Sunday, September 5, 2010

Things Can Change in a Heartbeat

I've been reminded this past week just how quickly things can change, particularly when it comes to senior citizens.  One week ago Friday, my mom ran errands for my grandmother and took her to the beauty shop, so that my husband and I could go to an estate auction out of town.  We took my husband's mother along.  My husband was so attentive and hauled our purchases to the car for us, got us cold bottles of water from our cooler and even brought his mother a lawn chair to sit in and rest.

The auction was a BIG one, and it lasted until well after lunch time.  We had our Yukon packed to the rafters with purchases.  My mother-in-law was particularly excited about a box of beautiful china dishes she got that were made in Germany.  She also got  an old foot locker to refurbish.  We enjoyed a late Subway lunch with her afterward before we headed home to unload our purchases.

By Sunday, Greg's mother was complaining of back pain.  She and her friends bought hand weights to use when swimming at our new Community Center pool, and she had used them for the first time on Thursday ... and she said she and her friends exercised pretty vigorously.  Then we stood a lot of the day for the auction on Friday.  On Saturday, she worked in her garage, standing on a concrete floor to sort the things in her boxes.  Somewhere in there, she got her electric lawn mower from underneath the house and mowed some high patches of grass in her yard.  And during all of this activity, she twisted her back badly ... to the point that she was sore on Sunday and in a lot of pain by Monday.  She started taking Aleve ... and lots of it ... but the pain was still fierce.

Her pain progressed each day to the point that by Wednesday morning, she was vomiting and dizzy.  The doctor was called, and he said, "Go to the ER."  My mother-in-law had never been to the ER ... will hardly take an aspirin.  She decided to wait a while and see if she felt better - and I truly think she did for most of the day.  But by the evening, she was worse, so my husband stayed with her for the second night in a row.

By the next morning, the pain was again so bad that my mother-in-law was dizzy and vomiting any time she tried to sit up.  So my husband called an ambulance and transported her to the ER.  The diagnosis was sacroiliitis, which the ER doc described as "excruciatingly painful."  He prescribed bed rest and several medications:  pain pills, muscle relaxers, steroids, and an anti-inflammatory drug.  She is not to stand or sit for long periods of time, nor bend over or lift more than 10 lbs.  The doctor said that once you have this, it's much easier to get it again and/or re-injure yourself.  So my mother-in-law, who is incredibly vibrant and active and belies her 84 years, will have to make some serious lifestyle changes in order to avoid further injury and pain, once this episode is over.

Meanwhile, my grandmother's dear friend and fellow church member - a man she depended on for everything from changing light bulbs to supplying her with fresh produce from his garden (not to mention wonderful friendship) - passed away Friday from cancer.  He had taken his wife and Mam-ma to a local Visitor Center to hear a musical performance last Saturday night ... sat with fellow church members at an after-service fellowship reception on Sunday night.  By Tuesday, he was in a Little Rock hospital, where he died Friday morning.

These two events have given me pause.  How did things change so quickly from one Friday to the next?!  How did a woman who was buying German china and old trunks end up flat on her back and incapacitated a few days later?  How did a man's cancer progress so quickly that he ate with friends one Sunday evening and was dead and buried before the next weeks' morning worship?

The point for those of us who are caregivers is that everything is fluid.  What is going smoothly this minute can be totally screwed the next.  Two winters ago, my grandmother attended a birthday party for a friend one Saturday afternoon, talked with my sister that evening around 7:30, and by 9:30 she was violently ill.  She ended up in the ER with five infections and was not only hospitalized for about 5 days ... she was then sent to the nursing home for more than a month of rehab!

So just because today is a good day doesn't mean everything is rosy or you can get complacent.  You have to stay on top of your game ... and ready for anything.  Just like your small child's fever can spike in a half hour - an elderly person's whole world can change in a matter of minutes.  In order to "keep all the tops spinning," you must be prepared and "bring your A-game."

And one more thing... while we were at the ER, I was once again reminded of the importance of taking an advocate along.  My mother-in-law was given Valium to ease her discomfort and make her more relaxed.  So when the radiology technician came to prep her for a CT-scan, there was no way she could answer the 2-page questionnaire concerning her medical history and health concerns.  Thankfully I was able to do this for her.  AND... since I had gone with her to her last doctor visit, I knew that there had been some question about her renal function ... and a discrepancy in her blood work.  I mentioned this to the tech, and she said, "Ohhh!  We're not going any further with the CT-scan until I see the results of the blood work."  Since the CT-scan required an injection of dye, it was important that the radiology tech be alerted about even a possibility of some problem with the kidneys.

