Speechless

I have heard many times that if you can't say anything nice--don't say anything at all.  I'm not really sure who actually first quoted the phrase.  But I do understand that while you are faced with difficult times and have to make difficult decisions, one must consider the audience, the outcomes and one's own role.  When all of these notions are considered, it's sometimes best to find one's self speechless.  But I do know for sure that the key to restoration is found in man's own will.  It is the will of man that allows him to soar or to plummet.

Dr. AWOL returned to town on Monday, August 16, 2010.  My grandmother was contacted by the nurse's station and was told that Grandad would be discharged on that day.  I'm speechless.  I can hear it in my grandmother's voice--the frustration, the disbelief.  I'd actually planned on working from home most of the day, then going out to the hospital to see Grandad later.  In lieu of my planned agenda, I got dressed and rushed with my East Lansing Aunt to the flipping hospital (O.K. I'm hinting at my feelings).

Nurse Uma Thurman was there and tried her best to speculate what dumb Dr. AWOL's (there's another hint) actions meant.  My grandmother had tried to call him most of the day.  We received no return calls.  I called the facility that I wanted Grandad to go to and they told me that unfortunately, since Grandad does not have an ongoing IV, a heart monitor or any other medical issue that would call for 24 hour medical monitoring, he would not be a candidate for their facility.

So where is Grandad going?  You guessed it, the place that Dr. AWOL thought was best.  Since Grandad will be going to the modern day Shady Pines (the place that the character Sophia lived in temporarily from the sitcom The Golden Girls), he will have to be under the care of Dr. AWOL's partner.  We'll call him Dr. Flash because I heard he's visited Grandad but my Grandmother and I have never seen him.  This would keep Grandad under Dr. AWOL's and Dr. Flash's care instead of allowing him to go back with his own primary care physician.

If I wasn't being speechless today.  I'd say that this is a crock of poop!  A doctor discharges a patient and doesn't notify the family of the patient!  Then he makes the decision of where the patient goes and doesn't notify the family!  He leaves out of town for-forever and doesn't even make a call to the family after numerous attempts have been made to contact his office!  He sucks, the system sucks and the world sucks!

Well, I guess it's so bad as that.  It's a good thing that I've learned to keep my composure and remain speechless.  This whole episode has made my Grandmother understand that we (our family) are the advocates for the patient and that we have to stand together to work through the many issues that we will potentially face when dealing with health challenges.

Fast forward two weeks in.  Grandad is doing quite well.  My Grandmother had seen the facility prior to his arrival and had it listed as her choice if we weren't going into the facility that I preferred.  So, it's a good facility and it's linked to the hospital.  Grandad has been on the feeding tube (the PEG) for these past two weeks.  He has only said a couple of words but not usually at the same time.  He seems to be a bit more aware and alert.  He smiles and looks toward visitors.  His ears are very sharp but his vision seems to be comprised somewhat.  I bought him a dry erase board and wrote something on it for him to read and possibility laugh about.  Since he's speechless, I was hoping he might be able to write something.  This is what I wrote on his board:

My Grandad has the best granddaughter in the whole wide world.  She is the smartest, intelligent, all-knowing person and the most beautiful woman ever and stronger than Wonder Woman!

I had to chuckle because it's been a very interesting week or two.  I know my thoughts are all over the place but they remain with helping Grandad restore his energy and get better no matter what.

Yikes! Friday the 13th!!!!

Friday, August 13, 2010

I didn't even notice the date until I typed the word Friday in yesterday's blog.  But then it hit me--it's Friday the 13th!  So I tried hard all day, to NOT think about Friday the 13th.  I tried not thinking about it when I showered.  I tried not thinking about it when my East Lansing Aunt told me she was delayed by fog (driving visibility was low).  I tried not thinking about it when I was driving.  I tried not thinking about it when I heard that there was a huge fire at an apartment building near my mom's house and that 6-7 fire fighters were injured and the entire area was closed down.  One of the fire fighters was transferred to Grandaddy's hospital. I tried not thinking about it when I found out that my Chicago uncle was ill and unable to come to see Grandaddy this weekend.  I especially tried to not think about it when I knew that Grandaddy was going to have his PEG operation today.  Today of all days!

Why is Friday the 13th associated with so many bad things.  I mean there's black cats, there's splitting poles, stepping on cracks, walking under ladders, sweeping your feet with a broom--these are all things that you can control to some degree.  You cannot escape Friday the 13th!

Well, on the good side, Grandaddy's operation was going to be done by the Chief of Surgery for the hospital (hopefully he's not 100 years old himself) and the procedure was fairly simple and only takes about 30 minutes or less and recovery is a short time period as well.  These are all very good things.  

East Lansing Aunt and I went to the hospital and visited with Grandaddy.  I got a chance to slip my long list of questions in to Grandaddy's chart.  Grandaddy's nurse was able to answer a few of the questions but not able to answer why he was taken off of blood thinners totally (upon admittance) then put on Plavix for a day then taken off again.  The chart notes that Dr. No Speaka De English Well did tell my Grandmother why the change was made but I'm sure my Grandmother wasn't able to understand the doctor well.  Who knows.  The nurse also told me that Triumph does extensive therapy and they might not take Grandaddy if he cannot do the extended therapy.  These folks and their misinformation.  That's not the criteria for Triumph at all.

