Putting Ruth to Rest

Val has arranged for internment of Mom's ashes on Friday, September 17, 2010 at 2:30 p.m. at Oakview Cemetary in Royal Oak, Section K (to the left of the pond as you enter). Let Val or Dave or me know if you would like to attend. We plan to have a small get together afterwards either at Pete's Broadway Cafe in Ferndale (Woodward Heights West of Hilton) or another suitable location.

Attending for sure will be Val, David, Byron & Colleen, Rev. Miller, Maggie and Rob Robbins, and Patricia Kuxhaus.

If you missed it, Byron has Ruth's old phone number.

Consoled

We are all pretty pooped out from the whirlwind of the last few days, but consoled by the outpouring of sympathy from so many at the funeral home visitation Tuesday evening and Wednesday's service.. Mom affected so many lives in ways we never knew, and it was heartening to hear stories about her from those present. She was quite a gal.

More proper thank yous will be forthcoming, but I would like to acknowledge those who made the last few days tolerable and the service so meaningful. Besides Rev. Miller, the soloist Marlene Plum and organist Melissa Ambrose-Eidson, we want to express a special thanks to the ladies of the Mary Martha Circle, of which Mom was a member practically since she joined the church in the 1940s. The luncheon they put on was wonderful on many levels. Additionally, John Wilk from Wessels & Wilk Funeral Home provided invaluable assistance, the beverages and snacks Colleen's family brought during the visitation were greatly appreciated. The outpouring of sympathy and caring has been just remarkable.

We plan to eventually scan the photos from the picture boards and put them up on this site, as well as the audio of the service, so we're not done with this blog  by any means. We encourage those of you who have "Ruth stories" to consider sharing them with us here. As we've learned the last few days, there is a lot more to our Mom than we ever realized!

Details

We'll be receiving visitors at the Wessels & Wilk Funeral Home Tuesday, June 29 from 3 to 8 p.m. Click here for a map. The service at the First Congregational Church of Royal Oak begins at 11 a.m. Wednesday, June 30 and will be followed by a light lunch. A map to the church can be accessed by clicking here.

If you have any questions, please feel free to email us and we'll get back with you as soon as possible (sorry, no phone numbers are going up on the web!).

I had been staying with Mom at night since she was admitted to the hospital on Thursday, and Dave, Byron and Colleen were there during the day. She was still relatively lucid and responsive early Saturday, and we reminisced about all sorts of random things as the sun came up -- the old Westinghouse refrigerator we had that ended up at Rose and Sam's cottage, going to the Royal Oak Farmers' Market every Saturday morning before the crack of dawn, Byron making popcorn as we watched Saturday Night at the Movies, Sunday drives, her parents, her grandchildren ... it was truly a gift to have those tender moments with her.

It was heart wrenching to watch as she and her life-long best friend, Priscilla, visited on Saturday, both knowing it was the last time they'd be together. Lots of tears were shed all around. These two women were so different yet had a friendship that endured through good and bad times. They used to joke about who would go first. Well, now we know.

Dave arrived Sunday morning just as the doctor was making his rounds, and he advised us that it looked like she would not be around for more than 48 hours. I made a quick trip to Grand Rapids (no speeding tickets), and during the seven hours I was away, her condition had eroded significantly. As nighttime fell she became quieter and quieter.Shortly after midnight she took her last breath, and the nurse confirmed what I thought: she was gone.

Byron and Dave quickly returned to the hospital. We said our goodbyes and thanks to this amazing woman. There were many times she was a royal pain in the neck (and other places), and her Polish stubbornness was legendary, but she also was a loving person who always saw what needed to be done and did it, up until the very end.What a gal!

She's at peace

Ruth Esther Kuxhaus, 91, of Oak Park died peacefully surrounded by family on June 28.  Born in Detroit on May 31, 1919, she was the oldest child of Chester and Viola Kotowski. She grew up in Pleasant Ridge and graduated from Lincoln High School in Ferndale. For many years she managed several RB Shops, and later worked at Jacobson's in Birmingham. Generous, never complaining, Ruth was happiest in the company of family and friends. She showed great strength and bravery in recent years as she battled a series of difficult afflictions. A greatly loved mother, grandmother, friend, and aunt, she will be greatly missed. 

Preceding her in death were her husband, Otto Kuxhaus; brother, Benjamin Kotowski; sisters Rose Tuma and Doris Steinberg. She is survived by her brother Arthur (Nancy) Kotowski, Newburg, OH; her children, Byron (Colleen) Kuxhaus, Royal Oak; David Kuxhaus, Ashland, KY; and Valeria Long, Grand Rapids; grandchildren Robert (Rebekah Winters) Long and Justin Kuxhaus, Seattle; Margaret Long, Oakland, CA; Laurel Kuxhaus, PhD Potsdam, NY; her life-long friend Priscilla Krippendorf; and many beloved nieces and nephews.

The family would like to thank the staff of Heartland and Beaumont Hospices and Hannah's Home Care for their care and compassion during Ruth's last weeks. Visitation at Wessel and Wilk Funeral Home, 23690 Woodward Ave., Pleasant Ridge, from 3 to 8 p.m. June 29. Memorial service June 30 at 11 a.m. at First Congregational Church, 1314 Northwood Blvd., Royal Oak. Memorial contributions may be made to the church.

Not good news

I neglected to include in the earlier post that in addition to the sigmoid volvulus, Mom has a bowel obstruction. That's what contributed to the excruciating pain and vomiting on Thursday. Given Mom's greatly weakened health, medical history, and age, the gastroenterologist felt she was an extremely poor surgical risk and would likely not survive surgery to remove the blockage and volvulus and recommended against it. Other physicans concurred. We -- Mom, Byron, Dave, and me -- sadly agreed that she has been through enough, and reluctantly have accepted that this will be the cause of her demise.

Mom is now an inpatient with Beaumont Hospital's Hospice, where she is receiving intensive palliative care. Her attending physician feels it is highly unlikely that she would reach the two week maximum stay for that unit.She is being kept comfortable with regular administrations of dilaudid, so is drowsy much of the time but manages to rally when she has visitors and as we have learned, hears everything!

As we face this passage, we are heartened by the support we are receiving from family and friends. We appreciate you keeping Mom and us in your hearts and prayers, and hope that you find comfort, as we do, that she is at peace..

A new development

An update ...

Over the past week or so Mom had a lot of abdominal pain, coupled with the inability to have a bowel movement. The pain became too much, and Wednesday morning Byron and Colleen took her to Beaumont's ER. She was given some dilaudid for pain, and had a CT scan of her abdomen (which the ER doctor said was the most puzzling one he had ever seen due to her colon resection back in the early 1960s).

The medical team's consensus was that she had a sigmoid volvulus (a twisting of the sigmoid colon). A gastroenterologist performed a sigmoidoscopy, which we hoped would take care of things so we brought her home. Unfortunately her abdomen is still distended and hard, and she's been in a lot of pain plus vomiting. The hospice nurse recommended we bring her back to see if more fluid could be removed and make her more comfortable,  so we came back to Beaumont where we are as I write. Please keep her in your thoughts.

Well, She Made It To 91

I spent a nice week with Mom and family, enjoying the hot Michigan weather and seeing friends. She continues to amaze me with her progress and what she is pushing herself to do.

My arrival Wednesday coincided with Julie from Hospice arriving to do the paperwork enrolling Mom in Hospice. The continuing, debilitating pain in her shoulders makes it possible for Hospice to provide care for pain management and other issues dealing with the deterioration of her health. Hospice will be providing some of her medication to include lidocaine patches for her shoulders as well as supplies and some other meds, their palliative care is great and Mom seems to like Julie and looks forward to her visits.

Thursday started off a little rough for Mom and Tanya. Both had some intestinal problems during the night but recovered enough for Mom to do some ironing in the afternoon. The young man who was supposed to mow her lawn didn't show up so I took care of that making sure the clippings were placed at the curb for pick up on Friday.

