Post by rockefeller on Mar 1, 2021 21:20:04 GMT
Symptoms of Ms. Rocks' congestive heart failure began well before Doctor Google diagnosed the condition, directing us to emergency and her subsequent admission into the new local hospital. Eight nicotine-free days later she was released to carry her own suitcase down a long hallway and flight of stairs. A week later a message on our answering machine said it was urgent she contact some local cardiologist whose name I forget. At her appointment his receptionist explained they'd been having trouble with their phones, hence the delay. Elevators were out in the new building and so heart patients got to climb two flights of stairs to his offices. He poked her calf with his finger (which we've since come to realize is the standard cardiologist medical examination), told her she needed a double valve replacement (mitral and tricuspid), rush-referred her to another hospital with a cardiac unit for surgery, then threw in a Holter monitor. Because he'd neglected to schedule his technician to install it at the time of the appointment, we returned the following Monday for this cumbersome device that prevented bathing or comfortable sleep for three days, that informed no diagnoses or decisions, and that I'd bet my good eye no one ever even checked the data from.
A week later the cardiac hospital scheduled an echocardiogram for the following Wednesday. As per printed instructions, we arrived 10 minutes early and phoned. Contrary to printed instructions, Ms. Rocks was not escorted to diagnostics, but just screened for covid, and got lost. She did eventually get tested, but because the hospital had no chart or history she was treated as a walk-in and admitted utterly unprepared into emergency there by a perplexed and (she said) aggressive doctor. She called me to, instead of take her home, come back and help her answer admission questions. In hindsight, this was the first indication of what became pathological confusion.
Because of covid, patients may only have one visitor for one hour a week, though we talked on the phone every day. On her fourth day I was unable to reach her through the ward's main desk in four tries, but that night got a call at home from a nurse Emma, who said they'd been trying to contact me all day to explain there'd been an "incident" the night before which had led to Ms. Rocks being restrained by security and given Haldol. Reportedly, she'd secluded herself in the bathroom and, when nursing staff entered, thrown water from the toilet on them. Bruises from the ankle straps are still visible. A gerontologist called shortly after (about 8PM) to get her mental history and recommend the antipsychotic Risperdal. But it was days later that a niece who works as a kinesiologist first used the term "delirium" to describe her condition. Doctor Google quickly confirmed this no-brainer of a diagnosis, for which restraints are ill advised. Ms. Rocks called after the gerontologist sounding confused, paranoid, terrified, and begging to be picked up and taken home. I somehow convinced her to wait overnight.
Next morning there was a morbidly obese Indian security girl sitting outside her door, whom I told could leave if she liked since I'd be there all day. Shortly after, three beefy Kevlar-wearing men in similar police-like uniforms appeared. I was in the private room and neither of us were wearing masks. One of the Indians (95 percent of this security company are East Indian, it's probably some sort of immigration portal) got in my face and ordered me to put one on. I complied, then said I needed him to back 6 feet off. He (having not been in a grocery store in the past year) replied that this wasn't necessary as we both now wore masks. I asked to speak to his supervisor, who it turned out was right beside him and even stupider and ruder, on an even more serious power trip, and who got my own heart rate up to 120 before parting ways. Nursing staff were all polite, though, and asked me to come back every day, all day if I could, to help her wash and stay grounded (she'd acquired some ugly heat rashes). By Valentine's Day, Ms. Rocks was adamant I take her out for a few hours to see family and friends. Nursing said a doctor would have to okay this, and we could ask when he stopped by on his rounds. Six (long) hours later, Dr. Whoeverthefuck said "No." We would have to self discharge, and the room would not be held. So we signed out, packed, and nursing staff (who struck me as supportive) wheelchaired her and her belongings (including the dozen roses I'd brought) down to the main entrance. Free at last.