At any rate, Grandaddy came through the surgery with flying colors.  East Lansing Aunt even made us stay 30 minutes longer after Grandaddy had gone down for the procedure.  She wanted to hear that he'd made it into recovery and that the procedure was successful.  I just wanted to get out of there.  I couldn't stand sitting and waiting.  It made me nervous.  But we waited but wasn't able to get any information until well after we'd left and gone to my Grandmother's house.  Grandaddy was returned to his room and resting within a 2 hour period.

Grandmother, her 1 of 6 from Grand Rapids, East Lansing Aunt and I went back in the afternoon to see Grandaddy.  He was really happy to see 1 of 6 from Grand Rapids.  He grunted a lot and they hugged.  Grandaddy shook his head some.  We could tell that he was having some pain.  He was fidgety.  His assistant told us that he'd walked earlier in the day to the bathroom sink and back with the Physical Therapist and the Occupational Therapist.  They had Grandaddy try to wash his face and do some other activities to see how he would be able to transition back into his daily life.

The IV nurse came in and let us know that it was time to change Grandaddy's IV.  Apparently, it's changed every 4 days.  But she wanted to make sure that he'd get pain medicine before changing it.  His nurse came back to the room after we'd called her to confirm that he'd be given pain medicine.  She asked about his allergy to Vicodin.  My Grandmother said that it makes him loopy.  The nurse gave him something else.  I totally did not commit whatever it was, to memory.  We could tell that he relaxed more.  He rolled on to his right side with his head touching the side rail.  I put a towel between the side rail and his head for comfort.  We were all concerned about his positioning because we were told by Jaclyn Smith that he's supposed remain at a 30 degree angle.  Grandaddy rolling over to one side seem to have his angle off a bit.  We were told by his nurse that his angle was fine.  We all told him goodnight for the evening and that we'd be back tomorrow.

We all decided to go to my East Lansing Aunt's favorite corned beef spot.  We picked up food and all headed back to my place.  East Lansing Aunt and I arrived first.  It was taking my Grandmother and 1 of 6 from Grand Rapids so long to arrive.  I called my Grandmother.  At that point, she was right outside my door.  She asked me if I'd seen the accident just one block west of my complex?  A car going north must've hit another car heading west.  Seemingly, the car headed west flipped over and caught on fire.  All four of us went downstairs to see the vehicle upside down and burning with huge yellow flames.  The ambulance, fire trucks and police were already on the scene.

My Grandmother told us that some good Samaritans pulled the driver out of the car just before it burst into flames.  I was thinking that it wasn't such a good day for that guy.  But my East Lansing Aunt pointed out that today was that driver's lucky day.  I guess it's all a matter of looking at things differently.  

I don't think that Friday the 13th is such a bad day after all.  My Grandaddy is able to get the nutrition that his body needs, Papa had a visitor from a 101 year old woman and the driver of the roll over hot rod is still on the planet thanks to some quick acting do-gooders.  Yep, Friday the 13th is O.K.

I still think we should've run over to the store to play the lottery for the number "fire".

Charlie's Angels are Still Working Girls

Thursday, August 12, 2010 had to be the best day ever!  I started the day with my laundry list of questions that I wanted answered from Dr. AWOL, Dr. No Speaka De English Well and Dr. Newly Attending.  My Grandmother had an errand to run so I picked her up and took her on the errand then she and I went to the hospital.  When we arrived, there was a "Sitter" in his room.  I guess he must be a known flight risk.  To our surprise, Grandaddy had been up walking with the Physical Therapist (PT) and all that was used to aid him was a lap belt (I think that's what they called it).  They only used a walker to help pivot him from to the bed. I don't know exactly how far he walked and he did have some difficulty following the instructions from the PT.  But the Sitter thought that Grandaddy's difficulty with instruction had more to do with his own stubborn spirit.  "He only wanted to do it when he felt like doing it", she said.

My Grandmother decided to go to the nurse's station and ask for Social Worker Spring to be paged (I don't know why we still say paged since most of the hospital staff seem to all have individual cell phones).  When Social Worker Spring arrived, my Grandmother invited me in the hallway with them to talk.  I guess they didn't want to either have Grandaddy overhear the conversation or they didn't really want to discuss it in front of the Sitter or maybe it was more comfortable for my Grandmother to sit in the waiting area near Grandaddy's room.  I think my Grandmother has been using that little waiting area as her own personal office.  It only has six seats in it with a table in the middle and the space is an opened square with three walls. It's adjacent to a public bathroom.  On the opposite side of the bathroom is the nurse's station.  When you sit in my Grandmother's office (as I will continue to affectionately refer to it), you see all the action on the floor.  On Wednesday when I sat there with my Grandmother and her 1 of 6 from Clio, MI, he told me that he counted 7 stretchers that passed the "office" in a matter of minutes.  He mentioned that it must be a hot day for the hospital.  I told him that we should play the lottery for the number "stretcher", "seven", or "hospital" or something.

As Social Worker Spring, Grandmother and I sat down to talk in "Grandmother's office".  I really took a look at Social Worker Spring.  She might be in her late 30s or mid 40s.  She had great skin.  Her skin tone was a strong mocha color but not beige, not much cream in the coffee.  She wore dark plastic rimmed glasses and was dressed in slacks and a top with a white "doctor's" jacket on.  She had to carry around a clip board and had this cell phone with a big noticeable plastic blue cover on it with a white label on the back of it with her first name typed on the label.  She was very pleasant and kept looking back and forth between my Grandmother and myself.  I sat in front, across the table, from Social Worker Spring while my Grandmother sat on the right side of her.

