Mom and all us daughters met with Dr. Kovitz, Dad's oncologist, yesterday about 5PM and discussed what specifically we wanted to do with Dad. He was very agitated all day and kept talking about wanting to go home and live with God. He also wanted the Sheriff to come rescue him. He's been insisting that he wants the catheter removed and wants no further treatments of any kind in his more lucid moments.
So, we all agreed that a "Do Not Resuscitate" order should be put in his chart and he should be discharged into a facility that can deliver hospice treatment until he dies. The cancer has progressed to a point where it has negatively impacted his quality of life, and putting him through anything more, we all agreed would just be cruel.
Today Mom is supposed to meet with a social worker to determine what Medicare will cover and the occupational and physical therapists are supposed to assess him to determine what he can and can't do. That will inform the hospice team what kind of care he will require.
Hopefully he will be moved out of the ICU and into a regular room today. Then it will just be a matter of moving him out of the hospital to a facility that will accept him and getting the hospice team assigned.
It still absolutely amazes me that just 10 days ago he was fine. And 8 days ago he drove himself to the ER. At least he won't be suffering much longer. Thanks to everyone for your continued support.
Tuesday, January 13, 2009
Monday, January 12, 2009
Dad's Info Over the Weekend per Lori the RN Sister
This is from Friday 1/9/09 - the photos in my post below was from Saturday, 1/10/09.
Daddy had lots of encouraging signs he was giving us today. Much more so than yesterday. He urinated again this morning, although it was only 180ccs and still very dark. He started doing a little bit more for himself like moving his bed position by pushing the buttons more and he actually held his own cup and drank from a straw some of the time. He was also better able to communicate. Once or twice he was clearly audible. He is still coughing up a lot of crud, but at least it is coming out of him. He still complains of pain though Mama and I both thought that he seemed much more comfortable and we think it's because of the Fentanyl patch they placed on him. He got morphine in the late afternoon after he told the nurse's aide that he was hurting. The nurse promised us that she would give it again just before she left for the day and that she would pass on the word to the night shift to give it to him on an every four hour basis.
Daddy is mostly coherent but does say some things that are a bit strange. For instance, he said to me "I'm not on chemo, right?" I said "Right." Then he said "But I am still getting therapy, where is it?" I pushed the IV pole into his line of sight and pointed to it and said "They are giving you fluids right here." I think that is what he was referring to. He also asked the GI doctor when they would be taking "the wire" out of him. Mama, the doctor, and I all looked at each other a bit puzzled. Either Mama or I told him that there was no wire in him. Mother later told me that she thinks that he meant the PICC line in his arm. Daddy was able to drink more water and suck on more ice today. He took a few small sips of Ensure and Mama got him to eat 2 or 3 bites of jello off his lunch tray. But that is all he took.
His labs are a mixed bag. The liver tests all came back worse than before, and his belly seems to be growing bigger by the day. His skin is mainly pink, but has a yellowish tinge that I fear will get worse with the liver worsening. His eyes are yellow. His electrolytes like potassium, sodium, etc are normal for the most part. His album level is very low which is not surprising because it is a nutrition marker. His BUN (blood urea nitrogen) level is extremely high at 72. His creatinine is high at 1.9. These are both kidney function indicators. These are probably so high mainly because of his severe dehydration. I hope that they turn around and that he doesn't go completely into renal failure requiring dialysis. His blood pressure is still very low for Daddy, who normally has high blood pressure, but his systolic, upper number, stayed above 100 all day. So that is much better than yesterday when it plummeted to 80. When his thrush gets better and his throat doesn't hurt so much and his pneumonia gets better, hopefully, he'll be going home with Mama.
My biggest worry about that right now is his extreme weakness. He is like a baby with that. He can't move himself in bed. He needs help with everything and then gets upset when we don't understand what he wants or exactly how he wants us to help him. Mostly he has been extremely patient with all of us and very, very stoic though. The nurse's aide was a doll today. She tried so hard to help Daddy and asked Mama and me how he likes things done and our advice on how best to deal with him. She gave him a good bath and I helped her. He didn't care much for the washing up procedure because every touch seemed to hurt him, and Lupe the aide was very gentle with him, and also because I think he might have been slightly embarrassed about having to be cared for to such an extreme. No modesty allowed in a hospital you know.
