Library Paste Notwithstanding

May 24th, 2019

I remember that, in the days of my youth, there were kids who sampled the paste every time we had an art project.  Of course, in an effort to dissuade them from their adventuresome behavior, they were usually told that paste was made from horses’ hooves.  That did not stop them.  No doubt such epicurean experimentation has stopped now glue sticks have come into fashion.  (However, I wonder if kids do give those scented ones a taste test now and then.)

“Did you ever sample the library paste when you were a kid?” I asked Nyel.  (And why, exactly did we call it library paste, anyway?  Was it of particular use with books?)  My question was not random.  Nyel had ordered clam chowder for lunch and I remarked that he seemed to be enjoying it — which mostly he doesn’t no matter where he is.  “Tastes like library paste,” he said.  But he kept on eating it.  And the rest of his lunch, too!

Bit by bit Nyel’s  appetite is returning, as is his strength.  He can now actually get himself into a sitting position, use his arms to scoot himself a-little-at-a-time toward the end of the bed and then transfer himself to a chair — even if there are a few inches of disparity in the height of the two surfaces.  This is a HUGE improvement. Everyone who sees him do it (the nurses and therapists and doctors often pause in his doorway to watch the “show”) and to clap and cheer.  (Quietly.  Like in a library.)

This morning one of the Orthopedic Team said he might be put back on his blood thinners next Friday.  We sincerely hope so.  Besides the obvious reasons, he won’t be discharged from here until that happens.  Meanwhile, we hope against hope that no new setbacks occur and that library paste morphs into more palatable fare.   Ki yi yippee yippee yay!

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

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…”

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?

 

Oysterville Never Looked So Good!

May 20th, 2019

Our Southeast Corner

There’s nothing like home when you’ve been away!  And if your home is Oysterville, Washington, and your return is in the merry month of May — it is lovely beyond belief!  Gigantic rhododendron “bouquets” nod at me from every direction.  They are early this year and the brisk wind is causing the blossoms to cascade to the ground in pools of bright pink and snowy white.  Only my beloved Nyel is missing to complete the perfection of Springtime in the village.

Tucker put the flags up in the churchyard this afternoon.  I didn’t realize how much I had missed them all winter.  I feel like they are my personal weather vanes.  Each time I look out our dining room and kitchen windows, I know just how the wind is blowing!

Flags Flying May 20, 2019

On my walk about the garden, I purposely avoided looking at the flower beds.  I doubt that I’ll ever be able to make up for this month of absence.  If only I could train those chickens to weed!  Never mind that the weeds must be forest-like to them, towering way above their heads.

I left Portland at first light — about 5:3o this morning — and arrived in Ilwaco in plenty of time for my early doctor’s appointment.  Then, the mail which revealed an overdue bill (and late fee) — wouldn’t you know? — but several nice notes for Nyel, too.  They are lined up on the table ready to take back with me tomorrow.

We had hoped that all Nyel’s “surprises” were over but… no such luck.  When the surgeon cleaned up his “wound” Saturday night, he sent in another blood sample for culturing.  We prayed that it would reveal nothing new.  But alas!  Nyel called with the news that it is another infection — a bad one — not what they thought it was yesterday.  Whatever it is, hospital personnel are all required to wear “hazmat regalia” so that they will not spread it around to other patients.  Nyel says visitors are not required to “suit up.”

Our Northwest Corner

So, talk of swing beds and rehab are tabled for this week, anyway.   Sorry if I offend anyone but… shit! shit! shit!  Worst of all, along with this new infection comes great pain.  He is getting morphine periodically.  I hate being here and not there; I return early tomorrow.  Yet I know I will feel helpless there, as well.

Complicated and Mysterious

May 19th, 2019

Nyel – May 19, 2019

Day 24 — Ever since the swing bed facility at Ocean Beach Hospital refused to accept Nyel, he’s been known here at St. Vincent’s as “complicated.”  The term is used somewhat affectionately by the doctors and nurses who have worked with him over the last few weeks, dealing first with one issue and then with the next.  No one denies that he is, indeed, complicated, and they also have some understanding of the limited size and capability of our little hospital.  Even so, it would still be our first choice of places for Nyel to gather his strength for eventual homecoming.

