Saturday, December 8, 2018
Thursday, December 6, 2018
Decided to update tonight so that I can pack the computer. I have to be there at shift change in the morning so I won't have a lot of time to sit around in the morning. I'll need to leave here about 5:30.
Bill didn't have as good a day today. They did the breathing test before I got there and it apparently did not go well. His nurse, who is my absolute favorite one, said the respiratory therapist also did not tell her and he had no-one to encourage to take deep breaths. She also thinks he needs me there to encourage him. So, that's the reason for being there at shift change, in case they start early again. Jacinta, the nurse, was going to leave a note that the test was not to be started unless I was there.
Dr. Munday came in and is debating another broncoscopy. He was very junky today and had to be suctioned quite a lot early. This time it was a little blood-tinged, both from the vent and the secretions from his mouth. Bill had also dislodged the vent and the tube had to be repositioned. That could also be where the blood came from. Jacinta also said that he became a little combative with her while she was suctioning, trying to hit her. So she changed sides of the bed and he tried with the other hand! She was so surprised because he's usually not like that.
They've continued to tweak his meds, especially the one keeping his heart rate up. She had turned it down a little before I left and he was doing fine. Dr. Edwards would really like to get him off of that one.
The kidney dr. came in and his kidney function has again improved. She's almost certain it was just dehydration that caused the high numbers. She change his IV fluid from normal saline to D5W, which is water, to remove some of the sodium that is causing the swelling in his hands. They also started Lasix this afternoon to try to pull that fluid off.
Jacinta also turned his sedation down a little bit before I left and he moved his hand when I told him I loved him and I'd see him tomorrow. Since we don't know what he hears, I talk to him all the time.
The endo dr. is still tweaking his insulin to go with the tube feedings. I also think the dietician is going to tweak the amount he gets per feed. I don't know if he's losing weight, gaining weight, or maintaining. But he's tolerating it well and digesting it.
He got a lovely bath from Jacinta and Magnolia and this time he couldn't be mean to Maggie like he was with the first bath she gave him the last time! He also got a couple of dressing changes and one small line removed. It was in his neck and it couldn't be flushed, so it was taken out. He has the central like with so many different lines coming off it I don't know how they keep them straight! He also has 2 other sites that can be used if necessary.
They ended up having two codes called last night, one just before I left and another after I left in the room next to Bill's. The nurse actually had the computer in the hall outside the room with a chair for her to monitor. I don't know if there is extra equipment in there or just what the reason was. I didn't look into the room to see. But, the first code did survive and the first thing the man wanted to know was where his wife was! He couldn't tell them his name, but wanted his wife!
My shoulder was better today. I was telling one of the nurse practitioners about it and he wanted to know what I was doing for it. I told her the meds I was taking and what strength and frequency. She said I was doing exactly what would be prescribed, just to make sure I ate with the meds and I have been doing that. She also said I could take them around the clock if I wanted. I told her the only time I didn't take them was through the night. That might be why it hurts so much in the morning! I'd like to go to bed, but I can't take them for another 90 minutes!
I did not get a chance to speak to the Palliative Care Team today, but I'll call first thing in the morning. I've gotten a lot of good advice from a lot of friends and family. So I feel more at peace with my decision.
Reservations are made for the hotel, just need to pack my suitcase and hope that a cat doesn't decide to go to. Kitty wanted to go out with me this morning, so I told Bill that she wanted to come and visit him! It will fee strange not to have a cat roaming on top of me at 4 in the morning at the hotel. I'll probably still wake up at 5!
All I can think of without actually getting up and getting my notebook out, and I'm too comfortable now to dig through my backpack. If I forgot anything I'll add it tomorrow night or Saturday morning.
Bill didn't have as good a day today. They did the breathing test before I got there and it apparently did not go well. His nurse, who is my absolute favorite one, said the respiratory therapist also did not tell her and he had no-one to encourage to take deep breaths. She also thinks he needs me there to encourage him. So, that's the reason for being there at shift change, in case they start early again. Jacinta, the nurse, was going to leave a note that the test was not to be started unless I was there.
Dr. Munday came in and is debating another broncoscopy. He was very junky today and had to be suctioned quite a lot early. This time it was a little blood-tinged, both from the vent and the secretions from his mouth. Bill had also dislodged the vent and the tube had to be repositioned. That could also be where the blood came from. Jacinta also said that he became a little combative with her while she was suctioning, trying to hit her. So she changed sides of the bed and he tried with the other hand! She was so surprised because he's usually not like that.
They've continued to tweak his meds, especially the one keeping his heart rate up. She had turned it down a little before I left and he was doing fine. Dr. Edwards would really like to get him off of that one.
The kidney dr. came in and his kidney function has again improved. She's almost certain it was just dehydration that caused the high numbers. She change his IV fluid from normal saline to D5W, which is water, to remove some of the sodium that is causing the swelling in his hands. They also started Lasix this afternoon to try to pull that fluid off.
Jacinta also turned his sedation down a little bit before I left and he moved his hand when I told him I loved him and I'd see him tomorrow. Since we don't know what he hears, I talk to him all the time.
The endo dr. is still tweaking his insulin to go with the tube feedings. I also think the dietician is going to tweak the amount he gets per feed. I don't know if he's losing weight, gaining weight, or maintaining. But he's tolerating it well and digesting it.
He got a lovely bath from Jacinta and Magnolia and this time he couldn't be mean to Maggie like he was with the first bath she gave him the last time! He also got a couple of dressing changes and one small line removed. It was in his neck and it couldn't be flushed, so it was taken out. He has the central like with so many different lines coming off it I don't know how they keep them straight! He also has 2 other sites that can be used if necessary.
They ended up having two codes called last night, one just before I left and another after I left in the room next to Bill's. The nurse actually had the computer in the hall outside the room with a chair for her to monitor. I don't know if there is extra equipment in there or just what the reason was. I didn't look into the room to see. But, the first code did survive and the first thing the man wanted to know was where his wife was! He couldn't tell them his name, but wanted his wife!
My shoulder was better today. I was telling one of the nurse practitioners about it and he wanted to know what I was doing for it. I told her the meds I was taking and what strength and frequency. She said I was doing exactly what would be prescribed, just to make sure I ate with the meds and I have been doing that. She also said I could take them around the clock if I wanted. I told her the only time I didn't take them was through the night. That might be why it hurts so much in the morning! I'd like to go to bed, but I can't take them for another 90 minutes!
I did not get a chance to speak to the Palliative Care Team today, but I'll call first thing in the morning. I've gotten a lot of good advice from a lot of friends and family. So I feel more at peace with my decision.
Reservations are made for the hotel, just need to pack my suitcase and hope that a cat doesn't decide to go to. Kitty wanted to go out with me this morning, so I told Bill that she wanted to come and visit him! It will fee strange not to have a cat roaming on top of me at 4 in the morning at the hotel. I'll probably still wake up at 5!