One funny thing he said was that when we changed his socks, I asked Mama to pull out a pair of dress socks and a pair of sturdier athletic socks so he could choose which he wanted. He said "Shit, I don't care." Lupe, Mama and I all had to laugh at that statement which was very clearly understood by all of us. I am hoping that he gets some physical therapy help at the hospital to get out of bed and sit in a chair, go to the bathroom, walk around some, etc, before they discharge him. He'll have to regain more function to be able to go home with Mama. But, it seems that the infections and resulting pain must be dealt with first. Also, his growing abdomen is a huge concern of course.
This is taking a big toll on all of us, but I know that none of us would have it any other way. Daddy changed our diapers and comforted us when we were too little and helpless to do it ourselves, now it's his turn for some payback. I know that we all love being with Mama and Daddy, even when it's hard, sad and very frustrating not to be able to help him more.
This news is from Sunday, 1/11/09...
Grandma Root convened all of us that are here, including Shari, who has now joined us, and let us know after a little discussion that she is putting the living will back in the chart. Dr. Patel, whom we all love, explained how things would probably turn out for Daddy very thoroughly and lovingly and that made Mama's mind up as to how Daddy will want things to go when it comes that time. Mama's a brave warrior!
As far as the long-term plan goes, it's still up in the air. Daddy's condition is taking us all on a frantic roller-coaster ride. Earlier in the day things were looking very grave, but then this afternoon he rallied. For instance, he's off the drug that was dripping into his veins to keep his heart rate down and his heart rate and blood pressure are stabilized and back to his "norm." He isn't even requiring the IV fluids now as he is taking in enough fluids and more "full liquid" foods by mouth to keep him in good standing. Also, his liver function tests have improved again today and his urine output is way up.
When I asked him about whether he is hurting he said "Yeah." I said "Where?" He said, "In my back and butt." He didn't mention his throat, chest or belly, which had all been very painful due to the infections and liver inflammation he's lately endured. Mama told Dr. Patel that his belly is much softer now and he concurred. The "back and butt" pain is probably due to the fact that for six days he's been laying in a hospital bed in basically the same position. Mama is going to ask about why he isn't being turned and moved around more.
He's weak as a kitten and still has to work hard to talk in a barely audible voice, but all the signs are now looking up for the immediate future. Hopefully, they'll get him back to a regular room on the floor tomorrow, since he no longer seems to require ICU care. Physical strength is a big issue however. Dr. Patel said that they will start his occupational and physical therapy back when his heart stabilizes and that happened today, so hopefully they'll start working with the strength issues again tomorrow. Dr. Patel also mentioned hospice, which will be needed probably at some point. I think hospice is a great idea when the time comes that he needs it. The nurses and techs who work in hospice care have a whole different outlook from the "floor" and ICU nurses who are working to correct immediate health problems and don't seem to have time for the more "mundane" things that the rest of us would call basic human existence. Comfort is their main focus and that is not a bad way to exit this life for any of us, comfortably as possible, I mean.
Daddy had lots of encouraging signs he was giving us today. Much more so than yesterday. He urinated again this morning, although it was only 180ccs and still very dark. He started doing a little bit more for himself like moving his bed position by pushing the buttons more and he actually held his own cup and drank from a straw some of the time. He was also better able to communicate. Once or twice he was clearly audible. He is still coughing up a lot of crud, but at least it is coming out of him. He still complains of pain though Mama and I both thought that he seemed much more comfortable and we think it's because of the Fentanyl patch they placed on him. He got morphine in the late afternoon after he told the nurse's aide that he was hurting. The nurse promised us that she would give it again just before she left for the day and that she would pass on the word to the night shift to give it to him on an every four hour basis.
