Hospital Duty: Dealing with Nurses (Part 5)

Nurses are the Backbone of Your Loved One's Care

Nurses are the Backbone of Your Loved One’s Care

The nurses serving your loved one can be you ally or enemy. They can work with you or keep you in the dark. It’s always my aim to work with them, to support them in any way I can, and to be as friendly and gracious as I can be. When I arrive I the morning, I check the white board in the room and find out who is staffing my loved one. There is always an RN and one or two other staff. These others vary by facility, but are always lower levels of licensing. In California, you will find Licensed Vocational Nurses (LVNs) and Certified Nursing Assistants (CNAs). As soon as possible, I make contact with each of these people and introduce myself if they don’t know me. I check on what’s happened through the night and any scheduled procedures for that day. I always try to be positive and upbeat. It will pay off when I need something.

Know Who does What in Your Hospital

It’s important to know who does what in your hospital. For example, only an RN can give medications, start an IV, or do certain other procedures like complex dressing changes. If you ask one of the other staff for this, all they can do is give the message to the nurse. Generally bed changes, grooming, and toileting are done by the other staff. Don’t ask the RN.

Show a Little Appreciation

Nurses these days are overworked and under-appreciated. Many work 12 hour shifts. They may or may not have time to review the patient’s full record, especially if things are changing quickly with the patient. This is where my notebook and I shine. I’m often the only person in the room who knows the what’s been done and what the history is. I assume that they know what they’re doing until I see something that concerns me. Then I’ll ask a question. Either, “what” or “why,” or if I’m sure something is not right, “Are you aware…?” The what’s and why’s educate me. For example, one nurse mentioned that my sister should not have an IV because the antibiotic she was on was hard on the veins. There were two IV nurses checking her arms for a good IV site. After a bit I said, “By the way, are you aware she’s on vancomycin?” They obviously hadn’t checked her chart. “Oh, that changes everything!” they said as they rushed out of the room to order a picc line. Incidents like this happened several times per hospitalization.

I always try to check out with the nurses when I’m ready to leave. And I always try you be upbeat and gracious. It usually pays off with both information and suggestions, and better care for the one who often doesn’t feel well enough or alert enough to be gracious. So work with your nurses. Be their asset, not a nuisance. You’ll be glad you did.

Read Part 1 here, Part 2 here, Part 3 here and Part 4 here.

Photo Credit: Christiana Care

Hospital Duty: Dealing With Doctors (Part 4)

Communicate with Your Doctor

Communicate with Your Doctors
Photo Credit: Yuya Tamai

My goal is to talk to every doctor on the case at least one a day. This isn’t as easy as it used to be. In the good old days, your primary care physician or your specialist was in charge of care. You knew her, had interacted with him, and knew where to find her. No more.

In the hospital system Sis and Mom are in, a hospitalist has primary responsibility for inpatients, with specialists being called in as needed. Hospitalists are hired by the hospital and provide the first level of care for all of the patients in the hospital. They usually work 12 or 24 hour shifts, so your loved one won’t have the same doctor throughout his or her stay. But the good news is that there is always a hospitalist available if your loved one needs attention at midnight.

If your hospital uses hospitalists, your job may be more complex. I’ve worked with some who have been fantastic and true advocated for my loved one. But I’ve also worked with those who have clearly missed a serious problem, those who don’t want to “waste” resources on an older or seriously ill patient, and those who were less than caring. I’ve had to fight hard to get a CT scan and once Mom was discharged with a clear blockage in her leg that required readmission the same day after I observed the problem and took her back. I asked for a different hospitalist for the readmission…

I’m often able to get the hospitalists to agree to come while I’m there since they are in the hospital all day, unlike a primary care physician making rounds at a specific time. Specialists, on the other hand, are coming from their practices and they come when they come. However, I would ask them to give me an estimated time or tell each one when I expected to be there and many have accommodated me. I keep a list of questions for each provider so I can use their time efficiently.

By being the constant voice for the patient, I find that most physicians not only work with me, but even appreciate my participation as long as I don’t try to do their jobs for them. Again, the patient is usually too sick to ask good questions or remember what’s said. They need an advocate who is tracking for them.

