Monday, December 12, 2011

What do Six Days, Five Doctors and Fifteen Pounds Have in Common?

The answer to this question can be answered in two words... Mam-ma Polly! 

When Timothy went back to his mother in Texas, Greg asked me, "What will you do with your spare time?"  It didn't take him long to get an answer!   Tuesday, December 6th, the nurse at Southridge phoned me at 4:00 p.m. to tell me that Mam-ma's blood pressure was high.  She said "I am going to give her the five o'clock blood pressure pill now and check her again in an hour, when it has time to work.  If she still has a high reading, I told her she has to go to the ER."  A little before 6:00 .m., the nurse phoned and said, "It's not as high, but it's still up there, and I think she should go to the ER.  She doesn't have any chest pain, but this reading is too high."  The top number had dropped from 167 to 142.  I don't know what the bottom number was, but it had been 104, I think, at 4:00 p.m.

So I gathered my purse and jacket and headed to Southridge to get Mam-ma. The nurse would have called an ambulance if I'd asked, but I figured I could get her there faster, and she seemed well enough to get in and out of the car.  It was "spitting snow," but we didn't have far to travel - less than 2 miles.  I drove Mam-ma to the ER, and I helped her get inside.  There were a few patients, but not many, and we were in an exam room by 6:30 p.m.  Her blood pressure now was something like 198/112, which didn't surprise me... but it stayed that high the rest of the evening.  The doctor assured me she was not having a stroke or a heart attack, but when asked, she did say she had shortness of breath.

The doctor ordered an EKG, a chest x-ray, blood work, and a urinalysis.  Sometime around 11:00 p.m., he said the x-ray showed fluid around the heart and a little in the lungs.  His diagnosis was mild CHF (congestive heart failure), and he said, "I'm going to give her IV Lasix and admit her.  She will need a catheter so she doesn't have to get up... we don't want to risk a fall."  I really liked the ER staff... especially this doctor, who we have seen before. He seemed to totally "get" Mam-ma - the fact that she is 99, and how delicate the balance is in her system.  I was quite surprised at how swollen her legs were.  She has had swollen ankles off and on for six months, but now her calves and even her knees were swollen.  The calves were red and shiny and looked like bratwursts that would burst if you stuck them with a pin!

Mam-ma's wonderful nurse got the catheter in and collected 400 ccs of urine.  Then she started the IV Lasix.  By the time we took Mam-ma upstairs to a room, it was midnight - and there was another 1300 ccs of urine in the bag.  The ER doctor said, "She is in incredibly good health for someone 99 years old, and we want to get her back to that and keep her there."  It looked like we were on the way.

By the time I left the hospital, it was just after midnight, and over 2" of heavy, wet snow had fallen... and it was still coming down hard.  Fortunately we live less than five minutes from the hospital, so I did not have trouble getting home - once I got all the snow scraped off my car windows!

I was back early the next morning to wait for the hospitalist.  I had been told they were on duty from 8:00 a.m. to 4:30 p.m., and I didn't want to miss this doctor.  He arrived somewhere around noon, due to icy roads, the nurses said.  I did like Dr. Quintinar, and he said Mam-ma was doing well - progressing.  About 3300 ccs of fluid had been collected.  Dr. Quintinar told me that he would not be back this week... his associate would see us on Thursday.

We did see a new doctor on Thursday - I was there at 10:00 a.m. - Dr. Lewis arrived around noon and started making rounds, getting to Mam-ma's room around 1:30.  He said he was ordering oxygen, and Mam-ma would have to wear it permanently to help with breathing.  No oxygen was ordered, and the next day, I asked him, "What about the oxygen?"  "Oh, yes... " he answered... "Oxygen... we will have to see if she qualifies for it."  This meant a test to see how she walked up and down the hall with and without oxygen.  The nurses said she did great... she did not need oxygen. 

Each day, the doctor would say, "Maybe tomorrow you can go home."  Mam-ma got daily physical therapy, which included walks in the hallways.  On Saturday, we saw a very kind Dr. Ruiz, who was quite intrigued with Mam-ma.  He gently stroked her face and hair and was very attentive and thorough.  He said, "You can go home Sunday or Monday."  Mam-ma told him, "You've disappointed me... I want to go home today!"  He replied, "Home is a wonderful place to be... but for now, this is your home."  He told me that the numbers were trending downward, but Mam-ma still had a little CHF. Also on Saturday, Mam-ma developed a little bit of a problem with getting to the bathroom in time.  I think it was probably all of the green veggies she had been eating all week... it seemed nearly every meal included a hefty serving of broccoli or mixed vegetables with broccoli.  Mam-ma told me, "I just LOVE broccoli!" which was news to me!

