We took a break from visiting Margaret on Tuesday and Wednesday as advised by her GP and took Louis into visit her on Thursday morning.
When we arrived Margaret was in her chair with a mattress in front of it. Both her legs were weeping but she actually looked a lot better. She was still very confused but a lot calmer.
I asked the carers if we could take her for a walk as it was a beautiful morning and they got her into her wheelchair. Helen held Louis' lead as I pushed Margaret's wheelchair around the block for about 45 minutes. Margaret knew that we hadn't visited but seemed to think that I had been away on a business trip which I did a lot of in the 70s and 80s. Helen was still in trouble as she hadn't visited while I was away! Margaret now refers to the Nursing Centre as "our home" and appears to consider the cares as bossy neighbours.
The RN told us that Margaret had settled down a lot and was being quite pleasant to everybody and much easier to care for. She was still having hallucinations and they wondered if Margaret had had any unpleasant experiences as a child as she was very scared of being sexually assaulted. I first met Margaret when she was nineteen and she has never mentioned anything to me except being chatted up by an American Serviceman near Hampton Court in her early teens. Perhaps there was more to it than she said.
Just before lunch Helen and I left to take Louis home and I told Margaret that I would return at 1.00 pm to see if her GP was dropping in during 1 and 2. Margaret was going to have lunch in the dining room and was taken there in her wheelchair as we left. When I returned lunch was over but Margaret was sitting by herself in the dining room. She had refused to eat anything and had got upset because I hadn't returned. In fact I was there just before 1.00pm. I wheeled her back to her room and the carers took her to the toilet and settled her in her chair. I stayed until 2.00 pm but her GP didn't visit. (He actually visited in the evening). Margaret was still very confused and we had a long conversation about my "business trips" and Helen's lack of concern about her being left at home on her own. While she liked some of the people who visted (carers and RNs) some were bossy and they didn't seem to realise that this was "our home".
Before I left I was advised to limit my visiting as Margaret got upset when I left and took some time to settle. She was quite OK after she had settled and quite happy if somewhat confused. Apparently she misses me and one day's absence is treated as weeks away on "business". I hadn't realised how much affect my life as an engineer working on defence programs entailing numerous trips away from had had on her. I do know that at its peak I spent more working days away from my office than in it for a few years. At the time Margaret was heavily into local theatre and film work and said that she was OK.
On Friday I couldn't make up my mind what to do about visiting but finally decided to go in by bus with Helen. We arrived at 12.30 pm to find Margaret sitting up in her chair having eaten a good lunch in her room. She was is quite a nice mood but complained that we hadn't been in for days. She knew that I had to go away but Helen should have looked in on her. Again she was back in the 70s when Helen was a difficult teenager and we didn't know where she was for quite long periods. Because we had come in by bus we set a definite time to leave at 1.50 pm as our bus left at 2.00 pm and could be a little early. Margaret took this quite well and seemed quite settled when we left.
We told her that I would return on Sunday with Louis but Helen would look in and have lunch with her on Saturday which is where she is now.
Saturday, September 11, 2010
Tuesday, September 7, 2010
A Tough Few Days
When we got into see Margaret on Friday morning she was lying in bed having had a series of falls. We think it was three in total. After the first two she had difficulty breathing and my GP, C, was called in. He prescribed morphine to settle her down and she was put in her chair. Unfortunately she was able to reach the controller and, being a compulsive button pusher, she pressed the lift button until the chair seat was nearly vertical and she fell forward off the chair. She has now badly bruised her good (right) arm and has even more bruising on her body.
Her breathing was gurgly and loud but she enjoyed Louis visit. I took him home after a short time as Margaret was too bruised to take for a walk in her wheelchair. I returned after an hour with a sandwich and a Gin and Tonic for Margaret's lunch. She again rejected the lunch provided and ate half a sandwich from home. She drank some of the G and T but really wasn't impressed with it. We stayed until 2.00 pm as Margaret's GP, A, was supposed to visit. He hadn't arrived by the time we left and we needed to feed Louis and get out own lunches. We later learnt that he arrived 10 minutes later but Margaret didn't remember him coming. We solved the chair problem by switching off its power supply after she had been installed so even if she found the controller it would not operate.
These pictures show Margaret in her chair and sleeping. This condition was not to last for long.
On Saturday we arrived to find Margaret on the floor - well actually on the mattress. Apparently she had fallen out of her chair by wiggling as far forward as she could to the end of the foot rest. The chair then tipped forward and she landed on the mattress and went to sleep. She had had an hours sleep on the floor as the carer's had just covered her up and left her to sleep. It takes at least two people to get her up and as she was comfortable and in no danger leaving her there was the sensible thing to do.
The carer's got her up when we arrived and placed her back in her chair. She was very confused and thought that she was in her own home but not in Queensland, possibly SA or even the UK. She kept trying to get up as she was "going out". She was in a a really nasty mood and poor Helen came in for a lot of flack for not visiting enough which is unfair as we moved over 2000 km from her. It was not a pleasant visit and Margaret's breathing was still laboured. We left after giving her a sandwich and some white wine. She only ate half a sandwich but actually liked the wine.