Read Part 1 here, Part 2 here, and Part 3 here.

 

 

The Power of Presence

The Power of Presence: A Love Story by Neil T. Anderson

The Power of Presence: A Love Story by Neil T. Anderson

Neil T. Anderson is well known in the Christian community for his ground-breaking books: The Bondage Breaker, Victory Over the Darkness, Freedom in Christ, and others. So I was intrigued when The Power of Presence: A Love Story was offered for review by Kregel. It was promoted as being a book about his care for his wife of 50 years, now gripped with agitated dementia.

My heart goes out to Dr. Anderson. He has served the community well, and is now serving his wife well. There are few things more draining than the dementia of a loved one, and he is devoting this part of his life to her. I wanted to hear more about that journey.

I’m not sure what I expected. Perhaps something like Henry Nouwen’s later writings as he moved from being a professor to serving in a facility for the physically and mentally handicapped. His books from these years speak to and offer hope to those who have been sidetracked by God. As a person who has been involved in family caregiving for over a decade and “looking forward” to many more years, I hoped that Anderson would have words of wisdom for the weary and confused. I hoped that he would bring alive the ministry of presence—both God’s and the caregiver’s.

I was disappointed. While he used his and Joanne’s shared story as a common thread, the bulk of the book was theological. And I had a hard time finding the unifying theme or purpose of the book. I didn’t gain better ideas of how to be a better caregiver, and I often couldn’t draw the connection between the story of Joanne and the theological ramblings. I’m sure if I had had my theological hat on, I would have found the book interesting. But I had my caregiver hat on, and the book was promoted as a “luminous meditation.” I wasn’t meditating and I wasn’t illuminated…

Hospital Duty: Keep a Notebook (Part 3)

Keep a Notebook

Keep a Notebook

One of the keys to my effectiveness as a patient advocate is the spiral notebook I maintain for each patient. This is simply a chronological record of everything I learn and questions I have. On the inside front cover, I list the names and telephone numbers of each physician. This was particularly important in my sister’s case where she saw at least a dozen docs—maybe more—over a period of a year and a half. I also keep track of the names of office staff I’ve talked to. They appreciate being called by name the next time I call back and I quickly learn who to talk to in each office to get what I need.

Each day I’m at the hospital I note the date and anything of importance that happens that day—tests, physician consults, med changes, allergies, answers to questions, problems, names of helpful staff, … anything. I also log telephone calls both during and between hospitalizations. I use highlighters and different colors of ink as needed to be able to find information quickly.

This binder has been invaluable over time. I’m often the only person in the room with an accessible record of care, especially over multiple hospitalizations. I can’t tell you how many times my notes have prevented duplicate tests or treatments or more important, treatment errors. This not only protects the patient, but also helps the staff do their job better. So as soon as you know you’re in for hospital duty, grab a notebook!

Read Part 1 here and Part 2 here

Hospital Duty: Your Presence is Required (Part 2)

You Need to BE There

You Need to BE There
Photo Credit: Lwp Kommunikáció

You Need to BE There

I know this isn’t always possible for GenSandwichers, but if a loved one is in the hospital, it’s important—no, essential—for them to have an advocate on site at least during the day. It would be ideal to have someone in the room 24/7 but I know that’s almost impossible for most of us. But try to be present as much as possible during the day.

When Sis and Mom were in the hospital, I would arrive as early as possible, which for this night-person was usually 9:30 or 10:00 am (unless I knew a key doctor was coming in at 7:00 am–ugh!), and would stay at least until after dinner. The exact times depended on what was being done that day, how important my presence was, and how far I had to drive. If a procedure was scheduled early, I would be there for that. Otherwise, I would arrive by 10:00.

Why is this important? These days you don’t get to stay in the hospital unless you’re very ill. This usually involves pain meds, painful tests, and even surgery. The result is that the patient is usually in no condition to advocate for herself or understand what is being done for what reason. She’s often sleeping, groggy, in pain, and disoriented. And some, like both Mom and Sis, are afraid to advocate for themselves. They take on even more of a passive victim spirit than usual. They don’t want to offend or inconvenience the staff, so they let things go.

