:comfort: to you both.

*hug*

Aw crap Wolf. So sorry. Anything encouraging today?

Yesterday morning I was awakened at 7am by a doctor wanting to get consent for a blood transfusion.

No problem. All of this stuff has been discussed and I know what the right answers are, even if I can't find where she squirrelled away the living will paperwork.

Why did I have to give consent? She was given a heavy-duty painkiller yesterday and she was totally zonked. Not capable of making her own decisions.

Unfortunately, when she gets meds that "good," she tends not to react well to them. She spent the rest of the day pretty much asleep, and later on was confused. Luckily I was there when they came in to do an echocardiogram ... she fought with the echo tech, and I had to help hold her.

This morning a nurse called to inform me that there would be a call from interventional radiology, for consent for a PICC line. She's had one of these before. Why does she need it now? Well, on the one hand, her veins are quite fragile, and, I'm told difficult to stick. On the other, she became angrily confused overnight, apparently wanted to leave the hospital, and pulled her IVs. All of them. She may have had as many as three running.

She is now restrained.

On the upside, the cardiologist thinks she clinically looks "better."

siswolf arrived yesterday evening from Rhode Island.

hang in there.

Hugs for wolf and prayers for momwolf.

momwolf remains confused, but the agitation seems to have abated somewhat. She hasn't ripped her (full) colostomy bag off in at least two days.

Yesterday I had a scary moment. It turned out to be a false alarm (for momwolf), but was quite devastating for someone else's family. As I walked onto the ICU floor I heard an overhead page go out "CODE BLUE, ICU." These are words that you don't want to hear as you're going to visit a loved on on the ICU (Interestingly, however, it was the only time that I heard a code called in the whole time I was there visiting). All of sudden people in scrubs blasted out of the unmarked doors along the hallway I was in and started running toward the ICU. As they crowded into the unit, I peeked through the door and made sure that the flurry of activity was not going on anywhere near momwolf's room. It wasn't.

A nursing student saw me hovering around the door and asked who I was there for. I told her I was coming for momwolf, but recognized that they were all quite busy and I was perfectly fine staying out of their way. She told me to come on in. As I was doing so, another family saw where the action was, and knew it was their beloved Pop-Pop. I truly felt for them, as I had been dreading that particular scenario. From a kind of clinical coolness standpoint, though ... in this unit, when there's an irregular rhythm ALL of the cardiac monitors in the rooms get a pop-up window showing all the telemetry details. Now, I can't read an ekg to save my life, except to be able to say things like "Wow, that looks really irregular. That can't be good." Trust me, Pop-Pop wasn't good, but I think I did see when they shocked him and his heart struggled to regain something approaching a regular rhythm. It did, for a bit. I didn't see the final outcome, although his room was empty later. Whether he died or went to CCU or surgery or cath, I really don't know.

So, momwolf was physically doing better. She had good color and all that, but she was out there. I stayed for a couple hours, more to reassure her than anything. She knows her own name and recognizes me, but still doesn't quite grasp that she is in the hospital.

Today when I went to the ICU to visit she was sitting up in bed and feeding herself. This is major, since yesterday I was spooning applesauce into her mouth. Her nurse told me that she had eaten all of her breakfast as well. I also learned that her foley catheter was removed.

She was deemed stable enough that she "graduated." This means that she was moved to the telemetry unit since she is no longer sick enough for the ICU. The service isn't going to be as personal there as nurse to patient ratios are higher on regular units.

I hope that she doesn't try to escape. I doubt that she was get far, but that doesn't mean she won't try. I have always told her that I will only come to take her home when the doctor says she's good to go. I reinforce this by refusing to bring clothes until she is ready for discharge. If she tries to leave against medical advice, she knows has to catch the bus wearing a gown that flaps open at the back and a pair of footies.

siswolf returned to RI yesterday (Saturday), since momwolf seemed to be more stable. This is all very tough on her. Okay, on both of us, but I can deal with momwolf being in soft restraints a lot better. siswolf can't bear to see stuff like that. She did fine with the wound care stuff after the 2006 surgery, but momwolf being completely insane is outside of her experience.

While leaving the hospital today I saw one of my patients sitting across the street on a bench, talking loudly to a bush. She likes the coffee in the hospital cafeteria. It's a regular part of her route. My ambulance has actually picked her up by waiting for her there when more than a week goes by with an open warrant on her. Not sure if I should warn work that they will be seeing her any time now.

This is better than what happened a couple of days ago, also out in front of the hospital ... "Hi, remember me? I'm the one who always comes in psychotic and off my meds!" (*sorry, that doesn't narrow it down much*)

Sounds better, glad to hear it.