But, we are also resigned.  His heart issues are complex enough and with no cardiologist on the staff of OBH, safety becomes a challenge.  Because of the removal of his entire hip joint and the ensuing need for a wound vac plus the additional evacuation of a hematoma  and shoring up of the wound site he has required orthopedic doctors and wound care specialists — also probably not available at Ocean Beach Hospital.  Complicated.

Add to that  the PICC line that goes from his right arm directly into his heart to deliver the antibiotics that are fighting his MSSA infection.  (To say nothing of today’s news that his recent surgery has revealed yet another infection.  Fortunately, this one not is not a staph infection and his antibiotic has been changed to one that will deal with both problems.  Very complicated.

Physical Therapy

I’m not sure if Ocean Beach hase an orthopedic doctor or an infectious disease doctor on staff, either; probably not.  And then there is the entire issue of physical therapy for a man with one seriously impaired leg who has been almost totally inactive since February 28th.  Yes.  Complicated to the max.

Now, added to the “complicated” descriptor is another, even more intriguing adjective:  mysterious.  That is one word that I’ve never really considered when thinking about Nyel.  The closest I might come to such a description is probably “the strong, silent type.”  I guess the silent part could indicate mysterious, although Nyel has always maintained, “what you see is what you get.”

Here at the hospital, his mysterious side has more to do with his reactions to certain medications.  Not only that, but his rather erratic reactions to certain medications that heretofore followed predictable patterns.  His blood pressure is one such mystery — it continues to plunge to unacceptable depths — but only in the mornings.  Each health care professional has a different explanation and, one by one, the obvious “fixes” have been tried and found lacking.  “You are a man of mystery,” they tell him.

Ultrasound

Another mystery seems to be why it’s his right leg (which is his good leg) that has swollen up to an abnormal degree, perhaps due to the fact that diuretics were withheld for some days before and after various surgeries.  “Probably.”  But his “bad” (left) leg has remained far less swollen.  “Hmmm,” said several of the doctors.  Finally, one of the cardiologists ordered an ultrasound to see if, possibly, he has developed a clot.  That mystery, however, will not be addressed until tomorrow (Monday.)  “You’re not supposed to get sick on weekends,” teased today’s nurse.  “Not in the hospital, anyway.”

Meanwhile, Nyel is feeling better than he did a few days ago.  His appetite is fairly good.  He is eager to work on some specific therapy goals — like transferring from bed to wheelchair to commode and back again on his own steam — without the use of Sara Stedy.  Those are things he will need to be able to do on a regular basis, once he gets home.  The hospital staff may consider him complicated and mysterious.  I say, he’s determined and forward-thinking.   Thank goodness!

 

 

 

 

 

Déjà vu At St. Vincent’s

May 18th, 2019

Ready for Surgery #4

DAY 23 – Nyel got back to his room about 2:15 a.m. after yet another surgery – this time to clean out the site of his last surgery.  The surgeon evacuated the large hematoma that had formed, cleaned everything up “down to the bone” and took care to stitch him as tightly as possible, hopefully to prevent formation of another hematoma. During the initial surgery three weeks ago, they were unable to do such a great job because “things got very dicey” and the surgeon had to close him up very fast.  Nyel still has a wound vac but now, please god, it will be able to keep the wound free of excess blood…  His blood pressure is scary low and they’ve ordered two units of blood… But bottom line:  Nyel feels great and looks oh so much better.  And his appetite is back!  Yay!    So… I’m taking a bit of time to reflect on the last few days here at St. Vincent’s.

On Thursday, when Nyel agreed to the orthopedic surgeon reopening his surgical site, Nyel asked if a cardiologist would be involved.  He had a question about his blood thinners relative to the procedure and afterwards.  The nurse wrote his question on the white board.  By morning the question had been erased.  No cardiologist had seen or talked to Nyel so we put another question on the white board:  “Will cardio be involved in surgical decisions?”

