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I think it has been three weeks since I've written about Gloria. It has not been an uneventful three weeks.
Three Thursdays ago Gloria and I started out with a normal morning -- we went out, had lunch, came back -- there were no suitable movies. I sat down to write while she lay down to have a nap. She woke up a couple of hours later, bright red, warm to the touch, clearly having trouble, saying "I'm so sick," which is not how she ordinarily describes a headache, an upset stomach, or any normal discomfort (she says "it's terrible," and then gestures to the part of her body that's bugging her). I dithered for a bit, and then bundled her into the car to take her to urgent care -- her doctor's office was closed and I didn't think she probably warranted emergency care, which was a mistake, as it turned out.
At the urgent care parking lot she vomited all over herself and my car. I took her in the bathroom there and I changed her shirt (we always have extra sweaters and things because she is afraid of getting cold) but didn't have a change of pants for her so I had to just wash and towel-dry what she was wearing as best as I could. After the usual long wait the doctor came in and said she had to go to emergency care because he couldn't rule out heart or other hospitalization issues with the resources at urgent care.
Now, for non-USians, what you need to understand is that her primary care doctor is part of a private practice which leases office space from a private medical shopping-mall sort of thing ("Valle Verde Medical Plaza"): urgent care is a separate private outfit in an actual shopping mall on the opposite end of Watsonville in the north-south direction (east-west if you're following the highway deignations, but that's a quirk of the coastline): the hospital they took her to belongs to another private corporation (headquartered in Salinas? or is Salinas just the regional headquarters of a larger hospital group? The pharmacy in the Valle Verde center belongs to a group headquartered in Palo Alto) and the ambulance that transferred her belongs to a separate private company with a satellite office five or so miles west (north if you're following the highway designation), next to the hospital they didn't take her to (which belongs to Catholic Hospitals West, which is yet another private corporation, but since CHW belongs to the Catholic Church it gets to be called private nonprofit even though it makes a profit).
If I had had the wit to realize that Gloria was going to be hospitalized, I would have cut out the urgent care, the ambulance, and Watsonville Community Hospital, and gone straight to Dominican, which for all its faults is the better hospital. Oh well.
They kept her at the hospital for a week. She had a urinary tract infection, not at all surprising as her grasp of hygeine has been crumbling and we had been behind the curve in taking over (i.e., she didn't want other people cleaning her up and we didn't force the issue, we just fretted to each other about it). After a week they transferred her to a skilled nursing facility.
Let me just say here if you have any say about what somebody is given to control their agitation, refuse Halidol. It didn't make her calmer, it just made her weak and even more confused. We thought she had lost tremendous ground cognitively, never to regain it, and it was horrible to sit next to her and her her muttering "help . . . help ... anybody? got to go home, help . . ." and not be able to get through to her or even get her to look at us.
A day at the skilled nursing facility, where there are very strrict rules about medicines, and she had returned to almost pre-illness consciousness. She has lost some mental capacity, but much more in line with the general trend of the condition of progressive aphasia, not the catastrophic loss she seemed to have in the hospital. Let me say this one more time: Halidol does not make the patient calmer. It just makes the patient weaker and easier to manage. It makes the patient less rational and more anxious, but easier to ignore.
Halidol is not kind.
Two days at the skilled nursing facility and Gloria was walking again, and trying to refuse the walker and walk on her own. We had to persuade her to use the walker for another week and a half because we couldn't get rid of the Foley catheter yet and really she wasn't that stable yet. Ever since, she has spent most of her waking hours on the move. She wants to leave. She wants to go home. She has no patience. But she's going home next week.
There are criticisms to be made of Pacific Coast Manor, but it is still overall a very well-run, very warm, very lively place. It seems to serve two populations. There are the acute rehab patients like Gloria, who have been ill or have had an injury or a surgery and are being treated before they go home,. Then there are the long-term care patients, whose condition will probably not improve enough for their families to care for them. You can't tell who's who by looking at them once or twice. There's a good staffing ratio, but they're really glad that we're there all day. For one thing, Gloria is still trying to escape whenever someone from her family is not there (Elaine and I count as family). They have this "wanderguard" bracelet on her that causes an alarm to go off if she walks out the front door (deactivated rather easily by sticking a finger or a pen into a depression at the bottom of the sensor box: I wonder that some of the wander-prone don't figure that out), but there are at least two doors that I have found that are not alarmed, the one by the laundry and the one that goes out of the physical therapy room, and neither of those places is always staffed. So when I'm with her, we walk and walk and walk and walk, mostly laps around the facility, but also out into the neighborhood a little. I've been trying to sign her out for longer walks -- it's only four blocks to the ocean and there's a pretty little park right across the street (which I'd have to convince her to let me wheel her in because it's on the bank of Soquel Creek, too steep for her to walk -- hello Soquel Creek, my darling urban watershed I monitored all summer!), but she balks when she realizes I'm not going to put her in my car and take her home.
