November 24, 2015. Dad and Michell woke up at 4:15 A.M. Dad still had some problems overnight, but I hoped to have him on the road to recovery quickly. I had Michell administer the trach care again this morning. I had to assist her a couple of times, but she was a little less nervous than she had been during her first attempt last night. During the administration of Dad’s morning meds, I added a couple of crushed Imodium tablets. Dad and Michell were able to get ready without much difficulty.
Kristin, Dr. Pfanner‘s nurse, called to tell me that the doctor had decided on an antibiotic for Dad that would take a couple of weeks to clear up the CDiff. The nurse also provided me with some guidance about laundering and cleaning anything that Dad had come in contact with. She also recommended that we purchase some isolation robes to protect ourselves and encouraged us to wear gloves. I told her that we would abide by her guidelines, but it sure seemed like the horse was already out of the barn. Dad had probably been sick with CDiff for several days. Because prolonged antibiotic use probably contributed to Dad’s CDiff, before hanging up, the nurse encouraged me to contact Dad’s pulmonologist to see if they would change his antibiotic. This was a difficult request. We weren’t going to meet Dad’s pulmonologist for a few weeks. I also thought that it was the infectious diseases doctor at the hospital who had prescribed the doxycycline, and I didn’t know when or if we would see her again.
I thought that the dialysis nurses should know about the diagnosis. I texted Sue, our friend and nurse practitioner at the dialysis center, to let her know that Dad had tested positive for CDiff.
When Dad and Michell returned home at 12:15 P.M., Dad was in a rush to get to the bathroom. As I was pushing him past the piano, I caught his hand between the wheelchair and the piano and gouged him good. His skin was very fragile and susceptible to tears, so now he was also bleeding. Because I had already helped enough, I left the chaos that I had created and drove to the pharmacy to pick up the antibiotic prescription. I returned around 12:30 P.M. and gave Dad his first dose of Flagyl. When I had a couple of minutes to talk with Michell, she told me that Dad had had 1,100 ml of fluid removed during dialysis. With his weight so low, this news wasn’t good, but at least the quantity wasn’t excessive.
It was Thanksgiving week, and I was working half days, starting at 3:45 A.M., so my day was over by the time that Dad returned from dialysis. Michell, Mom, and I ate lunch, and then I resumed the baking that I had started yesterday.
At 4:00 P.M., Mom tried to wake Dad, but he just grunted at her. He finally responded when she told him that he had his head on his sore hand—the one that I had injured. He then tried to get up by himself to go to the bathroom, which he’s incapable of doing. Michell tried to help him, but he told her to get out of his way. She finally got him into the wheelchair, and he kept telling her (and now me) to get out of his way. Michell kept trying to help him, but he kept shoving her away. She then got him the walker, but he pushed it into me and told me to get out of his way. During the arguing and raised voices, he called me by my mother’s name a couple of times, which I found a little disconcerting. He kept insisting that he could walk by himself. I finally stepped back and told him to walk. It took him about one second to realize that he couldn’t walk, and then he let us help him, although he still didn’t seem like himself.
In addition to the drastic personality change, he woke up looking different and years older than he had just four hours earlier. I checked the printout of precautions and side effects that came with the meds, and a couple of the severe side effects included confusion and irritability. I called Dr. Pfanner’s office and talked to the nurse about his drastic change and our concerns, and she said that she would consult the doctor and call back. When she called a few minutes later, she said that we wouldn’t like the answer, but the doctor wanted us to take him to the ER.
And then it got crazy.
When I called 911, I told them about Dad’s symptoms, and mistakenly used the word aggressive to describe his behavior. The 911 operator then started asking questions about weapons and alcohol and drug abuse, but I assured him that we didn’t have those concerns. Before hanging up, the 911 operator asked whether I felt safe hanging up the phone. I assured him that I did and made a mental note to never use the word aggressive during a call to 911.
Just a few minutes later, I heard the sirens, and a black SUV belonging to the sheriff’s department turned into the driveway. The deputy told me that the sheriff’s department is called whenever 911 receives a psych call. I assured him that I had not placed a psych call and that my father did not pose a physical threat to us. While we were talking, the deputy spoke into his shoulder mic and told two other deputies to “stand down.” Moments later the first fireman from Little River-Academy arrived. A couple of minutes later, the ambulance arrived, followed by another Little River-Academy fire truck. The EMTs, deputy, and I chatted on the front porch about Dad’s willingness (or not) to go with them. They asked about Dad’s wife and whether either of us had medical power of attorney, which we both possessed. The entourage of deputies and EMTs followed me into the bedroom, and I was able to talk Dad into going to the hospital. Michell rode in the ambulance with him and Mom and I followed them in my car. We sat in the driveway for what seemed like 10 minutes before the ambulance finally pulled out of the driveway. We finally arrived at the hospital at 6:00 P.M.
EMTs take the patient into the hospital through a designated door, separate from any visitors, including those who ride in the ambulance. I parked the car and Mom and I met Michell in the waiting room. While Michell left us to find a restroom, Dad, Mom, and I were ushered into an exam room. When the nurse arrived, I told her about the events of the day. When the resident, Dr. Stephanie Katrin Clark, arrived, said that Dad’s mentation problems could be from the CDiff and not the meds. She then ordered a chest x-ray to see if the lack of lung capacity was causing his confusion. She also ordered an EKG. Finally, the nurse arrived to take Dad’s blood. It was then that we learned that the reason why Dad’s ambulance stayed in the driveway so long was that the EMT was starting an IV. Having an IV in place simplified the nurse’s task, and she quickly acquired the necessary samples and turned them in to the lab shortly before 7:50 P.M. Before the nurse left the room, she started Dad on a saline drip.
