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...

Who needs oxygen?

Yesterday morning I looked out the kitchen window into the empty lot. There's a 4x4 canopy out there right now, serving as shelter. There were three people out there, moving about, trying to get night out of their legs. Their clothes were dirty and the dust of the previous days stuck to their oily unwashed hair. They talked to each other, planning their day, talking about who they might meet, who they would avoid, where they might get food or money. All they had was the clothes on their bodies, the canopy (which I think our regular homeless guy, Len, might have put there) and each other. And, as the song would have it, the sun in the morning and the moon at night... and they can breathe. It might not be much of a life from the point of view of outsiders, but it is a life.

Yesterday afternoon I went to the hospital to visit my mother-in-law, Marie. She's 93 and has had a turn of bad luck in the past 6 weeks. She took a tumble in her apartment and came to the hospital, where things went odd. No broken bones from the tumble, but she did wind up with an extreme achalasia, aspirate pneumonia, and a bout of hallucinations (either from painkillers or a mineral imbalance). Yesterday was the procedure for the peg feeding tube.

My mother-in-law has been on home oxygen for about a year following a bout of congestive heart failure and the discovery that her lung function was compromised, perhaps owing in part to the shrinkage of her skeletal structure. She was on oxygen when she went into the hospital, and she has been on oxygen for the 5 weeks of her stay.

When my other half arrived to visit her yesterday, the hospital bed was at too low an angle for the third day in a row. Because last week my mother-in-law had a procedure to inject botox into the sphincter at the base of the esophagus in an effort to solve the achalasia, she has no control over reflux. The head of her bed is supposed to be at 40 degrees or more to prevent her from aspirating stomach acids. I came after work, and I sat with her mother while she went to talk to the nursing staff about the bed issue. Again.

Marie was not in the best shape after this procedure, and no-one expected her to be. She was dozy and not really tracking. The oxygen tubes were in her nose, disappearing out of sight over the head of her bed, and the oxygen supply was burbling in the plastic container attached to the wall. The plastic container had a spare long, coiled plastic tube around it, and I noticed the green-tinted ends of it. Then I noticed another loose green-tinted end and realized with horror that the oxygen was on but my mother-in-law wasn't actually hooked up to it. The end of her tube was dangling behind the bed, not connected to the supply.

A week ago Tuesday I came to the hospital to wish my mother-in-law luck for the botox procedure. I found her lying on a gurney in the hallway, almost flat and feeling like the mess in her throat was coming up to choke her. She had a portable oxygen supply on, but she had no bell, and she had been trying to get someone to stop because she was afraid she was going to choke to death. No-one would stop. I got her attended to, and then they announced that the procedure was postponed because of an emergency.

I went away while they transferred her back to her room. When I returned, she was lying in her bed with her oxygen tubes in. The other lines were not reconnected yet (the feeding tube, the intravenous). She was anxious and disappointed. I spent some time with her, trying to calm her down and reassuring her that the procedure would go ahead in the next couple of days and she just needed to hang in there. She was still anxious, and she wasn't really tracking. It took a while before I noticed the oxygen hadn't actually been turned on.

I told the nearest member of the nursing staff (they seem to rotate every day, so you never know which one is responsible for which room on any given day). 10 minutes later two nurses came in. I asked them to turn the oxygen on. "Maybe she doesn't need oxygen," one of them said. I explained that she had been on home oxygen for a year, that she had been on oxygen for the 4 weeks of her hospital stay to that point, and that nothing had changed that would affect her need for oxygen. One of the nurses went to get the blood oxygen meter while the other stayed to argue with me. I held out my arms in as open a gesture as I could make and I said "I am not prepared to have an argument over this. Oxygen is essential for life and you will turn it on." [link to cerebral hypoxia]

They took the reading but refused to show me or tell me the result. They turned the oxygen on and left. They have been giving me the stony-faced treatment for the past week.

So yesterday the charge nurse came in, hooked up the oxygen, then brought in the machine. The saturation level was 60%. (When her levels were as low as 78% during her congestive heart failure episode we were told it was an emergncy.) It quickly climbed into the 80s as my mother-in-law breathed the oxygen in. Her mind sharpened over the next 15 minutes.

In that ward, there are 4 nurses for 19 patients. The provincial government has announced another set of cutbacks, and the management levels have been told they will have to re-apply and compete for their jobs. In the current climate, I can understand that staff are stressed and that the stress might lead them to make mistakes. I am trying to respect the difficult position they are in. I am not a nurse. But I am also thinking that 6 life-threatening mistakes in 8 days is not acceptable. It is inappropriate to brand me as a difficult family member for having caught those mistakes and having spoken up.

The nurse practitioner on staff yesterday danced around the issue, refusing to speculate about what a period of that level of oxygen deprivation might do to the brain. Do medical professionals not realize that people now have fairly easy access to that kind of information? Not only through general information sites, but through online respected medical journals (I have access because of my job)

We family members are also in a difficult position; we have a loved one lying in a bed in the hospital and being put at risk not by her illness (which is a situation that is resolving) but by the staff. We feel like we should be camping in my mother-in-law's room to prevent the staff from making mistakes.

The vagrants in the empty lot survived their day on the streets and last night they slept under the canopy. They got up relatively early this morning, helped themselves to water from our tap, and they have ventured out into the world again. Breathing.