Daddy is mostly coherent but does say some things that are a bit strange. For instance, he said to me "I'm not on chemo, right?" I said "Right." Then he said "But I am still getting therapy, where is it?" I pushed the IV pole into his line of sight and pointed to it and said "They are giving you fluids right here." I think that is what he was referring to. He also asked the GI doctor when they would be taking "the wire" out of him. Mama, the doctor, and I all looked at each other a bit puzzled. Either Mama or I told him that there was no wire in him. Mother later told me that she thinks that he meant the PICC line in his arm. Daddy was able to drink more water and suck on more ice today. He took a few small sips of Ensure and Mama got him to eat 2 or 3 bites of jello off his lunch tray. But that is all he took.
His labs are a mixed bag. The liver tests all came back worse than before, and his belly seems to be growing bigger by the day. His skin is mainly pink, but has a yellowish tinge that I fear will get worse with the liver worsening. His eyes are yellow. His electrolytes like potassium, sodium, etc are normal for the most part. His album level is very low which is not surprising because it is a nutrition marker. His BUN (blood urea nitrogen) level is extremely high at 72. His creatinine is high at 1.9. These are both kidney function indicators. These are probably so high mainly because of his severe dehydration. I hope that they turn around and that he doesn't go completely into renal failure requiring dialysis. His blood pressure is still very low for Daddy, who normally has high blood pressure, but his systolic, upper number, stayed above 100 all day. So that is much better than yesterday when it plummeted to 80. When his thrush gets better and his throat doesn't hurt so much and his pneumonia gets better, hopefully, he'll be going home with Mama.
My biggest worry about that right now is his extreme weakness. He is like a baby with that. He can't move himself in bed. He needs help with everything and then gets upset when we don't understand what he wants or exactly how he wants us to help him. Mostly he has been extremely patient with all of us and very, very stoic though. The nurse's aide was a doll today. She tried so hard to help Daddy and asked Mama and me how he likes things done and our advice on how best to deal with him. She gave him a good bath and I helped her. He didn't care much for the washing up procedure because every touch seemed to hurt him, and Lupe the aide was very gentle with him, and also because I think he might have been slightly embarrassed about having to be cared for to such an extreme. No modesty allowed in a hospital you know.
One funny thing he said was that when we changed his socks, I asked Mama to pull out a pair of dress socks and a pair of sturdier athletic socks so he could choose which he wanted. He said "Shit, I don't care." Lupe, Mama and I all had to laugh at that statement which was very clearly understood by all of us. I am hoping that he gets some physical therapy help at the hospital to get out of bed and sit in a chair, go to the bathroom, walk around some, etc, before they discharge him. He'll have to regain more function to be able to go home with Mama. But, it seems that the infections and resulting pain must be dealt with first. Also, his growing abdomen is a huge concern of course.
This is taking a big toll on all of us, but I know that none of us would have it any other way. Daddy changed our diapers and comforted us when we were too little and helpless to do it ourselves, now it's his turn for some payback. I know that we all love being with Mama and Daddy, even when it's hard, sad and very frustrating not to be able to help him more.
This news is from Sunday, 1/11/09...
Grandma Root convened all of us that are here, including Shari, who has now joined us, and let us know after a little discussion that she is putting the living will back in the chart. Dr. Patel, whom we all love, explained how things would probably turn out for Daddy very thoroughly and lovingly and that made Mama's mind up as to how Daddy will want things to go when it comes that time. Mama's a brave warrior!
As far as the long-term plan goes, it's still up in the air. Daddy's condition is taking us all on a frantic roller-coaster ride. Earlier in the day things were looking very grave, but then this afternoon he rallied. For instance, he's off the drug that was dripping into his veins to keep his heart rate down and his heart rate and blood pressure are stabilized and back to his "norm." He isn't even requiring the IV fluids now as he is taking in enough fluids and more "full liquid" foods by mouth to keep him in good standing. Also, his liver function tests have improved again today and his urine output is way up.