Following her Friday morning walk, which consists of walking up and down the driveway a few times, she and I sat outside the garage to enjoy the nice morning. She seems to enjoy sitting out there in the captains chair brought up from the basement and likes feeling the warm sun and enjoying the rose bush from Aunt Alice that has been full of blooms. Hospice Julie showed up as scheduled and the pain patches were applied. Within an hour the pain abated enough that she had almost full range of motion with minimum discomfort. Mom and Kim enjoyed a nice lunch from BWW with plans to have the left overs for dinner tonight.  John, the Hospice social worker, was with Mom when I returned from running around and they were having a nice chat sitting outside. Mom said she had walked the drive again and was feeling okay. When she got back in the house she was tired but looking forward to a visit from one of her friends.

Cousin Maggie came over Saturday morning and planted flowers in the front of the house, her birthday present to Ruth, and we enjoyed a nice visit before I took Mom to get her hair done. We discussed going to visit Priscilla but she wanted something for lunch and to go home. She spent the rest of the day resting, planning what she & Kim were going to have for dinner and talking on the phone. Val also was there with birthday presents and had a nice visit with Mom.

Following church on Sunday we went to visit Priscilla and her family. The girls had a nice time together and as always, enjoyed each others company. Val & I spent several hours with Denise and Sheila and her family and it seems everyone had a very nice time.

Dinner at Byron and Colleens Monday was a nice quiet celebration of Mom's 91st birthday. Byron grilled steaks, Colleen made a great salad and Sanders bumpy cake was complemented with Strohs French vanilla ice cream. Even the rain didn't dampen our enjoyment of each others company and Mom raved about how wonderful Byron's steaks were.

I left Tuesday morning, got home about 5:30 following an uneventful trip. I spoke with Maria from Hanna's Home Health Care about some concerns we had about her caregivers and was able to resolve the issues to ensure Mom continues to receive the care she needs and that she's paying for.

Mom looks forward to hearing from her friends and relatives and looks forward to visits throughout the day. Getting outside and the pain patches seem to have lifted her spirits and she is even turning the A/C on more frequently.

That's it for now. Hospice Julie will be making her weekly visit tomorrow and I hope her lawn gets mowed this afternoon.

That's all for now.

Busy Tuesday

Another busy Tuesday for our gal Ruth. Before we even left for her appointment with Dr. Weissman, she had physical therapy at home.Tanya came along to her visit with Dr. Weissman. He reviewed and reduced the number of medications she needs to take, and commended her on her positive attitude (she was fairly upbeat). She weighed in at 103 pounds, fully clothed.

Since it was around noon by the time we got done, we decided to go out to lunch at the Olga's Kitchen on 12 Mile and Southfield. Advice to any who may dine there: avoid the waiter named Jon. Following our rather strange meal, I suggested that since we were so close to Priscilla's house that we drop by. Mom managed to get up the steps into Priscilla's house, where she was having physical therapy. It was rather poignant to listen to their conversations. Here they were, these two young women who suddenly (to them) became old and frail.


They said their goodbyes and we returned to Meadowlark. Mom was adamant about making the cookies that they didn't get to on Monday, but it wasn't even five minutes after she sat in her chair that she dozed off. No cookie baking on Tuesday. Maybe they got to it today.

This coming weekend Kim will be staying with Mom. Next Tuesday is another trip to the wound clinic. We certainly know how to have fun!

The second weekend

It's been a quiet weekend thus far at Meadowlark. Mom's new Sizewise mattress came yesterday, and she slept so comfortably that she didn't get up until 9 a.m. Saturday. She's had some phone calls and an early afternoon visit from Byron while I was running errands. We had a late lunch and now she's taking a nap.

She continues to be frustrated and upset that she has physical limitations that prevent her from doing what she wants to do. That, plus her tendency to perseverate about some things that she has no control over gets her riled up. She's more guarded around Tanya and Kim (the new weekend caregiver) and they don't see this side of her. Which is probably a good thing. Today she was able to make her own oatmeal and dry dishes, but decided to postpone a project we talked about tackling this weekend.

Last week had some definite high points, though. Besides Art and Nancy's visit, a long time friend Bob Kennedy was in town from Chico, CA, and he and his sister Margaret came by to visit. Bob is no longer ambulatory, so he wasn't able to leave Margaret's car. The weather that day was perfect, making it possible for Mom to go outside and sit in the car and visit with him there. They had a wonderful time reminiscing, and Tanya thoughtfully brought tea and cookies for them to enjoy. And of course there were regular visits from Colleen, who brought Chinese one evening.

The week ahead brings a trip to Dr. Weissman, Mom's internist, who she hasn't seen since well before everything began to happen in November. We're hoping he can review the meds she's on and perhaps have her cut back on some of them.

Oh, the baby monitor tells me that nap time is over. Time to get back moving and help Mom "do her thing."

The first week at home

Mom had a busy Tuesday. In the morning the physical therapist came by, followed by an early afternoon visit to the wound clinic, which was the first time she left the house since coming home last week. Shortly after returning from the appointment, Mom's brother and sister-in-law Art and Nancy arrived for a visit. Mom was happy to see them, although she had to cut Tuesday's visit short to take a nap. Fortunately they're staying over and will see her again on Wednesday.

Mom's first week at home has had its ups and downs. She likes being home, but is too frail to do what she likes to do, which is to putz around and keep house. She's frustrated that she is lacking "pep." Tanya, who's with her Monday through Thursday, has been working to establish a routine. Unfortunately the  caregiver last weekend wasn't anywhere as competent as Tanya and the routine disintegrated. (That caregiver won't be back.) I'll be staying with her this weekend with hopes to keep the routine together and get her to eat more.

Receiving visitors and cards brings her great joy. Last weeks'  visitors brightened her days, and she was delighted to get a note from granddaughter Laurel. A note of caution to visitors, though: she's keeping the house at near sauna temperatures as she's always cold, so dress accordingly.

Mom At Home

Mom continues to adjust to being home. Much of the activity has stopped, OT, PT, and nurse have been here, evaluations completed and schedules established. Her former PT Ricky will be resuming his activities next week and she's looking forward to that.

She has enjoyed her companion Tanya this week, they have bonded slowly, but are getting along. They sorted out all the teacups this evening, matching cups and saucers and Tanya received one she expressed a liking for. She'll be leaving Friday morning when Phyllis, the weekend provider arrives and will return Monday morning for another fun filled week.

Mom has been sleeping late and not taking a nap during the day. She's been enjoying the visitors and phone calls and talking a lot about her life. She's still not sure about the cable TV, but is accepting it.

We've had a good visit and it will be difficult when I leave, on both of us, but she knows I'll be back in May for a while and has that to look forward to. She's also looking forward to seeing Val this weekend and visits from Byron and Colleen.

Not much more to report today. Stay tuned for further updates. Thanks

Home at last

Monday morning the bed, mattress and other equipment arrived from hospice, as planned. Monday afternoon Mom met with a hospice social worker again about becoming one of their patients, and after a 3-1/2 hour conversation, signatures and forms were completed. We figured all was well, but I should know better. Monday evening the hospice nurse called, apologetically telling me that they were mistaken; upon closer examination, at this time Mom is not a candidate for hospice care. They had thought she would qualify because of the need for pain control, but her wound by itself is not a terminal condition.

Nevertheless Mom returned to Meadowlark Tuesday morning after making her good byes to staff and friends at Heartland. She was sent home with her medications, supplies for wound care and best wishes. I discussed the equipment situation with the Heartland social worker, thinking an administrative event could take place and not disrupt what was in place. I should know better than to think!

Once home she was greeted by Tanya, the caregiver from Hanna's Home Health, who will be staying with Mom Monday through Thursday; another caregiver, Phyllis, will stay Friday through Sunday. I left Tanya and Mom alone so they could get acquainted. The topic of food came up and I made a run for corned beef, chicken noodle soup and fries from the Bread Basket. When I returned, her first visitor was drinking tea and eating cookies. Jean brought some flowers from the church altar on Easter and left with her teacup after telling Mom how she liked it. I proceeded to make several telephone calls with medical equipment companies, resulting in arrangements for the removal of the hospice equipment and delivery of replacements by Beaumont Home Health on Wednesday.

