Chugging along the rickety tracks to rehabilitation

May 2, 2018. The month of May seemed to be getting off to a good start. According to Mom, she had been successful in getting Dad to walk a little around the house. My heart almost stopped when she told me that she also took Dad to his barber for a haircut. Although you can park in front of the barber shop, it’s not exactly an accessible trip from the parking lot into the shop. Had I known in advance about this excursion, I would have been a nervous wreck worrying that he might fall while negotiating the front walkway. I was glad that I didn’t learn about this outing until after the fact.

chugginCross3When I spoke to Mom on the following day, she told me that Dad had had a good day in physical therapy and that they both liked the new therapist.

I had been in Johnson City for a workshop and had planned to spend the night there. Because I felt like I was coming down with a cold, I decided to drive to my parents’ house tonight instead of tomorrow morning. I wasn’t happy to be visiting them when I was sick, but Mom was looking forward to seeing me that weekend, sick or not. I’d had to be vigilant with my hand washing to ensure that I didn’t spread my cold germs around their house.

May 11. Mom is a meat-and-potatoes gal from way back, so for Mother’s Day, I thought that I would serve her filet mignon. I purchased some nice steaks and side dishes from Omaha Steaks for our early Mother’s Day dinner tomorrow night.  Shortly after Stan got home from work, we drove to Temple for the weekend.

chugginCross1When we arrived, I told Dad that I had taken care of tomorrow night’s dinner. He then told me that he had already planned Mom’s dinner, which surprised me. For many years, we had had an understanding that Mother’s Day dinner was my responsibility, although we often discussed the menu and the logistics of the meal. Now that he was confined to a wheelchair, I had assumed that he would not be able to share in the dinner preparation. Because I wanted to grill the steaks, a task better done in the evening, we agreed to have the steaks for dinner on Saturday and the dinner that he had planned on Sunday for the midday meal.

May 13. While Mom and I attended church, our husbands played cribbage. Whenever we were in Temple, Dad did not take his diuretics, which concerned me. In addition to his not taking the pills, he didn’t seem to be following a renal diet or curtailing his sodium intake. Because any mention of pill, diet, or walking seemed to ignite an argument, I tried to limit vocalizing my concerns during this weekend.

Dad had told me that he would need my assistance with the preparation of today’s Mother’s Day meal, which was an understatement. Although he had planned a nice menu for Mom’s dinner, Mom and I ended up preparing the meal. In addition to shrimp cocktail, barbequed spare ribs, green beans, and twice-baked potatoes, Dad also planned on Mom’s strawberry pie and Jell-O salad. We had a full weekend of eating high-on-the-hog. Unfortunately, as I had suspected, Dad did not take any diuretics while we were there.

chugginCross2May 14—17. Dad attended physical therapy today and would do so again on Thursday, three days later. He didn’t get out of his wheelchair on the days between his sessions; however, he felt especially positive after his Thursday session and said that he was getting ready to get rid of the wheelchair. I was hopeful that he had changed his attitude about exercising between sessions and that he was becoming inspired to get better.

May 21. Because his physical therapist did not come to work today, Dad’s therapy session was canceled. Unfortunately, he didn’t take the initiative to walk around the house either. When Mom tried to get him to walk the next day, he said that he was too stiff to walk. If I had been sitting in a wheelchair for 12 hours a day, I’d be pretty stiff too. I hated that wheelchair.

chugginCross4May 24. I suspected that Dad didn’t have the greatest physical therapy session today. According to Mom, Steve, the physical therapist, lectured Dad about the need to exercise between his physical therapy sessions. I hoped that Dad would listen more to Steve than he did to me. Dad had been out of the rehab center and had been attending outpatient physical therapy since mid-April and I could not see much of an improvement in his mobility. If anything, it seemed to be getting worse.

May 26. I had not planned to go to Temple this weekend, but something in Mom’s voice during our last phone call prompted me to change my mind, and Stan agreed that I should go. When I arrived, Dad was in his wheelchair, trying on a pair of new shoes that had just arrived in the mail. The shoe size was larger than what he had been wearing, but he could not get them on his feet. I was appalled by the level of exertion that he expended trying to get the shoes on his feet. You would have thought that he had just finished the four-minute mile. When I later asked Mom if he had been taking his diuretic, she said that he had had not taken a pill in quite some time.

chugginCross3My parents had planned another trip to the barber later today. Instead of taking him in Mom’s LeBaron convertible, I decided to drive him in Stan’s new SUV. We were able to get Dad into Stan’s car, but the trip from the car to the barber chair was a bit harrowing, and we practically dragged Dad the last couple of feet and into the chair. Fortunately, because it was a holiday weekend, the barber didn’t have any customers and was able to assist us. More harrowing than the walk in from the car was the walk back to the car. Once again, the barber saved our bacon and was able to help us maneuver Dad back into the car. The barber and I could barely get Dad safely to and from the shop. There was no way that Mom would have been able to manage Dad without me. Because he had been able to negotiate the walk on May 2, it seemed that his condition was worsening. I couldn’t understand why Dad and his physical therapists were not alarmed.