My Grandmother had questions about the Extended Care Facility (a.k.a. Nursing Home) that she and 1 of 6 from Clio visited the day before.  She really liked it.  She thought that it didn't look like a nursing home at all. The carpet was nice and there was no smell of bleach, sickness or urine (clean up on aisle 2).  The staff was pleasant and she'd even gotten a chance to speak with a couple who had a relative in the facility.  She asked the couple about another facility that she was going to view and the man took both his hands and wrapped them around his throat as to mimic choking or strangulation.  "As a matter of fact", the couple said, "we took our father out of that nursing home to bring him here."  

This nursing home does therapy and will check on him every 2 hours to make sure that he is changed (if he has to have a toileting aid in place).  There's an area to have your pastor come and hold church if you'd like and so on and so forth.  So, Grandmother and Social Worker Spring were just going on and on about the benefits of the facility and how myself and my Aunt from East Lansing would be able to visit the facility on Friday blah, blah, blah.  I was listening but I had all these questions for Social Worker Spring.  Well, really the questions weren't for her.  I didn't want to ask her anything.  I was just sitting in the meeting because my Grandmother had asked me to do so and being polite.

Then my Grandmother asked the question that she really wanted to have answers on.  I was really observing my Grandmother today.  She was quite the diplomat.  Well, first of all, she is cute as ever.  She's got Indian and a whole bunch of other things in her ancestry (as we all do, but her Indian is rather visible).  She's got a short haircut and always dresses really cute--not the "cute for her age cute" but the thoughtful cute that could be appreciated by any age.  But she is pleasant and realizes the need to bring up the positives first and then go for the jugular.  She brought up funny topics and liked to carry on conversation with just about anybody she met.  She would slow down her speech, use her hands and head to make points, articulates very well and picks up key words to integrate into her language such as "aphasic", which is a common term associated with difficulty with language and speech but the actual term is "aphasia".  I believe that the word "aphasic" is more of a developing medical word or medical slang (I crack myself up).

Basically, my Grandmother wanted to know what would happen to her income when Grandaddy goes to the nursing home.  For some reason my Grandmother thought that both her income and Grandaddy's income would be cut in half (which would actually be the better deal).  I'm not sure where she'd gotten that information because I remember when my Snazzy Great Granny's husband had to go to a nursing home, the state took his entire income.  Talk about shock!  Social Worker Spring cleared it up by saying that the insurance will cover the first 20 at 100% then the next 21-100 days will be partially cover by two funding sources.  If the patient should remain more than 100 days, then the patients income will be absorbed, all but $60, to cover the cost of long term care.  Wow!

As we sat and spoke to Social Worker Spring, my Grandmother laid out her contingency plan.  She'd told me the plan the day before but I guess the thought really sunk in when heard the new income information.  Of course, I knew that this all was devastatingly difficult to come to grips with, but my mind wasn't able to go to that place yet.  Instead, I was fixed on getting him to Triumph hospital and not to see this nursing home-fixed income split-relocation mess play out.  I waited patiently for my Grandmother to finish up with her last thoughts then I interjected with my own query about the other facility that Grandaddy had been in before and why wouldn't we go that route instead of looking at an entirely new facility?  Social Worker Spring told me what she knew about that criteria and that Grandaddy did not fit that criteria at his present state.  I thanked Social Worker Spring for her opinion but I would like to hear those words from the actual hospital.  But I pressed on until she and my Grandmother would allow Grandaddy to be evaluated by the hospital to make their own determination.  Social Worker Spring told my Grandmother that it was my Grandmother's decision to go with the evaluation.  My Grandmother, knowing that this evaluation meant so much to me, said that she just wanted to see what would happen and to satisfy this matter in "my" (me the local Grandaughter) head.

Social Worker Spring made a call to have the nurse call Dr. Newly Attending (still filling in for Dr. AWOL) and have him write up an evaluation to have Triumph review Grandaddy's chart!  While Social Worker Spring was making these calls, my Grandmother said,

     "Social Worker Spring knows what she's talking about."

     "She's not the hospital", I said. "I rather hear it from them."

     "She's the closest thing to the hospital", she said.

     "No she's not", I said. 

I guess my Grandmother was so surprised that I wouldn't settle with Social Worker Spring's opinion.  Social Worker Spring even said that no doctor would allow Grandaddy to go there (the place I want him to go).  But she's just a social worker. She should stick to socializing not medicine.  She should go organize a ballroom dance class or something (see, that's my opinion and I didn't share it with her).

After Social Worker Spring made her calls, she told us that the evaluator for Triumph was in the building today and could come see Grandaddy's chart today!  Yay!!!!!!!!

Charlie does have angels and he's re-employed them as evaluators of Triumph Hospital.  I guess the budget is a bit tight so Charlie only has two angels now.  One's been on the job for awhile while the other one is just on her fourth day of training.  I guess I call them Charlie's Angels because I've never seen nurse's in their off duty gear (not exactly true-I've known three nurses personally for awhile but I guess I only really think of a nurse when in the hospital not at the club).  Also, these nurses looked like they were about to step out into the night life.  They were fabulous--short skirts, long legs, jewelry, peek toe shoes and stilettos, long flowing hair pulled back and held into place by designer sun glasses--just fabulous!  They reminded me of the Farrah Faucet (blonde) and Jaclyn Smith (brunette) actresses from Charlie's Angels.  

