Saturday, March 17, 2007

Doubts, Dismissiveness, and D.N.R.s

After Jeanette headed off to work yesterday, I got Ian ready for school and took care of as many necessaries as I could. Then I drove the old Blazer to Dad's house and gathered up the things he'd asked for, and headed Wellsville arriving at the hospital at 11:00, the time scheduled for Dad to be transferred to Wellsville Manor. I had time to check briefly with the nurses and talk with Dad before Jeff and the wheelchair van arrived. I followed them over to the Manor and it had been snowing moderately by the time I walked in with Dad and Jeff. A nurse helped him get seated in his room and I talked with him while another nurse got their first set of vital statistics (blood pressure, pulse, oximetry, and temperature). The diet coordinator came and I helped answer questions, but reminded her that he had been on fluid restriction and low sodium and potassium intake while at the hospital, so she'd need to check the doctor's orders regarding things like orange juice, bananas, and so on. So we went to the nurses desk when she had finished, to see what was in the record. One of the nurses, twice, said "we'll take care of it" but I was thinking "no, she needs the information so she can plan his diet correctly, and I need to know what Dr. Coch's standing orders are". I didn't say anything out loud at the time, but keep reading.
I think it was difficult for Dad to answer questions like "Do you want eggs for breakfast?" because he's not accustomed to having the same thing every day. He isn't fussy about what he eats or drinks, and has difficulty choosing, anyway, so I was having a hard time not answering all the questions for him. I tried to let him choose and not meddle, but I think they could have skipped that whole interview because he would have eaten whatever they put in front of him, and they could change it every day and still get no complaints. He started off with liver and onions for lunch, and ate it with relish (pun intended). The dietician seemed truly astonished when he told her he would eat any vegetable -- she said "you mean you'll eat cauliflower and spinach?" to which I added "and brussels sprouts and turnip greens" and I should have added dandelion greens. Later on, a nurse came and confirmed that his only dietary restriction is the fluid restriction (1500 ml. per day), so they eliminated one or two servings of liquid at meals.
After the dietician took off, I put Dad's things away in his room (#323), and we talked some more until the admission director (that probably isn't her correct title, but she conducts the admission interview), Amy came in. She asked Dad about his preferences and asked the same questions Dr. Coch has to test for dementia or Alzheimer's. Dad did just fine except when asked to repeat three items spoken to him and then remember them while she asked him to spell a word backwards. He had repeated "apple, tree, and pen" just fine and then spelled "d,l,r,o,w" just fine but couldn't think of any of the three, even when she said one was a fruit, and the three didn't seem familiar when she told him what they were. He had remembered two of three, the last time Dr. Coch did it. I sat there reciting "apple, tree, pen" while she was telling him the word to spell backwards, but I could see it was taking all his concentration to take in what she was telling him. I talked with him afterwards and he said he used to be able to do such tasks but it's aggravating not to be able to anymore. I said it must be, especially since I think I'm better at it now than when I was younger.
When Amy began telling him she was going to ask questions to gauge his level of depression, I pretended to have to go to the bathroom, but stood outside the door and listened. I thought he might answer most honestly if he thought I wasn't there, although he's been quite candid with Dr. Coch, even when I have been present. I heard him give all the worst possible answers, in terms of feeling bored, useless, uninterested in new things, and so on. It has a lot to do with him wanting to work on his book but not feeling up to the tasks, and he's told me so many times. I waited a short time before I re-entered the room and helped Dad through her questions about whether he wished to have a Do Not Resuscitate order in place, meaning that it his heart should stop, they should not re-start it. Dr. Coch had given me the idea that Dad had told him he did want a D.N.R., but he told Amy he did not. We confirmed that he has a living will, so life-extending measures are not to be taken if he's in a coma or whatever, but I was glad to learn he does want to be resuscitated, for now.
Amy left and I chatted with Dad about how we can do things differently when he gets home (in two weeks or less) so he'll feel more useful and stimulated. Then we talked about his book, and he really got going then, in all the best senses of the word. It takes some patience to stay with him and keep him from getting side-tracked too far, but I did it. He's complained that people have not given him much feedback (except Sherm) about his book, and I've talked with him at length a number of times, but I hope he felt as satisfied as I did, that we had connected on his thinking yesterday. He seemed so much more able in that discussion than he did about what he'd be eating for the next two weeks.
I went to the nurses' desk and asked if there was anything else I needed to do, and was greeted with "I think we can handle it from here" that came out in a dismissive tone, just like the other nurse had given the dietician, and at this point all the bells and alarms were going off in my head. I had spoken with several of the nurses at Jones and been quite candid that I wanted to converse with them about Dad's vital statistics and the Doctor's orders and that I would be active in coordinating his care. All of them had been open, supportive, and seemed to welcome my participation in it, and more than one had remarked that many patients were simply dropped off and left alone.
At this point, I spent a little more time with Dad making sure he was all set, and made up my mind what to do next, and then went looking for Amy. I asked if we could speak privately and she pointed me toward her office, where I told her I had left the room to be sure Dad didn't feel reticent to be honest while she interviewed him about his depression level. She seemed understanding and appreciative of my doing so, and confirmed that he ranks as quite depressed, so we talked about what we might do when he gets home, to help with that.
We reviewed a few more things and then I asked if I could speak quite candidly. She said yes so I closed her office door. I told her that the dietician and I had been given answers by the nurse at the desk that seemed dismissive, and that this had made me uncomfortable. Then I told her the nurse's response when I asked if there was anything else I needed to do. I told her that I intended to be involved in Dad's care, that I am his medical proxy, that I care a great deal about him, and that I won't put up with staff being dismissive of me. Then I actually said "I won't take any shit with regard to my father's care."
She responded in what I felt was a very supportive fashion, confirming that having such negative experiences before my father was even settled in would not be acceptable, and that she would address the situation. At this point I said that if I had encountered someone whose style of working was just that way but that they were competent and caring in their work and that I needed to adjust somewhat, then she should tell me so. She asked which nurse was the one, so I told her it was two different nurses, and that such an emerging pattern was very disturbing.
She told me that one nurse was only filling in for someone that day, but that the regular nurse who would return on Monday was not that way. She reiterated that she would do something about it, and I told her I would check back when I visited again. I told her that if only one incident had occurred, I might not have said anything, but two in such a short time caused me to be alarmed. She spoke with earnest concern and we agreed to communicate more in the future to be sure everything from there would be copacetic (if you like etymology, look that word up).
I trust her.

