Bill, Tuesday July 23, Failed Transfer

Up front, Bill is good. But he is back at the hospital, and the 8 hour trip to the acute rehab facility was a trip to Hell.

I'm going to itereate and reiterate! Bill is okay, and what I am going to describe is not a setback. More of a turning around in a (very big) circle

The very short version of the story is that Bill spiked a fever, and the rehab doc saw the lethargy as reduced neurologic function. Couple that observation with the fact that Bill's blood pressure medicine was not maintained, as he had several hours of BP running 180 to 200, what do you get? Hmm, maybe another brain bleed: hemorrhage.

Back at the hospital, a CAT scan (or CT scan, is there a difference?) showed he did not have additional bleeding, so no new drain tube. A couple of antibiotics for the temperature (39 celsius, 102.2 F), cultures to try to ID a bug. Re-admitted to neuro ICU.

Now for the long story. Wait, bullet points are easier right now:

• The rehab facility representative (Anthony) told us yesterday they would make an exception for Ayn to remain, and not be kicked out in the evening. We were very happy. He promised he had cleared it up and down the chain, and gave us his backup contact (Mindy).
• The hospital case manager made arrangements for the transport. She asked if I thought 3 or 4:00 was better, and I said definitely 3:00 to get started on Portland traffic earlier and not run into shift change at the facility. 3:00 was confirmed a couple of times.
• Transport (ambulance) arrived to pick up Bill. After 4:00, so the six mile trip was complete about 5:30.
• You guessed it, change of shift is 7:00 so everyone is sort of winding down their work.
• A little background: the goal at the hospital had been to keep his BP below 160. Bill started at the facility at 161.
• We started asking about the normal 6:00 meds about 6:15. "We're waiting on the doctor to write the orders. The doctor said she's not concerned about BP unless it gets in the 180's." We asked for the latest BP, came up at 167. And we knew it certainly wasn't going down on its own.
• I left a voice mail for Mindy, who was supposed to be the go-to person if we had any problems.
• In the meantime, the "house supervisor" said Anthony had not cleared with administration anything about Ayn staying. But she could use the chairs out by the lobby.
• We didn't get to talk to the night shift doc until 8:00
• Bill had been in a flat position  since about 3:00. Ayn and I took it upon ourselves to reposition him -- this is important to prevent bedsores. We did not have pillows, so we made do with rolled up towels.
• BP at 8:30 came up as 183. Well that got people hopping finally, but it was another 15 minutes before two meds were administered. 20 minutes later BP was starting down, at 170.
• I went back to the apartment to rest. Ayn texted me 11:30, "they are still working on the orders," and for blood pressure, "they say they're watching it."
• 1:40 phone call from Ayn, "They are kicking me out. They say I can't stay. The house nurse says she's never heard of Anthony. And she said the 'sitting hours' were over at 9:00. She said I can't use the lobby chairs because they use that area for their nurses meetings." I got to the facility to pick her up by 2:00.
• Sitting outside in the car, we went over everything that happened. When Ayn expressed concern about Bill to the night nurse, he said, "Well he's not like the other really frail people here." I was in shock. I left another voice mail for Mindy (as of this writing, haven't heard from Mindy and I don't care). Ayn said one BP had been over 190.
• I finally decided I would go in and discuss the overall care and plans with the staff.  Yup, at 2:00 in the morning.
• As we approached the door, two security officers came out. Our first thought was, "OMG, they are going to block us from re-entering." But no, the older of the two said the charge nurse asked him to find out if we were still there, because they were calling for an ambulance to take him back to the hospital, and he possibly had another brain bleed. When we got to the floor, we were told he had gotten to 200 on BP.
• At the ER, the nurse and Dianne (Bill's stepsister, an RN), were trying to figure out what meds had been given at the facility. They had a copy of the chart, with the med orders, but the chart did not show the actual administration of the meds. I told them he got two meds at 8:45 and one of them started with an "L" but that info is certainly not something they can rely on in a critical medical situation!

As a reminder, dear readers, Bill is fine now, coming off a fever, and the CT did not show additional damage. We will all move forward once again!  But any guesses on where the path will NOT take us?