When I asked him about whether he is hurting he said "Yeah." I said "Where?" He said, "In my back and butt." He didn't mention his throat, chest or belly, which had all been very painful due to the infections and liver inflammation he's lately endured. Mama told Dr. Patel that his belly is much softer now and he concurred. The "back and butt" pain is probably due to the fact that for six days he's been laying in a hospital bed in basically the same position. Mama is going to ask about why he isn't being turned and moved around more.
He's weak as a kitten and still has to work hard to talk in a barely audible voice, but all the signs are now looking up for the immediate future. Hopefully, they'll get him back to a regular room on the floor tomorrow, since he no longer seems to require ICU care. Physical strength is a big issue however. Dr. Patel said that they will start his occupational and physical therapy back when his heart stabilizes and that happened today, so hopefully they'll start working with the strength issues again tomorrow. Dr. Patel also mentioned hospice, which will be needed probably at some point. I think hospice is a great idea when the time comes that he needs it. The nurses and techs who work in hospice care have a whole different outlook from the "floor" and ICU nurses who are working to correct immediate health problems and don't seem to have time for the more "mundane" things that the rest of us would call basic human existence. Comfort is their main focus and that is not a bad way to exit this life for any of us, comfortably as possible, I mean.
Saturday, January 10, 2009
Photos of Dad in Hospital
Flowers on the left are from Denise, ones on the right from Jeraine & Millie, and short ones in middle are from Uncle Herb & Aunt Beti.
Beti & Herb had a matching wrist corsage delivered to Mom for her 83rd birthday, which was on 1/8/09.
Here, Lori & Mark, the family's RNs try to explain lunch to Dad.
Ah, they finally agree on the gruel in the top left corner of the tray :-)
Dad was moved to ICU today about 4 hours after these photos were taken. Prayers for him are greatly appreciated. Thanks!
Beti & Herb had a matching wrist corsage delivered to Mom for her 83rd birthday, which was on 1/8/09.
Here, Lori & Mark, the family's RNs try to explain lunch to Dad.
Ah, they finally agree on the gruel in the top left corner of the tray :-)
Dad was moved to ICU today about 4 hours after these photos were taken. Prayers for him are greatly appreciated. Thanks!
Friday, January 9, 2009
Update on Dad from Lori (my sister the RN)
Hi all. A further update on Daddy here. Today, as we all know, was Mama's 83rd birthday! Happy Birthday Mama!
I picked her up this morning and we proceeded to St John's hospital to see Daddy. He woke up shortly after we arrived and was surprised to see me there, too. He realized after a while that today was Mama's birthday and mouthed Happy Birthday to her. He next wrote me a note to tell me to go buy her a birthday present from him to her and that she should write a check for it. I showed the note to Mama and she laughed and told him loudly in his right ear that she needed no birthday present from him except that he should cough up all the crud in his chest, get better, and get back home with her. Sixty-one years of married bliss showing up in all its glory there.
The nurse told Mama and me that Daddy had had his last dose of morphine at 9:40am and that he couldn't have another one until 1:40pm. Daddy was complaining of pain in his belly, throat and chest. This was at 10:00am. Daddy and Mama told everyone who entered his room that I was his daughter and that I was a nurse, to which they replied "we know." Mama expounded telling each of them that another daughter had taken off work and spent the last 2 days with them and that they didn't know what they would do without her. I told them that there were four of us daughters and that we'd each be taking turns being with them and making sure that they were ok. Mother was concerned about Shari's schooling obligations and told everyone proudly that she is working toward her Master's Degree and is very busy every day. In short, our parents are extremely proud of their children.
Daddy has thrush in his throat making sipping virtually impossible. He silently screams out in pain when attempting to do so. He has no voice. A first for our Daddy! He can whisper, which comes out in puffs of breath and I must lean my ear into his mouth to "hear" it and finally can understand it after several tries. He tries to write down what he is saying, but his handwriting is wavery and his strength is slight. We eventually understand what he is trying to communicate, but it is very taxing. He falls asleep often in the middle of an exchange and then awakens a few minutes later looking a bit surprised by his surroundings.
