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Monthly Archives: May 2013

Hospital Survival Guide

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iStock_000009782912LargeWho would have thought you’d need a survival guide to assure a safe stay in the hospital? Well, now you know, and after spending four weeks and 2 days (and counting) with my father in the Neuro Progressive Care Unit of one located on the northwest side of San Antonio, I consider myself an authority on the subject. Here is my list of Top 10 Tips to make your or your loved one’s stay a success, or at least not a total disaster.

1. Be your patient’s advocate. Ask the doctors and nurses what’s going. They may not tell you otherwise. Be specific; ask how he was in the night, which doctors have been by to see him, and whether there have been any new doctors on the case. One day you may have a surgeon and an intensivist, and the next your doctor load has increased four-fold, to include a gastroenterologist, a pulmonologist, an internist, and a cardiologist.

2. Don’t let anyone feed you if there’s a sign on the door that says, “NPO.” That’s a Latin abbreviation for “Nothing by Mouth.” Really; it happens.

3. Don’t be alarmed when you discover that the doctor taking care of your loved one is someone you’ve never heard of. This is a new phenomenon in healthcare. Although you may have been admitted for surgery by a doctor you know and trust, he probably will not be your “attending” physician.  Now there is someone called a “hospitalist,” or “intensivist,” who contracts with the hospital to oversee the care. Be sure to speak frequently to this person and ask for consults with specialists if you feel they’re needed. And, if a consulting physician causes you to curse violently in the post-op area, it is definitely time to demand a different consultant.

4. Get a second opinion if your gut tells you something doesn’t sound right. For instance, if a doctor tries to talk you into a tracheostomy when your vital signs are stable, it’s time to stall. Or, if a doctor tells you in the pre-op waiting area that he’s going to do a procedure involving insertion of a tube into an organ and you expected it to be inserted into a different organ, definitely stall. Don’t wait until it happens, there will be a complication, and you will have gained an extra week’s stay in your deluxe 9th floor private room.

5. Don’t sign a consent form until you’ve talked to the physician performing the procedure. Common sense, I know, but sometimes the doctor doesn’t want you to bug him with silly questions.

6. Don’t roll your eyes when someone called a “Director of Nursing” comes by the room at a particularly difficult time and cross examines you to see whether the nursing care has been “excellent.” Apparently, this is related to the hospital’s ability to be reimbursed by Medicare, and unless everything is “excellent,” the hospital’s payment for services will be reduced. Apparently, many, many hours of nursing training is taken up with learning this one reality.

7. Don’t be afraid to speak up when you see something that troubles you.  If your patient appears unkempt, or is beginning to look like Howard Hughes in his final days, ask the nurse to call occupational therapy to help the patient wash up, comb hair and brush his teeth.  If the floor is messy and sticky, ask for housekeeping to come clean up the place.

8. Ask for physical therapy to come work with the patient. If your loved one appears to be wasting away, and his limbs are getting stiff and “feel heavy,” ask the nurse to call physical therapy. And, if a therapist comes in the room and tells you the patient looks too tired, insist that they work with him anyway. Of course he looks tired! He hasn’t been up in 3 weeks! Even if it’s just exercises in bed. Each day spent in bed equals 5 days of rehab, or something like that.

9. Don’t be surprised that you can’t go directly home from the hospital.  Today there are social workers employed by the hospital who would like you to extend your stay in one of their comfy rehabilitation facilities where you can learn to “meet your goals,” i.e. go home and live by yourself. Word of warning: these places used to be called “nursing homes.”

10. Be afraid, be very afraid when you see an administrator, a charge nurse and 3 doctors standing outside your loved one’s room.  This is usually a sign that something bad has happened and the hospital knows you have a lot of lawyers, and even a doctor, in your family.

I hope none of you will need this list, but if you suddenly find that you do, I hope it empowers you to demand the care that you and your loved one deserve. Keep it in your purse, just in case!

