Back in the Hospital Again

Monday started off with Daddy, finally out in his chair, asking if he'd died overnight and had he reached 100 first? I told him I had to disappoint him on both counts. Well, in that case, he wanted something to eat. As I got dressed for work and Steve started fixing his breakfast, he kept mumbling, something ordinarily that stops once he's up and out of bed and back in touch with the world.

A couple hours later his physical therapist, Kathy, called me. She was concerned because he was still "out of it", and even mild exercise like arm lifts was shooting his pulse up to 115. She didn't even have him get up and walk. Listening to his chest, she heard rattling noises, something we'd not heard for a few months now. Was he coming down with pneumonia again? Or hosting a UTI (urinary tract infection)? After confirming with Steve that he could transport Daddy to wherever I gave him directions for, I tried to call his regular doctor.

Monday mornings are busy time.

I called Steve back and gave him directions to the St. Croix Falls hospital for their urgent care, along with a list of things necessary to do to get Daddy ready to move. It's not a simple process.
In this house, it starts with putting the dogs outside, since you don't know how long you'll be gone, and Steve's basset, Fred, is just barely out of puppyhood. There are outdoor clothes to locate, portable O2 to switch him to, the wheelchair to get him out to the car with after turning the car 180 degrees so the passenger door is accessible, the bag of pills to grab and bring along....

And after he's in the car you have to take the wheelchair back in and bring the dogs back into the house before you drive away. It's still too cold to leave them out for hours.

An hour or so later I get a call on Steve's phone. Expecting to hear some kind of update on Daddy's condition, I'm surprised to hear a feminine voice explaining to me that they've put Steve into their system as well, since he arrived so overstressed and out of breath that they considered him more urgent than Daddy and set him up with heart monitoring.

Did I need to quit work and come up there? No, everything was under control for now. And as it turned out, Steve recovered nicely with no indications of anything but stress, and Daddy was admitted "overnight" with suspicions of a UTI.

When Paul and I stopped in after work that evening, he was convinced he'd spent the last two days (his time sense is totally screwed up, a logical outcome of short term memory issues) on a ship where everybody had been partying down the hall. It had gotten so bad, he said that he'd almost gotten arrested by the police for drunkenness. But he'd walked and walked and walked until he found the door to his room and escaped from all the clamor. Each time a nurse came in he'd ask them which club they belonged to, puzzling all of them. He was concerned that I'd be mad at him and promised not to have another drink for a whole week, although by the end of our visit that dropped to no drinking until tomorrow.

As if.

Medically, they were treating him for a UTI, and hung the first bag of IV levoquin while we were there. The optimistic guess at that point was two days' stay. They were also starting the juggling act with his congestive heart failure, which showed up on the X-rays they'd taken in the ER while pneumonia hadn't. In fact they were impressed with how much better his lungs looked than on his last visit, last Thanksgiving. Yeah, no kidding.

I'd had to stop at home on my way in to pick up his advanced healthcare directive and his DNR orders for them to copy. There were some questions on his meds, the whole bag of which had come in with him. His portable O2 tank had to go home for recharging, now that he was on the hospital supply (set at 1.5 liters, later upped to 2 when his blood-ox levels weren't high enough), so by the time we walked out we were well loaded down with his things. Paul of course got the bottle and his meds, and I got the paperwork.

The one thing that occurred to me, since it wasn't covered by his pills supply and had come up since his last visit there, was to inform them of his swallowing disorder and his need for Thick-It in his liquids. They responded immediately, thickening everything about twice as much as we do at home. Amazingly, he didn't complain.

Tuesday morning when I walked in on my way to work, he greeted me with a demand of where I had been. I explained about sleep and work and how much time I'd actually been gone, and that seemed to settle him down. He's used to seeing me in the middle of the night, so I guess my absence made it seem even longer than the interminable length nights usually last for him.

What I noticed when entering the room was that his roommate was gone. Not even the bed was left. His double room was now a single. I hadn't met the roommate, since the curtain was drawn during the previous night's visit, but heard the nurses talking with him, and knew he was pretty sick. I had warned them that he'd get no sleep at night with Daddy in the same room, and my personal theory is that the roommate was moved out because he needed his sleep. Crowded as they were, they found something quieter for the guy.