After taking a much deserved, long nap, Mom and Tanya discussed dinner options and I went out to spend some time with friends. Sometime during the afternoon her telephone quit working so when I got home and determined the problem was outside my realm of expertise, I went online and placed a trouble ticket through AT&T's automated system. I was informed that the problem would be resolved by 8:00 p.m. Thursday, which didn't sit well, but Mom wasn't worried.

Mom slept until almost 10 a.m. Wednesday and woke up feeling cold. After getting cleaned up, having Tanya clean her wound and eating breakfast I reminded her that her bed was going to be picked up and a new one delivered. "Whatever," was the response. I also explained the problem with the phone and received the same response.

The equipment hospice delivered on Monday was removed Wednesday morning, the room vacuumed and made ready for the new equipment. AT&T repaired the problem with the phone, the Heartland Home Health nurse came by and Beaumont delivered their equipment. OT came by, PT called for tomorrow and all is well at 23110 Meadowlark.

Needless to say all the changes and activity has been a little overwhelming for Mom. She's dealt with it all with her usual aplomb and we talked about now that things are settling down, she'll be able to develop a pattern of living that works for her. Tanya helps her as much as necessary but allows Mom to do what she can. So far she hasn't been cooking, but I think that may change in a week or so as she regains some confidence. She has had several calls this afternoon, is enjoying being home, and getting comfortable with Tanya. Giving them space is difficult for me, but necessary. I hope to leave Friday even though I know Mom would prefer I stayed, but Byron & Colleen will be coming by, Val will be down again this weekend and hopefully other family members, friends and neighbors will stop by often.

Throughout all that she has gone through Mom's attitude remains positive and hopeful. She's where she wants to be. What a trooper!

Getting ready for Tuesday

We've had a busy week. Last Tuesday brought the every-other-week visit to the wound clinic. Mom's wound is looking  better, but as it was explained before, because of the severity of the radiation damage it will never completely heal. Call it medical semantics or what have you, we were told a stage IV wound remains a stage IV wound; it may resolve somewhat, but it will not become a stage III.

With that knowledge and weighing the options for bringing Mom home, the social worker at Heartland suggested we consider hospice. Mom and Dave met with hospice representatives, and Mom has decided that at this point, having hospice would be the best course of action to take. Hospice will help with coordinating the medical piece of in-home care and pain management. This also defines what path we will be taking with future medical decisions. Right now we are planning on having a caregiver with her 24/7, at least until we get a handle on how things are progressing and what she's capable and comfortable with.

In anticipation of Mom's return on Tuesday, there was a flurry of activity at Meadowlark this past weekend. Cable TV (yes, she did not have cable) and wireless internet were installed, the many layers of wax were stripped from the kitchen floor so the carpet adhesive would stick, a new twin bed for the little bedroom (aka Val's room) arrived, the carpeting was laid, a new stove was delivered, Mom's room thoroughly cleaned (which didn't take much, as everyone knows Mom is the queen of clean), the refrigerator stocked with basics, and a bunch of other things.

The rationale for the cable was so Mom and her caregivers would have some more viewing options, and the internet for us and the caregivers. Mom's kitchen floor was in bad shape and we decided carpeting would be a good option, providing a smooth surface for a walker or wheel chair and also lend some warmth. Her 30+ year old range was ailing and unreliable, so we replaced it. Same was true for the twin bed in the little bedroom, and since that's where her caregivers will sleep, we felt it best they be able to get a good night's sleep while they're there. Mom's bed got moved upstairs (the "boys' room") and a hospital bed will arrive for her on Monday.

Dave interviewed some home care agencies recommended by the geriactric case manager and has another to interview Monday. Mom is a favorite of many of the Heartland CNAs, and several offered their services for home care on a cash basis. While we're appreciative of their offers, we felt it best to go through an agency to insure there is backup and also to have bonded and screened people. We are also considering one agency we hired last spring before she broke her hip.

If all continues to fall in place, Mom should be sleeping under her own roof Tuesday night and be able to enjoy her magnolia tree, which is ready to blossom any day now.

Plan B, as it stands today - Part 2

Yesterday mom expressed a surprising desire to go to a nursing home. We had a good discussion about her fears, concerns and thoughts. I reminded her that her focus has always been on returning home and she should consider giving it a try so she can make a decision based on experience rather than fear. I also reminded her that she is very determined to do as much as she can and her continued positive outlook is an inspiration and motivator for many of us.

The plan for Byron & Colleen to stay at the house has changed. After much soul searching they realized that with their other commitments and schedules it just would not be possible. Their hearts were in the right place and the offer appreciated, but realistically just not feasible. Colleen did say she will be able to do the wound dressing twice a day as planned.

Like Val, I'm hoping the change in weather will provide the opportunity for visits from friends and even if she can't walk the sidewalks, they are pretty bad, she can and did walk her driveway frequently and as long as someone is with her and she should be able to resume that activity as well.

Not sure about baking cookies, but who knows.

Plan B, as it stands today

After our disappointing and frustrating foray into the world of assisted living, and weighing the options -- nursing home or going home with lots of assistance -- we've opted for the latter. The plan at this writing is to make the necessary changes (carpeting the kitchen, putting in a new stove, getting a hospital bed delivered, having cable and internet installed) and bring Mom home, hopefully on Easter or Easter Monday. Initially Byron and Colleen will stay with Mom at night Sunday through Thursday, and Dave and I will alternate weekend nights and days. We'll get a granny sitter (who should be able to do housekeeping and other tasks) for Monday through Friday daytime. Fortunately Dave is here this week so he will do most of the leg work in getting this arranged.

After a couple weeks we'll reassess and possibly hire someone to stay with Mom during the night as well as during the day, but continue to alternate the weekends. Or we may find that a nursing home placement would be more realistic. This won't be easy, but (a) she has wanted to come home all along and (b) not being in a nursing home environment will lessen her exposure to infection. We can do the twice a day wound dressing changes. Having her home will definitely have drawbacks; she will be isolated, and in an institutional environment, she has more opportunities for longer strolls down the hallways. But now that it's (finally) spring, perhaps more people can get out to visit her, and we could always take her to a mall, Meijer, or church for a longer stretch of walking (we found after she broke her hip that sidewalks are not very walker-friendly).

So with any luck, today should be her last Monday at Heartland. Fingers are crossed!

Now For The B Plan

Byron, Val & I spent several hours at Sunrise-Troy last Saturday, discussing Mom's possible move there. We talked about their assessment of her, expressed our concerns about the wound, but were told that she most likely would be able to move in, providing nursing care was arranged to attend to her wound. The nursing director wanted to see the wound herself, and said she'd visit Mom on Monday.

All of us liked the facility, and after viewing several rooms we chose one we thought she'd like. The measuring tape came out so we could determine furniture placement, Val wrote the check for the deposit, and after grabbing lunch (and watching a bit of March Madness), we visited Mom at Heartland and talked with her about moving into Sunrise for at least three or four months, until she regained more strength and the wound healed more. She reluctantly agreed that it would be a good thing and we moved on to discussing the move, which we planned for this coming weekend.

Kathy, the nurse from Sunrise, visited Mom Monday to assess her wound and review her medical records. She reported back to her higher ups at Sunrise, and on Tuesday we were notified that Sunrise's corporate office determined that because the wound is still Stage 4, she would not be eligible to move into Sunrise at this time. Needless to say we are disappointed.

Now for the B Plan. We don't exactly have one. Mom will continue at Heartland for the time being with efforts being made to either get her placed in an "active" nursing home, or have her return to Meadowlark. We are looking at home health care, 24/7 care and what modifications will be necessary to accommodate her continued use of assistance devices.

When I spoke with Mom last night, I shared the news that Sunrise was out for now because of the wound. She accepted this with her usual stoicism and is quite content at Heartland for the time being.