He was wearing a diaper, had an IV going with fluids in it, and sleeping with his mouth open and a gurgly sound coming from his lungs. At about 11:00am, Dr. Patel, an associate of his oncologist, Dr. Kovitz, came to visit him. Daddy became alert and answered Dr. Patel's questions, with me interpreting, throughout his stay. Dr. Patel explained that Daddy was neutropenic, meaning his white cell count is very low and that is why everyone in his vicinity must wear masks to keep from breathing germs on him. Also, that he thinks Daddy had a partial bowel obstruction because at some time during the night he passed a "semi-normal" stool. So, he believes that the constipation Daddy had experienced prior to his hospitalization was due to a stool that would not come out and then he had diarrhea passing around that and thus he became dehydrated. He said that all of these things were due to the last chemotherapy Daddy received a little over one week ago.
Also, he has the yeast infection, or thrush, in his throat, which is terribly painful, and it appears that he also has pneumonia. Daddy has been coughing up phelgm all day, greenish and sometimes bloody. Also, his liver tests are up, meaning that his liver is not working properly. Daddy's abdomen is swollen, although his arms and legs are skinny as can be. This is probably from his inflamed liver. Dr. Patel said that his liver problems are a combination of the tumor, which has grown from 5 cms. to 10 cms. and also from the assault of his latest chemotherapy treatment, which his liver is trying to rid from his body and fighting a tough battle on.
Daddy was still breathing room air at this point in the day and his oxygen saturation levels were about 95% which is ok. Dr. Patel said that Daddy would remain hospitalized throughout the weekend at least and that he would be the one to come in on Friday and that Dr. Kovitz would be back on Saturday. He was a kind and caring man, just as Dr. Kovitz is. I felt relief that Daddy is in his care. Daddy's legs are hurting him and I asked Dr. Patel if he needs TED hose, which are those tight leggings to help prevent blood clots from forming in the legs from too much lying in bed. He said that he would order them, but they still haven't been placed on Daddy. I will follow up on this in the morning.
Soon after Dr. Patel left, the tech (nursing assistant) came in the room to take Daddy's vital signs. His blood pressure was 80/44, which is very low, and his heart rate was 123, which is very high. These are signs of dehydration. The nurse was called in and she called a "rapid resonse team" meeting which consists of a nursing supervisor, the bedside nurse, a respiratory therapist, and the internist doctor. They came in and checked his oxygen saturation, which was still good at 93% and the doctor then said to give him a fluid bolus. So he squeezed Daddy's IV bag until 500 ccs went into him and then his blood pressure came up to about 120/60 which is good, but still low for Daddy. His heart rate went from 123 to 89, so that was good too. I wrote notes to Daddy throughout this time to explain to him who the various people were in his room and what they were doing. The nursing supervisor asked if Daddy was a "full code" meaning that everything that can be done for him would be done in the event of his heart stopping or his breathing stopping. So, Mama said that yes it should all be done. The doctor and nurse acknowledged this and later in the day, the nurse gave Mama back the copy of Daddy's "living will" that he had signed back in June, which states that he wants no heroic measures.
The internist also said that he thought that Daddy should have a PICC (Peripherally Inserted Central Catheter) line implanted because his veins are shoddy and he has already been stuck several times for peripheral IVs. These lines go into the inner elbow area and are very long and can last a long time and they can give fluids and medication in them and also draw blood from them. Mama said yes and Daddy agreed to have this done. Daddy's next possible dose of morphine was due at 1:40pm and so Mother and I decided that after he received that, that we would go out to lunch at Luby's. At 2:00pm, the nurse finally showed up to give him the morphine. We told him that we were leaving for lunch and he said ok.
Then the dietician met us in the hallway and we talked to her for a while about his not being able to tolerate anything by mouth because of the pain in his throat. Then, a delivery person showed up at the door with a beautiful vase of flowers for Daddy and a wrist corsage, smaller but made of the same flowers for Mama for her birthday, both from Beti and Herb. We brought them in to show Daddy and he was delighted, as was Mama with her gorgeous corsage. Meanwhile, the doctor told us that we no longer need to wear masks at Daddy's bedside because his white blood cell count had increased to half that of normal. So, good news there. Before we could leave, the PICC nurse arrived and said that she'd be putting in his line and that we would have to leave during the procedure. So we went to lunch.
