Archive for the ‘Medical Stuff’ Category

“Stop! Smell The Roses! Give Yourself A++!”

Thursday, May 23rd, 2019
Flowers From Dave and Stephanie

Flowerrs from Dave and Stephanie

Day 27 — Stephanie and Dave’s flowers arrived just at the right time.  It was mid-morning and Nyel had just endured two heavy-duty procedures.  He was in pain despite two IV doses of morphine, but was ready to “relax” for the rest of the day — relax and smell the roses!

Before eight o’clock the Occupational Therapist had come in.  Goal: to stand up from a sitting-on-bed-edge-with-feet dangling.  He struggled mightily and got oh-so-close.  “A+” said the OT lady!  Next she had him transfer to the Sara Stedy, sit on Sara’s seat, and scoot himself back onto the bed.  Mission accomplished.  She said what he had done was “huge.”  Nyel’s eyes told me he was underwhelmed but I had seen how hard he worked and what the cost had been.  “A++!” I say.

The Women in White

Then, in came four Women in White — the Nurse, the Infectious Disease Person, the Orthopedic PA, and the Wound Care Person.  The Nurse was here to help; the Wound Care Person was here to change the dressing; the other two were here to observe, although they also helped as needed.  It was hard to watch Nyel’s suffering but he said not a word — just lots of breathing in through the nose, out through the mouth as he has been instructed.

The Wound (On His Left Thigh)

I did manage to get a few pictures and, when all was said and done, I asked the Wound Care Person what she thought.  (They are watching for more infection and if they suspect any, he will need to have the site opened up for the fourth time!)  They are looking for redness, unexpected seepage, etc.  She was reassuring — thought it looked good, although there is redness that bears watching. The wound will be re-dressed on Tuesday.

So… there you have it.  Roses and lilacs and carnations and sweet peas and roses some more.  And he even ate some of his lunch!  Bit by bit, some progress is being made!  Now, if only they would re-start his blood thinners, I might sleep better, myself.

 

 

 

“They told me to take off my wedding ring…”

Wednesday, May 22nd, 2019

Wedding Ring Amongst The Miscellany

Day 26 — During the time that I was in Oysterville, “they” adjusted Nyel’s pain meds once again.  He had been in misery on Day 24 mostly, we think, because the the nurses are SO inconsistent about giving him his meds on time.  If they are late and he experiences break-through pain, it takes several (on-time) dosages to get him normalized.  Some nurses are timely.  Some are not.

The ones that are not always have excuses — “I was busy with another patient” is the most common and hard to argue with.  My personal favorite (NOT!) is the “He didn’t ask for it so I didn’t think he needed it.”  I think I might have raised my voice just a tad:  “He’s on a scheduled dosage!!!”

Nyel-The-Mixologist

In response to that particular go-round, “they” added yet another pain med.  Sometimes the two were being given together.  “No, no, no” said yesterday’s nurse.  You have to wait at least a half hour.  Those drugs are not good together.  Why is he on THAT schedule?”  I think her question was rhetoricaL… but it’s hard to tell with these Providence nurses.

When I walked in this morning Nyel said, “Those people are talking to me again.”  The “people” come to him when he is dozing.  He knows they are not real but, apparently, that doesn’t help matters.  “They told me to take off my wedding ring.”  And so he did.  “It’s right here on the table by my glasses.”  After I retrieved it and put it safely in my purse I asked, “And if they asked you to pull out your IVs, would you??”  “Probably,” was the answer.  YIKES!

Nyel’s White Board

So I ratted him out to Jon, his new nurse-of-the-day.  “He shouldn’t be given these pain two meds together — not even if they are given a half hour or hour separately.  One or the other.  Not both!” and Jon has crossed off one of the pain meds completely.  I didn’t know he could do that without a doctor’s order.  But I actually know very little…

The Tall and The Short Of It

The last time Nyel hallucinated it was in the ICU after his big “clean out the hardware” surgery early this month.  On that occasion he was an amoeba with millions of other amoebae.  They were racing for their lives in a game for which there were no rules.  Nyel said he lost and was then going down a ramp to the next game, also with no rules.  When he told the ICU nurse about it, she said, “Oh yes!  That’s called an ICU delirium and often happens after you’ve had anesthesia.  There have been a lot of studies about them.”  I looked online…  Wish I hadn’t.

