Back in the U.S.E.R.

Back in the U.S.E.R.

    The past few days have gone by in a blur.  My brother arrived from Hawaii for a visit to see my mother, his first in about six months.  We had been working on getting my mother back to an assisted living facility in her homeland of the islands, thinking that as her short-term memory faded, her long-term memory would revert back to where she grew up...the food, the people, the climate.  And all looked to be falling into place for a bit, the waiting list dropping from 170 people to a room suddenly opening up.  The timing seemed perfect, the costs about $1000 more per month (after all, this is Hawaii we're talking about, where a gallon of milk averages $7 and a loaf of bread somewhere close to $4) and the size of room being exactly what she had previewed some years earlier.  But as the deadline of only a few days drew near (demand is understandably high), we discovered that there were too many restrictions such as her needing to be mobile and able to exit the highrise on her own since they were an older building and had no sprinkler or fire suppression system.  What???  Was that even legal?  This was news even to my brother, a beautiful facility parked alongside a forest now appearing even to him as an old canker sore with disaster waiting to happen.  Anyway, moving her to this facility was suddenly off the table, which may have been fate anyway since she fell once again.

    Back to low sodium, a condition which she felt developed with her new blood pressure medication (or appeared to), a matter of speculation even among the docs.  Some meds affect people in different ways (the classic studies printed in the tiniest print that comes with each vial of medication, you know, the paper that you always throw out because you're tired of those same three pages in larger print cluttering up your magazines) and in my mother's case, this newest blood pressure med did seem to result in a drop in her sodium level.  And when your sodium level falls, you can exhibit many symptoms such as disorientation and changes in behavior and loss of memory and even feeling faint...symptoms that one could almost say were signs of dementia.  So where was the line in the sand?  Anyway at 4 in the morning a few days ago, she was found in the hallway, apparently out of her wheelchair and semi-walking until her weakened legs simply crossed or stopped or something and down she went.  No apparent injuries but a few days later, some bruised began to appear (at this point, her doc went full circle and now six months later, changed her blood pressure medicine back to what she was originally taking, the beta-blocking meds apparently not meshing with her body).  Off we went to the doc to have her checked out; her ribs were sore (nothing to be done with ribs, broken or not) and just as quickly we were back at her room.  My brother arrives, we take her out (a now-usual transfer from wheelchair to car) and she suddenly seemed much worse, the care aide telling us that she saw bruises on her thigh and my mother complaining loudly that she now hurt all around her pelvic area (she's quite osteoperodic, if you remember from way back, the scale basically stopping at negative-2 and my mother being a negative-5...old chicken-boned as the unprofessional term is used); did she suffer yet another proximal femur fracture with her fall?  The nurse at the facility did a cursory exam (some rotation tests of her leg) and called the doc...she needed an X-ray.  And here's where it got interesting.

    Okay, stop.  Enough of my mother, for this was more of a suggestion piece of what you might want to do should you encounter this situation.  There are portable X-ray machines, companies that roll these rather large and costly units around but come to your facility or home if your doctor authorizes it for insurance (most don't); and rather than order lab work, my mother's doc said to take her to an urgent care facility or to the ER (emergency room) which had such devices.  But without a doctor's order, would insurance cover it?  This is where you need to start calling (my mother's insurance authorizes 2 such urgent care visits annually)...but our urgent care facility didn't have such a device.  Uh-oh, one visit used up...so we (my brother and I) again asked and no, we were told, the urgent care would not only not charge for the visit but would relay all of their notes onward to the ER and would talk with our insurance company if there were any questions, telling them that they --the urgent care docs-- had advised the move to the ER.  And guess what...it happened.  The ER was more than ready for us, everything electronically transmitted well ahead of our arrival, the room ready and waiting and a battery of tests soon to follow (CT scans, blood and urine draws, IV ports put in place).  A decision was made to overnight her and a recommendation made for a short rehab stay...if insurance would allow it (ER visits are generally covered by most insurance companies but rehab gets tricky...with Medicare, a minimum stay of three days is required in a hospital before rehab is approved, but each insurance policy differs).  Case managers at the hospital would work with us...but the docs (the ER doc, the intern, the resident and the attending physician, along with 4 nurses and a spotting nurse that would watch my mother through the night to make sure she didn't leave the bed, something she had already tried) all felt that she would be up walking within a matter of weeks.

    So what made it all go so smoothly.  One, being there with her medical history in hand for one thing.  Yes, a majority of her records are right there digitally stored in the hospital files but I had also printed her blood work of a few days ago and a list of her allergies and medications before I arrived.  Each doc wanted a quick peek as they also listened to my story of her past history and baseline (where her usual pattern of memory and pain rested so that they could determine if she was improving or getting worse).  Also having her POLST, a Physician's Order of Life-Sustaining Treatment.  Call it what you will --Health Directive, Vial of Life, Dignity Order-- it's something paramedics and hospitals all want to see.  Do you want feeding tubes, intubation tubes (should your airway collapse), chest compressions (with my mother, likely leading to broken ribs), defibrillators,  the ICU.  She had filled one out earlier (with a doctor) and now the attending docs wanted to verify if her decisions and information were the same (they were)...into their digital system it went (again) but having the paper there to hand to the doc so that he could ask the questions was a time-saver.  Finally, a call to her assisted living facility...they had her medication schedule, not only what she was taking but when.  Everything from blood pressure meds to anxiety pills...the list was sent and into the hospital system it went for updated verification.

    This is a lot to think about, especially in a large and initially rushed situation where many questions are being asked.  But for me, I found that having many of those papers right at hand (from identification to the numbers of her insurance company...my power of attorney had already been scanned and entered earlier and was on file with the hospital, but I also had it in my pack of papers) was a blessing in disguise.  No running back to the house to grab them, no shuffling through files. What the docs needed was right there, either in my hand or in my head.  Not for everyone, I admit, but worth thinking about even for yourself (admittedly, if I were the one being admitted, it would likely be chaos because little of what I just listed is in the hospital's files regarding my own medical history).  Bottom line, check with your insurance ahead of time and have your papers ready.  Headaches (and scary entries into your checkbooks) can be prevented.