Oxygen part 5

Yesterday was a good day. Marie was feeling better, and despite the low oxygen setting her levels were in the normal range. She had physio and Big Mike, as she calls him, managed to get her standing - twice! Someone had taken away 12 cans of Pulmocare and 5 bottles of Ensure as well as some of the other paraphernalia that was cluttering up the place. And she'd been told the IV would soon come out - she'd be getting all her nutrition and liquid needs from the stomach tube and orally. This is terrific!

Her first warm food in 5 weeks was soup - but she tells me there was some confusion and instead of letting her eat it the usual way, they put it through her feeding tube! They had also given her prune juice - and she thought they might have given her a laxative as well.

Today I had to work all day, so Candas and I went this evening. The head of the bed was down too low AGAIN. We put it up. Later, when the ice cream came, Candas tried to put the head even higher, but the controls on that side of the bed wouldn't work at that point (again!), so Candas went around to the other side and those controls worked.

The water bottle was off the oxygen - probably a good thing, since she doesn't have moist air at home. Supper had been brought and taken away again before she even knew it was there - she couldn't see it and no-one said anything to her - or if they did, she couldn't hear. A nurse kindly brought her some ice cream while we were there. The nurse suggested we might want to bring food for the patient, because the food services are "hit and miss". The patient in the next bed is new - she transferred from another unit. Her food had to come from that other unit - and took several hours, according to the nurse.

The only stats on Marie's chart were from 16h00. Her blood pressure was the best it had been in quite some days. Her blood oxygen was 94. Looking good!

When we asked her about her day, and the physio, she said it had been difficult because she got so dizzy (any wonder, after being bedridden for almost 6 weeks!). And apparently, according to Marie, her blood oxygen went down to 80 when she exerted herself. But, according to the nurse, this is not entered on the chart - the physio gives his report directly to the doctor.

Marie was still suffering the effects of the laxative, but she was waiting for the shift change and the bedtime clean-up. She was upset about how dirty her hair is - I don't think it's been washed since she went into the hospitral - almost 6 weeks. She's been having trouble hearing, and today she put the hearing aid in. It kept squealing. I checked the manual and it said the reason for this would be excessive cerumen (ear wax). Candas says she has already spoken to the staff about whether or not the increasing deafness in the one ear, quite noticeable in the past couple of weeks, could be because she's not getting her ears cleaned. Apparently that is someone else's department. Of course, perhaps the patient could clean them out herself if they gave her the tools to do it - but since she can't get up... We'll have to bring something along and do it.

We are seeing more and more the reasons why Liepert's plan won't work. By having fewer nurses and assigning care tasks to a raft of less-specialized/less-trained aides, there is no-one who sees the patient on an ongoing basis. They come in, do their one assigned task, and go out - often not even talking. The patient gets no stimulation, and no-one gets a clear picture of what is happening to the patient over the course of the day. When a nurse has a small enough patient load to actually help with the care, the nurse can spot emergent problems. The nurse can notice if food has not been eaten - and she might know what the effect will be. The nurse can spot if the patient isn't really tracking, and check the oxygen levels. The idea of hiring cheaper untrained staff so the nurses seldom have to come to the room unless they are administering medication - well, it removes the element of attention and caring from the role of the nurse - and it is that attentive role which has made the nurse so valuable in the medical system. It is the nurse who can see if there has been a change in the patient's condition - but only if the nurse is actually able to be at the bedside often enough and long enough to know what that condition is.

The nurses who keep lowering the head of the bed clearly do not know what procedures have been done to this patient, or they would understand why the bed MUST NOT be lowered. But none of them really have time - and Marie is so grateful to the few who have spent a few minutes talking to her...