As usual, my every instinct is to bust him outta here… where are Jack Nicholson and Morgan Freeman when we need them?

 

A Nightmare of Continuing Confusion

Wednesday, May 15th, 2019

You know those nightmarish dreams where you are trying desperately to get somewhere but there are no familiar landmarks and no one to help?  Usually, there is a sense of urgency connected — like you are being chased or there is a terrifying and omnipresent danger that you must escape.  In real life that scenario is called St. Vincent’s Hospital.

Yesterday, there was a lot of flurry and scurry in Nyel’s room.  The Care Manager came in to say that the Ocean Beach Hospital had a swing bed ready for him and he’d be leaving at 10:00 this morning.  We told her that we had transport ready for Nyel (in the form of our friend Bill and his van) but she said he would need to be medically transported by ambulance.  The expense (perhaps as much as $6,000) would be ours.  We said, “Impossible.  As in you can’t get blood out of a turnip.”  She asked us what our income is.

A few minutes later she said she had managed to get a “scholarship” and the transport would be paid for.  Yay!  The hospitalist came in and said that all systems were go.  Nyel would be outta here Wednesday and he shook hands with each of us and said all the right things. In the evening, I packed up some of Nyel’s belongings and notified Guest Housing that I wouldn’t be staying after last night.

Wound Vac Image From Internet

Wound Vac Image From Internet

By this morning the game plan had changed…once again.  Nyel’s surgeon had come in early, said he had not been kept in the loop, had not reviewed Nyel’s”progress,” and did not like the looks of how the wound vac was working  Next the case manager (a new one) came in and said that, come to find out, the doctor at Ocean Beach had not yet reviewed Nyel’s case and so, although there was a swing bed ready for him, he had not yet been “accepted” as a patient.  Transport would be delayed until 2:00.

Meanwhile… Nyel’s blood pressure had taken a dive and for that reason the hospitalist weighed in again.  He made some changes to Nyel’s meds and said he would not be discharging Nyel today.  Maybe not until tomorrow.  (No handshaking.) About then, the case manager was back.  “Bad news.  Ocean Beach will not accept Nyel.  They don’t have experience with wound vacs.  How about the Providence rehab facility at Seaside?”

Wound Vac Check

We (probably mostly me; Nyel doesn’t have the energy) are totally bummed.  Everything is understandable but why in the world did they jump the gun so badly yesterday?   Was it a streak of deliberate cruelty on  the part of the staff?  Or systemic ineptness?  Whatever the reason, it’s par for the course for this damned place.  I’m only sorry that the Seaside facility is also part of the Providence “family.”  There are some families you just don’t want to be part of.

Another Turning On Our Journey

Monday, April 29th, 2019

 

1987

Nyel’s surgery yesterday was two-thirds successful.  First, they were able to take out all the hip repair hardware from his first hip repair surgery two months ago.  Second, they were able to put up necessary antibiotic barriers against the staph infection which apparently came along with the “hardware failure” (as they call the screw that went through the bone and eroded a tennis ball sized hole in his pelvis.)

1990s

The third thing the surgeons hoped to do was a new hip repair/replacement, but things got complicated.  Something got into his bloodstream and impeded his breathing.  They were able to stabilize him but, once his heart/lungs get back to “normal,” he will continue living without a hip.  And, his left leg will be shorter.  “There will be no more hip surgeries for Nyel,” the orthopedic doctor said.  “His heart can’t manage it.”

