Thursday, October 13, 2011

Medical Emergency

Photo of Dad and Dear Son. Dear Son has some seizure issues when he changes positions from lying to sitting so Dad sits him on the edge of the bed and holds onto him until Dear Son "gets his bearings". I decided to take this photo of them while we were waiting.

On Tuesday night, we had a medical emergency however in this case, it wasn't Dear Son, it was my Mom. She is currently in a nursing home and had been not been eating for the past week and was very weak, confused and had episodes of vomiting. Her symptons had started about two weeks ago with a fever and then the nursing home inserted a catheter to get a urine sample to see if she had a urinary tract infection (UTI) (Mom has been unable to walk since having plantar fasciitis in February and through medical missteps never recovered. In August, she was diagnosed as having mild dementia. She is in a wheelchair.). The nursing home diagnosed her with a UTI and gave her a 7 day course of antibiotics. Upon completion of that, my Mom seemed to get worse. She had some vomiting, didn't want to eat and was very weak. She was worried that her cancer was back (She had colon cancer 7 years ago and skin cancer.)

Sister sees her daily and had contacted her Cancer Doc and requested a call with Nursing Home Doctor. Nursing Home Doc never returned call from Cancer Doc (it's been over a week) and we pressed Nursing Home to return calls. Nursing Home had said all Mom's labs were fine and they had no explanation for her not eating or vomiting. Sister asked if and when they would repeat labs to confirm the UTI was gone and they told her they would not do it for another 10 days.

During the past 10 days, Mom had three falls at the nursing home. In Fall #1, she slipped off the wheelchair, and Fall #2 and Fall #3 were falls out of bed. They said she did not get hurt and when I questioned my Mom, she said her hip hurt but overall she thought she was o.k.

Her confusion got worse this week. I visited on Monday and she was in the lunchroom so I said I would wait in her room. She forgot I was there or that I even spoke with her. Another family member visited later in the day and Sister came at night to see her. When Sister inquired about visitors that day, she said no one came to see her.

Last night Sister called me in a panic and said she didn't think Mom looked good and wanted to know what she should do. Sister thought she should be evaluated at a hospital but the Nursing Home begged her to wait until Nursing Home Doc arrived, which would be about an hour. Paramedics had been called and Nursing Home asked if they could "clean her up" before they took her to the hospital. When the staff turned Mom over to change her, she screamed out in pain. Sister asked how long that's been going on and they said this was the "first time" she complained of pain. They tried to talk Sister in leaving Mom there until Nursing Home Doc could see her and Sister called me in a panic asking what she should do.

I told Sister to get her to the hospital asap. If she was sick and Sister was that concerned, then she should be evaluated in the ER. Worse case scenario, if nothing was wrong, (remember Nursing Home said all labs were fine) then no harm would be done by having her go to the ER however on the flip side, I thought it would be good for the ER to document some of her isssues, determine the source of her pain, as well as run labs to see where she was at. That way, if she was injured in the falls or whatever, they would find that.

Sister was not able to stay at the Local Hospital so I called my nursing friend to come over and stay with Dear Son so I could go. I wanted to go to provide information and to see what was going on. When I arrived, Sister was there and the CT scan had been doing showing a perforation of some kind. While we were waiting for the results, I noticed my Mom's hands turning dark grey, almost black. I had never seen anything like this and I ran to get some help. The nurse wasn't concerned and thought she'd be o.k. and I told her to get the doctor in immediately. He came in and nearly turned white. He started tapping on her chest, trying to get her to come to and asked for the remaining monitors to be turned on. At that point, her oxygen was 92, which wasn't horrible however we were losing her and the ER Doc said he could not make any promises she would make it.

Tests results came back and the ER Doc said there appeared to be a perforation of some sort however they weren't sure where. He explained that they would most likely need to do exploratory surgery to find out however they wanted to know her Advance Directives first to see if we even wanted to do the surgery. My Mom had made it very clear that she wanted a Do Not Resusitate a few months back and Sister informed the ER Doc she was a DNR. He said once the Surgeon arrived and evaluated her, that we'd have to make a decision with regards to surgery. I said that if something was perforated, that I thought she should have surgery to fix it. I mean, even if a patient is a DNR, in my opinion, it wouldn't be humane to let sepsis set in and for the patient to die. I thought she should have surgery to fix the issue and then see how she was doing after that. Sister wasn't so sure although she was very stressed and does not have much experience in these situations.
Photo of Sister pointing to pus in the catheter.