Furthermore, when the diagnosis was made, the doctor began talking about medication and going home, and my husband and I questioned him about his mother's pain.  She had arrived by ambulance, unable to move without being dizzy and/or throwing up.  Six hours later, the doctor wanted to send her home by car and start oral medications that we were to go and collect at our local pharmacy.  My husband asked, "Why can't she have something for pain in the hospital and let it have time to work before we leave?"  My question was, "Why can't an 84-year-old woman who lives alone and is about to be given heavy medication for excruciating pain be admitted to the hospital for a few days?" 

The answer to my husband's question came down to a matter of liability ... if she was medicated and left - and then fell in her garage getting into the house and broke her hip, the hospital didn't want to be held responsible.  Apparently they thought it was better for her to get into a car, ride across town, get out of the car, walk into her house up several steps, and then get to her bedroom and into bed and then take pain medication when we could get it from the pharmacy.  We didn't get this answer all at once in this concise manner ... but rather through a period of hems and haws and hints that led to our ultimate deduction that liability was the concern.

The answer to my question was, "There are certain criteria that have to be met for hospital admission, or Medicare and other insurance won't pay.  If we admit her, we can't guarantee she will meet all the criteria and be totally covered."  This seemed absurd to me... I have no doubt that between the ER doc and the personal physician, some finagling could have been done to assure that my mother-in-law met the criteria ... if she didn't already! And while I appreciated their concern about her money, this was not the issue at the moment!  Again, I felt there was an attempt to cover the hospital and any liability.  And people think we don't need health care reform!

So ultimately, we left the decision up to my mother-in-law, and she opted to get some pain medication in the ER, give it time to kick in, and then go home.  My husband signed a paper saying we relieved the hospital of any liability for the pain pill.  Don't get me wrong ... I do not like hospitals.  I was not necessarily advocating my mother-in-law stay ... but at the same time, her medications would have been monitored, she would have been given food and snacks that fit her dietary restrictions, and trained professionals would have hopefully monitored activities such as getting out of bed to go to the bathroom, showers, and more.  To be so hesitant to admit her seemed ridiculous to me ... but paled in comparison to failing to treat her pain and sending her home in the same shape as she arrived.  And had we not been with her ... or one of her elderly friends or a neighbor had brought her instead of us ... this is exactly what would have happened.

To top it all off, her discharge instructions included being told to that her family physician wanted her to be "in his office in the morning at 8:30." 

My husband decided he would wait until the next morning and see if his mother could even get out of bed before considering whether to make this trip.  The next morning, he telephoned the doctor's office to see if he could determine why the doctor wanted to see his mother, and the nurse said, "That's crazy!  She spent six hours in the ER yesterday - why would we want to see her today?"  Needless to say, the trip to the family physician's office was cancelled.

I cannot say this loudly enough, DO NOT LET YOUR LOVED ONES GO TO THE DOCTOR'S OFFICE OR THE HOSPITAL UNATTENDED.  Virtually everyone needs an advocate to go with them for medical exams and consultations, and you absolutely cannot leave someone alone in the hospital for any length of time.  Don't let the medical staff intimidate you.  Ask questions, and stand your ground.  Don't leave until all of your questions and concerns have been satisfactorily addressed.  If anything sounds strange or doesn't add up, ask about it. 

Be sure you make the medical staff aware of any and all medical conditions or anything else you feel is important and would affect the patient's care and treatment. Do not be intimidated or bullied by health care professionals.  Be polite, but firm.  In my mother-in-law's case, the doctor had given his diagnosis, stated his opinion and plan for treatment, and left the exam room.  We had to ask the nurse to find him and ask him to return, so that we could question him further.  And this is perfectly within our rights... and yours. So often, the patient is in no condition to challenge anything or give information.  Advocates are vital to the health and safety of medical patients ... and the same can be said for those who are in nursing homes and assisted living facilities.

Think of it this way... if we were talking about an infant or a small child, we wouldn't even consider letting him/her go to a doctor or into an emergency room for treatment without an adult in attendance.  We shouldn't allow this to happen to a person of any age, but particularly older adults.  As the advocate, be vigilant and thorough.  Pay attention, ask questions, and stand up for your rights.  Your loved one's well-being - or very life - may depend on how well you represent them.


Mark said...

It is frightening how quickly health can go downhill. The human body is amazingly resilient, yet fragile.

Too many people are intimidated by doctors and other healthcare professionals. Often even if someone accompanies a friend or relative, that don't have the courage to speak up like you and your husband did (strength in numbers!). You also saw firsthand how influential the legal system has been in shaping healthcare in our country. Just sickening sometimes.

Heather Mundell said...

Wow - excellent advice! I can't believe the skills that are necessary to be an informed patient these days! Thank God your MIL had you and your husband to be her advocate. Really good post.