Friends, This post is more of a journal entry  that will preface some additional posts over the next few weeks.  It is an example of MY view that the “care” in healthcare is missing nowadays.  It is about my personal experience over the past week. However, I fear it is typical of what many caregivers and their loved ones are experiencing. I received the call at 6:35 a.m. Sunday from assisted living nurse. “Mary”.   Mother had another fall.  A large bruise and cut at her right eye, from the fall impact and her eyeglasses, and she had severe shoulder pain.  Nurse said she had called EMT’s and mother was being taken to XXX ER.   “Won’t they have to take her to YYY ER? They always say if she hits her head, she has to go to YYY ER “I asked.   Nurse says, “Oh no.  She can go to  XXX  ER. It’s closer.” I quickly dress and drive to XXX ER….and mother is not there. And I wait, and wait.  Then I receive a call from ANOTHER nurse that in fact, the EMT’s said she had to go to YYY ER as she had hit her head.  Duh. I arrive at YYY ER to find mother sitting up quite alert with a HUGE bruise and gash on her temple.  I said “Well, good morning!”  She said, “I’m sorry.  I messed up. And I asked God why he did this to me!”  I just smiled and sweetly said “Mom, God didn’t do this. He told you to wait for help and not get up by yourself, but YOU didn’t listen again!”  And we go through the drill of blood being drawn, medical history given, a CT scan and x-rays.  The staff was nice, responsive and no major cleanliness boo boos occurred -Unlike our visit there LAST March. (Hope this won’t be an annual occurrence.)  After not TOO long waiting on news, the Orthopedic Resident came to explain that the CT scan was all clear. But the shoulder was pretty much worst case scenario. She had shattered her ball and a piece of clavicle had broken off as well. It would require surgery. Due to our previous hip breaks and also friendships with two excellent orthopedic surgeons, I indicated our preference to use either of them for the surgery.   Then I was told, since we would not be using the Orthopedist on call that day and who was already in the hospital (even though “my” docs do surgery at this hospital) they would discharge mom back to the assisted living with a sling and pain meds and I could call my ortho surgeons  first thing Monday.  Hmmmm I thought. Send her back??   She then said “This is not an emergency situation so you can wait.”    Well, ok, I suppose this all makes sense – sort of. So back we go to the assisted living.  I decide, given mom’s condition that I would stay with her all night.  She seemed to be doing well with an ice pack on her shoulder, a sling, and ibuprofen.   She ate a good dinner. The staff was attentive and the nurse who was to go off duty at 11 p.m. came in to check on us at 10:30p.m.and informed me that the night nurse coming in would be Mary, whom I had never met, would come in to check on us around midnight and then would check mom every couple of hours throughout the night.   Mary had been the one who called me to tell me Mother had fallen. I settled in to Mom’s recliner with an audio book and my computer, as I did not expect I would fall asleep quickly.  I was fully awake until about 1:30 a.m and no one had come to check on Mom.  I dozed a bit and at 4:00 I decided to go to get fresh ice for the ice pack. I padded out of mom’s room, down the hall, past the large living room area where  I noticed someone   with a blue blanket over them sleeping on the sofa.   I went in to the dining room to get the ice, and came back out. As I emerged, the dining room doors thumped.  The person on the sofa sat up quickly and looked at me over the back of the sofa and said “Hey there. Are you ok?”   Not, who are you, or what are you doing, but “Are you ok?”  I said,”Yes, I’m fine. I was getting ice. Who are you? “ as I walked toward her.  By this time she was sitting up and was folding up the blanket. She did not get up.  She said “I am the night nurse, Mary. I then said “I am Jane, Ruth’s daughter.  I am staying with her tonight.  ( Lucky I was not a robber or ax murderer!) Mary said “Who?” I said, “Ruth Thomas’ daughter.” Mary said for the third time, “WHO?” And I said, “Ruth, the one who fell this morning and you called me to tell me??? I am the daughter you called!!!!!” She then said (still SITTING ON THE SOFA )  “ OH, well how is Ruth?” I said, “Funny you should ask. I was told you would be by every couple of hours to check on us and you have not been by to check”. Mary said, “Oh, I don’t check on the residents if I think they are sleeping fine. I don’t like to disturb them”. I said “Well, how do you know they are sleeping fine if you don’t go and check on them and she did have  that serious fall this morning. “ And she said “Well no one told me anything about checking on her” I said “The nurse who was on duty before you, told me that you would be checking in on her at midnight and then several times thereafter, to not be surprised when you came in the room.” Mary said “Well, maybe the aide checked on her. “ I said “No, I have been awake and no one has come and besides I was told it would be the nurse.  