I'll be back in town tomorrow and will stay for a while to assist in any way I can. Val will come down Saturday and Tuesday when we take Mom to the wound clinic again.

That's it for now.

Another Field Trip

Yesterday mom and I visited Sunrise-Troy, the assisted living facility at Crooks & South Blvd. We toured the facility looked at two types of accomodations and enjoyed a pleasant lunch in the dining room where mom was able to talk with some of the residents. It was very enjoyable and while she would never admit it, I think she can imagine herself living there. A representative from Sunrise did an assessment of mom this morning and they see no problem with her becoming a resident. Stay tuned, there may be a new address soon!

We also spent a pleasant hour or so with her lifelong friend Priscilla, who has been in Evergreen Nursing & Rehab for a few weeks. It was a pleasure to see the two of them together and I made myself scarce so they could have a nice private visit. We returned to Heartland so mom could have her dressing changed, lay down and get some rest.

When I spoke with mom to remind her of the assessment today, she said felt the rooms were too small and wouldn't accomodate a wheel chair. She toured the facility, to include the rooms, in her wheel chair yesterday with no problem so I think she's just looking for excuses. I look forward to seeing her this afternoon and spending an hour or two with her, talking about this pending change to her living situation. Should be fun!

The Week So Far

I arrived at Heartland Monday afternoon about 4:30 and spent an enjoyable hour with Mom before heading to Meadowlark and unloading my car. She had her hair done earlier in the day and was looking quite nice. We sat in the hall by the window enjoying the warm sun and getting caught up. I reminded her I would be taking her to the Wound Clinic on Tuesday and Dr. Hale on Wednesday. We also discussed the plan to contact the facilities Darcy mentioned to see about moving on to the next phase of her recovery. It was late in the day so I didn't get much of an argument and encouraged her to think of assisted living as a short term stay, 2-3 months. She could think of reasons why not to go, it's not Meadowlark, and was unable to come up with anything positive to mention. She appears to be willing to try this option, though, so we will see what happens.

Tuesday morning I contacted Wynwood of Troy and scheduled an assessment appointment for Wednesday the 17th. I also called, and visited, Sunrise of Troy, and discussed an assessment with them after a brief tour of their facility.  We'll go there Thursday morning for a tour and assessment and then visit Priscilla. The weather has been so wonderful, it's a shame to stay inside all day.

After a nice lunch with Mom and Val we prepared to depart for the Wound Clinic. Cousin Tara & her daughter Andi (aka Dr. East) accompanied us on the journey to Beaumont. Val & Andi participated in the unveiling and assessment of the wound in Dr. Ordano's office while Tara and & visited in the waiting room. The staff at Heartland had commented that the wound is healing and looking pretty good. They didn't mention anything about the dead tissue around the wound resulting from Mom not getting out of her chair with any regularity and either standing or laying down to relieve the pressure. Dr. O did say the wound is healing, but is still considered a stage 4 wound. That being the case, twice daily dressing changes will continue until the wound reaches a point where a Vac-Pac can be used.

While her assessment for Wynnwood was taking place, I sat in the hall reading the Free Press. While paging through the paper I saw an obituary of someone I was sure Mom knew and noticed the memorial service was scheduled for 11:00 this morning at FCCRO. After the interview concluded I showed her the paper and she decided she wanted to go to the service. After she took care of her personal needs we made it to the church with about 10 minutes to spare. Following the services Mom enjoyed visiting with her many friends and admirers (surprise) and held court in the fellowship hall while eating a terrific church food funeral luncheon.

Seeing Mom sitting with her dear friends, watching her interact with people that came by to visit with her was such a treat. Her whole demeanor changed. There was a wonderful smile on the her face, she sat up straighter, was pleasant, caring and concerned to everyone who she saw. She looked and acted like she didn't have a care in the world. It was great.

We finally got out of church about 2 p.m. with enough time to get to Heartland so she could use the facilities, have her wound dressed, and get to her 3:00 appointment with the infectious disease doctor, Dr. Hale. Dr. Hale discontinued the IV antibiotics and the PICC line will be removed at Heartland this afternoon. We returned to Heartland, Mom needed to rest and I needed to get this post out. Sorry it's so long, but I wanted to get everything out before I forgot things. I'm sure there are some things I failed to mention, but will add to my next entry, if I remember. It'll be interesting to see how the visit to Sunrise goes on Thursday. They say they can accommodate a stage 4 wound; we just have to pay for the nurses to come in and deal with it.

That's it.

Next steps

Mom was delightfully surprised by a visit from Tim, Lori, Travis and Trevor Tuma on Saturday around lunch time. She walked with them from her room to the day room, where they enjoyed a nice visit. It's always good to see Tim and his family, and Saturday was no exception. Later that afternoon Margie, Mom's roommate until last Wednesday, came by with her sister and brother-in-law to visit and deliver several boxes of Girl Scout cookies.So if you stop by to see Mom, she can now properly entertain and offer cookies.

Last Wednesday Byron took Mom to her appointment with Dr. Hale, the infectious disease doctor. Mom continues to receive intravenous vancomycin for MRSA, and seems to be responding well to it. She'll see Dr. Hale again this Wednesday. She has an appointment at the wound clinic on Tuesday, and I'm curious to see how things are going because Mom says both Dr. Hale and the wound team at Heartland say her wound is healing quite well. Dave, who's coming in on Monday, and I will take her to the wound clinic appointment. 

Mom's Medicare eligibility for rehab expired on Saturday, but she's staying at Heartland for a bit longer as a private pay patient in order to finish up her IV therapy and determine her next living situation.She will not be receiving physical therapy, so visitors, take heed: that means she's likely to be in her room if you wish to visit. The geriatric case manager we met with felt that despite what St. Anne's said, Mom was a good candidate for assisted living and identified a few places that could do the wound care that she requires. One of the tasks Dave has on his dance card is to have Mom assessed by one or more of these places and hopefully move ahead on this. Mom, of course, would prefer to go home, but understands (or at least on Saturday understood) that assisted living is the best place for her to go next. Hopefully in a couple weeks we'll announce a new address for her.

An RB shop connection

Just after lunch on Wednesday, Mom and I met with Darcy, the geriatric case manager. She spent several hours with us, asking questions and listening to Mom's answers. She also assessed Mom, using the same tool that they used at St. Anne's. 

In response to Darcy's question about what kind of work Mom did, Mom said she had been in sales and for years managed the RB Shop in Royal Oak and later Birmingham. Turns out Darcy's father was a regular there when he needed to buy a gift for Darcy's mother. Mom claimed to recognize the last name; who knows, it's possible. The RB Shop connection elevated Darcy's credibility in Mom's eyes (never mind the nursing degrees and other credentials), but not that she needed it; we both felt at ease with her and it was clear she knew what she was talking about.

Darcy will use the information we provided, plus Mom's medical records, to recommend a placement for when her Medicare runs out at Heartland (March 13). Mom can stay on at Heartland as a private pay patient, too. A couple of the challenges we faced are the wound and the MRSA infection; they're two things no extended care facility likes to have.

After our time with Darcy, we dashed off to the wound clinic for our bi-weekly visit. It looks like we'll be making this trip for the foreseeable future for wound debridement. They'd like Mom to limit the amount of time she sits to two hours three times a day.

Tomorrow my cousin Tara and her daughter Andrea, who's a surgery resident at U-M, will be visiting Mom in the afternoon. It'll be interesting to get Andy's take on things. We're also looking forward to Dave's return in the middle of the month.

Picnic lunch

Mom and her roommate were sitting outside their room when I arrived around 11:30 Saturday morning. Since theirs is the last room in the wing, and there's no room across the hall from them, it's like they have another room -- their lanai. I brought their tables out so they could eat lunch there; it was like a picnic, sitting in the sunny hallway.

