An Appointment with the Doctor

CAREGIVING:  Wednesday was Kathy’s long dreaded doctor’s appointment. It was long dreaded because it was a first appointment with a new doctor and because it involved using an ambulance service to get her there and back. Since we switched insurance to NaviCare, Kathy had to use a different doctor. Ambulance is the only way to move her from place to place. Miguel from NaviCare had arranged both the appointment and the ambulance. The coordination with National Ambulance was really good. They called way ahead and asked questions about access; and whether Kathy could tolerate sitting up. Luckily I had removed the stairlift so that wasn’t a problem. Originally they were going to come at 11:45 for a 2pm appointment just to make sure there were no problems. The manager called me in the morning and said 1pm was plenty of time. So that gave me extra time to get a little nervous.

I was also concerned that while we were at the doctor’s office that Kathy would need suction. I called Riverbend, where her new doctor was. “Hi, this is going to sound like a stupid question but if my wife needs suction during that time period that we are there, you have a suction machine there. Don’t you?”

“Actually you better bring yours if you are concerned about it.” She put me on hold for a minute or two and came back. “I checked, and you should bring your own.” So the night before I was anxious/ticked that I was going to have to do their job too. When the guy from the ambulance company called I asked him if they had one in the van and would they be staying there during the appointment? The answers were yes and yes. So at least I didn’t have to lug a frigging compressor in a backpack with me. As it was, I brought diapers and pads and an irrigation syringe and lots of notes and checklists and a copy of her DNR (Do Not Resuscitate) form. I’m not sure why I brought the syringe. Maybe I thought I would get in a squirt gun fight.

stryker-chairThe ambulance arrive a few minutes after 1pm. The first EMT came in to see what was involved and told Kathy they were here to take her to her doctor’s appointment. I gave her her noontime meds so she was still pretty groggy.  They brought in a little stair chair climber thing. It did have some tiny footrests so it wasn’t exactly like this one. The two EMTs gathered her up by the pink fitted sheet she was on and lifted her from her bed onto the little chair. These photos make her look more terrified than she probably was. I was afraid she would break in half.

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The EMTs roll up the sheet to get a good grip so they can slide her onto the chair. Here she is still asleep. That is the backpack in the background with my stuff. I was going to put the suction machine in it.
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They slid her off her air mattress and onto the chair. She is very awake and tangled up in the blankets and stuff.
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Strapped in. They took the straps off and rearranged her a little better before they brought her outside. She was a real trooper.
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Once outside, they transferred her from the chair to a more comfortable gurney for the trip and her checkup.

2014-11-05 13.20.42The actual ride to Springfield took about 15 or 20 minutes, so we were still early for the appointment. The four of us waited out in the lobby for a few minutes. I started to do the obligatory new patient paperwork. They ask you for a bunch of stuff I can’t remember and for numbers you have written someplace else. I always keep a typed out list of meds so I didn’t write that down. There were lists of diseases and whether you ever smoked and used recreational drugs.

They called out Kathy’s name and then it got interesting. It turns out they do not have examining rooms large enough to fit the big stretchers. They are “working on it” but our appointment was out in a hallway. It was a little uncomfortable but I had watched a thing about the health care workers in Liberia helping Ebola patients. I thought this was fine. The nurse took Kathy’s blood pressure, pulse and temperature and everything was normal. She also received her flu shot.

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Our appointment hallway. The examining rooms near us were empty so I wasn’t worried too much about privacy.

Doctor Jennifer Jackson is her new doctor. Very kind and friendly. Unfortunately none of Kathy’s records had made their way to her, so most of the appointment was me trying to tell Kathy’s story. I probably should have given her the link to this blog to save time. Eventually they did find the records; and the computer system which had crashed earlier was now running. We discussed a lot of the difficult stuff: hospice, prognosis, keeping Kathy comfortable and not doing unnecessary tests and procedures. I gave her my copy of Kathy’s DNR form. She showed it to one of the other doctors and he brought out a new pink form for us to fill out. In addition to Do Not Resuscitate part there is a Ventilation section. If she /when she stops breathing we don’t want to have a tube shoved down her throat and have her hooked up to a breathing machine.

Dr. Jackson wants a wound care specialist to advise us on the skin around her PEG tube to address the redness. And she is referring us to a Gastroenterologist to check the actual feeding tube. It seems to be leaking a little when I give Kathy her meds and water. Kathy might get more physical therapy too. We will be coming back in a month for a follow-up.

The EMTs rolled her out to the ambulance and she was back in her bed by about 3:30. After I changed her we both took a nap.

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