Replacing the crumbled hip

August 21, 2018. Once again, Dad objected to my plan to come to Temple to sit with my mother in the surgery waiting room. I told him that I had to be there for Mom, but truth be told, if something went wrong, I’d never forgive myself later for not having been there to give him a hug and kiss before his surgery.

I had a full schedule today and didn’t leave Houston until 7:15 P.M. Houston traffic was still a bear, and I was thankful that I was able to bypass most of it with my EZ Tag toll tag.

I didn’t arrive at my parents’ home until after 10:00 P.M. I had a house key, but Mom had insisted that she would wait up for me until I arrived. As I expected, Dad had been in bed since 8:00 P.M. and was asleep when I arrived. Mom told me that we would be getting up very early tomorrow because Dad had to be at the hospital by 5:30 A.M. for his 7:30 A.M. surgery. At least one of us would be well rested.

hip4August 22. We all woke up earlier than necessary, and we were ready and in the car by 5:00 A.M. Needless to say, the streets of Temple were all but deserted at that time, and we were in the day surgery waiting room by 5:15 A.M. Dad’s name was called a few minutes later, and we rode the elevator to the second floor and located our surgical bay. We were greeted by Richard, one of Dad’s nurses, who handed Dad his surgical wardrobe. While Mom helped Dad to change into his surgical attire, I waited outside of the bay curtain.

After Dad had donned his surgical gown and cap and was situated on the gurney, Allison started his IV. Shortly after 7:00 A.M., the anesthesiologist arrived to address any questions that we might have. I mentioned our experiences of Dad’s challenges with extreme confusion following surgery. His not-so-comforting response was that as we age, anesthesia becomes more problematic, so today would be no better (and could be worse) than Dad’s surgery in March.

hip1Moments after the anesthesiologist left, Dr. Daniel Stahl, the orthopedic surgeon arrived. He described the surgical procedure, and while talking, he lifted the portion of the sheet that covered Dad’s legs. Dr. Stahl seemed somewhat alarmed when he saw the many sores on Dad’s legs. The doctor then told us that because of Dad’s age, his kidney issues, and the sores on his legs, the hip-replacement surgery was very risky. When he offered Dad a chance to cancel the surgery, Dad said that it was too late to back out now, to which the surgeon replied that until he made the incision, it was not too late to back out. I asked the doctor why he didn’t perform the hip replacement surgery in March. Evidently, the earlier surgery of mending the hip with pins was a lot less invasive and often sufficed. I, on the other hand, wasn’t feeling great about more surgery and starting over with rehab.

After hearing from Dad that he wanted to proceed with the surgery, the doctor told Mom and me that he would meet with us after the surgery, and then he left. At 7:25 A.M., Shasta, another one of the OR nurses, wheeled Dad to the operating room. As Mom and I proceeded downstairs to the surgery waiting room, she was noticeably upset. She said that during the pre-op visit on Monday, she had not heard that the hip replacement would be a high-risk surgery for Dad.

While we waited, I mentioned to Mom that Dad would probably require rehab. She said that after their previous experience with Cornerstone, she didn’t want him to go to a rehab facility. I reminded her about how weak he was after the last surgery and that we should be open to rehab, even if we went someplace other than Cornerstone.

Dad’s surgery was over at 9:30 A.M, and the surgeon stopped by to speak with us a few minutes later. He said that Dad came through the surgery fine and explained a bit about the condition of the hip from the earlier surgery. When I asked if we would bring Dad home from the hospital, he said that Dad should go to rehab for a couple of weeks. Before he left, he told us that we would be notified when Dad was ready to leave recovery. After the doctor’s disturbing comments prior to surgery, Mom and I were very relieved and eager to see Dad.

hip2An hour later, Mom and I were becoming concerned that we hadn’t heard anything about Dad. We were also starting to turn blue from the temperature in the waiting room, which must have been set to 65 degrees. We had seen several people leave the waiting room to see their loved ones and we were curious about our long wait. When I approached the waiting-room clerk to check on Dad’s status, she told me that “they” would call her when he had a room. At 11:15 A.M., almost two hours after his surgery, his recovery nurse, Karly, called us to tell us that he was still in recovery because there were no available beds on the orthopedic floor. I gave Karly my mobile phone number and Mom and I went home for lunch and to change into warmer clothes.