The Surgeon arrived to review the CT scan and prepare for possible surgery. Prior to that, they put a cateter in and were astounded at the results. Instead of urine, the tube was filled with pus. There was so much in fact, that the Surgeon said he had never, ever seen that much. He was so astonished, that he needed to call in two other doctors.

Photo of pus that drained in the first few minutes of putting in the catheter; this was in the ER.

The Surgeon reviewed the CT scan and then examined my Mom. He said there was no perforation in the GI tract and no perforation in her abdomen; in addition, there was no "free air". The good news was that her belly was reasonably soft (hard is bad). He said he thought her bladder was acting as an abscess and caused the pain. They diagnosed her with Acute Renal Failure, dehydration and admitted her to the Critical Care Unit.

They are treating her with Zosyn, a broad spectrum antibiotic as well as treating her for dehydration. At this point, the infection is quite serious and they can't make any guarantees on her recovery. The good news however is that despite the severity of the infection, her breathing and oxygen saturation were better than they would have expected. She is expected to remain in the CCU for four days or so.

Yesterday, I went to visit her in the morning and there was still pus draining from her bladder. They are astounded there is still pus draining. The urology consult came in yesterday and said that the bladder walls were so inflamed and that she had a, "whopper of an infection". Her kidneys are very impaired and not even operating at 50%. There is a lot of inflammation in her pelvis. At the nursing home, they had been giving her Naprosyn which was not good for the kidneys. The urologist doesn't think there is a tear but the infection is severe. They may be able to do another CT scan in a day or so but have to wait for some of the inflammation to subside. The CT scan they performed on Tuesday was without contrast. At this point, they aren't sure if she'll need surgery or not but if she does, she will be a higher risk because her blood pressure is so low (It was 78/59 yesterday morning.).

Today was better. The white blood cell count is dropping which means the antibiotic is working. Her white blood cell counts were 16. 8 when she came in and are now 11.8 (10 is normal). So far, the blood cultures for sepsis are not growing, which is good. I was unable to see her today since Dear Son doesn't attend school every day (he is only allowed to go three mornings a week) however other family members visited and I'll be able to see her tomorrow when Dear Son goes to school.

At this point, we hope things turn out o.k. This is Nursing Home #2 for my Mom. I had approval in August to get her into a four star nursing home however she was on the waiting list for so long that when the approval came in, she preferred to stay here. The 4 star nursing home has better medical care which is one of the main reasons I preferred it. Needless to say, she will not be returning home to Nursing Home #2 and we will most likely file a complaint against them. We suspect that when Nursing Home #2 inserted a catheter to take the urine sample, that she was infected. Worse, they ignored the infection and she nearly died. Sister made some calls and we should be able to get her in the better nursing home once she is released from the hospital.

All in all, a stressful week. On a better note, Dear Son's seizures had improved a lot. For several weeks he was having terrible seizures and things are much better. He's had some motility issues (he has them related to his gene defect), which caused some bloating and weight gain but those appear to be resolving as well. As a result of the weight gain, he's been getting extremely hard for me to move. While the weight gain is most likely the result of the motility issue, I've decreased his calories to lower his weight.

I hope at some point, life will get a little better overall. I'd really like to live a normal life, without all of these medical issues.


Mitzi said...

I am so sorry that you are inundated with so many medical issues in your family. After reading your blogs-I wonder how you do it all. I watched Dear Son's video of him in the rocking chair. It was wonderful to see him so happy and doing it on his own. I am a fan of both of you.

Dream Mom said...

Thanks, Mitzi. Yes, I love the video of him in the rocking chair. He is so happy at school.

Lexie said...

What a horrific ordeal! That nursing home needs to be shut down! I will pray for your mom's speedy recovery, now that she's in good hands. Best ~ L

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