All I can think of without actually getting up and getting my notebook out, and I'm too comfortable now to dig through my backpack. If I forgot anything I'll add it tomorrow night or Saturday morning.
Yesterday was a big day for Bill! At 12:49 pm they stopped the sedation and turned off the vent. And for 2 hours, count 'em, 2 hours, he breathed on his own. After the sedation wore off more he responded to commands for squeezing hands, wouldn't squeeze mine, but all the nurses, answered questions with nods and spontaneously moved his feet. He started trying to cough so I got the respiratory therapist and and she suctioned out a lot of stuff. She called Dr. Fox and told him how he did and he decided to put him back on the vent and repeat the test this morning. If it goes as well as yesterday, they will extubate this afternoon.
All of his numbers have been good. He was a little low on phosphorus so he got a little bag of that, but the medicine that regulates the blood pressure has been discontinued. The one to keep his heart rate up has been lowered, raised, lowered, just depending on what's happening. They had tried to drop it to 4 and that was too low, so it went back up to 5. She tried 4.5, but it still didn't get his heart rate to where they wanted it. When he was off the vent she moved it to 6 just to give his heart a little boost. They have also changed the parameters for that. Before, after his episode Sunday night, they wanted his heart rate above 100. It is now set at 80. So, that's an improvement.
The GI dr. came in and is just going to monitor his numbers. He doesn't think he has a GI issue going on and that the blood was from the ng tube insertion. They haven't drawn any more out. He's tolerating his feedings well. He hasn't had a bowel movement yet, but I could hear his tummy gurgling yesterday afternoon so, maybe soon.
I talked to Dr. Baymeadows, the kidney dr. She said she now thinks the high numbers were all due to dehydration. She was also appalled that he was treated so badly at the nursing home. And speaking of the nursing home, they called me Monday to ask if he would be returning when he was discharged! I was very polite and just said no, he won't. And, shortly after that, another one called and said that they would accept him as a patient. I told them that he was still in ICU and intubated and we didn't know when he would be discharged. She was very surprised that she didn't know that when the social worker made the referral. She, the social worker, has not been back in after she gave me the list of places to choose from, but since the other one said they would take him, she feels like her work is done. She did wave to me during rounds yesterday morning.
I've also received calls from the Palliative Care Team. This is the team that deals with end of life issues. Now, this doesn't mean that death is imminent. But, as Dr. Mullinax told me, they have the resources to help us make the best decisions for him, and with him if possible. He wants to have a family meeting as soon as possible, however he doesn't want to wait for the kids who want to come. Mary Rose and Aimee both live in Oklahoma and Mary has to work all week-end so the earliest they can get here is Monday for a Tuesday meeting. He wants to have the meeting tomorrow with the ones who can be there, Emily and Ryan and me. And is really pushing for a decision. I'm to call one of the team members today with a time. But, that long drive home is good for something, and I've come to a conclusion they won't like. But, I remember something my mother said was told to her when my dad died. She was told not to sign anything or agree to anything until she was ready, not just because someone said you must do that. The more I've thought about this, the more I think they are being very premature. We don't know what Bill's condition will be off the vent. We do know that he was physically weak prior to this happening and will most likely be even weaker. But, until he is off the vent, we don't know! Dr. Mullinax did say that Dr. Edwards thinks he needs to go straight into hospice. But, Dr. Edwards has not taken the time to get to know Bill and his strong will to live. He did concede that he's had 60 lives compared to a cat's 9 lives. And he's right there, which should tell him not to count him out. And, before anyone thinks that I have my head in the sand, just not wanting to give up on my husband, I know we are headed in that direction, but I also think, now is not the time to make these decisions. This is one thing that Bill and I have never discussed, who wants to talk about end of life issues, but, until we have that conversation, and he voices his wishes, we're not having the meeting. It's kind of like the social worker, I think they're trying to cover themselves with Medicare about too many admissions, in too short a time after discharge for the same diagnosis. I do know that statistics are kept on this and I think hospitals can be fined, if it is only to have their rating downgraded. Does this sound reasonable to anyone out there? Let me know, either here in the comments, or on Facebook, or a message, text, whatever. They did ask me 2 questions yesterday...if he's taken off the vent and then something happens over the week-end, do we re-intubate (yes, he had told them he is a full code) and, if the aspiration continues to be a problem do they do a jpeg feeding tube. He had the peg after the transplant and absolutely hated it and that's all I told them. He might be agreeable to that for supplemental feeding if his caloric intake is not enough. But, lets' try other measures first (also something they were supposed to do in the nursing home and didn't, meds in applesauce instead of with water).
So, there's where we stand. As for my shoulder, it is still very painful and I'm doing what Emily's dr. had her do with a strained elbow. I just can't reach where it hurts to put the pain patches on myself and if I want to leave for the hospital early, I don't want to have to get Emily up to do it. I'm sure she would, but she's already done so much. I did get some Biofreeze spray that sprays no matter how you hold the can and that works some, and I can do it, but the Salon Pas patches feel better.
Our weather is supposed to get super bad, and we just had a special weather statement issued for freezing rain, sleet on Saturday morning, with more to come on Saturday night. So, this was already playing in the back of my head and it looks like I'll stay in Memphis tomorrow night and Saturday night. Brianna can care for the cats and I can talk Joe through starting the generator if necessary. It won't heat the house but it's not supposed to be that cold, but it will keep the freezer going. The cats will just curl up on their blankets. Maybe they will curl up together! That would be a first!
That's all I've got for this update. I'll take this with me so I can update it at the hotel. There's a Hampton Inn on the hospital campus so I'll just stay there. I think I'd be more comfortable instead of sleeping in a recliner in the ICU waiting room. Been there, done that. And now my shoulder is saying I've typed enough!
All of his numbers have been good. He was a little low on phosphorus so he got a little bag of that, but the medicine that regulates the blood pressure has been discontinued. The one to keep his heart rate up has been lowered, raised, lowered, just depending on what's happening. They had tried to drop it to 4 and that was too low, so it went back up to 5. She tried 4.5, but it still didn't get his heart rate to where they wanted it. When he was off the vent she moved it to 6 just to give his heart a little boost. They have also changed the parameters for that. Before, after his episode Sunday night, they wanted his heart rate above 100. It is now set at 80. So, that's an improvement.
The GI dr. came in and is just going to monitor his numbers. He doesn't think he has a GI issue going on and that the blood was from the ng tube insertion. They haven't drawn any more out. He's tolerating his feedings well. He hasn't had a bowel movement yet, but I could hear his tummy gurgling yesterday afternoon so, maybe soon.