Once Mom and I were alone, I told her I had some bad news, that the people at St. Anne's said they couldn't admit her to their assisted living. As many of you know, she is quite stoic and kept up a good front, saying that she figured as much and that she wasn't surprised, but I detected some waivering, the trembling lower lip thing.

She is worried about what is going to happen to her. I assured her we would make sure she had the best possible care, and to that end, explained that on Tuesday, a case manager was being brought into the mix to help us sort it out and make recommendations. Even though Dave, Byron, and Colleen have looked at different nursing homes, I want to make sure we have enough information to make the best decision. I told her that the case manager would give her a test similar to the one they did at St. Anne's (but didn't suggest she practice her subtracting from 100 by sevens) and carefully look at her medical records. Her Medicare coverage for rehab ends March 13, so there is some time to weigh the options and make a decision before she has to leave Heartland. Staying at Heartland as a private pay is also an option.

Mom is on antibiotics for her infection, and having her usual gastrointestinal reaction to them, poor thing. Besides the visit from the case manager on Tuesday, she has an appointment at the wound clinic again to which I'll be taking her. The fun never ends.

Some new developments

The wound clinic notified us Wednesday that our stalwart Ruthie has acquired several bacterial infections, including the nasty methicillin-resistant staphylococcus aureus (MRSA). Whether this knowledge was the result of samples taken at the wound clinic last week or at Heartland yesterday we do not know, but we were told she needed to see an infectious disease doc ASAP. Fortunately this afternoon Byron was able to get her into the infectious disease physician who saw her during her last in-patient stay at Beaumont. And fortunately this physician's office where she sees patients on Wednesdays is less than a mile from Heartland. Tomorrow Mom will have a PICC line inserted (which they can do at Heartland) so she can receive intravenous antibiotics. 


We're relieved they can do this at Heartland instead of her having to be admitted to the hospital, but concerned about where we're headed, especially since learning on Monday that she is not a candidate for assisted living (which she doesn't know yet, but I will tell her on Saturday). To help us figure out what our options are and what would be the best placement for her, I'm meeting with a geriatric case manager next Tuesday who will do an assessment on Mom, including a review of her medical records, and recommend a care plan. We want her to be able to live in dignity and be pain free. It's really not that much to ask.

Mardi Gras

February 16 was another busy Tuesday for our gal. When I arrived at Heartland around 11 a.m., she was in physical therapy, doing leg lifts and knee raises. After a quick lunch we headed to St. Anne's Meade so they could assess her for assisted living. Even I struggled with some of the questions they asked (counting backwards from 100, by 7, tripped her up, as well as remembering three words). For the most part, she did okay with the mental acuity portion. Her walking is unsteady, although she's determined to ambulate better. The biggest obstacle she has is the wound. As a rule, St. Anne's does not admit people with wounds such as hers to assisted living as it requires regular nursing care. We may be able to hire nurses to change her dressing twice a day or engage hospice services for that purpose, so we're hopeful things will work out.


Immediately after our visit to St. Anne's we headed to her late afternoon appointment at the wound clinic. I've been taking pictures of her wound at each appointment so I can see if there's any progress, and there was a little improvement from two weeks ago. She has new directives for activity, however. She's to sit for only three hours a day and spend the rest of her time either lying on her side, standing up, or walking. Anyone who knows Mom will agree she won't take to lying around all the time very well. But in order to maximize the healing of the wound, she needs to do this. They also emphasized the importance of her getting adequate protein.

Institution food gets tiresome after awhile, so following the wound clinic appointment we got some take-out from Panera Bread for dinner. The dining room at Heartland was decked out from a Mardi Gras party that afternoon, so we were able to enjoy our soups and salad in a festive atmosphere.

Mom is on her third roommate since returning to Heartland after her January hospitalization, and it's likely she'll have yet another as this roommate is scheduled for discharge next week. Mom's occupational therapy ends this week, but physical therapy will continue and because of the wound, Medicare will cover her stay until the eligibility expires (mid-March). There are pros and cons to her staying at Heartland until then. Having medical care available 24/7 is a plus, but getting her settled into her new living situation, with her own things, is important too.

Groundhog day

It was a busy day for Mom. Besides physical and occupational therapy, she participated in her care conference then had an appointment at the wound clinic. The care conference (attended by Byron and me in person, and Dave via phone) revealed what we anticipated, and that is the recommendation for Mom is to go into assisted living when her stay at Heartland ends. The physical and occupational therapists feel she has another three weeks of therapy, and she could probably stay until the end of the Medicare coverage, March 13, because of her wound. Mom has gradually acknowledged that she is too weak to live on her own. Our task for the next couple weeks is to identify where she should live. Mom said that Byron and Colleen should choose the facility that is most convenient for them, which isn't an unrealistic consideration, but as her wound needs to be treated twice a day, she needs to be at a place where she can get that level of care.

The visit to the wound clinic was uneventful. Her wound was cleaned and treated, it's still hideous looking, and we discussed with the doctor what the outcomes would be if she chose not to do hyperbaric oxygen therapy. Mom spent quite a bit of time since the visit two weeks ago studying the literature the clinic gave her regarding wound treatment and hyperbaric oxygen therapy, and she decided she does not want to pursue it. Whether she does or not, it's unlikely her wound will ever completely heal. She can always change her mind, too. For the present, though, she finds it too confusing and scary.

We got back to Heartland just in time for dinner (tilapia). It was a busy day for the old gal, so I'm sure she got to bed early. 

Lunch with Mother

Going out for lunch on Saturday was a regular feature of my visits to Mom before she broke her hip. On Saturday, we resumed the custom. She wasn't too enthusiastic about going at first. She was upset about having an "accident" that morning,. and was feeling down in the dumps. Then shortly after I arrived a social worker came in to talk with her in preparation for Feb. 2's care conference. Mom once again said she knew she couldn't go home without assistance, and felt that going into assisted living would be okay. And that she wanted Byron and Colleen to pick out the place, because since they are the ones who live closest, it should be convenient for them. She felt St. Anne's Meade, which we visited in the fall, would be fine.She shared with the social worker her stories about working at the Sanders in Royal Oak and I'm sure she could have kept going all day had we -- and the social worker -- not had other things to do.

The social worker's visit perked her up considerably, as well as the sunny weather. I settled her into the Buick Lucerne I rented (her days of getting in and out of the TT are over), and went to a local Comerica branch to take care of some business (much more competent assistance than what I had encountered in Pleasant Ridge the previous Saturday). Things went smoothly, and her mood was positive, so we decided to go to lunch and opted for the Big Boy about a mile from Heartland where we split a patty melt platter and a piece of French silk pie. The picture is of her in the restaurant.

We got back a little too late for bingo. She's still concerned, as are my siblings and I, about what's going to happen next. We'll have a better idea after the care conference Tuesday afternoon, which is followed by an appointment at the wound clinic which I'll be taking her to (hanging on to the Lucerne for a few days). Good thing the weather has been cooperative.

Cold and cranky

When I arrived at Heartland this morning, Mom was sitting in her wheelchair with a book in her lap and her eyes closed. She complained about being cold, and insisted on going through her drawers to get them organized. "I don't know where anything is, I'm freezing, and I just don't understand any of this." Poor thing. It's possible she's cold and irritable because of her low hemoglobin. I checked with her nurse to see if she had a blood draw since the one early last week, but she had no record of it. It's also possible she's cold and irritable because her room isn't like a sauna; apparently her new roommate, Caroline, doesn't require the heat to be on full blast like her previous roommates.

Her life-long friend Priscilla visited yesterday, and she had a call from Dave just as I was leaving to run errands (don't get me going about Comerica Bank), so I know she had a couple positive things happen in the last couple days. She's apprehensive and afraid of what's going to happen when she's discharged from Heartland. It's too early to speculate much, but a lot might depend on the state of her pressure sore. Time will tell.

