjá þeim lækni, sem annaðist hana mest, spurði Sólveig, hvort hann héldi, að það gæti eitthvað hjálpað að leita til Hallgríms. Læknirinn reisti sig upp og sagði hátt: „Sólveig, bull, bull, bull.” – Við þetta svar brast Sólveig í grát, en þegar við komum út, sagði hún: „Mér er alveg sama, hvað þessi h…. a… segir, það er hvað sem öðru líður miklu betra að tala við Hallgrím en hann.”

Síðan gerðist það, þegar við komum í viðtal næst á eftir, að hjúkrunarfræðingur segir við Sólveigu, að nú þurfi hún að ræða við þennan lækni. Í ljósi þess, sem hann hafði sagt áður, segir Sólveig eitthvað í þá veru, að það sé „ekki uppbyggilegt að tala við hann”. Augljóst er, að hjúkrunarfræðingurinn hefur komið þessum orðum til skila, því að umræddur læknir ræddi ekki við Sólveigu eftir þessa heimsókn, þó að hún ætti nærri tvö ár ólifuð.

Fyrir kom, að Sólveig þurfti að leggjast inn. Eitt sinn fór hún á Landspítalann og fylgdi langur listi frá lækni yfir atriði, sem athuga þyrfti. Fór eg með til halds og trausts. Þá kom þar læknir og spurði formálalaust: „Af hverju ert þú hér?” – „Ég var boðuð hingað,” svaraði Sólveig. – „Var það út af heimilisástæðum?” spurði læknirinn þá, og fór lítið fyrir nærgætni í garð sjúklings. Eg benti honum þá á, að það stæði skrifað, hvað amaði að, en hann sagðist vilja fá það frá sjúklingnum sjálfum. – Þann tíma, sem Sólveig dvaldi á Landspítala, var vatnsílát við öndunartæki aldrei þrifið, svo að það var þakið brúnni slikju að innan, þegar heim var komið. Þá hafði næringarvökvi sullast á „sondu”-standinn og tekinn að mygla.

Skýrt skal þó tekið fram, að Sólveig fór að minnsta kosti tvívegis á Bráðamóttöku Landspítalans. Báðir læknar þar voru einstaklega alúðlegir. Sömu sögu er að segja frá Húsavík. Á sjúkrahúsinu var sérstaklega vel tekið á móti henni, og viðmót lækna og hjúkrunarfræðinga gjörólíkt því, sem var fyrir sunnan.

Tína mætti til ótal atriði, sem við vorum ósátt við. Hjúkrunarfræðingur frá Heimahlynningu kom með loftdýnu og fékk Sólveig þrautir í líkama við að liggja á henni. Reyndum við oft að benda á, að dýnan virkaði ekki sem skyldi, en fengum alltaf sama svar, að við hefðum ekkert vit á þessu, hún þyrfti bara að venjast henni. Þrautaráð var að hafa samband við seljanda dýnunnar og kom hann nær samstundis, leit á dýnuna og sagði hana ónýta. Þetta er aðeins eitt dæmi um, hvernig oft var staðið upp í hárinu á okkur og reynt í ljósi stöðu sinnar að benda okkur á, hvað við þekktum lítið til þessara hluta.

 

MATARLAUS Í ÞRJÁ SÓLARHRINGA

Eitt sinn hringdi eg í Parlogis, sem selur „sondu”-fæði, og pantaði mánaðarskammt. Þetta var á þriðjudegi. Daginn eftir er hringt frá fyrirtækinu og sagt, að leyfi fyrir afhendingu væri útrunnið. Við höfðum ekki hugmynd um, að það væri tímabundið. Eg spurði, hvað væri til ráða og mér bent á að hafa samband við SÍ. Þar á bæ var sagt, að aðeins væri „tekið mark á læknisfræðilegum rökum”. Haft var samband við forstöðukonu Heimahjúkrunar og hún sagðist biðja heimilislækni Sólveigar um nýtt vottorð með hraði. Á fimmtudag hafði ekkert vottorð borizt, svo að eg hafði samband við heimilislækni. Svar barst fljótt, sem hljóðaði þannig:

 

Beiðnin var send í gær [miðvikudag] í framhaldi af samtali við heimahjúkrun en var endursend með skilaboðum um að beiðnin þyrfti að fara í pósti á pappír. Það bréf fór í morgun.
Með kveðju”

