Writing this blog soon after the previous one, but some may still be wading in deep water, and there are a few more points I want to add to help you avoid the sinkholes. Also, when I return from Israel, I will have 7 year old granddaughter Libby for the rest of the summer, so I may have trouble organizing my thoughts as well! When I met with the staff at The Piper, they said I was bringing up things they had not thought of before. So I hope this blog will help you as you care for a loved one or even yourself.
A couple of days after the incident I related in the last blog, I locked myself out of the house for the first time in my life! Fortunately my wonderful neighbor Mary was home and she called a locksmith. While we were sitting on her deck enjoying a cup of coffee while we waited for the locksmith, I could envision The Piper needing me, and calling on both of the phones that were locked in the house. When I got in the house about an hour later, yes, every phone was lit up with several messages. They were from The Piper, but also from daughter Valerie, since they had also called her when they couldn't reach me. Bob had gotten up from his wheelchair and had fallen and had 2 gashes on his head. It is their protocol and I think everyone else's protocol that when there is a head injury they are required to take the resident to the hospital to check for subdural hematoma. But Steve, the nurse I am on a first name basis with, told me he figured he knew what my wish would be since he was on when the other incident occurred, but he had to hear me say it. I totally understand this policy in this litigious society. But Valerie had asked what Bob was doing, and they said he was sitting there happily, so we both said, no, don't take him to the hospital.
Which brings me to something you need to be aware of. In our county, there is a wonderful ambulance service, Johnson County Medact, which was started by, and originally trained by, SMMC doctors. They have a form that you fill out and keep on your refrigerator called "file of life." If they are called to your home, and you are unresponsive, they look for that paper. It tells which hospital you would like to be taken to, and where your DNR papers are in your house. If you call 911 and ask for an ambulance, and it is not an emergency, please tell them it is for "transport only" if you do want to be taken to the hospital and have the DNR papers ready to give them. Otherwise they are required to resuscitate you in the ambulance if need be. Another service they provide is to help pick people up off the floor at home if they have fallen. It is better to call them to do it for you if you are caring for a loved one, so you don't hurt your back trying to pick them up, and also they can assess for injury before moving a person.
One more pitfall I am hearing about that I want to mention is that when you go to a hospital (even an emergency room), you go where your insurance covers your care. But there is a potential for "out of network" doctors to be working there. I have heard of it occurring in the ED, and also anesthesia departments, and of course you don't think to ask, especially when there is an emergency. If it happens to you, dispute the bill (which will be much higher of course). Another thing The Piper and I have talked about is how to identify the residents that are DNRs. And not all the residents in the memory care units are DNRs. They have talked about putting a sign in the room, but what happens if the arrest happens in the common areas? Now the list of DNRs is kept in a notebook, and all staff is to be oriented as to where it is. But I know in the heat of the moment, things get forgotten. All nurses say for them personally, it will be tattooed on their chest. But for me that is not good enough. Clothes aren't always removed when resuscitation is started, so I am going to have it tattooed on my forehead....Anyway, for Bob, I went to the hospital and got a bracelet for him. It has changed since I worked at the hospital and now is a different color and says DNR/AND. I didn't know what AND stands for, and neither did a lot of the hospital staff, I found out! But it stands for Allow Natural Death. Then I wish facilities had a form to fill out about what the family wants to be called for, or what they want their family member taken to the hospital for. The Piper does not have one, so I wrote one out myself and signed it. At first I just wrote to take him to the hospital for a fractured hip or other bone. Then I got to thinking of all the other scenarios that could cause severe pain--kidney stones (Bob has had 2 of them) and gall stones, etc, etc! So I added the words "Or anything causing severe pain." But now that is kind of a moot form, since Crossroads Hospice is on board. I cannot say enough good about hospice care. I know it has a negative connotation for some, as they think end of life has to be within a certain period of time after hospice care is implemented. But they reevaluate every 90 days, and Bob could potentially come off hospice care and then be readmitted. But with the steady decline that is common with dementia patients, they can requalify easily for the most part, and stay on hospice care for a longer period of time. Hospice is the first one now called for any need that Bob has, and they are coming out to see him frequently and are also helping with his physical care, as well as medical care. The staff from The Piper and Crossroads Hospice and I had a family meeting, so everything is in place to work together for Bob's very best care. They call me with a report after every visit.
