Alzheimer's disease · Caregiver · Hospitals

Bad month / March 30, 2008

On March 18 my mother fell at her assisted living and was taken to a local hospital. I had just gotten into work when I got the call–I met her at the ER and so began the long wait. She had a UTI and was dehydrated, but x-rays and CT scans revealed nothing broken. But she was clearly in severe pain that ran down her left leg–whenever someone tried to elevate her upper body she nearly screamed.

The doctor admitted her for observation and I was initially pleased with the situation. On the geriatric wing is a large room beside the nurses’ station, with a window between the two and a CNA on duty in the room. My mother was put in this room, which was a relief. Although she was surprisingly calm during the 6-hour emergency room wait, I knew it was only a matter of time before she became agitated. My sister and I stayed with her until she fell asleep.

The first phone call I received the following morning was from the discharge nurse. The hospital was already trying to send her home–despite her obvious pain, and despite the fact that her assisted living facility would not take her back in that condition. And because she had not been officially admitted to the hospital, Medicare would not cover rehab. I explained this to the nurse, who suggested that I private pay for rehab. I don’t remember what I said to that, but she was stuck on the idea of discharge.

And so my sister and I decided that the best course was to plant ourselves by my mother’s bed and ask to see the attending physician. When she arrived we made it clear that we weren’t going anywhere until something had been diagnosed, and so she ordered an MRI and the hospital officially admitted my mother.

The MRI revealed an acute fracture of the T12 vertebra. By this time, my mother had been flat on her back for three days, which worried me. A Khyphoplasty (”glue” is injected into the fractured bone to stabilize it) was scheduled for the next day, but could not be done because my mother’s Coumadin level needed to come down. By this time it was Friday, and we ended up having to wait until Monday for the procedure, which went well.

The following day the hospital got its wish and discharged my mother to its affiliated skilled nursing unit for rehab. She was very confused and tired–the result of all the environmental changes and pain medicine, along with the UTI. We were happy to see my mother dressed in something other than a johnny when we went to see her the next day, but all she wanted to do was sleep. She was alert on the following day but not too articulate, which was understandable.

My sister got a call the day after that: my mother was being taken to the hospital with a fever and elevated heart rate. Off to the emergency room again, but this time we made sure she was taken to the hospital where her doctor has privileges. After x-rays and urine and blood samples, the ER doctor told us she had pneumonia.

I’d never seen my mother as agitated as she was that afternoon. She was completely incoherent at times, and then would revert to a calmer state. At one point she wondered if my sister weren’t too warm with the sweater she was wearing; a few minutes later she was grabbing at her johnny and catheter, and trying to tell us something–but we couldn’t figure out what.

So today, Sunday, is her second day in the hospital. I came home from the ER on Friday prepared for the worst. I know that aspiration pneumonia is frequently the last straw for Alzheimer’s sufferers. When we visited her on Saturday we found her sitting up–a good sign–but again trying to get her johnny off. She was very distant and uncommunicative, but her skin was cool and fresh-looking. She sat up for several hours (dozing most of the time) and we left when the nurses put her back to bed. They told us she’d eaten a good breakfast but not too much for lunch.

So I don’t know what will happen. I’m on my way to the hospital now. If she pulls through, I’m not sure she’ll be able to return to Garden Manor. What I’m thankful for is that her doctor will be able to see her tomorrow (he was not on the staff at the last hospital)–I trust him completely.

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