I talked to Dr. Baymeadows, the kidney dr. She said she now thinks the high numbers were all due to dehydration. She was also appalled that he was treated so badly at the nursing home. And speaking of the nursing home, they called me Monday to ask if he would be returning when he was discharged! I was very polite and just said no, he won't. And, shortly after that, another one called and said that they would accept him as a patient. I told them that he was still in ICU and intubated and we didn't know when he would be discharged. She was very surprised that she didn't know that when the social worker made the referral. She, the social worker, has not been back in after she gave me the list of places to choose from, but since the other one said they would take him, she feels like her work is done. She did wave to me during rounds yesterday morning.
I've also received calls from the Palliative Care Team. This is the team that deals with end of life issues. Now, this doesn't mean that death is imminent. But, as Dr. Mullinax told me, they have the resources to help us make the best decisions for him, and with him if possible. He wants to have a family meeting as soon as possible, however he doesn't want to wait for the kids who want to come. Mary Rose and Aimee both live in Oklahoma and Mary has to work all week-end so the earliest they can get here is Monday for a Tuesday meeting. He wants to have the meeting tomorrow with the ones who can be there, Emily and Ryan and me. And is really pushing for a decision. I'm to call one of the team members today with a time. But, that long drive home is good for something, and I've come to a conclusion they won't like. But, I remember something my mother said was told to her when my dad died. She was told not to sign anything or agree to anything until she was ready, not just because someone said you must do that. The more I've thought about this, the more I think they are being very premature. We don't know what Bill's condition will be off the vent. We do know that he was physically weak prior to this happening and will most likely be even weaker. But, until he is off the vent, we don't know! Dr. Mullinax did say that Dr. Edwards thinks he needs to go straight into hospice. But, Dr. Edwards has not taken the time to get to know Bill and his strong will to live. He did concede that he's had 60 lives compared to a cat's 9 lives. And he's right there, which should tell him not to count him out. And, before anyone thinks that I have my head in the sand, just not wanting to give up on my husband, I know we are headed in that direction, but I also think, now is not the time to make these decisions. This is one thing that Bill and I have never discussed, who wants to talk about end of life issues, but, until we have that conversation, and he voices his wishes, we're not having the meeting. It's kind of like the social worker, I think they're trying to cover themselves with Medicare about too many admissions, in too short a time after discharge for the same diagnosis. I do know that statistics are kept on this and I think hospitals can be fined, if it is only to have their rating downgraded. Does this sound reasonable to anyone out there? Let me know, either here in the comments, or on Facebook, or a message, text, whatever. They did ask me 2 questions yesterday...if he's taken off the vent and then something happens over the week-end, do we re-intubate (yes, he had told them he is a full code) and, if the aspiration continues to be a problem do they do a jpeg feeding tube. He had the peg after the transplant and absolutely hated it and that's all I told them. He might be agreeable to that for supplemental feeding if his caloric intake is not enough. But, lets' try other measures first (also something they were supposed to do in the nursing home and didn't, meds in applesauce instead of with water).
So, there's where we stand. As for my shoulder, it is still very painful and I'm doing what Emily's dr. had her do with a strained elbow. I just can't reach where it hurts to put the pain patches on myself and if I want to leave for the hospital early, I don't want to have to get Emily up to do it. I'm sure she would, but she's already done so much. I did get some Biofreeze spray that sprays no matter how you hold the can and that works some, and I can do it, but the Salon Pas patches feel better.
Our weather is supposed to get super bad, and we just had a special weather statement issued for freezing rain, sleet on Saturday morning, with more to come on Saturday night. So, this was already playing in the back of my head and it looks like I'll stay in Memphis tomorrow night and Saturday night. Brianna can care for the cats and I can talk Joe through starting the generator if necessary. It won't heat the house but it's not supposed to be that cold, but it will keep the freezer going. The cats will just curl up on their blankets. Maybe they will curl up together! That would be a first!
That's all I've got for this update. I'll take this with me so I can update it at the hotel. There's a Hampton Inn on the hospital campus so I'll just stay there. I think I'd be more comfortable instead of sleeping in a recliner in the ICU waiting room. Been there, done that. And now my shoulder is saying I've typed enough!
Wednesday, December 5, 2018
Tuesday, December 4, 2018
For those of you who usually get multiple text updates, or phone calls, I did none of those things as you know. I sent no texts, and was very selective on which phone calls I answered, and made none. There was no certain reason for that other than I didn't do it. It was a busy/not busy day, you'll understand that shortly. So, I just took lots of notes and this update may just be me copying them instead of trying to get them into some kind of coherent order. So, today, and maybe for the next few days, be patient with me. I'm going to do whatever is most convenient for me.
He's still critical, but stable. Austin was suctioning his vent when I got there and he was getting so much junk out that he thought they might do another bronchoscopy since he was already intubated. Another favorite nurse, Stacy, was his nurse for the morning, and when she suctioned his ng tube, the contents were almost burgundy, which indicates there was some blood. So a GI consult was set up. Dr. Williams ordered IV protonics twice a day to prevent any acid reflux, which could explain some of the aspiration. They are going to start some tube feedings just so he gets some nutrition, so the tube will stay in place for the time being. He also is not going to be taken off the vent, but allowed to just rest. He's still overbreathing it.
He was awake when I got there but they raised the sedation because he is still reaching for the vent and ng tube. He is also very agitated and reaching for the catheter. It wouldn't surprise me if he isn't restrained more when I get there today since I wasn't there throughout the night.
His right hand and leg are swollen and Stacy assured me that it is only because of the fluids he's getting. His urine output is good (and there goes the helicopter this morning, bless all the occupants, Lord, patient and flight crew) and the ultrasound of the kidneys was normal except for a cyst on his right one that we've known about for years.
His "crit", which is blood level, was 31 on admission and 25 yesterday morning. The standing order had been that if it was under 25 they would give a unit of blood, but he had not received any. His creatinine, kidney numbers, were 2.1 on discharge, which is a little high, but acceptable for him, 4.79 on admission which is extreme, and 3.17 yesterday. So it is coming down. Urine output is good and it wasn't as dark today as it was Sunday.
Respiratory came in a lavaged his lungs, which means she introduced some water into them and then suctioned it back out, along with other secretions. After she did that, and suctioned his mouth, he calmed down and did not need suctioned again while I was there.
Some of his meds have been switched to IV, some are being crushed and pushed through the ng tube and some have been held. He's still getting normal saline drips, Isuprel which is the drug that keeps his heart rate up, Levaphed which keeps his blood pressure up (this one they tweak and try to get him off once he stays at a stable rate. It was at 3 when I left and Noel was going to try to turn it down after I left.), Propofol for sedation and different antibiotics. I know one is Zyvox which he's had before and there is another one but I didn't get the name of it. He can also have some dilaudid to help with extra sedation if needed.
