Sunday, September 28, 2008

The Next Day

She had a little fall at home. No major injuries, thank goodness, but an emergency department resident put a stitch on the back of her head to close up a small laceration. Overnight telemetry monitoring is typically ordered for an 82-year-old presenting after a syncopal episode.

Over many years in telemetry nursing I've seen this hundreds of times. Often, but not as frequently as it should, it indicates a critical change of direction for the patient's life journey.

The patient had come to the hospital by ambulance the previous day. Her husband, also in his ninth decade, had driven himself in. He got tired and wanted to go home but he couldn't remember where exactly he'd parked his car.

One of our hospital security people was helping out. The husband gave her a description of the vehicle (which turned out to be wrong) and the keys to the car. She couldn't find it, naturally, because she was looking for a white station wagon when in fact, as we later learned, he'd driven a tan Corolla. At nine at night they provided him with a cab voucher so he could get home.

The white station wagon was in their driveway.

The patient herself was slightly confused. She couldn't accurately state the day or date and she didn't know which hospital she was in. When I asked her "who's the President?" she winked at me and said "Well! Not that little chimp Bush! I think Dick Cheney has been pulling all the strings for years now."

So she wasn't totally disoriented.

She wanted to go home so badly. I disconnected her IV fluids so she could walk around freely and I got her a cane (she said she used one at home) from the physical therapy closet. I probably should not have done that. If she fell here in the hospital and fractured a hip or something then my ass would've been skewered like a baby pig on a stick.

She dressed herself in her own clothes. She looked wonderful. A very hip blouse, a stylish long fall-colored skirt, and blingy flats. I recognized that style, and when she told me where she got it we chatted clothes for a few moments.

Me, not so stylish. Cool, but retro-geek.

Later another nurse came along with the husband, who had been wandering aimlessly in the hospital lobby area. He was so glad to see his wife. They kissed. The nurse, Lacey, pulled me aside and expressed her concerns about him. He'd forgotten where he'd parked his car again and he was lost in the hospital. By this time it was eleven in the morning and he'd apparently arrived hours earlier.

He was just as cognitively loose as his wife. But impeccably dressed, I must say, with a really nice tie. Picture Tim Gunn in short sleeves.

"That tie must've set you back fifty bucks," I said.

He replied that his wife had bought it for him. "More like double that!" he said with words salted in love and and long-held appreciation for his equally snazzy mate.

There seemed to be no medical reason to keep her any longer in hospital so the residents wrote discharge orders. Their daughter Carol, who lived in another state, called me and explained that such events happen monthly.

"This is just this just the crisis of the week," she said, "I want them to sell their house, which is way too big for them anyways, and come live near me in Denver. There's this beautiful assisted-living place a mile from me that's like a resort. They'd have their own apartment and all their things with them. But they're so stubborn."

That story. I've heard it a thousand times.

The patient's very nice and appropriately concerned nephew called me too. He lives here in The Valley. He and his wife were very close to the patient and her husband, checking in on them daily. He came by later to take them home. After all, they couldn't find their cars and it was getting late.

The patient just wanted to hop in her car and drive home. Same for the husband.

David, the nephew who obviously loved the genteel old couple very much, chimed in: "Well, it's getting late. Why don't I just take the both of home in my car. Maybe we could stop off someplace and get a late snack. There's that new Paradise Bakery at the Biltmore." They liked that idea. So did I.

In his caring eyes I saw the plan unfolding. He hated to do it, but it had to be done.

I looked at him. He looked at me. I sighed deeply. He gave a little shrug.

After they all left I called our security office and gave them the descriptions and tag numbers for the two cars. These would be on hospital property for a day or two or so... maybe even longer. They said they didn't mind. They probably know the story, too.

One day you're independent. When you run out of half-and-half for your morning coffee, you just drive out to the store. You pick up a few other things while you're there. And then the next day you never drive again.


Anonymous said...

Its scary that so often we actually end up sending these people home. It is getting harder and harder to justify keeping them for pretty much social service needs...

I haven't been a nurse as long as you, but I've seen that story many times already, too..

Woody (Tokin Librul/Rogue Scholar/ Helluvafella!) said...

"I hope I die before I get old."

I'll be facing it single, probably.

I'm 62 now, and I can feel it coming.

I'm not looking into the abyss, but I damn sure know where the sucker is. Sometimes it scares me dough-kneed...