If we consider last Friday to encompass part assessment and part therapy then today was the first real day of working on rehabilitation. Nancy seemed happy with today. When in bed she really has nothing to do although she has done a little reading and a little phoning.
Reading for entertainment is not something she is accustomed to but I have a few magazines, mainly the Smithsonian, with articles she will read.
Too much time on the phone drains the batteries and she can’t manage yet to reach the outlets to keep it charged. She always wants to have a little power left to call me if she thinks of something I need to know, do, or bring. And her voice, hands, and arms are not as strong as needed to talk for long.
The point of the above is that I think she is happy for the interruptions to having nothing to do brought on by the therapy sessions – speech, occupational, and physical. All are necessary but returning to a normal existence means being able to get out of bed and walk without assistance and that she cannot now do.
If she can get to the point where she can get into a wheelchair on her own then she can prowl the building and become engaged in other things and other people. There is a piano in a community room and she could maybe brush up on her skills. We will have to check on that as they may limit access to the piano to certain times and people. A lady from town came and played a few days ago for some of the residents and does so weekly. She then visited Nancy as they know each other via a university activity. Playing piano ought to be good therapy and self entertainment. I’ll have to get her to ask about this.
Visitors – that is about it. Several people visited Nancy today but there was not a scheduled event in the sense of, say, physical therapy. Her food trays continue to have a small drink that we thought was a mixture of something and cranberry juice. No so claims tonight’s server. I thought the something was white grape juice. The color, if not from cranberries, must be Red Dye #40. Just one of life’s little mysteries.
Nancy has been moving her legs more while in bed and can bend both at the knees quite well. Ten days ago she could not do this, especially the left leg which at that time was burdened with excess fluid and the knee hurt when we moved it for her. Both issue are gone and it gives us hope that she will make great progress in the coming week with out-of-bed therapy every day for five days.
Along with other muscles the tongue and swallowing apparatus degrade with inactivity. This is apparent with Nancy and I just assumed time would fix the issue. Not so maybe. And in the meantime there are things that can be done to make eating and taking pills safer and exercises to bring back the functions.
A speech therapist worked with Nancy yesterday to assess her status and explain to us how this part of her recovery would go. For example, food that sticks to the inside of your mouth, such as bread or corn, should be avoided. When taking pills one should tilt the chin down toward the breast bone so as to close off the airway (trachea) to the lungs. When we swallow a flap, called the epiglottis, moves down over the larynx to keep food out of the windpipe. For Nancy these parts don’t work as well as they should and so by choosing foods carefully and by being careful she can prevent swallowing and coughing problems.
She is also taking the anticoagulant Coumandin® which interacts with vitamin K which is found in green vegetables among other things, for example blueberries and tuna in oil. The greener the veggie (usually) the more vitamin K.
So the food she gets needs to be selected to account for these two concerns, swallowing with ease and not messing with the Coumandin®.
Her lunch included a cup of lasagna, a round soft bread stick and a cup of broccoli. One out of three made the grade. I guess the message didn’t make it from the speech therapist to the kitchen. Although, we both think something was said about the food service folks not being able to adjust until Monday. I guess I’ll have to stop and pick up a milkshake on my way tomorrow. And yesterday the Director brought her orange juice with a high protein addition. Today they were out of orange juice.
The bathroom door squeaked enough that if someone opened it, it would wake a sleeping person. Today I forced the pin out with a knife and put a bit of “this ain’t butter” spread on it to cure the noise issue. We will continue to educate the staff about the food issue.
I got up early this morning and sorted through some of the clothes here and carried various things into Nancy. Two T-shirts were among the things and as I took them out of the bag Nancy remarked that one was an XL and the other an XXL, and she was right. Still, she hasn’t been in street clothes since November 27. Okay, so the stuff wasn’t new but she looked like a new person.
The therapy crew got her dressed and she spent 3 to 4 hours doing occupational, speech, and physical therapy. Some of the time was spent just answering questions and making base-line assessments but she did quite a bit from a wheelchair and briefly stood between parallel bars – standing, moving forward and backward, and moving muscles that hadn’t been moved in 8 weeks.