Dr. Duncan from the gastro group came in and he flushed a lot of water through the ng tube and tried to recreate what Stacy suctioned. He only got water and stomach acid back, so he thinks that what she pulled was some blood from when the tube was placed. It may have irritated the stomach wall. But, he ordered another hematocrit level just to be sure. Those results had not come back before I left. He said if there was continued blood loss they would consider an EGD to look into his stomach, especially since he was already intubated to see if there was a little bleeding ulcer or something. And since he had complained that his stomach and back hurt before all this happens, that could make sense.
All of the nursing staff has been so solicitous of how I'm doing, it's a little unnerving. It makes me feel like we're on death watch, but since they haven't sent a chaplain or said to call in family, they just are making sure they are caring for me as much as for Bill. There were some tears again yesterday as it did get overwhelming at times, but just a rub on the back or a touch of a shoulder helped. Caleb, the aide, checked on me so many times. The last time he peeked in to ask if I was good I told him that since I was knitting, I was relaxed. (I didn't tell him I had ripped it out 3 times and it's only a 4 row pattern).
One of the most disturbing aspects of the day was with the social worker. She asked what my thoughts were on the nursing center he was at, and I told her that even though a nurse friend of Emily's gave it 2 thumbs up, and our nurse practitioner has placed her father there, we gave it 4 thumbs down. She later came back with a 2 page list of skilled nursing centers in and around Jonesboro and said she would be back today for my decision on which ones to call for placement! Now, I know that lately I've been Super Woman as my neighbor called me, but I haven't figured out how to be in several places at once! We are not going to go in blind this time and Bill is nowhere near ready for discharge. So, after discussing this with Emily, Ryan, and Mary Rose (along with input from my sister who worked in nursing homes), I am going to tell her that until we know what condition Bill will be in at discharge and what his wishes will be, we will not make a decision on placement and only then will we visit the different locations. Some are rated from much above average to below average. The below average ones won't even be considered...been there done that! I think they are pushing that to cover themselves with Medicare because he was readmitted so soon after discharge for the same diagnosis and that makes their numbers look bad, so if he comes back because the family didn't like placement, then it falls on us. So, that is my plan for our meeting today. And if necessary, Emily is ready to come down and take charge of that aspect. She said that my job and focus is Bill and only him right now. I don't need to be thinking of this.
I think that covers everything. I'm not leaving super early this morning. There's no real reason to. The ICU nurses will give me any and all info from the drs. if I miss any. They will also update me on meds and if blood was needed and anything I ask about. I've pulled a muscle in my shoulder and need to go to Walmart to get an Icy Hot pain patch. It's right where I can't reach it to rub regular Icy Hot. I used my long handled bath scrubby this morning. Note to self...buy a new long handled bath brush now for bathing. Using the old one could make for an interesting shower! But, since he will probably still be sedated, it's not like we can have breakfast together. And if necessary they will call and I'll head out.
I'm taking meds and a small "go bag" in case I get too tired to drive home, or need to stay. There is a Hampton Inn on the campus so I won't have to sleep in the waiting room (been there done that) and I would still be 5 minutes away if needed. Brianna can feed the animals if I decide to stay. But, if I'm not too tired and just want that 1 1/2 hour drive to think or not think, I'll still come home.
OK, we're caught up as far as I know. I also don't know again today if I will send texts and make/receive phone calls. It will depend on what's going on at the time with Bill, and in my head. So, don't get upset if you don't hear. This area will always be updated daily.
He's still critical, but stable. Austin was suctioning his vent when I got there and he was getting so much junk out that he thought they might do another bronchoscopy since he was already intubated. Another favorite nurse, Stacy, was his nurse for the morning, and when she suctioned his ng tube, the contents were almost burgundy, which indicates there was some blood. So a GI consult was set up. Dr. Williams ordered IV protonics twice a day to prevent any acid reflux, which could explain some of the aspiration. They are going to start some tube feedings just so he gets some nutrition, so the tube will stay in place for the time being. He also is not going to be taken off the vent, but allowed to just rest. He's still overbreathing it.
He was awake when I got there but they raised the sedation because he is still reaching for the vent and ng tube. He is also very agitated and reaching for the catheter. It wouldn't surprise me if he isn't restrained more when I get there today since I wasn't there throughout the night.
His right hand and leg are swollen and Stacy assured me that it is only because of the fluids he's getting. His urine output is good (and there goes the helicopter this morning, bless all the occupants, Lord, patient and flight crew) and the ultrasound of the kidneys was normal except for a cyst on his right one that we've known about for years.
His "crit", which is blood level, was 31 on admission and 25 yesterday morning. The standing order had been that if it was under 25 they would give a unit of blood, but he had not received any. His creatinine, kidney numbers, were 2.1 on discharge, which is a little high, but acceptable for him, 4.79 on admission which is extreme, and 3.17 yesterday. So it is coming down. Urine output is good and it wasn't as dark today as it was Sunday.
Respiratory came in a lavaged his lungs, which means she introduced some water into them and then suctioned it back out, along with other secretions. After she did that, and suctioned his mouth, he calmed down and did not need suctioned again while I was there.
Some of his meds have been switched to IV, some are being crushed and pushed through the ng tube and some have been held. He's still getting normal saline drips, Isuprel which is the drug that keeps his heart rate up, Levaphed which keeps his blood pressure up (this one they tweak and try to get him off once he stays at a stable rate. It was at 3 when I left and Noel was going to try to turn it down after I left.), Propofol for sedation and different antibiotics. I know one is Zyvox which he's had before and there is another one but I didn't get the name of it. He can also have some dilaudid to help with extra sedation if needed.
Dr. Duncan from the gastro group came in and he flushed a lot of water through the ng tube and tried to recreate what Stacy suctioned. He only got water and stomach acid back, so he thinks that what she pulled was some blood from when the tube was placed. It may have irritated the stomach wall. But, he ordered another hematocrit level just to be sure. Those results had not come back before I left. He said if there was continued blood loss they would consider an EGD to look into his stomach, especially since he was already intubated to see if there was a little bleeding ulcer or something. And since he had complained that his stomach and back hurt before all this happens, that could make sense.
All of the nursing staff has been so solicitous of how I'm doing, it's a little unnerving. It makes me feel like we're on death watch, but since they haven't sent a chaplain or said to call in family, they just are making sure they are caring for me as much as for Bill. There were some tears again yesterday as it did get overwhelming at times, but just a rub on the back or a touch of a shoulder helped. Caleb, the aide, checked on me so many times. The last time he peeked in to ask if I was good I told him that since I was knitting, I was relaxed. (I didn't tell him I had ripped it out 3 times and it's only a 4 row pattern).