I could tell that Mom was exhausted, and I was glad that I was there to help her. I also decided that I was going to help Dad to walk. He was able to walk 88 feet once today, but the next two times, he had to stop and rest for a moment at the halfway point.

chugginCross1I asked him if he had to stop because of pain (from the hip surgery) or because of exhaustion. He admitted that it was the latter. We proceeded to have a very civil and productive discussion about his condition. Not only was he easily exhausted, but he was showing signs of severe fluid overload. In addition to having swollen extremities, his legs were weeping fluid. I begged him to take the diuretics, and I told him that if he would, he would regain some of his strength and endurance. He promised me that he would start taking the pills on a daily basis.

The next morning he took his pill, and I left feeling more optimistic than I had in quite some time.

May 29. Dad had his assessment today during physical therapy and he was approved for another 30 days of therapy. Although this seemed like good news, it meant that he was not well. Also, his next appointment was not until June 7, which meant that he had a 9-day gap between therapy sessions.

According to Mom, Dad forgot to take his diuretic today.

chugginCross4June 18. According to Mom, Dad had been taking his diuretics on most days since I saw him on May 26. However, he found many reasons for not taking the pills, like trips to physical therapy. Today he didn’t take a pill because he spent a few hours at the dermatologist having a biopsy for skin cancer on his head.

Stan and I left Houston to spend a week in southern California with his family. While we were there, we also visited with some of my cousins. I wanted to call my parents every day, but the time difference posed some challenges; however, I was able to call them a few times. According to Mom, Dad was taking his diuretics as he had promised me. I was encouraged and looked forward to seeing a significant improvement when I returned to Temple at the end of the month. By that time, he would have been consistently taking the diuretics for three weeks. According to Mom, his legs had stopped seeping, so he was already on his way to reversing his dangerous fluid overload condition.

June 29. Stan and I arrived in Temple at 6:00 P.M. Instead of being pleased with Dad’s progress, it seemed to me that his progress had stalled. His legs weren’t seeping fluid, but his whole body still seemed very swollen. He also wasn’t wearing shoes because he couldn’t get them on his feet. When I asked Mom when he had last taken a pill, she said that she didn’t know.

I tried reasoning with him again about walking and taking the diuretics, but he lobbed excuses at me faster than Serena Williams. When I asked him to walk, he said that he didn’t want to at that time. When I asked if he wanted to get out of the wheelchair, he said, “Not if it means that I have to walk four times a day.”  I didn’t know how to respond. My mother was exhausted from trying to care for him, their 3,400 sq ft home, and their acre of property. I wanted him to get better and stay in their house if that’s what they wanted, but not at the expense of Mom’s health.

chugginCross2While Mom and I attended church on Sunday, July 1, Stan observed that Dad sometimes spontaneously drifted off to sleep while they were playing cards, which was also a symptom of fluid overload. He would sometimes fall asleep at the dining room table at the end of a meal.

I was appalled to learn that Dad wanted to install a ramp off of their patio, presumably to enable wheeling the barbeque grill onto the patio, but I suspected that it had more to do with wheelchair accessibility. He kept saying that he looked forward to activities that required him to walk, but it seemed that he was preparing the house for life ahead in that wheelchair. Mom told me that he wanted to walk again, but you couldn’t prove it by me.

Attempting to recover at home

April 13, 2018. A lot had happened since our last visit to Temple. Dad had checked himself out of Cornerstone, which meant that instead of receiving daily physical and occupational therapy, he would receive physical therapy twice a week at the Roney Bone and Joint Institute. After Dad’s unorthodox transfer home, Stan and I were anxious about his situation and were eager to set eyes on him.

home4Cross2Stan and I left Houston for Temple shortly before 3:00 P.M., but because of an accident in Cameron that closed the road in both directions, we didn’t reach my parents’ home until 6:30 P.M. Shortly after we arrived, I learned that Dad had not been out of his wheelchair since his last physical therapy treatment on April 10. In principle, Mom would help Dad with his rehab exercises between sessions with the therapists, so I was a bit concerned that nothing had happened since he had been home.

We had a nice evening, and I tried to contain myself and not say anything about Dad’s lack of therapy since his return home. The four of us discussed some of the chores that they needed Stan and me to do over the next two days. We played Oh Hell, and I won.

home4Cross3April 14. Following our Saturday breakfast of homemade waffles, we reviewed and refined the list of chores that Stan and I needed to tackle today. Mom and I went to Academy, Walgreens, and WalMart. Dad had asked Mom and me to find some exercise aids that he could use at home. We purchased a couple of items from Academy, but I doubted that he would use them. They were simple and inexpensive so our loss wouldn’t be significant. After we returned from our shopping expedition, I tried, without any success, to encourage Dad to try walking a few steps with his walker. I hoped that he would try walking a few steps before we left for home tomorrow.