Dad's room is on the west end of the building, with a bed and dresser and a wardrobe and recliner. He has a window looking out on the back yard and some scrub trees, so there were a few juncos and chickadees darting around in the snow when I was there. I think I might take a bird feeder over, just to give him more to look at. He had a TV at the hospital, but I think the only time it was on was when Ian got restless during one of our visits.
Carol, the yellow carnation is lovely, and Dad spoke appreciatively of your leaving the Mozart for him to listen to. I left some Readers Digests and the Alfred Sun for him to read, and brought him his diary. I need to drop off some note paper on the next trip.
Carol and I have talked about her and Barb coming over to stay with Dad some, after he gets home, and I am grateful for the offer. Cathy has talked about coming, and may this weekend, but the weather is not encouraging me about that. Bert has also made an overture about coming out to see Dad, but no plans are in place. I still don't know if I got the job at the Equestrian Center, and will learn Tuesday night if I win the election for village Justice, so then I can make commitments more easily, but either way, I plan to do some sorting, cleaning and sprucing up at 33, before Dad gets back home. He had rejected all my previous overtures regarding our moving in with him, and I checked yesterday to confirm that it was because, as he put it, it would complicate things. He added another point yesterday, but I can't recall right now what it was. When I told him Barb and Carol might come, he thought they would stay in their RV, but I told him I figured we'd clear up space upstairs for them. Jeanette and I agreed that we will, last night.
I'm thinking it's probably time to work toward renting out the upstairs apartment, perhaps to Tim and Pat Bancroft, since they have to move out of the house on Palmiter Road, or maybe to Bill and Jenn Schultze and their girls. Anyway, more on that later.
If you want to call Wellsville Manor, it's 585 593-4400, but if you want to call Dad's room, it's 585 593-0309.
Due to all the snow coming in, Ian's activities last night and this morning were cancelled, as was vespers, which Dad and Jeanette usually go to. I've got to close and go plow driveways and clear the church steps of snow.

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