CAREGIVING: Last Wednesday started out kind of normal. Louise arrived to help wash Kathy and help me change her. Since she arrives at 10 am on Wednesdays, that gives me a chance to give her her medicine and clean her teeth. And to take a shower, myself. Kathy’s nights have been restful since the last scare. It was probably a combination of the oxygen machine and some low dose morphine, but we were both sleeping through the night.
While Louise was giving Kathy her sponge bath, I received a call from Shannon, the hospice nurse. She wanted to visit Kathy today instead of Thursday. She would be bringing the nurse practitioner with her to recertify Kathy for hospice. Medicare requires them to reassess Kathy and make sure that hospice is still warranted.
By then Louise was ready for me to help roll and move Kathy and change her dressings. Louise has more energy than I do most of the time, but she is over 80. I’ll do a separate post about her and the other health care workers.
As we rolled Kathy to one side her feeding tube came out.
I believe my reaction was “Crap.” I started to try to put it back in the hole in her stomach. But Louise was really nervous, “Stop, Stop. You gonna hurt her.” Instead, I carefully taped the tube to her stomach with a big piece of gauze. If you remember from some recent posts the feeding tube was on its last legs. They are really supposed to be replaced every six months and this was hitting eight. Her meds were leaking out through the insertion side. The tube had to get cleared with a piece of wire every other day and just giving medicines and water yo her was a workout for my hands. If I didn’t concentrate her meds or water would spray all over both of us. It was hacked together with old parts and string.
When I was thinking of bringing her to the hospital a few weeks ago for her lung problem, I figured I would get a new feeding tube put in at the same time. I decided to keep her on hospice and spare her all that testing and any procedures. Unfortunately, the tube wasn’t going to get better on its own.
I got in touch with Shannon right away. Kathy’s feeding tube just came out. “Well, that’s not good”. She said she needed to talk to her boss about what to do. She was discharged from hospice by phone. Then I called the ambulance to take her to the hospital. Since I was calling 911 on a cell phone, I had to get forwarded back to the Hampden Police. Two officers came within a few minutes to look over the situation. Meanwhile, Louise finished straightening things up; I signed her papers and she was off. By then it was about 11 am.
While we were waiting for the ambulance, I changed into some long pants because I figured it might be chilly in the hospital. I called the health care agency so that they could notify the aides. Then I left a message with Michael at Navicare, Kathy’s Insurance company. Since this was not covered by hospice I wanted to make sure it was covered by Navicare. The last thing I need right now is a hospital bill.
Meanwhile, Marty was busy entertaining the police officer. Or vice versa. I asked Marty if he wanted to join the K-9 department and the officer said that they didn’t have one yet. Marty said he would think it over.
The EMTs arrived and came in to see what the layout was and what equipment was needed. They decided to use a “stair chair” rather than try to bring a regular stretcher up my walkway. They managed to get her down the stairs and onto the gurney and into the ambulance. I decided to follow in the Toyota if they kept her in the hospital. They drove pretty slow and took a long way to get there; through an intersection called the “X” in Springfield to get to the highway.
Emergency room: The ER at Mercy didn’t seem particularly busy. Our room assignment #30 was listed on a monitor in the ambulance entrance. It is technically called the emergency department most places. As an older male, I feel self-conscious saying “ED.” Kathy was rolled in and transferred to the hospital bed. An aide came in to take her vitals and confirm what we were there for. Then a nurse came by to introduce himself. We had a few neighbors. An elderly woman next to us had been clawed or bitten by her dog. She was playing with it and the dog got carried away apparently. With the curtains, I never saw her or the wound on her foot but it sounded like it was kind of nasty. The woman kept saying that she wanted to get out of there. The woman across the aisle could not speak English; so one of her daughters was there to translate. I couldn’t tell what language (maybe Polish) but the lady was really tiny and her daughter was really tall. She kept saying that her mom wanted to eat lunch. But they wouldn’t let her until they gave her an ultrasound and an x-ray of some sort. Later, when I looked over, another daughter had taken over the translation duties. She wasn’t as tall.
And we were waiting. And I was freezing. Fortunately, Kathy was wrapped up in extra hospital blankets. I was glad I had put on jeans before I left, but I wish I had worn a shirt.
I’m not sure why medical facilities are so cold. Maybe they figure if you die waiting, you won’t start to smell. Just a theory. Anyway, we were chillin’ as they say.
When the nurse came back I asked if it was okay if I suctioned Kathy. It sounded like she needed it. He said he would call Respiratory Therapy because I wasn’t allowed to do it. We waited more. I thought about taking a curtain down to use for warmth, but the dog bite lady was still waiting next door. I was able to answer some work related email from my phone. There were several warning beepers and buzzers going off nearby. It sounded like an obnoxious ringtone. You probably know the type. But it was from an IV pump in one of the stalls.
Fairly soon the respiratory therapy guy came down with a suction catheter to give Kathy her deep cleaning. The nurse wanted to watch because he had never done it before. This was the type of suction that is more invasive but gets deeper. It is a thin sterilized tube that gets fed through the nose and down the throat. I could tell Kathy was uncomfortable while he was doing it, but she felt better after it was done. He listened to her lungs and re-suctioned her mouth area and throat (without going through her nose). After a while a PA named Natalee came to put the new tube in. She asked me if I knew what size tube Kathy had. We tried to examine the tube, but it was so old the markings had worn off. I asked if they put in a larger tube each time it gets replaced. But she said they only have one size here. So this is it. Since the last tube was installed here she was able to find Kathy’s records and the actual size.
When I removed the bandages and tape on the old tube the PA showed me how the “balloon” had shrunk to the size of a grape. The balloon holds the tube against the inner walls of the stomach. It gets filled with about 20cc of saline water. After it was basically installed the outside ‘grommet’ showed that there was a lot of travel in the tube. She could pull it two or three inches out of her stomach before the balloon stopped it. She asked me if she should tape it down to Kathy’s stomach. I told her we Just need to adjust the sliding external ring first. She admitted that I knew more about it than she did. I slid the ring on the tube down to her stomach until it was closer to her skin.
Once that was done we had to wait for radiology to take an x-ray to make sure the tube was in the right position. Eventually they showed up with a portable machine and pushed some sort of ‘film holder’ underneath Kathy. I’m sure it was digital but it looked uncomfortable. 15 minutes went by and we found out the tube was in the right spot and they were calling the ambulance company for the ride home. I called the agency to tell them Kathy was on her way home and that Peg could come tonight as usual. I would need to clean Kathy up once we got home.
It felt like it took forever for the ambulance to come for the return trip. I asked the nurse if I should dial 911. He gave a nervous laugh.
The dog bite lady was still there, but she was getting stitched up. Later a ride showed up for her from her insurance program. No family ever arrived. By then the little lady across the aisle had left for home with one of her daughters. She was eating a big muffin.
Going Home: Eventually, the ambulance came. The EMTs scooped up Kathy and got her home. I got there a minute or so before they did. Marty was glad to see me and glad to go outside. They brought her up the stairs and put the roll of sheets and blankets and Kathy on the air mattress. I guess we were home by 4 pm or so and I started to clean up Kathy.
I figured it didn’t have to be perfect. Peg would be here in a few hours. My first task was to put a clean sheet on the bed with Kathy still in it. It isn’t as hard as it seems. I removed all the old blankets and pads from underneath her by rolling her on her side. Fortunately, she wasn’t soaked although she did soil her briefs. Once she was all cleaned up and resting on clean sheets, I gave her her medicine and water.
Then we both took a nap!