Thank you.”  And I proceeded back to mom’s room with the ice bag. 30 seconds later Mary came in to the room and said “So, do you need anything?” I said “No thanks. I’m fine.” She said “Ok, well I will be in the office if you need me”.  And I did NOT say, “Damn straight you better be in the office since I now awakened you from your snooze!” Ten minutes later she came back in the room and informed me “ So I went and read the paperwork and you were right. SO, it’s now about 4:30 and this can be considered a check, so someone will come back and check on her about” I said “Well, won’t you be back about 6:00 am? Mom takes her first meds, at about 6:00 am, so  won’t you be back around six -ish?” And she said “Oh, sure, if she gets meds then, I guess I will be back. But I have to pass a lot of meds, so it might not be right at six.” And I said “Correct, so that’s why I said six -ish” She said “Ok, see you later.” So needless to say, later in the morning, I had an interesting chat with the facility Executive Director. I also spoke with our preferred ortho folks who  said they would call me back  later today with surgery plan. Fast forward,  to later in the morning when mother had some sort of “episode” ….going stiff, head back, eyes wide, pupils fixed and dilated…her mouth quivering and a strange sound coming from her….yelled for nurse( the day nurse, a good one)….and after about a minute and a half mother was back with us.  Whew, but her PB was falling so we called EMT’s and went to XXX ER.   By the time we arrived there at 12:15, Mother was much more herself.  As the nurse was getting the info from the EMT’s and me,  a young resident walked by.  The nurse, looked at him and smiled and said “I haven’t killed anyone yet this morning” Well, that was good to hear. Then we had many hours of more blood work, on and off the bed pan, residents and interns coming in asking the same questions over and over and asking her if she could follow their finger with her eyes, and if she could squeeze their fingers. We also heard all the details of the other “ interesting” folks in the ER cubicles around us, including the guy next to us who had a strange rash that the nurses all said they had never seen before and he told us all he had MRSA. At one point a nurse said “Here Mrs. Thomas, let me put a diaper on you so we won’t have to worry with getting you on and off the bed pan.”   That would be most helpful, but did she have to use the word “diaper”? My mother’s lady like dignity has been challenged so many times over the past few years.  Once more I saw a familiar look of shame on my Mother’s face. At 6:00 pm we were told they would be keeping Mom and admitting her, they had spoken with OUR ortho surgeon and that was his preference.  We would get her stabilized.  Her blood work showed high white count that indicated the Uriniary tract infection we had begun treatment for just the day before.  The physician said he felt the “episode” was probably due to the trauma of the break and a sudden drop of blood pressure from moving from her bed to her wheelchair.  He was ordering a few tests including a urine test. . By that time, mother was very grouchy and VERY confused. She had not had anything to eat or drink ( well, I admit I did give her one sip of water) had NOT had her Parkinsons or dementia, meds,  her antibiotic for the UTI, ( she had only taken one dose since the problem was noted) , nor any pain meds, since early that morning.  She was becoming more and more stiff and more confused by the minute.  I ask about her meds and the nurse explained  that she would get them once we get to a real room upstairs.  She even showed my sister, who had arrived, that the meds are now entered in to the computer and should be waiting on us upstairs.  She also said she was to have taken a urine specimen but had not had time – that too, would be done when we got upstairs.  By that time, Mother was talking about  riding a bicycle, she wanted  to know when we were planning a party,  pulling at all her wires constantly, picking at the bed clothes and saying over and over “ I have to get out of here. We have to leave. We have to get out of here. Why are we here??”  The dreaded delirium had set in. Three hours later we arrived upstairs in our room. It was a double and the bed next to Mother’s bed is now empty, but is a mess and it appears someone just left. There is a bloody cotton ball lying on the tray table by that bed. You know, the kind they put on you after they take blood.   