30 October 2024
A day at the races is a chance to win, even if experience suggests just the opposite. So it was yesterday at Kaiser.
Joyce was asleep in bed when I got there at 1 p.m. Her dressing had not been changed and she hadn't had lunch. Dr. Lim had been replaced by Dr. Chambers, who wanted to talk to me about Joyce's "choice." What choice?
An RN did finally do the dressing change, but I had to remind her about a couple of steps and then reapply the Ace bandage she had awkwardly wrapped around the dressing.
A little while later, a physical therapist got her out of bed with my cajoling and into a chair after Joyce shuffled a few feet around the room, the most she's walked in weeks. She had her lunch (which came right after and was just fruit and soup) in the chair.
We were watching the early broadcast of the News Hour when Dr. Chambers arrived. She tried to suggest that PT had OKed Joyce for transfer to a SNF. Not so fast. This is the first time she's actually walked.
I worked with PT at my mother's SNF for a year. It's not itself the answer. The patient has to have an incentive to do the work or they don't accomplish anything. You need a running start, in short, to walk.
I worked with wound care at a SNF during that year. If you're lucky, a doctor visits once a week to update the order that two RNs try to implement despite the demands on them. It doesn't go well. It inevitably falls to a substitute RN, unfamiliar with the dressing, to get it done.
SNFs are nor sufficiently staffed. And skilled nurses are in very high demand.
I know this going in. But I also know I can't care for her at home in this condition (her state and mine). She can't get out of bed, climb stairs, make it to the bathroom. Basic stuff.
Unfortunately this compromise subjects her to some serious dangers. The cancer from infection that Dr. Tong always feared. And neglect in general.
Not a good day at the races, after all. But it rarely is.