SATURDAY — 0.48

The distance traveled today was 0.48 mile, one way.  Double that and we still didn’t make a full mile in the car.  I should have zagged or zigged on the way to or from.  I wasn’t sure whether to zig or zag so I didn’t.

Nancy got in and out of the car just fine.  The 4-wheeled walker ‘just’ fit in the back.  These things do fold but are still large and odd shaped.  The place we visited is a series of apartments with mostly senior folk and from the gender of those that showed up, about 94% female.   A few came with walkers much like the one Nancy is using.  There were a couple of wheel chairs and maybe a cane or two.  There were snacks afterward but of the dry cookie type or small sandwich variety.  I could have made a meal of the stuff but Nancy is into moist and softer things and we didn’t stay.

Also, we needed to return to her room for a potty stop and then she needed a nap. She very much wants to participate but from getting going to getting back was about 2 hours and that, currently, is a lot for her.

Changing direction a little, we’ve noticed that on her lower legs her skin is peeling much as it would if sunburned and there is some general redness there also.  This is the location of the worst of the edema and visible swelling during her ICU stay.  I suspect a connection and have briefly searched on the ‘web’ with little success.  The search results I’m getting are all over the spectrum and not what I want.  I guess my search terms need improvement.  If you have any ideas on this issue you can let me – John –  know here:   nancyh@ellensburg.com

MONDAY — swans

A swan seems to take off with difficulty, some even say clumsily.  Once airborne the legs tuck in and the neck stretches out – and the clumsy becomes graceful in flight.

Nancy is close, but not yet able, to get started on her own.  Wheelchair, potties, and most beds are low and she just can’t quite get up from them.  In the PT room they have a bed that is higher off the floor.  From it Nancy can get her feet on the floor and with the high handles of her ‘walker’ she can establish vertical posture.  Then she is ready and able to travel.

The grace of a swan in flight?  Maybe not.

But grace, nonetheless.

SATURDAY — rant

Friday evening, with Nancy doing well, I decided I would stay home on Saturday morning.  So I did.  I stayed home this morning to do a few things and failed – not in staying home but in getting anything done.  Dogs and horses needed attention. Nancy called several times.

Her roommate’s daughter had stopped at a well know food place and bought a milkshake – “one of the best shakes in town.”  Nancy thought she might like one.  To kill two of us birds with one stone I decided to order my meal as well.  $10 later I was on my way.  Why does a small milkshake cost $3.00 when I can buy a half-gallon of ice cream (on sale) for the same price?

Next “milkshake day” I’ll make it at home and carry it in.  And don’t get me started on how little things cost when I was young!

It is late afternoon and I’ll soon be headed back to town.  We have 100% cloud cover and it is sprinkling and I have to go out and feed horses.  And the dogs want to go out and run in the muck – not a chance!

I’ve looked all over for a phone number she wants.  Can’t find it.

Ran her soiled shirts (blouses) through the laundry.  Then ran the dish washer just to claim I’d done something useful.

In December Nancy was in the hospital and I bought a cell phone.  It has a camera.  It isn’t of much use unless I can get the images from it to my computer.  It has “Bluetooth” and a USB port.  I haven’t figured out the Bluetooth thingy yet so I went (today) and bought the appropriate cable for the USB connector.  I just spent an hour trying to figure that out.  No luck.  So I will make another trek to the AT&T store to see if they have any idea.  If that doesn’t work I’ll have to go find an 8 year-old.

Rant over.

THURSDAY — catching up

It is late afternoon.  I just returned.  Early A.M. breakfast with Nancy.  Then home to take care of horses and dogs.  11 A.M. meeting with human resources folks at the U to begin final paper work to transition to full retirement.  Home for lunch.  To “rehab” facility carrying violin.  The group Nancy plays with, played at her place at 2 P.M. today.

The therapy folks had to finish with Nancy early today (nice of them to do that) so she could rest an hour before the musicians began arriving at about 1:45.  She has seen some of them (most maybe) since last playing with the group in November.  This was her first play-date in nearly 3 months.  It is fair to say they all had a grand time, especially her.  To the entire group and a couple of spouses — Bravo!  (Made me tear-up.)

Now I’m home fixing supper – then I’ll jump in the car for the fourth time today for a drive to town.  This trip is for a meeting of our horse riding club for whom I do a small monthly newsletter.

Yesterday, just to catch up, I did breakfast and supper with Nancy.  Lunch I did with a dozen riders (I skipped the ride).  They parked near a trailhead of the cross-state (old RR) trail that is close to a restaurant.  Today it is raining so they picked the best day of the week to ride.

Tomorrow is the “swallowing study” so I expect another interesting day.

TUESDAY — a lot like Monday

Nancy is still troubled by the process of getting pills down, food swallowed, and having it all proceed through as it is supposed to.  The upper end of her digestive system seems to take issue with what most of us would consider food.  However, she does fine with fortified liquid drinks, especially if chocolate infused.  She has also reached accommodation with yogurt (orange cream) and various puddings, and last night with supper she was given puréed strawberries. These are high calorie items and can be fortified with protein, vitamins, and minerals and so, nutrition-wise, she is being adequately supplied.

Much of the issue with real food develops with the acts of chewing and swallowing, and, of course preference.  A finely chopped egg or tuna mix (no bread) will suit her,  but ham salad mix will present a problem if the ham had a rind on it that wasn’t taken off prior to grinding or chopping.  She won’t deal with those pieces and in trying to separate them out much of the dish is trash.   A ground beef–noodles–sauce dish is no better than one with an outer rind because of pieces of gristle.  In this institutional setting there isn’t much hope for refinement.

With her physical abilities improving (slightly) each day we can look forward to the time when she is home and I can begin with better ingredients and take the time to improve them with selective cutting and discards.

She remains scheduled for a trip to the local hospital to have a “modified Barium swallow” study.  It will be something like this: She will be given small amounts of a Barium preparation of varying consistencies from thin liquids to paste to a piece of coated cookie. As each of these is ingested the examiner(s) will observe images in real time on a screen and determine if and where there are problems.  Nancy is scheduled for early afternoon this Friday and afterwards I will know more.

SUNDAY evening — off topic

Many years ago (1986) Nancy and I were traveling and ended up in McCall, Idaho on the day the space shuttle Challenger exploded.  We stayed in our room and watched the television reports for hours.  I hadn’t thought of that recently even on this weekend when NASA has been trying to launch Endeavour.  But today I was sent a link to a video of a bird named after that space shuttle and as there is nothing new this evening regarding Nancy I will simply suggest you first read about this bird here:

http://en.wikipedia.org/wiki/Challenger_(eagle)

Then copy-&-paste the following into a Google search window

Petopia: Challenger the Celebrity, Free-Flying Bald Eagle

and you should get a link to the page.  Click on it and than click to watch the video. There are other sites with this video but this one worked well for me.

If you are not from the USA you might not get the same thrill out of this as most US citizens do.  My own thought was that I will feel a similar emotion when I watch Nancy pass outside of the rehabilitation center under her own control and walk free.

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.

Sincerely,

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.