Mother had shrimp and fries with a combination carrot/cheese cake for desert. She had me share the cake which was delicious and she took most of the shrimp dinner home with her in a styrofoam container to finish later. She said that with everyone's cards, gifts, and well wishes that she was having a happy birthday even though it was also very tough with Daddy's condition happening at the same time. When we got back to the hospital, Daddy's bed had been removed from the room. We found the nurse who explained that it had been difficult for the PICC nurse to get the line in him so they were doing it via fluroscopy in the fluroscopy suite and that Daddy understood that and had signed the consent for it himself. After about ten minutes they wheeled Daddy back into the room with oxygen in his nose via nasal cannula because his breathing became rougher during the procedure. The line is in his left elbow. After a while, the nurse finally got a Fentanyl patch for pain, which the internist had prescribed for him.
Daddy urinated 350ccs after no urine for 2 days. His blood pressure continued to be good at about 120/60 and his heart rate maintained at about 90. After spraying chloraseptic spray in his throat Daddy drank a big sip of his Juice drink and ate one or two bites of a popsicle from his dinner tray. To backtrack, when we first came back from lunch and found Daddy gone to fluroscopy, it was time for Mother's appt with Dr. Winfield about the abcess on her face. So we went over there and Dr. Winfield said to keep taking the antibiotic she is on and call him Monday for an appt if it hasn't gotten better.
At about 6:00pm, Mother and I were very exhausted and Daddy was able to sleep a bit so we told him that we were leaving for the night. He had his nurse call button, his suction apparatus, his chloraseptic and his pad and pen within reach and he mouthed that we should "go." We kissed him goodbye and then stopped by the nursing station to let them know that when he pushes the call button, to go to him rather than talk over the intercom because he cannot hear anything. The secretary said she would pass this on to the night shift. We will return in the morning. More updates later...
I picked her up this morning and we proceeded to St John's hospital to see Daddy. He woke up shortly after we arrived and was surprised to see me there, too. He realized after a while that today was Mama's birthday and mouthed Happy Birthday to her. He next wrote me a note to tell me to go buy her a birthday present from him to her and that she should write a check for it. I showed the note to Mama and she laughed and told him loudly in his right ear that she needed no birthday present from him except that he should cough up all the crud in his chest, get better, and get back home with her. Sixty-one years of married bliss showing up in all its glory there.
The nurse told Mama and me that Daddy had had his last dose of morphine at 9:40am and that he couldn't have another one until 1:40pm. Daddy was complaining of pain in his belly, throat and chest. This was at 10:00am. Daddy and Mama told everyone who entered his room that I was his daughter and that I was a nurse, to which they replied "we know." Mama expounded telling each of them that another daughter had taken off work and spent the last 2 days with them and that they didn't know what they would do without her. I told them that there were four of us daughters and that we'd each be taking turns being with them and making sure that they were ok. Mother was concerned about Shari's schooling obligations and told everyone proudly that she is working toward her Master's Degree and is very busy every day. In short, our parents are extremely proud of their children.
Daddy has thrush in his throat making sipping virtually impossible. He silently screams out in pain when attempting to do so. He has no voice. A first for our Daddy! He can whisper, which comes out in puffs of breath and I must lean my ear into his mouth to "hear" it and finally can understand it after several tries. He tries to write down what he is saying, but his handwriting is wavery and his strength is slight. We eventually understand what he is trying to communicate, but it is very taxing. He falls asleep often in the middle of an exchange and then awakens a few minutes later looking a bit surprised by his surroundings.