Jaclyn Smith was the seasoned professional.  It was just the fourth day of training for Farrah Faucet.  I just realized that I hadn't seen Grandaddy's assigned nurse all day, except for the abrupt almost, head on collision that she and I shared when she was walking out of another patients room into the hallway and I was walking down the hallway passed that patient's room.  I can't hear those darn rubber shoes!  I also saw her again when Social Worker Spring called her to get cleared on the write up for the Triumph evaluation.  But other than that, I hadn't seen her come into the room during our visit.  It's probably because my Grandmother was having all these meetings in her office today.  She and I didn't even see when the next nurse on duty came in and wrote her information on Grandaddy's dry erase board.

Jaclyn Smith did most of the listening and talking.  My Grandmother went on with her story first.  I had to hear it from beginning to end.  I deeply and thoroughly understand how life changing it all is but I really, really wanted to get to the topic of Grandaddy and his immediate needs.  I waited patiently until my Grandmother was finished and after Jaclyn stop talking.  I explained that Grandaddy was under their care previously and we'd like to see if he could return.  Jaclyn spoke with us for awhile and then went to get Grandaddy's chart.  There are some issues that would call for multi-layered care.  Jaclyn thinks that there's a real possibility with his numerous health challenges, that he will be able to go to Triumph.

Jaclyn also provided the most detailed information about Grandaddy's condition that I've gotten from anybody and since she wasn't working at the hospital attending to patients, she took her time and sat with us for almost an hour.  This is what she unofficially told us (of course Farrah Faucet did chime in from time to time-I didn't want anyone to think of her as a dumb blonde but she was in training):  Grandaddy was on Pecid (for his stomach) and Keppra (for seizures) until Plavix (blood thinner) was introduced on Wednesday then stopped (the Plavix).  Vitamin K (to thicken the blood) was introduced to possibly prep for surgery (the PEG feeding tube scheduled for Friday).  Jaclyn explained that the goal is to keep a potential stroke patient's INR (International Normalized Ratio) readings between 2.0-3.5.  Blood thinners are used to hold that ratio in those areas.  When Grandaddy came into the hospital, his INR was 1.8 which was typically below the level of being diagnosed as a hemorrhagic stroke (a bleeding stroke that is linked to blood being too thin).  She explained that it's very tricky to keep the blood where you want it in order to hold the INR readings between those two numbers, so the doctors have to monitor and be sure about the type of stroke and what steps to take.  She also mentioned that the area of stroke from the CATSCAN is very large which means that the stroke is still occurring.  He hasn't finished stroking!  Which explains to me, the loss of language and the ability to swallow over the last few days. 

Lastly, Jaclyn mentioned that when Grandaddy is given the PEG, he should remain elevated at 30 degrees so that food would not end up getting into the lungs.  She said that that was very important.

Thank you Charlie for putting your girls out here on these streets where we need them and thank you God for the quite voice inside me that said to keep pushing.  Jaclyn and Farrah, you're lovely.

To Be or Not to Be, That's Not My Question

Today, Thursday, August 12, 2010, I'm armed with tons of questions that I want answers to by tomorrow.  I'm really so lucky because I've had all kinds of support.  One friend said that when Grandaddy gets out, there will be an Iron Man II DVD waiting for him, another told me that the only way that I can help Grandaddy is to be active in his healthcare, my Indy cousin cracked up at one of my horrible jokes and vented about the needs for KY Papa, my East Lansing Aunt would always listen then say, "I'll make a call" in order to get my questions answered, my LA uncle asked me to get Skype so he could see and talk to Grandaddy, my San Diego cousin made sure his mom (my San Diego aunt) was updated, my sister helped me keep a level head, my girlfriends call to talk about random silly things, my preacher came by the very next day after he heard and so many people are praying.   Thank you all.

Well, I've decided that since Dr. AWOL is not available and the replacement Attending Physician is new to the case and that one Dr. that my Grandmother can't understand hasn't been seen, I decided to write all my questions down and email them to Dr. AWOL, Dr. "No Speaka De English Well" and Dr. Newly Attending.  Well here they all are:

Family Questions 

1.      What kind of stroke did he have?  We’ve read literature on hemorrhagic stroke.  Do you think this is the type of stroke he’s had or continues to have?

2.   How is this stroke different from previous strokes?

3.      What medicine is being used to treat this stroke?

4.      How is this medicine different from previous medications and why use it now?

5.      We have literature stating that he is on Keppra which is used to treat seizures.  Do you think he had a seizure?  If so, how is seizure related to stroke?

6.       What if any, side effects are there with taking Keppra?  Has he taken Keppra before?

7.       We were told previously that he would be on blood thinners for life to assist in preventing strokes.  While he’s been in Beaumont, he has not been on any blood thinners.  Why and is there a plan to reintroduce blood thinners during his stay?  Why/Why not?

8.       How long will the PEG need to be utilized?

9.      With the PEG inserted, how will he continue to strengthen his ability to swallow?

10.   What will be put in the PEG to provide nourishment?  Has the PEG procedure been explained to him?

11.   What thoughts do you have on his ability to regain speech?  Is there anything that we should do as a family when we visit to encourage him to speak?

12.   We would like for his eyesight to be evaluated unless you have already done so.  If so, please tell us what information you have on his sight.  It appears as if his sight has been affected by this episode.

13.   What is he overall physical condition and what are the plans for physical therapy?

14.   We’ve had great success at Triumph Rehabilitation Hospital.  We’d like to be moved back to that facility when he’s released.  How can you assist us with this matter?

15.   We’ve been told that your recommendation is to go to a nursing home facility, although we are not wholeheartedly opposed, please give the reasoning why we would not be able to go back to Triumph?  Have you contacted them on our behalf to make certain of your claim or who can we speak to in order to verify your reasoning?

