Tuesday, March 8, 2011

A slight challenge or is it something serious?

Pam had been doing well since bringing her home from hospital on Feb 24th. The old routine was quickly resurrected and life was good, but on Saturday morning, 5th of march, having given Pam an early (6:40am) shower prior to her 7am PEG feed, had just dressed her and was fetching her lifting sling from the spare room when she 'vomited'. At least, that's what Pam reported to me when I returned with the sling - but there was no sign of emitted vomit. Pam had evidently regurgitated some of her stomach contents into her mouth and had attempted to re-swallow it.

I wondered if she had aspirated any of it, and suggested the same. Pam said "I don't know", which sadly, I've leant to take as meaning "possibly yes". Pam's hoping to avoid 'what happens next'.

I put it to her, that if she began to feel the slightest bit out of sorts, I was going to ring for an ambulance and within 5 minutes, Pam asked me to do just that.

I should point out before going any further, the early start was to allow for the shower she wanted and yet allow me to get to another appointment I had at 9:00am. Maz, the TRIO Support Carer was coming in at 8:30.

The ambulance arrived just after Maz did, and Maz wonderfully took it all in her stride. The ambulance officers quickly determined an anomaly in Pam's left lung and whisked her off to the ED at Mildura Base Hospital, with Maz and I following by car.

Pam's chest was X-rayed and it was determined that she had aspiration pneumonia in her left lung and would be admitted for treatment. Strangely enough, Pam didn’t look as distressed as one would expect and I was relieved. She was eventually admitted to Ward 3 and by Monday, she looked like this...

Now here's the problem. The doctor on duty told me on Tuesday that the sphincter where Pam's oesophagus joins her stomach, has been weakened by her progressive MS and possibly by the stroke also. The net effect of this is that Pam may now regurgitate almost chronically. To counter this, Pam must be fed sitting up straight – and stay sitting up like that for several hours thereafter.

I took this thought home and concluded that if Pam’s reflux problem is to become chronic, then ipso-facto, so is her propensity to get aspiration pneumonia, chronically. This is not good – all pneumonias are life-threatening in my book. I’m going to have to talk some more to these doctors, I reckon.

Here I am, back again on Friday 11th March.

I've been previously given enough hints by hospital staff to think that today was the day to bring Pam home at last, but I had to take it steadily because Pam's electric wheelchair was currently being modified to suit her smaller frame - but was due for completion mid to late morning today. And so, off to the hospital I went to attempt to ascertain my new caring duties given Pam's new problems.

Having gotten that sorted, but also noting Pam's PEG tube was currently blocked, I was off to fetch the wheelchair from Country Care's workshop. In due coarse I was returning to Pam, but on the way there Dr Sarah (of MBH) rang me to say Pam would not be coming home today - something to do with the blocked PEG, as I recall. I can't say I was disappointed; Pam wanted to come home, but I didn't think she'd been well enough for long enough - if you know what I mean. Anyway, I eventually arrived.

Pam was sitting in an upright position in bed having finally been given her PEG feed. (The posture was intended to discourage gastric reflux.) However it wasn't too long before Pam looked at me and indicated with her hands that she was about to throw up, so I ‘up and got’ the spew-bowl in readiness. Pam obliged with three vomiting bouts and brought up quite a lot (considering up until now, she had always re-swallowed it). What happened next, of course, was that she proceeded to get it caught in her throat (and probably her lungs) and had a horrible gurgly albeit weak cough thereafter. I alerted the nursing staff of this and watched for a little while as a nurse settled Pam. The nurse told me that Pam wouldn't be coming home for a while, but was in the best place. And so I took my leave.

I took another call from Dr Sarah soon after, telling me that Pam might be able to come home at the weekend or possibly Monday.

I have the wheelchair already in the car and Pam's coming-home clothes are with her, so I'm all set to go and get her - but I'm not so sure when it'll be.


Well, it didn't take me long to find out.  On Sunday morning (13/03) I was there to hear the good doctor suggest that Pam could now go home.  Pam happily agreed and so did I - up to a point.  Pam still had oxygen being applied just 5 minutes before the doctor had arrived and I'd rather have seen her not needing that for a whole heap longer, but at the same time I was bored and wanted someone to care for.  Anyway, I was told to come back at 2pm. because there was much to resolve re pharmacy and paperwork.  At 2pm sharp, there I was with the wheelchair (I was IN the wheelchair).  Pam was nearly dressed, needed a colostomy change as well and by the time all that happened and Pam lifted into the wheelchair, out we went - into the rain which had just started.

By the time we were driving away, the rain REALLY came down, but just as we pulled up in our own driveway it had settled into much the same annoyance as when we left the hospital.  I got Pam in as quickly as I could; lifted her out of her chair and got her straight into her welcome bed.  It was 3pm.  Pam was in hospital this time for a week and a day.  It'd be nice to think she didn't have to go back for a long time.