On nice thing was that our friend, B, dropped in for a visit and this did brighten Margaret up for a while but she slipped back into her bad mood after B left.
On Sunday we arrived and Margaret was in her chair and very upset. She had been agitated all morning and had thrown her breakfast on the floor. Fruit and Yoghurt make a nice mess on the carpet which had to steam cleaned later. We learnt that after we left the day before she had asked the carers to take her to bus which would take he to Sunbury on Thames where she used to live 52 years ago.
She was upset all morning and we left both very upset by her behaviour. We know that she is very ill and the toxins from her kidney failure and the pain killing drugs are making her dementia and confusion worse but the constant aggression towards us both is difficult to take. When we tried to leave she tried to get out of the chair and come with us.
Early Monday morning Margaret's GP, A, phoned to see how Margaret had got though the weekend and said that he would visit her at lunch time.
The visit was worse that before and by 12.00 noon i had had enough and went out to the car park to wait for A leaving Helen alone with Margaret. I believe that Margaret was really nasty to her and told her to leave. A arrived at 12.45 pm and spoke to Margaret who responded with a long litany of complaints about us and the carers. Most of it was incomprehensible. A has now prescribed an anti-psychotic drug to ease her confusion and also sedate her. Her also said that for our own sake we shouldn't visit Margaret for two days to allow her to settle down. We will comply.
This is another broken promise as I had promised to visit Margaret every day. I hope that her confused unhappy mind doesn't remember this.
Her breathing was gurgly and loud but she enjoyed Louis visit. I took him home after a short time as Margaret was too bruised to take for a walk in her wheelchair. I returned after an hour with a sandwich and a Gin and Tonic for Margaret's lunch. She again rejected the lunch provided and ate half a sandwich from home. She drank some of the G and T but really wasn't impressed with it. We stayed until 2.00 pm as Margaret's GP, A, was supposed to visit. He hadn't arrived by the time we left and we needed to feed Louis and get out own lunches. We later learnt that he arrived 10 minutes later but Margaret didn't remember him coming. We solved the chair problem by switching off its power supply after she had been installed so even if she found the controller it would not operate.
These pictures show Margaret in her chair and sleeping. This condition was not to last for long.
On Saturday we arrived to find Margaret on the floor - well actually on the mattress. Apparently she had fallen out of her chair by wiggling as far forward as she could to the end of the foot rest. The chair then tipped forward and she landed on the mattress and went to sleep. She had had an hours sleep on the floor as the carer's had just covered her up and left her to sleep. It takes at least two people to get her up and as she was comfortable and in no danger leaving her there was the sensible thing to do.
The carer's got her up when we arrived and placed her back in her chair. She was very confused and thought that she was in her own home but not in Queensland, possibly SA or even the UK. She kept trying to get up as she was "going out". She was in a a really nasty mood and poor Helen came in for a lot of flack for not visiting enough which is unfair as we moved over 2000 km from her. It was not a pleasant visit and Margaret's breathing was still laboured. We left after giving her a sandwich and some white wine. She only ate half a sandwich but actually liked the wine.
On nice thing was that our friend, B, dropped in for a visit and this did brighten Margaret up for a while but she slipped back into her bad mood after B left.
On Sunday we arrived and Margaret was in her chair and very upset. She had been agitated all morning and had thrown her breakfast on the floor. Fruit and Yoghurt make a nice mess on the carpet which had to steam cleaned later. We learnt that after we left the day before she had asked the carers to take her to bus which would take he to Sunbury on Thames where she used to live 52 years ago.
She was upset all morning and we left both very upset by her behaviour. We know that she is very ill and the toxins from her kidney failure and the pain killing drugs are making her dementia and confusion worse but the constant aggression towards us both is difficult to take. When we tried to leave she tried to get out of the chair and come with us.
Early Monday morning Margaret's GP, A, phoned to see how Margaret had got though the weekend and said that he would visit her at lunch time.
The visit was worse that before and by 12.00 noon i had had enough and went out to the car park to wait for A leaving Helen alone with Margaret. I believe that Margaret was really nasty to her and told her to leave. A arrived at 12.45 pm and spoke to Margaret who responded with a long litany of complaints about us and the carers. Most of it was incomprehensible. A has now prescribed an anti-psychotic drug to ease her confusion and also sedate her. Her also said that for our own sake we shouldn't visit Margaret for two days to allow her to settle down. We will comply.
This is another broken promise as I had promised to visit Margaret every day. I hope that her confused unhappy mind doesn't remember this.
Thursday, September 2, 2010
Margaret Is Back In Noosa Nursing Centre
It has been quite a week. Over last weekend in Noosa Hospital Margaret's physical condition improved a little so there was no reason not to return her to her room at the Noosa Nursing Centre.
On Monday she was transported, by ambulance, back to the centre and returned to her old share room. Coincidentally the lady she was meant to share with was in the next room to Margaret in the Noosa Hospital and looked like being there for some time so Margaret has the room to herself; more later.
