Sunday, February 3, 2008

Things Can Change in a Matter of Minutes!

Saturday my grandmother went to a women's ministry luncheon at her church. The day before, she had her hair done at the hairdresser's, and she had me go to the store and get her the ingredients to make a pie. Saturday night, she phoned several people and visited with them, and then at 9:30 p.m., she called my mother, too sick to even get to the front door to unlock it. She was vomiting and had diarrhea, and she said her left arm hurt. My mom called me and said, "I'm not sure what to do." I picked up Mom at her house and we went to my grandmother's to assess the situation. It was obvious she needed to go to the ER. She refused an ambulance - "they will want to put in an IV and they'll bruise my hands." Her veins are small, and she does have trouble if the IV is not inserted expertly. So we helped her put on sweat clothes on over her pajamas, zipped her into a coat, and I quickly made a "bed" in the back of my Jeep, folding down part of the back seat so she could lie down and Mom could sit beside her.

Blood work, a chest x-ray and 3 hours later, Mam-ma was still vomiting and having diahhrea, and the diagnosis was in... strep throat, extra fluid in one lung signalling the onset of pneumonia, a UTI (urinary tract infection) and gastroenteritis. She had no symptoms of the first three infections... several days ago her throat had been a little sore, and she often has a persistent cough, but nothing extraordinary... and she had no symptoms of the UTI. The doctor offered to do "whatever you wish," meaning he could send her home or ask her doctor to admit her. I told him we wanted her admitted. At 95 and living alone, she could not go home in that condition, and while we could stay with her, I felt she needed medical attention. He was more than agreeable to this scenario.

By 2:00 a.m., the nurses had Mam-ma settled into a room, all of the questions had been answered in triplicate, all of the forms were signed, and Mom and I left her to rest for what was left of the night.

Thankfully, after my post of a couple of days ago, I had taken my own advice and updated Mam-ma's lists of medications, important numbers, etc. After last night, I came home and updated again - adding a list of her surgeries; allergies; chronic problems like arthritis, a thyroid problem, some mini-strokes, frequent headaches, high blood pressure, etc.; and the fact that she has a pacemaker, takes an aspirin every day, and that her normal body temperature is 96.4 degrees. The nurses were impressed and thanked me for having that information on one concise sheet for them.

Once a few years ago when I had to take Mam-ma to the ER, she was not feeling well, of course, and the nurse had the typical litany of questions. When she got to the question "have you ever had any surgeries?" Mam-ma looked up and said, "Now honey, you've got all that S#*T in your computer, so just go look it up!" Last night, she had reminded me of this when we were waiting in the ER (although she conveniently left out her expletive!). So when the floor nurse asked Mam-ma if she had ever had any surgeries, Mom and I just looked at each other and started laughing. Then we had to explain to the nurse, who thought we were perturbed at so many questions. Once we shared the story, she understood and got a good laugh, too!

So now my grandmother is resting and getting rehydrated and treatedwith IV fluids and antibiotics. She seems to be over the nausea, but she still is having trouble with the diarrhea, so she is very weak. The nurse indicated she felt the doctor would keep Mam-ma there several days. I hope so.

Those of you who know me know that I am really "big" on having an advocate with you at the hospital. While I have felt really comfortable with the level of care Mam-ma is receiving, and each shift has brought us a nurse who had connections to our family and knew my grandmother well, there have been moments when an advocate was needed. After all of the vomiting, I was surprised to discover this morning that Mam-ma's breakfast tray was a "regular" tray with eggs and coffee and orange juice. She said the liquids tasted good, although I questioned the wisdom of such high-acid drinks for her at that stage. She got soup for lunch, but for dinner, her "regular, no-restrictions except salt" tray contained baked fish, broccoli/cauliflower/carrots, rice casserole, cole slaw, fruit cocktail and a roll! The nurse who delivered it said, "try to eat all you can." I questioned the wisdom of this menu for a woman who still has such severe diarrhea, and they showed me the orders on her chart... "regular" meal, with no restrictions other than "low-salt". I nicely but insistently asked if she could have something more bland, and the nurse did bring her more chicken-noodle soup, and she ate a few bites. The nurse agreed that a bland diet for a few days might be better, and she said she would pursue this, so I will check again when I return.

