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!

It's All Part of the Sandwich!

Give me a week, and everything can change!  I visited my grandmother last Friday (if you are counting, that was five days ago), and she seemed so-so.  Of course, I'm sure the death of her friend Geraldine - "MawMac", my Birthday Buddy - impacted her and made her sad.  But overall, she seemed a little more frail and subdued in general.  Her associate pastor and his wife had been there for lunch, hosting all of the ladies from Mam-ma's church who live at Southridge for a meal in the parlor.  I asked her if she planned to nap in the afternoon, and she said she really didn't know what was planned.  Then she added, "Gladys thinks she's having a birthday party, but it's not her birthday!"

In the meantime, she casually mentioned that the doctor had been there that morning - her first visit with him since we switched and made him the primary care physician.  I asked, "And what did you think?"  She replied, "Well... I don't know.  He changed my medicine all up."  I questioned her further, and she said he had discontinued her lasix and reduced her B-12 dosage.  I looked down at her very swollen ankles and said, "I need to talk to the nurse about this."  I found the nurse, who confirmed that yes, the doctor had discontinued lasix, potassium, and he had decreased her B-12 shots from one every 2 weeks to once a month.  She told me the doctor and his nurse were still in the building... did I want to see them?  Yes, of course!  So she sent him to Mam-ma's room.

The doctor came in and explained that Mam-ma had told him she thought she had had a stroke during the week... and her speech was difficult and slow - as were her thoughts.  She wagged her bony finger at me and said, "You know this... I've been a tellin' you that I can't get my words together to talk right."  I agreed... but I reminded her that this had been going on for at least a couple of weeks - maybe longer.  She insisted it was since our trip to the ER the week before.  I told the doctor how she would not stay inside out of the heat, and the nurse piped up and said, "Oh, believe me, I know... I chased her halfway around the building this morning to get her back inside out of the heat."  I explained to them that Mam-ma doesn't believe she is overheating, because she doesn't feel warm, and she doesn't perspire.  They said they understood.

Still, the doctor said he wanted to temporarily make these changes, do some lab work to test blood counts and her thyroid, and see if the dizziness subsided.  He said if she felt like she was having a stroke - or might have just had one - she was to tell a nurse, who would administer an aspirin and call an ambulance to transport her to the ER for a CT-scan.  This would tell him whether to prescribe something stronger, like Plavix.  I am still not sure that I understand all of this for a nearly 99-year-old woman, but he did mention preventing a fall... and if the medication will do this or prevent a stroke that leaves her in a vegetative state, I am all for that.  It's just a gamble, in my book, to change anything at this point.  But this doctor is supposed to be a specialist in geriatrics, so we will trust his judgment... after all, I have signed for him to handle Mam-ma's medical care!

I did mention that we discovered at the ER that somewhere in the last 5 years, Mam-ma has had a documentable stroke on the right side.  The doctor confirmed this.  We had never been told this before... and it is not a TIA... one of those mini-strokes Mam-ma has felt like she experienced a few times.  This was a bonafide, measurable stroke... and one the ER doc said was common in older folks.  So she is prone to more of them, given her history and her age.  So we agreed to discontinue the meds and do the tests... and to monitor Mam-ma's blood pressure and overall condition for at least a week and see what happens.  The doctor shook my hand and went on his way.

Soon, there was a knock at the door, and Gladys' daughter-in-law, Margaret, appeared.  "Do you want to play Chicken Foot with Gladys and the other ladies this afternoon?" she asked Mam-ma.  "It's Gladys' birthday, and your Sunday School teacher and friends are coming to play dominoes."  "Of course she wants to play!" I interjected.  Mam-ma sorta shrugged.  I looked at her and asked, "You want to play dominoes, don't you?"  "Well, I guess," she replied.

Margaret explained that dominoes began at 2:00 p.m., followed by sandwiches and birthday cake at 5:00.  A former nursing home R.N., Margaret is a "take-charge" type, and she had already notified the kitchen that these ladies would be dining elsewhere that evening.  She said she would be back to help Mam-ma to the parlor and left.

I had taken a new bird feeder to replace Mam-ma's old one, which broke, and she was very tickled to have fresh birdseed and the new feeder. She also sent home a couple of items of clothing for me to launder.

I helped Mam-ma change her sweater, comb her hair, and she put in lipstick and some rhinestone earrings that matched her blouse.  I then walked her to the parlor for dominoes and the party.  Margaret gathered the rest of the ladies, and I greeted those who had arrived from their individual homes in town as they came through the door, including Mam-ma's dear friend, Ruby.  It looked like a lot of work had gone into planning these events, and I'm sure the ladies all had a great time that afternoon.  I was thankful Mam-ma had so much to do to occupy her for the rest of the day and evening.