One of the most disturbing aspects of the day was with the social worker. She asked what my thoughts were on the nursing center he was at, and I told her that even though a nurse friend of Emily's gave it 2 thumbs up, and our nurse practitioner has placed her father there, we gave it 4 thumbs down. She later came back with a 2 page list of skilled nursing centers in and around Jonesboro and said she would be back today for my decision on which ones to call for placement! Now, I know that lately I've been Super Woman as my neighbor called me, but I haven't figured out how to be in several places at once! We are not going to go in blind this time and Bill is nowhere near ready for discharge. So, after discussing this with Emily, Ryan, and Mary Rose (along with input from my sister who worked in nursing homes), I am going to tell her that until we know what condition Bill will be in at discharge and what his wishes will be, we will not make a decision on placement and only then will we visit the different locations. Some are rated from much above average to below average. The below average ones won't even be considered...been there done that! I think they are pushing that to cover themselves with Medicare because he was readmitted so soon after discharge for the same diagnosis and that makes their numbers look bad, so if he comes back because the family didn't like placement, then it falls on us. So, that is my plan for our meeting today. And if necessary, Emily is ready to come down and take charge of that aspect. She said that my job and focus is Bill and only him right now. I don't need to be thinking of this.
I think that covers everything. I'm not leaving super early this morning. There's no real reason to. The ICU nurses will give me any and all info from the drs. if I miss any. They will also update me on meds and if blood was needed and anything I ask about. I've pulled a muscle in my shoulder and need to go to Walmart to get an Icy Hot pain patch. It's right where I can't reach it to rub regular Icy Hot. I used my long handled bath scrubby this morning. Note to self...buy a new long handled bath brush now for bathing. Using the old one could make for an interesting shower! But, since he will probably still be sedated, it's not like we can have breakfast together. And if necessary they will call and I'll head out.
I'm taking meds and a small "go bag" in case I get too tired to drive home, or need to stay. There is a Hampton Inn on the campus so I won't have to sleep in the waiting room (been there done that) and I would still be 5 minutes away if needed. Brianna can feed the animals if I decide to stay. But, if I'm not too tired and just want that 1 1/2 hour drive to think or not think, I'll still come home.
OK, we're caught up as far as I know. I also don't know again today if I will send texts and make/receive phone calls. It will depend on what's going on at the time with Bill, and in my head. So, don't get upset if you don't hear. This area will always be updated daily.
Monday, December 3, 2018
I had to read back through the last post to see what it said. It's been an eventful 2 days! When I asked Bill Saturday if he had pushed his button for help to the bathroom, he just said he couldn't remember. It hadn't been moved and his urinal was by his bed, but he may have needed to have a bowel movement and, out of habit, just got up. I noticed that he had disposable underwear on and his new sleep pants were nowhere around, so he must have messed them, probably when he fell. I asked about them and they said to check with lost and found since they didn't have his name in them, but didn't say where lost and found was located. They just told me to make sure his name was in everything, even though I had indicated that I would do his laundry. But since he was wearing those when he got there, it was kind of hard to write his name in them!
He was on tank air, and it was on 5, but it was on pulse instead of continuous. This means that he would only get oxygen when he took a breath through his nose. I changed it and his nurse came in and his sats were very low again. But, she discovered that the regulator that was being used had to connections and the one he was connected to wasn't giving him any oxygen at all! The only good to come out of that was that we now know he can't consistently breathe room air!
He still didn't want to eat and I again forced him to eat some oatmeal. I told him if he didn't start eating they would put in a feeding tube and since he hated that when he had it before he tried to eat some more. We managed to coax him to sit in his wheelchair and I pushed him around some to orient him to where he was and where things were, like the dining room. I was hoping I could get him to eat lunch there instead of his room, but he said he wanted a tray. Lunch was just about an exact repeat of supper the other night, hamburger helper, just a different flavor and a different vegetable. They also serve them a fruit punch to drink. I don't know why they think old people would enjoy that!
One thing that we noticed is that the people who are eating in their rooms, whether they are bedfast or not, or need assistance or not, get fed after the dining room meal is finished and the patients (I almost put inmates!) are back in their rooms, or roaming around. Bill did not get his cold hot lunch for almost 1 1/2 hours after the others, and I had to ask about it!
He was ready to go back to bed after he picked at his meal so we got him back into bed. His sats were low again and he was on tank air. But, he didn't seem to be in distress again, just a little lethargic and he's been that way before, even when his sats were good. I asked if I could bring him food and they said yes, so I told Bill I was cooking his dinner and asked what he wanted. He said he would eat anything I cooked. When I went home to see what I had to fix I got a text from his nurse that his O2 was 93% and his heart rate was 77, really good numbers for him. Bill loves chicken so I took him 1/2 a sauteed chicken breast and a twice baked potato. He ate all of the chicken and half of the potato. I also took him a glass of tea. We visitied for a bit and he and his roommate started swapping war stories. He had been an Army helicopter pilot.
I got a call yesterday morning about 6 telling me that Bill had complained that his stomach and lower back hurt and then he vomited. His O2 sat was 44! He should have passed out! They gave him 2 breathing treatments and said he needed to go to the hospital and asked where I wanted him sent. I told them our local hospital to get him stabilized. I called Emily and we were waiting on him at the emergency room.
He was on a re-breather which gives high flow oxygen and he was still only in the 50s. The Dr. said he was in hypoxia and very critical. I told them to call Dr. Edwards at Baptist transplant and Dr. Edwards said to intubate him and get him shipped. He had also gone to the bathroom, so they had to get him cleaned up. He was awake but very agitated, mostly about messing himself.
Emily and I were sent to the waiting room while they sedated and intubated him and then the flight crew arrived to transport him. We left as they were taking him to the helicopter to go home and do what we needed to do before heading to Memphis. We were quite a sight, too. Neither of us were showered, but at that point, we didn't care. Because of where our house is located in relation to the hospital, we are right in the flight path for the helicopter, so I heard him fly over. At least it was a nice sunny day.
I discovered that, in our area at least, you can blow by a cop doing 95 with your flashers on and they won't stop you...or radio ahead for someone else to get you. Most of the time traffic did yield and traffic was light. I made the 1 1/2 hour trip in just under an hour.
Since he was a direct admit to the transplant ICU, we bypassed the ER and walked the long hallway. He was already settled and tests were being and had been run. One of our favorite nurses was on the floor, although she was not his nurse. So many people were in and out, xray, ultrasound for his stomach and kidneys, respiratory, cardiology for an echo. They also placed an ng tube which is the tube in his nose. It not only will drain stomach contents, but it can be used for feeding if necessary. One of the kidney doctors ordered a Foley catheter, and last night at shift change Alison told Lauren that it was not to be removed without a direct order from a dr. One of Dr. Threlkeld's associates was on call and she was not familiar with Bill at all, so she did a very thorough examination and then started a couple of precautionary antibiotics. Dr. Munday was on call for pulmonology and he said that since he was already intubated he was going to do another broncoscopy. I told him the staff here had suctioned a bunch of stuff out before he was transported, but he said they may as well do it and get some cultures going. So, we were sent off to the cafeteria for some lunch that I didn't want. But, they had some really good chicken and dumpling soup and Emily and I both had it. I ate all of mine and she was satisified.