About an hour later, Karly called and told me that a room on the orthopedic floor was being cleaned. When I asked her for the room number, she said that to avoid problems caused by last-minute changes, she could not give me the room number until he was in the room. At 1:15 P.M., as we were backing out of the garage, she called me again and told me that Dad was in room 546 South. We arrived at Dad’s room at 2:00 P.M., and Pastor Tom from my parents’ church entered the room about five minutes later. During his visit, he told us that quite a few of his church members had had hip replacements and recovered quickly. After a short visit and a prayer, Tom left at 2:15 P.M.

Dad’s nurse, Brittany, was very nice and spent a significant part of the day monitoring his vitals. His oxygen saturation level was low because he sometimes stopped breathing, but it eventually leveled out between 98 and 99%. She asked if he had any history of sleep apnea. We said that he didn’t, but I mentioned that we had seen similar breathing patterns after earlier surgeries.

hip3With Dad sleeping soundly, I was able to give the nurse an update on his meds. I also told her that he had a bit of fluid overload, and that his face was usually puffy in the morning, although the fluid usually dissipated by mid-morning. Unfortunately, as the day progressed his legs became swollen from sitting in the wheelchair all day. A couple of hours later, she said that Dad’s face seemed swollen from lying down all day, and she elevated his head.

Around 3:00 P.M., a millennial in red scrubs and many tattoos entered the room with a heart monitor, and hooked it up to Dad. When I asked her if she worked in the war room, she said yes. I had seen the war room employees in one of Dad’s earlier stays in the hospital and was relieved that his heart would be monitored. The color of employees’ scrubs identified their role at the hospital, and the red scrubs stood out among all of the others.

hip5Dad’s oxygen saturation and blood pressure levels looked good for most of the day, but his heart rate hovered around 109, which seemed high to me. When I asked Brittany about it, she said that as long as it wasn’t fluctuating between the 60s and 90s, he should be all right. She reminded me that because of his AFIB, he was being closely monitored by the heart team in the war room, and they would keep an eye on his heart rate.

Try as we might, Mom and I could not get Dad to open his eyes for more than two seconds, and he only grunted like a bear when we asked him questions. At 4:45 P.M., his condition had not changed, and we decided to go home for the day. Mom and I were sleep deprived, had been here for the better part of 12 hours, were starting to get hungry, and Dad would probably sleep for the remainder of the day.

hip1We were relieved that the surgery had seemed to go well and that his condition seemed stable. I didn’t know how well Dad’s new hip would work with all of his excess fluid. I hoped that he might have some dialysis during his stay, which I hoped might improve his mobility.

Because of his history of delirium and confusion caused by the anesthesia, the next three to four days would be important for him, and probably a little challenging for the three of us.

 

 

Is this fall number 5 or 6?

July 25. Dr. Ebert’s nurse called me today. She had repeatedly called my parents’ phone number but there had been no answer, and she was concerned that she might not have their current phone number. I confirmed that she had the correct phone number and suggested that she keep trying. About 30 minutes later, Dad called me to see if I had called him. Evidently, he had heard the phone, but my mother was away from home and he had not been able to answer it before it stopped ringing. I told him that the call was most likely from Dr. Ebert’s nurse. I couldn’t tell him why she was calling, but I was certain that she would attempt another call.

ouchCross4When I called Mom a couple of hours later, she told me that Dad had not walked or exercised since Stan and I had left on Sunday, three days ago. I suggested that she move Dad’s little step into the living room so it would be easier for him to access and perhaps use it. I didn’t think that it was a reasonable substitute for walking, but it was better than nothing. During our call, Mom told me that Dr. Ebert’s nurse had called to tell them that Dad’s November 20 nephrology appointment had been changed to Tuesday, July 31 (next week!), at 3:30 P.M. I was relieved that the appointment had been moved up because I didn’t think that Dad or his kidneys could wait four months to see a nephrologist. Also, with this schedule, I could do my volunteer shift at the wildlife center, drive to Temple for the appointment, and then come home on Wednesday in time for my shift in the cattery at the SPCA. Everybody wins.

fallGuyJuly 26. I called my parents’ home numerous times today, starting at 3:00 P.M. Finally, at 4:50 P.M., Mom answered the phone. I could hear Dad’s voice and a woman’s voice in the background, and Mom said that she would call me in five minutes.  When she called, she told me that Dad had fallen while trying to walk from the car into the barber shop. As they were coming home, neighbor Jo’s aide saw them and offered to help. She wheeled Dad into the house and started bandaging his bloody arms.