Thinking of you both, wolf!

More encounters with my patients. They have a route, you see, which includes getting some coffee and snacks at the hospital cafeteria. The community mental health center they all go to is just down the street. These patients were pretty nice, and I got a cheery "Hello, Miss!" from them.

momwolf remains medically stable(ish), not sure if she's still confused. She slept most of yesterday, some of her conversation was goal directed, but it was pretty limited, short answers and all. She had an MRI of her noggin done, and the results are "suggestive of a stroke," however, she's not showing any physical signs ... no weakness, paralysis, etc.

A kidney doctor tells me her kidney function is even less than the first guy said, but she's holding on. He said things like "quality of life" a lot. The plan remains managing her medically with no extreme interventions, as they are of limited value at this point.

Getting old sucks. Watching someone else deteriorate in front of you is extremely stressful. I watched my MIL and FIL pass and while it is inevitable its never easy. Sending you a cyber {{{{{{{{hug}}}}}}} to let you know someone is listening.

Oh wolf it's a bummer when you have to watch your mother decline. I'm doing the same right now - it's just no fun at all :(.

I don't know if your clinical/medical knowledge makes it easier or harder to deal/cope? Sorry to feel you going through this.
Queen Mother came to visit for a long weekend - first time I really noticed her aging. Guess I've been in denial. I don't like it. Already lost my daddy a couple of years ago (unexpectedly) - not ready to lose mom too.

In all honesty, both.

It would possibly be easier if I weren't effectively the only one doing it. My sister lives 5 hours drive away, and also isn't really good at dealing with this kind of thing.

There is a good possibility, that if the Neurologist clears her, momwolf may be moved to a nursing home tomorrow, mainly for physical rehab. The fact that she did not argue with the case manager when this was discussed with her lets me know that she is not yet firing on all cylinders.

I ran into my ambulance crew today. They were picking up the lady who screams all the time two doors down from momwolf. The Chief was one of the two EMTs and he offered to do any transport that's necessary. Hopefully I will be able to get that info to the case manager in time.

It's always good to have friends. Best wishes to you and your mother, Wolf.

momwolf is spending more of the day awake, but her thinking is still not clear. She is able to hold a conversation, but I catch her confabulating (this is a professional way of saying "she makes things up to fill in gaps in her memory she doesn't understand"). The docs are definitely confirming a left frontal-parietal stroke, however, it seems relatively minor. She is not showing any problems with visual-spatial perception, and she is able to add numbers together without difficulty (apparently that's where math hangs out). They were hoping to discharge her to a nursing home today, but a last minute CT scan got in the way of the plans. The neurologist wanted to make sure that she is not bleeding into her brain, since one of the meds they want to put her on for discharge is a blood thinner. That's the kind of trade-off I'm having to decide on ... a blood thinner could increase the risk of another stroke, however, it can also reduce it, because thinner blood will get through her pretty much occluded heart vessels and improve function of her heart.

A clot or a bleed? A clot or a bleed??

ach this is a tough time for you, having to mother your mom and make the best decisions possible when it's not your own body. It's like a "Welcome to parenthood", except it's unlikely your charge will tale care of herself 18 years down the line. I wish for clearcut decisions and easy transitions ahead.

I'm sorry its been so difficult wolf. I'm having a hard time wrapping my head around my Dads situation as well. What parts are really them? Good luck lady and like monster said clearcut choices.

momwolf is out of the hospital, but not yet home.

After several days of on-again, off-again discharge plans, she finally made it out the door of the hospital, and is now in the nursing home, but not terribly happy about it. Hopefully she will put up with it long enough to get enough strength back to manage on her own at home. Dr. Doom even stuck his head in the door to wish us a cheery goodbye. He had said that he hadn't expected her to make it through the first three days in the hospital, much less be able to be discharged. Don't get me wrong, I really liked Dr. Doom. I just liked having momwolf prove him wrong better!

The care manager at the hospital refused to take my very good suggestion that I had an ambulance that would take momwolf to the nursing home as a professional courtesy (i.e., FREE), and would be far more comforting to her as she knows quite a few of my crew members, and even the ones she doesn't know, she would trust on my say-so.

A different care manager finished momwolf's discharge and as she was talking to us about the instructions she said, "Don't I know you from somewhere?" I suggested it might have been because of the nuthouse, and she said, "No, that's not it ... did you go to West Chester?" Yep. We had lived on the same floor of the dorm ... 29 years ago.