I posted this to Facebook, but I will repeat it here for those of you not on Facebook (and because I really like it).
The journey of dementia is a journey like no other.
Dementia makes you realize that there's no time to waste.
Each moment is precious, a treasure in its own way.
We all know the last chapter in the book.
Dementia taught me that all any of us really has is today.
---Leanne Charmes, Memory People
Live life, and each moment, to the fullest!
Betty
Friday, May 26, 2017
Thursday, May 18, 2017
Just when you think it is smooth sailing, the storm appears very suddenly and it takes all your being to navigate. Before I begin this blog, I want to make it clear that what happened is no way the fault of the facility where Bob resides, The Piper. Also, I want to say that I have never before met a Nurse Practitioner, that I have seen professionally, or as a friend, that I didn't like. They are generally so competent and well prepared in their profession. Some doctors rely on their more current knowledge!
It was a gorgeous day, and I worked happily in the yard for 5 hours, not even coming in to get something to drink. When I came in, I was washing my hands and my mobile phone rang (I didn't have it out in the yard with me). All I can say is, GOD WAS WITH ME, and made me go in the house so I could answer that phone. It was the Nurse Practitioner that is employed by the doctor that serves The Piper. She told me that Bob had had a stroke and needed to go to the hospital immediately. I told her "wait a minute" and told her that this was the third time this very thing had happened, and it happens when Bob is absolutely worn out, and he just falls into a very deep sleep, and can't be aroused. She said, no he has had a stroke and we need to go to the hospital NOW. I asked what would be gained by going to the hospital, and she said it was too late in the window to do tPA, (the clot busting drug) but at the very least they would need to give him fluids and probably do a brain scan. I told her no, that I didn't want any extraordinary measures done, to please not to do anything till I got there, and I was on my way. She then said, "Because you are refusing care for him, you realize that you are saying it is OK to let him die. Is that what you are saying?" I thought to myself that it was a rather blunt way of putting it, but to her I said "Yes, that is what I am saying."
As I pulled into The Piper parking lot my phone rang again and it was her, asking if I was there yet. I told her I was just pulling in, and she said "I will meet you at the door." Of course that made me think he had already died. But when I ran in, she introduced herself, and instead of comforting me, started babbling on. I took a deep breath, assured myself that he wasn't indeed dead, and turned around and headed for his room with her following. When we got to the room, I looked at Bob and he was lying there, sleeping peacefully, but he didn't rouse when I shook his shoulder and called his name (no sternal rub....). She then informed me that he had a normal temperature that morning, but that it had spiked to 101 degrees and that she suspected meningitis. I asked her why she suspected that. She said because when she was called to assess Bob, he was slumped over. She had tried to raise his head to assess his pupils, and he had groaned like his neck was sore. I told her "Oh, please! Bob always wakes up from a nap with a krink in his neck, and has for years." She said no, she was sure he had meningitis, and she was going to send him to the hospital for a spinal tap as she had to protect the other population of The Piper. I told her she wasn't going to do any such thing. She then told me to call the family as it wasn't going to be long. I told her our daughter and family that live 4 hours away had gone camping and weren't available by wifi or cell phone service. She then said, "Well then. We need to call hospice for you so you will have some support." I told her to please call Crossroads or Ascend Hospice. She left, and I headed for the car to get the bag I had packed with a toothbrush, a snack, and a book. When I came back in, she was in the common area. I asked if she had gotten ahold of hospice, as I was going to put that on hold, and she said yes, she had called Encompass. I asked why she had called Encompass when I had told her the two I wanted, and she said, "Because they can get here faster." I told her to cancel that. I went back to the room, again touched Bob, and he responded. So I put a straw to his lips to give him a drink. He drank 2 glasses down without stopping. I went out and told her that he was responding and drinking water like he couldn't get enough of it. She asked "Did he choke?" I told her that he did not. I went back to the room and was met by the nurse from The Piper and the director of nurses from The Piper. I told them what had happened, and asked what would have been done had they not been able to get ahold of me. They said that they would have taken him to the hospital per her direction. And I am sure it would have been Providence Hospital as it is closer, and not to Shawnee Mission Health where all his records are, and where I had written all over the chart that SM was where he was to go. Again I told them that God was with me, as taking him to the hospital could have been disastrous. Bob drank 4 more 12 oz glasses of water and was responding well, so I went home late that evening after telling both nurses he was not to go to ANY hospital, and please let him sleep. Of course I couldn't sleep, so I got up early and took a shower, and was at The Piper before 0730. Here was Bob, sitting at the breakfast table, happily eating breakfast.
