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.
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