The trip to the wound clinic

Cozy in her new sky blue down coat, I took Mom to her Tuesday afternoon appointment at the Beaumont Wound Clinic. Pictures and measurements of her wound were taken and treatment discussed. Her hemoglobin was low again (8.6) as was her potassium, which are items of concern. In addition to Dr. Ordona, she was attended to by four nurses and an aide (it takes a village). The discharge nurse emphasized that she needs to eat more protein to help with the healing and also shift the pressure on the wound by standing for a few seconds every 15 minutes if she's sitting, and lie on her side when in bed. She goes back on Groundhog Day, at which time Dr. Ordona may decide whether to recommend her for hyperbaric oxygen therapy (the hyperbaric physicians make the final call on that). The accompanying picture is of Mom looking at the picture of her wound; she was stunned at how horrible it looks, although it looks better than it did the first time she went to the wound clinic.

Her room on the second floor of Heartland is nice, although it's about as far from the nurse's station as one can get (before, her room was right next to the nurse's station). Her roommate, also named Ruth, seems to not be quite all there and Mom hasn't been succesful engaging her in conversation, which is hard for her as playing six degrees of separation is one of her favorite pastimes. Mom seems to be in relatively good spirits, although she is still perplexed as to why the wound developed ("I always used Lysol and Pinesol to clean the bathroom") and misses Dave. Byron and Colleen continue to visit regularly and I'll be back on Saturday.

Monday January 18, 2010

Byron received word this morning that mom was being moved to the 2nd floor. She is currently in room 230-1 and her phone number is 248-729-4447. The 2nd floor, in addition to physical therapy, is more of a medical floor and they're better equipped to handle the wound care and ensuring she doesn't sit in her chair all day long. She was just a little upset that she was being moved but once she found out the staff on 2 is just as nice as the staff on 1 she was better. Byron & Colleen are on their way back from Cadillac and will be visiting with her shortly, and Val is coming down tomorrow to take her to her Doctors appointment. That's all I know today folks, stay turned for late breaking developments.

I spoke with Mom around 7:45 this evening. She was perturbed because late this afternoon she was asked if she would be willing to switch beds (not rooms) with another patient who needed the larger bed that she had ("there are a lot of big women here right now," she observed). She said she agreed to the exchange, as long as they made sure she had a specialty mattress. Well, the switch occurred, but they hadn't made up her bed yet, and she didn't want to get ready for bed until the bed was ready for her. She was going to buzz for the aide once we rang off.

She's on her own for a bit. Dave is back at his home in Kentucky Sunday afternoon, and Byron and Colleen will return from their weekend up north sometime on Monday. I'll be there Tuesday afternoon to chauffer her to her appointment at the wound clinic. The excitement never ends!

Back Where It All Began

Mom was discharged from Beaumont this morning around 11 a.m. and returned to one of her favorite places, Heartland, in Troy. She is in room 103 which is the room she was in when she was recuperating from her hip surgery. The phone number is 248.729.4341. She has unpacked and set up her area the way she likes it and has had a visitor already, with flowers! Thanks Janet

She will continue to receive antibiotics IV as well as her usual assortment of medications and patches. The wound will be treated twice a day, just like in Beaumont and will be seen by Dr Ordano on Tuesday. When asked, she doesn't admit to being in any pain or discomfort. They're currently looking for a different wheelchair for her with a pad, and I'm not sure if the mattress on her bed will suffice. She knows she needs to not keep pressure on the wound and turn/sleep on her side as much as possible. That's it medically.

When we arrived and requested assistance, one of her favorite aides, Kimberly, came out, gave her a big hug, welcomed her back and suddenly my presence didn't matter. (As Val pointed out, she's probably just as tired of seeing me as I am of her.)

When we arrived at her room and I started unpacking her things she was busy getting to know the family of the woman in the next bed, finding out all the stuff that she needs to know and expressing concern that she won't have a tray until the evening meal. A sandwich with tea were delivered and she was happy. I left her to complete unpacking and organizing her stuff to her satisfaction, returning about
5:30.

When I came in this evening she was sitting in her doorway, holding court with new residents since last week, getting reacquainted with others she knew before and in general being Ruth. It was great to see her smiling, animated and enjoying herself with others.

My car is packed and my plans are to sleep in my own bed tomorrow night. Byron & Colleen should be back in town tomorrow some time, Val will come down Tuesday for her Dr appointment and I'll be back in March.

Thanks for following along with Ruth's Great Adventure.

Anyone Have An Eraser?

I spoke with mom early this morning, reminded her that she is scheduled for discharge to Heartland as we've discussed and that all that needs to be done is the discharge paperwork.

She was in such a snit! After she ranted that she had no clothes to wear, she didn't know what was going on and that all her children wanted was for her to be out of her house. She calmed down after we discussed all her concerns, again, and I told her my plans to be there around 1 p.m.

When I arrived, she was sitting in her chair, finishing lunch and seemingly in a good mood. She said she found the clothes that were hanging in her closet, I reminded her again that we were waiting for discharge paperwork, the continuing care nurse came in, reinforced what I said and she responded with her usual "whatever".

When the doctor came in mom told her that she had had two more episodes of "her bowel problem". The doctor told her that means she'll be staying in Beaumont a little longer to allow time for that to clear up, explaining that if she was discharged with this problem, Heartland would send her back to the hospital and we'd be back where we started. Mom understood and said she didn't mind.

In anticipation of discharge today I had packed up some of her things so we unpacked and settled in for another day overlooking the atrium and fake foliage. After notifying Byron, Colleen & Val, I decided to return to Meadowlark and get this out.

As it stands right now, I suspect she will be in Beaumont through the weekend. I've checked with continuing care and Heartland is still holding a bed for her, should she be discharged this weekend.

I knew there was a reason I didn't wash the floors this morning. This blog is so therapeutic, thanks for reading.

Maybe We Can Pencil In Plans Today

When I spoke with mother earlier this morning she was in a snit because no one had come in to see her this morning, except to bring her breakfast, take her vitals and do daily blood work. She was having a wonderful time sitting on her pity pot and making herself miserable.

When I got there, about 30 minutes later, she was in bed, had her wound dressed and been to the bathroom, and still feeling sorry for herself. We talked for a while, spending time focusing on getting back to Heartland, reassuring her they do want her back and will have a bed for her. She seemed to be okay with that and was happy to see the Dr when she came in.

We are still waiting for the results of some samples that were sent to the lab, but all other indicators are fine. She feels strongly that mom may return to Heartland tomorrow, but that won't be for certain until the lab work is returned. Mom will continue to receive IV antibiotics at Heartland and the care instructions for her wound have been written already. I spoke with the continuing care nurse who assured mom that Heartland does have a bed for her, but it's on the second floor. We discussed the possibility of checking in around 2 tomorrow, if discharge is a go.

That's all we know so far today, I'll post any new developments later this afternoon.

When I returned to the hospital this afternoon Barb Deiss was visiting and mom was in a quandry. She is under the impression that Heartland doesn't have a bed available and she doesn't have any place to go. I told her what I knew and also reassured her that if she doesn't go to Heartland tomorrow, I'll be staying until she gets in.

Dinner was nice, she liked the dressing with the turkey and she has been sitting up most of the afternoon, feeling pretty good.

More will be revealed with the new dawn.

Her Bags Are Packed...She's Ready To Go

Okay, maybe today's title is a stretch, but those items mom needs at Heartland are packed and loaded in my car ready to be transported back to South Boulevard & Livernois.

After a rather explosive morning, it was determined that the antibiotics appear to be creating a small problem. I arrived early enough to talk with the Dr about several things. Starting with this mornings problem, her antibiotics have been changed and she is starting to receive Flagyl in an effort to counteract possible side affects. We discussed how much this will delay her discharge and she felt that based on tolerance of these changes, she may be discharged tomorrow or Friday. Her hemoglobin was 12 today and there doesn't appear to be any evidence of blood exiting her body. This leads to the next topic, the frequency of anemia and need for 4 blood transfusions since May.