Upon hearing this news, I lost my cool. When we were in town this past weekend for Stan’s birthday, Mom mentioned that Dad needed a haircut. I told her to wait until we returned so that Stan and I could help get Dad into the inaccessible shop. Mom said that as soon as Dad fell, she could hear my words in her ears. I told her that she and Dad needed to reassess their living options, and she said that they would never live in a nursing home. I wished that they understood that they had options other than their large, unmanageable home or a nursing home.

Before I hung up, I told Mom to contact the orthopedic surgeon and schedule an X-ray to ascertain whether or not Dad had broken or rebroken any bones.

home4Cross3July 27. After spending a few hours away from home today, I logged on to Dad’s MyChart account and noticed that his Tuesday appointment with the nephrologist had been rescheduled to a date and time that I could not make. The change was required to accommodate a new appointment with the orthopedic surgeon. I called Mom to see if she would let me try to reschedule the nephrologist appointment to a more convenient time for me, and she agreed. I spent the next 30 minutes on the phone with a very patient woman who worked at the appointment desk at the dialysis center. I was able to reschedule the appointment with the nephrologist to Monday afternoon. It wasn’t the most convenient time, but I could make it work without missing any of my commitments or appointments in Houston.

July 29. After attending my church in Houston, I packed a small bag and drove to Temple. Traffic was better than I would have expected on a Sunday afternoon, but parts of US 290 still left me white knuckled. Although the seemingly 100-year construction project was nearing completion, some of the road conditions were still far from ideal.

gliderhairWhen I arrived at my parents’ home, Dad was sitting in a glider chair with his legs resting on an ottoman. It was the first time since his surgery in March that he had been able to get himself in this chair. In addition to it being much more comfortable than his wheelchair, having his feet elevated might help reduce the swelling in his legs. Unfortunately, while he was on the glider, he was watching the Texas Rangers beat the Houston Astros.

After dinner, the three of us played a game of Oh Hell, and Dad won.

July 30. Besides the afternoon appointment with the nephrologist, Dad had a 9:10 A.M. appointment with the lab. According to my parents, Dad seemed to be having weekly trips to the lab for blood draws. Each specialist ordered lab work that addressed only his or her area of specialty. With any luck, Dad wouldn’t need any more blood draws for a few weeks. After we returned home from the lab, Dad helped me assemble a canvas stretcher for an art project. Before we were finished, I had hauled at least six different tools from his workshop into the living room, but we had a good time working with the difficult stretchers.  After lunch, we all snoozed for a few minutes before going to the dialysis center to meet with Dr. Maaz Syed Ahmed, the nephrologist.

My parents had a little difficulty understanding him, but they liked this doctor. He encouraged Dad to keep taking one pill/day and to monitor his weight and blood pressure. Dad’s creatinine level was elevated above high normal, but the doctor didn’t think that that Dad’s level was alarmingly high. The doctor also did not recommend that Dad resume dialysis, but he provided the following guidelines:

  • Restrict fluid intake to less than 50 ounces per day.
  • Do not exceed 2,000 mg of sodium per day.
  • Schedule an appointment with a wound specialist to address the wounds on his legs.
  • Walk as much as possible, but when seated, keep his legs elevated.
  • To address any pain, take Tylenol. Do not take aspirin or Advil.

The doctor asked Dad to schedule a couple of follow-up appointments before we left the building. Dad now had another appointment in October with the nephrology PA and then in January with Dr. Ahmed. I hoped that Dad liked this doctor enough to follow his recommendations, which seemed to dovetail with Dr. Ebert’s advice on July 17.

As soon as we returned to their home, I packed up my car and drove back to Houston, arriving shortly before 7:00 P.M.