He started to wake up shortly after we got back to the room and responded with nods and squeezes. But he got very agitated and started to reach for the ng tube so they had to use some mild restraints and then lightly sedate him again.
Dr. Edwards came in and said that it was lower right lobe pneumonia, which means aspiration again, and I don't remember him choking and I don't think it would have become that apparent from aspirating from vomiting that morning. He said that the right side of his heart was a little sluggish and he had compared all of the echos. I told him it was always sluggish from the transplant and he just didn't want to hear that. He thought that if this was going to keep happening, and therapy didn't help, he would have to have a jpeg which is the feeding tube in his stomach and just not be able to eat or drink. Bill will not like that at all! But, that's a bit down the road before we have to make that decision. He didn't think there was any medical reason for us to stay the night so we decided to go home.
We had noticed that his heart rate kept alarming and Alison assured us that it was just because of the sedation, so they stopped one of them. But, the next time his blood pressure was checked it had dropped to 82/54 and his heart rate dropped to 40 and suddenly, we had just about every nurse on the unit in the room. Jacinta was massaging his chest and trying to wake him up, a crash cart was brought in and they were getting all kinds of things...just like you see on a medical show. They did not have to shock him but they gave him a medicine to keep his heart rate around 100, which is what they give after transplant. Before we left his heart rate was back up and his blood pressure was back up. We still decided to leave, as there was nothing we could do but wait anyway. They said they would call if there were any changes and I haven't heard a thing.
They are hoping to extubate him today and remove the ng tube. I don't know what other tests will be done, we'll see when I get there. Emily is not going with me today, she is going to work. But, if I need her to come, she will leave work, grab Bryan and head down. She said Bryan would probably call one of his cop friends for an escort, they did it before with the last heart attack!
I did ask Bill if he thought he was dying with all of the tubes and everything and he told me no. I told him that was good because he promised me that he would live to be 103 and I was going to hold him to that and that he would not be going back to that nursing home. We may have some difficult decisions to make in the next few days and weeks, but they don't have to be made immediately.
So, long update and I need to get moving. There is more to tell, but that will have to wait. For now the hairdryer is calling my name, along with getting dressed and feeding the outside cats and, and, and.
Keep us in your prayers, we can both use them!
He was on tank air, and it was on 5, but it was on pulse instead of continuous. This means that he would only get oxygen when he took a breath through his nose. I changed it and his nurse came in and his sats were very low again. But, she discovered that the regulator that was being used had to connections and the one he was connected to wasn't giving him any oxygen at all! The only good to come out of that was that we now know he can't consistently breathe room air!
He still didn't want to eat and I again forced him to eat some oatmeal. I told him if he didn't start eating they would put in a feeding tube and since he hated that when he had it before he tried to eat some more. We managed to coax him to sit in his wheelchair and I pushed him around some to orient him to where he was and where things were, like the dining room. I was hoping I could get him to eat lunch there instead of his room, but he said he wanted a tray. Lunch was just about an exact repeat of supper the other night, hamburger helper, just a different flavor and a different vegetable. They also serve them a fruit punch to drink. I don't know why they think old people would enjoy that!
One thing that we noticed is that the people who are eating in their rooms, whether they are bedfast or not, or need assistance or not, get fed after the dining room meal is finished and the patients (I almost put inmates!) are back in their rooms, or roaming around. Bill did not get his cold hot lunch for almost 1 1/2 hours after the others, and I had to ask about it!
He was ready to go back to bed after he picked at his meal so we got him back into bed. His sats were low again and he was on tank air. But, he didn't seem to be in distress again, just a little lethargic and he's been that way before, even when his sats were good. I asked if I could bring him food and they said yes, so I told Bill I was cooking his dinner and asked what he wanted. He said he would eat anything I cooked. When I went home to see what I had to fix I got a text from his nurse that his O2 was 93% and his heart rate was 77, really good numbers for him. Bill loves chicken so I took him 1/2 a sauteed chicken breast and a twice baked potato. He ate all of the chicken and half of the potato. I also took him a glass of tea. We visitied for a bit and he and his roommate started swapping war stories. He had been an Army helicopter pilot.
I got a call yesterday morning about 6 telling me that Bill had complained that his stomach and lower back hurt and then he vomited. His O2 sat was 44! He should have passed out! They gave him 2 breathing treatments and said he needed to go to the hospital and asked where I wanted him sent. I told them our local hospital to get him stabilized. I called Emily and we were waiting on him at the emergency room.
He was on a re-breather which gives high flow oxygen and he was still only in the 50s. The Dr. said he was in hypoxia and very critical. I told them to call Dr. Edwards at Baptist transplant and Dr. Edwards said to intubate him and get him shipped. He had also gone to the bathroom, so they had to get him cleaned up. He was awake but very agitated, mostly about messing himself.
Emily and I were sent to the waiting room while they sedated and intubated him and then the flight crew arrived to transport him. We left as they were taking him to the helicopter to go home and do what we needed to do before heading to Memphis. We were quite a sight, too. Neither of us were showered, but at that point, we didn't care. Because of where our house is located in relation to the hospital, we are right in the flight path for the helicopter, so I heard him fly over. At least it was a nice sunny day.
I discovered that, in our area at least, you can blow by a cop doing 95 with your flashers on and they won't stop you...or radio ahead for someone else to get you. Most of the time traffic did yield and traffic was light. I made the 1 1/2 hour trip in just under an hour.
Since he was a direct admit to the transplant ICU, we bypassed the ER and walked the long hallway. He was already settled and tests were being and had been run. One of our favorite nurses was on the floor, although she was not his nurse. So many people were in and out, xray, ultrasound for his stomach and kidneys, respiratory, cardiology for an echo. They also placed an ng tube which is the tube in his nose. It not only will drain stomach contents, but it can be used for feeding if necessary. One of the kidney doctors ordered a Foley catheter, and last night at shift change Alison told Lauren that it was not to be removed without a direct order from a dr. One of Dr. Threlkeld's associates was on call and she was not familiar with Bill at all, so she did a very thorough examination and then started a couple of precautionary antibiotics. Dr. Munday was on call for pulmonology and he said that since he was already intubated he was going to do another broncoscopy. I told him the staff here had suctioned a bunch of stuff out before he was transported, but he said they may as well do it and get some cultures going. So, we were sent off to the cafeteria for some lunch that I didn't want. But, they had some really good chicken and dumpling soup and Emily and I both had it. I ate all of mine and she was satisified.