Without doing invasive testing, I'll get back to this, she felt that there may be an ulcer that is slowly causing this problem. I discussed our concern about this situation and questioned if an endoscopy/colonoscopy would be the next step. Dr B said that right now, as the result of her heart attack in November, she is not a candidate, they prefer to wait at least three months before submitting her to these tests. She went on to add that should there be evidence of blood, causing concern, testing could be revisited.

So that's what is going on so far today. After she was cleaned up, calmed down and felt safe (but cold) I left for a few hours. Cousin Pat called about where to visit today and is planning on visiting mom this afternoon. When I spoke to mom a while ago, she said her friend Joyce was also coming to visit so I've decided to stretch my few hours to a few more and will return later today with her mail.

Those of you readers that are familiar with mom's logic, she doesn't want to eat for fear of another episode. The Dr, nurse, and I, have explained that the antibiotics appear to be the problem and it is important to the healing process and gaining strength to eat. Last night she complained about the fish and potatoes being too salty and her lunch of chicken cacciatore was too spicy. She declined something different last night, ate one piece of fish and her soup and fruit. Not sure what she's doing this afternoon but will mention tis to her nurse when I seem him this afternoon.

If there are further developments, I'll pass them along.

By the time I returned this afternoon, all her visitors had departed and she was quite animated. She had another eventful trip to the bathroom resulting in her wound being cleaned again. Byron came for a brief visit and assisted mom with her dinner. She has been sitting up a lot today and while there is some discomfort she is not in pain and comfortable

Thanks for reading

Tuesday - January 12, 2010 - The News Of The Day

When I arrived this morning mother informed me that they were kicking her out. I investigated this claim and learned that she is nearing discharge. I also learned that she does have a cracked rib as a result of time spent on her right side on that comfortable operating room gurney and for a while following surgery. She tells me that she is not in any pain right now and feels fine.

Dr Ordano contacted me with the good news from pathology. There is no infection, no evidence of tumor or malignancy and he cleared her for discharge back to Heartland. He also said he will continue to monitor her recovery in his office and I made an appointment for next Tuesday at 3:15. Her attending physician will have to write the final discharge paperwork, before she can move on.

I spoke with the continuing care nurse, Mary, about getting back in to Heartland. Their medical representative here at Beaumont checked her records and cleared her to be readmitted to Heartland when she's discharged. Mary has talked with Heartland and they look forward to her coming back.

It is anticipated that she will be discharged tomorrow or Thursday, depending on bed availability. Mom is anxious to move out of the hospital and back to Heartland, she isn't as active as she is used to and I think misses the company of the staff and other residents.

Her blood work is fine, her wound is healing. She's cold all the time and can control the temperature and has told me what to pack for her. She doesn't know that I've got her stuff together already, have ironed her blouses and am ready to load the car at a moments notice.

She had a great visit with her friend June and June's neighbor this afternoon and even though she found the food too salty tonight, doesn't want anything else to eat.

Pleasant dreams and drive safely.

Another Pleasant Beaumont Monday

When I arrived this afternoon, mom was sitting up in the chair, finishing lunch. She was pleased with her mail and enjoyed a nice card and letter. She mentioned that her derriere was sore and that she had been sitting up all day. I suggested she should consider getting back in bed on the soft mattress and after making her way to the bathroom, getting cleaned up and back that's what she did. Her nurse and NA were very attentive and kept a frequent watch on her. Byron received a call from the Dr earlier today requesting approval for a blood transfusion, apparently her hemoglobin level had dropped significantly and there was some concern. After getting the okay, they were finally able to get a new IV started for the transfusion and got it up and running about the time dinner arrived.

Reverend Miller visited for a while, we enjoyed talking about a variety of topics and I shared Byron's knowledge on the Olmacher questions posed earlier. Mother shared her familiarity with the Olmacher name and rattled off several other names associated with the early days of downtown Royal Oak business. It was quite pleasant.

She has been fed, had easy access to her phone and church directory as well as her call button. I think I'll take off soon to be back early and meet with the doctor.

Sunday In Beaumont With Ruth

It has been a pretty good day for Mom. She had several visitors, including all her children. She also enjoyed sitting up in a chair and reading the paper, and visiting with a friend from church (thanks for the flowers, Kathy). After she got back in bed she commented that she had been awake all day and she's in fine spirits even though she hasn't had a nap. When I arrived around 10:30 a.m., she and Val were in xray, checking out her ribs. She forgets she napped for an hour when she got back to the room.

I cornered Dr Ordano earlier this afternoon. He still feels Mom will be able to return to rehab, hopefully by the end of the week. The results of the biopsy will not be available until the middle of the week and I'm going to check with Continuing Care about getting her back into Heartland by the weekend. He also said he will follow up with her in the Wound Center and in a couple of weeks have her evaluated for the hyperbaric oxygen treatment.

I watched as her evening nurse changed the dressing and have to say as gross as it is, it looks a whole lot better than it did on Tuesday when we were at the Wound Center. It's not pretty, but it does look better with all the dead tissue gone.

I'll be taking off in about an hour and returning tomorrow afternoon. Thanks to everyone who called and visited today; she really appreciated it.

Another Saturday night with Lawrence

As I type Mom is watching the Lawrence Welk show, her favorite, on the PBS station (it's like a time warp to the mid 1970s). She's resting okay; her right ribs are still tender, and we learned just a few minutes ago that although an x-ray was ordered, it hasn't occurred yet. Cathy, her nurse, said the mobile x-ray unit has quite a backlog so it might be a while before it happens. I didn't notice any redness or bruising, which might be present if a rib were fractured. She winces whenever she has to move, but so far hasn't asked for any pain meds.

I haven't seen the wound, but Cathy, who changed the dressing twice today, said it was fairly deep and she was surprised that it got to that state. It made me wonder if we should have been more attentive to it when she was at Heartland. They were treating it, but obviously whatever they were doing wasn't effective. So here we are.

I arrived around 10:30 this morning. One of the first things she said to me (other than where's Dave) was that she still couldn't figure out why she was in the hospital. I explained to her what I knew, and she asked why her procedure couldn't have been done as an outpatient. Poor thing. At least she has a decent room this time. The south tower is like a Hilton. There are actually shelves for flowers (which reminds me, I should pick up something for her tomorrow), the rooms are bigger and the curtains between the beds provide more privacy, halls are carpeted to cut down on noise, and of course, she has the window and a lovely view of the atrium and the faux maple trees that are in a perpetual state of early fall.

She sat in the chair about an hour before and during lunch, then we got her back in bed for a nap. I left to have lunch with Dave, Byron, and Colleen, then ran some errands. By the time I returned she was finishing up dinner, and was happy when I reported that we had lunch together. But still a pretty sad gal. She's dismayed, confused, and frustrated that she's in the hospital. And since not many of her friends know she's here, she hasn't had any visitors and only one call that I know of. So if you're inclined to visit or call, please do; she definitely rises to the occasion when people other than us are around.

And where was Dave today? He had a much deserved day off. Not quite the same as being at home but I hope he enjoyed it.

Photo credit:
Beaumont Hospital South Tower atrium from HOK|ideas work,  http://tinyurl.com/y8p94bc

As The Sun Sets......January 8, 2010

Since returning to her room, mom has been sleeping on and off, mostly on. She did eat some of the chicken sandwich and salad that were brought in, but declined dinner.
She is in some pain/discomfort but not at the site where the procedure was performed. Her right side is very painful and she was concerned that she felt bone protruding. Her nurse checked her out, pointed out that during the procedure she had been on her right side, probably longer than she is used to, and her ribs protrude on both sides of her abdomen. I mentioned her pain tolerance to the nurse and wondered if a rib could have broken due in part to her osteoperosis. She didn't think so based on her physical examination of the area and administered her regular pain medication. So she's sleeping again.

I'm going to take off, head to the house and have a quiet evening, I hope. Val will be here tomorrow so I may take the day off and enjoy some of this fine Michigan weather.

Oh yeah, Reverend Miller mentioned that Royal Oak General had an earlier name, an article in Sunday's Daily Tribune mentioned Olmacher Hospital does that sound familiar to anyone? Ask mom.

