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.

MONDAY — hey, it’s a Monday

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.

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.

SAT-SUNDAY — routine functions

Saturday was a routine day, for a weekend.  There was some good food, some not so good food, and several visitors.  Nancy stayed in bed resting from her workout on Friday but she did – she claims – do some in-bed exercises.  I made her promise to get the Sunday morning staff to get her out of bed.

Sunday AM, and she did get moving this morning.  She was assisted into the bathroom (there is no bath there!  Do I call it a throne room?  [See below.] ), then into a wheelchair, and now she is having breakfast.  She was talking with me when they brought her tray.

On Saturday, with help,  I located that aisle and shelf in our friendly grocery store whereon they stash the nutritional drinks often marketed to diabetics.  There are several brand names but I wanted chocolate with high protein and as EBRG is a relatively small town I had a choice of one.  The package contains 6 – 8 oz. plastic mugs ($1.62 each) of a brown liquid composed of water, sugar, and about 74 other things listed in print too small to read by those of us that remember Bill Mazeroski’s series winning home run in game 7 of the 1960 World Series of Baseball (Pirates over Yankees).  Half of the selection was ‘high calcium’ and half was ‘high protein’.  Nancy is improving daily but frequently is disdainful of that part of her meals meant to supply protein.  The supplement I bought contains 12 grams of protein (about 24%) of the suggested part of a standard 2,000 calorie per day diet.

Having related the above I will say that as she has begun to move about more it appears to me that she is also eating more and otherwise improving.  Thus, I was very happy to hear this morning that she had used the bathroom and was in the wheelchair by breakfast time.

[About that term bathroom:  What she actually was in need of was a flush toilet.  Have you ever called the place a flush toilet room?  Me neither. Other names used include: can, commode, crapper, pot, potty, stool, throne, and my favorite ‘the john’

There is an interesting history regarding this device.  Read about it here:

http://swopnet.com/geo_mileshome/Thomas_Crapper.html

Seattle was originally built on low ground and initially installed flush toilets would do a reverse flush when the high tide came in.  First they posted tide tables beside the potty in the throne room.  Later the device was put on an elevated platform.  The problem disappeared as the space around the buildings was filled in and street level was raised one floor along with the entrances, store windows, and the small out-of-the-way rooms containing the john.  You can find things to read on Seattle’s early history and their reverse flushing commodes or take a tour while visiting.  Search on ‘underground Seattle’.]

FRIDAY — the connected walker man

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.

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.

Sincerely,

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.