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‘Senior ER’ designed to reduce stress for dementia patients

emergency room

Photo by Kenn W. Kiser

One of the most frightening calls I received when Dad was in memory care was that he had been taken to the emergency room. Unfortunately, I received several similar calls over the course of the year Dad was in residential care.

The emergency room visits were usually prompted by falls. Even if Dad seemed OK, regulations required the memory care staff to send Dad to the hospital to be checked out. The worst part was that no staff member accompanied Dad. I can’t imagine the confusion Dad must have experienced, on top of his dementia, with the chaos that accompanies an emergency room visit.

Even for a person without dementia, the emergency room is a daunting experience. I’ve only been to the ER  once as a patient, in high school, and it was an exhausting, fruitless experience. I’ve been to the ER several times with others having medical issues, and it is always a nightmarish experience. Why do medical emergencies seem to always happen in the middle of the night? Really though, it doesn’t matter if it is high noon, emergency rooms and hospitals in general seem to be caught in a time warp where it always feels like it’s 3 a.m.

There is so much hurry up and wait. People rushing in and out. Poking, prodding, medications being shoved in your face, or pumped into a vein. So many questions that have to be answered rapidly, and repeatedly. It’s enough to rattle a mentally sound person.

That’s why I am optimistic that some hospitals are reinventing the ER experience for those with dementia. Lutheran Medical Center in Denver was recently profiled for its Senior ER program. They’ve taken half of their emergency room space and retrofitted it to make it a more soothing, less chaotic experience. Everything from mattress thickness to lighting and noise level has been moderated to prevent the onset of delirium, which can hasten death.

The Senior ER has been such a success that people of all ages are asking to be admitted to that wing.

 

 

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Memories of hospital visits

I came across photos recently of when my mother was first in the hospital, recovering from surgery after her delayed colon cancer diagnosis.

The photos were taken in the ICU, a day or two after her surgery. I thought they captured the conflicting set of emotions that family members experience when a loved one is in the hospital.
Joy mom hospital
I paced many a hospital hallway in those days. When I needed a break from staring at Mom’s frail body hooked up to so many machines, I would stand in the doorway and watch the hushed but high activity taking place on the floor. People moaning uncontrollably in pain, relatives leaving a patient’s room looking pale and worried, children laughing and playing, blissfully unaware of the sadness and fear surrounding them.

There are so many emotions one experiences during these times, from fear and anxiety to hope and even a few much-needed laughs. Hospitals are like other worlds, with their own time structures, rules and cast of characters. For those working there, it’s just another day on the job, for patients, it can be a matter of life and death. Visiting relatives get to see it all.
joy mom hospital 3
While you learn a lot about humanity inside those hospital walls, I hope to never be back inside one, or at least not for a very long time.

What lessons have you learned from hospital visits?

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Doctors dropping the ball on nursing home transfers

Anyone who has spent any time in a hospital, whether as a patient or a caregiver knows that seeing the doctor is like finding the holy grail. I remember endless hours just waiting for the elusive doctor to appear, just so he could take a cursory glance at my mom or dad, flip through the chart, and then provide the signature we’d been waiting all day for. This is especially frustrating during hospital transfers.

hospital hallway

A recent University of Missouri survey of that state’s nursing home staff members found that there is poor communication between the doctors at transferring hospitals and physicians on staff at the admitting nursing homes. The survey also found that orders are often incomplete and difficult to read. The transfer process can take hours, creating a frustrating experience for both staff and families.

I wrote recently about the guilt I felt about Dad’s last minutes in this world. His DNR order had not transferred from the hospital to the skilled nursing facility, so the nursing home staff were legally required to take all measures to save his life when he collapsed in the shower. The result of that failure: my dad suffered broken ribs as he died.

The blame for this failure is not just on the doctors, hospitals and nursing homes. As family members for loved ones who are ill, we become patient advocates. I remember wondering if the DNR order for my dad had transferred, but I never inquired with the staff at the skilled nursing facility. It had been so difficult to get Mom to agree to the DNR at the hospital, I frankly did not want to deal with that drama again. I hoped Dad would pass quietly on his own, but as many of you know, that often doesn’t happen.

So yes, as patient advocates we need to demand better communication between the hospital staff and nursing home staff. But we also need to check behind them, and then double-check, to make sure medical care orders are recorded properly. Dealing with these issues may be frustrating, but it is much better to know that you tried than to have to live with a lifetime of regrets.

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A storm of emotions

Today was Mom’s surgery day. We had to be at the hospital before sunrise, and the air outside was swirling eerily, a rush of warm wetness with an undercurrent of bitter cold wind. A winter storm warning was in effect, but no one knew quite what Mother Nature would bring.

It was a relief just to get Mom to the hospital. Then she was taken and I was left to sit and stare at the clock in the waiting room, and try to occupy my rushing thoughts like I had done so many times before with Dad. It began to rain, with the skies dark and bruised with clouds.

hospital

Almost two hours dragged by before I receive word Mom was out of surgery. The doctor rushes out and lets me know Mom did great and everything went as planned.

