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I was half-way to work on my bike the other morning when my cell phone rang. It is unusual for me to get calls at that time. Occasionally, Sarah might call to say that Theo was too sick to go to school. But I had dropped Theo off at camp myself, so it was not likely to be her. In fact, it was the director at Shady Lane, my mother’s board and care facility. Usually, when they call me, I know it is not going to be good news.It wasn’t this time either. Effie woke up with a new mysterious pain and swelling in her left shoulder. She needs go to the emergency room and get some x-rays.
I turned the bike around and headed home. First, I called my boss and had some files uploaded to an ftp server so I could slave a little during the interminable emergency wait. Then I called Kaiser to see if it was possible to get an urgent care appointment. After some two-fisted phoning with the advice nurse on the land-line, and the facility director on the cell, we got an urgent care appointment with her regular doctor. I downloaded the files onto the laptop, got myself together and headed to Shady Lane to get mom.
At the appointment, her doctor sent us straight to radiology for x-rays. It seemed to be a slow morning and so we didn’t have to wait long at radiology. The tech was in his 50’s and sort of animated in a, for want of a better term, New Yorker kind of way. He took a picture. He commented, “yeah, fractured humerus. Nah, they won’t do surgery for that. Don’t quote me.” He seemed knowledgable and competent. Then the fun began.
He wanted to get some more shots from other angles, of course. He went over to her and sort of barked, “She just needs to relax and let me move her. People make it a bigger move than it needs to be.” She was perched on a stool in front of the imaging screen. He grabbed the stool and sort of twisted it a couple inches. She, taken by surprise, yelled out. She’s short, feet barely touch the ground, and on her third set of hips. And she’s sitting there with a broken upper arm. She doesn’t like to have her stability taken away like that. I tried to calm her.
The tech repeated the stuff about staying calm and not making a bigger thing out of it, sort of getting louder in the process. I was sort irked but keeping my deferential attitude. I tried to help move her, but he waived me off. After some wrangling, he got her repositioned where he wanted and took another shot.
Then he moved her again in the same sudden way, and again she yelled out, “Ohh!” I tried to calm her down. Meanwhile the tech started his spiel again about how “people make this a big thing and it isn’t. Just get her to relax and hold still where I put her.” I tried to suggest I could help move her. I also had a sense that we should stand her up, let her shuffle once and sit back down. The tech practically shouted, “No, I don’t need that much. I just need an inch. Tell her to relax!” I reassured her, although I myself was feeling confused and disoriented. This guy’s manner was like nothing I’d ever experienced in a hospital. The more he told us to relax, the more worked up he got himself. It was bizarre and a bit frightening. I think he managed to get another shot.
He wanted to reposition her again, and again he sort of yelled about staying calm and twisted the stool. She yelled and moved the other way. I said, “Maybe I can move her. ” He said, “Well, if you were a radiologist, maybe you could. But you’re not. This is incredibly complex bone structure.” Then he said, “Fine, you stay in here with her,” and he grabbed a big lead apron and actually put it on me. I stood there, I’m sure, with my mouth agape. Then he said something else, but I don’t know what. Once he said it, I nearly blacked out with rage. The next thing I heard was someone shouting, “NOW YOU ARE FUCKING PISSING ME OFF, MOTHER FUCKER!” and realized the voice was mine as I took the lead apron and threw it on the ground in front of him.
He took a step back, “ok, ok, let’s just hold on a minute, let’s have the supervisor help.” He turned and pivoted out of the lab and down the hall. Unfortunately, the supervisor was not around at the moment. It gave me time to calm down. So, he came back and we agreed to start over. Not saying much, we got my mom positioned and he took a final shot.
As we left the lab he came up and in the same slightly manic way, sort of apologized and shook my hand and almost tried to hug me. I felt bad about losing my temper, but I wasn’t in a kiss-and-make-up mood. We wheeled our way way back down to the doctor’s office to find out what the prognosis would be.
Ever since I was laid off from my job in February, life has been exceptionally hectic. This seems completely counter-intuitive. This is because I obviously have much more free time than I did when I was working full time. Nonetheless, the free time seems to fill up fast with things that I either wish to do or that come up that I must do.
One huge thing that has come up is caring for my mother. This started the very day I was laid off when she fell and broke her wrist. About three weeks later, her left hip, which had been painful for months as the prosthesis from a much earlier hip replacement was rattling around loose in her femur, finally just broke. That is, her femur just started disintegrating. It was time to attempt a total revision of the hip replacement. This was a major undertaking that just a couple months before was seen as not worth the risks by an orthopedist at Kaiser Richmond. But now the risk of a failed surgery, becoming wheelchair bound, was already a reality.
The first orthopedic surgeon to look at her new situation, basically thought he could not do anything for her, but offered to refer us for a second opinion. The referral was to Dr. Bini, director of orthopedics for Kaiser East Bay. Dr. Bini was very confident he could fix her. “I can cut this and replace that; and if that doesn’t work, I have some other toys I can play with.” But he was very upfront about the risks: “For a 91-year-old, the anesthesia is dangerous. Or afterwards, she gets a clot and it goes to her lungs, that’s it. Or she gets pneumonia, which it’s unlikely she’ll recover from.”
We decide to move forward with it, and he schedules her for April 29th, at the end of an already full day of surgery for him. He just adds her in. So, there were three days of appointments for tests, including blood, urine, ekg, and biggest of all, a heart stress test with nuclear imaging.
Finally, she has the surgery. Dr. Bini calls me 5 or 6 hours after I left her with the pre-surgery team to say that the surgery went great, and that she came through it well. By Friday, she was recovering really well and they were planning on discharge to a rehab home the next day.
But the next day, Saturday, she started having terrible trouble breathing, and a chest x-ray showed patchy fluid throughout her lungs. It looked like pneumonia. By Sunday, she was moved to ICU, on an oxygen machine that helped keep her lungs inflated (bipapp?) and the doctors there were mostly talking to me about her health directive and “do not resuscitate” (DNR) status. We were all preparing for the end game. But I know these old Greeks, and her in particular. She’s too stubborn. Monday morning, the doc on watch suggested that she could be on the breathing machine indefinitely and that if she goes a couple days without change it might be time to think about pulling tubes out of her and just keeping her comfortable till the end. I said let’s see what we can pull back in terms of intervention and see how she does. So, over the course of a couple hours, we took her off the back-pressure oxygen, and got her down to just a little oxygen through a nose tube, not even a mask. And there started the big rally. The ICU docs were surprised.
She continued to improve through the week in terms of her infection and ability to breathe. However, she refused to eat, take her meds or otherwise cooperate in any way. Her lack of English, baseline dementia, and combination of lack of sleep and regular morphine all had her totally delusional. I was having to come in everyday to try to get her to eat and take some meds. By Friday, the ICU docs were again concerned that this was going to send her into decline again. And they felt like the hospital environment was a big factor in her disposition. They wanted to discharge her to a skilled nursing facility for rehab and focus on getting her on a normal routine. Saturday they did that, and sent her to Kaiser Post-Acute. Of course, that didn’t change her attitude much. They called me this morning to talk to her about eating, letting them take her vitals, and starting physical therapy on her hip. I tried. Later in the morning, we (Sarah, Theo, and my friend David) all went there for a mother’s day visit, and to see what the situation is. I actually got her to eat several bites of pureed food (can’t blame her for not liking it), and let them get her vitals. It looks like that is going to be the drill for the coming days, until she gets oriented. Assuming she ever does.