16.   What are your thoughts on his overall health plan over the next week – 2 weeks – 1 month?

I'll have answers tomorrow and probably more questions too....

I'm on my way to pick up my Grandmother so that we can go to the hospital together today.  This will give her a bit of rest.

Doctor Gone AWOL

Wednesday, August 11, 2010 was a pretty terrific day.  I arrived at the hospital and shortly after came my Grandmother and her 1 of 6 (it's a private joke that's not hard to figure out).  My Grandmother had to finally give me the Dr.'s office number because I had tons of questions and wasn't settled with the answers that they'd given her so I asked to talk to the Dr.'s directly so that I have a good understanding of Grandaddy's condition.

Well, my Grandmother set up a family meeting with Grandaddy's Attending Physician.  I called his office to find out that he would be out of town for the rest of the week and that he had his office to contact Dr. "My Grandmother can barely understand you because of your accent".  We were to meet with her on Friday.  This wasn't the best news but at least we'd have some additional answers.  We'd rather meet with the Attending Physician (at least I would) because he'd recommended that Grandaddy go a nursing home for 2 weeks for rehabilitation and strengthening.  Grandaddy was in a rehab hospital before that we simply loved!  It didn't make sense that he was going to have to go to a nursing home.  Why couldn't he go back to the same facility where we'd had so much success previously?  

A nursing home poses another problem.  The state of Michigan will look at my grandparents' finances and cut their income in half which would cause a great hardship for them.  My Grandmother is considering temporarily moving out of state for those 2 weeks - 100 days with one of her 1 of 6 just to be able to live comfortably for that time frame.  Goodness gracious.  I don't know what impact this will have on my Grandaddy's overall health and improvement.  My LA uncle said that I needed to get Skype (I don't know why that thought suddenly occurred).

Anyway, I'd rather speak to the southern Dr. who apparently has gone missing.

Grandaddy is much better today.  He had a sitter in his room because he kept trying to get out of bed.  He was coherent.  He had his eyes open.  He had half smiles and nodded to respond to some of our questions.  He was waving his hands as expressions to communicate.  As soon as the sitter left, he sat straight up in bed (as if to signal to begin his covert operation).  He put his feet on the floor and began scooting toward the left side of the bed.  I asked him what he needed.  I asked him if he had to go to the bathroom and he shook his head to signal yes.  I told him that he couldn't get out of bed.  I wiped the right side of his mouth where he had a little saliva dripping down.  My Grandmother came and stood in front of him.  I told her that I would get the Assistant to help him.  She'd gone next door with another patient.  She came in and I decided to go out.  I'm sure Grandaddy didn't want me to be all up in his business.

They were going to try to give him the swallow test again today but Nurse Uma was there and told me that they still wanted to give him the PEG at least for a little while to get his body built up.  My Grandmother signed the authorization for the PEG and I asked for a copy of the order for our records.

Social Worker Spring (I call her that because her name is the same as one of the months in spring) gave my Grandmother an entire list of nursing homes to review.  We looked over the list and narrowed down two that were close in proximity and in decent areas.  Although, I still want to know why Grandaddy can't go to the rehab hospital.  I asked that question to Social Worker Spring and she didn't not have an answer.  My Grandmother tried to answer saying that Grandaddy had a different kind of stroke.  See, that's where things get tricky because my next question is, "well what's so different about this stroke and what kind of stroke did he have?"  But I didn't want to appear quarrelsome in front of Social Worker Spring who didn't have any answers anyway nor insensitive to my Grandmother who is trying her best.  But I will state all of these questions before I let them move him from the hospital.  Somebody has to have an objective opinion and advocate for patient and the family's best interest.  I stated that to both my Grandmother and Social Worker Spring and 1 of 6 that there are some additional questions to ask the absent Attending.  How can somebody be absent and attending?  He's probably at a Grand Ole' Opry Concert.

I went off to work as usual but had a stop to make after work and before the hospital.  As I was in the parking structure of my "stop before the hospital", my Chicago cousin called me and we laughed and talked about Grandaddy's condition.  My Grandmother also called and told me that she and 1 of 6 had a chance to visit the nursing homes that we selected.  She was really impressed with one of them.  I was glad that she'd gotten a chance to visit the facility and had a good feeling about it.  She even talked to a couple visiting their relative.  They gave the place a glowing report.  I know that I'm unsettled about this nursing home thing.  Grandaddy's momma, the snazzy one, never liked the idea of a nursing home.  I think she passed right before she lost her independence just so she wouldn't have to go to one.  And since I was practically raised by grandparents, I've visited these places and they are just so sad and depressing.  And they smell bad.  Grandaddy still has vigor and life in him.  I know, I'm conflicted.  Dr. AWOL better answer my questions.

I got off the phone feeling a lot better about things.  I convinced my Grandmother that the Dr.s work for us, not the other way around and we have questions that they must answer.  I stopped by this event for a friend of mine and the toasts went so long.  I was positioned where I couldn't walk out until it was over.  It was over at 9PM.  I knew I wouldn't make it to the hospital by then.

The End of Puree

The next two days, Monday and Tuesday, August 9th & 10th, were really challenging for me.  Mostly because, even though I'd visit the hospital each morning and each afternoon, I wasn't really able to have a good conversation with Grandaddy's medical team.  I did see his nurses and assistants but I didn't have a chance to put my eyes on his Attending physician or the Neurologist.  So, I heavily relied on my Grandmother to provide information and updates to me as well as pose my questions to the doctors.  This was a rather difficult process.

