Since September,
2016 Fred has developed an intimate relationship with the Health Care system –
in fact we both have. Fred’s started with pains in his chest; mine transgressed
into a lot of advocacy and frustration in dealing with a broken Medical System
and a spouse that needed a lot of care.
In Emergency, in
September, they confirmed that Fred had not had a heart attack but they did not
know what was going on.
After a week in
the hospital, they really couldn't find anything wrong with his heart – needed to
do more testing. His kidneys were not functioning at their peek and they won't
do an angiogram (which is the only test that would give us any more information
about what his heart is doing) while his creatinine is so high and this can
only be done in Calgary.
According to the
doctor, there is nothing we can do for that except keep flushing out his
kidneys with lots of water. I asked the doctor whether our elevated levels of
anxiety were warranted and he said we are in the process of dealing with of
some of the issues so we can relax a bit.
Finally, they
decide they can dilute the dye enough to be relative safe for the angiogram and
we managed to get an appointment for the angiogram and possibly an angioplasty
– clean out the artery – and insert a stent to keep it clear.
We were at the
Foothills hospital in Calgary (about 2 ½ hours away) by 6:45 am on Friday, October 21. Fred was
admitted and had an angiogram, angioplasty and a stent put in by 10 am.
Another oops!
Things screwed up! They were still trying to figure out why he was still short
of breathe and got pain sometimes but not others so they kept him in there to
monitor.
They decided that
he had a sticky valve and it should be either repaired or replaced and that
meant surgery. BUT they won't have any definite plan until their conference
meeting at the end of the week.
They flew Fred
back to the hospital in Lethbridge and he stayed there for over a week until
the first of November.
Got a phone call
from the cardiac team in Calgary saying they want him up for a consultation interview with the
surgeon – so off to Calgary, again.
Saw the surgeon
who said everything looked good for surgery in early January.
Doctor did a lot
of explaining which helped ease our totally frantic minds!
He explained
all the worn out or damaged parts of Fred's heart and what has been done and
what still needs to be done to sustain his lifestyle.
It all
sounded so reasonable
Because he had the
angiogram and the angioplasty, he needed to be on the anti rejection drugs for
at least 6 weeks before they can do the open-heart surgery. So he targeted the
first week in January for the surgery – 5 days to a week in the hospital and
then 2-3 month to recuperate.
I asked him if we
should cancel our reservations on the Island
for March and he said "No".
Good sign!!
So
much for Good Signs!!
There is no way
that a surgery as complicated and complex as a heart valve replacement could be
as ordinary and mundane as they let on. As time got closer, our anxiety levels
grew and grew. When they postponed the surgery until after the New Year, our
demeanours were rather indescribable.
It took all we
could do to get it together and travel the 3 hours to Calgary to the ‘Foothills Medical Centre’.
The Cardiology
Department (called the Libin Cardiology Institute) is a well-oiled
mechanism. In fact, Henry Ford would by very proud of the organizational
structure . . . it brought to mind the assembly line at a Ford Motor plant: Assembly
Line Americanization (https://michiganjournalhistory.files.wordpress.com/2014/02/fall-12-firsht.pdf)
The steps are
precisely defined and do not deviate:
1. Do the surgery.
2. Doctor reports to patient’s care-giver (s).
3. Doctor tells the staff when visitors can
see the patient.
4. Patient in Cardiac ICU.
5. Visitor (s) sees patient.
Hustle-bustle . . .
6. Patient stays in the ICU until there is a
bed available in the step-down unit.
7. Then the patient is moved to a less
monitored area until they can manoeuvre 3 flights of stairs.
8. The Patient is discharged.
So, let me tell you what it is like from a
Patient and Care-givers Point of View
Steps 1 to 3 - The first three steps seemed to go
smoothly and according to Libin’s standard procedures.
The doctor reports
that the surgery went well and we do not see him again the whole time we are
there.
Steps 4 and 5 - The Cardiac ICU is wedged into a tight
little space that is too small for the number of patients and staff jammed into
it.
This is where they
supposedly keep a close eye on the patients – or at least on the monitor screen
that records each patient’s progress generated by wireless devices attached to
various parts of their bodies.
