Category: Post Visit

So, last things first.  The elderly man mentioned yesterday was keeping his wife from getting good sleep so someone reported that the couple thought it would be a good idea to move him out.  The woman told me she did not ask for nor like the move but Nancy became a convenient ‘necessity’ to accomplish what someone wanted.

It seems the move from Yakima was approved by the insurance company for a 3-day evaluation period with, upon asking, a 7-day follow-on.  Then each 7-day period has to be approved prior to the end of the prior period.  This protocol seems not to have been understood by everyone aware of Nancy’s arrival and so the messages we were getting were jumbled and conflicting.

Confounding the issue was Nancy’s late arrival (just before 4 P.M.) in contrast to the more common morning arrival.  Thus occupational and physical therapy folks were very busy with their duties.  With various functions going on all day they have problems keeping to a schedule if something unexpected happens.  If someone needs a bath and that team shows up just before the therapy team then there is a reshuffling of appointments as if one had missed the partner in a square dance move.

By late this afternoon either Nancy or I or together had visited with most of the folks working to coordinate her rehabilitation.  We got to explain her condition and how she got to this point and they began to put together a plan to move forward with her needs.  As I understand it this is what is needed for the place to get approval for the following week.

I now need to gather proper shoes or slippers, and enough clothes for her to appear in public.  Ye ‘old hospital gown won’t do in the physical therapy room.

It used to be people had ‘family doctors’ but now we have ‘primary care physicians’.  We are back in home territory now and I alerted our doctor and he came by and visited after seeing his clinic clients.  I left the two of them after a bit to come take care of things at home – feeling a whole lot better about today than about yesterday.

Nancy is now in a facility in Ellensburg.  A crew picked her up at about 2:45 this afternoon and by 4 P.M. she had made it into a room which will be her new home for a few days.  As I write she is answering questions for the medical staff.  I’ll post this and grab a few things for her and head down the road.  The only glitch today was that the person who had to sign discharge papers was nowhere to be found.  She had gone into a meeting and turned off her cell phone and anyone that would know her whereabouts was apparently in the same meeting.

I’ll get more posted either late tonight (10 or 11) or early in the morning.  I’m on Pacific Time.

>>>>>>>>>>>>>>>>>>>update

After visiting with Nancy I am trying to stay hopeful but it is not easy.  As she just got there and has not interacted with any physical therapist there is, as yet, no way to judge what will happen next.  Such as it is, that’s the good news.

The day’s problems began with the missing necessary signature as mentioned earlier.  Next the insurance company representative would agree to sending Nancy to Ellensburg in a wheel chair type van.  Nancy has not been using a wheel chair and cannot get up or down or out of bed without aid.  She didn’t want the wheel chair deal so we went with the next option which we have to pay for.  $1,000 later Nancy is in Ellensburg.

Upon arriving in the facility one person indicates she is expected to stay only 3 days.  A second person says, no, it is seven days with a second week likely.  It was too late in the day to question this – no one was around that would know.

She was told that the report they received on her indicated she was sufficiently strong to get out of bed and to the potty on her own.  Where did that come from?  The reason for not allowing her to go to the 5^th floor rehab unit was that she could not do such a thing and thus would not benefit from the sort of rehabilitation offered there.  Besides, the previous afternoon Nancy had told the director she could not traipse to the potty on her own.

This next thing isn’t regarding Nancy but I think it is relevant.  Here is the story:  In early December an elderly Ellensburg man has a stroke and is taken to Yakima for treatment.  Several days later the wife falls in her home and breaks her hip.  For the past two weeks, until this morning, they were sharing a 2-person room.  Now the man has been moved out to a room down the hall and Nancy has been moved in.  These are very nice folks, both in wheel chairs.  I was there at supper time and the staff served Nancy and the pair their dinners in the room while I was there.  We had a pleasant visit but later the lady got into bed and the man wheeled himself off to watch TV for awhile before going to his new room.  I acknowledge that Nancy and I do not know the reasons for this situation – it was not explained to Nancy today – but it did not seem right.

We hope to have answers tomorrow.

