Tuesday, October 21, 2008
OT: The Hospital -- parte dos
So she came home on Thursday evening, weaker than anything, with an N/G feeding tube down her nose and a Foley catheter to boot. She'd had a "cardiac incident" the night before that required heroic intervention -- oh, just call it a heart attck, but they didn't want to do that given that her discharge was already set up and scheduled, so "incident" it was, and what they did worked. Not a problem.
We carried her into the house on a sheet; she was too weak to stand, let alone walk. She'd been in the hospital two weeks, during which time she was never allowed to even sit up, let alone get out of bed. She wasn't allowed to eat or drink (the infamous "NPO") and for five days, she had no nutrition at all. Finally, they started feeding her through the tube, said she had to have a PEG in her stomach to feed her -- she couldn't swallow, you know. She'd been tested.
When it was pointed out that she'd been eating and drinking normally at home before she was hospitalized, and that she'd been eating and drinking normally the first two days in the hospital (before the angiogram and the stents), they were sore amazed. "It cannot be," they insisted. "She's so thin. She's obviously not been eating or drinking for months."
Sigh. So they tested her again. She didn't swallow the ice fast enough. FAIL! The pudding went down fine. FAIL! But the juice... she choked -- actually coughed briefly as it was going down. EPIC FAIL! "She can't swallow, it's proved now, shut up. We know what we are doing."
No. Actually, you don't. She hadn't had anything in her mouth for days. It really takes some gall to claim she's not doing it right when she has to remember what "it" is. Damn. She's 88 years old. You try to remember everything when you're 88.
But "gall" and hospitals are close acquaintences I've been told. And fifteen/twenty years ago she had her gall bladder out when they did the appendectomy. Made perfect sense.
Thin? Well, they weighed her in her hospital bed, 53.5kg, pretty darned normal for a woman of her age and size. Obviously starving to death, right? In fact she'd lost about 20 lbs of fluid build up caused by congestive heart failure (which is the source of most of her current health problems.) Her limbs are atrophied due to lack of exercise, cussedness and old age, but she's got plenty of meat on her torso. Somehow they missed that.
So she came home, too weak to even hold her head up, and we got her in bed, as comfortable as possible, and she said, "I'm home?" We said, "Yep, you sure are!" And the biggest smile you ever saw came across her face, just pure joy, and we figured she'd be... OK.
She had a doctor's appointment at the doctor's office (her primary physician rather than the hospital resident) the next day, and we went through the same routine to get her to the car and out to the clinic. Her doctor, who's been treating her for more than twenty years, took a brief assessment, looked at the voluminous paperwork in front of her, and asked: "Has she had anything to eat or drink since she's been home?" We said, "Some sips of juice. No problem." The doctor asked her, "Do you want to keep that tube in your nose?" She said, "No, it hurts." "OK," said the doctor, "it's coming out. It's gonna be uncomfortable, but I'm taking it out." Pull-pull-pull, out it comes. Doctor asked her, "Do you want a tube in your stomach for feeding you?" She said, "Do I have to?" Doctor said, "You don't have to do anything you don't want to." She said, "Then no, no tubes at all."
OK. It's set then.
We all discussed what's going to happen now. No more hospitalization unless she breaks her hip or something. Hospice care at home, she eats and drinks as well as she can, no more heroic interventions if she gets a heart attack, stroke, or pneumonia. She gets well or she doesn't as the case may be, she takes her meds, the nurses come to her, the doctor makes house calls, and we take it a day at a time.
She got 100% better right that minute. "Thank you!" she said. "I love my doctor!" Well. We all cried. It was just amazing.
We went back home. She was still very weak, but she obviously had more spirit and energy than before, big, big smile the whole way.
Nurses came, we explained the new routine, she was happy, they checked her out, treating her for this and that, change to hospice care, no tube feeding.
She's been home since the 16th, eating and drinking like a "human being" like she says, taking her meds, she even stood up, with help, yesterday. "I'm determined to walk again," she said. Yes.
The transformation from the hospital -- where she was getting progressively worse and they wanted to keep her for another 3-5 weeks -- to home, where she is progressively getting better every day, and she is so much happier, is startling.
That's the story.