PenultimateFullSizeRenderAugust 3-5. After Stan arrived home from work, we drove to Temple and spent the weekend with my parents. Dad ignored my requests to walk with him and did not walk during the weekend. He and Stan built a higher step, which Dad was excited about using. I still didn’t think that the step was a reasonable substitute for walking, but Stan gave me a look that suggested that I not raise any objections. Dad had enjoyed working on this little project with Stan and felt that it would help him. For me to raise objections wouldn’t accomplish anything and would only irritate Dad.

As expected, we played Oh Hell Friday and Saturday nights.

August 7. Mom was not at home when I called today, so Dad and I had a chance to discuss her birthday dinner. She would be 91 in a couple of weeks, and Dad had assured Mom that I knew how to prepare her favorite food, chicken-fried steak. I had never fried a chicken, let alone steaks, and I was thankful that I had a membership with Omaha Steaks. I was pretty certain that they knew how to prepare chicken-fried steak. Because Mom loved balloons, I planned to get her some, and I also planned to have flowers in her honor delivered to the church for the August 19 services.

August 9. Dad accompanied Mom to the store today, but he stayed in the car. He had not been walking, but he had convinced himself that using the little step that he and Stan had made would be an adequate substitute for walking. Evidently, getting Dad from the house into the car was a real struggle, and it became clear to Mom that walking was important. She decided that Dad must start walking again and planned to broach the subject with him. I stressed to Mom that he needed to walk over the weekend so that he could get into the car on Monday for his physical therapy.

August 12. Dad didn’t walk today, but Mom said that she was able to help him transfer from his wheelchair into the glider chair (with ottoman). She said that he fell asleep as soon as he was situated. I was glad that he was out of his wheelchair and sitting with his legs elevated. I’m unable to watch television in these glider chairs because their soothing gliding action puts me to sleep within moments.

fallGuyAugust 13. Dad slipped or fell out of bed this morning while trying to transfer from the bed to the wheelchair. According to Mom, it took her about 30 minutes to get him up and into the wheelchair. This event marked the second time in the past couple of weeks that he had slipped to the floor. Getting Dad up and off of the floor exhausted Mom, which concerned me. Fortunately, he didn’t have a physical therapy appointment until 10:30 A.M., so they both had a little time to rest before they had to go to his physical therapy appointment with Christi. Shortly after PT started, Mom and Dad told Christi about his fall this morning. She stopped the therapy session and scheduled an appointment for Dad later in the day with the orthopedic surgeon’s PA. She said that she would consult with the surgeon and then call my parents to see if they should continue therapy. The therapist strongly suspected that Dad would require hip-replacement surgery. Ye gods.

August 15. My parents still hadn’t heard from the surgeon’s office, which meant that Dad was just sitting around without any physical therapy—regressing.

I was a little anxious about today’s activities. Tomorrow was Mom’s 91st birthday and her driver’s license would expire. The Temple DPS office was small, and when the 30 chairs inside were full, people had to wait outside in the 100-degree heat. Mom planned to go early to avoid the worst heat of the day, but I worried about her standing outside in the heat and sun. I also was worried that she might not get her license renewed, which would create an impossible situation for my parents. Until Dad was up and around, she was the only driver in the house.

badRehabCross1When I called Mom this evening, I was pleased to learn that she waited only 15 minutes outdoors and then another hour inside. Even better, her license was renewed. One hurdle down, numerous more to go.

August 16. Today was Mom’s 91st birthday. On this date 41 years ago, Elvis Presley died, and later today we learned that Aretha Franklin had died of pancreatic cancer. After Mom and I discussed the sad news of the day, she told me that someone from the surgeon’s office had called and scheduled a pre-op visit for Dad on Monday, August 20, followed by surgery on Wednesday. I just hated the thought of more surgery. It seemed to me that we were back to where we were on March 24 when Dad fell and broke his hip, and I dreaded the thought of another hospital stay.

