September 4, 2018. Yesterday had been rather a mixed bag for Dad, and Mom and I were a bit anxious to see him and see how well he fared during the night. I hoped that he had slept through the night and that we would find him as alert as he had been yesterday morning.
However, when we arrived at Dad’s room at 7:45 A.M., it was empty. Thinking that something bad had happened to Dad, Mom became very upset. Because his bed was missing, I assumed that he had been transported somewhere for a test. When I found Nakita, Dad’s nurse, she said that he was in dialysis. I began a slow burn. Yesterday, when the physical therapists left, they said that Dad should be able to get out of bed today and sit in a chair. Dialysis this morning would mean that he would not be in any condition to have physical therapy today, so he would not be sitting in the chair, which we so desperately wanted. I had been very clear with the nephrologists that I didn’t want Dad to have dialysis in the morning. Also, Dr. Duran, the attending nephrologist, told us yesterday that they would start Dad on a Monday-Wednesday-Friday dialysis schedule. Today was Tuesday. Evidently, Dr. Tanner, the nephrology resident, had visited Dad’s room at 6:45 A.M., and Dad was taken to dialysis shortly after the shift change, at 7:05 A.M. I was furious and asked Nakita to page Dr. Tanner and have him come to Dad’s room.
While I was stewing about Dad’s schedule for the day, Nakita shared some information that completely deflated my anger at nephrology and hopeful feelings about Dad’s progress. It seemed that Dad had not had a good night. According to the night nurse, Dad had been very confused and had pulled off all of his bandages. And when Nakita arrived to work this morning, she found Dad’s hospital gown on the floor.
Mom was out of her heart medication and I wanted to pick up her prescription from the pharmacy before the hospital parking lot filled up. When we hadn’t heard from the nephrologist by 8:30 A.M., we left the hospital to pick up her Eliquis. As we were leaving, we encountered Dr. Hunt, the attending physician, as he was exiting from a crowded elevator. As we exchanged pleasantries, I expressed my concerns about Dad’s mentation and told the doctor that we were running an errand and would be available to speak with him soon.
During the past week, two of the four elevators in the north tower had been out of order. Today, only one elevator was operational. Needless to say, lines of visitors and employees queued up for long waits. Considering that a wheelchair was often used in the elevator, the number of other passengers was not always as many as expected, contributing to the wait time. According to the hospital personnel who worked on the ground floor and had received the brunt of complaints, they had been complaining to their management about the situation for over a week. I was already in a bad mood, and this minor inconvenience was my tipping point. When Mom and I eventually returned to Dad’s room at 9:00 A.M., I grabbed my phone and initiated the following Twitter exchange with the hospital:
My father has been a patient in the north tower of Baylor Scott & White Hospital in Temple since August 27. At least 2 of the 4 elevators have been out of order the entire time. Thanks @bswhealth_templ
Thank you for sharing, Melody. We have passed your feedback on to the appropriate department for further review.
People are getting pretty annoyed that only one elevator is working. You’re just shy of an angry mob.
Thank you for sharing this feedback with us, Melody. Our Maintenance team is aware and currently working on the elevators. We appreciate your patience.
I don’t know if the Twitter exchange helped, but within a couple of hours, another elevator was back in service.
Dad’s dialysis session ended at 11:00 A.M., and he was back in his room by noon. Unlike his condition a couple of days ago, he was far from alert when he was returned to his room, and I could not rouse him. By 1:15 P.M., his condition had deteriorated. He had not eaten for over 24 hours, and Nakita had not been able to obtain his temperature from his armpit or by mouth, and after she consulted with the doctor, she called for a RAPID. Once again we heard the ominous announcement: Rapid response medical alert; in-patient room 634 North. Within moments, Dad’s room filled with 6 North personnel and some familiar faces, including Gail, the RAPID nurse, whom we had first met on August 23. Dad’s blood pressure was 84/50, and they had to take his temperature with a rectal thermometer, which showed that his temperature was very low. To increase his internal temperature, the doctor ordered a Bier Hugger, but until it arrived, they piled warm blankets on him.