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NPCU

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Another afternoon in the hospital. Neuro Progressive Care Unit, to be exact.Alarms sounding when a patient tries to escape from his bed.Muffled yells for help somewhere down the hall.Incessant beeping when the i.v. antibiotic is finished running. Worried family members treading slowly up and down the halls.Exchange of quick, understanding, empathetic glances. Muffled beeping from a machine when the patient is disconnected and taken elsewhere for tests.Get back in your bed.Quiet laughter from the nurses’ station.Realizing they have lives away from here.Suctioning.Stop it.I will not be subjected to this. Labored breathing.Wheezing and gurgling.Coughing.Squeaky wheels of gurneys and beds and carts rolling down the hall. Loud raising of bed rails, then locking into place.New patients arriving.”Housekeeping,” someone calls from outside the door.Rubber soles of tennis shoes running.Curtains parting.May I come in? I’m here to give you a breathing treatment.How are you doing today?I’m here to take your blood sugar.They’ll be here soon to take you for your x-ray.Can you stand up?Do you know where you are?Do you know what year it is?Do you know why you’re here?Let me check your wrist band.Are you Mr. S——? I’m here to give you your evening meds.The stomach is sleepy.Can he walk unassisted?Curtains closing.Can we go home now?A priest will be here tomorrow.I want to see my mail.Can you adjust my pillows?What day is it?It’s time for Antiques Roadshow.I’m very tired.Don’t leave me.Go home to your family.

“Good night. I love you.” 18 days and counting.

High School (or Junior High School) Musical

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arts-sound-music_584If you want to reaffirm your belief in teenagers, try attending a musical hosted by a school in your neighborhood. Oh, I know what you’re thinking,”Are you kidding? If I don’t have a child in that production, then I’m really not interested in watching other people’s children sing off key and stumble through some dance moves.” I understand; it can be off-putting, but, I swear it’s worth it.

Earlier this spring, I attended a performance of Rodger and Hammerstein’s “The Sound of Music” at my youngest daughter’s high school auditorium. It was a spur of the moment decision; my husband was temporarily defeated by cedar fever and the only itch I felt was to get out of the house.  My daughter was making plans to go with friends when I announced that I wanted to go. Surprisingly, she was fine with that. Of course, I reassured her that I wouldn’t sit near her. I arrived about 15 minutes prior to curtain and was surprised to find that there weren’t many seats left.  For a moment, I’d forgotten this was Alamo Heights where there is great support for the Fine Arts. Luckily, I had a friend in ticket sales who sold me the best seat in the balcony. As I hurried upstairs, I looked around at the crowd. Everyone was excitedly finding their seats, greeting friends and neighbors, some with large bouquets of fresh flowers for their special cast member. I recognized some of my daughter’s friends dressed up and decked out as if for a Broadway show. Then, looking down towards the stage, I saw that the first few rows of seats had been removed and replaced by an orchestra pit full of students dressed in black with their instruments gleaming. Soon the lights went out and, when that familiar orchestral prelude began, I was immediately transported to long-ago nights spent with my family, gathered around the television set. I could just see  Julie Andrews in that beautiful meadow with the mountains in the background.  As tears spilled over and I dug through my purse for Kleenex, I was glad my daughter wasn’t near enough to roll her eyes at me. Over the next three hours, I was completely entertained. I laughed, I cried, and I remembered my senior year of high school. The musicians in the orchestra and the actors singing on stage were not so different from those who performed when I attended musicals at my high school in the ’70’s. Students who walked the halls everyday, some unnoticed, had been instantly transformed into rock stars. On stage they were singing and dancing, confidently and self-assuredly, and they were belting out beautiful tunes apparently without a smidgen of stage fright. The audience was similar, too; there was the same wild applause after the first number when realization struck that this great performance was being hosted by high schoolers. There was the same tittering when the leads kissed for the first time on stage, the same hoots and hollers when a child or his friend appeared on stage for the first time; and the same burst of excitement when audience members greeted each other during intermission, declaring somewhat surprisedly, “This is really good.”  And, for one night, or a weekend, the kids on stage were literally in everyone’s spotlight. The entire community was pleased to be in their presence. When the last scene came to an end and the music faded into the background, mothers, fathers, and fellow students all sought the student actors out to offer bear hugs and congratulations. I found myself slapping everyone on the back and saying, too loudly, “Good job. You were awesome.”  The actors gleamed and shone, but seemed a little bemused by all the attention. Everyone filed out of the auditorium smiling and humming, “The Hills are Alive,” enjoying this “feel-good moment.”

