Another Fall

Another Fall

    Prescient or ironic? Or both, or neither?  I couldn't tell, but here's what happened.  Within an hour of uploading the last post, I had walked the dogs, my wife had initiated a long search for me in the car, 9-11 had been called, and my mother now rested in the emergency room.  She had fallen again, this time on the tile in her bathroom, possibly due to a reaction to some new blood pressure pills she was taking.  Turns out that Carvedilol (as with naporoxen, or Aleve as the popular brand is known) has a tendency to pull sodium out of your body, and in some cases dangerously so, said the doc in the ER.  My mother's sodium levels had dropped substantially, something that may have contributed to her dizziness and resultant fall...at least, that was their suspicion.  Also, my mother was allergic to Bystolic (used to treat blood pressure) and Carvedilol (her newly prescribed blood pressure pill) was somewhat related to Bystolic.  Perhaps her primary doctor missed that, although the attending doc in the ER noted that a person reacting to one drug doesn't necessarily mean that person will react to a similar chemically-related drug (although odds are higher).  More tests would need to be done...it was 9:30 in the morning and my mother was fast asleep.

    It would be five hours before my mother would be moved to a new room, one in the normal patient portion of the hospital, the in-patient portion.  She was hungry and thirsty (no food or drink until all the tests were in, said the doc), but gaining clarity with each passing nap and hour.  Her blood pressure had risen from 84/53 to a more normal 110/74.  She looked scared.  Then came the POLST, a Physician's Order for Life Sustaining Treatment.  While not an Advanced Health Directive, the POLST is also legally binding once signed by a physician; posted in a room and well within sight (say, on the inside of the entry door or taped onto the refrigerator), the POLST allows emergency personnel to rapidly make decisions such as whether to resuscitate you or what your wishes are once you're being transported to the hospital or during your stay there (when one actually reads an advanced health directive, you'll find them lacking in many areas...the POLST fills in many of those gaps, adding to but not replacing the directive).  So, despite my mother being in pain (but fully alert), the attending physician felt that it was a good time to go over the POLST with my mother (she had had several such notices in her home, but all were filled out with emergency contacts and had little about what she wanted done should she be found unconscious...still, it all made me think that I had better go back and read my own health directive and print out my own POLST).  Did she want to be resuscitated? (at her age, he explained, such processes as CPR could lead to bruised or broken ribs, the trauma sometimes not worth the resulting pain in recovery); did she want ventilators and feeding tubes and such?  And with each question, my mother answered resignedly but firmly, "I'm old," then slowly shook her head.  The physician verified that it appeared that she was answering no to each question and that she would want basic comfort treatment but little else, then he would sign off each box.  For me, it was one of those grim but necessary situations, he --as a doctor-- taking the initiative to do what I had meant to do in the past few days, having recently acquired the form only a week earlier.  And what had taken him less than five minutes to do (and make official) likely would have taken me substantially longer...imagine doing this with your own ailing parent or relative, having them answer questions that few of us care to confront, especially at a later point in our lives.  For me, from a healthy viewpoint where such a possibility of a life-threatening situation seems rather far away, the answers come fairly easily.  But put me in a hospital bed with my head groggy and my age up there and a doctor asking me such questions and well, it might prove to be a bit more scary as if I were suddenly answering pass/fail exam questions for admission into the final academy.

    All of this contrasted with the location of the hospital.  In this case, the fairly new hospital was a marvel of blue-tinted windows that reflected the snowy mountains on both sides.  It's architecture was state of the art, blending in nicely and not feeling at all like it was out of place despite the constant starting and later landing of the emergency helicopters, the Life Flights.  Placed in a field, one could almost picture the television series of long ago, MASH, the people running to greet the chopper and whisking away the wounded.  And inside the hospital, the quiet somber feel was one of both worry and respect, the people waiting patiently for word of their loved one's condition, while deeper in its recesses lay the patients themselves, oblivious for the most part to the whirl of doctors and nurses and aides and machinery around them, the steady electronic graphs and beeps of the monitoring machines becoming almost life-sustaining in themselves with their steady beeps and wavy lines.  Once outside however, noticeable to most anyone leaving from the emergency side of the building, there stood a Costco, a store like so many Costcos that buzzed with life, its parking lot as full as the shopping carts that were being pushed down to their owners' cars.  With my mother asleep in the emergency ward, I step outside and headed into Costco to have some print cartridges refilled and to basically drag a cart around a bit mindlessly.  Once there, it was as if I were in the moors, the fog eerily getting me through the day as if I were in familiar territory.  And as I stepped out of the Costco and back into the hospital, it was what I had witnessed in Vegas, the summer's heat being almost crippling outside but broken with each entry into an artifically-cooled and cold, hotel.  Hot, cold, hot, cold.  Emergency, Costco, Emergency, Costco.  But my mother was alive, and getting ever more alert.  To me, the final stage of the equation was far from here, the Life, Death, Life, Death threshold.
    
    Still, there was much going on, my feeling as if I was the running Indiana Jones with the giant ball coming down at me.  So far though, all was going okay.  Back at my own home, the real estate papers for my mother's house (the one my brother and I were cleaning over the past week) were due, the proper initials and signatures in the right places, the legal deadline (to notify the prospective buyers and their realtors) now just an hour or so away (don't ask me for details as this is just what my mother's realtor told us).  Print out the offers (page 10, she said), initial in the right area, scan it, and email it to her...post haste.  One hour to go.  I called from the hospital, my mother had finally been transferred and had been moved to a room upstairs.  No problem about the papers, I told the realtor...and off I went, back to my house, a quick hello and update to the wife and then up to the computer to print out the page 10s, look them over and initial them, then scan and send them.  But it turns out that Windows scans images in a picture (.jpeg) mode and, if you subscribe (or have a conversion program) those .jpegs can be easily turned into .pdf files, which is what the realtor wanted (computer speak and basically of little importance).  Ah well, she'd figure it out, she said...not to worry, she'd received them.  Phew...company was coming and my wife had put in an equally full day in readying the house, cleaning and vacuuming and buying the groceries and preparing dinner (making her special recipe of blue cheese steak, something she loved but hadn't made in nearly 20 years because I don't eat beef, or pork, or chicken, or...well, you get the idea).  She was pooped.  Then our friend arrived, 12.2% alcohol beers in hand (hey, most wine is just over 13%...what exactly were we drinking?).  But as it turned out, his company was perfect.  He had gone through all of this before ("I'm ahead of you on all of this," he would tell us), both of his parents being moved 3 times before being settled into a local memory-care home (the new term for Alzheimer's and dementia facilities).  He had seen the progression, had had the phone calls, had gotten the 9-11 advisories that his parents were once again in the emergency room.  It pulls it out of you, he told us, drains your energy, but again reminding us that in truth we had it easy compared to those staying at home and caring for one or sometimes two parents with dementia, losing sleep and wondering if their parents had left the stove on or the door open or were now walking down the street at midnight, all while probably trying to raise a child and hold down a job and keep their own sanity and strength.  Yes, we did have it lucky, a point highlighted as we downed another beer and ate a normal meal and had a normal conversation.  A good night...and we were all more than a bit tired when the night came to an end.  Good night, he told us, which it was, and my wife and I headed off to bed and fell asleep...and that is when my heart began acting up.