We visited Margaret soon after her re-admission and she was very unhappy as she thought that she was going home. We called back in the afternoon and took Louis into visit her which was a great success as he jumped on the bed and gave her a great sloppy kiss. We stayed for a little while and checked her medications were in order and that they were aware of her weak condition. We needn't have worried she is now noted as requiring two people to assist her at all times even if using her wheely walker.
We didn't take Louis on Tuesday morning.but stayed for about three hours with her. She had spent the night sleeping on the floor! She is considered a risk of falling out of bed so her bed is lowered as far as possible and a mattress placed on the floor to minimise the effects of any fall. Margaret prevented this by actually crawling onto the mattress and falling asleep. She was covered up and tucked in and spent a quiet night sleeping on the floor which she also did on Tuesday and Wednesday nights. Margaret was very confused all the time we were there. She appears to be living back in the late 1970's when we lived in Woodville, South Australia. In particular she constantly reminded Helen not to be naughty girl. Margaret also thought that we were going to catch a bus back to South Australia and asked how we would get from the Flinders Street Bus Station home. She was happy to hear that we would take a cab. She sat up in a fairly basic arm chair and kept falling asleep. After lunch, which she didn't eat, she was put back in bed. When I said good bye she said that i mustn't leave her as she wanted to come to South Australia with me.
Tuesday evening Margaret's GP ,A, phoned me to say that he had visited Margaret on Monday evening to sort out her medications and had seen her on her mattress where she was quite comfortable and happy. He had visited just after lunch on Tuesday would visit her again on Wednesday lunch time and would discuss future care then. He also said that Margaret told him that I had left her to return to South Australia.
Wednesday morning I clipped Louis and we took him in to visit Margaret. She was sitting up in her arm chair. Her legs were beginning to swell again and she was even more confused. Helen was still in trouble for sneaking out of the house and not coming back all night, a thing she used to do in the 1970s. We got assistance to get her in her wheelchair and took her for a walk around the block. While Helen was pushing her she complained that Helen was deliberately hitting all the bumps! Poor Helen she was cropping it while actually being quite sweet and careful.
I took Louis home and left Helen at the centre. While I was away Margaret kept getting Helen to rescue me as I was stuck in her en-suite bathroom. Helen had to open the door wide to show here that I wasn't there. Over lunch she wouldn't eat anything and actually threw her Apple Crumble at Helen.
I returned in time to see A who will place Margaret on the Palliative Care Programme next week. She is however very week and even with assistance has had her knees buckle when being transferred from her chair to wheely walker. We are going to to take in her favourite sandwiches and some wine for lunch on Thursday. A was also concerned with Margaret's legs and when I suggest a chair with leg rests agreed that it was necessary. After Margaret gave A a long talk about the "Landlady" not being nice and poor Helen hadn't got anywhere to stay he left and will return on Friday, making four visits in five days.
Helen and I went to the local agents for electrically assisted recliner and lift chairs to check their availability and, by chance, he had the ideal chair available immediately. It was second hand but looks new. I notified the home that it would arrive between 9.30 and 10.30am Thursday morning and was asured that it would be OK.
We arrived just after 9.30 am this morning, Thursday, and the char had been delivered and Margaret was being settled into it when we got to her room. The Carers were concerned that it was too big and took up the space where Margaret's mattress was placed at night. This meant that the space for the other occupant was pretty much taken up by Margaret. We thought that we could rearrange the furniture but as Margaret had fallen asleep in her new chair decided to leave it until she woke up. Margaret slept all morning and even if the chair is only used for a short time seeing her comfortably sleeping in it makes its expense worth while.
I went home to make Margaret's lunch time sandwich while Helen stayed behind. Margaret stirred occasionally and talked about our two dogs. We haven't had two dogs since 1984! After I returned the space problem was solved by moving the other occupant' bed out so to all intents and purposes Margaret is in single room for the time being.
At 12.00 noon Margaret again rejected the lunch from the home although it
looked very appetising but ate the Liver-wurst and Tomato sandwiches I had made instead. She also drank a little fizzy white wine, which by law can't be called Champagne in Australia, to wash it down. we left her at 1.00 pm still snoozing in he new chair.
We both agreed that Margaret is significantly weaker that when she left hospital and will take Louis into see her tomorrow morning.
On Monday she was transported, by ambulance, back to the centre and returned to her old share room. Coincidentally the lady she was meant to share with was in the next room to Margaret in the Noosa Hospital and looked like being there for some time so Margaret has the room to herself; more later.
We visited Margaret soon after her re-admission and she was very unhappy as she thought that she was going home. We called back in the afternoon and took Louis into visit her which was a great success as he jumped on the bed and gave her a great sloppy kiss. We stayed for a little while and checked her medications were in order and that they were aware of her weak condition. We needn't have worried she is now noted as requiring two people to assist her at all times even if using her wheely walker.