Just as I was getting ready to head out the door and sign on for work, the social worker showed up full of questions about his home situation and where he should go after discharge. I knew she'd get no sense from Daddy, so quickly interrupted her with the answers to all the questions she was going to ask about how we're set up and who's watching him and how much assistance he's getting. I've been there before. I fully believe we're taking much better care of him at home than any nursing home would bother to provide, especially the 24-hour supervision. They'd poke their noses in occasionally, on their schedules, not his, and with no continuity of care/information. I already know how blind he is, for example, and wouldn't take him to physical therapy, stand him in front of a chart on the wall, tell him to do what it says, and walk away! That actually happened two years ago, and prompted our removing him from the TCU (transitional care unit) he was placed in well before they thought he was ready to leave. Had we followed their lead, he'd never have gotten well enough to leave.

I heard from Steve just after lunch, when he went in to stay with Daddy for a while and keep him company, reminding him to take liquids and assisting with supper. His first sentence was, "We have a small problem." As he'd walked in, Daddy was sitting up on the edge of his bed, trying to get out. (Somebody forgot to set the bed alarm?) Seeing Steve, he yelled at him,"Get the hell out!" When Steve asked him what was the matter, he grumbled on about he didn't want to talk to Heather, he didn't want to talk to Steve (my brother this time), we were keeping him prisoner and he was going to walk out, find his own place to live, and do as he pleased.

Oh yeah, that's going to happen. Uh huh.

Just then was time for his chest X-ray, and Steve said it took five nurses to try to get him moved. It wasn't that he was combative, exactly, but supremely uncooperative, as if he'd suddenly turned into rubber. Steve didn't report what was being said during this, but I can imagine.

We have no clue what set him off. Likely it was something from a dream. Whatever, there are benefits to short term memory issues. When he returned from X-ray, he was all sweetness and light, his usual self. Of course, now he spent the rest of the day back in WWII. Occasionally he knew he was in a hospital, but he was obsessing about whether anybody had heard the rumors that his whole unit was being deployed tomorrow, and by unit he gestured to the whole wing of the hospital. When I arrived after work, he confided to me that it was likely he'd be gone tomorrow, and questioned each nurse walking in about what they knew. I just informed him that it didn't matter what the unit did; as long as he was still sick, he was staying right here. Well, did I want to go tour the parade ground?

Uh, no thanks.

It's so hard for him to answer the phone. Even if he could see it, which he can't except as a blur, he can't reach it. We've given up trying to call in. So when I get there in the evenings, I call my brother on my cell and hand it to Daddy so they can have their regular evening chat. For two days he said nothing that made sense, but my brother is patient and listens anyway. Even when my dad is more rational, a ten minute call becomes the same three minute conversation repeated three times. Even with those limitations, he remembers that they talked and that his son cares.

Next morning when I arrived, Daddy was sleeping. I do what I usually do at home, sitting next to him and putting my hand on his, and telling him "good morning" to wake him up. Wednesday, he opened his eyes, recognized me, then looked around his room and asked, "This isn't home, is it?"

He's back! Something in his medications has been working. That was Wednesday, and this is Friday. We hoped he'd come home yesterday, now hope for today. The problem is, they're trying to find the right balance of medications to keep his blood pressure high enough to prevent dizziness while keeping his fluid levels low enough to ease his congestive heart failure. The next step in their plan is take him off Flomax, a prostate drug that has low BP as a side effect. With a permanent catheter, it seems unnecessary for him to have the drug.

With that, my growing concern is his muscle tone. He spends nearly all his day prone, occasionally being moved to a chair for short periods, like for meals. Yesterday the nurse stood him up to hold onto his walker for the three steps to the chair, then decided his diaper had a present in it that mandated its removal. Was she prepared for that? No. Was there a replacement in the room? Or a box of baby wipes? Or a medicated patch to replace the one on his backside that had become soiled from stool easing its way in from the edges? No, no, and no. Each required a quick trip for supplies, while Daddy just stood there. Even at home he doesn't just stand at his walker, and my concern for him grew, especially as he was showing his growing distress from standing. We told him to sit when he needed to, and finally he did, about two seconds before the nurse returned from her latest supply run. So of course she wanted him to stand again without much rest.

The diapers supplied in the hospital are very flat and fasten with two tapes on each side. They are perfect, I suppose, for bedridden patients. Not so much for the mobile ones. I offered to help hold it in back while she fastened it in front, after watching her struggle with it for a while. This finally got it around him, but with the first step towards the chair (finally!) it dropped to his knees.

Like Randy (county nurse) said about fastening a diaper when I was explaining this to her later in a conversation about health concerns, likely discharge dates so she can visit him at home and evaluate his care needs for the aids she supervises, and communication on issues between herself and his hospital doctor, "It ain't rocket science."

Oh well, we're bringing one of his own diapers from home for when he leaves. It's like elasticized pants with a central pad. It stays up. Along with whatever is left of his dignity.