Joyce's KP Adventure mikepasini.com headlines
Joyce Goes to the ER
26 September 2024
On Wednesdays I walk two miles to Trader Joe's in Stonestown, do the half-weekly shopping and grab two buses back (so the frozen foods won't defrost). Lately the new drivers on the 48 line have been skipping the Laguna Honda bar stop (just a painted bar on the street, not shelter or benches at the stop), which adds a quarter mile to my walk. This time the driver stopped short by half a block, which is what was on my mind at noon as I made it onto Ulloa with two bags of groceries.
I saw a few people huddled along the side of the school building and peeked to see what was going on. I saw a leg protruding from the plants. And I recognized it. It was Joyce. She'd fallen on her way to CVS.
The crowd worked at the school and had already tended to Joyce and called 911. Since I'd just called 911 myself for her, I knew it would be a while so I hurried home to put the food away before returning.
By that time the parish priest had arrived. But not the fire department.
Diane from the school, got a white comforter to put on Joyce to keep her warm. I could see she'd hit a rock on the ground with the side of her face but she was alert and talking.
When the fire department ambulance arrived, I told them she could stand but not move well. The two emergency medical responders were able to lift her screaming from the bushes using a blanket wrapped around her to a standing position. But they had a hard time getting her onto the chair because it was slightly elevated.
Once she was in they lowered it to a bed and rolled her to the ambulance. I took a seat riding shotgun. And off we went to the Kaiser ER.
℘
WE HAD A LONG WAIT to get into the ER. The EMRs stayed with us, though.
She finally got triaged and parked along the wall as Hallway A, where I sat with her as Dr. Robin evaluated her condition before her shift ended.
She observed falling three times in 12 hours is serious. So she ordered blood work, a brain scan, a face scan (because she had hit on her left cheek) and physical therapy to evaluate her mobility.
Then she was moved to Room 3 where we waited for all these orders to happen.
Cynthia the RN took her blood after putting a second line in (the fire department had put the first in), so she had two, which annoyed her almost as much as breaking a nail in the fall.
Merritt the PT came in to see her walk but when he went out for supplies she was whisked away for a CT scan of her head and face. When he returned, we had a chat about how she moved around at home. Not much.
It took a while for her to return and longer for him to come back. But he got her to sit on the edge of the bed and step down to a walker and walk around 90 feet with no dizziness to the bathroom, which she managed on her own.
So he found her mobile but recommended a walker.
She never uses her trekking pole in the house, manages the stairs without a problem and couldn't easily use a walker outside the house navigating stairs and hills and bus steps (although the more modern buses are quite accommodating, kneeling to the curb and without steps). Our medical insurance doesn't cover walkers, anyway. Imagine.
Results from the tests started coming back. Dr. Brim said the blood tests showed an elevated white count so they suspected her wound may be infected. I pointed out that Dr. Tong had just looked at it yesterday. They had a call in to her but there was someone on call now. Meanwhile she thought they might do another CT scan of the wound and take the dressing off to get a photo.
Which meant, as the only person around who knew how to dress the wound, I'd have to consult.
Off she went for that scan. When she returned I asked if she was hungry but she wasn't. I told her they don't serve food in the ER as a rule but do provide it if you ask.
We did see Dr. Brim again. She said she had talked to Dr. Tong who doubted the wound was infected (which would have broken our three-year record of no infections dressing the wound at home). It could be a urinary tract infection but sometimes a traumatic fall like this will trigger a white blood cell increase, Dr. Brim said.
The CT scan of her head showed no stroke or brain bleed, everything was fine there. But the CT scan of her face showed small fractures in her left cheek. There's no treatment for that (except to avoid blowing your nose).
Sheila the RN came in to do the wound dressing change after gather supplies. They didn't have Vashe so we used saline solution. But they did have Santyl. They had Kerlix and ADP pads but only the smaller Mepilex bandages.
Once Sheila had removed the dressing, she and Dr. Brim took photos, marveling at how good the wound looked after three years (and a day after debriding). Then I advised Sheila on dressing the wound. She used quite a bit more of everything that I do. Half the tube of Santyl, two ADPs and about nine bandages to avoid irritated skin.
"There you go, Joyce," she said. "You can put on your tongs now."
℘
KAMAL THE SOCIAL WORKER discussed the walker recommendation and insurance issue with me. And that home-care physical therapy has been ordered. Then we talked about releasing Joyce.
I said I'd be more comfortable if she stayed overnight to see if she can manage getting in and out of bed and to the bathroom herself without falling. Because if she came home and fell we'd be right back in the ER. She agreed.
That took us to 10 p.m. so I left before Joyce got a room in the hospital, take the 43 Masonic home through Haight Ashbury and past UCSF Medical Center carrying a bag of medical supplies Sheila had given me.