As I was leaving and thanking her nurse and aide I was informed a portable xray has been ordered to check out the rib situation. Gotta love that response time.

Can you believe it? I've actually got internet access from Meadowlark. Go figure.

Well, We're Glad That's Over

Mom was wheeled into the OR about 1240 today. The usual questions were asked and answered, forms signed and explanations offered. Earlier today Reverend Miller came by to visit and stayed with us until we were informed of the delay. Mom was glad to see him, appreciated his prayers and kind words. I was able to get out of the surgical area long enough to kill a few lung cells, grab something to eat and return to the waiting area and get settled in when Dr Ordano came out to get me at about 1:15.

He reports that the wound did go to the bone and they were able to clean away all the dead tissue as well as the wound area. They took a sliver of the bone and a sample of the tissue and sent them to pathology for evaluation. It should be some time in the middle of the week before the results are in and mom will remain in Beaumont until then.

While in the hospital, mom will continue to receive antibiotics to fight infections and since he has put no restrictions on her, should be able to get up and walk about as much as she can tolerate. He also said it would be okay to return to Heartland and resume physical therapy adding the staff there should be able to continue to treat the wound side.

Dr Ordano said the healing process will be slow for mom due to the soft tissue necrosis he mentioned earlier. He also said that since the dead tissue has been removed there may be some discomfort or pain returning to the area. He has written orders for inject-able pain medication should that be necessary.

We also discussed the hyperbaric oxygen treatment he mentioned earlier. She will need to be evaluated before it can begin, if it starts it will last for 6 weeks and is a 2 hour treatment Monday - Friday. Since medicare is paying for this, there are stringent governmental criteria that must be met. (I'll spare readers my comment about the chamber Michael Jackson had.)

She should be out of recovery and back in her room by now so I'm going to post this and go see how she is doing. Thanks for your patience.

Thursday, January 7, 2010 - Addendum-Part 2

This just in! Surgery is on.

Cardiology just came in and cleared mom for surgery tomorrow. As previously reported, she is scheduled for 10:30 so they will be taking her down around 9:30 tomorrow morning.

That's all folks

Thursday, January 7, 2010 - Addendum

Tara from Dr Orando's office came in to check on things and told us that surgery is scheduled for 10:30 tomorrow. She reiterated that they are waiting for cardiology to clear her for surgery but our fingers are crossed. It was explained to mom that if they can't get her clearned for tomorrow, it will be Wednesday before they can get her done. Tara also expressed hope that cardiology will have cleared her by then.

I'm hoping cardiology will be here some time before I leave around 7 or very early in the morning.

Keep your fingers crossed.

Thursday, January 7 2010

When I arrived this morning, mom was back from xray and getting cleaned up. Xray of what you might wonder, I don't know and she didn't either. As the day progressed normal activity was carried out. Blood work, periodic checks of BP and temperature those items of normal activity. The chaplain for this area came by and spoke with mom for a while. I mentioned to her that mother has expressed being afraid. Afraid of what's currently going on, what's going to happen and about death. While they were discussing these topics I left to meet a friend for lunch in the cafeteria.

When I returned, mom was sleeping and Dr Raam with Dr Sandburgs group left a note indicating that she is on the schedule for surgery tomorrow dependent on clearence from cardiology. Her blood work is good, hemoglobin went up a little, she's eating well and making use of the facilities at her disposal.

The nurse from continuing care was in and the usual questions about living arrangements were answered. I patiently explained that she was sent here by Heartland where she was sent after being in patient here for 3 weeks and we'd like to have her go back there. She does need some additional PT and it is hoped we can get her back there next week. The continuing care nurse suggested we also have a backup plan.

She has been sleeping a lot today and whever she wakes she is disoriented. I was off the floor for a few minutes and when I came back she was all upset because someone had been in and lead her to believe she was going to get kicked out and they were calling Val because she couldn't find any of the phone numbers. Someone had given her the log book and she was going through it, finding the numbers and checking out what was in the book. Further questioning leads me to believe when she woke up, she was thinking about th CC nurse and when I checked with her nurse, she informed me that no one had been in that she was aware of.

When she wakes up from a nap she seems disoriented. Not sure why she is here, what's wrong and believing she is going to be kicked out. I've gently answered her questions, calmed her down and gotten her back to today. I'd like to get her up walking a little bit or at least doing some exercises while she's in bed but it hasn't happened yet.

That's about it for today. Drive safely



I'll check with the unit secretary after 8 p.m. for the time of her surgery tomorrow.

A room with a view

Mom was admitted to Beaumont this afternoon and is in room 6314, south tower. She's in the bed by the window and has a view of the atrium. Nurses, CNAs, PAs and Drs have been in to see her, the same questions have been answered again, and they were finally able to start an IV. Her phone number is 248-898-6314 and she has already received several calls. I spoke with the Dr regarding when surgery will be. He won't know until tomorrow some time, but hopes it will be on Friday.

On the drive from Heartland Mom talked about her fears. Fear of dying and fear of what's going to happen next. I suggested she talk to her God about it and maybe find some solace.

As the attention continued, her spirits seemed to lift. She's looking forward to dinner shortly and is glad she's on a regular diet.

That's it.

And so we're going back to Beaumont

Sorry I couldn't come up with a more clever title for today's entry. It does catch your eye though, doesn't it?

The NYE celebration at Heartland and subsequent days of parades, football games and visitors were pretty normal. Val, Colleen & I visited Saturday, a friend from church visited Saturday evening, and Byron & Colleen and I visited on Sunday. Yesterday she participated in physical therapy and had some good workouts. Today when I got here, her PT got her up and walking prior to leaving for the appointment at the Wound Center. Pretty regular stuff for Mom and she was feeling pretty good, raving about the vegetable soup she had for lunch.

Prior to the Dr looking at the wound (measured at 50 mm x 40 mm, which translates roughly 2" x 1.5"), the nurse explained what causes decubitus ulcers (bed sores), as well as problems associated with them. In her presence I made sure mom understood everything and let her know she didn't do anything to cause the problem. In talking with the nurse I expressed surprise that she hasn't been in any pain or discomfort, but learned that since this sore is in her sacrum (the location of the bone infarct), there are no nerves and hence no pain.

Dr. Ordona came in, took a look, asked some questions and then discussed the cobalt treatments she received all those decades ago, in the early 1960s. He pointed out that this is the long term affect of the cobalt and the issue is soft tissue radiation necrosis. Mom spoke up at that point, sharing that Dr. Schuneman (our family doctor of yore) told her the cobalt would probably wreck havoc on her body in 40-50 years. As luck would have it, Dr. Ordona remembers Dr. Schuneman's name, and also saw patients at Ardmore hospital, where Mom had her colon cancer surgery. I didn't think he was that old! Anyhow, it made Mom feel connected, always a plus.

At his recommendation, Mom is going to be admitted to Beaumont tomorrow and he is (hopefully) scheduling surgery for Friday. If it can't be scheduled for Friday, it will have to be on the following Wednesday (the 13th). The options presented were to go to the ER for admission right then, waiting for a hospitalist to be assigned, or let Dr. Ordona's office try to get a bed and have the hospital contact me tomorrow. I picked door #2 and brought her back to Heartland.

The procedure to be performed will consist of removing the dead tissue, possibly scraping the bone and testing for an infection in her bone. This will be done under mild sedation with a local anesthetic. Since she is in no pain and has no feeling in that area, that seems like the best thing to do. Her stay in the hospital will be 5-6 days following surgery and then discharge to some kind of nursing home.

Follow up care will consist of hyperbaric oxygen treatment daily. This treatment will take two hours a day. She will receive this treatment while in the hospital, I think, but will require it daily following hospitalization for at least six weeks.

One other option that was discussed was plastic surgery to fill in the hole, but the soft tissue radiation necrosis precludes that.

So that's it. The hospital is to contact me tomorrow. If I haven't heard from them by noon, I'm to contact the Wound Center for assistance. Hope I didn't forget anything.