03 February 2012

A good hospital story, for a change

Two weeks ago I had to call an ambulance to take Allen to hospital. He was taken to our local hospital, suffering from pneumonia. That was the end of a difficult week in which three generations of my family came down with a nasty viral gastro bug that our grand-daughter picked up on her very first day at a childcare centre. Poor little Charlotte seemed to take the 24 hours of vomiting and diarrhoea quite in her stride. But her parents and grandparents weren't so lucky.

Allen and I had gone down to Brisbane to help make Charlotte's first week at childcare a bit easier by picking her up each day after lunch, instead of her having long days in her first week of care. But things didn't turn out as planned. She, both her parents and I successively succumbed to the dreaded lurgy. I hoped Allen would be spared (after all, he wasn't changing nappies). So I rushed him home on Day 4, when I was well enough to sit upright in the car for the hour's driving. But on Day 5 it was his turn. Still, the gastro seemed to pass without too much trauma. But he did have great difficulty dealing with vomiting. And we think perhaps he ingested something nasty into his lungs at this stage. Whatever the reason, by Day 6 he had a high fever and obvious difficulty breathing.

The less said about being in hospital with aphasia, the better - that's been my attitude in the past. But here at our local Noosa Hospital, I can happily say the hospital experience, though not exactly pleasant, was made much easier for us both by their very enlightened approach to caring for persons with any form of dementia. Allen's progressive aphasia is progressing to the extent that he is now often mildly confused at the best of times. But when he's very tired, his confusion increases. And when he's as ill as he was the first week in hospital, he really hasn't much idea at all what's going on.

As we have private insurance, he was first placed in a very spacious and pleasant private room. But by the second day there, doctors and nurses recognised that Allen couldn't manage when left alone. He could not remember how to ring for a nurse – or even, in the first days of treatment, where he was or why. So he was transferred to a 4-bed ward in the public section of the hospital. Here conditions were definitely less convivial for visitors (e.g. no spacious lounge for making cups of tea or watching the Australian Open on large-screen TV!) But that hardly mattered. The outstanding feature of this ward (and of several others like it) was that this 4-bed ward had a full-time nurse IN THE ROOM 24 hours a day. In fact, the attending nurse was not allowed to leave the room, even to walk down the hall for linen, without a substitute nurse standing in.

The level of personal care in this ward was almost the same as in an Intensive Care Unit, even though these patients' medical needs may not have required high-level clinical nursing. They did require a high level of care, however, since almost all the patients I saw come through this ward in our 10 days there were persons with some degree of dementia or delirium. Having a nurse in constant attendance meant these patients were able to be safely treated for their medical problem AND safely cared for. No one fell out of bed or wandered down the hall. Anyone needing to go to the bathroom had only to call or show some sign. Everyone got assistance with meals to whatever extent this was needed. Most importantly, in Allen's case, someone was always there to remind him what was happening, where he was, when his wife would be back and generally reassure him. If we had had this facility when Allen left Intensive Care two and a half years ago, I would not have had to spend weeks sleeping in a recliner next to his hospital bed. I don't know the extent to which all hospitals offer this service to patients with cognitive impairments but it's a question worth asking before admitting anyone with dementia for treatment, if you have a choice of hospitals.

Allen is now in a standard 2-bed room at a small rehab hospital that he knows and remembers. He's been both an in-patient and a day-patient there in recent years, and so I hope this will help him to settle in well for the week or two of rehab that he's about to receive. If he doesn't settle, then I'll bring him home and just take him in for regular physiotherapy. But the fact we've managed to come this far is due to good nursing geared to the needs of a very special group of patients.


Red said...

Not so good to hear about the unfortunate illness but really good to hear about treatment where they have been thinking outside the box.
Hope the recovery goes smoothly and quickly.

Chartreuse said...

Thanks, Red. Allen was very confused all day today, so the rest of his body seems to be recovering faster than his brain. There's all kinds of good rehab therapy scheduled to begin on Monday, provided we can bring him round to better understand what's happening, so he can cooperate fully.

Anonymous said...

I am glad this one has turned out to be not as bad as it could have been. I admire your stick with it, and do what is best for Allen approach. I know exactly the room you are describing, and as in ICU, I know I sleep better when there is someone watching over Bill when I am unable to. I find it so interesting that so many nurses and aides just stick the tv/nurse clicker down the side of the bed and say calls up if you need anything...that is the last he will remember that. Glad you are well enough to write, be home, and hopefully get some rest while Allen is regaining some strength. Good luck on Monday. Stay well, gin

Chartreuse said...

Thanks for your comment, Gin. First four days in rehab have passed uneventfully - two days of assessment and then a weekend when nothing much happens anyway. This morning (Monday) the real work begins. Apparently Allen fell when getting out of bed (though I only found out because his room-mate told me). That prompted a doctor to approve an increase in A's sleeping meds, which left A asleep all day on Day 3. Not a good prospect for effective rehab. So I've requested they go back to original dose and give it before midnight (not at 2.30am!). That was done. Result: A alert and 'himself' all day Sunday. Still working on getting him to use the 'CALL' button, though. So far, no luck. Still, if he's not over-medicated, he can now get out of bed and use his walker. But then he's likely to find himself stuck on the toilet, and that's a different type of button to push. Oh dear, what a battle. Even so, I could now take him home if necessary, and we could manage. The main thing is to prevent further injury from falls. And even good rehab isn't worth that side effect.

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About me

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I started this blog in 2009 when I became a full-time caregiver. My husband had been diagnosed a few years earlier with primary progressive aphasia. Over the next four years until his death in 2013, we went on a journey of discovery about this rare condition. My blog is about what I learned, how we both coped and how the journey deepened our love and appreciation of each other. Allen’s journey is over, but mine goes on.