After this incident, I spoke with our wonderful family physician and asked if she could take over Bob's care at The Piper. She said certainly, but she would like to think about hospice care instead, and asked if she could send in a consult to Crossroads Hospice. I said of course, but would he qualify? She said he would qualify on at least 2 counts--loss of mobility and loss of weight. So Crossroads came to evaluate Bob on Tuesday. He has gone from using a cane in December, to a walker in April, to a wheelchair in May. His weight has gone from 183 in the doctor's office in September (too high) to about 175 in December (fighting weight) to 163 now (too low). So Crossroads accepted him immediately. I am so happy. He got a new bed, with a foam bolster so he can't get out of bed and fall, a new snazzy wheelchair, all incontinent supplies, and all for free. They will take over his entire physical (including bathing) care, and medical care. It couldn't be better to give me peace of mind while I am in Israel and Jordan in June. I still pay for him to stay at The Piper, and they also help care for him. I met with the hospice nurse yesterday, with the chaplain and social worker today, and we have a family meeting with Piper staff tomorrow to make sure everyone is one the same page. So I hope the boat is upright again! I am sorry this is so long, but I don't want anyone to experience what I went through. It came out of the blue so quickly I couldn't believe it was happening.
In closing--May the Lord walk beside you to comfort you.
May the Lord walk above you to watch over you.
May the Lord walk beside you to keep you safe.
May the Lord walk before you to show you the way.
I certainly believe He was with me in these last 2 weeks as the ship was floundering!
Betty
P.S. Because I can write better than I can talk, and because it was therapeutic for me, I wrote an email to the NP. I asked her to please listen to the family when they tell you something, as they know them much better than you do, and know their idiosyncrasies. I told her not everyone fit into a mold, and Bob is one of them. I asked her to please think before she jumped to conclusions. I asked her to please consider the clients she was serving--she was serving dementia patients, not ED patients. I asked her to please learn from this experience (she has only been employed 2 weeks but I don't know if she is a new grad. She is not young). On a side note, I was told by a Piper staff member that the very same thing happened to someone else a few days later and her response was "what are the family's wishes?" Yay!
It was a gorgeous day, and I worked happily in the yard for 5 hours, not even coming in to get something to drink. When I came in, I was washing my hands and my mobile phone rang (I didn't have it out in the yard with me). All I can say is, GOD WAS WITH ME, and made me go in the house so I could answer that phone. It was the Nurse Practitioner that is employed by the doctor that serves The Piper. She told me that Bob had had a stroke and needed to go to the hospital immediately. I told her "wait a minute" and told her that this was the third time this very thing had happened, and it happens when Bob is absolutely worn out, and he just falls into a very deep sleep, and can't be aroused. She said, no he has had a stroke and we need to go to the hospital NOW. I asked what would be gained by going to the hospital, and she said it was too late in the window to do tPA, (the clot busting drug) but at the very least they would need to give him fluids and probably do a brain scan. I told her no, that I didn't want any extraordinary measures done, to please not to do anything till I got there, and I was on my way. She then said, "Because you are refusing care for him, you realize that you are saying it is OK to let him die. Is that what you are saying?" I thought to myself that it was a rather blunt way of putting it, but to her I said "Yes, that is what I am saying."