This past weekend, I attended a Junior High School’s production of “Bye Bye Birdie,” hosted in a packed school cafeteria. My sister, of whom I’m in awe, has served as the volunteer drama coach at her children’s private school for the last year. Two of my nieces had roles in the musical, so, on Saturday night, my high-schooler and I went to watch. My daughter had a small role in the play when her high school choral department presented it last year. Frankly, we couldn’t imagine that middle schoolers could pull this off; it is a long show with difficult harmonies and melodies. We were hooked when the lights went down and a black, chubby, red-lipped Albert Peterson sat at the desk of Almalou Records and was serenaded by his lovely “Spanish Rose,”  braces and all. Then came the wonderful “Telephone Hour,” with a gaggle of pre-teen girls singing into vintage phones. We giggled when an eighth-grade Conrad Birdie swaggered onstage, began singing, and all the girls screamed, then exaggeratedly fainted. And, we nearly died laughing when Kim’s dad, Mr. McAfee, appeared with painted on mustache, his two children towering over him by a foot or more. By the end of the play, my daughter and I were grinning from ear to ear, having thoroughly enjoyed every minute. Sure, some lines were flubbed, and some kids sang off key. Some looked nervous and stiff, and some were naturals. But, it was clear that all these middle-school actors were having a blast. The set was sparse, the costumes were hand-made or borrowed, and the production was far from professional, which made it all the more endearing. We hugged my nieces and stood back as parents and grandparents stormed the stage bearing bouquets and smothering kisses. My sister later told me that one of the play’s scene-stealers was a troubled boy who had just transferred from an alternative school, having gotten into trouble due to overwhelming problems at home. Unbelievable; he’d sung and danced his heart out and looked as if he’d enjoyed every minute.

Driving home from both productions, I couldn’t help but wonder if the actors would be greeted with the same enthusiasm when they returned to school Monday. Probably not, there’d be a basketball game, or a soccer game, a pep rally or a spelling bee. Teenagers have very short attention spans. But, I’d be thinking about it for days afterward, appreciating the enthusiasm and innocence of youth in a world that sensationalizes the faults of a few.

