29 December 2025
We were in the pre-op waiting room at 7:15 am for Joyce 7:30 surgery to close the wound when Dr Holland came by to tell us Joyce's latest lab results showed her creatinine level was double the normal rate (2.14 from the 1.11 maximum level). He suspected dehydration was the cause.
He discussed the situation with the anesthesiologist who later explained to me that administering anesthesia under those conditions would risk kidney failure.
So the surgery itself has been postponed.
Dr. Holland thought she might be returned to Golden Heights until her hydration improved and her creatinine returned to normal levels. But I said that wasn't likely to resolve the situation. It's how she got into the situation to begin with.
Despite my constant reminders to the staff she was not given the pre surgery Ensure Kaiser provided. The nurse in admitting gave her one. She drank a little. I took it and had her finish it in prep.
So he looked into getting her admitted to the hospital to address the problem with a little more attention than Golden Heights provides.
Beds open up in the afternoon after patients are released in the morning but Erin the Pre-Op RN thought she might get in earlier because she doesn't need telemetry.
So we waited for an admitting doctor to evaluate her even though she was expected to stay after surgery anyway. And waited.
The game must be played by the rules.
The admitting doctor however is in the ER so we had to go there for more labs and admission. I ask Erin if we're going to get charged for an ER visit and her jaw dropped. She used to work in the ER and not long ago, so she knew exactly what I was referring to. They want a credit card before you leave. She promises to tell them not to charge us and if they do, fight it, she said.
Joyce had to be signed out of the hospital to register in the ER, only after which she could be triaged and get a bed in the ER.
And then there had to be an exchange of gurneys: the surgery one for an ER one.
The admitting doctor Elizabeth Andrews saw her in 2022 remembered her. We went over everything. Again extending the stay a week is an issue. But overnight might reveal if hydration resolves the kidney issue. Dr. Holland wanted her hydrated for five days, she says.
She returns to ask about the wound dressing so I give her the recipe.
Ash the RN takes over, doing a physical exam. I showed him a photo of the wound so he wouldn't take the dressing apart.
He suggests a Purewick but Joyce refuses and he tells her he'll "honor her wishes as a human being." I point out he is talking to the dementia, she refuses everything but she did recently agree to one in South City. And that I'll work on her.
Which I do. Without it collecting her urine, which will increase with hydration, she will be relying on staff to keep her dry. That risks infecting the wound. So it's for her own good.
Ash returns to take some blood for this mornings labs.
Her blood pressure is 85/55 at that point, which is 10:20 a.m. I mention she hasn't had anything by mouth all day and Ash promised to see if he can get her something to eat. Not that she'll eat it.
After an IV drip and a very little lunch, her blood pressure registered 127/55. But by noon it was down to 102/61 again. Ash gave her the medications she usually takes. That got it back up to 110.
She had a Purewick installed even though a bladder scan showed very little urine in her bladder.
A patient care coordinator came by to tell us the SNF can only hold her bed for seven days. I tell her I've already discussed it with the SNF and they've promised to hold her bed. Medi-Cal may have something to say about that, though.
I show Joyce the Purewick working with the front phone camera and she says, "Do I have to keep this hat on?" She meant the hair cap for surgery. No, I answer, but it's keeping her warm.
I let the nurses know there is now urine available for the lab.
And the hours pass. I tell Ash the RN that I've had it. He promises to get his manager to talk to us.
Jeremy the ED manager says he can get an ETA on a bed and arrange for the dressing change that has not occurred. I suggest we send her back to golden heights for wound care.
But by the time they could arrange that, the wound care nurse at Golden Heights would leave for the day. And then too I've never seen them do an IV drip there. And her kidneys need that.
So I'm forced to choose between the sudden need to continue wound care and her hydration.
Jeremy returns with the news that a bed is being vacated at 3 p.m. and, after it is cleaned, she'll be moved to it.
I decide to take the bus home, post this report tapped on my phone during the day and return to the hospital with her wound supplies because, whatever they say, they never do have them.
On the bus ride home Admitting calls me to "update her information." They were not aware her surgery was cancelled and thought she was going home. I ask them to call back at 4:30 when I return to the hospital.
I tried to proofread this on the bus so I could update you when I got home. Developments were so confused and complex that it wasn't possible to respond to anyone who texted or called during the day. I had my hands full dealing with it all.
Joyce, oddly enough, was surprisingly cooperative. She kept apologizing for putting me through all this. She's the one going through it, though.
As soon as I got home to post this, Dr. Holland called to let me know the new plan. He had just changed her wound dressing himself and told me not to worry about it. In fact, he was increasing the changes to twice a day to avoid any infection.
I had mentioned the Purewhich to him but was concerned about fecal matter since she's not wearing pull-ups in the hospital. But he said the increased frequency of the changes would mitigate that.
He also said he thought the would was still closable "dimensionably" so he hoped to do it within a week. But the holiday may interfere with that. He'll keep me posted. Take the first cancellation, I advised him. He laughed. They do that.
He also said he hopes the hydration resolves the kidney issue. If he can't get a s surgery date before a week, he may have to send her back to the SNF with an IV drip. He had discussed doing one last weekend but there was "resistance." I thought he meant from Joyce but he meant from the staff. I told him I'd never seen one done there.
I told him he had reassured me. "Good," he said. He apologized for the delay and promised to let me know as soon as he had another date.
It's 3:50 p.m. as I post this.