 

Sem sagt, SÍ krafðist þess að fá vottorð á pappír, sem hafði það í för með sér, að Sólveig yrði matarlaus frá föstudegi til þriðjudags. Nú voru góð ráð dýr. Haft var samband við Landspítala (Fossvogi) og þar fékkst einn lítri af „sondu”-næringu. Síðan varð að kaupa LGG, súrmjólk og sitthvað fleira, sem talið var óhætt að gefa Sólveigu. Sem betur fer tókst að mestu leyti að brúa þetta „matarlausa” bil fram að kvöldi þriðjudags.

 

HVAÐ ER UNNT AÐ LAGA?

Hér að ofan hafa örfá dæmi af fjölmörgum verið rakin. Tilgangurinn er sá einn að sýna mönnum, hve illa er staðið að mörgum atriðum í heilbrigðiskerfinu og að brýn nauðsyn er að bæta.

 

  1. Ótækt er, að 10-14 manns geti sótt um hluti til SÍ án þess að sjúklingur eða aðstandendur fái að vita um það. Við fórum reyndar fram á að fá að sjá umsóknir eftir á og þar komu fram ótal villur eða rangfærslur; í einni umsókn stendur, að lofthæð á íbúðinni sé 151 cm og mjög þröngar dyr inn á salerni. Það var líkast því, að við værum ómálga börn, sem þyrfti að hafa vit fyrir.
  2. Afgreiðsla SÍ á einföldustu hlutum, eins og þverslá á hjólastól, gat tekið allt að sex vikur. Oft var eina ráðið að hlaupa til sjálfur og kaupa nauðsynlegustu hluti, enda kom nokkrum sinnum í ljós að þeir voru ranglega afgreiddir.
  3. Lítið eða ekkert samráð virðist vera á milli þeirra aðila, sem sjá um umönnun sjúklinga. Til dæmis var rangt lyfjakort gefið út af líknardeildinni í þrígang.
  4. Það er ólíðandi, að SÍ skuli nánast krefjast þess, að menn selji ofan af sér umhugsunarlaust. – Þetta minnir óneitanlega á hreppaflutninga á fyrri tíð.

 

 

AÐ LOKUM

Sólveig andaðist aðfaranótt 15. nóvember 2016 eftir rúmlega þriggja og hálfs árs baráttu við þennan skelfilega sjúkdóm, sem MND raunverulega er. Hennar heitasta ósk var að fá að dvelja heima og erum við þakklát fyrir að það gekk eftir. Þetta var óneitanlega erfiður tími, en við eigum því láni að fagna að eiga að stóra og öfluga fjölskyldu, sem stóð við bakið á okkur allan tímann, og ekki sízt er vinahópur mjög stór, sem veitti okkur óviðjafnanlegan stuðning hvar og hvenær sem var. Þá má heldur ekki gleyma sjúkraþjálfara, sem kom tvisvar í viku, svo og konum þeim frá Heimahjúkrun Reykjavíkur, sem voru boðnar og búnar til að veita alla aðstoð langt umfram það, sem hægt er með sanngirni að fara fram á. Án þeirra hefði lífið orðið mun þungbærara.

Við feðgar tókum þá ákvörðun að láta líkið standa uppi þann dag og gefa fólki kost á að eiga hljóða stund við dánarbeðinn. Það komu um 60 manns. – En klukkan hálf fjögur hringdi síminn. „Við erum að koma frá Sjúkratryggingum til þess að sækja sjúkrarúmið hennar Sólveigar,” var sagt rámri röddu. „Já, en bíddu við, líkið stendur hér enn uppi,” svaraði eg. – „Nú, er líkið ekki farið. Þá komum við bara seinna, blessaður,” sagði þessi ráma rödd og lagði á tólið.

 

Það kom þá í ljós seint um síðir, að þeir hjá Sjúkratryggingum Íslands geta haft snör handtök. En heldur þótti okkur það óviðfeldið, að Heimahlynning Landspítalans skyldi senda það út í tölvupósti strax að morgni, að Sólveig væri látin. Að ósekju hefði það mátt bíða, því að varla er það í þeirra verkahring.

 

Reykjavík, 10. nóvember 2017

Ágúst H. Bjarnason


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