When the room cleared, Dad’s eyes were open. I tried to get him to look at me, but he would only stare to his upper right. I kept trying to get him to engage with me, but I couldn’t get much more than a grunt. I kept telling him to say “Hi Mel,” but he only grunted. I had not seen anyone from the neurology team, and I was very concerned that he could not interact with me.
At 2:00 P.M., I went downstairs to the cafeteria to get Mom something to eat. When I returned to Dad’s room, he was under the Bier Hugger. His blood sugar, which had been very low during the RAPID, was now up to 104. While standing next to his bed, I thought that his belly seemed bloated. When I mentioned it to Nakita, she agreed and said that she would speak with the doctor about it. When the nurse left, I tried to get Mom to try the hummus, without much success. She had never had it before and was less than impressed with one of my favorite foods. She was a fan of cookies, and I was able to coax her to eat a chocolate chip oatmeal bar. I could understand how the events of the morning would affect her appetite, but I couldn’t have her getting sick.
At some point, Dad’s RAPID was closed and reopened, but they closed it for good shortly after 2:30 P.M. It was clear to me that his condition was still very fragile. His inability to look at me and respond had rattled me and I was having a difficult time staying strong for Mom.
At 2:55 P.M., Dad was transported to the x-ray department for a CT scan of his belly and head. As he was wheeled back into his room 25 minutes later, Leslie from physical therapy stopped by to tell us that a nephrologist had called her this morning to tell her that Dad would be dialyzed today. She had adjusted her schedule so that Dad would be her last patient, but after seeing him now, she said that they would try to see him tomorrow.
At 3:55 P.M., Dr. Hunt stopped by to give us an update on Dad’s condition. He said that Dad’s brain CT scan was normal and that his lactic acid levels were good. In short, all of Dad’s vital signs had significantly improved since this morning. Before he left the room, he reiterated that they would do everything necessary to keep his heart beating, but nothing to restart it. I didn’t think that this discussion was necessary, but the doctor said that he wanted to have this information in advance of any potential problems. He said that he would return when he had the results of the belly CT scan.
At 4:00 P.M., because Dad was not able to take his medications orally, Nakita administered his afternoon medications intravenously.
Dr. Hunt returned to let us know that the CT scan of his belly didn’t show anything bad; however, it did show that he was retaining fluid from his liver that was associated with his cirrhosis. The day after his surgery I had been told that his liver enzymes were elevated but I wasn’t aware that he had cirrhosis and asked about the long-term effect of this fluid. He said that at some point, the fluid would need to be removed; however, Dad had too much going on now to think about such a procedure at this time.
After all of the professionals had left the room, I started singing “She’ll Be Coming ‘Round the Mountain” to Dad. It was a song that Mom and I sang when Dad practiced walking at home. Every so often, he would mumble “driving six white horses” or “kill the red rooster.” He was almost unintelligible, but the nurses, Mom, and I could tell what he was saying. Sometimes he made a sound like a little laugh, but it wasn’t in response to anything that we could understand. The person that we loved seemed so very far away.
By 5:00 P.M., Mom was exhausted and wanted to go home. We had a simple dinner of sandwiches and baked beans, a meal that would not have sufficed for either one of our husbands. Just as we finished eating, there was a knock at the door. Our neighbor, Jim, had arrived bearing brisket and potato salad. Although the meal was a few minutes late for tonight’s dinner, we would eat it tomorrow.
About an hour after dinner I returned to the hospital so that I could be there during the shift change. Dad was sleeping, and while I was in his room, Nakita started his nighttime dosage of antibiotics and albumin. She said that she had just received the orders for new meds for Dad and she wanted to administer them before she left for the day. She added that his vital signs hadn’t changed since we had left for dinner.
I left the hospital at 7:15 P.M. This had been a depressing day, and I was nervous about the next 12 hours. On the way home, I stopped by HEB for some much-needed ice cream and wine.