August 31, 2018. Mom and I arrived at Dad’s room for his tenth day in the hospital shortly after 7:30 A.M. The room was dark and Dad was sleeping. I opened the blinds to let in some light, but the daylight did not affect him. I was able to wake him, but afterward, he seemed uncomfortable. I asked him if he needed a bedpan, and he seemed to indicate that he did. At 7:55 A.M., I summoned the nurse for assistance, but no one answered the page. Thank goodness that Dad’s need for the bedpan was just a miscommunication.
At 8:10 A.M., Dr. Tanner, the nephrology resident, told me that Dad had had 2,400 ml of fluid removed yesterday during dialysis. He said that the nephrologists needed to know whether Dad wanted to continue with dialysis or use the diuretics to remove fluid following his discharge from the hospital. If he wanted dialysis, the nephrology team would make the arrangements with the dialysis center. I knew full well what Dad’s decision would be. While he was in the hospital, he probably believed he had no choice in the matter, but I’d bet good money, given a choice, he would not want dialysis. The problem was that history had shown that he wouldn’t take the diuretics as prescribed, which is what led to his fluid overload condition and his two falls. He had been healthy and active until he quit going to dialysis. I hoped that Mom might be able to sway his decision.
At 8:20 A.M., Maira and Carrie, the nurse and aide (CNA), changed Dad’s dressings and got him ready for the day. While they were changing his dressings, they said that they didn’t like the look and smell of his surgical wound. Maira said that she would have the doctor look at it. Dr. Hunt chose to delegate this task and called upon the orthopedic team to check Dad’s surgical wound. A few minutes later, a couple of orthopedic residents came by and applied a new dressing. They assured us that the wound was fine and should not cause a problem for Dad.
During the morning rounds Dr. Hunt said that according to Dad’s CT scan, he had had a stroke in the thalamus. I hadn’t been concerned about the CT scan because I was sure that Dad had not hurt his head when he fell out of bed. I now felt like I had the wind knocked out of me. It seemed like Dad couldn’t catch a break. The doctor said that he planned to call neurology to have them check on Dad. In my distress, I texted my husband Stan about this turn of events, which was probably not fair to him. There was nothing that he could do 160 miles from us, except worry.
Once again, the nurse asked me to help Dad with his morning meds. It was a struggle, but I was eventually able to get him to swallow his aspirin and Midodrine pills. A CNA stops by every couple of hours to check Dad’s glucose level. Shortly after the mid-morning reading, Carrie returned with a container of apple juice that she wanted Dad to drink. Evidently, his glucose level was down to 75, with 100 being normal.
So far, the most significant untruth told to us was the statement made by Leslie, Dad’s last ICU nurse. She had assured us that although there was a higher patient-to-nurse ratio on 6 North, they had many CNAs who could attend to patients. Carrie laughed out loud when I asked her about the additional aides. Contrary to the messaging in ICU, the patient floors have five or more patients per RN and as many as 19 patients per CNA. It’s no wonder that the CNAs and nurses appreciated the time that I spent helping Dad to eat and take his meds. These were busy people who relied on family and other patient advocates to assist with patient needs. I was grateful that I was in a position to be with Dad so that I could assist him.
Shortly after the morning rounds, Dr. Harris, a resident from the neurology department, stopped by to assess Dad. Dad was able to push against the doctor and follow a variety of instructions. Dr. Harris said that that the stroke was small and most likely was not the cause of Dad’s confusion, good news that probably improved my blood pressure and stress level somewhat. His current level of confusion was similar to what he had experienced during his previous hospital stay in 2015 and was probably transient and not permanent.
Moments before noon, Angie and Judy, the physical therapist and her aide, arrived for Dad’s session. They had barely started when Dad’s lunch arrived, which was typical. I wasn’t sure if he’d ever enjoy a hot meal in this place. Angie and Judy had just had Dad stand up when the neurological team, led by Dr. Jennifer Rasmussen, entered the room. I asked if they could stop by later after his physical therapy session, but the doctor said that they wanted to watch the session so they could see how he responded to physical therapy, so their timing was perfect. After a couple of minutes, Dr. Rasmussen pulled me aside and said that Dad seemed to be doing fine. She added that the stroke could cause sleepiness, but that Dad should not suffer any lasting effects. I was so pleased that it was all that I could do to keep from hugging her.