Sunday, we saw Dr. Konero.  If you have lost count, that's five doctors, counting the ER doc.  He ordered a stool sample to evaluate the bathroom issue before he would agree to dismiss Mam-ma.  This morning, all the stars aligned, and we got discharge orders.  Along the way, one doctor doubled one of Mam-ma's blood pressure medications.  Another came along and cut the other BP medication in half.  One discontinued her Lasix altogether after she lost almost 10,000 ccs of fluid and about 15 lbs... another reinstated it. 

In the end, we went back to Southridge with tiny ankles and a slender face and tummy... and the exact same medications and dosages we arrived with last week!  Dr. Konero said that Mam-ma seemed to be regulated on these dosages, and he ordered a daily weighing to monitor the fluids and a daily check of her blood pressure to determine whether or not she should get her Lasix pill.  As I helped her dress, she said, "These pajamas are gonna be too tight."  I told her, "I bet they aren't now!"  As they buttoned with room to spare, I added... "That's what losing 15 pounds will do for you!  I was reminded of all the times in the last months/years I have dressed Timothy as I helped Mam-ma into her pajamas and robe.

A nurse wheeled Mam-ma downstairs to the building entrance, where my wonderful husband had brought the car and parked it for us.  He helped us get her in the car, and two aides met us at Southridge with a wheelchair and got Mam-ma into her room and settled into bed.  She sank into her pillows and was almost instantly dozing.  I asked if her bed felt good, and she said, "Heavens, yes!"

So hopefully we will have a few days of quiet, rest, and recovery.  The RN at Southridge said she would order physical therapy for Mam-ma to help her regain her strength.  I am so, so grateful that Mam-ma is at the ALF and could return to such care and attention.  Had she been living at home alone, I am not sure what would have happened when she was discharged.  I know she was in no shape today to return to a home to live alone.

This afternoon, I counted my blessings and marveled at God's timing.  He allowed me time with Timothy before his return to Texas - time without having to dash back and forth to a hospital to check on Mam-ma Polly.  When Timmy left, God gave me a couple of days to collect myself - and finish our Christmas decorating.  Thankfully, while spending big chunks of each day at the hospital, I was not having to worry about Timothy - or leave him at home with Greg.  And now, I will hopefully have time to get things ready for Christmas - and Mam-ma will have time to regain her strength so that she can celebrate with us.  I even found time while sitting at the hospital to get all of our Christmas cards signed and addressed!

The one caveat I would offer about this week's experience was how CRUCIAL it is that you stay with a loved one who is in the hospital.  It was not necessary for me to stay with Mam-ma 24/7... due in large part to the fact that this is a very small town, and I literally grew up with many of her nurses and therapists - some of whom refer to her as "Aunt Polly" - so I trusted them to look after her in my absence.  But even with that, I did have to make several trips to the nurses' desk to ask for things she needed, and to check on lab reports, etc.  And I spent a great deal of time sitting and waiting for a doctor to make rounds. 

Had I not been there to get the reports, I would not have known that the changes in medications were being made... that one doctor said he was ordering oxygen and then apparently forgot.  I am not sure the order to weigh Mam-ma daily at Southridge would have ever made it onto her discharge papers if I had not stepped to the nurses' desk Saturday night and asked about it.

At the end of the day, things fall through the cracks, even with the best medical staff in the world.  I really, really liked the nursing staff.  I actually liked every single hospitalist and felt comfortable with each of them.  They were attentive and took plenty of time to listen to my concerns and answer my questions.  And this was important, because Mam-ma can barely get her thoughts together these days, so she would not have remembered anything the doctors told her.  And when they asked her questions most days, she would look at me in frustration and say, "Debbie, you tell him."

So please do not leave your loved ones unattended in the hospital for more than a short nap or perhaps at night when you are certain they are settled and ready to sleep.  Too much happens... too many details can slip through the cracks. You would want someone to be there for you... do the same for your loved ones.  "Hospital sitting" is the most tiring activity in the world.  But it is also one of the most important when someone you know and love has to stay there.

When I left Mam-ma's apartment at Southridge today, I begged her to please call an aide for help before she got up for anything in the next few days.  I told her, "The last thing in the world we want to have to do is go back to the hospital!"  And I meant every word!

1 comment:

Mark said...

Great post covering both angles of your sandwich generation-ness, especially the part about remembering Timmy while dressing Mam-ma.

15 pounds! Good gravy! That's a lot of water in a lady that size.