Friday, January 18, 2014, 2 pm. Walmart. Maneuvering the shopping cart (or “buggy,” as they call it here in Western North Carolina) around the place packed with people gathering supplies for what was supposed to be a blizzard, luckily turned out to be flurries. I was picking up a few things to top off my Shabbat preparations: mineral water, blue corn chips, orange-and-red striped tulips, and cheesecake. My phone rang: my mom. Her cell phone, which was odd at that time of day. Alarms go off in my head.
Dad has fallen again–the second time this week. The many-th of this year. Falls are increasing in frequency, varying in severity, but always accompanied by a decrease in function afterward. He has a dementia that is not Alzheimer’s. He’s had many small strokes. And he’s got a narrowing of his spinal canal that causes him to have to wear diapers because it’s pressing on the nerves that control his body functions. And to make things even better, his vertebrae–all of them–have been slowly but progressively disintegrating so that he’s bent over in a “C” shape when he walks–if he is able to walk, which is sometimes, with difficulty, with a cane or pushing his wheelchair, which is where he is parked most of the time.
So far he’s managed by sheer force of will to do his shower by himself. But this time he fell right over on his back, hitting his head for the millionth time on the hard tiled floor, and my mom was not able to get him up; so she did the right thing and called the ambulance. As of the time she called me they had still not shown up and Dad was still lying prostrate on the floor naked as a jaybird and twice as wet.
It took them a good twenty minutes to arrive. Good thing there was nothing life-threatening. And when they finally got there, they came in such hordes that there was nowhere to park both the First Responders van and the Ambulance, which couldn’t even get into the tiny parking spot at the end of the long dirt road where they built their home 40 years ago. They couldn’t figure out how they were going to backboard him out, given that my parents built their house into the side of a cliff and there is very limited access. My mother said it was like the Keystone Cops.
After I got her call I put the cheesecake back in the freezer and just left my cart where it was, and drove the ten minutes to the hospital, thinking surely they must have arrived at the ER by then. But no. I waited a good half hour. My mom arrived in her car, and it took the ambulance another fifteen minutes to get around to unloading poor Dad, who was immobilized on a backboard.
CT scan of head and neck were fine, but he had a new compression fracture of L1, the first vertebra below the thoracic (chest part) spine. And as I gazed at the cardiac monitor, I noticed a very strange rhythm, or dysrhythmia really. It looked to me (and it has been a very long time since I read EKGs) that he has a partial or intermittent block in the electrical system that runs the heart. It happened in “runs:” the pattern would get normal for a minute or so, and then pop back into the abnormal rhythm. I observed that his level of consciousness varied with the rhythm. When it was weird, he would get confused and less conscious; when the rhythm was normal, he was more aware and oriented. That explains a lot, because he’s been “going in and out” a lot lately. Surely when his rhythm is weird, his heart is not pumping normally and his brain, already battered, is not getting enough blood.
As if that is not enough, he has a urinary tract infection–probably the same one he had about a month ago that was inadequately treated with the wrong antibiotic and no follow-up culture to see if it had cleared. I was furious then and I’m furious now.
Thankfully, he was admitted to the inpatient service. The last many times he has fallen and hit his head, they have sent him home, even when he injured himself badly enough to need stitches. But this time, with the combination of the fall and the dysrhythmia and the kidney infection and the broken back, for heaven’s sake, they kept him.
Today, Saturday, January 18, my mother, the doctor, and I, unanimously made the decision that he will go to a nursing home for “rehabilitation” after his hospital stay. This is a very sad state of affairs. In all my years of doctoring, and in all my mother’s years of being a geriatric social worker, neither of us has ever seen an 89 year old person who is sent to a nursing home for “rehab,” be discharged from there to come home, because by that point the person is really not “rehabilitatable.” If my dad makes it out of that nursing home I will be very surprised and very elated. But I don’t think he will.
He’s been through at least four six-week courses of twice weekly physical therapy to try to improve his balance and ambulation. All that’s accomplished is to cause him great pain and distress, but he’s soldiered on with it because he’s not a quitter. In fact, the main reason for most of his falls is that he’s trying like hell to be independent.
I’m terrified to think of him in a nursing home with a broken back, because I know what they will do: they will leave him lying in the bed, with the excuse that it’s not safe to get him up in a chair, much less walking with assistance, and neglecting to turn him every two hours like they’re supposed to. I’m terrified that he will develop bed sores. Maybe I’m just, just, just overthinking….but this is what I’ve seen. And if he develops a bed sore, he’s gone, because he’s diabetic and his immune system can’t take it.
So I know where I will be spending most of my time, making sure that he’s properly cared for. It’s a sad time, a time we’ve all seen coming, and now it’s upon us.