Later, Mam-ma phoned me to say she was "home," and that she had had a really good time, but she was too tired to return to tea. She said Gladys went back to her apartment at 6:00 p.m., because she goes to bed early but that... "Some of the rest of us stayed until 6:30!"   The next day, Mam-ma phoned me again, with some excuse for calling that didn't make any sense.  Basically, she just wanted to talk.  And if I remember right, she did that again on Sunday, too.  It was fine... I certainly didn't mind... but all of a sudden, she became more needy for several days.

Saturday afternoon, I picked up Timothy at my sister's.  Our plan was to take him to church Sunday morning, and keep him Monday while my sister worked, then take him to daycare for the day on Tuesday.  My sister would pick him up there after she finished working.  That was the plan.  When I picked up Timothy at my sister's, his nose looked a little runny.  I questioned her, and she said, "It was running "green" when I picked him up at daycare on Thursday, but he's been fine since."  Honestly, I didn't notice a runny nose again that evening, but he did seem to have a slight cough.  I turned on the vaporizer, hoping to help with any possible congestion when he laid down for the night.

In the middle of the night, Timothy awoke - just before 3:00 a.m., pressed his little nose and said, "Nose!"  He was stuffed up and coughing.  We were awake 2 hours, watching Jack's Big Music Show, before he was able to settle in and get back to sleep at 5:00.  He slept until nearly 8:30 - there would be no getting to church by 9:30!

Sunday afternoon, Timmy laid down for a nap, and after sleeping for an hour, I heard him crying.  I went to check on him, and he was drenched... clothes, hair was literally dripping wet... bed linens were soaked.  I put him in our bed under a fan and cooled him down... and he slept another 2 hours.  When he awoke, his cough seemed to increase gradually. We played outside for just a bit late Sunday afternoon. A front had come through bringing cooler temperatures and a breeze, and Timmy enjoyed playing on the driveway with toy trucks - and running in the grass in our front yard.  It's been so hot in Arkansas for weeks that we have not had many chances to play outside.  When it only "cools" to a humid 85 at night, that's not much fun for outdoor play.

I figured Timmy would be up half the night after his 3-hour nap, but he went to bed around 10:00 p.m. with no fanfare. I ran the vaporizer again... just in case he had trouble with congestion in the night. He slept fitfully - was all over the bed - but he didn't wake up until almost 7:00 a.m.  He sat up in bed, pointed at the TV, and said, "Jack!"  I turned on the TV, and he said, "Milk!"  I went to the kitchen to get him a cup of milk, and before I could return, I heard him coughing... and wheezing... then gasping for air.  I got him up and started trying to prepare a steamy washcloth with eucalyptus oil... something I have done in the past for him.  I put a few drops on a steamy hot washcloth and held it to his face for him to inhale. He would have none of that!

By this time, my husband had come to see about us.  He had been in his office upstairs, and he said he heard the wheezing from there.  He said, "That sounds like asthma!"  I agreed, and we both felt Timmy needed instant medical attention.  We threw on clothes and loaded Timothy into the car and headed for the hospital, which is only about 2 minutes away from our house.  Once there, Timmy was quickly admitted.  Then the fun began...

Everything went fine for the first temperature check and when the nurse put the pulse-ox clip on his finger.  But when that device was too large, she had to switch to a band-aid style device, and he was not having it on his finger.  She tried the band on his toe, with mixed results.  Then the nurse added the BP cuff... and when it tightened on Timmy's arm, he started to scream.  It was downhill from there.

Timmy was in hysterics, and nothing we did could console him.  Both Greg and I tried to reassure him, but he was having none of it.  The ER doc was great... and very patient.  But he could not hear anything in his stethoscope when he listened to Timmy's lungs except screaming and my hand patting his back to soothe him.  He almost never got the device into Timothy's ears to have a look.  The one thing that went well was looking into his throat.  With all of the screaming, there was a clear shot well past his tonsils!

The doctor ordered a breathing treatment for the respiratory distress.  A very nice therapist arrived with a mask that sported a cute little dragon face.  She tried to show Timmy how the mask would make smoke.  It took three of us to hold him down to put the mask on... no, near... his face.  The treatment was supposed to last 5 minutes... we might have made it 2 minutes before calling it quits.  But it was enough to greatly decrease the wheezing and gasping.

