Wednesday, March 20, 2013

Wednesdays with Dorothy: Another Trip to the Hospital

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Dorothy’s health had rallied after that hospitalization early in February.  She was able to resume her plans for her 82nd birthday party on February 18. We picked her up at her apartment and took her to The Cracker Barrel where she and her friends gathered to celebrate with southern cooking and a homemade birthday cake (supplied by her friend Nioka).  In the weeks afterward, some of us were concerned about Dorothy’s ability to continue to live by herself. Even though she had aides who came into her home on certain days to help with housekeeping and health needs, we knew that the time was probably at hand when she would need more care.  Her friend Lona had checked with the social worker during Dorothy’s last hospitalization to find out about the process for nursing home admission, should the time come for that, though Dorothy was not at all inclined to move into a nursing home.  Dorothy did, however, become open to the possibility of assisted living in the Birmingham Trade Towers Building. I had some relief in the possibility that she could move to a greater level of supervision.

A Critical Turn

It was not long before Dorothy’s health took another turn.  It was on April 1, 2012 that we received word that she was back in the hospital – this time on the Coronary Care Unit at UAB Hospital.  Her friend Nioka had gone to see her at her apartment the day before and saw that she was struggling to breathe so she took her in for medical evaluation.  My wife, my daughter, and I all managed to get by to see here the day we heard she had been admitted to the hospital.

Once I got there, I found Dorothy was resting comfortably. She was on oxygen and about four different IV drips.  The IV medications included lidocaine, amiodarone, and dopamine.  From my work as a cardiac nurse, I recognized that lidocaine and amiodarone helped to reduce fatal cardiac dysrhythmias and dopamine helped to maintain heart rate and blood pressure.  Dorothy had probably had another heart attack and was in severe congestive heart failure. When I learned how she arrived at the hospital, I was surprised that she had even survived until then.  When her friend found her in physical distress, she drove her to Dorothy’s doctor’s office.  It was at the office that the medical staff saw that she needed hospitalization.

Knowing the critical nature of her illness, it was indeed amazing that she had survived to make it to a hospital bed in the intensive care unit. When I found her, she was fully awake and alert and was able to recount to me the events that lead to her hospitalization.  She was watching an old movie on the television, so I sat and visited with her for a while. 

Wendy Walters is a social worker at UAB Hospital whose specialty is family support and end-of-life care. Wendy was a great help in making sure that Dorothy's plan of care was consistent with her needs and wishes. Dorothy’s friend Lona was quick to get social work services involved since Dorothy had no family and her health called for some important decisions to be made very soon regarding her well-being. Social work services played a key role in outlining the most appropriate care. When the medical team consulted with Dorothy, she made it clear that she wanted no “heroic measures” taken and did not want to be placed on life support.  The medical team decided, taking Dorothy’s wishes into consideration, to get her weaned off of the IV drips and then to provide comfort care.

I was not at all certain that Dorothy could be successfully weaned off the IV medications that were supporting her heart.  If the medical team was able to get the IV drips stopped, I thought that it might only be a matter of hours before she would slip into unconsciousness or death.  My wife, my daughter and I were committed to spending some time with Dorothy each day as our schedules allowed.  Sometimes we were there together, often we were playing “tag team” with one arriving as another was leaving.

To my surprise, Dorothy continued to maintain her strength even after all the IV medications were stopped.  On April 4, the fifth day of her hospitalization, Dorothy was moved to the Palliative Care floor. Palliative care is a term for providing comfort measures when there is no expectation of improvement. It is often the last stage of care during a terminal illness.






(Photos on this page are of typical hospital settings, courtesy of Wikimedia Commons)



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