Author: admin

Nancy was carted over to the hospital this afternoon and seated between the open ends of a horseshoe-shaped thingy that lit up a monitor with an image (in shades of white, gray, and black) of her mouth and jaw, and points south.  Lowest on the screen were the top two metal sutures used to tightly re-close her split sternum.  If you lower your chin to your chest you will come close to where the top one of these appears.

Nancy was given food items containing a small amount of Barium sulfate that acts as a contrast agent with respect to the body tissue and bones.  That is, whereever this stuff goes can be seen on the screen as near black globs.  Because Barium is of relatively high atomic number (Z = 56), its compounds absorb X-rays more strongly than compounds derived from lighter nuclei.  Although barium is a heavy metal, and its water-soluble compounds are often highly toxic, the extremely low solubility of barium sulfate protects the patient from absorbing harmful amounts of the metal. Barium sulfate is also readily removed from the body.

The compound is administered as a suspension of fine particles mixed with foods of different texture.  Nancy had grape juice, applesauce, a fruit mixture, mashed banana, and mashed chicken.  Following her time in the ICU with tubes down her gullet Nancy existed primarily on non-solid foods, especially fortified drinks.  As more-solid textures were introduced she became accustomed to small bites and tentative swallowing.  Frequently she would chew something for awhile and then spit out the solid parts.

The passageway from lips to stomach experienced little real action for many weeks.  The muscles along the way degraded, lost their tone, or underwent “disuse atrophy.”  I think this is what we suspected and confirmed today.

As Nancy ingested the barium sulfate laced food all parts worked as they should except at the very lower limit of the image there was a just noticeable slowing of the material (the dark glob on the screen) and then it dropped out of range for the set-up being used.  Thus, while her real food intake is improving she instinctively remains cautious and rightly takes small amounts and swallows carefully.

In the room today for the exam we had Nancy, the imaging specialist, two swallowing specialists, and me.  Not that my opinion was needed, but we all agreed on what we saw, and what we thought it meant.

During Nancy’s time in the hospital (except when sedated) she continued to use her hands and arms – right more than left.  Since January 20^th she has had therapy on a regular basis.  Yesterday she was able to play her violin for the hour jam session with her friends, and it is now six weeks since open heart surgery.

However, Nancy is not yet able to get herself out of bed nor into a standing position from a sitting position.  Noticeable progress is apparent as regards these very visible muscular activities.  The tone of these less used muscles is returning more slowly than those in her hands and arms.  It seems reasonable that the equally atrophied muscles used for eating that we cannot see at work will likewise take longer to regain their capabilities.

So, having found nothing really out-of-whack, we expect continued improvement.

[whack?  See:   http://www.worldwidewords.org/qa/qa-out2.htm ]

Well, the work week began.  Everyone did their job as usual.  Nothing was particularly exciting or new.  All those with some knowledge of the rehabilitation process that talked to us said it would be slow.  It is slow.  What more can I say.

I’ve got some paperwork to catch up on.  You probably do to.

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.