IMG_3501My parents had a large vegetable garden. Between Dad’s stint in the hospital and rehab and Mom looking after him, weeds had taken up residence among the tomatoes, squash, beans, and cantaloupe. While surveying the garden, I wondered why the vegetables couldn’t be as low-maintenance as the weeds. After lunch, I weeded the vegetable garden while Stan planted a couple of rose bushes and a couple of saplings in the yard. The day before Dad fell, he had placed bags of mulch in the front gardens. A couple of weeks ago, Stan had spread the mulch but thought that we needed to purchase a couple more bags, but Dad wanted only to use what he had purchased. When I had finished weeding the vegetable garden, I redistributed mulch in the front gardens. I had often said that my parents’ large yard kept them active and was good for their health. The large yard was now becoming a chore for Stan and me, and we fantasized that they would consider downsizing.

home4Cross4During our happy hour, Dad announced that he and Mom had decided that they could not continue living in their home for many of the reasons that concerned Stan and me. Dad said that they wanted our opinion and looked to us to do some research. We discussed many options, and it seemed that they wanted to move into a small house, which wasn’t my first choice for them. However, I knew of a 55+ community in The Woodlands and discussed its possibilities. I allowed myself to dream of all sorts of possibilities that included them living in or near Houston.

April 15. While Mom and I attended church, Dad and Stan played cribbage. After lunch, I tried again to get Dad to walk a few steps with his walker before we returned to Houston, but was unsuccessful. Stan and I left at 2:40 P.M. and arrived home at 5:50 P.M. Although we were concerned about Dad’s lack of therapy, we were very encouraged that my parents were open to moving.

home4Cross3April 16. I spent a few hours scouring the web for independent-living communities in Harris County that had decent reviews. I spoke with a representative from an independent-living community in The Woodlands, Texas. The community sounded exactly like what my parents wanted, but I wasn’t convinced that this was the best place for them. Although it provided many amenities, it was a gated neighborhood that didn’t provide transportation, which could be problematic in the future. I did a little more research but didn’t find anything that I liked well enough to suggest without first visiting the property.

April 28. Stan had a bad cold, so I traveled to Temple today without him, arriving at my parents’ home shortly after 10:30 A.M. My mother had been worrying the heck out of me with her stylish shoes that wouldn’t stay on her feet. During the past year, Mom had lost a lot of weight, and now her slimmer feet often stumbled out of her shoes. Sunday had become one of the most dangerous days of the week as her shoes fell off while we walked to and from the church. I had told her that we would shop for some stylish, yet sensible, shoes as soon as I arrived.

After finding the perfect shoes, we dashed into HEB for a few groceries and then went home for lunch. Dad told us that he had exercised four times while we were gone. Because he had “exercised,” he wasn’t willing to walk with the walker.

home4Cross2I had a difficult time hiding my disappointment when Dad told me that he and Mom had decided to stay in their house and not move. Several thoughts came to mind, but for once, I decided to keep my thoughts and concerns to myself. However, I wished that they had told me sooner about this decision so that I wouldn’t have wasted so much time looking for viable options for them.

We ended our evening with a game of Oh Hell, and Mom won.

April 29. Mom and I attended church this morning, which gave her the opportunity to test and show off her new shoes. I still wasn’t able to get Dad out of his wheelchair, so I had to settle for batting .500 during this weekend trip.

 

Leaving rehab just a tad too soon

April 6, 2018. Today was my last day of employment. After 19 years, one week, and one day with my employer, I had been informed that I was ready to pursue other interests. In anticipation of my employer’s significant US layoffs, I had left Temple last Thursday so that I could be in the office in case I was included in the reduction.

badRehabCross7My week in Temple for Dad’s surgery had put me behind in many of my responsibilities at home, so when Stan suggested that we return to Temple tomorrow, I brought up several reasons why I could not leave town for the weekend; besides, he had plans to play golf on Saturday. When he said that we could drive to Temple after golf, I agreed to the trip.

April 7. I hit the ground running and finished my grocery shopping before Stan left to play golf. While he and his friend Mike were playing a couple of rounds of golf, I checked off tasks on my to-do list and was ready to leave town when the guys returned at 2:00 P.M., and we left home shortly before 4:00 P.M.

badRehabCross5I had decided that I would not tell Mom that we were coming for a short weekend visit. Knowing her the way that I do, I knew that she would try to tidy up the house or prepare dinner during our three-hour drive. When we were about two miles from Cornerstone, I called Dad. Although he answered his phone, he couldn’t hear me. We continued our drive to the facility and surprised him when we walked into his room. During our 20-minute visit, I adjusted the speaker control on his phone so that he could hear callers. I then called Mom and told her that Stan and I were with Dad and that we would be arriving soon. In the 30 minutes that elapsed before we arrived at my parents’ home, Mom had rushed around the house, trying to tidy up. Truth be told, even when she thought that the house was a mess, it still looked like it was minutes away from a photo shoot for House Beautiful magazine.

April 8. Stan was right to suggest that we visit my parents this weekend. It was obvious to us that Mom was approaching the end of her rope. With Dad away, she wasn’t sleeping well, and she was skipping meals. During the day, she spent most of her time at Cornerstone and then was distressed about not getting anything done at the house. She was also too tired to cook when she got home and had lost weight that she couldn’t afford to lose. During our short visit, I prepared six protein- and carbohydrate-rich single-serve casseroles for her to eat. I didn’t want her to get sick while Dad was in rehab.

badRehabCross2April 10. Dad had been the sole occupant of his semiprivate room and had been enjoying his privacy. Although the Cornerstone staff encouraged patients to visit some of the common areas, Dad had no interest in leaving the room except for physical therapy. Today the staff notified him that he would get a roommate on Friday, three days from now. Shortly after receiving this news, he started complaining in earnest about the facility. He didn’t like the therapists, and the room was too small. I agreed with him that the rooms were small, but the rehab stay was supposed to be short, and he could leave his room and spend time in the common areas. Nothing that I said about the facilities and the purpose of rehab seemed to sway his opinion. Dad now seemed to be more concerned about his accommodations and not about his rehabilitation mission.

