The Mom & Me Journals dot Net: Cataloguing the Highlights

The definitive, eccentric journal of an unlikely caregiver, continued.

Apologia for these journals:
    They are not about taking care of a relative with moderate to severe Alzheimer's/senile dementia.
    For an explanation of what these journals are about, click the link above.
    For internet sources that are about caring for relatives with moderate to severe
        Alzheimer's/senile dementia, click through the Honorable Alzheimer's Blogs in my
        links section to the right.

7 minute Audio Introduction to The Mom & Me Journals [a bit dated, at the moment]

Monday, June 02, 2008

Cataloguing the Highlights
It seems imperative that I begin to get everything down regarding this recent episode in my mother's health into which I involved the hospital here in Prescott, hospice and rehab. Right here and now I'm just going to catalog highlights that I want to be sure to remember, then fill in the detail later.

Sometime between 2200 and midnight on 5/14/08 I took Mom to the ER because her legs were collapsing underneath her.
I provided the ER with a detailed list of all her chronic conditions and all her current, regular medications. At one point I noticed one of the nurses transferring this information to an official form. I also provided the hospital, immediately upon her arrival, with copies of all my POAs, which included my General Durable Power of Attorney, my Health Care Power of Attorney and my Mental Health Care Power of Attorney. I provided these copies even though I already knew that they've been given these documents before and supposedly have them on file.
A bit later I was able to talk the ER doctor into letting me look at her labs over his shoulder as he scanned them into the computer. Everything looked normal for her.
Between 0200 and 0300 on 5/15/08 I was informed that my mother was going to be admitted. I went home.
The next day her condition appeared to have degraded. She was losing the strength in her upper body and her speech was degrading; specifically, I could see that she was fighting to form words and sentences but wasn't quite making the connection between her brain and her mouth.
I assumed that her condition was being well monitored and that the medical personnel were trying to find a reason for her collapsing legs. In the meantime, I made it clear to medical personnel that the collapsing legs part of the episode was very much like her low sodium incident in August, 2004, except that the reason didn't apply in this case, but my assumption was that everything that was beoming apparent about her condition was due to some sort of physical problem that I was hoping could be addressed, after which I believed she would, again, benefit from short term rehab.
That day, 5/15/08, I also insisted on going over her medication list and discovered some mistakes, specifically in the administration of her glipizide and lisinopril. I saw to it that all mistakes were corrected with the charge nurse on the floor that day. Because, I assume, I mentioned the possibility of short term rehab, Mom was assigned a case worker to handle further referrals.
On Friday, 5/17/08, I was informed by the staff that Mom was being transferred to rehab that afternoon. I questioned this with the social worker because, as I explained, by any stretch of the imagination my mother had not been in the hospital three nights, which Medicare requires before they will pay for a rehab stay. By the way, I also mentioned, do we even know why Mom's legs are collapsing, why she is dementing further and why she is losing her ability to control the rest of her body as well as she had been able to when I brought her into the ER Wednesday night?
The social worker responded, admitted that I had caught an error that needed to be corrected and that my mother would, indeed, be staying in the hospital at least two more nights.
In the meantime I noticed she had been put on a saline drip, which was fine with me since she was having trouble feeding and hydrating herself.
Mom's condition continued to degrade through Saturday, 5/17/08. I operated under the assumption that tests were being done and attempts were being made to discover the cause of this degradation.
Some time Saturday I decided I wanted to look at my mother's chart to determine what had been done. I had a hell of a time gaining access because, the nurses argued, although all my powers of attorney were in place, my mother was being asked if I could see her chart and she was saying no. This was proven to me as one nurse questioned my mother about me seeing her chart and she said, "No," then, explained, in very halting speech, that she didn't think it was necessary for me to see her chart. It was pointed out to me that my HCPOA extended only insofar as my mother was unable to "communicate" her wishes in regard to her health care and, clearly, "she could talk".
I left the hospital for a few hours to mull this over. When I returned I questioned the wisdom of assuming that my mother being able to talk was a poor determination of how far my role extended in her health care. After all, my mother had not wanted to go to the ER on Wednesday, had clearly stated several times while in hospital that she wanted to go home and had also said she was not interested in going into short term intensive rehab, yet the hospital staff had taken my decisions over hers. About four nurses became involved in this heated discussion, which took place in the hall outside my mother's room. Finally, the hospitization doctor stepped in to resolve the problem. He administered an intensive, off the cuff oral interview to my mother, in the presence of all these nurses who believed they were protecting my mother, and proved beyond a shadow of a doubt that my mother was clearly demented and not able to make wise decisions regarding her medical care. Thus, I was allowed access to her chart.
I reviewed the chart with the hospitization doctor that night. This is when I discovered that her diagnosis mentioned nothing about her collapsing legs, but classified her reason for admission as "failure to thrive". In addition I discovered that the hospital had put her on Effexor (for depression) and Aricept (for the dementia that the nurses had been arguing was insignificant and was no reason for me to see the chart). I immediately had both drugs cancelled, against the protests of the doctor. I also argued that she was not "failing to thrive", that, in fact, something else was going on that needed to be investigated.
Sunday morning I was informed by another case worker that had been assigned to my mother that she was due to be transferred to rehab that afternoon. Within hours, though, it was apparent to me that my mother had degraded to the point that she would not be able to participate in her own rehab. I argued this to the hospitization doctor, who finally agreed that I was right. The transfer was canceled and a neurologist was called in to evaluate her, under the assumption that something was going on in her brain.
With the help of a podcast that clearly demonstrated to the neurologist what my mother had been like the morning previous to her leg collapse and, as well, the evening of her visit to the ER, and with the help of her last head CT, which I had on my computer and brought in for the doctor to read, which confirmed that her brain profile was unchanged since 2004, the neurologist guessed that she may very well be suffering from pneumonia, despite the lack of fever and coughing.
That afternoon her lungs were X-rayed and the diagnosis of pneumonia was confirmed. She was immediately put on IV antibiotics and the fight to overcome the pneumonia began.

To be continued.
- posted by Gail Rae @ 06:23 email

this post

Comments:

Excellent documentation. Great records to review.

# posted by

Patty McNally Doherty : Tue Jun 03, 04:58:00 AM 2008