Apartment Hunting

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images-3My daughter, Claire, and I  spent last weekend in the lovely community of Auburn, Alabama searching for a place for her to live when school begins in the fall. She is a graduate student, so her needs are different from the typical Auburn student. She doesn’t need two pools, a large party room, multiple bedrooms and bathrooms, or hundreds of other students living next to, above and below her. Instead, we were looking for a quiet space for one, not too far from the university. Our search began Friday night at an old complex near campus where a grad student hosted her during her interview weekend. “Too old; needs updating,” we both agreed on first glance. The next day we had several appointments to look at a few newer units. Rising early to make a 10:00 appointment, we arrived at the “Williamsburg Place” complex a few minutes ahead of time. We slowly drove around the grounds and realized that it was surrounded by mobile homes and trailers and was in the backyard of a Taco Bell. “Eww…gross,” we both exclaimed at the same time. Claire called and cancelled the appointment. Undeterred, we began driving around the city. As we approached campus, several nice looking complexes caught our attention, and a routine developed: I’d wait in the car while she ran in and asked for info on a 1-bedroom. Each time, as I looked at her expectantly, the answer was either, “None available,” or “Outside of my price range.”  After a few stops, I was ready to offer her a housing stipend. Closer to campus, we found a quaint red brick building that advertised “Closest to Campus Living!” She quickly looked it up on her phone and found that it was the most expensive rental property in town. We decided this would be a good time to stop for lunch. We chose the “Amsterdam Cafe,” where we each enjoyed some good ole Southern dishes accompanied by large glasses of sweet tea. Fortified, we proceeded to our 1:00 appointment at “Lakewood Commons.” Entering the complex, we were encouraged by the pretty grounds and red brick buildings set far enough apart to give the illusion of privacy. A nice young man took us to a unit in the back of the complex. He told us we could choose between an apartment facing the “lake” or the “forest.” The lake appeared to be a partially dried-up mud hole that I imagined housed a multitude of snakes as well as mosquitos bearing West Nile virus.  I didn’t even want to imagine what the forest might be housing. “Thank you!” we both cried as we ran to our rental car.  Our next appointment was at “The Greens,” a new complex built on a 9-hole golf course. Claire doesn’t play golf, but it sounded placid and appealing. As we drove further and further away from campus, signs for The Greens appeared on the side of the road. Turning in, we couldn’t help but notice the large landfill across the street from the complex. The buildings must have housed 250 people each, and there had to have been 25 or more buildings on the grounds. We never did find the golf course. Claire cancelled another appointment.  Deflated, but trying to remain positive, we told ourselves that at least we’d learned the layout of the town,when suddenly, out of the blue, appeared “The Garden District.” Now this looked promising; the entrance to the complex was beautifully manicured with lots of fresh green grass and blooming spring flowers. As we drove inside, we noticed the buildings were all painted different colors, with green ivy-covered walls and black wrought iron balconies to resemble, you guessed it, New Orleans’ own Garden District. Claire and I both brightened as she ducked inside the leasing office. “Probably too expensive,” I told myself, just before she returned to the car, grinning. Good news: although more expensive than some, cable, utilities and water were all included. YAY! Off we went with another cute leasing agent to look at a “show unit.” What can I say? It was adorable, updated and charming. The agent pointed out that the kitchen was “really small,” and that’s why this unit had a mini-fridge in the closet. Peering into the kitchen we saw that she wasn’t kidding; there was NO stove, a two-burner cooktop and another mini fridge. Hmmm. Oh well, Claire doesn’t cook much anyway, we told ourselves. Proceeding into the bedroom, the agent pulled back curtains to reveal two small closets. Claire asked, “Are there no doors on the closets?” “No,” replied the leasing agent, “But you can get some cute curtains like these!” Noticing a rather large window unit in the bedroom, I asked, “Is there central heat and air?” “No,” said you-know-who, “but these do a really good job of circulating air. And, the studio apartments are all on the bottom floor so they stay cooler than other apartments.” Really? In Alabama in the summertime? Our enthusiasm was waning, but just a bit, when Claire asked if we could look at the few studios available for rent. Of course we couldn’t, but we were allowed to ride by the front of them. Oh, and one more thing…the floor plan may be different than the “show unit”; in some of the studios one must walk through two closets before entering the living space. Huh?  Driving away, we both proclaimed the Garden District “a real possibility,” and went to soothe ourselves with dinner and a glass of wine.  We settled into a booth at the charming restaurant at the Auburn Hotel right in the center of campus, and sighed with relief that our busy day was ending. Then we waited. And waited. I was about to go to the attractive bar behind our table and pour myself a glass of Chardonnay. Finally, a young waitress appeared to pour water and take our order. Salads, oversoaked in dressing, were soon delivered to us. Hungrily, we devoured them anyway, and, as we finished, said waitress came to the table with an over-sized pepper mill asking if we’d like any pepper for our salads. We both nearly laughed out loud, then noticed that her glasses were attached to her head on only one side. One arm of the eyeglass frame was missing. I’m sorry; we did laugh out loud. Next came the entrees which she nearly placed right on top of our salad plates before another young waitperson showed up to swoop away the first course. Dinner was pretty dreadful; pasta soaked in olive oil and sun-dried tomatoes. “Another glass of wine, please!”

After dinner, on the drive to our hotel, Claire said that she’d like to go back and see the first apartment we’d considered.  So, she called the grad student who’d hosted her a few weeks earlier, and asked if we could come by.  She happily agreed, and bright and early the following day we headed over to the place that had, at first, looked drab and old. Suddenly it seemed perfect. The apartment was roomy, comfortable, close to campus, and had a full-size refrigerator, stove, cabinets, and even doors on the closets! Imagine that! We high-fived each other, as Claire’s grad student friend looked on bemusedly, then skipped out to the car, sure that we’d found the perfect habitat for next semester and beyond. Sometimes “comfortable and convenient” overrule “charming and updated!”