“Will he be able to walk?” the words came tumbling out, of course, though they really weren’t my first and foremost thoughts.  There was a long pause.  And then, “Maybe some.  With crutches or a walker.”  Another pause.  “It will depend on how determined he is.”

Nyel is still in the ICU and on a ventilator.  He is responsive – can nod or shake his head in answer to questions and squeezes my hand when I tell him I love him.  The doctors have not told him yet about the one-third of his surgery that didn’t happen.  The one-third which would have kept him along the path he has walked these past seventy-five years.

2006

As I sit in the ICU trying to make sense of all the information on the monitors… trying to understand what all the doctors are telling me… my thoughts run the gamut.  Will we have to have all the left legs of his trousers shortened?  How much mobility can he expect – as in will he be able to cook in our current kitchen or should we consider remodeling?  What will we be like as a three-legged team and how can I be of most help to him as we begin this new path on our journey?

And please, please keep him safe and strong and pain-free…

The Balancing Act

Sunday, April 28th, 2019

Nyel, Pre-Surgery

Nyel has been moved up in the world – from orthopedics on the sixth floor up to the cardiac unit on the eighth so he can be monitored “on the telly” as the nurses say.  The transfer happened about 7:30 this morning because the morning lab draws showed that his potassium count had plummeted.   His 10:50 surgery has been postponed to 1:50 (maybe), depending on whether they can get the potassium numbers up.  “We don’t want him to have a heart attack on the operating table,” the nurse said.  YIKES!

It’s always a balancing act.  They’ve been diuresing him to get the fluids off.  Pulling off all those fluids is the reason for the tanking potassium.  Now, he’s getting more potassium by IV and, also, orally by pills dissolved in water.  “We don’t want him to have a heart attack on the operating table.”  YIKES some more!

The biggest balancing act of all, of course, is between his cardio needs and his orthopedic needs.  Right now, the heart is taking precedence.  This is precisely what we wanted to happen when we were here two months ago.  Thank goodness they are listening this time around!  Not that it’s an easy call.  Ignoring either could result in a life-threatening situation.  We feel fortunate that the team of heart doctors are working closely with the orthopedic team and we trust that the best possible choices are being made.

Meanwhile, I had an unbalancing time of it myself late last night.  I was getting up from my “sleeping chair” and through sheer stupidity (as in sitting for a moment on the footrest part of the chair) fell to the floor when the footrest retracted.  In the process I whacked my head on the wall and, inadvertently screamed, bring nurses and aides on the run.  There was a bit of blood but, in the end (ahem!) it was my tush that hurt the most, although probably not as much as my dignity.  This morning I feel a tad battered and bruised but am in fine fettle otherwise.

The DO NOT FALL signs seem to mock me at every turn.  I tell myself, “It was an accident.”  Yes, of course it was.  It was not an “on purpose.”  Bottom (ahem!) line, these recliner chairs really suck.  I do hope the rest of this day proceeds on a more even keel and that our equilibrium – internal, external, mental and physical – will continue to harmonize toward health and happiness.  And home!

A Miracle for Mary

Monday, April 22nd, 2019

The recent outbreak of measles in Washington put me in mind of Mary Douglas, the daughter of Jalek, an Indian woman, and her husband John Douglas who was one of the first white settlers in this area.  John, a cooper on a whaling vessel, had been to this area in the early 1840s, liked what he saw, and when he suffered an injury in 1846 – an injury serious enough to put him out of seafaring – he returned here and laid out a donation land claim on land just south of what would become Oysterville a few years later.

The story of Mary and the measles is best told by Lucile McDonald in her book Coast Country:  Douglas built a “studdin’ ” of upright posts, with a cedar shake roof and an attic with a gable-end door and an outside stair.  Is daughter Mary slept up there on a feather bed on the floor.  An attack of measles had left her blind in early childhood.  She had no medical attention until she was fourteen, when Dr. James R. Johnson (in 1854) began to practice across the bay at Bruceport.

