So… here’s the skinny!

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!

One Step Forward, Two Steps Back

March 12th, 2019

It’s a familiar dance step – one that goes with a variety of tunes.  Curiously, it doesn’t have a name – at least not one I can find among the 37 dances listed in the Oxford English Dictionary.  Not one dance from #1 “Pop Goes The Weasel” and #2 “The Virginia Reel” to #36 “The Rumba” and #37 “The Shimmy”  — not one is based on that familiar pattern of one step forward and two steps back.

But, even so, it is the step-pattern of choice here at St. Vincent’s Hospital.  There are a few variations, of course.  Sometimes there are three or even four steps back and, sometimes no step forward at all.  It’s all very confusing to the willing learners such as Nyel and myself.  And, the confusion is often compounded by the dance instructors (read doctors), themselves.  Not only do they disagree with one another, they often (apparently) disagree with themselves.

Take yesterday, for example.  A dance instructor (read doctor) from another dance team (read medical discipline) came in for a consultation.  His suggestions for a change in the dance pattern sounded terrific.  It seemed that his plan would soon have Nyel moving two or three steps forward without backward movements or even dips.  But, somehow, there was a change in his thinking after he left here and his original plan was scrapped.  Nyel’s dance routine was suddenly in a reversionary mode – steps that were tried days ago, and were found ineffective then, have been put back in his routine.

We’ve requested a conference with both dance instructors together.  Although both have agreed, they have come in separately.  That has happened twice this morning – they apparently don’t understand the terms “conference” and “together.” One comes and justifies one thing.  The other comes in and justifies something else.  Perhaps they are still trying to coordinate.  The only thing that seems consistent is that Nyel will not be leaving this dance studio for the foreseeable future.  Probably not for another week.

Through the magic of cyberspace, Nyel is in communication with his Number One Danseur in Seattle who has offered to consult with these St. Vincent’s’ hoofers if they initiate the request.  Neither Nyel nor I believe that they will consider doing that.  Stay tuned… if you can find the appropriate melody.

Sleeping on Chairs and Other Indignities

March 11th, 2019

Sleeping Sydney 2-11-19

Well, it ain’t the life of Riley, this hospital living.  For me it’s a bit of a combination between camping and being homeless.  For Nyel is it’s a lot like being in an institution run by the deaf and dumb.  (Forget politically correct.  All that terminology and, especially the HIPPA stuff. does nothing but impede progress we have found.)

So, the/camping/homeless thing is my bailiwick.  I did a lot of camping back in the day when that was our only choice for a vacation.   We could never afford a tent so, when rainstorms caught us in the middle of the night, it was often sleep on the cement floor of the john or curl up in the back seat of our VW bug.  Here at St. Vincent’s my choices, by comparison, are quite luxurious – the primitive (“makes-my hips-hurt-to-look-at-it” according to Pat Thomas) recliner chair, or the extra wide chair with arms or the plain old institutional armless chair.  I’ve made do with each.

I’m the one, also, dealing with “all” my personal possessions – my purse, my toiletries kit, my meds, my laptop, my cell phone (never mind that I have to go to the lobby for service) and my change of clothes.  I’m not concerned that anyone will take this meager collection, but meager is definitely the operable road.  I grabbed what I could think of for the projected three- day stay.  It’s now been seven (for me; ten for Nyel) and anyway, why was it I thought one pair of sox would do??? I should have thought to bring a grocery cart.

Nyel, of course, is given everything he needs – except water which is restricted.  His difficulties are more serious than keeping track of his worldly goods It’s more like trying to hold the hospital staff responsible for his lack of progress.

“Everyone is different” is their mantra, on the one hand.  “Most people respond to…” is their conflicting excuse.  So… they keep him on meds that work for “everyone else” but obviously don’t work for Nyel – the same meds his doctors took him off long ago because (here’s the deaf part) THEY DON’T WORK FOR NYEL

The dumb part is how they make Nyel feel for trying to explain “their” job to them.  Like Nyel hasn’t been paying attention during the fifteen years he’s been dealing with these issues?  So far, not one of the eight doctors who have seen him (about evenly divided between orthopedic and cardiology) have paid attention to what Nyel has told him about his reactions to certain drugs, which regimen has been successful, etc.  They have chosen to “start from the very beginning” and Nyel, consequently, has regressed.

All I can say is… it’s a good thing I learned long ago to sleep wherever I need to and that Nyel is basically a non-violent person.  Otherwise, this “Monday Report” might be coming to you from a different kind of institution – a homeless shelter for me or jail for Nyel.

