Saturday, January 17, 2009

Caregiving gets bloody

Thursday late afternoon (January 15) was a crazy ride.

Thursday and it's almost dinner time. Mom made teriyaki chicken. Apparently dad is not partial to teriyaki chicken. But this was an extreme was to get outta dinner. I usually just feign a stomach ache.

Dad's "bedside commode" was too far away from the couch. Dad used the commode & then attempted to transfer to couch without putting weight on the poor left foot.

As dad tried to keep weight off his left foot, he gently slid to the floor. However before he was safely on the floor, dad struck his head on the corner of a brick hearth. OMG.

The amount of blood was crazy. (I grew up in this same house with the massive brick hearth together with two older brothers. We wrestled, fought, did gymnastics and I had some crazy slumber parties in that room. Absolutely no head injuries. But I digress)

I am somewhat embarrassed to admit that I was hysterical on the phone with 911 and yelling out instructions to my mom while at the same time putting family pets behind closed doors. Don't get me wrong. I am typically not a sissy when it comes to blood. But this was crazy.

The amount of blood from this head injury was like a horror movie. I even e-mailed dad's orthopedic surgeon and explained the blood and assured the surgeon that dad was going to die. Okay, perhaps a bit traumatic.

911: "Is the blood running of squirting?"

Me: "Squirting"

911: "Must be an artery. Let me speak to your mom."

I put the calm 911 operator on speaker phone. The 911 operator instructed mom to push hard on the squirting until it stopped. "If blood is still coming out, you aren't pushing hard enough."

Meanwhile I scurried around the house and made sure that all family pets were locked up.

The 911 operator (Wake County, NC) was phenomenal. He stayed on the line with me until the Cary Area Rescue Squad and Fire Department arrived.

I thought it wouild be appropriate to let dad's treating Duke University surgeon know dad had an accident and was en route to the Duke ED. Silly, naive me.

While the EMS personnel were strapping dad on a board, I called Duke University Hospital and asked to speak to the orthopedic resident on call. (I told the resident that dad's orthopedic surgeon should know dad was injured and on his way to ED.

Wow. I know the orthopedic resident on-call does not know my dad but this
goomer was so indifferent that I felt like I was bothering him about his boss' patient.

Oh yeah, almost forgot: Duke University Clinic doctors have no communication with Duke University ED doctors. What am I? Dense? Haven't I been down this road?

I asked the Cary Area Rescue Squad if they would take my dad to Duke ED in Durham. The EMS said they culd but shy bother with that trip to Duke. They thought dad should go to Wake Med in Raleigh so that he would be cared for sooner. Okay. These are the professionals. I took their advice

The whole time the blood was squirting and about 8 EMS personnel were in the family room, dad was completely coherent. No LOC, no vomiting, no confusion.

Then before I could gather together dad's meds and a couple bottles of water for me, dad was out and on a stretcher and in the rescue squad.


The ED was tough. I did not think about the rescue squad's choose of hospitals. But mom reminded me while we were processing dad into the Wake Med ED, that this was the same ED where my oldest brother was brought when he died in a car wreck.

Mom had never actually been with me when I helped dad through an ED visit. I hope I taught mom that even as the patient's wife, she has some control.

Of course I hoped and expected that this Wake Med ED visit would be less traumatic then when my big brother Roy died.

Dad was a ED bed for several hours before any CT scans were done. Dad's hand (and in fact entire body) was covered with dried blood. Dad was still wearing the same bloody pajama bottoms. The crusty blood from the dried bloody pajama bottoms were sticking to my dad. I'm sure that was horrible uncomfortable.

I asked the nurse for warm, wet towels to clean his hands and stomach. I got the wet towels. But apparently dad's insurance does not cover warm water. Bummer. Dad was a good sport with the cold, wet rags.

I asked the nurse for a blanket for dad. He was cold. That request took 15 minutes. And the blanket was not even warmed. Again, the insurance issue probably required chilly blankets of his bloody and half naked body.

Dad's ED bed was spit distance (geez, I wish I had thought of that before now) from the nurses' station. The EMS came in and handed off patients. Wow. This was better than watching an episode of Nancy Grace.

I was so disturbed to clearly hear the first and last names of incoming patients. I knew the name of:

1. the male patient who was a known morphine seeker,

2. the female patient who overdosed and was apparently providing some degree of humor to the nurses,

3. the name of the male Hispanic patient who attempted to escape a jail. Apparently the patient/inmate suffered some wounds from the bob-wire.