Life-saving Fluids

About 10:30 a.m. an orthopedic P.A. came in to have Nyel sign the surgery consent form.  Nyel asked him if a cardiologist would be able to weigh in.  I wish I had tape recorded his gobbledygook answer.  The only part that is indelibly etched on my mind are these sentences:  “Well, even though you are on the cardiology floor, the orthopedics people check with you every day; the cardio doctors do not.”

So???? Nyel and I weren’t sure what that meant.  It sounded a little (no…make that a lot) too competitive to me.  The  P.A. had also mentioned that the cardiologist on duty today was on “the orange team.”  What the hell?  I wondered if Nyel is considered the football, the shuttlecock, the hockey puck or what.

As it turned out, the cardiologist was in surgery and did Nyel want to postpone his “procedure” in order to talk with him? That could mean, of course, the P.A. pointed out, that Nyel’s surgery would be postponed, perhaps until sometime next week…  I’m sure he was just stating the facts but it sounded a bit like a threat of some kind to me. “No,” said Nyel.  “Let’s get on with this.  But, if the doctor is out of surgery before I go in, I’d still like to see him…”  I knew he was thinking, as was I, for god’s sake, get me outta here!! Soon!”

Nyel and His Nurses

What is it about this hospital, anyway?  We are both totally convinced that the reason Nyel is here at all this time around is because we could NOT make ourselves heard back in February when we requested a consultation with a cardiologist.  And here we are again…

Postscript:  Nyel did not go to surgery until 8:00 p.m. last night.  The cardiologist did not show up.  It is now 10:15 the morning after.  The cardiologist has not shown up.  His assistant popped in a few minutes ago and said that “the doc” is still trying to get in here.  Yeah. Sure. You Betcha!

 

Nyel: NPO Again

May 17th, 2019

Day 22 at St, Vincent’s this time around — This was to be Transfer to Providence Seaside Swing Bed Day. Operable word: was.  Instead, it’s NPO day — NPO is hospital speak for nothing by mouth — a medical instruction meaning to withhold food and fluids. It is from the Latin phrase nil per os which, translated literally means “nothing through the mouth” and is usually the order given when surgery is anticipated.

By nine yesterday morning, Nyel’s discharge plan was in place.  He would be transferred to Providence Hospital, Seaside about two in the afternoon.  At tennish, one of the orthopedic PA’s came in to check his wound vac.  She had been in several times before and seemed efficient and clear about conveying information to us.  Before she left I asked her about the amount of blood being sucked into the wound vac cannister — “It seems to be increasing…”  and I asked about its color — “It seems lighter, not dark like we were told it would be.”

She reassured me on both counts (or tried to).  We had been told initially that there would be less and less blood except when he was moving and that the blood would be very dark (almost black) because it was “old blood” from the hematoma, not “new blood” fresh from the wound site.

Two hours later, she was back with a (new to us) orthopedic doctor who was seeking Nyel’s permission to do some more surgery.  “I thought about what you had asked me,” the PA said, “and I took a long look at Nyel’s charts and at the numbers.  I think your concerns were correct.  He may be bleeding from the wound site, itself, and not just from the hematoma.”

  

Apparently, there had then been a consultation among surgeons and other ortho doctors, the cardiac people had been consulted, and they were all recommending going back in and closing Nyel up more securely — doing what could not be done three weeks ago because he was in danger of dying on the table.  “There will be no bone involved this time,” the doctor said.  “Just tissue.  He should be fine and it will make a huge difference in his healing. Plus,” she reminded us, “he did fine when they removed the pacemaker after his initial surgery.  This one will be a similar sort of surgery — nothing like the initial one when they were removing hardware and infection from the bones.”

So… Nyel had to give up the swing bed situation.  At this point there is no projected discharge date — it all depends upon how it goes — when they can put him back on blood thinners and diuretics for his heart and any other meds they have put on hold until he recovers sufficiently from this latest surgery.  Then, and only then, will he be back to square one (or is it two or three?) in terms of getting out of here.  As always, Nyel is stoic — the most patient patient ever.