 

Maybe enlisting the assistance of a physician would help

July 3, 2018: Independence Day fell on a Wednesday this year, but for Stan and me to celebrate the holiday with my parents in Temple, we had to have our celebration on the preceding weekend. Afterward, I had left their home with some concerns that I hoped Dad would address. However, when I called Mom today and asked her if Dad had taken a pill today, she said that he had not, and he was through taking them. When I asked her why, she said that Dad felt that he was making enough urine without the aid of the diuretics. I couldn’t believe that he was reneging on our agreement to take one pill every day. I understood that it was his life, but what he did also affected the rest of the family, especially Mom. I also wasn’t sure that he understood the possible consequences of his decision.

ouchCross4In desperation, or maybe out of frustration, I called my friend Sue, the dialysis nurse practitioner, to sanity-check my assumptions and fears. Unfortunately, all of my fears about what Dad was doing to his body were well founded. After sharing the highlights of my 30-minute conversation with Stan, he encouraged me to write a letter to Dad, outlining my concerns, describing Dad’s symptoms, and listing the probable consequences of his decision to quit taking the pills. I agreed, but because I felt that time was of the essence, I decided to email the letter to my parents and then tell them to read the message. In my perfect world, they would print it and refer to it often.

July 4: It was raining in Houston, and it rained most of the day. The media dubbed the rain event the Fourth of July flood.

I called Mom to see how they were faring and to tell them about our weather, but there was no answer. I waited a few minutes and then called again. This time my mother answered, but she seemed out of breath. It seemed that while Dad had been showering, he had fallen off of the shower chair. It’s not easy to fall off of a shower chair, but because of his fluid overload, his center of gravity was out of whack. He didn’t break any bones, but he dislodged a large scab on his elbow, causing his elbow to bleed profusely. I didn’t want to keep Mom too long from her cleanup activities, so I quickly told her that I had emailed her a letter for Dad. She said that she would be having a “talk” with Dad later today and she would print my letter and have it handy during their discussion.

ouchCross2When I called my parents again later in the day, it seemed that my parents had had a come-to-Jesus meeting. According to Mom, following their little talk, Dad took his pill and said that he would continue taking them. From her lips to God’s ear.

July 9. Dad saw the orthopedic surgeon today. He said that although Dad’s hip was healing, it was not completely healed. Considering that Dad had severe osteoporosis, I was thrilled that the doctor expected the hip to heal. Mom added that the doctor said that he thought that Dad’s leg seemed thinner; however, I had a hard time believing that he could recall the size of a patient’s leg that he saw a month earlier.

July 10. According to Mom, Dad was still taking his pills. Stan and I had been spending every other weekend at my parents’ place, but because of a work conflict, Stan would not be able to accompany me to Temple this coming weekend. When I relayed this information to Mom, she was very disappointed. I suspected that Dad was also disappointed. My father cared for Stan and always looked forward to seeing him. Stan also seemed to have a calming effect on my parents.

ouchCross1July 15. Mom and I usually attended church when Stan and I were in Temple. Because Stan wasn’t here, Mom thought long and hard about whether she should attend church and leave Dad home alone. She finally decided that we would go when Dad insisted that she and I attend church. Unfortunately, while we were gone, Dad tripped on one of the front wheels on the wheelchair when he tried to stand. He wasn’t badly hurt, but his fragile skin was quick to tear and bleed. When we returned home, Dad had a bloody leg and sock. Feeling guilty for having left him alone, Mom dug into her stash of bandages and tended to his leg.

When I asked him if he had taken his pill today, he became a bit miffed at me, telling me that he had a lot of things to do today and he didn’t want to take the pill. After telling him that I couldn’t think of anyplace that he needed to be, he eventually took a pill. My health discussion with Dad seemed to deflate his mood, and getting him to take his pills felt like a hollow victory.

goodRehabCross2Fortunately, he didn’t stay mad at me for long, and we spent quite a bit of time planning for his 90th birthday celebration on October 6. We were expecting one of my cousins and her family, and we needed menus for three days. Dad and I were partial to many of the same foods, and we developed menus that contained some of my favorite foods as well as his. Dad also wanted to play a few hands of Oh Hell during the festivities, and he drew a seating chart of how we would seat seven people around a table that accommodated six.

