walk intwo weeks prior. He assessed her and reviewed her medications
sister had the discharge orders that had all the medications listedand said Mom was severely dehydrated and way over medicated! The ER doctor said,
I want to know who discharged her with this medicine?Mom was admitted to ICU.
The plan was to not give Mom anything other than occasional Tylenol and fluids and allow her body to process (flush) all the medication. This went on for days and of course there was mention of a pacemaker and Mom still said "no" or "we'll see".
By Friday her kidneys had shut down and her liver was beginning too shutdown. Friday evening we had a family meeting and presented Mom with the facts about her situation and that a pacemaker was the only way to live. She asked three questions:
1. How big an incision and where
2. what would she have to do later -- what would her life be like
3. How long might she live
The first two were easy but the third is anyone's guess as only God knows that answer. Mom agreed to get the pacemaker. The ICU nurse said, "She only agreed to get your sister off the phone" Nope, she asked Mom and Mom confirmed again.
That night they inserted a temporary pacemaker through her groin and she had to late flat on her back until the first of the week. Mom's kidneys were already working once she was back in ICU. Her liver took longer -- it was back to 75% function on Sunday morning.
On Tuesday they put in the permanent pacemaker and continued to 'tweak' her medications for the rapid heartbeat. They told us she would be in ICU another day, then transferred to cardiac telemetry for 2 or 3 days and undergo some therapy. She would then be discharged to a rehab. So, we're thinking transfer would be first of the following week. My sister asked that they make sure to call her before transferring Mom out of ICU so someone could be with her.
Well, Wednesday night (barely 24 hours after surgery) AFTER 9pm they moved Mom to the cardiac telemetry unit -- and naturally did not call anyone. We found out the next morning -- Thursday. We also found the doctor saying on Thursday that they needed to get Mom up and walking as she needed to be discharged. My sister just about freaked out and called me.
Time for Research
We contacted the hospital's risk management OR ambassador hotline OR patient advocacy group and explained that last time Mom was in (2 weeks ago) the hospital discharged her with too many medications that resulted in severe dehydration and over-medication. Now they were talking about discharge again and just the day before they were still adjusting medications for the rapid heartbeat. I DON'T THINK SO! That group was very empathetic and immediately put the cardiac telemetry unit's head nurse in charge of the situation for resolution.
We found that the doctor SHOULD NOT have said what he did and they were not going to discharge Mom before the weekend.
We began working and talking to the cardiac telemetry head nurse and nursing team and doctors. Mom improved slightly but was so very weak she could not even hardly sit up. This was a woman that had driven herself to get her hair done just 3 weeks prior and now she was in a hospital bed and could not even sit up without assistance.
January 9, 2009 - notes (personal thoughts) while with Mom in the hospital
Mom is in the hospital and says she is 'miserable' she said
"don't ask me to explain it i can't i just feel bad all over i feel exhausted"
The staff in the hospital are now trying to be very helpful and sympathetic. Yesterday though they were doing nothing for her and were talking discharge. this morning i called the "ambassador hotline" and said we needed time to speak with doctors and understand what is going on. I said that on 12/23 she was discharged with meds and then on 12/30 911 called and she was severely dehydrated and over medicated and i would be darned if they were going to discharge her without ensuring meds are right this time. That snapped them in gear and doctors responded. head nurse of cardiac floor talked to me and was so sympathetic she lost her dad last year and still hurting and totally understands the need to care for our parent!
Mom was so tired and couldn't sleep so i got them to give her sleeping pill. It just kicked in and now she is sleeping hard. They are moving us to a private room soon (its 11:30pm) so maybe I can get a few hours sleep before morning.
Just before the pill kicked in mom was blaming "them" saying they didnt care and i tried to explain that they were trying. She said "i can see you if you were like this you would have already laid a cussing on them" :-) yea maybe but i sure hope not! I hope i keep my trust and understanding of people all my life. I know i have it now at 50 and i know mom has never trusted anyone :-(
i love my mother but i am not her and she is not me - we are two entirely different people.
i pray her time comes quickly and the suffering is over soon. shes so tired and she seems so much like daddy did almost looks like him and talks like him. is he here?
January 10, 2009 -- more personal thoughts while with Mom in the hospital:
6:30am
just moved to private room - mom slept thru it. it is not the best room but don't have to worry with anyone else coming in and there are three chairs.
when nurse came in she said (before the move) that mom's heart rate spiked to 108 and asked was she doing Anything - nope just sleeping. maybe she had a dream.
when nurse was waking her up to give her a pill i said "can you believe 3 weeks ago this woman was driving herself to get her hair done?" nurse said "yea we get some people in here 5 or 6 times and each time they are so much worse. one lady that came in several times just died a few weeks ago". for some reason that really pulled my string and i was hit with that overwhelming heartache again :-(
i noticed yesterday that mom's house had not yet been straightened up - the pallet on the couch still :-( guess i'll try to rapidly address some of that when i go shower this morning. then kids are coming around 11:30 so sister and i can go visit a couple of the nursing homes in prep for discharge. maybe that will happen monday? up to doctors.
i have to go back to work by wednesday and was afraid to tell the boss that i have to take husband to doctor thursday to get staples from his knee replacement surgery New Year's eve removed - hell i've been out 3 weeks! fortunately 4.5 of those were holidays. .
9am
mom was so sweet this morning since she got sleep. She didnt drink much Ensure for breakfast and now back asleep.
doctor (heart) just came by and said her heart rate was regulating fine. her lungs are clearing but he said that could take weeks and requires getting up and moving around. he said she would feel better the more she does and noted she didn't eat breakfast.
she's back asleep now. maybe she'll get more activity later today
Which Facility?
Mom has to be transferred to a rehab facility as most available help for in-home care requires the person to be able to clean and dress themselves. Mom was no where near capable of that, so it was time for quick research to find a suitable and good facility.
There are several websites that provide review information and comparison data on nursing homes by zipcode. This data usually includes inspection results and possibly personal reviews. Important data to us was ratio of nurses and aides per patient and hours per day per patient for therapy and care....in addition to all the inspection results. It takes very little time to tap this resource of information and make an INFORMED decision in a short amount of time -- one weekend.
We chose a facility that was just a few miles from my sister's home and near Mom's best friend. The facility is NOT long term care, it truly is about rehab and Mom's friend spent three weeks there the year before to rehab from breaking her shoulder. Mom's friend even offered to go see Mom a lot if she could get in that facility. My sister and I visited the facility that Saturday and were impressed -- no smells, people looked good -- they even had a neighbor dog visiting :-)
So, that next Monday, January 12, 2009, Mom was transferred by ambulance to the rehab center. At this time Mom was not real aware and slept a lot and very very weak. She was setup in a room that did not have another patient -- an empty bed. We got her settled that day and tucked in for her first night.
..............to be continued................
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