Tussy Mussy

We got off to an inauspicious start this morning. I arrived at the hospital at 7:30, to find that she was sitting in her bed on the phone ordering breakfast, and the physical therapist du jour was standing bedside. The therapist was saying something about coming back to see her later, most of the comment, however, I missed. As soon as the therapist left, Lea turned to me, started whining, teary eyed, and asked me if I would help her get to the bathroom. She said that she had been ringing for the nurse since 3:00, and no one had come in to help her.

She immediately started working herself over to the edge of the bed, as though in a great rush, so I started helping her by removing the pumps from her calf, the ice bag from her knee, and unplugged the IV so I could roll the tower with her. We moved as quickly as we could, but it still wasn’t fast enough, as we left a trail of evidence behind. I quickly wiped up the floor, and helped her over to her bedside chair where she could sit while I changed her bed.

She was very lethargic, barely keeping her eyes open long enough to carry on a conversation, and was making incongruous statements about the lack of care she had gotten over night, and saying that the nurses just don’t seem to care about her. She also asked me if Lance had called on the single ring. I asked her what that was, and she said, pointing at the IV tower, “You know, the one not like that one.” She was referring to the alarm on the IV tower that sounds two notes incessantly whenever it wants attention.

She then said she was waiting to hear back from Link on whether they had talked to him about the schedule for the three men in the Bible. When I asked her what that was, she said she didn’t know, they were going to tell Link. She said next summer we need to take the granddaughters to Worlds of Fun, a theme park in Kansas City we frequented when our sons were boys.

She was obviously over medicated, and I knew that I could easily read too much into what she says in that condition, but I wanted to find out what had happened with her overnight. After I changed her bed, gown, and footies, I moved her back into bed, Since the Nurse Call button was still disconnected from the switchboard, a standard overnight practice to reduce the noise level, I went out to the nurse’s station to find her nurse. The nurse stated that she had talked with Lea at 5:40 this morning, and that Lea didn’t say anything about needing to go to the bathroom. She did, however, seem to be very lethargic.

When Dr Miller came into the room to check on her, he removed the TET hose from her right leg to examine the operative site and noticed that the swelling had gone down quite a bit, and that she should feel more comfortable. He tried to talk to Lea, but she kept falling asleep, so I suggested that her Dilaudid dosage be reduced back to 3mg now that her pain is better under control. She woke right up when I said that, and, with wide eyes, stated, “But, I need it! I hurt!” Dr Miller told her not to worry as he patted her on the shin. She went back to sleep.

Her nine o’clock dose was reduced to 3mg, and by ten o’clock I could see a definite improvement. The physical therapist came in right after Dr Miller left, and was ready to take Lea for a walk. I pointed out how lethargic Lea was, and she offered to come back later. When she came back at ten she felt much more comfortable about taking Lea out, because she planned to have Lea learn to negotiate steps with her walker.

Since Lea still has drop-foot in her right leg, the therapist suggested to Lea that she go up steps backwards, which will give her better balance than going up normally. We only have two small steps for her to go up to get in the front door at home, so I don’t anticipate a great deal of trouble with this, and I built her a step for the back door that is large enough it should be easy to navigate.

Mid afternoon Lea went on the CPM again, with the angle of knee bend set to 75 degrees, which was about all the knee could be bent without causing her a lot of pain. After an hour of exercise on the machine, she had to quit and go to the bathroom. Then, she didn’t want to go back on the CPM to finish her second hour, saying she hurt too much.

We notified the nurse that she was in pain and she was given a Dilaudid. I asked the nurse if her schedule was still every six hours, and discovered the order had been changed to whenever she needs it, not to exceed one dose every six hours. Immediately after she swallowed the pill, she laid back on the pillow and began to rest, dozing off in just a few minutes.

Her blood count has also dropped over the last two days, and yesterday she was given an injection that is supposed to help in the production of blood cells. She has been quite cold today, and I have her under about seven layers of hospital blankets. She probably feels cold due to her anemic condition, so Dr Cittadine ordered a transfusion of blood. Unfortunately, she ran a low temperature all afternoon, and she couldn’t be given the blood until that was eliminated.

She started asking for more pain medication at 5:30, and was told that it was way too early. She wasn’t due for another dose until nine o’clock, and wasn’t very happy about that. She started crying from time to time, was very irritable, and at one point said she felt like she was getting chest congestion. The nurse gave her a Tylenol to reduce her fever and make it possible to give her the blood.

 I’m afraid an awful lot of her discomfort is drug addiction, and she knows how to play on sympathies. Creating a fuss sometimes will get her enough medication to escape into a fog where she doesn’t have to deal with anything. Tonight, however, the nurse called Dr Cittadine at home, and he asked to talk to me to see what I thought should be done. I told him that I am concerned about giving strong doses of Dilaudid due to the intoxication it causes, and that I’d like to find some other non-narcotic medication that would fight the pain but not be addictive.

After some discussion, he decided to go with Vicoden, dosed halfway in between the Dilaudid doses. Lea wasn’t very happy about the decision, but after about 45 minutes of fretting and stewing she suddenly realized that she was feeling quite a bit better. What a relief! While Tylenol is on her “bad” list, since it metabolizes in the liver, she can use it occasionally. Vicoden, while it has a small amount of Tylenol in it, is mostly metabolized in other organs.

Lea appeared to be much more comfortable later in the evening, as she received the transfusion of two pints of blood, and her pain level seemed to be under better control. She was less groggy than this morning and fairly alert, doing much less of the delusional talking in her sleep that she does endlessly under large doses of Dilaudid.

As the evening wore on she became calmer. She was receiving the blood without any complications. She finally started getting warm, and had me remove all the blankets, leaving her covered by only a sheet. The nurse told her that it can take up to four hours for a person to receive a pint of blood, but that she appeared to be taking it in a bit quicker. She said Lea can not get her next pain medication while she is receiving the blood, so, there will be an interval between the two units so she can be given the medication.

Mom came up before lunch and spent most of the afternoon with us. Lou came visit for a while, and Pat and Joe also stopped by. Pat brought Lea a homemade tussy mussy from her flower garden. Lea loves flowers, and asked Pat if she knew what message the tussy mussy should convey. In Victorian times each flower had a special meaning, so a tussy mussy carried a specific message based on the flowers used to make it. Pat just laughed and said the message of this one was “whatever caught my eye got picked.” Lea got a chuckle out of that!

Lea learning to walk up backwards, and Pat’s tussy mussy.