The doctor wanted to rule out pneumonia... and the only way to do this was with a chest x-ray.  He said, "I do not want to draw labs unless I absolutely have to... so hopefully the x-ray will tell us what we need to know."  The x-ray tech, a woman who attends our church, arrived.  Timmy was still in hysterics.  She said he would have to sit on the end of the table, but that I could hold the film between him and me and hold him.  We tried to accomplish this, but Timmy would not let me put the film between us.  The tech clearly got exasperated and irritated, and at one point, she quipped, "Where are the parents?"  "They're in Texas," I shot back, equally irritated - with her!  This was not the time to explain family dynamics and who we were and why we were there with this child!

The tech said, "I think you two are going to have to leave the room, and we'll call in nurses to hold him."  Now, this sent me spinning.  I asked if there was any other way... could we not just get some medicine and leave?  The nurses said there was no way the doctor would prescribe anything without at least a chest x-ray.  The nurse and respiratory therapist arrived and assured me they would hold him and not let anything happen to him.  Reluctantly we walked out, and I told Greg, "I'm giving her 2 minutes!"

Almost instantly, Greg saw the light come on signaling that one x-ray had been accomplished.  The screaming subsided... but only slightly.  I was in tears, and now Greg had TWO babies to console!  Poor man!  The door opened, and the tech asked me to come back in and help hold up Timothy's arms for a profile shot.  I tried... as he protested... and we got an x-ray of arms - I think mine, the respiratory tech's and the nurse's... perhaps the baby's!  They decided to roll with the one good x-ray, which the doctor gave me the "thumbs up" on and declared all clear - no pneumonia.

So the doctor determined this was probably allergies or viral... but he ordered a workup at Timothy's pediatric office to rule out asthma.  He wrote an optional prescription for a steroid syrup for the wheezing... and he recommended an OTC antihistamine to control the symptoms and the cough, plus children's acetaminophen for the fever.  Greg and I loaded our exhausted, sweaty little boy into the car and drove home.  We started him on children's Zyrtec, and he seemed to improve throughout the day... although he took another 3-hour nap.

Tuesday, Timothy was out of sorts from whatever ailed him, plus the medications.  He was a typical 2-year-old for much of the day and had a fairly short fuse. I did not send him to daycare, because he was irritable and may have still had a slight fever. He slept three hours again in the afternoon.  Today, his grandparents took him to the pediatrician, who says this is allergies, not asthma.  He gave them an inhaler and said to keep using the OTC antihistamine.

To say I am somewhat drained is an understatement.  I am trying to take these things all in stride, but it's been a crazy two weeks.  I have made two trips to the ER, been to two funerals for dear friends, and tried to console a 99-year-old and a 2-year-old... all while trying to continue to have some semblance of a life!  I know from previous experience that this is really small potatoes in the scheme of things... and no big deal compared to what others are dealing with!  But I, like many others, have been thrust into circumstances I never expected... this "sandwich" life... and momentarily, it can throw me for a loop!

In an attempt to cope, I am reading the book Boundaries... When to Say Yes... How to Say No by Henry Cloud and John Townsend.  I have also downloaded a couple onto my Kindle... one recommended by a dear friend and young mother of 2... Shepherding a Child's Heart by Ted Tripp... and another that looked good... Don't Make Me Count to Three by Ginger Plowman.  I have learned a lot from the Boundaries book already and even found a matching workbook at a yard sale last weekend, so I plan to really study it in-depth (did I mention I have issues with boundaries?!).  I will be sure to report and give a review of the other two when I finish.  I also did a Google search about 2-year-old tantrums and found some great links...

• http://www.nasponline.org/resources/behavior/tantrums_ho.aspx
• http://www.mayoclinic.com/health/tantrum/HQ01622
• http://www.babycenter.com/0_tantrums-why-they-happen-and-what-to-do-about-them_63649.bc
• http://www.askdrsears.com/content/how-handle-2-year-olds-tantrums

Finally, I have to say that I'm looking for ways to cherish every moment with both my grandmother - and Timothy.  Honestly, I don't know how long we will have Mam-ma with us... and Timothy's visit is supposed to be short-term.  So I want to treasure this time with both of them.

When I took Mam-ma to the ER, I had grabbed my Kindle as I went out the door.  I had downloaded a really great short story written by my friend, John Sykes, called Shirley Takes the Shot.  It's about a hog killing in the South.  I knew my grandmother would love it, so while we waited for labs to be processed, I read the story to her.  She laughed and chuckled... and she recalled a hog killing or two from her past.  It was a good time... one of those really neat, precious moments that we don't have often enough these days... and one that will be treasured for a long time.

When you can find a way to make lemons out of lemonade even while sitting in an ER exam room, things can't possibly be all that bad.  I hope you are finding treasured moments of your own these days.