We had hoped to move Nancy to Ellensburg when she is ready to leave the hospital but there is a glitch.  She still needs more attention than the places in Ellensburg can provide.  She will likely stay in a skilled facility in Yakima for two to three weeks, perhaps, beginning as early as Tuesday.  That is unsettled.  It is clear she needs care because of her weakness.  It is also clear that there are truly sick and injured people that need hospital space.

Over the next couple of weeks Nancy will have to go to check-ups with hospital staff and doctors so being only a few miles away will be good.  Ellensburg is 45 minutes away by interstate highway and while the next few days look fine weather-wise that might not continue.

The floor she is now on – called the Advanced Care Unit (ACU) – was buzzing with activity today.  One of the ICU nurses from the second floor wheeled a person into a room near Nancy and then stopped in to visit for a minute, and ended up staying 15 to help with Nancy’s care.  I’ve no idea what is happening in the rest of the hospital but these two units (ICU & ACU) are activity centers.

Moving to a different type of facility may be a cultural shock.

We actually had a discussion with the surgeon today about the possibility of a pre-release conference concerning procedures, medications, and behavior beyond the hospital.  He and the surgery nurse were both visitors today and they are still thinking of releasing Nancy to the rehabilitation facility this coming week.

Early in the morning they took several vials of blood – enough for eight different tests.  Then they gave her a pill for anemia.  Go figure!

Other than the blood draws this was an uneventful day for Nancy.  Visits from other sorts of doctors, other than the surgeon, have dropped off as Nancy has gotten better.  One measures progress by odd means.

Yesterday the hospital admitted 30 people.  I wonder what all the reasons are?  When I left today – via the locked doors – there appeared to be a family reunion in the waiting room and adjacent hallway.  Rules are for only 2 at a time to go in for about 10 to 15 minutes each.  I think they won’t all get inside today.

>>>>>>>>>>>Sunday update . . .This is from a phone update from Nancy.  At 7 P.M. they booted her out of the ICU because of two new admittees needing critical care.  By 7:20 she was in a room on the fourth floor but didn’t have anymore information but did confirm that there is still a group of about 20 people outside the ICU – that may increase with two new folks in there.

Yesterday as late as a quarter to 5 the plan was to move Nancy.  At 5:30 the plan was cancelled.  I thought she was being moved during the time I was writing last night.  Not so.  She is still in the ICU and, perhaps, to remain there over the coming 3-day weekend.  Then she might get shipped off to Ellensburg.  I’m hedging my bets now.

I do know that the social services folks at the hospital have contacted the admitting folks at one of the local skilled nursing/physical therapy facilities – with an estimated time of arrival of early next week.  We’ll see.

I think the removal of the chest drain resulted in a bit of extra fluid building in Nancy’s body, especially the feet and legs.  They gave her an extra dose of diuretic but they removed the bladder catheter a couple of days ago also.  Guess who is happy he is not having to deal with the consequences of that combination of decisions?

(Yesterday I mentioned the lifting machine in Nancy’s room.  Actually the term used is a “Standing and Raising Aid” or SARA.  The link here will let you have a look at it.  The first image has the optional potty in place. )                http://www.allegro.hu/arjo%20encore.pdf

Today Nancy asked for me to bring her something to read.  That’s new.  I guess she has healed enough to bet bored.  To bad they can’t shift her a little more into the center of the area and let her keep track of all that is going on in the ICU.

She had visits from the surgeon, a cardiologist, and a physical therapist (the only one that actually did anything).  She seems to be eating better each day, something she has been told is necessary for healing.

She is still very weak but improving and that is now the focus.

There was not a room on the fourth floor so she gets to spend tonight in the ICU.  Tomorrow may be the day but who knows?

The chest drain is gone and the hole sutured shut.  That is a sort of milestone, I suppose, indicating the reduction of danger from open heart surgery.  However, the sutures will have to come out in about two weeks and so – in my mind – when that happens I will think of the heart surgery episode as having closed.  I’m thinking here in terms of danger level because I know there is still a long healing processes.  It will be a major step down in terms of stress – not actually an end.

Today also marked the beginning of a more aggressive plan to get Nancy moving and back on her feet.  A physical therapist arrived about 2:15 P.M. and I left for home.  Such folks have been coming daily but the doctor and the operating room nurse were both in today to indicate the stepped up activity.

The Advanced Care Unit (ACU) has been asked to make a room available and to insert an extra nurse into the schedule.  ACU did not have an empty room today but Nancy will be kicked upstairs (4^th floor) soon, possibly as early as tomorrow.