He started to wake up shortly after we got back to the room and responded with nods and squeezes. But he got very agitated and started to reach for the ng tube so they had to use some mild restraints and then lightly sedate him again.
Dr. Edwards came in and said that it was lower right lobe pneumonia, which means aspiration again, and I don't remember him choking and I don't think it would have become that apparent from aspirating from vomiting that morning. He said that the right side of his heart was a little sluggish and he had compared all of the echos. I told him it was always sluggish from the transplant and he just didn't want to hear that. He thought that if this was going to keep happening, and therapy didn't help, he would have to have a jpeg which is the feeding tube in his stomach and just not be able to eat or drink. Bill will not like that at all! But, that's a bit down the road before we have to make that decision. He didn't think there was any medical reason for us to stay the night so we decided to go home.
We had noticed that his heart rate kept alarming and Alison assured us that it was just because of the sedation, so they stopped one of them. But, the next time his blood pressure was checked it had dropped to 82/54 and his heart rate dropped to 40 and suddenly, we had just about every nurse on the unit in the room. Jacinta was massaging his chest and trying to wake him up, a crash cart was brought in and they were getting all kinds of things...just like you see on a medical show. They did not have to shock him but they gave him a medicine to keep his heart rate around 100, which is what they give after transplant. Before we left his heart rate was back up and his blood pressure was back up. We still decided to leave, as there was nothing we could do but wait anyway. They said they would call if there were any changes and I haven't heard a thing.
They are hoping to extubate him today and remove the ng tube. I don't know what other tests will be done, we'll see when I get there. Emily is not going with me today, she is going to work. But, if I need her to come, she will leave work, grab Bryan and head down. She said Bryan would probably call one of his cop friends for an escort, they did it before with the last heart attack!
I did ask Bill if he thought he was dying with all of the tubes and everything and he told me no. I told him that was good because he promised me that he would live to be 103 and I was going to hold him to that and that he would not be going back to that nursing home. We may have some difficult decisions to make in the next few days and weeks, but they don't have to be made immediately.
So, long update and I need to get moving. There is more to tell, but that will have to wait. For now the hairdryer is calling my name, along with getting dressed and feeding the outside cats and, and, and.
Keep us in your prayers, we can both use them!
Saturday, December 1, 2018
It's a rainy, fairly warm morning with a little thunder and lightning thrown in. Started last night as predicted and rained hard through the night. I think it's supposed to last all day, but I'm not sure, been a little out of touch with news and weather the last couple of days.
Yesterday was quite interesting. Bill didn't feel well and we felt that he was just tired from the transfer. He's still disoriented about where he is. I think once he can move around some and look out different windows he'll realize how close to home he is. That may be a bad thing, I don't know, but he's still confused on his location.
He didn't want to eat at all. I forced him to have some oatmeal and he ate a couple of bites of scrambled egg. His lunch was fried catfish with slaw and black-eyed peas...good southern lunch. He only ate a couple of bites of fish.
I love the med nurse he had, we'll work well together. I told her I was going to be very hands-on and be there every day and she said that's what she liked, involved family. His blood pressure was low yesterday morning, but he had not had his midarone. That's the new med to keep his pressure up. He was also coughing a lot, even though he was sitting up far enough that his lungs could expand. When she was assessing him, his O2 was very low, only in the 60s and his heart rate was elevated, but not extremely high. With sats that low he should have been blue and gasping for air. But, he was not, he was just moaning a little and moving his head from sided to side.
I asked later to borrow her pulse ox to check it again because he just didn't seem right. I checked the concentrator and it was on the right setting. This time his sats were in the 50s! Heart rate still wasn't extremely high and he still didn't show any outward signs of distress. That's pass-out range. Charlise came immediately and asked if I wanted him transferred to the hospital or just monitored for a bit. I said to monitor, especially since he had just been moved, and she said she needed to call her supervisor and the nurse practitioner for the dr., but she wanted to try something first. She brought in a tank and changed him over and...oh my God!...he went straight to sats of 92! Apparently the concentrator was not producing a high enough concentration of oxygen and he was probably just breathing room air! The effect not only of the sats rising so fast, but in his entire demeanor was amazing! He perked up, he ate part of his dinner, which was like a stroganoff Hamburger Helper made with ground turkey. I told him to pretend that I cooked it and he said he couldn't even do that to make it taste better. I told him he didn't have to eat the fried okra, or the burnt dinner roll, but he had to eat some of the entree before he could tackle the strawberries and whipped cream, which was mostly whipped. He also started talking to his roommate and they were getting to know each other when I left for the night.
Charlise got permission to keep him on tank air for the night, but at the setting he's on, those tanks don't last long. I wondered how well he would be monitored in the night. I told him that since he could tell when nothing was coming out of the tubing to call them and tell them he couldn't breathe.
I don't know how well that went, but I got a phone call at 1 this morning. He had gotten out of bed and fell in the bathroom. They said he wasn't hurt but he had a panic attack which he has done before and they took him off the humified air (on the concentrator) and used something called a Christmas Tree and he was breathing much better. I asked why he wasn't on tank air like he was supposed to be and she just assured me that his sats were good. I don't know if they brought in another concentrator or what. It was storming at the time and since she assured me that he was OK, I didn't get up and go.
I have a feeling that since Bill knows he's not supposed to get up, that in the night his call button was moved, along with his urinal. That happened all the time at the center in Florida in was in after the transplant. There they had his bed very low to the ground with gym pads around it so that if he fell he wouldn't fall far. This bed is sitting up pretty high so he could get his legs under him, but since he hasn't walked without help for more than 2 weeks, it's not surprising that he fell. So, I'll investigate this morning when I get there to see just what happened. Charlise may like working with me, others may not be as happy!
I had to leave for a couple of hours yesterday and I think physical therapy came in and assessed him. OT and Speech came in late in the afternoon. The OT guy, a very nice young man from the Philippines, was impressed with Bill's hand and arm strength. He was also impressed that he still dresses himself, including putting on socks with no aids. I told him he complains about the buttons on his shirt being too small, so they are going to work on some fine motor skills and just general strengthening. Speech watched him swallow and didn't see any issues and she assessed his memory. I told her about the strokes and that he did have memory issues. He surprised me with some of his answers, remembering some sequences with words and numbers, but dates were a thing of the past. Looking back now, all of that was done before we discovered the low sat problem. I wonder if I could get her to re-evaluate him Monday before deciding on a treatment plan. His mind was so much clearer after that.