So, momwolf gets to the nursing home without incident, and we're getting her settled into her room, when I discover that there's some stuff in the closet and drawers. I mentioned this to the Admissions Director, just to ask to have environmental services come in and decon the room, etc. Next thing I know they are pushing momwolf, bed an all, down the hallway to a private room. Man, I love the way they apologize!

Hopefully she'll really work at the physical therapy stuff, because she's already complaining. I may have to bribe her with food from Panera.

That's a big hurdle cleared. Hope the progress is as linear from here on. :thumb:

Good to hear the momwolf is heading in the right direction! Sending you strength for the next bit (I know how hard it can be to keep a mum in a place like that when she wants to leave ...!).

I always stop by this thread to keep up, Wolf.
As ever, love and healing thoughts to you and yours.

Oh that is so good to hear!

That's great news. I hope she settles in alright. My mom has been under the weather for months now, but so far it's not serious enough for hospitalization or nursing home.

Good news, Wolf. Momwolf is fortunate to have such a caring daughter. Bless you.

momwolf had her assessment by PT today. She will also be receiving OT (i think this means they have her fold laundry and make tea for therapeutic reasons) and will be working with a speech therapist. She doesn't have any deficits in her speech, but the speech therapist also works with cognitive skills.

momwolf promises to work very hard, because she wants out of the nursing home ASAP.

Her across the hall roommate is brain injured. He is very friendly, and often sits in his wheelchair in his doorway, giving cheery greetings to everyone who walks by. He also sings. Loudly. All day.

He told me that he was hit by a car when he was a child. He lived with his parents for his whole life, until they passed away. He was unable to sustain his housing on his own and became homeless. Somehow the homeless shelter got him into the nursing home for long-term care. He said he appreciated what was done for him very much, and that he is quite comfortable and well-taken care of.

Did I mention he sings?

I suspect that his brain injury probably occurred sometime in the 1970s, because that's his preferred musical era. He's either about my age or just a little younger.

He sang the Bobby Sherman hit, "Julie, Julie, Julie do you love me" and then segued into "Go Away, Little Girl." Actually, his rendition of "Go Away, Little Girl" bordered on being creepy.

So far momwolf is tolerating him. She thinks I shouldn't talk to him quite so much, though.

Tonight I bribed myself with some Panera. momwolf just wanted a soda. Big :thumbsup: to the Napa Almond Chicken Sandwich.

Perhaps your mom could devise some harmonies for the singing guy?

She is trained as a classical vocalist, and sang with a semi-pro chorale group prior to her skull fracture, so that is a possibility.

There you go! Making music, so they say, is good for all sorts of cognitive activities etc ...

How's your Mum today Wolf?

All Sunday momwolf was quite irritable and demanding. I suspect that the problem had it's root in there being physical therapy in the morning. After her initial assessment on Saturday, she was told that she would next go down on Monday.

Across the hall dude, he made a funny that was quite clever.

He's a big guy, probably 400-500 pounds. He asked a passing staff member for some more of the entree. He's always gaming staff for extra portions. Now, he didn't just ask for more food. He said, "Is there a pastability that I can have some more spaghetti?"

I will always remember momwolf's voice as the Voice of God on our school's PA system, paging people. I knew she was voice-trained!

It's Columbus Day Weekend, so guess what that means ...

I haven't had time to post much since October 1st, because that's when momwolf came home.

It was a little unexpected. One day she was doing PT in the nursing home, and next day I get a phone call announcing her readiness for discharge.

Of course they were wrong. Okay, maybe not as wrong as three years ago when I had to call an ambulance to pick her up off the front walk because she could only walk 10 feet or so from the car, but let's just say wrong-ish.

Actually the first week was pretty good. We were set up for home services (nurse to monitor health condition and PT), and already had all the homecare equipment from before.

momwolf actually liked the nurse and the PT. This does not always happen.

So, things are moving along, siswolf went home, and I'm off work again.

Except for some irritability on momwolf's part (mainly demands for things like some mmm mmm good Campbell's Soup, which is far to high in sodium for someone with a tendency toward CHF), things had been going fairly well.

Except for this week.

I probably should have not taken no for an answer two days ago when I knew she was starting to go into acute CHF. I tried asking momwolf to go to the hospital, but no go.

There were some very big problems with the blood thinner that she was on, her lab values came back at a very scary level, and so the PCP discontinued the coumadin until things settled down.

Okay, fine.

Yesterday the nurse thought momwolf might be heading into failure ... except that she was probably already there. Her feet were swollen, but about at what the nurse considered near to baseline.

Apparently momwolf's body has decided to hide fluid elsewhere ... upper legs, arms, and other places that the nurse wouldn't ordinarily check.