The rain began to pound harder, and the wind picked up with it. Ice pellets start to pop off the ground in the hospital’s garden.

I am led back to see Mom in ICU. She is calm and peaceful, just like Dad had been when he was sedated last year while on a ventilator. There is a serenity that could almost pass for death, but the machines and Mom’s rising chest prove she is quite alive. She opens her eyes and recognizes me. With Mom, I expect this more, but I remember being caught off guard when Dad seemed to recognize me a little over a month before he died.

CNN was just beginning to report the Connecticut school shootings while I was stroking Mom’s forehead in ICU.

I walk back out to the hospital lobby to let Mom rest. People are gathered around the huge windows, staring out into a winter apocalypse. The driving rain has turned into a wet snow, which is being blown sideways by the 40 mph + winds.

The weather reminds me of the winter storm we slogged through last year to see Dad’s body at the mortuary. We barely made it back home before the roads became impassible.

And the same thing happened today. I hated to leave Mom but the nurses said she was doing quite well and I didn’t want to get stranded at the hospital overnight. There were a couple of scary slides and heart-pounding moments on the way back to Mom’s place, but I was finally able to close the door on this emotionally draining day.

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The secret lives of hospital staff members

When a loved one is in the hospital, you come into contact with a whole array of professionals that you might not meet otherwise. During Dad’s November 2011 hospital stay in Albuquerque, we met a fascinating respiratory therapist.

While he was twirling dials and recording data off of Dad’s ventilator machine that he was in charge of managing, the respiratory therapist told us about the novels he had written. One was about a serial killer, and I can’t remember what the other one was about, but it had a complicated plot line. He said the two books had TV rights picked up by HBO. There was no particular reason to lie about it, so I guess he was telling the truth. With all of the events that have transpired this year, I haven’t had time to follow up on his projects to see if they ever saw the light of day.

But beyond discussing his writing, he was just a fascinating man in general. He could fly helicopters and would help in search-and-rescue operations. He was an intriguing mix of risk and responsibility.

Since I would love nothing more than be a successful writer, I had to ask why he was still working at a hospital. He simply replied that he loved the work. I was glad to know that someone so dedicated to his work was personally taking care of my dad’s breathing needs while he was under sedation.

Recently I thought about this interesting man again, and wondered if he’s still working at the hospital or if his writing career has really taken off. As a writer, I hope for the latter, but for the patients’ sake, I hope for the former.

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Dad vs. Mom in the hospital

It’s impossible for me not to compare my parents and their completely opposite experiences in the hospital. Of course, there are many reasons for the extreme contrasts. Dad had a mental illness, Alzheimer’s, which dominated any physical ailments that he suffered from. So for Dad, hospital experiences were muted. Sometimes, the physical symptoms could be treated with medications and procedures, but there was no cure for the disease that was robbing his mind. Luckily, he was not an aggressive dementia patient, but he was a shadow of his former self. The nurses and other caregivers that took care of Dad on his numerous hospital visits seemed to be able to see beyond the current shell of a man.

But unlike Mom, Dad never received the high fives and accolades that Mom has, as she recovers from surgeries and other medical setbacks. I thought about that again today, as Mom was wheeled out of the hospital by a nurse. She has developed a hernia from her surgical procedure back in July. She will need to have surgery in the next month, but for now, she can go home. People waved and cheered as she was rolled down the hallway, towards the front door to freedom.

While Dad was never violent, due to his dementia, he could not be a fully cooperative patient. Mom on the other hand is every nurse’s dream. Charming, funny, and always wearing makeup, she is the bright spot in what can be otherwise dreary days for healthcare workers. Mom may be battling physical ailments, but mentally, she can still delight others.

Just like Dad used to be able to do, before Alzheimer’s robbed him of his personality.

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An anniversary not to be

This week my parents would have celebrated their 41st anniversary. Last year, Dad was in the hospital, barely hanging on to life, a hulking ventilator lurking in the corner of the room, breathing for him. The fact that it was their 40th anniversary was the only reason why I had wanted him to hang on for dear life. I knew it was important for Mom to mark that day with Dad still alive. The hospital staff had called us a few days before, asking for permission to “pull the plug.”

Dad was under conscious sedation, so I certainly don’t think he had any idea we were celebrating their 40th wedding anniversary. The hospital staff brought Mom a slice of cake from the cafeteria to mark the special day. Mom read aloud the message in the anniversary card she had bought for Dad. It had a picture of a wine bottle on it. The card’s message read:

“Being in love with you has a wonderful way of making a world that makes sense.”

Mom added: “Pat, today is our 40th anniversary. You have been a wonderful husband and companion to me and I treasure you.”

Mom had the card cremated with Dad, as her final message to her mate of 40 years.

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