As I pulled into The Piper parking lot my phone rang again and it was her, asking if I was there yet. I told her I was just pulling in, and she said "I will meet you at the door." Of course that made me think he had already died. But when I ran in, she introduced herself, and instead of comforting me, started babbling on. I took a deep breath, assured myself that he wasn't indeed dead, and turned around and headed for his room with her following. When we got to the room, I looked at Bob and he was lying there, sleeping peacefully, but he didn't rouse when I shook his shoulder and called his name (no sternal rub....). She then informed me that he had a normal temperature that morning, but that it had spiked to 101 degrees and that she suspected meningitis. I asked her why she suspected that. She said because when she was called to assess Bob, he was slumped over. She had tried to raise his head to assess his pupils, and he had groaned like his neck was sore. I told her "Oh, please! Bob always wakes up from a nap with a krink in his neck, and has for years." She said no, she was sure he had meningitis, and she was going to send him to the hospital for a spinal tap as she had to protect the other population of The Piper. I told her she wasn't going to do any such thing. She then told me to call the family as it wasn't going to be long. I told her our daughter and family that live 4 hours away had gone camping and weren't available by wifi or cell phone service. She then said, "Well then. We need to call hospice for you so you will have some support." I told her to please call Crossroads or Ascend Hospice. She left, and I headed for the car to get the bag I had packed with a toothbrush, a snack, and a book. When I came back in, she was in the common area. I asked if she had gotten ahold of hospice, as I was going to put that on hold, and she said yes, she had called Encompass. I asked why she had called Encompass when I had told her the two I wanted, and she said, "Because they can get here faster." I told her to cancel that. I went back to the room, again touched Bob, and he responded. So I put a straw to his lips to give him a drink. He drank 2 glasses down without stopping. I went out and told her that he was responding and drinking water like he couldn't get enough of it. She asked "Did he choke?" I told her that he did not. I went back to the room and was met by the nurse from The Piper and the director of nurses from The Piper. I told them what had happened, and asked what would have been done had they not been able to get ahold of me. They said that they would have taken him to the hospital per her direction. And I am sure it would have been Providence Hospital as it is closer, and not to Shawnee Mission Health where all his records are, and where I had written all over the chart that SM was where he was to go. Again I told them that God was with me, as taking him to the hospital could have been disastrous. Bob drank 4 more 12 oz glasses of water and was responding well, so I went home late that evening after telling both nurses he was not to go to ANY hospital, and please let him sleep. Of course I couldn't sleep, so I got up early and took a shower, and was at The Piper before 0730. Here was Bob, sitting at the breakfast table, happily eating breakfast.
After this incident, I spoke with our wonderful family physician and asked if she could take over Bob's care at The Piper. She said certainly, but she would like to think about hospice care instead, and asked if she could send in a consult to Crossroads Hospice. I said of course, but would he qualify? She said he would qualify on at least 2 counts--loss of mobility and loss of weight. So Crossroads came to evaluate Bob on Tuesday. He has gone from using a cane in December, to a walker in April, to a wheelchair in May. His weight has gone from 183 in the doctor's office in September (too high) to about 175 in December (fighting weight) to 163 now (too low). So Crossroads accepted him immediately. I am so happy. He got a new bed, with a foam bolster so he can't get out of bed and fall, a new snazzy wheelchair, all incontinent supplies, and all for free. They will take over his entire physical (including bathing) care, and medical care. It couldn't be better to give me peace of mind while I am in Israel and Jordan in June. I still pay for him to stay at The Piper, and they also help care for him. I met with the hospice nurse yesterday, with the chaplain and social worker today, and we have a family meeting with Piper staff tomorrow to make sure everyone is one the same page. So I hope the boat is upright again! I am sorry this is so long, but I don't want anyone to experience what I went through. It came out of the blue so quickly I couldn't believe it was happening.
In closing--May the Lord walk beside you to comfort you.
May the Lord walk above you to watch over you.
May the Lord walk beside you to keep you safe.
May the Lord walk before you to show you the way.
I certainly believe He was with me in these last 2 weeks as the ship was floundering!
Betty
P.S. Because I can write better than I can talk, and because it was therapeutic for me, I wrote an email to the NP. I asked her to please listen to the family when they tell you something, as they know them much better than you do, and know their idiosyncrasies. I told her not everyone fit into a mold, and Bob is one of them. I asked her to please think before she jumped to conclusions. I asked her to please consider the clients she was serving--she was serving dementia patients, not ED patients. I asked her to please learn from this experience (she has only been employed 2 weeks but I don't know if she is a new grad. She is not young). On a side note, I was told by a Piper staff member that the very same thing happened to someone else a few days later and her response was "what are the family's wishes?" Yay!
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