He was wearing a diaper, had an IV going with fluids in it, and sleeping with his mouth open and a gurgly sound coming from his lungs. At about 11:00am, Dr. Patel, an associate of his oncologist, Dr. Kovitz, came to visit him. Daddy became alert and answered Dr. Patel's questions, with me interpreting, throughout his stay. Dr. Patel explained that Daddy was neutropenic, meaning his white cell count is very low and that is why everyone in his vicinity must wear masks to keep from breathing germs on him. Also, that he thinks Daddy had a partial bowel obstruction because at some time during the night he passed a "semi-normal" stool. So, he believes that the constipation Daddy had experienced prior to his hospitalization was due to a stool that would not come out and then he had diarrhea passing around that and thus he became dehydrated. He said that all of these things were due to the last chemotherapy Daddy received a little over one week ago.
Also, he has the yeast infection, or thrush, in his throat, which is terribly painful, and it appears that he also has pneumonia. Daddy has been coughing up phelgm all day, greenish and sometimes bloody. Also, his liver tests are up, meaning that his liver is not working properly. Daddy's abdomen is swollen, although his arms and legs are skinny as can be. This is probably from his inflamed liver. Dr. Patel said that his liver problems are a combination of the tumor, which has grown from 5 cms. to 10 cms. and also from the assault of his latest chemotherapy treatment, which his liver is trying to rid from his body and fighting a tough battle on.
Daddy was still breathing room air at this point in the day and his oxygen saturation levels were about 95% which is ok. Dr. Patel said that Daddy would remain hospitalized throughout the weekend at least and that he would be the one to come in on Friday and that Dr. Kovitz would be back on Saturday. He was a kind and caring man, just as Dr. Kovitz is. I felt relief that Daddy is in his care. Daddy's legs are hurting him and I asked Dr. Patel if he needs TED hose, which are those tight leggings to help prevent blood clots from forming in the legs from too much lying in bed. He said that he would order them, but they still haven't been placed on Daddy. I will follow up on this in the morning.
Soon after Dr. Patel left, the tech (nursing assistant) came in the room to take Daddy's vital signs. His blood pressure was 80/44, which is very low, and his heart rate was 123, which is very high. These are signs of dehydration. The nurse was called in and she called a "rapid resonse team" meeting which consists of a nursing supervisor, the bedside nurse, a respiratory therapist, and the internist doctor. They came in and checked his oxygen saturation, which was still good at 93% and the doctor then said to give him a fluid bolus. So he squeezed Daddy's IV bag until 500 ccs went into him and then his blood pressure came up to about 120/60 which is good, but still low for Daddy. His heart rate went from 123 to 89, so that was good too. I wrote notes to Daddy throughout this time to explain to him who the various people were in his room and what they were doing. The nursing supervisor asked if Daddy was a "full code" meaning that everything that can be done for him would be done in the event of his heart stopping or his breathing stopping. So, Mama said that yes it should all be done. The doctor and nurse acknowledged this and later in the day, the nurse gave Mama back the copy of Daddy's "living will" that he had signed back in June, which states that he wants no heroic measures.
The internist also said that he thought that Daddy should have a PICC (Peripherally Inserted Central Catheter) line implanted because his veins are shoddy and he has already been stuck several times for peripheral IVs. These lines go into the inner elbow area and are very long and can last a long time and they can give fluids and medication in them and also draw blood from them. Mama said yes and Daddy agreed to have this done. Daddy's next possible dose of morphine was due at 1:40pm and so Mother and I decided that after he received that, that we would go out to lunch at Luby's. At 2:00pm, the nurse finally showed up to give him the morphine. We told him that we were leaving for lunch and he said ok.
Then the dietician met us in the hallway and we talked to her for a while about his not being able to tolerate anything by mouth because of the pain in his throat. Then, a delivery person showed up at the door with a beautiful vase of flowers for Daddy and a wrist corsage, smaller but made of the same flowers for Mama for her birthday, both from Beti and Herb. We brought them in to show Daddy and he was delighted, as was Mama with her gorgeous corsage. Meanwhile, the doctor told us that we no longer need to wear masks at Daddy's bedside because his white blood cell count had increased to half that of normal. So, good news there. Before we could leave, the PICC nurse arrived and said that she'd be putting in his line and that we would have to leave during the procedure. So we went to lunch.
