Tuesday, July 27, 2010

Directive -- my version

Ian said it well.  See his entry for 27 Jul 2010 titled DIRECTIVE:  Aging and Dementia

Our dad is a bit better today.  According to this afternoon's charge nurse, he is no longer coughing.  It occurs to me that I  have neglected to ask if he is running a fever.  He ate breakfast, but not lunch.  He is avoiding milk products, including Ensure.  I suspect that he feels they cause vomiting.  He refused the clam chowder today.  Hmmm -- milk based item.  But he's not showing any of the unhappy body emptying that went on while he was on the anti-biotic.

He's had two doses of medication from the nebulizer, but a nurse has to stand at his bedside until the treatment is finished.  Before said nurse gets to the hallway, he has the mask off his face.  Not a good response is the medication is still being dispensed.

Today was my volunteer day, followed by lunch with the Regent and the rest of the Historian Committee across the road at Oahu Country Club.  Lovely setting, excellent company, good lunch.

Give thanks for modern medicines and those who administer them.  Don't forget to pray.....

Saturday, July 24, 2010

Patient Advocacy

When someone you love is hospitalized, you want to believe they are getting the best care available.  But what is best?

The care facility where my father has been for the last 20 months is good.  It's not in the Cadillac class, but it is clean, never reeks of urine, and the staff is caring and responsive.  There is just not enough staff to go around.  That's where we, the family, make a difference.  We spend a longer period of time with "our" patient, even on short visits, than staff has time to give.  We notice different things.  We are more likely to pay attention to subtle changes.  

On a visit earlier this week, I comment to my dad that I didn't like the sound of his cough.

"I think I have pneumonia." he said.  "Hurts."  

I asked where it hurt.  He rubbed his hand across his lower chest, near the bottom of his rib cage.  

Part of me said, "He a dementia patient.  How aware is he, really, of his body?"  Another voice said, "He is notoriously unable to accurately describe what his body is telling him."  And in the other ear, "But what if he is right?"  So on my next pass by the nursing station, I asked if anyone had commented on the quality of his cough, or if he had complained to anyone else about chest pain.  

"It may be nothing."  I told the nurse on duty.  "But I'd rather be a nag than miss something important.":  

How did we want to proceed?  "Understanding that we want him to be comfortable, let diagnosis and treatment be the doctor's call."  

Yesterday, he was asleep when I arrived.  There was a wheelchair next to his walker at the foot of his bed.  His clothes and his gait belt were in the wheelchair.  The PM shift had just come on duty.  No one, it seemed, knew about the wheel chair.  Except the charge nurse just going off duty.  He had been in the dining room earlier and got very weak.  He may have vomited.  He was too unstable to walk back to bed.  Hence the wheelchair.  

By the way, his doctor ordered an x-ray.  He does have pneumonia.  It's mild.  He's on antibiotics and a diuretic.  Apparently the combination is making him very groggy.  He had vomited.  He is refusing food.  He does that when he doesn't feel well.  

It could have been a lot worse.  If I hadn't commented on his cough.  If he hadn't complained of pain.  If I hadn't reported my observation to the nursing staff.  If no one else took the time to listen.  

Give thanks for all those medical folk who provide the very best care they can, often under stressful conditions.   Give thanks that they are there to do what we, the family, cannot.  

Don't forget to pray ......  

Friday, July 2, 2010

Ahhhh! Back on line!

... finally, off the mobiles and onto a laptop.  So much one cannot do with just a mobile, but "just the mobile" is certainly better than nothing.

Granddaughters.  Here they are, tolerating the old folk (great-grandmother, grandmother, great-uncle and great-aunt ... and mom) after a day of beaches and other tourist-in-Honolulu things.  That's Katie on the left, the image of her maternal grandfather, who looks like his own mother.  Miriam, center, was part of the family for 10 mos., but headed home to Germany the day after their return from Honolulu.
Meghan, on the right, is the same bundle of energy she was a 3 --- go,go,go, then drop.   She has moments when she is her mother all over again.

Actually, both Katie and Meghan seem to tire more quickly than other teens I know, probably because of their unique physical issues.  Here they are by mid-afternoon Saturday after a morning hike to the top of Diamond Head, a mid-day tour of the Stadium Swap Meet, an hour with another pair of old folks (cousins, of course!) and finally a stop for Pineapple soft serve at the Dole  Plantation.  No wonder they were tired!

Their mother, Christie, has the long, dark braid down her back.  She has refused to cut her hair since she was about 7 and I promised her if she would not brush out the huge tangle at the back of her neck (thinly disguised by a surface layer of combed hair), I would cut her hair short.  She didn't, and wouldn't allow anyone else to help. ...  I thought she looked charming in a pixie cut.  She didn't.  'Nuf said.

Give thanks one more time for the teens, tweens, and younger folk in your life.

Give thanks for Chris and his companions as they head out for a tour in Afghanistan.  It's Chris's second in the Middle East.  Last time he stayed more or less in one place.   This time he'll "be on the road" much of the time.

What ever your feelings about the war, pray for the safety of those who are out there on the battle field.

Don't forget to pray....