See, the visiting hours are 10AM-10PM, so the doctors usually were gone by the time I would arrive.  I was working this week from 12:30PM-6PM.  After I'd get off of work and visit the hospital, decisions had been made, doctors were gone home, a new nurse and assistant had been assigned to him in the evening and all of my needed information had to come from my poor Grandmother.

She had to be extremely tired and scared.  And if anyone could guess my mentality and attitude on some of the decisions that the physicians made--I probably wasn't the best person to deal with over those two days.  Some of my frustration was with Grandaddy's continued weakening state.  He was talking on Sunday (1 day after being admitted), and now Monday and Tuesday, he has no speech at all and he seemed to be so lethargic.

Monday morning, the Assistant was in his room finishing breakfast.  She told me that he had difficulty keeping some of the meal down i.e. the pureed pancakes (which syrup) and pureed oatmeal.  Well, let Grandaddy tell it and he would say that the food is horrible so he really didn't want to keep it down anyway.  He always complains about hospital food.  

I sat and watched while the assistant tried to switch up and give him the pureed bananas.  He seemed to like those better.  The Assistant and I marveled at the color of the pureed bananas.  They were pink!  We had to smell them to make sure that they were indeed bananas.  I think the hospital chef secretly wants to be an apprentice for Wolf Gang Puck.  Whoever heard of pink bananas?  Anyway, the bananas went down.

The nurse came in and wanted to give Grandaddy some medicine.  I forgot to ask what she was giving him.  I was just caught off guard by his inability to talk and difficulty swallowing (dysphagia).  The nurse put the medicine in a spoonful of yogurt and fed him the yogurt because this pill could not be crushed.

The Speech Therapist came in as well and said that she wanted to be there when Grandaddy is eating to make an analysis.  He was in decent spirits.  I was kidding with him about flirting with the nurses.  I let the shade up or down by his command.  I wiped his face with a warm (the water doesn't even really get warm) washcloth.  I rubbed his head a bit.  I sat on his bed.  I asked him to try to cough (I heard the Speech Therapist and Physical Therapist ask him to do this).  

I returned in the evening to find that he wasn't able to eat anything at all for the rest of the day and was not to be given any food by mouth.  I looked on his dry erase board and it read....Diet--NPO.  I didn't know what that stood for but I knew that it was the end of pureed foods.

By Tuesday morning, I was all set to get to the hospital early and take my mother with me.  But the good Lord knows, I had a plan and my dear mother must've had a different one.  We had an errand to run before visiting hours.  I told her that I had one hour until we needed to be finished with our errand and get to the hospital.  It's all my fault because, she'd asked me to stop at her favorite neighborhood store (here I was trying to get her to grocery shop at Kroger in Grosse Pointe).  She was only supposed to pick up three items while I sat in the car, coffee, bananas & cereal.  It was Tuesday morning around 9AM.  Nobody was even really in the store from what I can tell and it still took her 40 minutes.  Oh well, I had to drop her back off at home and ask my Grandmother and her son to bring mom to the hospital because now I'd be late for work.

At the hospital, I found out who Grandaddy's nurse would be for the day.  I absolutely loved her!  They call her Uma Thurman.  I didn't really see the resemblance on Tuesday but I made a point to observe her more closely on Wednesday.  She was exact, matter of fact but pleasant and hopeful (well I thought she was hopeful).  See, my Grandmother had mentioned that Grandaddy might have to have a feeding tube inserted and that that tube would probably frustrate him and cause him to have to have restraints on his arms.  Well, I was a bit disturbed by all of this.  I questioned my Grandmother about how would his swallowing ability be strengthened and speech restored if there is a tube down his throat, what would be his physical therapy plans if he is restrained and how would be able to use the bedside urinal if his hands are not free?  This one decision could adversely affect so many other areas of his overall health.  

Thankfully, Nurse Uma cleared a lot of things up for me.  Since Grandaddy cannot swallow, he has to have nutrition (my Grandmother made sure that I understood the urgency of having nutrition in order to strengthen other areas).  A swallow test would be given to him today and if he passes, he will continue to be given pureed foods.  If he doesn't pass, he would be given a Percutaneous Endoscopic Gastrostomy Tube (PEG) which is inserted in the mouth and throat to be guided toward the stomach, however the tube does not remain in the throat area.  Nutrition/Food would be added externally to the stomach.  There would be an incision in the stomach area as well.  I knew I loved her as Poison Ivy and I've seen Kill Bill 1 Million Times (I dated someone who at one time was the biggest Kill Bill Fan Ever)!  

Dr. Lloyd would do the surgery and he is the Chief of Surgery for this medical group!  Yay!  I'm happy!

So, before I left Tuesday morning, I had a long talk with Grandaddy.  Well, I pretty much gave him a pep talk.  I told him all about the swallow test and the possible PEG operation.  I told him that he needed to study for his swallow test.  He wouldn't pass if he cheated.  He had to practice like playing an instrument.

Thankfully, my Chicago cousin had started a prayer band the day before for Grandaddy and Papa in KY who is extremely ill as well.  My East Lansing Aunt and Uncle were there visiting with him.  I texted my family from the mid West to the West Coast to let them know to pray at 12 noon for Grandaddy to pass his swallow test and for and all out miracle for Papa!