We didn't take Louis on Tuesday morning.but stayed for about three hours with her. She had spent the night sleeping on the floor! She is considered a risk of falling out of bed so her bed is lowered as far as possible and a mattress placed on the floor to minimise the effects of any fall. Margaret prevented this by actually crawling onto the mattress and falling asleep. She was covered up and tucked in and spent a quiet night sleeping on the floor which she also did on Tuesday and Wednesday nights. Margaret was very confused all the time we were there. She appears to be living back in the late 1970's when we lived in Woodville, South Australia. In particular she constantly reminded Helen not to be naughty girl. Margaret also thought that we were going to catch a bus back to South Australia and asked how we would get from the Flinders Street Bus Station home. She was happy to hear that we would take a cab. She sat up in a fairly basic arm chair and kept falling asleep. After lunch, which she didn't eat, she was put back in bed. When I said good bye she said that i mustn't leave her as she wanted to come to South Australia with me.
Tuesday evening Margaret's GP ,A, phoned me to say that he had visited Margaret on Monday evening to sort out her medications and had seen her on her mattress where she was quite comfortable and happy. He had visited just after lunch on Tuesday would visit her again on Wednesday lunch time and would discuss future care then. He also said that Margaret told him that I had left her to return to South Australia.
Wednesday morning I clipped Louis and we took him in to visit Margaret. She was sitting up in her arm chair. Her legs were beginning to swell again and she was even more confused. Helen was still in trouble for sneaking out of the house and not coming back all night, a thing she used to do in the 1970s. We got assistance to get her in her wheelchair and took her for a walk around the block. While Helen was pushing her she complained that Helen was deliberately hitting all the bumps! Poor Helen she was cropping it while actually being quite sweet and careful.
I took Louis home and left Helen at the centre. While I was away Margaret kept getting Helen to rescue me as I was stuck in her en-suite bathroom. Helen had to open the door wide to show here that I wasn't there. Over lunch she wouldn't eat anything and actually threw her Apple Crumble at Helen.
I returned in time to see A who will place Margaret on the Palliative Care Programme next week. She is however very week and even with assistance has had her knees buckle when being transferred from her chair to wheely walker. We are going to to take in her favourite sandwiches and some wine for lunch on Thursday. A was also concerned with Margaret's legs and when I suggest a chair with leg rests agreed that it was necessary. After Margaret gave A a long talk about the "Landlady" not being nice and poor Helen hadn't got anywhere to stay he left and will return on Friday, making four visits in five days.
Helen and I went to the local agents for electrically assisted recliner and lift chairs to check their availability and, by chance, he had the ideal chair available immediately. It was second hand but looks new. I notified the home that it would arrive between 9.30 and 10.30am Thursday morning and was asured that it would be OK.
We arrived just after 9.30 am this morning, Thursday, and the char had been delivered and Margaret was being settled into it when we got to her room. The Carers were concerned that it was too big and took up the space where Margaret's mattress was placed at night. This meant that the space for the other occupant was pretty much taken up by Margaret. We thought that we could rearrange the furniture but as Margaret had fallen asleep in her new chair decided to leave it until she woke up. Margaret slept all morning and even if the chair is only used for a short time seeing her comfortably sleeping in it makes its expense worth while.
I went home to make Margaret's lunch time sandwich while Helen stayed behind. Margaret stirred occasionally and talked about our two dogs. We haven't had two dogs since 1984! After I returned the space problem was solved by moving the other occupant' bed out so to all intents and purposes Margaret is in single room for the time being.
At 12.00 noon Margaret again rejected the lunch from the home although it
looked very appetising but ate the Liver-wurst and Tomato sandwiches I had made instead. She also drank a little fizzy white wine, which by law can't be called Champagne in Australia, to wash it down. we left her at 1.00 pm still snoozing in he new chair.
We both agreed that Margaret is significantly weaker that when she left hospital and will take Louis into see her tomorrow morning.
Friday, August 27, 2010
Margaret is Still Fighting
Helen and I visit Margaret for up to six hours a day. On Tuesday night she removed her catheter and cannula which means that she is no longer on a drip and they can't do a proper fluid balance. It has been decided not to replace them.
She is not eating anything very much and is very weak. She cannot stand without assistance which, with her broken arm, means that it takes two people to get her to and from the bath room. Her pain control appears to be working and she is quite feisty as I found out when I tried to feed her on Wednesday. She grabbed the fork, threw the food at me and if I hadn't been quick would have skewered me.
Helen tends to fuss over her Mum and she was told, "Shut up and go away you silly cow!". Margaret did apologise later but as Helen said it made up for all the times when she had been a silly cow and Margaret still supported her.
In spite of all her problems Margaret's kidney function is improving. On Monday her Creatinine Level was 436 micromol/litre and eGFR 9 ml/min which is for all intents and purposes is complete kidney failure. By Wednesday they had improved to 200 and 22 respectively. If we can keep getting fluid into her she will survive a little while longer. This has been achieved by stopping all her diuretics which now means that she is at risk of pulmonary oedema and heart failure. I have been asked by her specialist if Margaret has and wishes concerning resuscitation. Fortunately she has an Advanced Health Directive and has given me her Enduring Power of Attorney for Health Matters. She does not want to be resuscitated and the Specialist was relieved as this is probably the best and kindest thing for Margaret.
Because Margaret is not actually receiving any medical treatment and her arm is beyond repair she will be sent back to her room in the nursing home early next week where she will receive palliative care. Here we will be able to visit her at any time and take Louis into visit her. We hope to be able to have a birthday party for her on the 26 September when she will be 74. We celebrate our 52nd Wedding Anniversary on the 20 September.
