THURSDAY — solving the purloined stuff

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.

WEDNESDAY — actually Thursday A.M.

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.

TUESDAY — another survey

Nancy had a very busy day with therapy in the morning and a trip to Yakima and the doctor’s office in the afternoon.  Minus some stitches she returned about 4 P.M.  All is well.

The mail brought a survey form from the hospital.  We have both been responsible for surveys – in-person varity and mail type.  We are very critical of these one-size-fits-all forms.  Acutally, we hate them.

I wrote a response to this one and show it below.  I will tell you in advance that Question #8 asks if her bathroom was kept clean.  In the ICU there is no bathroom.  So, my response:

> > > > > > > > > >

Dear Mr. ——————-,

My wife, Nancy, entered your hospital early morning on Friday after Thanksgiving via an emergency transfer from Kittitas Valley Community Hospital.  Her treatment in the catheterization lab went well and she expressed satisfaction with those that treated her.  However, by Saturday afternoon she experienced a complete cardiopulmonary collapse and was in the ICU, completely sedated, for eight days.  Before she was brought out of sedation I received, at home, a survey form asking her thoughts on how well she was treated.  I returned the form with this message:

I suggest you and your staff consider adding another step in your patient surveys protocol.  Namely, before sending this form you ought to determine the whereabouts and medical status of the recipient.

Later Nancy was taken from the ICU to the ACU and two days later sent back to the Cath Lab for a temporary pacemaker and then to the ICU again.  I received another survey.  I wrote a second letter, thought about it for a day – and never delivered it.

Nancy had open heart surgery on Dec. 29th and was discharged and sent to a rehabilitation facility on Jan. 20, 2010.  Total days in your hospital: 55

The discharge triggered the current survey request.

I can assure you that Nancy is very thankful to be alive and gives the credit for that to the doctors, nurses, and staff of Yakima Regional.  Also, I can assure you that answering this survey would require that Nancy make guesses and assumptions and/or leave things unanswered.

I will provide just two examples of where the survey form, if answered, would suggest a false or inappropriate idea.  Question #9 “was the area around your room quiet at night?”  The correct answer is almost never.  That sounds bad – except she was in the ICU for 51 of the 55 days.  What should one expect in a place with the key word of the title being “intensive?”  Question #23 “the admission process.”  First, she doesn’t remember being admitted in any formal sense.  I guess it depends on one’s viewpoint as to whether that is a “best” or a “worst” experience.  If she wasn’t admitted she could have gotten hung up in the system like “poor Ol’Charlie on the MTA.”  I guess I will ask you to look at question #8, also.  Knowing she was in an ICU bed for 51 days how would you suggest she answer that?

Also, we think she is “white” (Q.#27) but some family members think her DNA is a little suspect.  Her mother gave her the middle name “Lee” as in Robert E. Lee to compensate, claiming relationship.  Touchy subject.

Yes, she does recommend Yakima Regional Medical & Cardiac Center to anyone, including family and friends (Q.#22).  No we do not like these surveys.

She is currently here:

Nancy B. Hultquist    Room 28

Kittitas Valley Health & Rehabilitation Center

1050 East Mountain View

Ellensburg, WA  98926

Please feel free to visit and ask any questions you like.


MONDAY — on the food front

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.

SUNDAY — a lazy day

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.

SATURDAY — Trying to keep track

Saturday and Sunday are off days for therapy so Nancy has directions to move body parts while in bed.  Does she do that? I don’t know.  She does fire-up her cell phone and so must use her hands, arms, and voice.  She tires easily, so that activity is still a bit limited.

On another topic, I had to deal with the local hospital about our share of the payments from last summer’s treatment (June & July).  Nancy entered the hospital via the emergency room, was admitted, and then had out-patient treatment after that.  These episodes triggered 3 billing events.

The billing agent has to submitted to the insurance company.  What they don’t pay is submitted to Medicare.  The remainder is our responsibility.

The hospital software is triggered at the end of each month to send us an overdue notice even though Medicare has yet to be heard from.  The billing agent must intervene manually to stop this overdue notice but may forget.  Then we get 3, more or less, identical letters (billing code and amount differ).  None of these do we have to pay but I had to call and remind the agent to do whatever the software requires (reset the date, I guess).