Mom told me that Dad had an appointment this coming Tuesday with his cardiologist, Dr. Elizabeth Ebert. I had met Dr. Ebert on several occasions, and I hoped that she would not mind if I contacted her about my father in advance of his appointment. I assumed that my parents would not tell her about his reluctance to take his pills, so I planned to send her a message via MyChart, Scott & White Hospital’s patient portal. I had been using this website to communicate with Dad’s physicians when he was at home on home care. His credentials were cached in my browser, which enabled me to periodically monitor his test results and correspond with his doctors.

July 16. I wrote the following email to Dr. Ebert and hoped that she would read it before Dad’s appointment the next day:

“Hi, Dr. Ebert.
I’ve been encouraging my father to see you. Dr. Issac (his nephrologist), said that he could try getting off of dialysis if he would take diuretics. My father has been taking them on a less-than-regular basis, and I am concerned about fluid overload and how it might be affecting his heart and lungs. He views the diuretics as an imposition that affects the quality of his life. He hasn’t seen any nephrologist since November 2017. My parents trust you, and I hope that you can have a frank discussion with them.

Thanks.
Melody Locke”

fastCross2July 17. When I spoke with Mom this evening, she said that Dad’s appointment with Dr. Ebert had gone well. While they were in the doctor’s office, she referred Dad to Dr. Concepcion, a senior nephrologist with Scott & White. I knew and liked Dr. Concepcion, but he spoke with a heavy accent, and I feared that my parents would have a difficult time understanding him. After our call, I told Stan about the upcoming appointment with the nephrologist, and he told me that I needed to go with them, and I agreed. When I logged on to Dad’s MyChart account, I was dismayed to learn that the appointment was scheduled for November 20, more than four months from now, and a year since his last appointment.

PenultimateFullSizeRenderJuly 22. Today was Stan’s birthday. We had arrived in Temple yesterday and celebrated the previous evening with some of his favorite Midwestern foods. He and Dad also spent some time playing cribbage. While Mom and I attended church today, the guys played more cribbage and took time out to build a mini step that Dad could use to exercise his legs while he was sitting. I was able to get Dad to walk twice this weekend. We now sing She’ll be “Comin’ Round the Mountain” when he walks. We could usually sing four verses before he had to stop and rest.

barberPoleDad said that he needed a haircut and would see the barber either this coming Wednesday or Thursday. Recalling the difficult time that Mom and I had getting him into the barbershop during a previous visit, I implored her to wait for a weekend when Stan and I could help get him into and out of the building. I didn’t get much of a response, but I hoped that Mom would recall the harrowing experience.

July 24. I logged on to Dad’s MyChart again today to see if Dr. Ebert had left any notes about Dad’s last appointment. I was pleased when I read the following message:

“RE: Visit Follow-Up Question

I spent a good bit of time last week with your father (and mother) in the clinic. I expressed how important it was to take his diuretic every single day. He did complain that it was an inconvenience and he did not feel that he should have to take it daily. I explained that with his kidneys, he needed to take the diuretics if he wished to stay off of dialysis. I told him that as long as he had 6 to max 8 hours, then the diuretics would have worn off. I told him that if his appointment was at 2 in the afternoon, then he should take his diuretic at 6 am; or if he had a 10 am appointment, to take his diuretic as soon as he got home. I also encouraged him to follow up with Nephrology. He informed me that he did not wish to go back to Dr. Issac, so I instructed him that he should see another Nephrologist. He requested a recommendation. While I do not know all of the Nephrology department, I reported that Dr. Concepcion is very good. Unfortunately, it appears that an appointment was not scheduled until November. Because of the delay, my office will be contacting him requesting that he do some lab work so we can see where everything is now (electrolytes, renal function, etc.). We are also going to get him an appointment with a nutritionist to discuss an appropriate diet (requested by your mom). If he continues to have some difficulty, then I will also request that he be seen by one of our Heart Failure nurse practitioners so that they can continue to monitor him and reinforce the need to take his medications.

Sincerely,
Dr. Ebert”

I hoped that Dad would heed her recommendations. I felt that with Dr. Ebert as an ally, Dad might start taking his pills on a regular basis and reduce some of the fluid in his extremities, which would improve his center of gravity and reduce the weight in his legs.

 

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.