Tuesday evening, I returned to the hospital with a posse.  I had three of my "parents born in Africa, we were raised in Canada but now live in Michigan but claim we live somewhere else" girlfriends accompany me to visit Grandaddy.  I walked in and asked him if he didn't mind the company.  He shook his head to state that they could come in.  I re-introduced them to him.  He opened his eyes and looked toward each one of them. He used his weak right hand that was in a "C" shape to open and close which meant he was waving.  Each one of them came over to him to say hello.  One of them looked at his IV and she directed me on a couple of questions to ask the nurse.  Grandaddy was laying on his right side and he kept trying to look and turn his body toward my girlfriend who was sitting near the window fidgeting with something.  I guess he could hear her.  I told him what she was doing.  I also talked to him about the little girl that I was attempting to get to use the toilet.  I'd told him about her yesterday.  Well, today, I tried letting her go bottomless for 10 minutes in the kitchen.  Well, she wet the floor (and not the potty) 3 times!  He smiled and made a sound in his throat when I told him that story.

He apparently wasn't able to take the swallow test.  He was in a deep sleep.  Too sleepy to really be awakened earlier so they did not give him the test.  They've added sugar (dextrose) to his Keppra IV now to assist with getting nutrition in his body.  I feel like we had a good visit and I was so glad to have company come with me and see his condition and feel hopeful as well.

I just wished that I could hear him complain about the medley of puree that they were serving him.

Suddenly the Sabbath

Sunday, August 8, 2010 arrived.  Grandaddy was admitted to Beaumont Hospital in Grosse Pointe the day before.  I know that many people speak highly of the Beaumont Hospital Group.  I know a lot of babies born at the one on 13 Mile & Woodward.  However, the Grosse Pointe hospital was newly acquired.  It was once Bon Secours Hospital.  That's the place where a friend of mine was having a procedure done during the unfortunate Northeast Blackout of 2003.  She survived.  Also, another friend of mine took her son there to be treated for a health condition with reoccurring effects.  She wasn't really comfortable with the questions asked nor the care so she packed him up and went to Children's Hospital.

Beaumont in Grosse Pointe happens to be the closest hospital to where my grandparents live now so that's the direction in which the ambulance drove.  One unfortunate thing is that my Grandfather's primary care physician does not have privileges in the Beaumont health care system which means that this doctor cannot visit my grandad nor have any say about treating him.

On the flip side, the facility is great!  The floor that my grandad is on has an outdoor courtyard with flowers and sitting areas.  The windows in the rooms are low and have real shades to pull down and up.  It's very clean and has a great smell.  There are at least 3-5 people sitting at the front desk upon entry to answer any questions you may have.  The Assistants, the Nurses and the Food Service workers are so friendly and informative.  The visiting hours are 10AM-10PM so you can hang out there all day long.

Grandaddy's Attending Physician is Dr. Parker.  My Grandmother seems to like him a lot.  Grandaddy's Neurologist is Dr. Lumley.  I've not spoken to her personally but my Grandmother says that Dr. Lumley has an accent that is very difficult to decipher.  The nurse I met on Sunday was Judy (I believe).  She was older and rather helpful.

When I walked in to Grandaddy's room, my Grandmother had arrived.  We came later in the afternoon because we were told that Grandaddy would have an MRI and an EEG so he would be out of the room for awhile having tests done.  I was a little concerned because Grandad still wasn't back and his bed was completely bare.  There weren't any sheets or pillows on it.  The only sign that we had the right room was his bottom set of teeth were on the night stand along with his watch.  My Grandmother was on the phone with her son when I'd decided that I wanted to know where my grandfather was.  

I went to the Nurse's station and stood near two doctors who didn't rush to finish there conversation.  After waiting a few minutes, the female doctor who was seated asked if she could help me.  I then asked her about my grandfather.  She said, "we're not taking care of this guy, I will page his nurse."  The male doctor who was standing close to me (and earlier in conversation with the foreign nucklehead) said to the nice Ms. Dr. Foreigner that I just wanted to know where the patient was.  So understanding that medical doctors sometimes don't really have as many social graces, I just went back to the room to wait for the nurse that was paged to meet us.  Nurse Judy let us know that Grandaddy was still having tests done.

Well, even after 2PM, he still was testing.  We waited about 30-40 minutes, then he was rolled back into the room on a stretcher.  Three other female assistants entered the room and prepared to transfer him from the stretcher to his hospital bed.  One of the assistants tried calling out to yet a fourth assistant to come in to help transfer Grandad but the fourth person seemed to be delayed a few minutes.  When the fourth assistant walked in she had a casual comedic demeanor that she seemed to correct as soon as she saw family members of the patient present.  She also said something like, "oh, I didn't know you all were waiting for me."

With two assistants on one side and two on the other, they counted, one, two, three, then lifted Grandaddy to the bed.  Apparently the bed's mattress was softer and more flexible than they expected.  It flipped up in the lower left side corner (the side from which they were transferring him from).  The change in the mattress alerted Grandaddy and he began to hold on to the side rails for caution.  The assistants began talking, letting him know that the mattress was really soft and assuring him that they were not going to let him fall.  They corrected the problem and got him comfortably situated into the bed.