They have a lot of activities going on, some which seem kind of dumb but some of the patients always participate (and not just always the same ones). The most annoying that I've seen is the Cowboy Church on Friday afternoons. The Cowboy Church is headed up by this big guy who is the maintenance director of the place. He has a five (six?) piece band, all these kind of recovery-looking guys -- you know what I mean, they look like they led a hard life and credit leaving their rough and rowdy ways behind to Jesus's tender mercies and the fear of God. The frustrating thing is musically they're pretty hot so you kind of want to listen to them as they go on and on and on, but they spend most of the time bragging on how they have worked black magic on God (no that's not how they say it, but they do boast that when they pray to God for something to happen, it happens, just like that, and they give weirdshit promises that God will do obscure things for the old folks -- what does it mean to say "He will establish you?").
Yesterday was Gloria's 80th birthday and she got sung to over and over. First the activities director who is probably over 21 but only just came to her with a mylar balloon. Gloria's daughter (here from Australia, spending a klot of her time clearing uop Gloria's house and doing research on the next phase of care) bought her a kid's picture book and an ice cream cake. The Cowboy Church guy ambushed us with a full instrumentalized version, which was nice, but he had to ram a "Jesus loves Gloria" verse down our throats, even though what he must have observed is that Gloria spent all afternoon running away from Cowboy Church! -- it happens in the front lobby so it's almost impossible to avoid if you're doing laps. Gloria loves music, but she's a Unitarian.
Gloria's definitely lost more language than cognition, though. She's doing more communicating with gestures. She's become even more clingy than she was, which is understandable since we abandon her for several hours at night. Thursday she wore Shelley's jacket for a long time. Friday she wore my jacket, which was so much too big for her that it was cute. It was my jean jacket that I try to collect pins on (my election volunteer pins are currently lost, and the Lenin pin won't stay on, so it has only the Heart Association donor pin, the Watershed volunteer pin, and a thing from Germany with the hammer and sickle replaced by a divider and hammer indicating that East Germany used to think that it was "workers and intellectuals" not "workers and peasants").
This is too long already, so no other fronts: instead, I'll spam. Later.
Three Thursdays ago Gloria and I started out with a normal morning -- we went out, had lunch, came back -- there were no suitable movies. I sat down to write while she lay down to have a nap. She woke up a couple of hours later, bright red, warm to the touch, clearly having trouble, saying "I'm so sick," which is not how she ordinarily describes a headache, an upset stomach, or any normal discomfort (she says "it's terrible," and then gestures to the part of her body that's bugging her). I dithered for a bit, and then bundled her into the car to take her to urgent care -- her doctor's office was closed and I didn't think she probably warranted emergency care, which was a mistake, as it turned out.
At the urgent care parking lot she vomited all over herself and my car. I took her in the bathroom there and I changed her shirt (we always have extra sweaters and things because she is afraid of getting cold) but didn't have a change of pants for her so I had to just wash and towel-dry what she was wearing as best as I could. After the usual long wait the doctor came in and said she had to go to emergency care because he couldn't rule out heart or other hospitalization issues with the resources at urgent care.
Now, for non-USians, what you need to understand is that her primary care doctor is part of a private practice which leases office space from a private medical shopping-mall sort of thing ("Valle Verde Medical Plaza"): urgent care is a separate private outfit in an actual shopping mall on the opposite end of Watsonville in the north-south direction (east-west if you're following the highway deignations, but that's a quirk of the coastline): the hospital they took her to belongs to another private corporation (headquartered in Salinas? or is Salinas just the regional headquarters of a larger hospital group? The pharmacy in the Valle Verde center belongs to a group headquartered in Palo Alto) and the ambulance that transferred her belongs to a separate private company with a satellite office five or so miles west (north if you're following the highway designation), next to the hospital they didn't take her to (which belongs to Catholic Hospitals West, which is yet another private corporation, but since CHW belongs to the Catholic Church it gets to be called private nonprofit even though it makes a profit).
If I had had the wit to realize that Gloria was going to be hospitalized, I would have cut out the urgent care, the ambulance, and Watsonville Community Hospital, and gone straight to Dominican, which for all its faults is the better hospital. Oh well.
They kept her at the hospital for a week. She had a urinary tract infection, not at all surprising as her grasp of hygeine has been crumbling and we had been behind the curve in taking over (i.e., she didn't want other people cleaning her up and we didn't force the issue, we just fretted to each other about it). After a week they transferred her to a skilled nursing facility.
