Any Nurses out there??

trianglejohnNovember 3, 2005

I need some help fast.

My father fell off the roof and broke his neck and a few ribs. He's 78 years old.

He's in the hospital and at first they expected a complete recovery, now the story has changed and there are complications.

I have family members there at his bedside just about 24 hours a day but they are confused and concerned about the care he is receiving. I am getting out there as soon as possible (could be days). Everyone is hoping I can make sense of the situation. What they really want is someone to review his chart and make sure everything is being done. There have been some oversights that make my mom and sister worry that they are going to have to closely monitor everything to make sure it is done correctly and on time. It is a worrysome situation. I am no doctor, I've never even seen a patients chart so I don't know what help I can offer on that front.

Any advice?

He has minor fractures in the vertebrae of his neck and upper back, a few ribs, his collar bone and his sternum. None of this requires surgery. They've said it could takes up to 12 weeks to heal.

He has developed pneumonia and a blood infection while there as well as an irregular heartbeat. He is in ICU at the moment but we fear they will move him back out onto the main floor at any moment. The care he recieves in ICU is far better than what he got originally.

One oversight was with feeding. He couldn't keep any food down so they suggested iv feeding but no one started it til his 10th day. After my sister pointed it out to the doctor he made a notation on the chart and since then his situation has improved. All this makes her wonder what other treatments have been overlooked.

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John, I'm so sorry to hear about your father. I'd be worried too, based on your description of the lack of communication between the doctors, nurses, and your family.
Is there a way you could get a list of his current treatments? I'm a vet student, but most critical care we do is the same as human medicine. I can look up human medical references too- our library at school is great. I can at least try to see if all his bases are being covered. In general, he needs supplemental oxygen, antibiotics, IV fluids and feedings, pain control, and diagnosis and treatment of his heart problem (although I suspect it's related to the septicemia).
In the meantime, if possible, I think your family needs to have a long talk with the doctor. S/he needs to explain what is happening to him health-wise, what his treatments are supposed to do, how long to wait before determining a lack of response, what to watch out for in terms of complications, what is supposed to happen next, what to do if this course of action doesn't work.
I'm sending positive vibes to your family in the meantime. I hope his recovery from now on is quick and painless.

    Bookmark   November 3, 2005 at 9:04PM
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At his age, this could be tricky. With pneumonia, he needs to cough, etc to clear his lungs. Antibiotics and oxygen can't do everything. But with the cracked bones, this could be almost impossible for him to do. Just about everything that can be done for one thing is going to mess up healing something else. Lying still is best for the bones, it's worse for the pneumonia and heart. Any movement is going to cause a great deal of pain until the bones knit. Pain medication can cause problems too.

    Bookmark   November 4, 2005 at 11:43AM
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They moved him out of ICU today - they said he had improved enough. They are transfering him to a special bone and joint rehab facility because they said that the regular floor staff where he is now is not capable of administering the proper physical therapy. But as of this afternoon they hadn't told anyone where this facility is or what it is called.

This is one of those situations where he specifically asks the doctor about managing his pain during his physical therapy sessions. A "can I stop when it hurts too bad" kinda moment. The doctor says to work as hard as you can but if the pain is too bad you can quit. Doctor leaves the room, in walks the nurse/therapist and she ignores dad's pleas for mercy and forces him to keep going. Now I imagine her job is to push him hard. But she wasn't in the room when the doctor told him he wouldn't have to endure intense pain at this stage and she doesn't listen when my sister or mother start to complain. Instead she kicks them out of the room during his therapy session.

This sort of treatment has soured the whole experience for the family - they now hate the nurses and fight with them frequently. Somehow they think that I will be able to solve all of this when I get there. I wonder where that idea came from.

Thanks for all your help - I should arrive there mid way through next week.

wish me luck

    Bookmark   November 4, 2005 at 5:09PM
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Physical therapy hurts. He can stand more pain than he thinks he can. Those muscles and ligaments need to be stretched. It's not going to be easy for him. But he can do much more than he thinks he can. Your sister and mother need to stay out of the treatment room. Unfortunately, Humans have a bad habit of misbehaving when they have an audience, in other words, he could be mommy's Big Baby. Remind them that fighting with the nurses isn't going to help insure that he gets the care he needs.

    Bookmark   November 5, 2005 at 3:01PM
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John, you need to be an advocate for your dad.....get tough....ask why there are no pain meds? And ask again until you get an answer!
Ask where he will be sent....and keep asking until youg et an answer.
Many dr's and nursed have a "God complex" they think whatever they decide is best and they never ever need to explein anything they do to anyone....that's wrong!! Ask questions.....scour the web, educate your self as to what is ususlly done in these cases and question everything done!!
Yes PT hurts! But there are meds to ease the pain...
Take charge....if something has been promised and doesn't show up.....walk to the nurses station or if necessary to the pharmacy and find out why it's not there...
Get tough...Dr's and nurses have many patients and only those who are the most vocal get the best care.
Linda C

    Bookmark   November 6, 2005 at 8:38PM
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There have been many studies that show pain kills. And I mean that literally- people without adequate pain control die at higher rates, are sick longer, and don't recover as completely as people with adequate pain control. That's why we in vet med use so many pain control meds- our patients can't tell us where it hurts or how much. They are more subtle than begging for mercy as your poor father was doing.
Yes, PT is necessary, but there is no reason for it to hurt that much. It's causing more harm than good. Either she wasn't doing it right or she was pushing too hard. I certainly didn't make my dog cry when doing PT on her after her knee operation- it's completely inappropriate (doctor's orders). And her knee recovered better than expected.
Please keep us updated, and if there's any research or anything else I can do let me know. I hope he gets out of the hospital and into recovery very quickly.