She is not eating anything very much and is very weak. She cannot stand without assistance which, with her broken arm, means that it takes two people to get her to and from the bath room. Her pain control appears to be working and she is quite feisty as I found out when I tried to feed her on Wednesday. She grabbed the fork, threw the food at me and if I hadn't been quick would have skewered me.
Helen tends to fuss over her Mum and she was told, "Shut up and go away you silly cow!". Margaret did apologise later but as Helen said it made up for all the times when she had been a silly cow and Margaret still supported her.
In spite of all her problems Margaret's kidney function is improving. On Monday her Creatinine Level was 436 micromol/litre and eGFR 9 ml/min which is for all intents and purposes is complete kidney failure. By Wednesday they had improved to 200 and 22 respectively. If we can keep getting fluid into her she will survive a little while longer. This has been achieved by stopping all her diuretics which now means that she is at risk of pulmonary oedema and heart failure. I have been asked by her specialist if Margaret has and wishes concerning resuscitation. Fortunately she has an Advanced Health Directive and has given me her Enduring Power of Attorney for Health Matters. She does not want to be resuscitated and the Specialist was relieved as this is probably the best and kindest thing for Margaret.
Because Margaret is not actually receiving any medical treatment and her arm is beyond repair she will be sent back to her room in the nursing home early next week where she will receive palliative care. Here we will be able to visit her at any time and take Louis into visit her. We hope to be able to have a birthday party for her on the 26 September when she will be 74. We celebrate our 52nd Wedding Anniversary on the 20 September.
Tuesday, August 24, 2010
A Traumatic Day
Yesterday, Monday, was a traumatic day. Helen and i went shopping before dropping in to see Margaret at 9.15 am. As we walked in we were met by the RN who had been trying to contact me by phone. Margaret had had a serious fall. She had hit her head quite hard and had a gash on her forehead which would require stitches. An ambulance had been called and she was going to hospital.
The ambulance arrived promptly and she was in the Noosa Emergency Department by just after 10.00 am. The senior nurse on charge was D who had fixed up a serious skin-tear for Margaret back in April. He was superb and soon had Margaret calmed down and on a drip and blood taken for testing. She was in total shock and very confused. X-rays were taken of her head and arm. This took some time so Helen and I had a coffee to keep us going.
The Trauma Doctor came and showed us the X-ray results. Her head is fine and would be stitched up but her arm was seriously damaged. The original break had re-broken and the humerus shaft was displaced from the ball joint at the shoulder by about 30 mm. This would normally result in a complete shoulder replacement as the socket was also damaged but in Margaret's case this wont be done as she wont survive the surgery.
Worse still her kidneys had shut down and the Doctor wanted to put her on Dialysis ASAP. I asked her to consult her specialist who was on call. When he arrived he said the arm was irreparable and in time the ball would become necrotic as it had no blood supply. She will never gain the use of this arm. Her kidneys were in the End Stage Failure state and she would not be suitable for Dialysis. I had two options to consider:
She was admitted to the ward about 3.30 pm.
We went back to the Nursing Home to get some things and she will keep her room providing she is back in nine weeks. Home to feed and exercise Louis who had been on his own since 8.00 am and then back to the hospital just before 6.00 pm.
Her specialist called in to see her and had a quiet chat with me. He is stopping most of her medications in order to give the Kidneys some chance to recover but she is critically ill at present.
Helen and I went home for dinner and are off to visit her this morning at about 9.30 am. Visiting is not until 11.00am but they make exceptions when the patient is so ill. Actually, as she has no usable arms (one broken and the other immobilised by a drip), we are useful to give her drinks and feed her. We will leave after her lunch to have our own, feed Louis and walk him then rest up before we go back for her evening meal at 5.00 pm. We will come home about 6.30 pm for our dinner.
Helen is staying until things resolve themselves.
The ambulance arrived promptly and she was in the Noosa Emergency Department by just after 10.00 am. The senior nurse on charge was D who had fixed up a serious skin-tear for Margaret back in April. He was superb and soon had Margaret calmed down and on a drip and blood taken for testing. She was in total shock and very confused. X-rays were taken of her head and arm. This took some time so Helen and I had a coffee to keep us going.
The Trauma Doctor came and showed us the X-ray results. Her head is fine and would be stitched up but her arm was seriously damaged. The original break had re-broken and the humerus shaft was displaced from the ball joint at the shoulder by about 30 mm. This would normally result in a complete shoulder replacement as the socket was also damaged but in Margaret's case this wont be done as she wont survive the surgery.
Worse still her kidneys had shut down and the Doctor wanted to put her on Dialysis ASAP. I asked her to consult her specialist who was on call. When he arrived he said the arm was irreparable and in time the ball would become necrotic as it had no blood supply. She will never gain the use of this arm. Her kidneys were in the End Stage Failure state and she would not be suitable for Dialysis. I had two options to consider:
- Return her to the Nursing Home and start Palliative Care immediately and she would die within a couple of weeks.
- Leave her in hospital where he would try and get her kidneys working again as they had done at Nambour in June . She has seven days before the Kidney Failure became irreversible.