Douglas arranged for her to live at the doctor’s house for a short period.  It was a fearsome adventure for Mary, who was dependent upon her mother.  Her clothes were packed for the journey in a tiny trunk adorned with bright nailheads, which her father had brought from San Francisco.  This was the only familiar object the blind girl took with her.  That night she went to bed in the doctor’s house, lonely and disturbed, wondering how she would manage to dress in the morning in a strange place where she could not find her way by touch.

Day dawned and Mary awakened.  A miracle had happened.  She could see again!  During the night the doctor had treated her eyes; likely some very simple thing had been wrong with them… By the time John Douglas died… Mary had become Mrs. Frank Garretson.  Her daughter treasured the little trunk with the bright nail heads, taken on that miraculous voyage across the bay to Bruceport.

And, in the Small World Department:
Frank Garretson was one of “The Bruce Boys” who entertained my great-grandfather, R.H. Espy in 1853 and who R.H. described as ” a clever fellow” which meant he was a good poker player!

Tommy and Irene Nelson’s Cannery, Oysterville

Frank and Mary’s daughter, Irene Garretson, married Tommy Nelson and lived across the street to the south of the Oysterville Church.  When I was a girl, she and Tommy had a small cannery behind the house and, in the late 1940s, canned gourmet quality smoked oysters under the label “Espy’s Own” which was an enterprise of my grandfather Harry Espy’s and my uncle Willard’s.
Both Irene and Tommy are buried in the Oysterville Cemetery (as are Frank and Mary Garretson.)

Also buried there is Dr. James R. Johnson whose daughter married Richard Osborne Goulter, our Oysterville neighbor Bud Goulter’s great-grandfather and making Bud Dr. Johnson’s great-great-grandson!

The Home Stretch

Friday, March 15th, 2019

Daffodils on Bay Avenue

What a difference a day makes!

Bright and early yesterday morning, after eleven days away from home, I headed for the beach to take care of a few necessities on the Homefront.  Like finally receiving delivery of our new, back-ordered-for-three-months stove and keeping an appointment or two of my own.  Nyel had given me a list of things to do and get for him, as well, and besides all that… we both felt that I had done all I could to get his care situation turned around.  It’s not that we had given up hope exactly… but we felt it might be time to let some dust settle on the hospital front.

My drive was uneventful weather and traffic-wise.  Until the home stretch!  I had stopped for a moment at the Ocean Park Library to pick up a book waiting for Nyel and then headed east on Bay Avenue, curious to see if Tom Downer’s daffodils were up and blooming.  Were they ever!  Hundreds of cheerful yellow blossoms filled the verge from Eric’s gallery to the Charles Nelson House at the corner of Bay and Sandridge.  Talk about a glorious welcome back to the beach!  OMG!

Better Than The Yellow Brick Road!

I arrived home about noon-thirty and called Nyel to see how it was going!  He hadn’t sounded so cheerful since my birthday night before TBH (The Broken Hip.)  Apparently, no sooner had I left but “everybody and his brother” – hospitalist, cardiologist, the orthopedic team, his current nurse, etc. etc. – crowded into his room.  No one called it the “Care Team Conference” (that we had been advocating for since Monday) but, that was what it seemed to be.  Everyone weighed into his progress, pro and con, and what the next steps should be!   YAY!

The decision was made to get him onto oral diuretics so he can be transferred to a rehab situation – maybe as early as today!!!  No sooner had they left than Nyel got a couple of phone calls – one from his cardiologist’s assistant in Seattle saying that his doctor was again offering to oversee his recovery (the heart aspects) long distance and, hard on the heels of that, a call from our Primary Caregiver in Ilwaco who said he would be comfortable working with the cardiologist and managing things from this end.  So… it looks as though Nyel might still wind up in rehab at the Ocean Beach Hospital in Ilwaco!  Double Yay!