Dad had his first post-op appointment with the orthopedic surgeon today, and my parents used the services of the Cornerstone bus to get to the clinic. The surgeon wasn’t there, but they met with his physician’s assistant (PA). She told my parents that she could order outpatient rehab for Dad (which he would receive twice each week) and that he could leave Cornerstone at any time.

badRehabCross7With the blessing of the surgeon’s PA, my parents decided to check out of Cornerstone before Dad’s roommate was admitted to the facility, and several days short of the recommended two-week stay. Mom assured me that she would help Dad with rehabilitation exercises on the days between physical therapy. The separation was taking a toll on Mom, Dad didn’t want a roommate, and they had decided that they didn’t think that the therapy was helping. I was opposed to their plan, but she said that it was their life, and she was right.

Mom had not eaten dinner last night, and I was relieved to hear that she ate one of the prepared single-serve casseroles tonight. I hoped that she would start taking better care of herself when Dad got home. On the other hand, Dad had been eating well, although it didn’t seem that Cornerstone had been serving him a renal diet.

At 9:45 P.M., I received a call from a Cornerstone employee. She had been trying to call Mom but it didn’t seem to her that the phone number was correct. After telling me the number that she had called, it was apparent that she had transposed a couple of the digits. When I asked her if there was a problem, she said that Dad had slid out of bed and was found on the floor. She went on to say that Dad had been uncooperative, but they helped him back into the bed and he seemed unhurt.

badRehabCross4After hanging up, I tried calling Dad at Cornerstone to get his side of the story and see how he was doing, but after the phone rang a few times, I decided to hang up. I didn’t want him to try to get to the phone if it happened to be out of his reach. I called Mom, and she was breathless when she answered the phone saying, “Melody, is it Dad?” The ringing phone had awakened her, but by the time she reached it, the caller had hung up. My call came moments later, and I told her about the call from Cornerstone. Mom said that the incident surprised her, saying that he had been out of bed before to use the bathroom. This incident only heightened my concern about Dad coming home early.

April 11. My parents’ next-door neighbor, Jo, and her caregiver arrived at Cornerstone this morning to help get my father home. My parents called these two women angels, and they were. Mom had not called them; I didn’t know how they knew that Dad was leaving, and I don’t know how Mom would have been able to transfer Dad into the car and then transfer him out of the car and into the house. My parents didn’t have a wheelchair yet, so their friend used an office chair to get Dad into the house from the car.

A representative from American HomePatient, the provider for the wheelchair, called me today. She was trying to call my parents, but their records had my parents’ former phone number, which had changed after my parents returned the last rental wheelchair to American HomePatient.

badRehabCross2When I called my parents’ home, Dad answered the phone and told me that Mom was at WalMart. She was shopping for medical supplies that she would need to care for Dad. During our conversation, he told me that he would start receiving physical therapy on April 23, 12 days from now. This news worried me, which seemed to be my default state these days. When I expressed my extreme concern about such a long gap in his therapy, he said that he and Mom were just old people trying to get by the best that they could. So now, in addition to being worried, I was also feeling guilty for questioning all of their decisions.

 

So far, so good at the rehab facility

March 30, 2018. After spending most of the week with my parents, I was now back home in Houston so that I could spend the Easter weekend with my husband. I was pleased to learn that Dad had received physical therapy today. He had not received physical therapy every day at the hospital, so I hadn’t assumed that he would have therapy today. In the hospital, physical therapists didn’t work on the weekends, and I didn’t know if physical therapists worked on the weekends at the Cornerstone rehab facility. Having therapy today lessened the potential gap in his treatment. To ensure that Dad would reach his physical therapy goals in the targeted time, he needed frequent sessions. Significant gaps between sessions could slow his progress or cause him to regress. My parents and I were intent on Dad being able to safely leave Cornerstone within two weeks.

goodRehabCross1Shortly before 11:00 A.M., the case manager called me from Scott & White Hospital to tell me that Dad was still in the hospital but would be transferred to Cornerstone later today. She said that she had tried to reach my mother, but no one answered the phone. I told her that I was in Houston, but my mother was with my father at the hospital and that she could speak to both of my parents by going to his room. I was a bit surprised that she had not tried Dad’s room first. Even if my mother hadn’t been there, Dad would have appreciated knowing the details of his transfer.

Later today turned out to be noon, just an hour after she called me. The previous occupant of Dad’s semiprivate room had already been discharged, so Dad had the room to himself. I hoped that he would have a private room for a few days. He didn’t receive any physical therapy during the afternoon, so I was thankful that he had received therapy this morning at the hospital.