I say “we don’t have to pay” but, in fact, we will have to pay some part of them eventually but what and when are not known.  Anyway, so as to show our intent to pay we set up an auto-withdrawal from our bank to the hospital – so how does one be late with a payment when it is triggered by the hospital requesting if from the bank?   After the visit to the emergency room on Friday following Thanksgiving there was another $2,000 tacked on so I wanted to up the auto-payment.  How does one do that?  Nancy did it the first time.   The lady at the bank says I need Nancy’s password.  Fine.  She is totally sedated.  I had to wait until she was brought out of the (?) dark.  I had just gone through this same sort of thing with a credit union because a staffer there wrote 12/15/09 on a piece of paper and not 11/15/09.  I spent 25 minutes listening to ugly “on hold” music before I could get them to fix that.  What fun!

I would like to explain, but can’t, the three nearly identical pages of “this is not a bill” but it is an “important tax document” that I got from the insurance company.  An imaging firm (not part of the hospital) billed for reading 3 x-rays or something but the hospital had not yet billed for anything.  That’s still a mystery.

This past Friday the postal service brought a fancy multi-colored check – $64.92 – from the local hospital with accompanying documentation saying Invoice #CEMC4525.  It appears as though I billed them for something and they are paying me. I have no idea what this is about.  On Monday I will have to call the agent and inquire.

I have the feeling this is all going to get worse.

FRIDAY — end of a long week

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 27th.  This was more difficult.  We applauded when she finished the third trip.

THURSDAY — not much that’s new

Nancy is making slow progress with regaining her physical abilities.  They had her using a walker today and the two PTs (physical therapists) with her did not have to save her from falling or anything else.  She didn’t go far but she did move her self around and about.  They help her stand-into-the-walker and then return to a seated position in the wheelchair.  She stayed in the chair for awhile after returning to the room and then a PT visited the room to help her stand, swivel, sit, and pivot back into bed.  None of this is she able to do on her own but they are helping her do it – not doing it for her.

The food leaves a lot to be desired but I’m supplementing by sharing a milkshake with her and carrying in yogurt.  She did have a soup tonight that was good but the sliced tomatoes, while red, were not.  I suspect that the meals are crafted to provide complete nutrition for the day if the person eats all (or most all)  of the three meals.  That’s not happening with her and probably not with most of the residents.

Visitors brought both flowers and candy today  — she ate the flowers and I ate the candy.  Just kidding.  Actually, the flower was a potted one and I can bring it home, find a bigger planter for it, and keep it going as an inside plant – it is a white Kalanchoe.  You can find a picture of a red one here:

WEDNESDAY — slips to Thursday

Last evening, when I normally would have been writing something for here, I responded to a batch of e-mails and just as I finished with those the phone carried a call from a friend.

She and I share the unwelcome situation of have spouses that suffered major heart related illness in 2009.  This also means that her husband and Nancy have many experiences to compare.  He had a major heart attack last spring that culminated in a heart transplant late in the fall.  They live in  a sparsely populated mountainous area remote from a major medical center and so he has been hundreds of miles away – and still is.

We each knew of the unfolding medical issues of the other but keeping in communication was nearly impossible.  Thus, we had a long phone call and when it was over I had some chores to do and never thought again of making my “occasional” update about Nancy.

She is still doing well – I’ve talked to her twice this Thursday morning – and I will remember to get something on here tonight.

TUESDAY — another day, another pound

They added weights to Nancy’s ankles, one pound each, part way through the workout today.  That’s how progress is measured.

Actually, they had to.  She now weighs less than when we married in 1969.

That seems like another world and another lifetime ago.

Maybe the physical therapy will redistribute the remaining excess stuff a little but I suspect this weight loss thing will cease as she rebuilds some muscle.

When she lost some weight last summer we went to a few garage sales and picked up a few things and also ordered a few things from a company that started and grew along with my father’s family back in Warren, Pennsylvania.  History here:

Our family never got involved except I’ve had cousins work there and they and other family members would buy returned goods on special days (at pennies on the dollar).  That’s our once-upon-a-time connection in case you need to know why we buy clothes from a small company in a small town in a place we have never lived.

The clothes purchased last summer are now too large.  Guess what’s next?