The Rose City Mixed Quartet

About that time, the Rose City Mixed Quartet arrived to serenade Nyel (!!!) and the Physical Therapist who happened to be working with him right then (and who also belongs to a singing group in Portland) joined in on the madrigal “Paul and His Chickens.”  (Nyel said, “She later told me that it had been the BEST day of her entire working career!”)

When I checked back with Nyel in the evening, he said that the day just kept getting better and better.  Sue and Bill stopped by in the afternoon and stayed for a couple of hours.  “You have to share that chocolate,” I told him.  “How did you know they brought some?” he laughed.  “I know Sue and Bill…” was my response.

Waiting for Farmer Nyel

We realize that things can change in a trice, but we are both feeling so much more hopeful now than we were twenty-four hours ago.  “What do you think caused all the turn-arounds with the St. V’s people?” I asked Nyel.  “I haven’t a clue,” was his response.  As usual, they didn’t explain themselves and Nyel didn’t feel he had much part of the decision-making process.  But… that entire concern is moot for the moment.  I’m heading back to Portland and hope to return with the ever-patient patient before too many more clucks and cock-a-doodle-dos from Farmer Nyel’s flock.

Oh yes… the stove couldn’t be installed yesterday – they brought the wrong connecting parts…  But even that didn’t mar the joyous thought that things are finally turning around for Nyel.  And did I say that neighbors Carol and Tucker had me over for the best dinner I’ve had in since February 28th?  It really was a day to hold in my heart!

Onward? Upward? Hard to say…

Thursday, March 14th, 2019

Yesterday, shortly before dinner, Nurse Mario came into Nyel’s hospital room and announced that they were transferring him up to the 8th floor where they could monitor his heart more closely.  Yay!  Finally, the hospital gods were paying attention to Nyel’s needs and a positive step forward would be taken!  Or would it?

When Mario arrived with this latest news, we were still expecting the promised conference with Nyel’s “Care Team.”  They had not been able to pull it together on Tuesday when I had requested it as a “next step” up the steep slope of hospital protocol when one is not satisfied with patient care.  The meeting had been postponed to yesterday morning.  Then to yesterday afternoon.  Then, before we could say WTF, he was being transported up to the eighth floor.  Apparently, the care conference was off the table.

New Room

Initially, we were pleased.  The explanation Mario gave us led us to believe that this was so Nyel would now have better access to the cardiologists who would be taking the lead in his care.  His progress with the orthopedic part of the team had been sufficient so that, under other circumstances he would be sent home.  (And, by the way, one of the “Case Managers” dropped in to say, Ocean Beach Hospital has changed their mind; he is not a candidate for their swing bed facility.  Because of his congestive heart failure.)

We were feeling a bit blind-sided (but in a good way) about the move to this eighth-floor room until Nyel’s new nurse explained that this is not a cardio unit, as we had been led to believe.  The same hospitalist(s) will be overseeing Nyel’s care and the same physical and occupational therapists will be working with him.  The major difference in locations?  This room is on a newly renovated floor and has telemetry capabilities.  He is now hooked up to a heart monitor and someone “down the hall” can keep an eye on his heart rate and rhythms.  Otherwise… same old, same old.

3/13/19 – Another Step Toward Home

Who made the decision to move Nyel?  Why was it made?  Is it something that we are in agreement with?  All moot questions, apparently.  At least this hospital remains consistent in its determination not to involve the patient with regard to his care.  As it happens, we had a visitor all afternoon who witnessed the transfer process – from Nurse Mario’s announcement to helping schlep Nyel’s “stuff” from Floor 3 to Floor 8.  She didn’t happen to stay long enough to learn that not much has changed.  I’m eager hear what she thought had transpired.

Even though I strongly suspect that we have somehow gone through the looking glass, I am continuing to ask for a Care Team Conference.  As far as we can find out, it is the only option still available to us with regard to having a say in Nyel’s care.  Or to registering our uncertainties about what is being done for him.  The odds of it happening? Probably slim to none.

So… here’s the skinny!