She got a powered bed and can now raise and lower the entire platform and/or tilt the foot or head areas.
She had several visitors including a couple of young friends that because of age restrictions are not allowed in the local hospitals. (Coughs, colds and the swine flu scare even caused the local hospital to remove all the magazines and booklets from the waiting rooms.) But the rehabilitation center expects visitors and seeing old friends (well, young friends) again was a nice surprise.
And in the mail today came a plastic card – densely printed with information. It came from the company that supplied Nancy’s new heart valve and it has all the relevant stuff a medical specialist might want to know about it – including the name of the surgeon that stitched it in. Like other important cards it is to be carried with you. For the wallet, more stuff. And in this case, it is new.
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.
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 5th 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.
Today seemed somewhat like a Keystone Kops or Three Stooges movie. Looking for an appropriate place to house Nancy just got silly.
Several of us believe she will progress very rapidly once she is out of the hospital environment and into a place that focuses on physical therapy (PT). The fifth floor has a PT unit with doctors and nurses – and a reputation of “aggressive” action. (No. I don’t know what that means.) However they know Nancy is not ready for aggressive therapy and so have agreed to start her slowly. This was thoroughly discussed and thought to be the best solution for the patient. Great.
But the person in charge of giving the go-ahead at the insurance company is working only from faxed reports. She doesn’t believe Nancy needs the 5th floor environment at this time. She thinks somewhere else will be a good fit for a week and then maybe return to the 5th floor.
One of the suggested places has no rooms. Another one sent a representative to the hospital. The idea, I thought, was to talk to Nancy, nurses, and PT folks and decide if the facility would work for Nancy. The representative came to the hospital and starting talking to people and asking to look at reports – but had no name tag nor credentials and, I think, the hospital case worker contact was not around. Exactly what happened I don’t know, but apparently the on-floor head of the ACU objected to the visitor on privacy grounds, and “bingo” – Nancy was deemed not a fit for the facility in question. Maybe I’m misinformed about this but I think something went wrong.
At some point the surgeon and nurse came by, said hello, commented on how good Nancy looked, and went on down the hall. Nancy has moved on from their rather substantial and expert skill set.
After I left the head of a rehabilitation place in Ellensburg came to visit Nancy. We don’t know why he was in Yakima but the hospital case worker made contact and in he came. Nancy and her music making friends visit his place once each month to entertain the residents. So he and Nancy recognize each other by sight but are not very well acquainted. He talked with Nancy (maybe others there) and thought his people could take care of Nancy. He is to meet with his staff Wednesday morning and will get back to Nancy with his plan. As we go into Tuesday evening, nothing is certain.
Well, the hospital did promise not to set her on the street corner with a sign asking for a ride to Ellensburg. And I’m not going to be heading down the south-bound lanes of the interstate if she is being carted north. I already have an “I’m stupid!” sign and don’t need another.
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.
Nancy weighed about 9 pounds less this morning than she did yesterday morning. That’s what a double shot of diuretic will do for you. Today she only got a single dose but tomorrow or Monday they will double dose her again. It really showed in the lower legs, ankles, and feet. They also want to keep her lungs clear so they are being aggressive about this.
On a lighter note, the head nurse of the surgical team and I were commenting on the natural color that has come back into Nancy’s eyes and face. She had been a bit grayish. We realized Nancy hasn’t looked in a mirror since Thanksgiving. Unknown to us is that the over-bed food stand has a mirror hidden underneath the serving part. I’m glad we didn’t know that a month ago. She needs her hair cut and her face is thinner but she actually looks healthy. As regards hair, she began losing a little with the endocarditis last May and she thinks she is still doing so. Unlike someone being treated with chemicals and radiation for a tumor where hair loss is more rapid, this is a slow motion loss as her body seeks to repair other damaged cells and neglects the hair. I think that is the idea as expressed to us today. I’ll see if I can find any info on the Web.
The same nurse brought in the photographs from the surgery and they made copies for Nancy. I was gone by then but via the phone Nancy claims that even on standard paper they are very good quality and I will be able to scan them. I saw a few of the originals the day after surgery but I don’t know what all they have given us.