No rest for the
wicked – they start them doing exercises and moving around right away – that
is, when the nursing staff are not overtaken with their pregnancies and babies
(or that is the way it appears when the visitors or patients look for
something. You could usually find them huddled in the hallway discussing the
latest pregnancy symptoms or baby behaviour).
Step 6 – the beds in the Step-down Unit
seemed to be at a premium and it took a couple of days to get moved into
another unit where patients get less attention but apparently each patient is
monitored from mechanisms at the nursing station.
Step 7 – The Step-down Unit is where they ‘get the patient
ready to leave’ or be discharged, as they put it. There are physical therapists
with exercises you need to do; respiratory therapists with breathing
instructions to get and keep the mucus out of your lungs; dieticians – “Oh my,
your kidneys are not functioning very well – you need to avoid these food.
Here are dietary suggestions when you are on blood thinners . . .;
pharmacists with a list of over a dozen medications with a schedule of when
they should be taken, and the occasional doctor who comes around.
Each has
his/her own specialty and each gives the patient reams and reams of information
that becomes overwhelming the patient becomes totally confused.
Another day . .
. Onward and upward! –
Fred managed to ascend and descend a couple flights of stairs.
I talked to the
Social Worker to see if we could get him transferred to Lethbridge. The message I got was that “Lethbridge is also wanting for beds and it may be a
week or so before he could get in there”.
7:30 am – the morning of January 11, 2016
7:30 am – the morning of January 11, 2016
Swollen feet and
all – they are discharging him . . . NOW!
The sign on the
wall says “Discharge time 9:30 am”
No, they want him
out now.
I DON’T THINK
SO!!
I wasn’t ready . .
. packing both myself and the car; getting to the hospital; getting parked;
getting to where Fred had been . . . all that took time.
I arrived at the
room where Fred had been; an empty bed; a severe sense of being invisible . . .
no one but the cleaning staff would even acknowledge I was there or tell me
where Fred might be.
“Down at the end
of the hall,” she told me.
And there he was
sitting in a chair along the wall in front of a blank television monitor.
They needed me to
be there – it was only 10:30 am – they needed me to watch the EXIT video
so they could complete their get-out-of-hospital check-list; and get him
out of there so the assembly line could start again.
We were rather
compliant until it came time to leave . . . now what?
He could not get
his shoes on because his feet were so swollen; he couldn’t walk that far,
anyway; I could not handle a wheelchair plus his suitcase . . . the reluctance
to help was overwhelming.
Finally a new
student popped up and said she would help us.
Great! BUT she was
only allowed to go as far as the front lobby of the hospital (more rules and
regulations) and a Volunteer would have to help us from there.
We found the
Volunteer but she could not leave her post at the Information Desk until the
only other Volunteer showed up (there were only two) to take her place.
Finally, finally, he showed up and the km trek to the car in the only heated
parking lot began.
No strain . . . lots of pain
First off, they
discharged him with no pain medication. There we were, in the car for almost 3
hours - he hurt and was certainly not a happy camper.
We stopped a few
times but all he could do was get out of the car and turn in a circle. It was
so windy and slippery, he was afraid that if he walked around, he would fall
down.
We got home and
discovered he really couldn't get himself into the bed and the hide-a-bed was
too low so we tried to pillow him up in one of the chairs.
My first chore was
to go pick up all the scripts that the hospital sent to the pharmacy. It was then I found out that the doctors had
not even sent along a prescription for anything for the pain.
Believe me when
you get your chest broken open and put back together, THERE IS PAIN!!
Why oh why would
they possibly not give him a prescription for the PAIN MEDICATION?
I sat with the
pharmacist for almost 1/2 hour while she explained and described each one of
the medications so I understood what they were; what they were for and when he
had to take each one.
Night No. 1 was a total fiasco - no sleep - up and down trying to keep him relatively comfortable.
Day No. 2 – a marathon - getting a script for Pain meds which meant getting a hold of the doctor; getting him to make a referral for Home Care; cancelling the lab because there was no way of getting him there; and finding a way for Fred to be comfortable for the night so we both could sleep.