One disturbing aspect was that, instead of the 2-3 weeks we were told he would be there, they said it was 3 months! I told Bill that, if he worked very hard on therapy, and I could tell that he would be able to function better at home, I would take him out after the 3 weeks. I think that 3 months is the maximum amount of time that Medicare will pay for short-term care. I know they pay 100% for the 1st 21 days and then Tri-care will kick-in with what Medicare doesn't pay. They rushed through the paperwork so fast when he was admitted, they didn't give a length of stay. So, something else to check out Monday since there will be no administrators in over the week-end.
Once I see what he's doing with this new concentrator, I may call Jaron, our Lincare rep, and ask about a temporary one from them. It may be like when we're travelling. They provide concentrators and tanks wherever you are. If that can be done, and I would have more peace of mind, I'll tell them (the nursing home) to remove the concentrator charge from the billing. My sister, who used to work in nursing homes advised me of this.
Once again it was an eventful day. But, I didn't have to get up and drive to Memphis, or drive home in the rain and storms. I'm going to get the bills paid since it is the 1st of the month and hard boil some eggs to make egg salad for lunch. It still hurts to chew some, although I can tell a difference this morning in how my mouth feels, so maybe I'm getting used to the new teeth. But a softer sandwich sounds good and I haven't had egg salad for a long time. Have a good week-end. Stay dry if it's raining where you are, warm if it's snowing, and enjoy warm weather if that's your location. Happy December!
Yesterday was quite interesting. Bill didn't feel well and we felt that he was just tired from the transfer. He's still disoriented about where he is. I think once he can move around some and look out different windows he'll realize how close to home he is. That may be a bad thing, I don't know, but he's still confused on his location.
He didn't want to eat at all. I forced him to have some oatmeal and he ate a couple of bites of scrambled egg. His lunch was fried catfish with slaw and black-eyed peas...good southern lunch. He only ate a couple of bites of fish.
I love the med nurse he had, we'll work well together. I told her I was going to be very hands-on and be there every day and she said that's what she liked, involved family. His blood pressure was low yesterday morning, but he had not had his midarone. That's the new med to keep his pressure up. He was also coughing a lot, even though he was sitting up far enough that his lungs could expand. When she was assessing him, his O2 was very low, only in the 60s and his heart rate was elevated, but not extremely high. With sats that low he should have been blue and gasping for air. But, he was not, he was just moaning a little and moving his head from sided to side.
I asked later to borrow her pulse ox to check it again because he just didn't seem right. I checked the concentrator and it was on the right setting. This time his sats were in the 50s! Heart rate still wasn't extremely high and he still didn't show any outward signs of distress. That's pass-out range. Charlise came immediately and asked if I wanted him transferred to the hospital or just monitored for a bit. I said to monitor, especially since he had just been moved, and she said she needed to call her supervisor and the nurse practitioner for the dr., but she wanted to try something first. She brought in a tank and changed him over and...oh my God!...he went straight to sats of 92! Apparently the concentrator was not producing a high enough concentration of oxygen and he was probably just breathing room air! The effect not only of the sats rising so fast, but in his entire demeanor was amazing! He perked up, he ate part of his dinner, which was like a stroganoff Hamburger Helper made with ground turkey. I told him to pretend that I cooked it and he said he couldn't even do that to make it taste better. I told him he didn't have to eat the fried okra, or the burnt dinner roll, but he had to eat some of the entree before he could tackle the strawberries and whipped cream, which was mostly whipped. He also started talking to his roommate and they were getting to know each other when I left for the night.
Charlise got permission to keep him on tank air for the night, but at the setting he's on, those tanks don't last long. I wondered how well he would be monitored in the night. I told him that since he could tell when nothing was coming out of the tubing to call them and tell them he couldn't breathe.
I don't know how well that went, but I got a phone call at 1 this morning. He had gotten out of bed and fell in the bathroom. They said he wasn't hurt but he had a panic attack which he has done before and they took him off the humified air (on the concentrator) and used something called a Christmas Tree and he was breathing much better. I asked why he wasn't on tank air like he was supposed to be and she just assured me that his sats were good. I don't know if they brought in another concentrator or what. It was storming at the time and since she assured me that he was OK, I didn't get up and go.
I have a feeling that since Bill knows he's not supposed to get up, that in the night his call button was moved, along with his urinal. That happened all the time at the center in Florida in was in after the transplant. There they had his bed very low to the ground with gym pads around it so that if he fell he wouldn't fall far. This bed is sitting up pretty high so he could get his legs under him, but since he hasn't walked without help for more than 2 weeks, it's not surprising that he fell. So, I'll investigate this morning when I get there to see just what happened. Charlise may like working with me, others may not be as happy!
I had to leave for a couple of hours yesterday and I think physical therapy came in and assessed him. OT and Speech came in late in the afternoon. The OT guy, a very nice young man from the Philippines, was impressed with Bill's hand and arm strength. He was also impressed that he still dresses himself, including putting on socks with no aids. I told him he complains about the buttons on his shirt being too small, so they are going to work on some fine motor skills and just general strengthening. Speech watched him swallow and didn't see any issues and she assessed his memory. I told her about the strokes and that he did have memory issues. He surprised me with some of his answers, remembering some sequences with words and numbers, but dates were a thing of the past. Looking back now, all of that was done before we discovered the low sat problem. I wonder if I could get her to re-evaluate him Monday before deciding on a treatment plan. His mind was so much clearer after that.
One disturbing aspect was that, instead of the 2-3 weeks we were told he would be there, they said it was 3 months! I told Bill that, if he worked very hard on therapy, and I could tell that he would be able to function better at home, I would take him out after the 3 weeks. I think that 3 months is the maximum amount of time that Medicare will pay for short-term care. I know they pay 100% for the 1st 21 days and then Tri-care will kick-in with what Medicare doesn't pay. They rushed through the paperwork so fast when he was admitted, they didn't give a length of stay. So, something else to check out Monday since there will be no administrators in over the week-end.
Once I see what he's doing with this new concentrator, I may call Jaron, our Lincare rep, and ask about a temporary one from them. It may be like when we're travelling. They provide concentrators and tanks wherever you are. If that can be done, and I would have more peace of mind, I'll tell them (the nursing home) to remove the concentrator charge from the billing. My sister, who used to work in nursing homes advised me of this.
Once again it was an eventful day. But, I didn't have to get up and drive to Memphis, or drive home in the rain and storms. I'm going to get the bills paid since it is the 1st of the month and hard boil some eggs to make egg salad for lunch. It still hurts to chew some, although I can tell a difference this morning in how my mouth feels, so maybe I'm getting used to the new teeth. But a softer sandwich sounds good and I haven't had egg salad for a long time. Have a good week-end. Stay dry if it's raining where you are, warm if it's snowing, and enjoy warm weather if that's your location. Happy December!
Subscribe to:
Posts (Atom)