Yes, I took a photo of it.   A nurse came in and I said, “Would you mind at least removing that bloody cotton balls, we were just in the ER beside a guy who said he had MRSA so I’m a little jumpy about that.” The nurse said “Oh, sure, but everybody has MRSA these days” That struck me as a terrible thing to say.  WE didn’t have MRSA and we didn’t WANT it!  Didn’t really reflect a germ control attitude, in my opinion. After another hour, it was  ten p.m.  We asked again about the meds.  My mother who is 86 has now had this broken shoulder for about 36 hours and has had NO pain meds since 8:00 a.m. this morning. Nor any of her  usual meds.  I understand the need to wait to see if she was going to have surgery or some other procedure. But we now knew that was not going to occur, at least not tonight.    The nurse said “The hospitalist says she can have Tylenol, but he is not going to let her have the Parkinsons’ or dementia meds, nor the antibiotic.” Then, I simply snapped. I said “Then you tell him he needs to come and see me right now. It has been a very long day. Aside from the broken shoulder, that we still have not really done anything for, my mother has two and only two problems, Parkinson’s and dementia and delirium has set in. So she is going to get meds for those conditions one way or another. I can go to the assisted living and get them and give them to her myself, or we can do it the right way and get them here. And by the way, YOU should NEVER EVER say to a patient or family member that “everybody has MRSA nowadays.”  That statement was a terrible reflection on the sanitary conditions in this hospital and not what a “customer” should hear.   My mother does NOT have it and we don’t WANT her to have it!  And I am sorry to be this way, but we are very tired and this has gone on too long.” That nurse, very wisely and genuinely then apologized and said she understood and she went to get the hospitalist. He walks in and introduces himself and begins to explain that sometimes when a patient comes in they stop all meds  in case the meds are interfering with the patient’s current issues. He informs me that my mother is becoming delirious and that the parkinsons and dmentia meds will only make it worse. That with delirium, the best thing to do is to orient her to where she is and why she is here and to try to keep her calm. Honestly, he said that. Ask my sister.   That philosophy of dealing with delirium is so old school, this guy must know Fred Flintstone and live in a cave.  I have worked in the field of dementia for over 12 years.  I have never ever heard that before. I have taken workshops on delirium and read many articles on the topic. I have simply never heard that those meds could increase delirium. I said, “Do NOT tell me about delirium.  I happen to know about delirium.  My mother is here because she has a broken shoulder that needs fixed.  Tell me how these meds are interfering with THAT.  This woman has dementia,  Parkinsons and  had a severe trauma YESTERDAY MORNING,  that we still have not fixed.  She has a UTI that normally causes some delirium and she had not had her meds for that. She has not had any of the  meds  she normally takes each day.    She is on regular doses of Tylenol and ibupofin as she has chronic back and hip pain.  And now has a broken shoulder and has had no pain meds today.  Anyone with a dementia comes in to the hospital  as a delirium risk.   So all sorts of precautions should be taken so as to avoid delirium – yet none of those have occurred.  So, tell me then, how can  all that NOT be causing her delirium?????   When we arrived here today she knew that Obama was President when the ER nurse asked, she knew who she was, who I was and that she was in the hospital. Now, eight hours later she has no clue. I THINK THAT HAS HAPPENED because of what has gone on here. He then said “Do you happen to have a list of the meds she normally takes? I whipped it out of my purse in a hot nanosecond and handed it to him.  He said “I will be back”. He came back shortly and said “I have consulted with the admitting physician and we will allow ibuprofen,  Parkinson’s and dementia meds. I said, “Thank you so much.  We really appreciate it.”  And he left. I write this at 2:00 a.m. Mother is dozing but is fidgeting with the bed covers, pulling at her IV and  muttering nonsense constantly.  My sister is asleep. I am listening to the loud DRIP, DRIP, DRIP of the shower in my mom’s bathroom.  No urine specimen has been taken so no antibiotics have been given. I know you all think I make this stuff up.


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