Frankly, I had already decided that I was going to issue an ultimatum today.

momwolf beat me to it. She started screaming for me at 0500 hrs today.

I took one look at her and said, "I am calling an ambulance."

Okay, it was more than one look, and also involved getting a set of vital signs, which actually weren't as bad as I'd expected. Bad for a normal person, but not so bad for momwolf, you see.

Ambulance shows up, joy of joys, one of my friends is the medic.

Better yet, my friend the ER doc was working this morning, just finishing up his shift, so we got premiere service, including fairly quick admission onto the cardiac care unit, which momwolf didn't actually need, but they were out of beds on cardiac telemetry.

Dr. Doom met with us in the ER, and to help expedite the admission, pushed the litter up to the CCU himself. Go Dr. Doom!

You'd think that would be enough for one day, right?

momwolf is firmly ensconced in a bed on the CCU. I went home to grab something to eat and bring some of what she considers essentials back to the hospital (box of real, soft, name-brand tissues, instead of the 3"x3" sandpaper the hospital hands out in itty bitty boxes).

I go back for evening visiting. momwolf is petulant, and a bit scared. I spent a lot of time reassuring her, and a bit of time chatting with one of the nurses who remembered her from last month.

Then I heard screaming.

A woman on the other side of the unit was shouting. From what I gathered from her ranting and from the nurses' conversation, she was demanding to leave, and, more importantly, she was demanding to leave with an IV still in her arm.

The situation quickly escalated with her refusing to allow the nurses to touch her, and made it's way up to her assaulting two nurses. Then the nurses started screaming and calling security.

Now, as I was sitting there, I was thinking, "You know, I could resolve this in about three minutes."

A nurse came in to reassure momwolf and I that everything was safe and under control.

I explained that I was used to such situations, and was quite interested in seeing how someone else dealt with such things.

Security failed to handle the situation.

And the cops got called.

As things were heating up I repositioned myself so that I was in the doorway of momwolf's room, both to have a better view (shame you can't have a microwave on a cardiac unit, I would have liked some popcorn), and to be in position to repel any attempts to get into another patient's room to escape the evil staff who wouldn't let a (my assumption based on what I saw and heard the patient saying) junkie go home with a nice IV line to shoot up through.

She assaulted the cop too.

Another big surprise there. I was pretty sure he was going to taser her. Saw him reach for it, but he changed his mind. There are some officers in his department who wouldn't have thought twice about it.

Heck, if you're going to get tasered, on the CCU is probably about the best place for it.

I did not get the opportunity to tell the cop "Don't you dare try to take her to the nuthouse!" I really wanted to, though.

So, anyway, that's how I got an extra half-hour of visiting past visiting hours tonight.

Tucked momwolf in, left an origami crane or two or three behind in various parts of the hospital (two in the ER, one in CCU). The cranes are something that I do to burn some nervous energy rather than pacing. Apparently momwolf would probably rather I pace, because she got upset at me for making the cranes today. Getting upset at me seems to take her mind of the direness of her own situation, I think.

Oh, one of the multiple calls I got today was from a very cheery nurse who said she was from Hospice, which is being offered because momwolf has essentially decided that she won't get any invasive tests, doesn't want CPR, defibrillation, or intubation, but is okay with medical management of her condition. The Hospice nurse said she and momwolf had a great conversation, in which the nurse never said the "D" word (yes, she really called it that), but spoke in glowing terms of comfort, and learning more energy conserving ways of doing things, etc. etc. She didn't think momwolf associated Hospice Care with what we all know hospice care is.

Yeah, right.

When I walked in tonight what's the first thing momwolf tells me?

"The Death Nurse was here to see me today."

She's still sharp. She might not be entirely clear on what she had for breakfast this morning, but she's not ready for the nursing home with the anti-escape ankle bracelet monitors yet.

Hugs to you wolf. It's hard being us.

momwolf remains in the hospital tonight, but there is a good chance she will be discharged tomorrow.

Most of the time, this is happy, encouraging news.

Not today.

Dr. Doom called me early this morning, explaining that they had done everything they could, and that if momwolf were younger and stronger, there were a large assortment of things they could attempt, including cardiac cathertization, and probably re-do her cardiac bypass.

As she is on the cusp of being 80 (her birthday is October 23) and she is medically fragile, these really aren't possibilities.

So, her discharge home will be into hospice.

I've been given a very nice brochure and a copy of the Hospice and Palliative Care Manual to look over.

I'm not retaining much of what's in there, although the words "dignity" and "compassion" and "quality" get used quite often.

momwolf, siswolf, and I have been doing a lot of crying.

