Archive for the ‘Medical Stuff’ Category

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.