Let me just say here if you have any say about what somebody is given to control their agitation, refuse Halidol. It didn't make her calmer, it just made her weak and even more confused. We thought she had lost tremendous ground cognitively, never to regain it, and it was horrible to sit next to her and her her muttering "help . . . help ... anybody? got to go home, help . . ." and not be able to get through to her or even get her to look at us.
A day at the skilled nursing facility, where there are very strrict rules about medicines, and she had returned to almost pre-illness consciousness. She has lost some mental capacity, but much more in line with the general trend of the condition of progressive aphasia, not the catastrophic loss she seemed to have in the hospital. Let me say this one more time: Halidol does not make the patient calmer. It just makes the patient weaker and easier to manage. It makes the patient less rational and more anxious, but easier to ignore.
Halidol is not kind.
Two days at the skilled nursing facility and Gloria was walking again, and trying to refuse the walker and walk on her own. We had to persuade her to use the walker for another week and a half because we couldn't get rid of the Foley catheter yet and really she wasn't that stable yet. Ever since, she has spent most of her waking hours on the move. She wants to leave. She wants to go home. She has no patience. But she's going home next week.
There are criticisms to be made of Pacific Coast Manor, but it is still overall a very well-run, very warm, very lively place. It seems to serve two populations. There are the acute rehab patients like Gloria, who have been ill or have had an injury or a surgery and are being treated before they go home,. Then there are the long-term care patients, whose condition will probably not improve enough for their families to care for them. You can't tell who's who by looking at them once or twice. There's a good staffing ratio, but they're really glad that we're there all day. For one thing, Gloria is still trying to escape whenever someone from her family is not there (Elaine and I count as family). They have this "wanderguard" bracelet on her that causes an alarm to go off if she walks out the front door (deactivated rather easily by sticking a finger or a pen into a depression at the bottom of the sensor box: I wonder that some of the wander-prone don't figure that out), but there are at least two doors that I have found that are not alarmed, the one by the laundry and the one that goes out of the physical therapy room, and neither of those places is always staffed. So when I'm with her, we walk and walk and walk and walk, mostly laps around the facility, but also out into the neighborhood a little. I've been trying to sign her out for longer walks -- it's only four blocks to the ocean and there's a pretty little park right across the street (which I'd have to convince her to let me wheel her in because it's on the bank of Soquel Creek, too steep for her to walk -- hello Soquel Creek, my darling urban watershed I monitored all summer!), but she balks when she realizes I'm not going to put her in my car and take her home.
They have a lot of activities going on, some which seem kind of dumb but some of the patients always participate (and not just always the same ones). The most annoying that I've seen is the Cowboy Church on Friday afternoons. The Cowboy Church is headed up by this big guy who is the maintenance director of the place. He has a five (six?) piece band, all these kind of recovery-looking guys -- you know what I mean, they look like they led a hard life and credit leaving their rough and rowdy ways behind to Jesus's tender mercies and the fear of God. The frustrating thing is musically they're pretty hot so you kind of want to listen to them as they go on and on and on, but they spend most of the time bragging on how they have worked black magic on God (no that's not how they say it, but they do boast that when they pray to God for something to happen, it happens, just like that, and they give weirdshit promises that God will do obscure things for the old folks -- what does it mean to say "He will establish you?").
Yesterday was Gloria's 80th birthday and she got sung to over and over. First the activities director who is probably over 21 but only just came to her with a mylar balloon. Gloria's daughter (here from Australia, spending a klot of her time clearing uop Gloria's house and doing research on the next phase of care) bought her a kid's picture book and an ice cream cake. The Cowboy Church guy ambushed us with a full instrumentalized version, which was nice, but he had to ram a "Jesus loves Gloria" verse down our throats, even though what he must have observed is that Gloria spent all afternoon running away from Cowboy Church! -- it happens in the front lobby so it's almost impossible to avoid if you're doing laps. Gloria loves music, but she's a Unitarian.
Gloria's definitely lost more language than cognition, though. She's doing more communicating with gestures. She's become even more clingy than she was, which is understandable since we abandon her for several hours at night. Thursday she wore Shelley's jacket for a long time. Friday she wore my jacket, which was so much too big for her that it was cute. It was my jean jacket that I try to collect pins on (my election volunteer pins are currently lost, and the Lenin pin won't stay on, so it has only the Heart Association donor pin, the Watershed volunteer pin, and a thing from Germany with the hammer and sickle replaced by a divider and hammer indicating that East Germany used to think that it was "workers and intellectuals" not "workers and peasants").
This is too long already, so no other fronts: instead, I'll spam. Later.
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