11 August 2025
I took Joyce's computer to Golden Heights today for an evisit with Saroya, the Kaiser Memory Clinic nurse practitioner. It was an adventure.
To start with, Joyce slept in her clothes, so she didn't have to get dressed. Staff is supposed to help her get from the wheelchair to the bed (a short hop) and put her gown on for the evening. But they didn't last night.
There's a lot of congestion in the hallways, so I put her chair across from the fish tank and she walks that far. Then I wheel her down to the scale and she stands up fro the chair to weigh herself. She's a little less than yesterday.
That's when I discover that the Pacific room is not free for her noon evisit with Saroya. Someone is playing the piano, banging out one tune after another, as half a dozen residents are having lunch.
There's no other room available of course, so I take her back to her room, move the bed over and set up her laptop on the little tray table. Then I ask Julian at the desk for a Post-it note, but he doesn't have any, so I ask for a piece of paper and a piece of tape, to make a do-not-disturb warning for the door "the old fashioned way." I just ask not to be disturbed because an evisit is in progress and put it on the door, which I close to block the noise from the hall. Which is always as noisy as a high school hallway between classes.
The note works for the most part, although twice someone knocks and sticks their nose in. It is lunch time after all (usually 12:30 for this room). But by then we're talking to Saroya, so I just put my hand up and they retreat. They can't get by us anyway.
I did promise the RN I'd watch Sylvia the roommate, who likes to get out of bed. Her private caretaker hadn't arrived yet. And there's a big pad on the floor between the beds so if she falls there, she won't break anything. But she doesn't get up and only makes one vague complaint during the call.
But really. Is there no place in the whole facility to have a private call with your doctor?
The solution, apparently, is to schedule the next evisit for later in the afternoon because after the call, when I take Joyce to the Pacific room to eat lunch, no one is in there. It's as quiet as a ... well, nevermind.
When Saroya joins the visit, it's a good call. Joyce is responsive to her questions and I don't have to chime in much at all. I only know what goes on from 11:30 to 1:30 or so, after all. And I talk about that in terms of her physical exercise, jigsaw puzzles, appetite and toileting.
Saroya asks if she dresses herself (and she does, entirely) but Joyce says she chooses what she wears, which is stretching it. And Joyce tell Saroya she brushes her teeth (but she does need a little help to do it from the wheelchair). I really don't interject anything about those things.
I discuss her anxiety about walking (but Joyce says once she gets up she's OK, which is also not really the case). And her lack of appetite.
She discusses her medications, noting the increase in the Lexapro (without any side effect Joyce confirms) and suggesting an increase in the Mirtazapine to address the anxiety.
Again I confirm the goal is still to get her home. The toileting and appetite are the two big problems with that. She does manage the stairs and did well with friends this last Wednesday, I report. She's just more and more with it.
I mention that the RN at the quarterly meeting had suggested toileting sessions in which a CNA will sit her on the toilet several times a day using pull-ups instead of diapers. But they haven't started that yet. She promises to look into it.
She asks if we have any other questions before the 20-minute evisit ends.
We'll do this again in four to six weeks, Saroya suggests.
After I put everything away and open the door, I take Joyce down to the Pacific room and bring her lunch tray there.
She's about halfway into the meal when Saroya calls my phone. I put her on speaker (since no one is there and she wants to talk to both of us).
She asks permission to set up a psychiatric consultation by phone or evisit for Joyce to discuss her anxiety. To my surprise Joyce says she thinks that would be a good idea.
She also will prescribe 45mg (up from 30mg) of Mirtazapine, her antidepressant, at bedtime. Let her know, she says, if it causes problems sleeping.
And she talked to Raquel the RN, who has been very helpful to me lately arranging passes and getting Boost, to supply Joyce with Boosts at every meal and to begin the scheduled toileting sessions I had mentioned.
I thank her for promptly addressing those issues.
Joyce doesn't eat much after that. She did have most of her soup and a little of her salad, most of her pudding and some of her ice cream, a bite of her main plate but left it mostly untouched. She drank her milk and prune juice and some coffee before polishing off the Boost.
I take her back to the room to brush her teeth and then say goodbye, the adventure finally concluded to everyone's satisfaction.