    Bookmark   November 6, 2005 at 11:21PM
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Well, I made the three day drive just fine (had to bring my dog along since I didn't know how long I would be away). Dad is now in a specialty care facility and the care is superb seeing as they are brand new and have only a handful of patients. It is a short term acute care facility aiming to be accredited as a long term acute care facility - so they will allow him to stay as long as he wants. He receives physical therapy everyday except on weekends (we cheat and saddle him up anyway). His improvement is messured in hours not days, you can see the difference between breakfast and his evening meal each day - quite amazing.

He is enjoying the pampering and moment by moment attention.

He fell while building a new carport, it was just over 10 feet to the roof where he was standing. The roofing panels wrapped him up on the way down so he couldn't use his arms to break the fall and kinda landed on his head and neck. He broke the knobs off the backs of all the vertebrae in his neck and a few in his back (as well as cracking his sternum and a few ribs and clavical). No damage to the actuall core of his vertebrae so no chance of spinal injury and paralysis.

The truly amazing thing is that while in the hospital and even in this fancy rehab place the staff just doesn't have the time to pay attention to the little details. You explain that the fall damaged his throat and that swallowing is difficult. This means that meals have to soft and in small bits in order for him to eat them and that pills must be crushed and mixed with pudding in order for him to get them down. The nurses understand this and act as if many of the elderly patients have these problems.... but his meals come late (sometimes cold), pain pills come late (has to have these for physical therapy or to wear his harness to sit up and eat), its like we have to explain this fact over and over. We end up feeding and bathing and giving him is crushed up pills. The staff has thanked us profusely and I believe them.... but I had no idea that they weren't available for these little things that I figured would be standard care. I worry about all the other patients without bedside caregivers. He has improved enough that we don't have to stay with him around the clock anymore and I will be able to drive back home after Thanksgiving.

Thanks for all your kind thoughts and prayers.

    Bookmark   November 18, 2005 at 8:52PM
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I am now back at home three states away. Everything was going well until the day before Thanksgiving when he pulled a small muscle in his neck. He decided to rest over the holiday weekend to avoid the pain so we let him. This proved to be a bad decision and a staf infection set into his lungs (he's already gone through this once as well as pneumonia while over at the big hospital). So I got to drive away while he was going downhill.

My sister is there taking care of him now and reports that he has finally gotten the picture - you won't get well if you lay in bed all day. No matter how bad it hurts you have to get out of bed. He is slowly improving once again.

It is kinda sad that at this point he doesn't wanna do anything where he can get hurt. Doesn't want to go outside or participate in any of his old hobbies. Hopefully after he recovers he will forget this nonsense. With hard work he is expected to make a complete recovery but at his age he was hoping to avoid any hard work... makes it kinda hard on us kids who always think of him as ageless and youthfull.

    Bookmark   December 1, 2005 at 3:56PM
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When my mother broke her hip and was in rehab, they made sure to give her painkillers 1 hour before each therapy session. They told me they were going to do this, otherwise she wouldn't have been able to do much in therapy. You always want to be ahead of the pain, you don't want to be chasing it. I am very surprised that the PT staff in the hospital was not medicating him as part of standard procedure.

I can understand his reluctance to do anything physical at this point -- he is no doubt afraid and doesn't want to go through a similar experience again. But it's been a few weeks since your last post: how is he doing?

    Bookmark   December 26, 2005 at 4:25PM
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Well the PT and OT staff has murmured their displeasure with the speed that things happen at the hospital - they are often floored at how much of the clean up and management we take care of. I don't care, I don't care if I impress them, I don't care if I upset them, I am there to make sure that everything possible is done right the first time and I will knock people out of the way if I have to. The staff enjoys most of my family (there has been a few harsh words with some) and they really like my father as a patient (he's quiet entertaining), and they have learned that if I am standing by the nurses station glaring at them but not saying anything - that someone was supposed to do something, something that they promised to take care of "right away" and yet they got sidetracked and it hasn't happened yet... they've also learned that I will simply walk into the staff only supply rooms and get fresh linens and towels without even asking any more, I just don't have the time to be nice or courteous anymore. I secretly believe that a few of them are relieved when I am there; because being an ex-zookeeper I will clean up any sort of mess without hesitation, feces, vomit, mucus, none of it bothers me - just show me the supplies and I'll take care of it without complaining. It just shouldn't take hours to get a bed changed, especially when there are only 5 patients on his floor!!!

My dad is not doing so well. He is half way through his 3 month recovery period where his movement is restricted to allow the bones to heal correctly. And they are. His bigger problems are the infections - all of which were caught at the hospital. He now has the staph bug hiding out in a valve of his heart (should clear up with antibiotics) and damage to his kidneys from some of the drugs. If you saw the article in last Mondays USA Today newspaper about hospital bugs gone awry - my dad has all three that are profiled.

If you want to read more about him and my efforts to help him recover check out the sorta blog going on over on the Carolina Gardening forum in GardenWeb. Go to the subforum folder "Conversations" and look for "TJ's tale of woe". The gardeners on that forum are all good friends (an very active group compared to other forums) we get together twice a year so the opinions and comments can swing wildly about, be warned we go off topic a lot.

I'll be back home with dad the middle two weeks of January.

    Bookmark   December 26, 2005 at 8:08PM
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