When my sons were little, I was always looking for
"teachable moments." Life would present a circumstance and I could springboard from that happening to explain a larger truth or appropriate action. Well, I think that in the past two weeks I have experienced many teachable moments.
On November 14, I returned from my short vacation to Mexico to find my mother quite unwell. Being a stubborn, independent woman, she refused to allow my brother to take her a doctor or the ER. One look at her and we bundled her into the car and headed for
UCLA Santa Monica ER...no discussion! She was admitted and had emergency surgery for a perforated bowel. One week was spent in CCU where she was intubated and things were precarious. Then one week was spent on the regular ward where she continued to heal medically until she became fully stable. Today she was transferred to a rehabilitation center to begin the task of rebuilding her strength so she can resume her life. For me it has been 19 days of being with her from 4 to 7 hours a day every day and I am a more knowledgeable person because of the experience.
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| Mom 16 days after emergency surgery working a Sudoku Jay made for her. |
What have I learned???
The importance of being able to communicate your needs. My mother had a breathing tube in her throat for three days. She was conscious and aware but she could not speak. She worked desperately to communicate with me while her eyes were filled with terror. We tried to use an alphabet board where she attempted to point to letters to spell out words, but it was too hard for her eyes to focus. What ended up working best was her lifting her index finger of her right hand and writing the words in the air using her Palmer Method Cursive Writing while I tried to say the letters I thought I was seeing. This took TIME. Most nursing staff do not have the time nor the patience to wait out a delayed or laborious response.
When someone is hard of hearing you need to speak slowly or else the sounds become garbled. My mother has hearing aids in both ears. We decided with the medical staff that we would leave them in her ears 24/7 so she could hear requests and follow commands. I continually had to remind everyone to slow down their speech when talking to her. Speaking loudly doesn't help especially if you are speaking rapidly and then turn away before the listener has time to process and understand what you just said.
When you are sick your most important needs are your bodily comfort and dealing with confusion. When we managed to get a phrase we could understand from my mother it was something like,
"I need to move my legs." "My mouth is so dry!" "How long have I been here?" This was the focus of her awareness. Time passes differently when you are in and out of alertness. She felt like she had been there a year when only a few days had passed.
Every patient needs an advocate. No matter how they try, it is impossible for the constantly changing nursing staff to keep all the details straight. I became the repository of knowledge and I was the one who worked for continuity of care. At each change of shift or set of doctors making rounds, I was the one who had the consistent story. Details were lost, changes made and not fully communicated. Many times it was my information that made an important difference.
You need to write things down it keep it all straight. I quickly realized that I could not rely on my memory alone. I have a small purple spiral notebook that everyone came to recognize. As a word was spoken, a question answered, a procedure implemented, I documented it. Each day, under the date, I wrote NAMES: the RN for the shift, the Care Partner, the Charge Nurse, the Attending Doctor. Who said what. In fact, sometimes I was told...
"Wait, let me rephrase that before you write it down." Not only did this help me keep things clear for myself, but it established my credibility with the staff and they listened when I spoke with them
Your physical strength can change very quickly. It does not take much to knock the pins out from under you. If a body lies helpless in a bed for even 3 - 4 days, you begin to lose muscle strength and something as simple as lifting a spoon to your mouth seems impossible. My mother went from a fully ambulatory woman to someone who was totally helpless.
It is important to keep everyone aware of the reality of the patient's personhood. People become a statistic...
"She is the perforated bowel in Room 623 Bed 2...and she is 95 years old." I continually told her story...describing who she was before her surgery.
"She may have been born in 1916 but she was a fully independent woman living on her own, cooking, shopping, paying bills, caring for a disabled daughter, reading at Saturday Mass...in fact coming in for surgery caused her to miss her scheduled driver's test at the DMV. This is the life she wants to return to." I told it so many times that it was entered into her records.
When put to the test, you will find an inner strength you did not know existed. I grew up in an environment that respected authority and I always did what I was told. I get squeamish easily and do not like the sight of blood. Yet, when something seemed wrong or needed to be done, I was able to act. I found myself engaging doctors in discussion until I was sure I understood, even if they were inching their way out the door. I was assertive, yet polite, asking that people be paged if I needed a question answered. I responded to my mother's physical needs if no one seemed to be answering the call button. I could do this. And though I went home exhausted each night, I awoke refreshed and energetic enough to do it again the next day.
Appreciation has a power and in reality most people want to do a good job. As with any organization there are those who are shining stars and those who are willing to do the minimum. I really tried to polish the shining stars! I was impressed overall with the level of skill and care my mother received at UCLA Santa Monica. Very special thanks to the entire CCU staff and: Resident Surgeon,
Dr. Lee Blanton; Attending Physician,
Dr. Pooya Bokhoor; Charge Nurses,
Bina and
Alizia; RN,
Hazel who all interacted with me and my mother in a most compassionate and skillful manner. I made sure to express my appreciation to everyone and to show I understood the handicaps they may be working under. I provided feedback instantly when possible and as written documentation after the fact, naming the individuals who helped so much. I obtained the names of key people: the hospital administrator, the Unit Directors of Medical and Nursing so that copies were sent to them. Within a few days people knew me by name, stopped me in the hall to talk, and seemed appreciative themselves of my efforts to help them help my mother.
It is important to have someone in your corner. We may think we are independent, but bottom line, everyone needs
"someone who has her back!" This works both ways. I was the
"someone" for my mother. She awaited my arrival everyday, she searched for me the moment she opened her eyes, she told me ...
"You have saved my life...what would I have done without you." But also I needed someone who had my back. My family was all very supportive, calling to check on me and see how they could help, but the one I relied on most was my wonderful husband, Jay. And he was there for me. He was also impacted by this...his life was turned upside down. Yet, each night I came home to a hug, a glass of wine that was handed to me and an ear that was willing to listen to me process my day by telling every little incident no matter how long it took me. I could not have faced each day without knowing he was there for me.
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| Jay with my Welcome Home Hug |
I apologize for the length of this post. As was my original intention, the main purpose of my blog is to capture those events that add meaning to my life. This has been a most significant event and I am a better person for it.