YOU Are the Advocate

So my job is to advocate for them. My job is to not be afraid. Of course I try my best to be polite, innocent, even humorous so as not to offend, but I’m awake and alert when the patient isn’t.

Of course, it helps if you know something about medicine, but that isn’t a requirement. My rule of thumb is to ask questions until I understand. If I can’t get an answer from one person, I ask the next one. I keep asking until I learn the terminology and understand the concept. Then I can explain it to the patient. I find that most staff members are willing to answer questions if I’m sensitive to the timing. And since I try relieve them of some of their more mundane responsibilities like refilling water or calming an anxious patient, they quickly learn to value my presence and work with me.

So if possible, be present as much as you possibly can.

See Part 1 here

 

Hospital Duty: The New Boomer Job Description (Part 1)

hospital duty

Hospital Duty — You are Needed
Photo Credit: wan mohd

 

 

 

 

Welcome to My World

I got another call this week. A friend’s mom had fallen and had been seriously hurt. She spent a few days in the hospital, but as soon as her labs were stabilized, she was summarily discharged. No explanation. No PT. No follow-up care scheduled. Problem is, her mom can’t walk, can’t take care of herself, and is hallucinating. But the bigger problem is that my friend didn’t have much of the information she needed to make decisions or manage her mom’s care. She had not been present at the hospital, didn’t know who her doctor had been, or why her mom had been discharged.

Then I got another call. Another parent had been admitted, but the daughter was questioning what was happening and why. A nasal gastric tube had been placed to removed intestinal fluid, but nothing had happened for many hours. Finally a nurse realized what was happening and dealt with it, but her father had declined in the interim.

Been There, Done That, Bought the Tee Shirt

My friends called because they knew that I’ve  been there. I’ve had a lot of experience with hospitals. Not as much as some, for sure. But a lot. I’ve literally spent months in the hospital overseeing the care of my mom, my sister, and my husband. I’ve been there for surgeries, broken bones, and mysterious problems. Over the years, I’ve gained a lot of experience with hospital duty, and would like to share what I’ve learned with my readers. Especially those of you who are GenSandwichers and beginning to care for aging parents.

So for the next several days, I’ll share what I’ve learned and welcome your comments.

 

When There Are No Easy Answers

When There Are No Easy Answers by John S. Feinberg

When There Are No Easy Answers: Thinking Differently About God, Suffering, and Evil by John S. Feinberg

We’ve all heard the stories. Some of us live them. How do you reconcile the worst types of suffering in life with the notion of a good God?

John S. Feinberg is one who is living “the worst” of suffering. His wife, Pat, has suffered from Huntington’s Disease, an incurable, debilitating, genetic disorder, for over 25 years. For many years, she has been unable to walk, talk, or respond. In addition, his children are at risk because the disease is genetically transmitted. Pat’s mother probably suffered from Huntington’s and the information was in her medical record, but was not made available to them until years after her diagnosis. So Feinberg, a seminary professor, was hit with not one, but several, tragedies–each one raising theological and emotional questions.

In When There Are No Easy Answers: Thinking Differently About God, Suffering and Evil (Kregel Publications), Feinberg uses his theological training and life experience to grapple with the many questions that suffering raises. The result is a raw attempt to make sense of the nonsensical. He tackles the character of God and the stupidity of friends. He offers theological assessments and practical tips.

I was especially drawn to this book because my husband has Parkinson’s Disease, and while he is still quite functional, I know from friends in my support group what most likely lies ahead. I strongly recommend this book for anyone struggling with theodicy – the question why a good God permits the manifestation of evil, for anyone facing personal or health issues they don’t understand. It isn’t an easy book to read, although it is quite readable. It will make you think, pray, and discuss. It will help you become a woman of splendor. And hopefully, will give you answers to make the journey a little more tolerable.