When Mom called me a little after 5:30 P.M., she told me that the day had gone very well and that Dad was determined to be fit enough to go home in five days. Mom’s enthusiasm and optimism about today’s events rubbed off on me, and I had a good feeling about Dad’s prospects.

goodRehabCross5March 31. I wasn’t sure what time Mom planned to leave home this morning for Cornerstone, so I called her mobile phone, hoping that she might have it with her. Mom usually kept her phone in her purse and had a difficult time answering it before the call was transferred to voicemail. I knew that Dad kept his phone on the bedside table, so when there was no answer, I tried his mobile phone number. As I had expected, Mom answered Dad’s phone.

I could hear a lot of background noise during the call, and Mom said that Dad’s room was a hubbub of activity. The occupational therapist and an aide were getting Dad ready to take him to the shower, which was located down the hall. Because of all of the distractions, I told her that I would call her later this afternoon.

goodRehabCross2When I called Mom at 5:30 P.M., she gushed praises about the physical therapist. Mom said that the therapist was kind but firm and that she did a great job with Dad. After spending an hour in physical therapy, my exhausted father returned to his room. I don’t know how much time he spent with the occupational therapist this morning, but if every day was like today, Dad just might be ready to leave in less than a week. I was very pleased that the residents of Cornerstone received therapy on Saturdays. Because tomorrow was Sunday and a holiday, I didn’t think that he’d receive therapy, but at least he would have only a one-day gap in his treatment.

April 1. Today was Easter Sunday, and I called Dad’s mobile phone as soon as I returned home from church. After four rings, the call went to voicemail. I called again with the same result. On my third attempt, I received a text from him, which had to have been the result of some fumbled fingers because he does not text. Now that I knew that he was there and most likely was holding his phone, I called again, and this time he answered. We talked for almost 25 minutes. He was in a great mood. He said that Mom had been there for a couple of hours before she went to church. The Cornerstone staff had delivered bags of Easter candy to the residents, and he proceeded to itemize the contents of his bag during our call. When he found the six-inch Hershey bar, he said that he would start with it. While we were talking, a caregiver arrived with his meds. He told her that he was on the phone and would take the pills later. In jest, I told him to take the pills with his candy.

After all of the effort that it took to convince him to enter this facility, I was thrilled with his positive attitude and good mood. We had a great talk, but when his lunch arrived, he was done with me. Evidently, Cornerstone’s food was pretty good too.

goodRehabCross3Mom called me a couple of hours later from Dad’s room. Dad was in physical therapy, and because my parents’ neighbors said that they might visit this afternoon, she remained in Dad’s room during his session. While Mom and I were talking, an aide wheeled Dad into his room. I was thrilled that he had had therapy on a Sunday, and Easter Sunday at that. At the end of our call, I was feeling good about this facility and Dad’s care. It seemed that his stay at the Cornerstone facility was going to exceed my wildest expectations.

 

 

Maybe rehab won’t be so bad after all

March 29, 2018. Mom left home for the hospital shortly after 8:30 AM., and I followed her in my car about 15 minutes later. By the time that Mom arrived at Dad’s room, he had been visited by Mike (today’s physical therapist) and a nephrologist. According to Dad, Mike had had him walk around the bed. He seemed to like Mike and was eager to have another session with him.

When I arrived, Dad was finishing his breakfast of hot cereal, pancakes, eggs, and a few cups of apple juice. Dad looked much better today and had a healthy appetite. He was still a little confused about the dreams and hallucinations that had occurred during the night, but he seemed to be in a good mood. Unlike Dad’s previous surgeries, I had been able to warn him about the potential for hallucinations and confusion after this surgery. yoRehabCatI was encouraged that he shared his events with me so that we could sort out what was real. During the day, he asked me about a cat that was sitting in the corner of the room. Although it seemed real to him, he believed me when I told him that there was no cat in the room, although he could still see it.

noRehabCross3The morning’s happy mood took a nose dive when Alisa, the nurse, tried to give him a doxycycline capsule. He insisted that he would not take this pill because it had made him vomit. Alisha said that she would give him a Zofran for nausea to take with the antibiotic.  I reminded him that he had had problems with this antibiotic when he took it on an empty stomach, but he had just eaten breakfast. He eventually calmed down and agreed to take it, but I was not hopeful that he would take the second pill after dinner.

Sara, today’s physician’s assistant, stopped by at 10:15 A.M. to tell Mom and me that Dad could be discharged to Cornerstone as early as today. Mom told her that we wanted to meet with a Cornerstone representative and tour the facility before Dad was discharged. Sara thought that our request was reasonable and would relay our request to the case manager. When I asked her if we were responsible for Dad’s meds, she said that the hospital would send Dad’s list of medications to Cornerstone and that they would obtain them through their pharmacy.

yoRehabCross1At 10:30 A.M., I went to the cafeteria to get some coffee for Mom and me. When I returned, Dad was in the bathroom. Being able to get out of bed to use the bathroom was a significant and welcome milestone after hip surgery. With his movement at glacial-speed, the short trip took quite a bit of time, but Carrie, the aide, eventually got him back into the bed at 11:10 A.M. After watching the process that was required to get Dad from the bathroom to the bed, Mom was convinced that we had made the right decision to have Dad discharged to a rehab facility. Dad had insisted that he could have out-patient therapy, but Mom and I together could not have safely transferred him from home to the rehab facility.