The Pioneer Connection

March 10th, 2019

“So, you come from the beach,” she said.  Not a question exactly.  Susan Watkin, Family Nurse Practitioner, was one of the many workers who came in yesterday, one after another, to check on Nyel’s well being, his needs, his hopes for getting outta here.  I didn’t pay much attention until the words “the beach” registered.

“Of all the people we’ve met here, you are the first to refer to Oysterville as the beach,” I said.  “You’ve been to the Long Beach Peninsula before?”

“Yes,” she said, “My great-great-great grandparents lived there.”

“So did my great-grandparents,” I responded.  “They may have known one another.  My family name is Espy.  Who were your ancestors?”

Richard and Mary Carruthers’ Pacific House, c. 1870

“Oh!” was the response.”My mother is the one who’s into genealogy.  I’ll find out and let you know tomorrow.”

“Great!” I told her.  “I’m not so much into genealogy as I am into the history of the area and the old family stories,  Chances are I’ll know who your ancestors were.”

She didn’t wait until “tomorrow.”  She was back in a trice.  “Carruthers!” she said with a big smile and, I imagine my smile was equally radiant,  “I do know a little about the Carruthers!” I told her.  “When you come in tomorrow, we’ll talk!”

“Letters To Louise” by Carol Carruthers Lambert

I can’t wait!  Does she know that Richard and Mary Carrruthers owned the famous Pacific House in Oysterville?  Or that one of her cousins lives in Warrenton and wrote a book about the Carruthers Family called Love Letters to Louise?  Or that her great-great-grandfather replaced my great-grandfather as County Sheriff in November 1868?  (R.H, Espy resigned after only three months in office because, goes the family story, the county insisted that he pay for his badge of office.  He refused as a matter of principal.  The historic record is silent concerning who paid for Carruthers’ badge.)

I can’t wait to talk to her again today!  No telling what we’ll learn from one another!

On a scale of one to ten…

March 9th, 2019

Daytime: Nyel’s Chair at St. V’s

Hospitals are, at once, busy and boring places to be.  At times, usually from four to six in the morning, there is a regular parade coming in to poke, prod, and otherwise check on patient progress.  The phlebotomist is usually first, taking precious vials of blood back to the lab so various tests can be made and “the numbers” can be sent to the doctor in time for him/her to give updated orders for the day. Then comes the nurse’s aide to weigh the patient, followed by the nurse who takes “the vitals” – blood pressure and temperature and, sometimes, a measurement of urine output.

All the weights and measures along with various comments and notes are dutifully put into the computer for the care team’s reference.  Sometimes the doctor actually appears in person to talk over the plan of action for the day but, usually, “doctor’s orders” are delivered electronically and the patient is informed of treatment adjustments by the nurse. Questions are fielded back to the doctor and may or may not be answered in a timely manner.

In our experience, which unfortunately is considerable, breakfast arrives around seven in most hospitals – unless they are holding all food intake for an upcoming “procedure.”  The food and the processes surrounding it – the ordering, the delivery, the tray collection – are probably the least standardized of all the routines.  In this hospital, someone comes in person around ten in the morning to take the patient’s food order for lunch, for dinner, and for the next day’s breakfast.  There is no food service for guests.

The day continues with various procedures, bedside consultations, exercises, medication deliveries, measurements of vital signs etc.  During the down times, which are few, Nyel dozes and I go off to one of the hospital cafeterias to get grab a meal or coffee to bring back and eat in the room.  (In this hospital, I feel the need to be present and accounted for as much as possible.)

Nighttime: Sydney’s Bed at St. V’s

This is the seventh hospital Nyel has been in during the last ten years.  We find ourselves staving off the boredom between spates of activity by playing the Compare and Contrast Game – from the way the hospital organizes its staff to the quality of the meals and the attitudes of the workers.  And, of course, to their treatment of family members and patient advocates.  “On a scale of one to ten…” our conversations often begin.

Mostly we compare the amenities for patients – which, after all, should be hospital’s major focus.  But in this day and age when it seems universally recognized that family members and loved ones play an important role in a patient’s recovery, Nyel and I also discuss accommodations made for the non-patient team member (that would be me).

For overnight stays in the patient’s room, some hospitals offer cots and, in some, the nurses even make them up with sheets and blankets.  Usually, though, this is a do-it-yourself operation, which is fine and understandable. In other facilities, it might be a window seat that is offered for guest-sleeping or, here at St. V’s, a chair that (sort of) makes into a bed. Here, there is also the option of a motel-like facility across the street (if space is available), but then you can’t be on hand when things might be happening.  On a scale of one to ten…

We’ve toyed with the idea of writing a Patient’s Guide – sort of the hospital equivalent to Consumer’s Report.  Unfortunately, though, when you need a hospital, you aren’t often in a position to pick and choose.

