Sunday, November 8, 2009

Francis' senior nurse weighs in

Dear Family and Friends,

First of all, -- Francis has been making great progress since midweek when his erratic blood pressure and great weakness alarmed me! He literally stayed up all day today, dozing periodically in his chair when he wasn't reading the Boston Globe. He'd alternate with one, then two legs resting on a chair, a perfect position to strengthen his front thigh muscles when he activated them, or to lengthen his rear leg muscles when he relaxed.

Not only that -- but twice today, with the help of a walker, and free from his PCA, he walked on his own (with a nurse nearby) the whole length of the hall past the doors that lead into the doctors' offices area and back. That's the first thing he told me when I returned from Lynn's birthday celebration lunch with Lee and Rowan. And he wanted to do it again with me tagging along, -- right then and there when I arrived! Blood pressure was normal again today too!

It's interesting that in spite of this progress, after I read Francis a few more of your emails on rehab facilities, we were actually leaning toward his going for rehab, -- because your positive experiences of rehab were so convincing: "regularity and discipline" of daily PT sessions... "probably more consistent than he would have at home..."

But Susan, the experienced nurse who set up Francis on the PCA (patient controlled analgesia) last Wednesday, gave us an earfull tonight, and I took down every word: "Honestly, I really don't think you need rehab! You have no skilled nursing needs other than pain services. And those could be taken care of with VNA services once the Anesthesiologists figure out the dosage of pain meds you need, (judging from Francis' recent "patient controlled" input.)

She added: "You just need a little strengthening." She explained that if Francis had a fractured hip and needed assistance, or needed to be taught to walk again, it would be different. "But you can get up!" (Yes, indeed, since Francis has been doing the PT Linda and I showed him, he can! Even from his low chair too!) Susan also said the rehab he'd get at the rehab would not be superior to what I can provide at home in addition to VNA's PT sessions 3 x a week.

Even on the subject of his blood pressure she said "If at home your blood pressure should go low again, (You can use an automatic cuff at home) you can just sit at there at the side of your bed before getting up. That's all we do here to help you." All in all she concluded, "You'd do better at home -- for the food and the rest." (I had forgotten about the rest! There's better rest at home too!)

Obviously we're both won over by Susan's informed opinion. Her assessment comes from in the moment, close-up observation of Francis' progress.

So the one piece missing now is the Anesthesiologist's plan of action. I'm leaving the house at 7:30 am tomorrow morning to be in Francis' room at 8:00. Susan coached me to be assertive with the Anesthesiologist. She told me to have him paged and to tell him, that:
1) Francis should be discharged after his last radiation treatment on Tuesday morning, but that
2) after 5 days of Francis' using the IV- PCA "we still don't know the plan for his subcutaneous PCA" so he can be discharged!!!
3) We expected it would be figured out earlier! So,
4) Could it be figured out asap so that he can be discharged in time? Or
5) if not Tuesday, -- when?

Time for yoga practice now, and to bed for early rising!


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