At 7:49 P.M., I texted Sue to inform her that Dad had had 1,100 ml removed this morning and that he was now in the ER getting 500 ml of saline. I didn’t know if she could provide us with any information that might help our situation.
A little over an hour later, Dr. Clark returned to the exam room and said that she wanted to admit Dad. She said that his blood pressure was soft and he seemed dehydrated. I told her that we had to be home tomorrow for his 60-day home-care assessment. She said that she would give him another 250 ml of saline to improve his blood pressure. The next thing I knew, a tech arrived and said that she was to take Dad to radiology for a CT scan. I told her that it was our understanding that Dad could leave after he had received the 750 ml of saline and that I didn’t want him to have a CT scan. I also told her that he was out of Medicare days (and S&W Senior Care days), so admitting him was out of the question. After the tech had left the room, I explained to Dad and Mom that Dr. Smith had told me that Dad’s CT scan in August had not been normal, but he had then added that the CT scan of someone his age wasn’t normal anyway. I didn’t trust this doctor to say that the results of a CT scan weren’t normal, which would be another reason to admit him.
Shortly after the radiology tech left the room, we heard a knock on the door and a woman entered, identifying herself as the social worker and a problem solver. I again explained why we had to go home. My argument didn’t seem to sway her, so I told her that Dad was uninsured and that unless she could pay his hospital bill, I wasn’t interested in anything that she had to say. She left the room and returned a couple of minutes later with Dr. Clark and with the charge nurse. The doctor then informed me that Dad had suffered a heart attack. Today would mark the second time since July 22 that I had heard this, and I suspected that she was no more correct than the previous doctor had been. When I pressed her for details, she said that his numbers were elevated so that he might have suffered a heart attack. She also said that his kidney function was very high and that according to his medical history, he was very sick. I explained that his kidneys were in terrible shape and that he was ERSD and on dialysis. One of our problems was that the Scott & White Home Care department was not on the same records program as the hospitals, so the latest information accessible to the medical staff at Memorial was from September 29, some 57 days ago.
The social worker and charge nurse explained to us that to take Dad home, we would have to sign an AMA, which would ensure that he could not be recertified. They had effectively trapped us into a no-win situation. We didn’t trust them or the hospital, and even if we did, Dad was uninsured, and we had to get out of there. I told them that I wanted to make some phone calls. I called the Home Health after-hours phone number and told them about our situation. I was transferred to Leo, the night nurse who had originally admitted Dad into home care. My phone died, and when I used Mom’s phone, Leo and I kept getting disconnected. When the nurse returned to the exam room, we told her that we would sign the AMA so that we could take Dad home.
At 10:38 P.M., I texted Sue again and told her that Dad had been dehydrated and that we might need to rethink the amount of fluid we’re pulling off of him, especially when he has diarrhea. At the rate that he was receiving fluids at the hospital, it wouldn’t be long before they replaced everything that had been removed during dialysis.
Eventually, the nurse came back, and my mother told her that we were ready to leave. After we signed the AMA, the nurse removed the IV lines and called for an ambulance to transport Dad home. About 30 minutes later, the EMTs arrived with a gurney. Mom and I recognized both of the EMTs. One of them had been by the house several times and the other, a woman, had brought him home from dialysis earlier today. When the EMTs took Dad to the ambulance, Mom and I passed through the waiting room, where we found Michell, who had been waiting patiently for almost five hours. Michell quickly left the waiting room and joined Dad for the return ride home in the ambulance. Fortunately, we had been able to text with Michell, so she had some idea of what was happening.
The four of us finally arrived home around 11:15 P.M. I started cleaning up in the kitchen and toasted the biscotti that I had baked earlier. We were hungry and too wired to sleep, so Mom also prepared a plate of cheese and crackers. Michell was with Dad in the bedroom. The poor guy was suffering from CDiff and had been trapped in the ER for more than five hours.
At 11:45 P.M, we heard a loud pounding at the door. I peeked around the corner to see if I could tell who was at the door and was momentarily relieved when I saw the uniform of a sheriff’s deputy. When I opened the door, I met Deputy Ryan Blankemeier. He said that his department had received a call that we had taken Dad home from the hospital too soon and he was here to ensure that my father was OK. Deputy Blankemeier looked pretty confused when I told him that it was the nurse at the hospital who called for the ambulance to transport Dad home.
I told the deputy that Dad was on the commode and that he would have to wait until Dad was decent. From where we were standing in the hall, the deputy could hear Dad and Michell talking. After a while, the deputy said that he felt like he could leave, but I insisted that he stay. Eventually, Dad was decent, and I escorted the deputy to the bathroom to see him. I told Dad that the deputy wanted to ensure that he had gotten home OK. He said that “she” got home OK. I told Dad that it was him that the deputy cared about, and Dad said that he was fine, but it was “touch and go there for a while.” Dad laughed, and the deputy smiled. I eventually escorted the deputy to the front door shortly after midnight.
It was well after midnight before Dad was in bed and approaching 2:00 A.M. before I got to bed.
I hadn’t realized how upset Michell had been about the day. I had mentioned in an earlier post that she was astonished when I openly disagreed with a doctor. To sign an AMA and bring Dad home, followed by the visit from the sheriff’s department, was just a bit too much for her. After Dad had gone to sleep, she called a friend and cried about the day and then cried herself to sleep. At this point, she wasn’t sure if she would return next week and would have to pray for guidance. I hoped that she said a prayer or two for all of us.