Author: admin

Nancy did well in the physical therapy room today.  She was helped from the wheel chair into a standing position and into a simple ‘walker’ and as she walked I followed with the chair.  While upright she is supported by another person holding onto her “gait belt.”  You may know this by another term, such as transfer belt or transfer aid, and it may (or may not have handles or loops for the assistant to grab.  The ones used for Nancy are simple heavy canvas straps with a single buckle.  Not fancy but they give a sturdy no-slack support.  She did two rounds of the circuit (about 100 feet) during the first excursion.

A person from a medical supply firm showed up with a half-dozen walkers of various styles.  The PT crew inspected them and used another lady and Nancy to test them for sturdiness and height.  Unlike the one Nancy has been using in the PT room, these were more fancy, with wheels (with hand brakes), and a seat.  Most are gray or black but the model that seemed most suitable for Nancy had a dark red anodized aluminum frame.  [Years ago when I was pretending to be an archer I assembled arrows both from wood and anodized aluminum.]  The process is described here:

http://en.wikipedia.org/wiki/Anodizing

Most folks are more likely to see this surface treatment on promotional items such as you will find by using Google Search, click on “Images” and cut-and-paste the following as a search phrase

[  carabiners “anodized aluminum”  ].

The ‘walker man’ had a bluetooth headset for his cell phone and talked with a person in their warehouse during his demonstration.  Very convenient.  It made me wonder why out in the facility the patients must still summon help by pressing a button on the end of a ten foot cord that then turns on a small light over the doorway in the hall – a light that might not be seen for several or several tens of minutes.  Then an aid comes into the room, turns out the light, assesses the patient’s need, and either helps or goes and finds someone, like a nurse, who can.  This signaling method became practical about 1910.  You do the math.

On another front the morning nurse did not have on her chart that it was allowed for Nancy to have the small carton of chocolate flavored drink with which she has been taking pills.  Two of these a day has been standard procedure now for at least a week.  Not this morning!  A little later someone brought her a cup of vanilla ice cream.  Then at supper an aid promised to bring her a scoop of strawberry ice cream.  The person was interrupted and that scoop never showed up.  The indignity of bureaucracy, procedure, and slow motion chaos is impressive.

The case was simple really.  A patient inmate is to be moved out of the middle space in a room with three.  Nancy is expected to need a place to be while her floor is cleaned and waxed.  Someone carries items from Nancy’s bedside table to the new and temporary location thinking she might want them there.  That was nice of someone.  Only that came before they actually moved the lady out. When they got around to doing that they packed up Nancy’s stuff and carried it to that lady’s new space.  When Nancy was returned to her room late in the afternoon no one was around that was involved in all the moving.  This morning with a bit of discussion among the workers Nancy’s stuff was tracked down and returned.  No harm, no foul, as some say.

For Nancy today was routine.  Several types of therapy.  Continued incremental progress.  They are going to send her over to the hospital (about 5 blocks) and have her inspected by a gastroenterologist.  That’s someone who studies your gastro, I guess.  On Wikipedia it claims such a person – a highly trained specialist – studies the digestive system and its disorders.  That sounds better than having someone poking around your gastro.

The major news of the day is a new roommate.  The facts.  Small town 20 miles from EBRG.  Well built, old homes on large lots. Elderly lady.  Husband deceased.  No family for hundreds of miles.  She falls in the kitchen, smacks the back of her head and breaks a wrist.  She can’t get up or out and can’t reach the phone that rings periodically.  On the third day, the caller, calls others in the town and they go and find her.  The main problem is dehydration and a lot of bruising and the previously mentioned injury.  A bad deal that could have gotten worse quickly.  Did I mention it was her right wrist?  And, yes, she is right handed.  Bummer.

I have to go and pick up a certificate of appreciation from the Kittitas County Conservation District tonight.  I don’t need the sheet of paper but the food is good, they serve me for free, and they are nice folks.  I help unbox, sort, re-package, and sell native trees and shrubs each spring.  So, I won’t write again until Friday evening.

On Wednesday the staff got Nancy out of her bed early and off to the therapy wing of the facility.  Then they took the small stuff in her room,  piled all on to the beds, and wheeled the three contrived wagons out and down the hall.  We have deliberately limited the things I take in but still there were chairs, night stands, waste baskets, and Nancy’s magazines, a few personal items in plastic bags, a dog biscuit box with greeting cards, and a small yellow lined tablet with her notes – a daily log of people, events, and comments. I did not see this but I have an image of the Oklahoma Joads leaving the Dustbowl and heading for California.  The purpose of this evacuation was to clean and wax the floor while having only one person without much stuff to deal with.  (Some long term residents have decorated extensively.)