Shortly after Dad was settled back into his bed, Dr. Bolanos and Dr. Duran, the nephrologist, and her entourage arrived. Dr. Duran said that Dad’s kidneys were back to where they were before this surgery, whatever that meant. Dad hadn’t seen a nephrologist or had a blood test since early December, so I wasn’t convinced that his kidneys had been in great shape when he entered the hospital. I knew several of the Scott & White nephrologists and was disappointed that one of them was not working at the hospital this week.

When the nephrologists left, Dr. Bolanos spoke with Dad again about rehab, and he was still very resistant to her recommendation and dismissed her reasons why he should have in-patient therapy, insisting that Mom needed him at home. After a few minutes of unsuccessfully trying to change his mind, she left the room.

yoRehabCross1After the doctor left, Dad started talking about how he wanted to extend his hospital stay so that he could get the physical therapy here that he needed before he went home. I explained to him that his insurance didn’t allow patients to extend their hospital stays for physical therapy. I also reminded him that hospitals were germy places and that he didn’t want to stay any longer than necessary. I added that the hospital wanted to discharge him either this afternoon or tomorrow morning and that there was no way that Mom could take care of him. Because Mom seemed to be Dad’s primary concern and his stated reason for not going to rehab, I had told her that it was up to her to convince him to go to rehab. When she started telling him about her appointment at Cornerstone this afternoon, I excused myself and went to the waiting room so that they could talk in private.

Shortly after I returned to his room at 11:45 A.M., Brenda, the occupational therapist, and Carrie, the aide, arrived for a therapy session with Dad. The goal of an occupational therapist is to prepare the patient to become independent in the job of daily living, and today she wanted to get him into the bathroom. Brenda and Carrie had him practice sitting on and standing up from the commode. She also had him stand at the sink and brush his teeth.

yoRehabCross2During Dad’s therapy session, Mom told me that he had agreed to go to Cornerstone and complete his therapy as fast as he could. The doctor and therapists had estimated that he would require two weeks, but he planned to be ready to come home in half that time. I was thankful and encouraged by his change in attitude. I left the room to find Dr. Bolanos to let her know that we were all on board with his rehab plan at Cornerstone.

I needed to return to Houston today, but Mom wanted me to join her for her appointment with Marie at Cornerstone. Because we wanted to spend as much time with Dad as possible, I picked up a soggy sandwich from the cafeteria for us to split and eat in Dad’s room. At 1:00 P.M., I woke Dad from a nap to tell him goodbye. It was a good goodbye, and I felt optimistic about his prospects. Mom and I left the hospital together and drove in separate cars to Cornerstone for our 1:30 P.M. appointment. After Mom signed a huge stack of papers, Marie provided us with a tour of the facility that ended at what would be Dad’s semi-private room. The current occupant was due to be discharged tomorrow morning, which meant that Dad would have the room to himself for some time. Everybody was very nice, and it seemed like a nice place. I hoped that Dad would do well here.

yoRehabCross2After our meeting, Mom returned to the hospital and I drove to my parents’ home, where I worked for another hour before driving to my home in Houston. Five days ago, Mom called me with news of Dad’s fall. Because of his severe osteoporosis, I feared the worst for him. With Dad seeming to be inspired to get back on his feet, I now felt optimism that I hadn’t thought possible.

They say that he has to go to rehab, but he says No.

March 27, 2018. Because I was concerned about how Dad fared during his first night after surgery, I didn’t sleep well and woke up just before 2:00 A.M. I hoped that he had slept well and that he had not tried to get out of bed during the night. Mom and I didn’t have much of an opportunity to visit with Dad yesterday after his surgery, but I had warned him that he might experience some confusion after his surgery. I knew that I would be spending a few hours at the hospital today, so I set up my computer shortly before 5:00 A.M. and worked for about four hours. Thirty minutes later, Mom and I arrived at the hospital.

noRehabCross3When we entered Dad’s room, we found that a nurse and a couple of nursing students were turning Dad in his bed. Until patients can get out of the bed, they must be turned every few hours so that they don’t develop bed sores. After Dad was resituated in his bed, Dr. Bolanos entered the room. Within moments, the two of them were arguing about Dad’s antibiotic suppressant drug. He insisted that the doxycycline gave him an upset stomach and that he hadn’t taken the pill in six months. She suggested that he take the antibiotic with food or with Zofran, which would prevent any nausea. He agreed but said that he would take only one pill a day and not the prescribed two pills. Fortunately, she avoided the subject of rehab during this visit.

Although Dr. Bolanos had steered clear of the contentious subject of rehab, Kim, the physician’s assistant, took the bull by the horns when she stopped by Dad’s room. While she was there, she described the different types of physical therapy available to patients and the patient requirements for each option. For Dad, she reinforced Dr. Bolanos’s recommendation for in-patient therapy at a rehab facility. As before, Dad insisted that he had to go home and take care of his garden and wife.

Dad_ot-paintShortly after lunch, Amy, the occupational therapist arrived and had Dad stand with the walker. Before Amy left the room, Brooke and Lisa, the physical therapist and her assistant, arrived. They had Dad stand up and sit down and then sit in a chair. While he was enjoying being out of bed, Pastor Tom entered the room. While Tom was there, he spoke of the many benefits of rehab. The pastors in that church always seemed to answer my prayers. Before Tom left, he urged Dad to get well quick because he needed a Christian in the church, which was a running joke between them. Tom had a very busy schedule this week, and Mom and I greatly appreciated his taking the time for a visit.