Does HIPPA not apply in an ED?

I also heard about a colleague of a female nurse who was anorexic.

Then, the male nurse-ish person came by dad's room and informed us that he was taking dad for ex-rays and that he would be back within 30 minutes. Clearly, this young man did not know me or my type.

Me to young man: "Any reason that I can't follow and stay with my dad until the CT is actually taken?"

You would have thought that I asked to perform the surgery myself.

The young man looked confused. But he really had no choice. Mom looked horrified. I told mom to just relax in the chair and I would follow with dad.

I kept talking to dad so that he could hear my voice. "I'm right here dad." "This is all good." "I trust everyone here." "They just need to check your brain and neck."

It really does not matter whether the patient is 5 or 105. They are scared and hospitals are cold and intimidating. Stay with your patient.


I sat in a chair outside the CT room. The "control room" of the CT scan was being run by goomers. (It's okay, I think that legally I can use that word since I do not know the Wake Med Raleigh employees' names. In fact Wake Med employees only have their first name on the name tag "Nurse Mary."

So as I am sitting down in the hallway waiting for dad's CT, I am hearing the three women and the one man in the CT Scan Control Room talking about how some fellow employee was disciplined and he was supposed to only receive an oral warning . . . but . . . the poor fellow received a written warning. "How can they do that?" "He needs to complain to someone."

Meanwhile the young blond female tech who was actually operating the CT Scan was rudely barking ambiguous orders at my dad. "Stop moving. "Stay still." "I see you moving your fingers."

Recall that dad is still covered with dried blood that I could not completely clean with a cold, wet rag.

The finally straw was when the CT Scan machine operator tech chick complained to her colleagues "he keeps moving, what am I supposed to do with him?" In what reality is that attitude necessary. I heard my dad in the CT room. He sounded terribly unconfortable. And remember, his head was still bleeding!

I calmly stepped into the doorway and calmly reminded the techs that the patient is scared. I suggested that if they would speak to him in a calm, kind voice then he might be less frightened.

The techs slammed the door shut so that I could not hear them any more. Too late.

Good grief. How does one qualify to be a CT Scan tech? Is this a six month on-line course from a foreign country? Were the techs working as TSA airport screener employees last week?

The patient (my dad) is a 75 year old Stage 4 cancer patient with a long standing infection and a very recent serious blow to the back of the head.

I have made this statement a thousand times --- unless the hospital or ED patient is dad's prior clinic physician then they are strangers. Absolute strangers. And scared, elderly, sick patients do not inherently trust strangers. That lack of trust does not make the patient demented or uncooperative. Just human.

As patient advocates we are duty bound to demand that the medical profession treat our patients respectfully.

Five hours later, the CT Scan was read. Brain and neck looked fine. Dad had lost about 500 ccs of blood with the injury. No need for transfusion.

There was a half-hearted effort to clean to blood from his hair. Four staples placed. A turban placed by two giggling nurses. Then I was told to bring the car around.

The DC instructions were a joke. Signatures were in the form "/staff sig/." The DC nurse told me that results from labs and x-rays would be confirmed within 48 hours. I asked her what labs were taken and the DC nurse replied that "only this is just a form." Then the DC nurse then giggled and showed mom and me a page that automatically prints out that will let dad back into class. Ha-ha, isn't it funny that we do not take the time to prepare client specific DC papers??

I questioned whether dad had a concusion and what I should watch for. "If his condition worsens, bring him back."

I questioned whether dad should try to eat or drink before he leaves. (Duke always would do that to make sure he could keep foot down.) Oh, no time for that. The nurses had more gossiping about patients and discussions about colleague discipline.

Dad was home by 1:00 am Friday.

Friday early morning sleep was tough. I slept with the "daddy monitor" in case he needed me. He did. His head was (and still is) bleeding when he lies his head on a pillow. I helped dad transfer safely to the bed-side commode.

Dad was still cognizant that he had a bad leg that he should not stand on. But he was scared of falling. I could not blame him.

BIG CHANGE when dad woke up Friday morning. Dad did not remember ever getting married to mom. He did not believe I was his daughter. Dad even accused mom of trying to ruin his reputation. Uggh.

I reminded myself to stay calm. He's had a bad head injury. Maybe this is temporary. Mom and I showed unconditional love and support to dad all day Friday.

By Saturday morning things were much better. Dad remembers more. But he feels weak and sick-ish.

More later. This ED visit definitely reminds me of more ways to advocate . . .

I just need rest.

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