I left so that Mam-ma could rest, and hopefully she will sleep well tonight. I am still amazed at how she went from attending a luncheon at noon to being in the ER with three infections and such a serious "bug" less than 12 hours later. You just never know what will happen with a 95-year-old!

So my "lessons of the day" are:

  1. to reiterate the importance of having an up-to-date list of all medications and medical conditions, especially allergies, and to be familiar with medical history or have an accurate accounting of it on paper.
  2. to advocate for your loved one. You may feel like the "Queen B" but their well-being is the bottom line and the only thing that truly matters.
  3. remember to never let your guard down when dealing with seniors... things can change in a matter of minutes!

Monday Night Update
Mam-ma Polly is apparently better, because she is C-R-A-N-K-Y!!!! When I went in she had her finger in the air shaking it at this young blond girl with a fistful of papers saying, "What I really want is a piece of cornbread and a glass of buttermilk!" Turns out somehow Mam-ma got flagged as a "New" CHF (congestive heart failure) patient, and this girl was the dietician, there to go over a low-salt, low-fat diet for heart patients with her. The LPN came with Mam-ma's tray and she was distracted and the dietitian pointed to buttermilk on those pages and whispered, "let's not say this word out loud, but this is a no-no." I questioned why she was reviewing all of this and discovered the "flag" and I explained that Mam-ma was not a new CHF... that she has had CHF for years. We don't know how she got this on her chart. I told her Mam-ma has a cardiologist, a pacemaker, and the whole nine yards.

So, for supper they brought her a chicken breast on a bun with lettuce and purple onion rings, a tossed salad with cherry tomatoes and carrots, and french fries and more applesauce. The dietician immediately said, "don't eat those greasy french fries." Well, Mam-ma took one bite of the chicken and ate her applesauce, and that was that. The LPN brought her a Sprite. I went to the desk and talked to her RN and told her about the broccoli/cole slaw, and the ham at lunch, and that I had called the doctor's office, and the doctor's wife (who is the receptionist) was going to talk to the doctor about this, and I said, "Look, she has to have something to eat, and tonight she got blah, blah, blah (and named it all)," and her RN changed the orders to a bland diet. So Mam-ma will be mad at me tomorrow!*lol* Then the nurse showed me that they have not only got soups, but they also have peanut butter, crackers, puddings, and yogurt. Mam-ma agreed to some chocolate pudding, and she ate several bites but said she didn't want it. Did I mention she is cranky?!*lol*

The dietician was still at the desk, and I told her, "I don't mean to be rude, but she is 95, and I buy her a half-gallon of buttermilk nearly every week, and if she wants to drink buttermilk at this stage of the game, I am not telling her she can't!" She said she didn't blame me. She also told me her TV was "dark" and she couldn't see it. I tried to adjust it so that it would work for her and she could possibly watch "Wheel of Fortune." She said my cousins, Lori and Rick, had called and were coming back tonight, so that will give her some company.

Oh, and she said, after her pudding, "Now I have to go to the bathroom." I went to get a nurse, and when I got back, she was halfway out of bed. She said, "I didn't wait earlier today... that nurse came in and I told her I couldn't wait, so I just got myself up." I helped her up as the LPN appeared, and I told her Mam-ma couldn't wait, and she said, "That's fine... she's been moving around really well today, and as long as somebody is in here with her, that's fine." Well, I'm not sure somebody always IS in there, but I can't be there 24/7, so we will pray she doesn't fall. Maybe she will improve faster than we expect and avoid the whole nursing home scenario. Hey, I can dream, can't I?!

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