We drove back to her restaurant where about a dozen family members were waiting. Happy but addled, she had a good visit. Lots of questions and advice. (I was still thinking Alzheimer's at this point.) That night we slept downstairs in our living room, her in a rocker by the gas fireplace, me on cushions on the floor, where, except for her wanting to put logs in the "woodstove" at about 4:30 AM and hiding some laundry in strange places, went pretty well. Later that morning I helped her bathe, though nearly called the fire department before finally extricating her from the tub (on the 3rd floor). Then back to the restaurant, more family, a part-timer she's fond of, her ex (who's had bypass surgery) and some grandkids. And that afternoon a drive around town, then over to some longtime friends' place. Toward the end of this visit Ms. Rocks complained about her chair hurting her back and had noticeable shakes. At home, after driving around some more, she knelt over a low marble table and complained of more back pain. Unable to get an intelligible response from her, I called 911 and she was taken back to and readmitted into the local hospital. Later I got a call asking if she was DNR, as it might come to that. (We both are.) One of the ambulance drivers had said "Sepsis." Subsequent blood cultures confirmed an infection (undiagnosed in the 12 days she'd spent at the second hospital prior to self discharging against medical advice). She was put on IV antibiotics. Three days later she was stable and returned by ambulance back to the second hospital and the same room we'd left five days prior. A different Indian guard at the door was all. I was still encouraged to spend as much time as possible with her and covid restrictions were again waived.
A CT scan came back negative. Another echo showed nothing new. Numerous cardiologists poked her calves with their fingers. Another gerontologist tried to push antipsychotics on her. I finally got her to agree to the nicotine patch. Her delirium persisted but became less paranoid. The guard disappeared. One cardiologist, a Dr. Chamberlain, actually got to know her a little, and even performed a physical exam, with her lying down and everything. He seemed rather excited about her heart rhythms and sounds, said he didn't think it was rheumatoid, more likely MS (mitral stenosis) and asked her if he could have his medical student also examine her as a teaching exercise, being she was a "textbook case." Covid has made teaching opportunities hard to come by, he said. She agreed, and was reexamined under instruction. Next visit, Dr. Chamberlain suggested she try a low dose of Seroquel at night and in the morning, which he claimed to have had good anecdotal success with in treating delirium. That night she slept "like a log" but the morning dose made her "foggy" and, in my opinion, worse, with more hallucinations ("Is that a monkey down there in the hall?") and delusions ("We're at Wal-mart.") So he agreed to halve the bedtime dose (to 12.5 mg) and cut out the morning one. Next day she was markedly improved, so obviously lucid that the surgeon never bothered to ask her the month, where she was or why on her rounds. The next day we played cribbage without a board, and the next learned Gin Rummy online and played that for a couple days. (I lost.) Aside from some weird delusional dream memories that persist ("I bought these pajama bottoms from the hospital at a lawn sale.") Ms. Rocks is her "normal" fun self.
Saturday she was transferred to a private room (that'll cost us) in 3 West, the better, quieter, pre-surgical ward. She's tentatively scheduled for surgery Friday. And I, no longer deemed essential to her care, am back to only 1 hour a week visitation (despite the importance their years old brochures place on family presence in patients' recoveries and combating common post-surgical deliriums).
In reflection, I find it funny that Wal-mart enforces stronger distancing and masking protocols than this hospital. One morning there were at least six nursing students and one nurse crowded around Ms. Rocks and her IV pole in the 6 x 6 "pill room" / vestibule area. The rounds doctor who'd refused our leave wears his mask under his nose. I've been told not to worry about putting my mask on when staff enter the room, though I do, only for their peace of mind, anyway.
It blows my mind that the top cardiac unit in the region failed to diagnose both delirium and a blood infection, and that it's my best friend from university, who's been a physician for over 40 years, that's now providing me the best consultation and advice. E.g., "Find out who the responsible physician is." E.g., "They'll probably administer weeks of antibiotics," and, "A PICC line is a good idea." (She's having one installed tomorrow.)
A sign in one of cardiac floor's public washrooms advising "Do Not Place Hands in Toilet" made me feel like a genius.
Anyway, that's where I've been the past few weeks.
I've learned that cardioplegics are used to stop the heart prior to bypass surgery and that delirium and dementia are very similar except that with delirium you don't play along with the delusions, but with dementia you do. So, Doomey, you're right. We've never named VCs or discussed submissions here. What was I thinking?
I read Marg's SF about a murder on some deep-space medical station while Ms. Rocks was napping last week. Full of sexy, multihued aliens, I found it an apt diversion. It's kind of funny, and so would probably stand a better chance here: scifilampoon.com/submissions/ but am sending it up anyway that clearer heads may prevail. Yes. Yes I am.