Thursday, July 3, 2014

Back in the Hospital

Robert is on Day Three in the hospital.  We got here by way of the Emergency Room but it really has just been a matter of time before he had to come in.  After all, Robert was hospitalized three times last year for pneumonia and sepsis and had bronchitis four times this year but without any hospitalizations.

The way things have been going he really was due for a hospital visit.

He isn’t here for pneumonia (although he has a bad cough and is starting to run a fever).  We brought him in because he can’t walk. 

That’s unusual for him. 

Robert has had a steady decline in his health since I took over his care in 2009.  I mean, that’s one reason I took over his care: he was declining.  Falling more frequently, not making safe decisions, not recognizing when he had a raging infection – even allowing a homeless woman to live with him and his companion. 

Yeah, he was declining. 

Since I’ve taken over his care, he has needed to use a walker at all times, has recurring pneumonia, needs to be cleaned after using the restroom, has urinary incontinence and sometimes bowel incontinence. He has a swallow disorder so is on a modified diet, has constant congestion and a cough, has increased his seizures and is on a new anti-seizure medication which (it pains me to say this) has reduced his seizures. (It pains me to say that only because I’ve blamed his rapid decline this year on these new medications.)

More decline.

This year I have needed to help him get out of bed, use a shower chair so he didn’t fall and help him put on socks when dressing. He slept until noon on the weekends.

The decline really seemed to be speeding up.

Three weeks ago, he had increased difficulty moving his legs. I put him in a wheelchair for Day Program. A few days later, we had to start using it at home too.  Richard and I helped him transfer from the wheelchair to the toilet or shower chair or recliner or dinner table chair. Robert slept until noon on the weekends but also needed to stay home from Day Program a couple of days a week to sleep in.

Each day after that, more help was needed until he could not move his legs – particularly his right leg.  I could see him thinking: Leg – MOVE! But it wasn’t listening.  It stayed firmly planted wherever he put it.  Transferring him became a real struggle. He slept until 3:00 in the afternoon and ate half of what he used to.

Now that’s a real problem!

His neurologist settled on a new diagnosis: Cervical Disc Disease with Myelopathy.

Labs were run and an MRI was scheduled to confirm this new theory.  Unfortunately, Robert had a great deal of back pain while lying down for the test and couldn’t stay still.

An MRI with sedation was ordered but not yet scheduled and neurology cautioned we should go to the ER if he continued to decline. 

Robert slept all day at Day Program on Monday, even falling asleep in mid-sentence and during lunch.  I mean, he didn’t even eat his pudding!

By Monday night, he could not move from the wheelchair to the bed without Richard and me lifting him.

Okay, things are declining faster than I can even keep up. 

I let Robert sleep in on Tuesday but debated about taking him in to the ER.  I called neurology who agreed he should be taken to the hospital.  They thought he could get a CT scan of his neck done and then the MRI with sedation if needed.  It was Tuesday afternoon so I thought it would be a great time to take him to the ER. I got him cleaned up since he hadn’t been out of bed since the previous night and called the paramedics.  There was no way Richard or I could get him in or out of the car so the ambulance was the best solution.

Robert was agreeable about going to the hospital and our local fire department greeted us like old friends since we hadn’t seen them since last December. It is really nice when people remember us and I love our fire department but I really wish we didn’t have to have them on speed dial.

Can’t we just know them because we brought them cookies when the kids were little?   

Robert was loaded into the ambulance and was whisked off to the hospital.  I gathered my essentials (phone charger, note pad, logs for seizures and vitals and other symptoms) and kissed Richard and the dogs goodbye.  Richard planned to meet us in the ER later in the day. 

My optimism about a quick and quiet visit to the ER was squelched before I even made it to the emergency department check-in desk. Visitors and patients waiting to be seen were overflowing into the hallway and parking lot. I gave the front desk Robert’s name and was given a visitor pass with his room number on it. 

Which was a hallway. 

Robert was on a gurney hooked up to an EKG machine. The other patient in this hallway asked a passing nurse for crackers and juice. Goodness – how long has he been here? I wonder if a change of address form is going to become necessary.

We were in for a long afternoon. 

Next post: Passing Time in the ER

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