While the beds were parked in the hallway the magazines and the yellow note pad and therapy-related papers disappeared. The things might have gotten stuffed into something or into someplace we don’t know about by the movers but they were not around to ask when Nancy was allowed back into her room.  The alternative assumption is that one of the residents wandering the halls carted a few things off to another place.  The nurse was not surprised about the missing items and wrote a memo to add a search directive to alert the staff at the morning meeting.

With the floor of her room freshly waxed they taped it closed like a crime scene and took her into the middle space of another room that is the permanent home to two very elderly and frail women.  The families of these two have decorated the spaces with personal and family items.  Nancy’s temporary space, between these two decorated oases, impressed me as being starkly empty.  She sat in the wheel chair beside an unmade bed, a table with a glass of water, and a cell phone.

The afternoon was saved by having her hair cut.  Since arriving in EBRG Nancy has had her hair trimmed by the same lady and she came at Nancy’s request.  So in an empty spot between the home-like spaces of two elderly strangers we both got new looks.  Why not?  My hair needed cut.

Some progress was made on the food issues today.  The speech and swallowing specialist worked with Nancy prior to lunch and then came to her room to watch while she chewed and swallowed.  When one doesn’t swallow well it is called dysphagia, or disordered swallowing.

To get proper nutrition food has to be prepared in a manner to make it easy to swallow and some foods have to be avoided.  We have assumed, in Nancy’s case, that her difficulties originated from the insertion of a breathing tube (endotracheal intubation) in the ICU.  There is a possibility that her problem preceded that and the intubation just added to an existing issue.

As early as last spring we recall some episodes of her not being able to swallow well, followed by spitting up something she had just tried to swallow.  This may be a false lead and her problem might clear up with a bit more time and exercise.  Swallowing a liquid such as water or anything else like water can be a problem because it goes down so quickly that your throat, being a bit out of practice, doesn’t have time to close off the airway.  Liquids that are a bit thicker – tomato juice, say – allow more time for a sluggish throat to function.  Thickened soups and drinks are recommended.

So, the dysphagia consultant examined the food in Nancy’s lunch.  There was ground meat (beef, maybe) with a gravy and mashed potatoes without gravy.  Well the problem with ground beef is that when cooked it adheres together (think of a grilled burger – if it didn’t stick together it would fall through the bars of the grill).  Thus, the meat portion met the letter of the directive but not the intent.  The consultant took it back to the kitchen and came back with the stuff newly ground.  That helped.

At supper the protein portion (tuna, I think) was prepared properly and brought in a bowl, that is, not as a sandwich.  No chewy sticky bread is good.  A thin watery soup accompanied the meal.  Not good.

I keep two canisters of yogurt in a small ice filled cooler in her closet.  We used one of those with supper to help add calories and nutrients.  The soup went back to the kitchen untouched.  I suppose I will be carrying corn starch or tapioca in small plastic bags to add to soups such as that tonight.  Carrying small bags of white power around in these troubled times seems to be unwise, however.  I may rethink this issue.

At this point a don’t consider a lazy day as being a good day.  Without weekend therapists Nancy doesn’t get out of bed.  She does move her arms and legs but there is very little stress on the “getting going” muscles.

I hope this stage is soon over and she can get in the chair and scoot around the halls on her own.  I don’t think she minds the inactivity as much as I do.  Getting up, in the chair, and then standing and walking is very hard for her now – a real exertion even with help.

She will go to a doctor’s appointment in Yakima on Tuesday afternoon.  This ride will be in a wheelchair in a van.  We expect she will get the stitches out where the chest drain holes are (were) but we do not have an idea what else will be accomplished.

We also think her current roommate will be going home on Tuesday.

Good or not, this week will bring some changes.

I went in early today and was in the PT room while Nancy did the therapy thing.  Among various exercises they got her out of her chair and with the support of the ‘walker’ she managed about 100 feet.  They did this three times starting from the chair each time.

We name things strangely.  For example we claim to park on a driveway and drive on a parkway.  We all know to get olive oil they squeeze olives. So, then, how do we get baby oil?  The ‘walker’ isn’t properly named.  It doesn’t walk, even when you push it.  It slides.  They seem to have rubber cups or tennis balls on the end of the legs.  If it has wheels, it rolls.  If it has both does it slide-roll?  We should call it a slideroller.

Anyway, that is the most exercise she has had since she walked to the car the morning she was having the heart attack – November 27^th.  This was more difficult.  We applauded when she finished the third trip.