Shortly after noon, Perry, a transportation tech, arrived to take Dad to Interventional Radiology (IR) to have a tunneled line put in to replace the IV in his neck. From what Dr. Hunt said, the tunneled line posed less of an infection risk. Mom and I accompanied Dad and Perry so that one of us could sign the consent form. We arrived at IR at 12:30 P.M. After waiting 20 minutes, I got someone’s attention and asked if we could sign a consent form so that we could leave for lunch. Mom and I went to the cafeteria to get our lunch, but we ate in Dad’s room. I had promised Dad that we would be there when he returned, and I wanted to keep that promise. Knowing our luck, he’d be alert, and if we weren’t there, he’d give us holy heck.
At 1:20 P.M., in response to my earlier text message, Stan texted me to see if we could talk. When he called, he said that he could come up tonight if I needed him. Had I not received good news from the neurologist, I might have welcomed his offer, but I didn’t want him on the road with all the crazies leaving town for the Labor Day weekend. Stan was also relieved to hear that the stroke was very minor and promised that he would come up early tomorrow morning.
While Mom and I were waiting in Dad’s room for his return, we overhead a conversation about room 631 north, which was just a couple of rooms away. Apparently, the room had bedbugs. Ye gods!
After Dad was returned from IR, I reheated his lunch, which had been delivered almost two hours ago and was cold. I was pleasantly surprised when I looked up and saw our friend, Marilyn, standing at the door. While she was there, Mom and I learned that the husband of our dear friend Sally had died on August 17. I was acquainted with Sally’s husband, and his passing was a real loss. I felt guilty for being so absorbed with Dad’s hospitalization that I could not console a friend. While Mom and Marilyn were visiting, I helped Dad eat some of the Salisbury steak, pasta, peaches, and some Nepro. He then wanted to taste the pureed chicken noodle soup. I didn’t think that it looked all that good, but he said that it was the best thing on the tray.
While he was eating, I noticed that blood was running down his chest from the dressing that the interventional radiologist placed over the tunneled line. I summoned the nurse, and she called the doctor because the wound seemed to be bleeding profusely. Dr. Hunt called IR, and they said that they would send someone up who could put in a stitch. A couple of minutes later, transportation showed up to take Dad back to IR. Because Dad was bleeding, the nurse accompanied him and kept pressure on the wound. When we arrived at IR, the doctor didn’t want to add a stitch because he thought that it would cause more bleeding. I asked if they could use Steri Strips instead of stitches. The doctor thought that was a good idea and used three on Dad before he applied a clean dressing. Inwardly, I was rolling my eyes. The Steri Strips seemed like such a simple solution. I couldn’t believe that I had to suggest it.
We returned to Dad’s room at 4:15 P.M., and a couple of minutes later Dr. Duran and Dr. Tanner, the nephrologist and her resident, stopped by to discuss the possibility of dialysis tomorrow. Because patients were usually too tired for physical therapy after dialysis, I asked them if they would please dialyze Dad in the afternoon so that he could have PT in the morning. They said that they would see what they could do to accommodate my request.
At 5:00 P.M., the nurse asked Mom and me to leave the room while she cleaned up all of the blood on Dad and changed some of his dressings and his gown. Between Dad’s bleeding episode and the handiwork of the interventional radiologist, Dad looked like an extra in a horror movie.
When we returned to Dad’s room at 5:30 P.M., his dinner was waiting. As I started to get him ready for dinner, he proceeded to complain about everything, starting with his hearing aids. He then made a huge deal about the notations on his many bandages. When the nurses change dressings, they initial and date the top of the bandage so that other nurses can tell when the dressing was changed and who changed it. From Dad’s vantage point, the writing was upside down, and it annoyed him. I tried for a good 15 minutes to explain that the dates written on the bandages were for the benefit of the nurses, and not him, but without success. During this hospital stay, he frequently latched onto some notion like a junkyard dog and would not let it go. With this issue still unresolved, Mom and I finally said that we had to leave for the day. I was glad that he had had a good lunch because with all of his complaining, he hadn’t eaten much dinner. I hoped that he’d forget about the labeling of the bandages by the time that we returned tomorrow.