She was admitted to the ward about 3.30 pm.
We went back to the Nursing Home to get some things and she will keep her room providing she is back in nine weeks. Home to feed and exercise Louis who had been on his own since 8.00 am and then back to the hospital just before 6.00 pm.
Her specialist called in to see her and had a quiet chat with me. He is stopping most of her medications in order to give the Kidneys some chance to recover but she is critically ill at present.
Helen and I went home for dinner and are off to visit her this morning at about 9.30 am. Visiting is not until 11.00am but they make exceptions when the patient is so ill. Actually, as she has no usable arms (one broken and the other immobilised by a drip), we are useful to give her drinks and feed her. We will leave after her lunch to have our own, feed Louis and walk him then rest up before we go back for her evening meal at 5.00 pm. We will come home about 6.30 pm for our dinner.
Helen is staying until things resolve themselves.
Sunday, August 22, 2010
Update
On Saturday morning Helen and I visited Margaret at 9.30 am to find her sitting hunched up on the edge of her bed. We couldn't get her to talk to us and she was nearly falling over. Her carer sat next to her and held her up while she called for a hoist to lift her up and back safely on the bed. We are not sure what happened but we think that she had tried to get out of bed for some reason and could not stand up and just froze. She had been catheterised the night before to check her urine flow and she may hve been confused by the tube and collection bag.
We hadn't taken Louis in and she really wasn't up to a walk so she stayed in bed. She was really confused and her both her legs are now massively swollen. She hadn't taken her breakfast medications so I gave them to her. I left at 12.00 noon to feed Louis and get some rest leaving Helen to hold the fort. Margaret was dressed for lunch, which she didn't eat, and was transferred by hoist to the dining room to watch a video on the Large screen TV about ballet which Helen thinks she enjoyed. She was taken back to her room and hoisted back into bed and Helen was left to look after her. This proved very traumatic as during the afternoon she began to fall out of bed and Helen had to support her while trying to get hold of a carer to help. Margaret became very aggressive and actually bit Helens arm leaving a great imprint of her teeth on Helen's forearm. She also ripped poor Helen's necklaces off and threw them away. The carers helped get her back in bed and she was given a sedative.
By the time I got back to pick up Helen and take out for dinner as she had been there for eight hours without a break Margaret was calm but in some pain and I asked the RN is she could have some morphine. We went out to a Local Surf Club to have a meal with Margaret's cousin and daughter but arranged to come back at 8.30 pm to help settle Margaret down for bed. Unfortunately this message wasn't passed on to the carers so when Margaret started to ask where we were she was told that we weren't coming back. Margaret freaked out and would not remain in her room so was taken to the dining room to sit in solitary state and unattended in the dining room. When we arrived she had thrown a cup of tea and some biscuits on the floor and was very upset. I managed to get her to stand up and transfer from her armchair to her wheel chair so we could take her back to bed where with some difficulty we managed to settle her down. The RN brought in some sedatives and a sleeping tablet which she had refused to take. She took them for me and we stayed until they took effect and left her sleeping quietly. At home we both had a stiff gin and tonic as our sedatives and watched the Australian Election results.
This morning we were back at 9.00 an to find Margaret sitting on her wheely walker in her bathroom refusing to come. She was showed and dressed but was holding her partially healed arm in an awkward manner. She got out of bed and fallen in the bathroom during the night at 11.00 pm and had another fall at 6.00 am. Paradoxically she had been very quiet and well behaved and taken all her tablets. We got assistance from two carers to get her into her wheel chair and took her for a walk around the block to give her some fresh air as it is a beautiful sunny day. When we returned her GP called in. He is still concerned with the swollen legs but the infection appears to be lessening. He was worried that she may have re-broken her left arm and she will have X-rays tomorrow. He also reviewed her medications and she will be given more drugs to lessen her anxiety and aggression. He is now on call to visit any time. It is likely that Margaret will be placed on the Queensland's Health Palliative Care Program in the near future. A specialist will examine her and set up a care plan which will be administered by the RNs and monitored by the GP.
I went home just before 12.00 noon to feed Louis but shall return about 2.00 pm with Louis to try and cheer Margaret up. By then she should be a lot calmer. We should be able to leave her in the RN's care overnight and she will be on regular surveillance in case she fall again.
We hadn't taken Louis in and she really wasn't up to a walk so she stayed in bed. She was really confused and her both her legs are now massively swollen. She hadn't taken her breakfast medications so I gave them to her. I left at 12.00 noon to feed Louis and get some rest leaving Helen to hold the fort. Margaret was dressed for lunch, which she didn't eat, and was transferred by hoist to the dining room to watch a video on the Large screen TV about ballet which Helen thinks she enjoyed. She was taken back to her room and hoisted back into bed and Helen was left to look after her. This proved very traumatic as during the afternoon she began to fall out of bed and Helen had to support her while trying to get hold of a carer to help. Margaret became very aggressive and actually bit Helens arm leaving a great imprint of her teeth on Helen's forearm. She also ripped poor Helen's necklaces off and threw them away. The carers helped get her back in bed and she was given a sedative.
