Unfolding

At first annoyance. Little things not done. Big things skipped. Then behavior began to falter. The evidence was first unexplained behavior. Uncharacteristic missteps. Faltering movements. Missed handles. A foot placed in the wrong position, then a trip, and a fall. The falls were happening too frequently.

Then, food left on plate. Mealtimes became time consuming affairs. Still there was food left on the plate. Then skipped meals. Couldn’t be certain. But the food was being tossed from the plate, scraped into the garbage disposal or the waste can.

Medications had always been a regime. Time consuming and daily. Rhythmic opening and counting out of pills. Scheduling blood sugar tests, adjusting insulin pump settings, and still more pills.

This routine became sketchy. No longer routine. Odd times popped up. The schedule was off.

In later days the trip to the bathroom became arduous and lengthy. Not in steps, only measured in time.

Then a call for help, the necklace panic button to the emergency service. Three calls in less than an hour. Each call investigated and determined manageable. All except the last call. That one I felt should be accepted. I did not know what was happening, just that it wasn’t good.

So, I asked the service what protocols were followed in such circumstances. The operator answered with a suggestion to let the paramedics visit to determine what they could do and what they would advise. I took the advice. The EMTs arrived and settled him in a seated position. They removed soiled clothing. They put on presentable shirt and pants. The patient was noncommunicative. They advised a trip to the ER.

They took him and I beat them to the hospital in the car. The ER visit was quickly established. Tests were run. Dehydrated. Malnourished. No energy. Blood sugar was low. Blood panel tests showed the need for a transfusion. That was arranged. Hours later we received word that he would be admitted for observation, an overnight thing.

Moved to a hospital room, the overnight began in mid-evening.

Two weeks later he was released and transported to physical therapy at a local nursing home. Medical staff had stabilized him at long last. Blood workups were clean and healthy. Other symptoms continued to be thready and in need of nursing care. But the primary need was energy, stamina and mobility under self-management. Hence physical therapy.

Two to three weeks of therapy was prescribed. We have now completed three weeks and he remains for a fourth. Staff is pleased with his progress toward satisfactory mobility. Medical questions remain. Diabetes. Laryngectomy and stoma maintenance. Lung functioning without bronchitis or congestion. Regulating Parkinson’s and lessening its impact. Nursing care was stepped up. But the need persists.

We are apart now five weeks going on six. Daily trips to the hospital were replaced with daily trips to the nursing home. Mood swings of the patient were frequent and deep. Feisty, stubborn.

Complaints of skipped meals, those not served. When checked the complaints were false. Food was served to every patient on schedule, just like normal. He had forgotten. It was only two hours ago. But to him it was real. More instances of similar complaint. Same answer. It had slipped his mind.

So now we wondered anew about symptoms. Was he making progress? Or wasn’t he?

Medical staff is forming an opinion on selfcare. Can he do it? Should he be sent home? Will he fall back into what precipitated the ER visit in the first place? Is this to be a recurring event? And what happens on the home front for personal care? Can family and aging spouse keep up with the needs, demands?

No answers to these questions. But they are asked. They are pondered. No answer yet.

We are wondering when the insurance company and Medicare will balk and demand an end to nursing care. If so, then the options are a move to permanent nursing home care, or at home care with visiting staff. Will family be able to fill in the gaps?

Still no answers to these questions. Just the question mark. Stated or left unsaid, the question mark remains in full view.

February 20, 2023

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