 

Lethal Harvest: Fiction Friday

Lethal Harvest by William Cutrer and Sandra Glahn

Lethal Harvest by William Cutrer and Sandra Glahn

Lethal Harvest: A Novel is a difficult book to review without spoilers, so forgive the vagueness. It is a captivating medical thriller that centers on the disappearance of one member, Tim Sullivan, from a partnership running a fertility clinic in Washington, D.C. Sullivan is a nephew of the current U.S. president and, like him, carries a recessive gene for akenosis, a neurological disease that results in rapid deterioration of motor function. Unbeknownst to his partners in a DC fertility clinic, Tim is conducting research into akenosis using DNA implantation techniques. About the time the disease begins to affect the president, Sullivan’s car runs off the cliff.

Meanwhile, one of Sullivan’s partners confuses clones of discarded eggs (which, unknown to him, Sullivan was using for research) with the correct eggs for implantation. The twins that result develop confusing health challenges, resulting in a lawsuit, a bombing, and new challenges for the third partner, Ben McCay, an obstetrician and chaplain.

While there were some weak plot elements, including threads that didn’t seem to move the story forward and too much focus on the romantic relationship, these were overshadowed by the moral, ethical, and medical aspects of the book. It was a page turner. If you love medical thrillers, this is a good read. [Note: this edition of the book is an update of an earlier edition, which was a Christy Awards finalist.]

 

Dwelling Places: Words to Live in Every Season

Dwelling Places: Words to Live in Every Season by Lucinda Secrest McDowell

Dwelling Places: Words to Live in Every Season by Lucinda Secrest McDowell

I was excited to be invited to review this book by Lucinda Secrest McDowell. I usually like her writing and I was ready for a new devotional. This book takes an interesting approach. First, it is organized by season, with a theme for each – dwell for fall, shine for advent, renew for Lent, and grow for summer. Then within each section, each day focuses on one word, finding the word in a Scripture verse. Interesting approach. Good potential. The layout is typical devotional: bible verse, narrative, prayer. The narrative usually offers a brief story or anecdote,  followed by some discussion of that theme.

Sadly, the book disappointed at every level. First, it’s unreadable and looks self-published even though it’s published by Abingdon. I know their goal – small format with each devotional contained on two facing pages. So the book measures 5” x 7” – a nice, portable size. But to accomplish the goal, they used what looks like about an 8-point font with 3/8 inch margins. Definitely not a book for anyone over 40! The paper is common newsprint.

Reviewers were asked to select a season to review. I chose Summer (grow). I love summer – gardens, vacations, family, leisure… Some of the words chosen fit the summer theme, but several were a reach. With few exceptions, I also found the narratives to be ho-humm. Not bad, but not underlinable.

All in all, this book was a disappointment. Look elsewhere for your new devotional.

Lucinda is sponsoring a drawing for some really fine prizes. Enter at https://promosimple.com/ps/9d4a by July 5. Winners drawn July 6.

Hidden Agenda: Dropping the Masks That Keep Us Apart

Hidden Agenda: Dropping the Masks That Keep Us Apart by Steve Brown

Hidden Agenda: Dropping the Masks That Keep Us Apart by Steve Brown

You wear a mask. I wear a mask. We all wear masks. But it should not be so. And Steve Brown is determined that we know every possible way we adopt hidden agendas.

No one can argue with his premise. It’s human nature to hide our true selves. We fear authenticity. We may abhor phonies, but when it comes right down to it, we’re all about as phony as they come. And then we pretend no one notices.

Brown’s style pulls no punches. He’s clear, concise, and in your face. He writes with the humor of an excellent speaker, punctuating truth with a dash of absurdity. The book reads like a spoken sermon, laced with phrases cleverly turned and fingers pointed.

As well written as the book is, I found it rather tedious. It seemed that he made his point well in the first couple of chapters. Then he made it again and again and again. It reminded me of the speakers’ mantra: “Tell ‘em what you’re going to tell them, tell them, tell them what you told them.” Except that he put several more “tell them’s” in the middle.  And yet, perhaps this is a new concept to some readers. Perhaps some are blinded to their hidden agendas and need them pointed out in several different ways before they get it.

Brown redeemed himself in the last couple of chapters when brought it home and applied the concepts to the church where he advocates “a new kind of family.” The book includes discussion questions at the end of each chapter, making the book useful for small groups or personal journaling.