Nurse Judy let us know that Grandaddy was being treated by a medicine that is associated with seizures.  My Grandmother had mentioned to me earlier that morning that the doctor thought that Grandaddy had a seizure and not a stroke.  I was clearly confused by it all because I was unaware that strokes could cause seizures, that my Grandaddy had had a seizure and that he looked as if he'd had a stroke from what I could tell (not that I'm a medical professional).  My Grandmother also mentioned that Dr. Lumley had treated Grandaddy while he was in St. John earlier in the year.  Dr. Lumley asked why was Grandaddy off of Keppra (Levetiractam, a seizure treating medicine) and who took him off of the medicine?  Of course, so many medicines, so little time and so many collective health conditions between the two of them, my Grandmother couldn't remember who, when and why Keppra was taken out of Grandaddy's scheduled 100 pills a day plan.  At any rate, Dr. Lumley put Grandaddy back on Keppra.  He was also on Pecid for his stomach.  Those were the only two medications that he was on.

I suppose the goal of the hospital is to introduce a couple medicines to treat the immediate symptoms and since his primary care physician could not treat him in this hospital (maybe they need to move back toward the DMC hospitals), these doctors wanted to perform tests and draw their own conclusions about his condition.

Grandaddy seemed pretty tired but he was aware of his surroundings and able to respond to my questions.  However, I was only able to understand every third word or so.  He was attempting to utilize his right hand.  My Grandmother commented to me right away, "look at his right hand, it isn't working right."  The hand was bend with the fingers in a "C" shape but he attempted to use it to grab at things.  He seemed to be grabbing at something in the air and missing it each time.  Also, his mouth was drooping on the right side.  My Grandmother commented right away on that too, "look at his mouth."  He wanted those bottom teeth in!  He was sort of trying to boss us around as usual but we had some difficulty understanding his sentences.  

The Physical Therapist came in and introduced herself.  She spoke with Grandaddy and asked him to be prepared to scoot down along the bed then stand (with assistance) and move to the chair so that he could eat lunch (we'd asked him if he was hungry and he let us know that he wanted food immediately).  His lunch was already in the room and had been sitting for awhile.  We had to order a new hot tray.

He had some difficulty understanding the directions from the Physical Therapist (PT) to scoot down along the bed.  He thought that she wanted him to lay down in the bed (he was in a seated position on the bed, she wanted him to scoot up toward the head of the bed and showed him how to do so but he didn't quite understand).  The PT got another assistant and they helped Grandaddy get to the chair beside the bed.  He didn't have to do any walking.

So then began lunch........A fresh serving of pureed carrots, pureed mashed potatoes and pureed chicken with thickened cranberry juice and some kind of pureed fruit.  Yummy!  My Grandaddy usually complains about hospital food.  I guess if he wasn't so hungry, he'd probably kick this try right off of the table and into the hallway.  Well, at least it didn't smell awful.

Grandaddy tried to eat on his own but couldn't grab the spoon with his right hand.  He tried using the hand as if it was the spoon (or had the spoon in it).  He'd motion his right hand toward the mashed potatoes ultimately putting his cupped fingers in the food then lifting it to his mouth.  This is when I realized that something seriously has affected his motor skills, coordination and or eyesight.  My Grandmother and I fed him.  We did the same at dinner.

This is a Sabbath that we definitely were in prayer.

Where's my Iron Man?

Well, Saturday, August 7, 2010 was a typical day.  I started out with a bike ride around Belle Isle then headed straight over to my grandparent's home where I was assigned to do laundry.  I was on the phone when I unlocked the door.  I headed straight to the kitchen and began scavenging for something to eat.  Alas, indeed, they'd eaten already so I found toast.  I was just telling my friend that I was at my grandparent's home when my grandfather (not seeing that I was on the phone) barged into the room and said, "Where's My Iron Mon?"  He was referring to the DVD that I borrowed back in the winter when both he and my grandmother were doing time at one of the local hospitals.  I told him that I'd left it at home because I had to put my bike in the car but that I would bring it to him tomorrow.  Of course, my friend who I was speaking to on the phone was cracking up laughing and said, "you'd better get that man his Iron Man movie."

While I was there doing laundry, Grandaddy was out in the yard, apparently, getting the car out of the garage.  He'd come in to report that some wire was hanging down on a tree in the alley.  So, my grandmother and I promptly let him know that he would not be apart of the rescue mission for the wire so he could just get that out of his mind.  When he went back outside, I asked my grandmother what he was doing and where he was going. She said that he was going to get the car washed.  For some reason, that didn't set well with me so I thought that I should go with him.  I put on my shoes and hurried out the back door only to see him already in the car and starting out of the driveway.  I ran behind the car, yelling and waving my hands but he didn't see me.  I can't believe that he didn't check his mirrors!  He always fusses at me about that.  So he didn't see me and I was left in driveway hoping that he'd be ok on his trip.

My car was originally parked in the driveway.  I pulled in to in when I arrived.  So, Grandaddy had grabbed my keys, moved my car to the backyard, opened the garage manually, pulled out his car, closed the garage and left.  I thought for sure that I'd catch him when he returned, but I was down in the basement with the laundry when he again, opened the garage, pulled his car in to the garage and manually closed it.

Well, I thought that he was at least finished with all his self imposed chores of the day.  He knew that I had to go to work at 3:30PM.  I'd finished up the last drying load and folded the clothes.  As I went to grab my keys and head out of the back door to my car (because Grandaddy had moved it there), I could see that the car had been moved.  I asked Grandaddy where my car was and he told me that he'd put it back in the driveway.  I told him that I could've done that myself.  But he said that he knew that I had to go to work.

I received a call from my grandmother at 4:52PM.  She told me that my grandfather was having another episode (which meant a stroke) and had to be taken to the EMS by ambulance.  She said that he wasn't coherent or responsive.  The first thing I thought was, what happened to my Iron Man?