Hip, Heart, Hallucinations

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.

Hoping for Hip! Hip! Hooray!

March 7th, 2019

Window Project, Oysterville Church 2019

When it comes to old structures like our house or the church across the street, I am in favor of repairing (if possible), restoring (if necessary) and replacing (never!)  I know there isn’t always a choice, but I love the old workmanship and, if it can’t be saved but replication is possible, then so be it.  But the choices aren’t so varied with people just yet – at least I don’t think so.

Nyel’s Hip Repair

These thoughts have come to mind in the last few days as many folks have kindly asked how Nyel is doing after his “hip replacement” and, I have to confess, I keep thinking of what friends have experienced after one or both hips have been “redone.”  So many people have sailed through – “back to work in a week” said one friend.  Don’t we wish.  (“Work”   meaning chicken duties in Farmer Nyel’s case, of course!)

As I understand it, the surgical procedure used to repair a broken hip can vary depending on a number of factors.  According to one website: In general, fractures of the very top of the thigh bone, called the femoral neck, are treated with replacement.   If the femoral neck fracture is not at all displaced, a repair of the break may be considered.  Apparently, that isn’t the problem or solution for Nyel.

Fractures below the neck of the femur, called intertrochanteric fractures, are treated with surgical repair using rods, plates, or screws. Nyel has  experienced a displaced subtrochanteric left hip fracture with full shaft width displacement.  For him it’s been the rod and screw treatment!

So, starting at the top of that long left leg:  a rod through the two parts of the  brokenhip, a connecting rod through his femur down to his kneejoint, held in place by two screws.  There, mid-leg, is his bionic knee.  Next comes the tibia and fibula – both broken in October.  The tibia was repaired with a plate and six screws – maybe more, says Nyel. The spiral fracture of the fibula has actually healed on its own.  So, there you have it.  Metal from hip to ankle!  I asked Nyel if that left leg felt heavier than his all-flesh-and-bone right leg.  “Maybe,” he said.  Maybe, indeed!

Full recovery from this hip repair may take up to a year and, according to many sources, only about 50 percent of people regain their full function.  The biggest challenges are mobility, strength, and balance.  In Nyel’s case, “full function” went out with the quadriceps surgeries seven and five years ago.  But we’ll be working hard to get him back to the best possible level of functionality. Step One:  Get him stabile enough to get out of here and get home to the chickens!  It’s in Oysterville that Farmer Nyel and his bionic parts really shine!

Underwhelmed at St. Vincent’s

March 6th, 2019

Nyel at St. Vincent’s 3-6-19

So far here at St. Vincent’s Hospital in Portland, it’s been a matter of hurry up and wait.  Nyel was ambulanced here from the Ocean Beach Hospital ER late Thursday night.  He had a badly broken hip.  His surgery took place Friday morning.  The surgeon called me during the procedure to ask if, prior to his fall, he had been complaining about his knee.  It was an inauspicious beginning.

The surgeon was unaware that Nyel has had two (ultimately unsuccessful) surgeries to repair his quadriceps which failed following a knee replacement in 2010.  “I just wondered if this break to his hip somehow caused an injury to his quadriceps,” he said.  Obviously, he didn’t get the patient’s medical history…

Since the surgery, Nyel’s blood pressure has plummeted to the point that they cannot safely have him stand so he can begin walking – an urgent priority, it seems, after hip surgery.  Over the last three days they have given him five units of blood, two boluses (intravenously delivered saline solutions) and encouraged him to drink fluids to the point that he felt sick and could not eat for two days.  All this to get his blood pressure up.

Broken Hip Repair

They have stopped getting him up to stand on the scales (because of lightheadedness from low blood pressure) but as of day before yesterday, he had gained 17 pounds of weight (from fluids) in twenty-four hours.  This morning: 25-pound weight gain over his ‘protocol’ weight at which point, in the normal course of events, his regular cardiologist wants him to double his ‘usual’ dosage of diuretics.  Here at St. Vincents, they have given him no diuretics, usual or otherwise – because of the blood pressure issue, they say.  “It’s a balancing act,” they tell us.