Mother had shrimp and fries with a combination carrot/cheese cake for desert. She had me share the cake which was delicious and she took most of the shrimp dinner home with her in a styrofoam container to finish later. She said that with everyone's cards, gifts, and well wishes that she was having a happy birthday even though it was also very tough with Daddy's condition happening at the same time. When we got back to the hospital, Daddy's bed had been removed from the room. We found the nurse who explained that it had been difficult for the PICC nurse to get the line in him so they were doing it via fluroscopy in the fluroscopy suite and that Daddy understood that and had signed the consent for it himself. After about ten minutes they wheeled Daddy back into the room with oxygen in his nose via nasal cannula because his breathing became rougher during the procedure. The line is in his left elbow. After a while, the nurse finally got a Fentanyl patch for pain, which the internist had prescribed for him.
Daddy urinated 350ccs after no urine for 2 days. His blood pressure continued to be good at about 120/60 and his heart rate maintained at about 90. After spraying chloraseptic spray in his throat Daddy drank a big sip of his Juice drink and ate one or two bites of a popsicle from his dinner tray. To backtrack, when we first came back from lunch and found Daddy gone to fluroscopy, it was time for Mother's appt with Dr. Winfield about the abcess on her face. So we went over there and Dr. Winfield said to keep taking the antibiotic she is on and call him Monday for an appt if it hasn't gotten better.
At about 6:00pm, Mother and I were very exhausted and Daddy was able to sleep a bit so we told him that we were leaving for the night. He had his nurse call button, his suction apparatus, his chloraseptic and his pad and pen within reach and he mouthed that we should "go." We kissed him goodbye and then stopped by the nursing station to let them know that when he pushes the call button, to go to him rather than talk over the intercom because he cannot hear anything. The secretary said she would pass this on to the night shift. We will return in the morning. More updates later...
Wednesday, January 7, 2009
My Dad's in the Hospital
His liver tumor has doubled in size and he had an adverse reaction to the new chemotherapy they started on 12/30/08 -- the combo put him in the hospital. He's been there since Monday and isn't doing well at all. I've been with my mom, trying to help out, but I'm really glad that my younger sister Lori will be taking over for me tomorrow & Friday. She's a registered nurse and will know how to make sense out of the medical jargon.
Exhausted, so I'm going to bed now. Will update soon.
Exhausted, so I'm going to bed now. Will update soon.
Monday, January 5, 2009
Answers to Alena's Questions
After reading about the strict regulations on dogs in Germany, Alena asked:
I want to know what Germany did with all the people who already had those breeds of dogs, but didn't have the $$ to pay for the fees or classes? Do they just take their pets away?
My friend Iris got back to me after checking with the local authorities and answered:
I want to know what Germany did with all the people who already had those breeds of dogs, but didn't have the $$ to pay for the fees or classes? Do they just take their pets away?
My friend Iris got back to me after checking with the local authorities and answered:
In case an owner can't pay the dog tax he will be visited by a taxman, who tries to confiscate something with the value of the tax. The owner has the right to pay the amount in partial amounts and also the right to apply for a respite. The law says: Yes, the dog can be removed. The mayor can submit the proposal to give the dog to another dog holder who is able to pay. This is - from the legal side - very close to an injunction.But in fact this has never happened in our county.
Sunday, January 4, 2009
Evidence of My Mid-Life Crisis
At least I have a good reason for purchasing a "new" vehicle (it's actually a 2006 model). The Honda Hybrid had 100,300 miles and in October we had to spend $1300 for a new electric battery. When I took it in over the Christmas holidays for its 100,000 mile check-up I was told that it needed 2 new catylitic converters or it wouldn't pass the next emissions test (due in June) and each converter cost $900! I couldn't see putting another $1800 into a car with that many miles on it, and decided trading it in now was the best option before it had even more mileage on it. Click here to see a slide show of my MINI and here if you want to see it with smaller photos but music included by the Doobie Brothers!
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