 

Twenty-one Days and Counting

May 16th, 2019

The Hub

If I were clever like Mary Garvey or Wes Weddell or Larry Murante or Andrew Emlen or Cate or Fred or our neighbor Tucker… I’d write a song.  I don’t know if it would be a lament along the lines of “Danny Boy” or a ballad like “The Sloop John B” or more likely a nonsense song like “I’ve Got A Lovely Bunch of Coconuts.” Only the subject is clear in my mind — the trials and tribulations of the patients at St. Vincent’s.  Although, I’d probably call it St. V’s for the sake of the rhyme scheme.

I think there would be  a verse dedicated to each of the hospital hurdles we’ve encountered — the rules, the hierarchy of doctors, the inconsistency of nurses, the push and pull among therapists, the ever-changing dietary limitations for starters.  The chorus, of course, would be about mysteries of communication under this roof.  Perhaps the title should be something like “And Don’t Tell the Patient Anything at All.”

Command Center

I’m pretty sure it’s not just us.  Yesterday, as I waited for the elevator, a woman was pacing back and forth nearby talking on her cell phone.  “Thirteen people have been in to see her this morning.  They all said something different.  Two of them were doctors.  They said something still different –not what any of the other thirteen had said and they didn’t agree with each other, either.”

I was so tempted to weigh in with Nyel’s experiences.  But… none of my business.  If I’d already had my song written, I’d have broken into the rollicking chorus.  (I do think it needs to be rollicking, don’t you?)  Stay tuned, as they say.  A Hospital Hit is in the making!

 

A Nightmare of Continuing Confusion

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.

My Aunt Mona and Sara-Stedy

May 14th, 2019

Mona, circa 1920

My Aunt Mona, whose full name was Ruth Muriel Espy, was the most different of my mother’s siblings — at least the most different of the ones I knew.  Albert, Medora, and Sue all died before I was born, but Mona lived until she was 68; I was 32.

Mona always thought of herself as the “ugly duckling” of the family, not because of her looks, but because she considered herself the least intellectual and the poorest student in a family that valued education above all else.  She was petite, scarcely five feet tall, with luxurious auburn hair, envied by every girl in the family.  Following high school, she attended Washington State College in Pullman where she studied nursing and worked as a practical nurse on and off throughout her life.

Mona spent much of her adult life in Southern California, was married and divorced twice, and had no children.  She became interested in politics and, like Papa, was a devoted Republican.  One of her prized possessions was a letter signed by President Eisenhower, himself, thanking her for her work as a committee chairman for his 1952 presidential campaign.  After Mama’s death in 1954, Mona moved to Oysterville to care for Papa.  Mona spoke of herself as “Papa’s girl” and, certainly she took after him in many respects.  She was loquacious, gregarious, and could readily to relate to folks from every background, every walk of life.  Her funeral in 1972 had the largest attendance in Oysterville’s history.

We (and by that I mean the family) thought of Mona as “a character” — but in a good way.  One of her passions was gadgets — especially kitchen gadgets — and, even though we moved into the family house more than twenty-five years after her death, there were still dozens of ‘reminders’ of her passion for every conceivable effort-saving (or spending) contraption.  I’m sure there are still melon ballers, jar openers, egg separators, and thermometers for cakes, meats, candies, etc. still lurking in the cracks and crannies of the house.

I thought of Mona-the-Nurse and Mona-the-Gadget-Lover when Nyel was introduced to Sara Stedy® the other day.  Says the website:  Sara Stedy® is a new enhanced standing aid, builds on the success of Stedy, a proven mobility-promoting support aid that encourages more mobile patients and residents to stand up independently. … The innovative pivoting seat improves transfer efficiency and patient stability.  It works slick as a whistle in getting someone with no hip (and therefore very little mobility) moving from one place to another.

Sara Stedy®

Out of curiosity, I looked on Amazon and found that Sara Stedy® and her many cousins are readily available for prices from sublime to ridiculous.  Fortunately, we think Nyel will be able to gain enough strength in his good leg and his arms and shoulders that he can manage from bed to wheelchair and back again by the time we get home two or three weeks from now.

Meanwhile…. we might be on our way back to the Ocean Beach Hospital swing bed situation as soon as tomorrow!  Cross your fingers for us!  It all depends upon bed availability!