I'm going to have to stop typing now, before I electrocute myself. Tears are salty and a good conductor.

I'm so very sorry, wolf. It's harder than fuck to look at your parent and know there is nothing that can be done to save them.

Hugs.

I'm sorry, wolf. :(

I know the alternative, but I'm still sorry this decline is dragging on for her... for you and your sister, too. :(

Hospice is the next step for my Mom, too... she's 81... I'm not looking forward to it.

Oh wolf, I am so sorry. It is so awful to be powerless to help your mother - the one person who was once able to make it all right for you.
You, your sister and your mother are in my thoughts (now I must stop typing for the same reason as you).

Hugs from the capnhowdy camp to the Wolf family. FWIW, Hospice is a great organization. They were very helpful and supportive during my wife's demise. I shudder at the thought of what it would have been like without them.

Oh Wolf. I'm so sorry to hear that. My prayers continue to be with you and your family during this most difficult time. Hugs and healing thoughts from all of us.

I'm so sorry wolf. You and your family are in my thoughts.

Aw, I'm sorry wolf...

Wolf, call if you need anything at all. I'm here.

sorry about momwolf!

sorry, wolf :(

Very sorry Wolf.

The hospice people I met are very nice. They helped a lot when my father-in-law passed away.

So sorry to hear that, wolf.

I'm sorry things have turned this way. Everyone in Grifftopia is pulling for you. I've been in your shoes but it doesn't give me any words to help. g

*Shakes head* that's so sad Wolf. So sorry you're all going through this.

momwolf is happier to be home. She called me her last night in the hospital demanding, "Get me out of this Hellhole!"

Frankly, it's the nicest of the possible nearby Hellholes.

So, she's here, the hospice nurse manager met with us yesterday.

Sometimes I wonder if momwolf really understands the implications of hospice, then she'll say something that seems to indicate that she gets it. She said last night that she didn't want to talk about it, hopefully we'll get the chance to do so today. Right now she's dozing in her chair.

Dammit. I need to remember to bring a box of tissues into my bedroom. I don't usually need them here.

Thanks, everyone, for your support.

I can't say at this point that there are good days and bad days for momwolf. It's more like a good bit of time here, a bad bit there.

I try not to lose patience with momwolf, but sometimes it's hard when you discover all of a sudden that you're wading through a lake of urine because she missed the toilet.

So far we've met with the nurse, physical therapist, care aide, and the chaplain.

momwolf's breathing continues to worsen, she's at 2.5 Liters of Oxygen now, but seems fairly comfortable at that level. So far she's resistant to trying any of the medications in the "emergency kit," although the nurse has suggested that one or two of them will help her breathing and will help her sleep. She has been waking me up at 3-4am the last two nights.

Kind of like being at work, isn't it?

Place a strategic pair of wellington boots by the bathroom door?
Oh wolf, hugs to you!

Hang in there, Wolf.

Thinking of you and momwolf.

I am trying to figure out where the "dignity" is in this process. momwolf keeps wondering where the "comfort" is ... she's not feeling comfortable, lately.

One of the things that makes this hard is that I'm all about doing stuff, fighting to the end and all that.

Well, we made it through momwolf's birthday.

siswolf had to return home today as there are some things she must do at the office, but she promises to return on Monday.

I am hoping that momwolf will stick around until at least then, because I do not want to be alone for this. I understand though, that when the time comes, it will come, regardless of what I want.

momwolf was up and out in the living room most of yesterday, but it was a challenge getting her back to bed. She slept through most of the day, but was rousable, did have some of the Chinese food we brought in for dinner and her Lemon Cake.

The Hospice Nurse came in the afternoon, wished momwolf a Happy Birthday, and brought her a birthday card. She thought that momwolf's condition was "an advance of the disease process" and "it shouldn't be much longer."

siswolf talked to her in private and apparently the nurse thinks she'll at least make it through the weekend, based on her experience.

Today momwolf has remained in bed. She wakes intermittently, tells me she loves me and siswolf, and has decided that her nightgown was uncomfortable, and so, she is nearly naked. She has at least for the time being agreed to keep a sheet on.

I've given her some of the magic liquid medicine (it's morphine) in hopes that it will make her more comfortable.

Interestingly, siswolf is turning out to be the more task focused and practical one ... she looked up funeral homes online and has written down their contact information.

Supposedly I won't have to make the initial contacts, I just have to give the information to the Hospice staff and they make the calls.

Wolf, every time I see you've posted in this thread my heart gives a lurch. You and your family are in my thoughts.