At 3:00 P.M. I returned to the house so that I could get in a couple more hours of work. I was feeling the effects of my sleepless night and drank coffee to keep myself awake until 5:00 P.M., which was when I logged off for the day. While I was working, my parents’ neighbor, Jane, dropped off a Cobb salad that she had purchased for us while she was in Austin. Mom and I devoured this much-appreciated gift for dinner.

March 28. Dr. Bolanos stopped us in the hall as we approached Dad’s room. She told us that Dad was very confused. He thought that he was at home and he was also having hallucinations. Also, during the night, he had gotten out of bed, and the nurses had found him on the floor when they responded to the bed alarm. To help prevent him from injuring himself, they exchanged his bed for one that could be lowered within inches of the floor. As if this news wasn’t enough, she added that Dad was argumentative and was still fighting the notion of going to rehab.

noRehabCross1When we entered Dad’s room, we encountered chaos. Dad was eating breakfast and arguing with Alisha, an aide who was trying to take his blood pressure, which was required before he could have his morning meds. He insisted that he would not take the meds, and wanted her to leave. Steve, the electrical technician, was also in the room, trying to repair a problem with a spastic call light and oversensitive bed alarm. It didn’t help matters any that Steve and a nurse were discussing the problems with the system.

I asked Alisha if she could leave so that Dad could finish his breakfast, and she agreed to come back later. As soon as she left the room, another woman entered the room. She introduced herself as Lisa, the nurse manager, and asked if we were having problems. I told her that the room had been like a sea of chaos when we arrived, which was not helping my father’s anesthesia-induced confusion or his mood. She took control of the situation and orchestrated the activities of the nurses, aides, and Steve until a relative calm settled over the room. The only challenge, which remained for a few hours, was the bed alarm and call light. Dad’s new bed did not have a built-in bed alarm and an attached call light. The nurses were using a chair alarm and the rigged-up system was somewhat faulty. I finally had Steve turn off the maddening bed alarm, promising to have the nurse turn it on when Mom and I left.

noRehabCross2Adding to the parade of people who dropped by was the case manager, who asked whether she should start looking for a rehab facility for Dad. Dad didn’t hear her question, and I quickly ushered her out of the room. Rehab was still a touchy subject, and I didn’t want us to launch into another argument in front of the case manager. I returned to the room and told Mom that she needed to see the case manager in the hall. While Mom was gone, she signed the appropriate paperwork to set the discharge process in motion. While Dad had been in surgery, I had asked Pastor Tom about Cornerstone, and he said that he thought (based on his visits to many rehab facilities) that it seemed like a good facility. We hoped that Cornerstone, which was within a couple of miles from my parents’ home, could accommodate Dad.

Mom and I had hoped to be with Dad during his next physical therapy session, but we hadn’t heard anything about today’s schedule. To ensure that we didn’t miss the session, I went to the cafeteria to buy lunch for Mom and me. While Dad enjoyed a lunch of pork chops, Mom and I ate yogurt and fruit. Dad admitted that his lunch was pretty good, which was practically an enthusiastic endorsement of the hospital food. We finally asked the nurse about Dad’s schedule, but she said that there was nothing on his chart today about him having physical therapy. With that disappointing news, Mom drove me back to the house so that I could get back to work.

noRehabCross3Shortly after Mom returned to the hospital, Pastor Tom returned for another visit. Tom told Dad how rehab had made a difference in his recovery when he broke his ankle after jumping from a plane while he was in the army. Although Tom’s words probably fell on deaf ears, I felt like we should have baked Tom a pie for trying to sell Dad on the notion of a rehab facility.

Shortly before I logged off from work, I answered a phone call from Cornerstone. Marie was calling to inform us that Dad had been accepted and that she wanted to make an appointment with Mom so that they could finalize the arrangements for his two-week stay.

Now, all we had to do was get Dad to agree to the transfer from the hospital to the Cornerstone facility.

 

Back at Scott & White Hospital. Oh, joy.

carCross1March 25, 2018. After last night’s disturbing phone call from Mom about Dad’s fall, I wanted to get an early start to Temple so that I could be there during Dad’s surgery. I was up by 5:30 A.M., called Mom 45 minutes later to let her know that I was coming, and left home at 7:40 A.M. Because of my early departure, and some good highway luck, I arrived at my parents’ home at 10:15 A.M. I quickly unpacked my car, drove to Scott & White Hospital, and made my way to room 566 in the south tower.

I had just missed the surgeon, who had stopped by to tell my parents that barring any emergency surgeries, Dad’s surgery was scheduled for that afternoon at 1:20 P.M. Shortly after I arrived, Dr. Karla Bolanos, Dad’s attending physician for the week, stopped by to visit with Dad. Dad was very charming and witty, giving her the impression that he was a cooperative patient. At this stage of the process, he actually was very cooperative because he had no idea what was in store for him.

noRehabThe doctor said that Dad would have his first physical therapy session and evaluation the day after his surgery. Following the surgery, he would remain in the hospital for 2-3 days and then move to a rehab facility for two weeks of rehab. It was at this point in the conversation that Dad balked and said that this plan didn’t work for him. He had no intention of going to rehab; he was needed at home. Unfortunately, Mom seemed to agree with Dad. In an attempt to sell my parents on the notion of rehab, I related the story of their friend Sally and her experience with rehab after her hip-replacement surgery, but my parents were not swayed.