The fourth floor rooms are directly off the hallway and visitation is easier in contrast to the 2^nd floor ICU rooms which are configured on the periphery of a central personnel station.  Thus to get to an ICU patient you have to ask over a phone to be allowed in and you walk through the work space of the doctors, technicians, and nurses.  Once inside that space there may be a security guard when required, patients may be wheeled in or out, coming from or going to operations, or, in fact, if there is a lot going on you won’t be allowed to enter.

I suspect some such thing happened recently because Nancy woke to find a balloon and candy “Get Well” package in her room.  This seems to have been purchased at the downstairs gift shop but the clerks there this afternoon don’t recall selling it and have no way of determining to whom it was sold.  So, ‘thanks’ to the person or persons responsible.  Nancy will thank you in person if the mystery guest signs in, please.

(If you are under a certain age you probably won’t recognize the television connection to this last phrase.)

The only news today is that there may be news tomorrow.  It is quite likely the chest drain will come out tomorrow.  That will be followed by a move out of the ICU and up to the fourth floor.  The move could be on Tuesday or Wednesday.  Plans are not set yet.

It is increasing clear that Nancy is having no problem recovering from the surgery.  I wonder “what might have been” had she gone into the hospital for an elective operation that relied on heparin?  The initial use of heparin was with the Friday after Thanksgiving heart attack – not a seriously invasive procedure such as cutting one’s chest and heart open.  I wonder if she would have survived both the surgery and the heparin allergic reaction?

Having gotten the explanation of the operation posted last night I’ll not do any more now but hope to have something to report on Tuesday.

I’ve mentioned the drainage coming from Nancy’s chest.  From just after her operation until today the rate of discharge has steadily decreased and is now just half of what it was.  It still seems a lot to me but the surgeon thinks that it will soon be time to remove the tubes.

The pleural space is the space between the inner lining and the outer lining of the lung.  A drawing can be found here:

http://www.nlm.nih.gov/medlineplus/ency/imagepages/9968.htm

A tube, usually about as big around as a small finger is inserted in the pleural space. This tube is sutured into place and the skin around the tube is sutured. This tube can be hooked to suction to facilitate drainage.  The function of this set up is to help get the serum or fluid out of the body without allowing fluid, air, or organisms to enter.

You can learn a bit more about this by visiting the following site.

http://web.mac.com/kieran.mcmanus/Chest_drains/Chest_drainage_systems.html

There is a simple drawing showing three bottles and the basic set up.  Scroll down to see the 3-chamber plastic unit such as is being used for Nancy.  This is not shown in use here but continue scrolling down and there is a photo of a plastic unit (a Portex bag) showing the color of the initial fluid being drained from Nancy.  Over time this color has become more pink and transparent.

The pleural fluid allows the pleurae or membranes to slide effortlessly against each other during the breathing process.  The fluid is produced and reabsorbed continuously.  The decrease in volume and the change in color indicate the improvement taking place within Nancy’s body, especially the chest cavity.

Soon the sutures holding the tubes in place can be removed, the tubes pulled, and the holes closed – then her lymphatic system will have to take over the absorption of any excess fluid.

Everyone seems to be in agreement that as Nancy consumes better food and starts to move more (as in physical therapy) she will speed her recovery.  The doctor is pushing the food aspect and indicated he is currently keeping the chest drains in especially to prevent any pressure on her lungs.  When I arrived today the physical therapy team was completing a session with her and then later the nurse brought a padded chair and propped Nancy’s feet up to lessen the pressure in her legs.

Her heart rate, breathing, and oxygen saturation (without supplementation) were all in good range today.  All signs that the repair of her heart has worked as planned.

A few days ago the ICU was a bit quiet.  Not so last night and today.  We never know who is there or why but it is easy to tell when patients in serious need are there.

One of Nancy’s new “friends” following along suggested a tattoo on Nancy saying “No Heparin” and seems like a good idea.  The question is where to put it.  A medical bracelet was/is a good idea also.

I’ve thought of getting a sweatshirt listing all the things she has endured in the last year – something like

“2009 was a great year –

I survived

and then the list”

We’ll need a big sweatshirt or tiny print.