By the time I got back to pick up Helen and take out for dinner as she had been there for eight hours without a break Margaret was calm but in some pain and I asked the RN is she could have some morphine. We went out to a Local Surf Club to have a meal with Margaret's cousin and daughter but arranged to come back at 8.30 pm to help settle Margaret down for bed. Unfortunately this message wasn't passed on to the carers so when Margaret started to ask where we were she was told that we weren't coming back. Margaret freaked out and would not remain in her room so was taken to the dining room to sit in solitary state and unattended in the dining room. When we arrived she had thrown a cup of tea and some biscuits on the floor and was very upset. I managed to get her to stand up and transfer from her armchair to her wheel chair so we could take her back to bed where with some difficulty we managed to settle her down. The RN brought in some sedatives and a sleeping tablet which she had refused to take. She took them for me and we stayed until they took effect and left her sleeping quietly. At home we both had a stiff gin and tonic as our sedatives and watched the Australian Election results.
This morning we were back at 9.00 an to find Margaret sitting on her wheely walker in her bathroom refusing to come. She was showed and dressed but was holding her partially healed arm in an awkward manner. She got out of bed and fallen in the bathroom during the night at 11.00 pm and had another fall at 6.00 am. Paradoxically she had been very quiet and well behaved and taken all her tablets. We got assistance from two carers to get her into her wheel chair and took her for a walk around the block to give her some fresh air as it is a beautiful sunny day. When we returned her GP called in. He is still concerned with the swollen legs but the infection appears to be lessening. He was worried that she may have re-broken her left arm and she will have X-rays tomorrow. He also reviewed her medications and she will be given more drugs to lessen her anxiety and aggression. He is now on call to visit any time. It is likely that Margaret will be placed on the Queensland's Health Palliative Care Program in the near future. A specialist will examine her and set up a care plan which will be administered by the RNs and monitored by the GP.
I went home just before 12.00 noon to feed Louis but shall return about 2.00 pm with Louis to try and cheer Margaret up. By then she should be a lot calmer. We should be able to leave her in the RN's care overnight and she will be on regular surveillance in case she fall again.
Friday, August 20, 2010
A Stressfull Week
On Saturday Margaret was strangely docile. She was very confused but not aggressive nor did she ask me to take her home. We spent the visit talking and going for a walk with Louis. Margaret's legs were still very swollen and the left leg was worse that the right and also very inflamed. I though that her GP was visiting over the weekend but he didn't show up on Saturday or Sunday.
On Sunday Margaret was almost non-coherent but still very quiet. She said that she hadn't eaten since Friday. We had a brief walk with Louis.
On Monday I thought that she was too ill to go out to have her hair done but she insisted. She had a nice cut and style which I thought looked very nice and i know she enjoyed her hairdressers cheerful chatter. The only problem that her legs were worse and still no GP visit.
On Tuesday I dropped into the GP's surgery and left a message that Margaret was very ill an her left leg was now seriously inflamed and painful. I needn't have bothered. When I got to the Nursing Centre Margaret was the centre of attention. She had refused her medication, struggled with her carers during her shower and was now in the dining room telling everybody that she was being poisoned and had been assaulted. The staff could not calm her and had given her an injection to settle her down. She listened to me and let me get her back to her room where I managed to get her to take most of her tablets which she had spat at the RN. The RN had phoned the GP and they tested her for a urinary infection which showed positive so they put her on antibiotics. The GP would check her that evening.
She was still delusional when left and about 6.00 pm got a call from Helen who had tried to talk to her. The RN said that Margaret had somehow escaped from a locked ward and walked 50 metres to an adjacent building and had a fall. As soon as Helen hung up the RN called me. She thought that somebody, a visitor, had let her follow them out as she did not know the code to the doors. She had multiple bruising and skin tears on her left (broken) arm. Her GP had arrived as they were dressing her arm and was appalled by her condition. He phoned me later to say that her leg was seriously affected and agreed to meet me next day when he would check up on Margaret.
On Wednesday she was still both aggressive and scared. She had refused her tablets again as the carers and RN where trying to poison her. She was also in pain. I got her to take her medication and sat with her until the GP came at about 2.00pm. All the time Margaret was trying to escape using her wheely walker or her wheelchair. I let her wheel herself down the corridor until she had to stop with exhaustion then put her back to bed. She would not eat lunch and had had no breakfast. i don't think that she had eaten anything significant since the Previous Saturday and now she was too scared to eat even for me. When the GP came he said that her infected leg was causing the delusions and confusion and that he had increased her antibiotics. By now I had booked Helen a flight from Adelaide to make sure she could see Margaret before things got too bad. The GP said that it was time.
On Thursday I picked Helen up from Brisbane Airport and drove her straight to the Nursing Home to find Margaret sitting in the dining room listening to music. She didn't want to go back to her room because she would be assaulted and even accused me of thumping her. Helen and I calmed her down and gave her her medication which she had previously refused. Her legs were terrible. We got her back on the bed and made her comfortable and she drifted in and out of sleep until lunch time. She had one bite of a sandwich and a morsel of chicken and then started howling in pain. It was pitiful to hear and watch. The RN and carer helped settle her down and get her back to bed again. Her GP dropped in and was dismayed to see her condition. She is now on heavy antibiotics and increased diuretics but the swelling remains and the infection is worse. Before he left I asked him what was the likely outcome and did she have weeks or months left. He said that if the infection gets any worse it would be days, if not possibly weeks but not months.