Shortly after Dr. Bolanos left us, I left the room to call Stan and my friend Rhoda, both of whom wanted an update on Dad’s condition. On the way to the lobby, I saw the doctor at the nurse’s station and spoke with her about Dad’s diuretics, his swollen legs, and I requested that she order an infectious diseases specialist to check Dad to see if he still needed the antibiotics to suppress infection in his lungs. She appreciated knowing about the diuretics but said that Dad would need to take suppression antibiotics for the rest of his life. Furthermore, she said that he needed the antibiotics because of his new heart valve. It seemed to me that he needed the antibiotics for a couple of good reasons. Because antibiotics can affect the kidneys, I had hoped that he could quit taking them, but the doctor dashed that hope.

pegOutCross1When I finished making my phone calls, I returned to Dad’s room. Dr. Bolanos returned to the room a few minutes later and told us that they had noticed a spot on Dad’s heart that looked like a clot. Before they could operate on Dad’s hip, they would need to run some tests, which were scheduled for tomorrow. By now it was 12:30 P.M., and Mom and I were hungry and decided that we would leave Dad for an hour and go home for lunch. When we returned to Dad’s room, because his surgery was rescheduled for tomorrow, his NPO restriction had been lifted, and he was eating lunch and complaining about the food. Some things never changed.

At 3:30 P.M., an imaging tech arrived with an ultrasound machine to scan Dad’s legs for blood clots. She couldn’t tell us anything, and we assumed that we’d hear something soon from the doctor.

Shortly before 5:00 P.M., Mom and I left the hospital for home, having not seen any medical providers after the imaging tech left the room.

March 26. Mom and I arrived at Dad’s room shortly after 9:00 A.M. Dad said that he had been told that his surgery was scheduled for 1:20 P.M. Dr. Bolanos stopped by the room and told us that Dad was scheduled for a VQ scan at 10:30 A.M. I had never heard of a VQ scan, but I learned that it evaluates the circulation of air and blood within a patient’s lungs. The transportation tech arrived 10 minutes before the scheduled time and transported Dad to the procedure location. Not knowing how long he would be gone, Mom and I started getting antsy when he hadn’t returned by noon—especially because he was scheduled for surgery at 1:20 P.M. We didn’t want the surgery rescheduled for tomorrow. We also didn’t want to leave the room for lunch and risk missing the doctor.

ouchCross4Dad was returned to his room at 12:15 P.M., and a couple of minutes later, we were told that he was still scheduled for surgery today. Less than 30 minutes later, another transportation tech arrived to take Dad to the OR prep area. Mom and I were both allowed to accompany him. Dad wasn’t in favor of my coming, but I wanted to speak with the anesthesiologist. Dr. Daniel Stahl, the surgeon, stopped by to tell us about the surgery. He said that Dad would need three pins and that unless they found something different from what they had seen on the x-rays, the procedure should take less than two hours.

I told the anesthesiologist that following Dad’s previous two surgeries, he had had a heck of a time dealing with the anesthesia. For three to four days, he had been very confused and had had hallucinations of animals, insects, and water in the room. The anesthesiologist said that he had Dad for his second surgery in May 2015. He said that if this surgery lasted no more than 90 minutes, he could use a spinal tap. Dad would be aware of what was happening, but he wouldn’t have any pain, and he would not suffer the after-effects of the anesthesia. He said that he would confer with the surgeon and try using a spinal tap if we agreed that was the route that we wanted to take. He thanked me for the update on Dad’s history, and Mom and I hoped that we had found a solution to Dad’s post-op dramas. While we were speaking with the anesthesiologist, the nurses were having a heck of a time finding a vein so that they could type and screen Dad’s blood.

anotherFallCross1When the nurses had finished drawing Dad’s blood, Mom and I made our way to the OR waiting room. After waiting for about an hour in the freezing-cold room, we were pleasantly surprised to see Tom, my parents’ pastor. I don’t know how he found us, but pastors seem to know their way around hospitals. We had a nice visit with him, and during our discussion, I mentioned my concern about Dad’s reluctance to go to rehab. I hoped that Pastor Tom would be able to have a guy-to-guy talk with Dad sometime before he was discharged from the hospital. After talking with Mom, I learned that part of her reluctance to send Dad to rehab was because of the promise that my parents had made years ago to not put the other in a nursing home. I explained to her that he would be admitted to the temporary resident section of the skilled nursing facility, not the permanent resident section, commonly referred to as a nursing home. I think that she felt somewhat better about rehab after our discussion.

Just a few minutes after Pastor Tom left us, the surgeon arrived to tell us that the surgery had gone well. Unfortunately, because of Dad’s spinal compression, the anesthesiologist was not able to use a spinal tap and had to use a general anesthetic after all.

Oh, joy.