19 November 2024
Christina generously drove me to the DMV to see if my license had ever been suspended for an "unexplained loss of consciousness." We sat there for an hour and a half waiting for I017 to be called before learning there was no restriction on my license, probably because it had never been reported by Kaiser (despite four doctors warning me they would have to suspend it).
So when we got to the SNF we were not surprised to see Joyce still in bed. She refused to get in the wheelchair for the second day in a row, Cassie the Occupational Therapist, told me. She did sit on the side of the bed and do some leg exercises, though.
"Can we try again?" I asked her. If Joyce agrees. So I went back and twisted Joyce's arm until she agreed.
Cassie came back with the lift and Jayce the Physical Therapist and they got her into the wheelchair. I rolled her out of the room and down the hall when I heard, "Michael? Ms. Abbott?"
LAUREN THE SOCIAL WORKER
It was Lauren the Social Worker who I had talked to on the phone a few days ago. I asked her if she worked for Golden Heights or Kaiser. Kaiser. We went to the dining hall to chat.
They had just had their Tuesday care meeting to discuss discharge plans. When they got to Joyce they did not craft one. She has not participated in therapy and is not stable enough to go home.
Joyce said she had pain when moving (from being rigid in bed most likely), feels awkward and like she will fall. So she's afraid to get up.
Lauren suggested a meeting with Blake the Psychologist. As with everything, Joyce declined but I suggested she meet with him once to see if it helps. It it doesn't, she doesn't have to see him again but if it does, she can. At least try it once. So she agreed.
I asked her about the transport costs and she said to take the transports and ignore the bills because we haven't hit our deductible yet and aren't likely to before the end of the year when they'll reset.
Dr. Dimaano, the Kaiser doctor assigned to Joyce at the SNF, is in the building today for the discharge meetings, so Lauren offered to have her see us.
DR. DIMAANO
As we rolled out of the room, Dr. Dimaano grabbed us and sent us back to the dining hall. Joyce later said she remembered seeing her before.
She broke the discussion into three parts: the wound, mentation, the medications and rehab.
The Wound. She had been in touch with Dr. Tong who said we can suspend the biweekly debridements for now as long as there is no serious deterioration. She praised Ann the Wound Nurse, who I met when Joyce was first admitted.
She also noted the two cultures done on the wound at the clinic came back with no serious infection, just the normal bacteria that grows on an open wound. Which is just what Dr. Tong told me on the phone.
Mentation. Dr. Dimaano said reports are that Joyce is experiencing a two-year decline in her mental facilities and ability to engage with things. She asked her if she'd been talked to about dementia.
Then she explained it affects memory and executive functions.
She noted Joyce has a Dec. 12 appointment at the memory clinic when this will be addressed.
Medications. Joyce's weight loss and failure to be able to eat because everything tastes awful and makes her want to gag may, she said, be attributable to the Zoloft.
She said these drugs take six to eight weeks to have an effect. It hasn't been that long but if there are no benefits or some problems, there is no point continuing them.
So she's stopping that and increasing the Mirtazapine (Remeron), of which Joyce has been taking a small dose.
Rehab. Staff finds Joyce hard to motivate. I acknowledged that she refuses on reflect but is mostly afraid. She was doing all these things as recently as last month.
Dr. Dimaano explained that if she refuses to do the therapy, the therapists will stop coming and therapy will end.
Joyce responded positively to that admonition. I said she had agreed to get in the chair again tomorrow and first try standing up.
Dr. Dimaano gave me her number in case we have any questions or issues. She'll be back on Thursday.
I rolled Joyce back to the room where two CNAs hoisted her back into bed. I had tried to get her to stand up from the wheelchair and turn into the bed but she couldn't get up from the chair.
Tomorrow perhaps.