Saturday, April 23, 2011

Sorry I Shortchanged You Last Week--

An attempt to make up for it by being early this week. Warning: this will take a while to read so you can either read half now or come back when you have more time. I'd guess it will take at least 10 minutes. (I will attempt to maintain anonymity for the individuals and the facility since I have learned a few lessons along the way. You must know, however, that the main characters are me and my husband, aka Pete.))

The whole darn saga started with a scheduled back surgery for a problem which has developed through the years. Three verterbrae were deteriorating and pressing on the nerves around them resulting in extreme pain. There comes a time when something must be done. And you go in knowing that you have probably not experienced comparable pain before.

The story of the hospitalization is a chapter in itself and can wait. This mostly concerns the Rehab facility which is like a nursing home but involves physical problems rather than medical problems. The first few days in the hospital were relatively routine so the move to Rehab was made on the 5th day. We soon found that there were no instructions for continuing pain management from the surgeon and we had to start from scratch. Our first decision became the opportunity to "stay with your primary care physician or go with the house doctor." No further description of the differences was forthcoming so we elected our own Doc who knows Pete very well as opposed to a complete stranger. First decision, first mistake.

After 2-3 days of limited pain control our doctor did prescribe drugs to make him more comfortable and the following day a drug to help control edema - probably the partial result from inactivity. Since I had to make the request from our doctor, we could see that there was little involvement from the facility and this would be an untenable situation so on advice from our doc we changed to the in house doctor.

We are now coming up on the weekend and another problem has developed. Some years previously Pete had surgery on his right knee due to damage from our 130# dog who gave him what you guys call a cross body block. And, about 2 years ago, he had spoken to the orthopedic surgeon about developing problems. Naturally? the perfect storm occurred at this time. The rehab for back is walking and more walking. The knee simply failed and that pain eclipsed the back pain for a couple of days. At that time I had to threaten to move him back to the hospital if they did not at least order an x-ray so we could eliminate the kind of thing that may have been evident through that first step. They finally did this and I'm not sure whether it was with or without a doctor's order. (The in house doc had rec'd notice Friday at noon that he had a new patient.) It wasn't until Tuesday that a Physicians' Asst. popped her head in his door, introduced herself and was gone.

I had learned by Saturday evening that the radiologist had diagnosed "degenerative joint disease." This told us what we already knew so we waited and waited on Monday for the doc to talk to us about what should be done next. Catch 22. No walking, no back healing. Resting the knee, no walking. I stalked the PA, stole 3 minutes of her time and determined that nothing was in the offing as far as medical care was concerned.

My next move on Wednesday was to ask the ortho surgeon for some advice and assistance as to what we should be doing next. On Tuesday I had written a description of our problems to the Administrator of the facility who was apparently surprised that we had not had the usual family conference with the Social Worker, Lead RN, Activities Director, Asst to and the Rehab Director. As it turns out, there is a government regulation requiring that to happen within 5 days of entrance to the facility. We were then 8 days in. On the 9th day we had what I can only call an adversarial conference.

The opening salvo was fired by the Rehab Dir who said that Pete was being non-compliant and twisting his body which caused the pain in his upper thigh and knee. Of course Pete was upset by this and I knew it wasn't true having spent the better part of each day at the facility. (I double checked my observations with 2 adult kids who had visited as well.) It was downhill from there. Later in the conversation the Rehab Dir indicated that she knew the history of the knee (previous surgery, etc.) but had not included it in any of her reports due to "lack of space" on her forms. No way. When we had tried to tell anyone at all, we were given the brush off. They simply were not interested.

I then had a problem with the Social worker about follow up on the ortho thing. On Wednesday I just went ahead and was able to get an appt for 1:50 that afternoon at which time he rec'd a cortisone shot so he could start moving around and after the back thing is finished he will have to go to work on the knee. Incidentally, FYI, Pete is 83 if you're curious. His improvement has been almost instantaneous.

The RN tried to stress their dedication to pain management which as you already know I had to institute with our family doc and the fact that the in house doctors were on call 24/7. You have got to be kidding. She also said we really didn't have a complaint since it is only required that a patient see a doctor within a week after admittance. One week of simply being in pain with no recourse? I stopped the recorder, the meeting was over and we returned to his room. A half hour investment in nothing more than confirmation that inept is the most kind word I can think of.

The whole thing was a nightmare. The last straw was when I had time to reflect on the x-ray. The ortho doc took an x-ray that even I could look at and see the problem. I'm now thinking, what in the world was going through the minds of the Rehab gal, the PA and the in house doc when they looked at that x-ray and didn't understand the consequences? When I asked, I was told that they had never seen it. They rely only on the radiologist's diagnosis. This is incredible and dangerous. Even if he could have stood and put weight on it, it would only have made a bad situation worse. The deterioration could have been anything between 5% and 95%--who could know?

I tried to get him transported to a nearby facility but there was no room at their inn so we backed off and he is still in the original facility.

During the 3 hours generally spent in church on Good Friday I took some down time for prayer and reflection which resulted in my writing an apology to the administrator (partly because I didn't want them taking out their frustrations on Pete.) However, the other reason for doing so was to try to give them an out by pointing to the fact that undoubtedly the government regulations which govern much of their behavior has only resulted in giving the lowest common denominator of service. Call it human nature, but if they don't have to see a family for 5 days, are they going to break their necks doing it earlier? If they are allowed not to see a patient for a week, will they really try to see them earlier unless the RNs are screaming because the patient is screaming?

End result is that the apology made me slow down, the Administrator moved Pete to the window bed that had been vacated the day before and they changed out the mattress that he had requested, and the Rehab has improved immeasurably. (The climate in the Rehab had been frosty for a couple of days but has now totally improved.)

We can finally see the light at the end of the tunnel, Easter is tomorrow and I'm off to Bible Study with three of the kids expected for a visit by noon today. My Parish Commission committee is responsible for the Easter Egg hunt and we have a big pink bunny arriving at 11:30. I think the nightmare is over. (I'll come back later to proof this thing.)

God bless....

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