Wednesday, March 13th, 2019

Yesterday Nyel was (apparently) privileged to be part of the ‘Providence St. Vincent Medical Center Department of Nursing Monthly Skin Evaluation’.  According to the handout that was supplied by the “Skinny Nurse” (as they call the designated skin-check-nurse on this floor):  As a part of our nursing department’s ongoing quality improvement efforts we evaluate all inpatients on a given day once per month for any skin problems.  This is over and above the assessment your assigned nurses do each day.

What Nyel and I understand from that is that if you are “lucky” enough to be in the hospital on the particular day of the month that is the designated “Skin Day,” you get an extra examination.  We are not sure how this helps the many patients who are in the hospital only on the other 29 or 30 days of the month.  If this skin check routine is part of some “study” or for the benefit of the staff, it might make more sense.  As it was presented, though, Nyel and anyone else who happened to be “in residence” on Tuesday, March 12, 2019, get a bit of extra attention – part of an ongoing improvement effort but only for some???  Hmmm.

‘I don’t know what these dots are … but ya mind if I connect them?’

The information sheet goes on to say:   The evaluation is done by nurses who are experts in skin care issues and requires that they look at all your skin surfaces.  It will only take them a couple of minutes to do this… They will come in pairs and identify themselves to you…. The “pair” turned out to be a single person who has been Nyel’s day nurse several times during recent rotations — a nurse we like very much.  Yesterday he was wearing his specially trained “Skinny Nurse” hat.  No one was with him.

He looked at specific areas of Nyel’s skin that he remembered as problematic from previous days – “all” skin areas as designated on the handout were not a part of his procedure.  In fact, he needed reminding that Nyel had a skin tear (perhaps from tape) near his surgical incision that a wound specialist had been called in to look at several days ago.  Sigh…

Still and all… it’s nice to think that Nyel is among the few who are benefitting by this bit of extra attention.  Yay!

Hip, Heart, Hallucinations

Friday, March 8th, 2019

Nyel and Physical Therapist 3-7-19

This morning begins Nyel’s eighth full day as a patient at Providence St. Vincent’s Hospital in Portland.  When he arrived in the wee hours of March 1st, the focus (of course) was his broken hip.  That has been repaired and all protocols have been put in place for his healing and eventual recovery.

Once the hip was repaired, his orthopedic team was alerted by his Number One Advocate (that would be me) that perhaps a bigger issue might be his long-term congestive heart failure.  Eventually, a staff cardiologist was consulted and has weighed in on matters such as diuretics and blood thinners and other medications.  Yesterday there were some dramatic changes.

Most gratifying was a twelve-pound fluid loss in a twelve-hour period.  Yay!  That slowed down to a three-pound loss last night but, gradually the 27-pound accumulation of fluids is diminishing!  Today they are re-starting his blood-thinners which is also a huge relief to me, though the ortho team has assured me that his system has retained enough to prevent clots. (I would like to hear that from his UW cardiologist or even from the consulting heart man here.)

Casey Comes Visiting 3-8-19

During all of this, patient Farmer Nyel, has been enduring severe muscle spasms around his left hip.  They have given him muscle relaxants to help that situation but he had a surprising reaction.  After a period of deep (unable-to-be-aroused) sleep, he informed everyone that he had been visiting a monastery that was apparently under restoration.  “There were stained glass windows on the wall to my rightt and there was a lot of scaffolding behind me.”

He also reported having several conversations with staff members whom he knew, even at the time, were not present in the room.  In fact, at one point, he appeared to be asleep and reached out to accept something (a glass of water?) as he said with eyes still closed, “I believe I’m hallucinating again.  There’s no one there is there?”  It wasn’t scary – not to him or to those of us observing him – but it was decidedly weird.  They have changed muscle relaxants so we shall see…

All in all, Nyel’s care seems more inclusive and we are seeing some positive progress.  His work with the therapists – occupational and physical – has picked up after skipping that day of deep sleep and interesting visions.  Yay!  Back on track.  The Homeward Track we hope.