Richard fell on Wednesday of Holy Week, fracturing three ribs on his right side and also the C-7 vertebrae in his neck. He also had a nasty wound on the upper part, on the back of his head. So an ambulance was called. Luckily, after an x-ray was done for his head, there was found to be no hemorrhaging, which was a relief. About 15 years ago we brought in one of our charges; his name was Paul, who also hit the back of his head from a fall in his room. The point of contact was lower down near the base of his neck. He seemed to be fine, as Matt and I drove him into the Emergency Room. We both talked to him on the way in, to make sure he did not drop off to sleep. Once he was taken back to the care area, Paul started to decline. First loosing his ability to speak, then he could not move his left side and finally he fell unconscious. He was rushed to another hospital that could give him better care. He never regained consciousness, but died two weeks later when they took him off the respirator. He died within two hours.
Richard has COPD for years and about six years ago came very close to death. While in the hospital, his family got him to get a stomach feeding tube inserted so he could be feed. They did some procedures and then sent him home to die. He did not die and has lived with a good level of health for the intervening years. Over that time period I was always worried about him coming down with a cold that would lead to pneumonia, but that did not happen. Because of his COPD, having fractured ribs can be problematic, so they put him in the hospital. They e-rayed his chest and he was found to have both bronchitis and pneumonia. So he was put on two rounds of intravenous antibiotics every day. His oxygen level was low when he was not on a breather mask, set at 15 milliliters. His level was up to 97% on the mask, but when they tried the nose cannular, his O2 level would go down to 70% in a few minutes. He did not like the mask and kept taking it off, for he had some confusion. In the end they had to use some hand restraints; which in fact helped him to relax and sleep. So we had people sit with him round the clock. I made a choice to do the night watch from 8PM-8AM, because of Holy Week. Many were busy preparing for the weeks liturgical services. I did it also because I am used to sitting and waiting, it goes with the job of being a caregiver.
So I went with my books, some writing material, and a big coffee thermos that I bought at a QT, which is near the hospital. I always get ‘Columbia Supreme”, a strong bitter coffee that I like when I have to stay up at night. I would also get a couple of pastries to munch on while there. I find these snack, while unhealthy, do keep me energized while I am at the hospital or ER.
Richard was placed in what was once a two bed “Medicaid” room. Now it has one bed, so the room is big and not a closet like so many of the rooms at the local hospital. The rooms are so small that furniture has to be moved just to change the position of the garbage can. Ok, an exaggeration, but it does show how small the rooms are. In this room I could keep the light on for reading and it did not bother Richard so much. I tried one night to turn off all of the lights so that Richard could rest better; big mistake. His confusion became greater and he thought he was trapped in a basement somewhere and it would take the army and fire department to get us out.
They were able to hydrate him a couple of times, but then stopped for fear that it would make his pneumonia worse. He would not eat or drink and would only allow small spoonfuls of water (mixed with thickener) to help with the dryness of his tongue. He did not feel thirst. He always knew who I was and also the men and women who came in to sit with him. Sally, a friend of ours, a nurse now retired did a few hours as well. So his confusion, as far as I know, did not go so far that he did not know those around him.
After they did all they could for him (he was in the hospital one week), they told us that they were going to try to wean him off of the breather mask and keep him on the nose cannular. Perhaps because the pain from his fractured ribs improved, he was able to keep up his oxygen level above 90. He was even asking to be turned over on his right side, the area of the fractured ribs, so that he could sleep.
So he is now home, but before he came Hospice was called and he was enrolled. We waited for them to bring two concentrators to help with his breathing. He arrived home at about 7PM in the evening. He is comfortable, even though he has been diagnosed with “Last stage COPD”. We also have a large recliner in the gathering area and he seems to be comfortable sitting there for a few hours at a time. He is trying to comply with our wishes and is drinking some. Small sips, trying to get him to slowly drink 8 oz glasses of orange juice over a certain period of time, which will help to keep him comfortable and alert during the day, for his family is coming to visit him. He does not want to eat, so we are giving him high calorie shakes to drink, again, slowly. For he also has some trouble in swallowing and can aspirate easily, so we also use some thickener in his drinks, which allows him to swallow without it going down his wind pipe into his lungs.
He has a very loving family and both Rose and I have been keeping in touch with them over the last week. While Richard was in the Hospital, I used to call his nephew, Jerry, every morning on my way home, to let him know how his Uncle was doing. Jerry is very close to Richard and also has his ‘medical power of attorney’, so he was also keeping in contact with the doctors and nurses at the hospital.
So at this time Richard is in a waiting mode. If he is actually dying, then he will continue to not want to eat or in fact drink very much either. Until then, when he enters the phase of actively dying we will continue to encourage him as much as possible. Even though he is on hospice, that is not necessarily the end for him, there are those who come around and are discharged from hospice. He seems at peace, slightly confused and compliant, but in the end, we will do what he wants. I talked to him this morning and let him know that when we come in to get him up into the recliner, he can always say that he would rather stay in bed. For we are hear to serve him and to try to make him as comfortable as possible while he is with us, so please speak up. He is 86 years old, so even if he makes it through this, he will be at a different level of care than he was before, but he will adapt. Some call this “the new normal”.