Tuesday, August 31, 2010

What a Difference Three Days Make

Mom, with a steady flow of intravenous fluids and now heavy duty antibiotics, is finally showing improvement.

• Her kidney function is at a 2.2, down from 4.8 so she officially is out of renal failure.

• Her white blood count is almost normal.

• Neurology consulted and Mom had a CT scan. She did not have a seizure. Instead, since her blood pressure was so low, her brain did not receive enough blood and her body went into “tremors.”

• Her blood pressure is normal.

• She still has diarrhea and this is the main concern. Infectious Diseases consulted and she is now on Vancomycin, the strongest antibiotic for this type of infection. If this doesn’t work, she would need surgery. But everyone is hopeful the antibiotic will kill the c.diff.

Mom is highly susceptible to dehydration and this is going to be the main concern going forward. Anyone with a parent or loved one in a nursing facility knows that keeping a resident/patient hydrated in that environment is a huge issue.

Before Mom went into the hospital for this third time, we had bought a portable non-breakable water bottle for her with a built in straw. She liked it and drank a bit more, but the bottle when full was too heavy and cumbersome to carry. When I’m with her at the home, I push fluids. The rest home does their best as well. But she just isn’t getting enough.

Any ideas or suggestions? I feel truly desperate about this. If we can’t keep her hydrated, chances of her being hospitalized again are almost guaranteed. And the bigger concern for me…does this mean changing her from a rest home to nursing home is on the horizon? I believe at the nursing home, they are able to administer IV fluids whereas at the rest home, they are not. But I’m not quite sure about this.

And it looks like taking her home is becoming less likely. But that is a blog for another day.

Saturday, August 28, 2010

Mom Continues to Worsen

Mom continues to worsen. She was coming along nicely at rehab until they took her off of the antibiotic for c.diff. The infection returned, she had a seizure, and we’ve added a UTI and possible pneumonia. She is back in the hospital. They are replacing her current antibiotic with a much stronger one and getting a doctor from infectious diseases to consult.

My leaving the hospital is dangerous for her - the seizure information did not travel with her from rehab, her history somehow shows a prior stroke when she never had one, and they have a DNR order on file when instead she should be full code. I’m afraid to even go down the hall to the bathroom.

I watch her now as her body twitches under the bright white hospital sheets. Her mouth is open and dry; her bald head sweaty and cold. And I think - this is what we’ve come to and in such a short time. Three month ago she was walking on her own, still giving me lip, delighting at my husband’s attention, downing her double cheeseburgers with gusto. And now her speech is slurred, she can barely move and I have to beg her to eat a banana.

I am reminded again how the one thing we can count on in life is change; that it is futile to cling to any one state. Even her current medical condition will be temporary – she will either get better or worse. So I strive to stay unattached, to float above what is happening; to report the facts with accuracy and keep everyone on track, but to not get swallowed with emotion. I’m doomed if I do. And if I’m doomed, Ma has no chance.

Friday, August 20, 2010

A Month of Hospital Stays

The last month has been a particularly trying one for me and Mom. She has had two hospital stays within a three week period and is now in a rehab facility to regain some of the strength she lost after being contained to her bed for so long.

To be brief:

• First hospital stay was due to infectious colitis (a virus or bacteria that attacks the colon and causes inflammation)

• Second hospital stay was for c.diff (Clostridium difficile, often called "C. diff," is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. Illness from C. diff most commonly affects older adults in hospitals or in long term care facilities and typically occurs after use of antibiotic medications.)

What was really shocking to me, and what I’d like to discuss here for those of you who have parents in and out of hospitals, was the mistake the hospitals made with mom’s medications. I am curious if anyone else has experienced the same.

My mother’s medication list and schedule were faxed over from the rest home to the first hospital where a worker transcribed the list onto the hospital’s form. The worker apparently didn’t read closely enough and transcribed “300 mgs of seroquel, ½ tablet (150 mgs), once in the evening” to “300 mgs of seroquel once per day.”

Luckily I was there when my mother was being given her morning meds and was able to clear up the issue before she was given the wrong dose at the wrong time. I chalked this up to a one chance in a thousand mistake until the same exact transcription error happened at the second hospital which is totally unaffiliated with the first!

Unfortunately I was not there to catch the error and Ma had been given two doses over two mornings. Her blood pressure dropped to below 85 on the top, she was extremely weak, slurring her words, and unable to sit up. The doctors became very concerned and rechecked her meds and noticed the error.

Needless to say, the first thing I did when going into the rehab center was personally check the med list with the nurse, pointing out the seroquel doses specifically and requesting to see the transcription when it was done.

It is so clear that my duties as mom’s caregiver did not end when she went into the rest home. In fact, I’ve had to become a more vigilant advocate of my mother’s health now that we are dealing with more organizations responsible for her care (rest home, hospitals, etc.).

Good news is she is on the road to recovery and we believe her rehab stay will only be about a week long. After that, she’ll return to the rest home and I’ll return to my consideration of taking her back home, which seems more unlikely after these hospital stays.