Today Margaret is much the same and the infection and swelling persists. She also appears to have stopped passing urine which is a sign of complete kidney failure. Margaret's GP has gone away for the weekend and my GP is taking over. By chance I had to see him for a regular checkout this afternoon and he told me that the two GPs have decided to cease all medication which had only long term affects and the milder painkillers. From now on she will be on morphine injections. He is visiting her this evening and Helen has stayed to talk to him.
During the day Margaret's cousin and her daughter dropped in to visit her. They stayed for several hours and while Margaret was drifting in and out of consciousness she appeared to enjoy their company. We all went for a walk with Louis. Margaret is still scared about being assaulted and has now added rape but there is no physical evidence to support her assertions any more than me thumping her or the carers poisoning her. I did report this to the nursing home in case Margaret is overheard by other visitors.
I shall give Helen a phone call to let her know that i will come and pick her up at 6.00 pm as it is raining.
On Sunday Margaret was almost non-coherent but still very quiet. She said that she hadn't eaten since Friday. We had a brief walk with Louis.
On Monday I thought that she was too ill to go out to have her hair done but she insisted. She had a nice cut and style which I thought looked very nice and i know she enjoyed her hairdressers cheerful chatter. The only problem that her legs were worse and still no GP visit.
On Tuesday I dropped into the GP's surgery and left a message that Margaret was very ill an her left leg was now seriously inflamed and painful. I needn't have bothered. When I got to the Nursing Centre Margaret was the centre of attention. She had refused her medication, struggled with her carers during her shower and was now in the dining room telling everybody that she was being poisoned and had been assaulted. The staff could not calm her and had given her an injection to settle her down. She listened to me and let me get her back to her room where I managed to get her to take most of her tablets which she had spat at the RN. The RN had phoned the GP and they tested her for a urinary infection which showed positive so they put her on antibiotics. The GP would check her that evening.
She was still delusional when left and about 6.00 pm got a call from Helen who had tried to talk to her. The RN said that Margaret had somehow escaped from a locked ward and walked 50 metres to an adjacent building and had a fall. As soon as Helen hung up the RN called me. She thought that somebody, a visitor, had let her follow them out as she did not know the code to the doors. She had multiple bruising and skin tears on her left (broken) arm. Her GP had arrived as they were dressing her arm and was appalled by her condition. He phoned me later to say that her leg was seriously affected and agreed to meet me next day when he would check up on Margaret.
On Wednesday she was still both aggressive and scared. She had refused her tablets again as the carers and RN where trying to poison her. She was also in pain. I got her to take her medication and sat with her until the GP came at about 2.00pm. All the time Margaret was trying to escape using her wheely walker or her wheelchair. I let her wheel herself down the corridor until she had to stop with exhaustion then put her back to bed. She would not eat lunch and had had no breakfast. i don't think that she had eaten anything significant since the Previous Saturday and now she was too scared to eat even for me. When the GP came he said that her infected leg was causing the delusions and confusion and that he had increased her antibiotics. By now I had booked Helen a flight from Adelaide to make sure she could see Margaret before things got too bad. The GP said that it was time.
On Thursday I picked Helen up from Brisbane Airport and drove her straight to the Nursing Home to find Margaret sitting in the dining room listening to music. She didn't want to go back to her room because she would be assaulted and even accused me of thumping her. Helen and I calmed her down and gave her her medication which she had previously refused. Her legs were terrible. We got her back on the bed and made her comfortable and she drifted in and out of sleep until lunch time. She had one bite of a sandwich and a morsel of chicken and then started howling in pain. It was pitiful to hear and watch. The RN and carer helped settle her down and get her back to bed again. Her GP dropped in and was dismayed to see her condition. She is now on heavy antibiotics and increased diuretics but the swelling remains and the infection is worse. Before he left I asked him what was the likely outcome and did she have weeks or months left. He said that if the infection gets any worse it would be days, if not possibly weeks but not months.
Today Margaret is much the same and the infection and swelling persists. She also appears to have stopped passing urine which is a sign of complete kidney failure. Margaret's GP has gone away for the weekend and my GP is taking over. By chance I had to see him for a regular checkout this afternoon and he told me that the two GPs have decided to cease all medication which had only long term affects and the milder painkillers. From now on she will be on morphine injections. He is visiting her this evening and Helen has stayed to talk to him.
During the day Margaret's cousin and her daughter dropped in to visit her. They stayed for several hours and while Margaret was drifting in and out of consciousness she appeared to enjoy their company. We all went for a walk with Louis. Margaret is still scared about being assaulted and has now added rape but there is no physical evidence to support her assertions any more than me thumping her or the carers poisoning her. I did report this to the nursing home in case Margaret is overheard by other visitors.
I shall give Helen a phone call to let her know that i will come and pick her up at 6.00 pm as it is raining.
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