Since Sunday, I have requested that they bring a staff cardiologist in for a consult.  So far (this is Wednesday) that has not happened.  Because he has had congestive heart failure for five years and is on a strict protocol regarding weight gain from fluids, I’ve asked why they have stopped his regular regimen of diuretics.  “We are waiting to see…” is the answer.  “Could he please talk to a cardiologist?” I ask.   “Yes, we’ve noted your concern…” is the answer.  “Maybe today…”

First Steps

Always ‘The Plan’ seems to be “let’s wait to see if this transfusion (or this orange juice or this Gatorade) will help.”  They’ve taken hm off all pain meds and muscle relaxants though his pain level is elevated from muscle spasming.  “Analgesics tend to lower blood pressure.  Let’s see if eliminating them will help,” they say.  Each time I ask for a cardiologist’s input they say, “You have the absolute right to advocate for your loved one.”  (Duh!)  Somehow, my advocacy is going nowhere at all.

Nyel told me a few minutes ago that he’d like to be moved to the Seattle Medical Center where his cardiologist is.  If they can’t honor his request to bring a cardiologist in from another floor in this very hospital, I wonder what response he will get to the transfer request…

I keep thinking about the Hippocratic mantra, “Do no harm.”  I wonder where that fits into the St. Vincent’s picture.

Birthday Bash and Late Night Crash!

March 5th, 2019

Sydney’s Birthday Dinner

On balance… but that was part of the trouble.  My birthday began well enough.  Almost.  It was to be the Christmas we were unable to have with Charlie and Marta but only Charlie could come.  Still, Nyel made reservations at the Bridgewater Bistro, Cate filled in for Marta,and we met Patty and Noel for a marvelous dinner with visiting by Tony and Ann thrown in.  And Dave Drury and his trio played Happy Birthday!  To Me!

Andrew Emlen of the Skamokawa Swamp Opera

We got home about nine – pitchy black outside.  Nyel took the flashlight and went to check on the chickens.  It seemed to be taking him a long time.  I looked out the east window and could see his light but it wasn’t moving.  Just then my phone rang.  “I’ve fallen.  I think I broke my hip.”  I called 911.  Charlie grabbed blankets.  (It was below freezing but, fortunately, the grass where he had fallen was fairly dry.) Aid Car.  Ocean Beach Hospital ER.  X-rays.  Bad break. Yes, hip.

Charlie Visits Nyel at St. Vincents

Nyel was ambulanced to St. Vincent’s in Portland where he had surgery on Friday morning. Blood pressure plummeted.  Much concern.  Charlie and I feeling helpless at the hospital.  Sunday, no improvement.  Charlie and I went home to host an SRO House Concert for the Skamokawa Swamp Opera. (Fabulous!) Phone calls to the hospital before, during, after.  No improvement.  Transfusions.

One Step at a Time

Monday Charlie and I caravanned into Portland.  Nyel feeling lousy but sitting up and actually walking ever-so-slowly with a walker.  I am staying until he is ready to go home; Charlie said his goodbyes and back to L.A.  “I think we have to stop celebrating Christmas – no matter what time of year it is,” he said.  And we both remembered Christmas of 2016 when Nyel went into congestive heart failure and this merry minuet of hospital stays began.

Damn!  Damn!  Damn! This gentlest of gentlemen has had way more than his share.  We’d gladly give up Christmases and Birthdays, too, for Nyel’s good health.

Conflicted & Confused about Kid Safety

February 28th, 2019

Keeping its children safe is one of the paramount responsibilities of a society.  No sane person would argue that belief.  But it’s the how question that is usually the sticking point.

When I read of the Ocean Beach School District’s proposed two-point-five-million-dollar bond in yesterday’s Chinook Observer, I was aghast at my own reaction.  Total conflict!  How, I wondered to myself, can our community agree to pay for all the safety measures outlined in the article when our own recently elected sheriff is hedging on the gun control initiative just passed by the state?  (And, make no mistake about it, the proposed school bond and our attitudes concerning gun control are  inexplicably related.)

To be clear:  I voted for Sheriff Robin Souvenir.  And I voted in favor of gun control Initiative 1639.  The initiative is now being challenged in court and our sheriff, along with many others in the state, is not willing to enforce its provisions until it works its way through the courts.  It confuses me when the very people we elect to oversee enforcement of the laws that keep us safe decide, instead, to interpret them or to “wait” for further clarification.

I am conflicted, too, by the “safety” measures that are being proposed to protect our children.  One entry point into our school buildings, a full-time ‘resource officer,’ security cameras, improved lighting and fencing, etc. etc.?  Sounds a lot like a prison to me.  So… until we can come to grips with the root cause of our school safety problems, we plan to imprison our children?

Frankly, that’s not how I want to spend my money and it’s not how I want the next generations of children to grow up. And, yes, I’ve heard all the arguments put out by the NRA and their followers.  Not one of those self-serving reasons answers my concerns about locking our children up to keep them safe.  Not one.