I must have hit 5 different furniture stores and finally found a power recliner that would fit into the condo - remember he cannot use his arms to get up or down because it would put pressure on the sternum. (Actually, the recliner is really nice)
home care were on –the-job right away; the specialist wanted him to get his blood checked - my first statement to the nurse was to ask the doctor if he wanted to come over and try and get him to the lab. That quickly prompted the effort to get someone to come over and draw the blood - which happened.
Night No. 1 was a total fiasco - no sleep - up and down trying to keep him relatively comfortable.
Day No. 2 – a marathon - getting a script for Pain meds which meant getting a hold of the doctor; getting him to make a referral for Home Care; cancelling the lab because there was no way of getting him there; and finding a way for Fred to be comfortable for the night so we both could sleep.
I must have hit 5 different furniture stores and finally found a power recliner that would fit into the condo - remember he cannot use his arms to get up or down because it would put pressure on the sternum. (Actually, the recliner is really nice)
home care were on –the-job right away; the specialist wanted him to get his blood checked - my first statement to the nurse was to ask the doctor if he wanted to come over and try and get him to the lab. That quickly prompted the effort to get someone to come over and draw the blood - which happened.
What do
people do if they can't advocate for themselves or have someone else to do it
for them? They must just get lost in the shuffle.
And that was only the first week!
Good
Surgery . . . Rugged Recovery
It is totally
amazing how the surgery . . . process leading up to the surgery; the actual
surgery; immediate after-surgery care . . . is so well planned and carried out.
Unfortunately, the phase between the after-surgery care and the recovery phase
. . . the planning for the after-surgery state of affairs and issues . . . is
almost non-existent.
The Disregarded
Patient – The Forgotten Step
Step 9 – What happens after the patient leaves
the hospital?
Once patients hit
the second step-down bed, it becomes a race to get them out of the support
and protection of the institution.
Unfortunately,
they forgot that most people do not fit into the scenario they present in the
video.
This is especially
true for the patient who does not live in the city. To their credit, the staff
is well versed in the resources available in the immediate community.
Unfortunately, they seem totally unfamiliar with resources and restrictions
outside their areas.
The only service
area that reached out to resources in Lethbridge was the Pharmacy. They forwarded a list of
all the prescriptions to the pharmacy in Lethbridge.
Unfortunately,
again it was an attempt but not complete. The omission of pain medications
created considerable unnecessary anxiety. Also, neither the Family Doctor nor
the Internal Specialist was notified about prescriptions.
Fortunately, in
our case, for the most part, we tend not to just sat back and let things happen
and pursued every avenue we uncovered to get the right help for what we needed.
I think we have figured out which doctor to contact for what and who you don’t
ask in regard to which issues.
For example, Fred
has a weekly blood test to adjust one particular medication which is cardiac
related. The results go to two different doctors (the Family Doctor and the
Internist-Cardiac guy) and they both call to give him the results and
directions for the coming week. We have tried to tell them we only need to hear
from one (preferably the Internist) to no avail so we just let it happen.
We now have
relationships with 5 different doctors and a bunch of other care-providers:
1. The Cardiac Surgeon – who we have not seen
since the surgery
2. The Internist – who we go to with the heart
stuff here in Lethbridge
3. The Renal Doctor – he does various tests
and monitors the kidney function – responsible for functioning from the kidney
to the bladder.
4. The Urologist – again does various tests
and monitors the bladder and catheter – responsible for functioning from the
bladder through the urethra.
5. The Family Doctor – supposedly co-ordinates
things – Supposedly is the operative word here. Unfortunately he does
not seem to get information from the other service providers.
Provincial Health
Services:
a. Home Care nurse
b. Home Care workers (in twice a day to do the
physical stuff)
c. Dietician
d. Cardiac Rehab Program
That’s all I can
think of right now.
Individually, each
service seems to have competent and well trained staff . . . BUT . . . as a
care-giver or patient . . . it feels like the patient has been left out of the
equation. The patient is there to give the doctors something to work on.
The after-care
procedure feels much like taking a car in for service. After the car is hooked
up to the diagnostic machine and the gas and oil are checked, a specialist takes
over to suggest which specific module needs to be repaired or replaced.
My poor aging body
and mind are having a difficult time keeping up with everything!!
But we will not surrender!!!
But we will not surrender!!!
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