11 April 2006

Hey, Mom's doing okay!

So my oldest daughter and I spent five days up in Minnesota last week so we could visit Mom in the hospital, while she was recovering from her heart attack, quadruple bypass and valve replacement.

Last I saw her, she was looking surprisingly good. And my sister, Betsy, called yesterday to let me know Mom (that's her in the photo) had indeed left the hospital and was heading home.

And that's a good thing.

While I was very happy with the work the surgeon did, as well as the support Mom got from some of the nurses and staff, overall the experience was an incredibly frustrating one, particularly from the vantage point of communication and getting and conveying information.

I don't think I ever talked to the same person—and this includes doctors, nurses, PCAs, social workers, hospital administrators or anyone actually associated with her care—on two consecutive days until the last day we were there. (Wait, I take that back. The lady at the booth in the parking ramp was the same one every day. And by the second day, she remembered me.)

Anyway, every conversation had to start at the beginning—there didn't seem to be any sort of institutional memory or sharing of information among the people involved in Mom's care. It was like dealing with a bunch of one-person terrorist cells: No individual knew enough to give away what was actually going on. (Once I even had to tell the new nurse after the shift change when Mom last had her medication, because the previous nurse had neglected to note it in her chart.)

So the revolving cast of characters made it incredibly difficult to get anything done or to follow up once we'd tried to accomplish something.

For example, we needed to get some medical equipment for when Mom went home—including a hospital bed—and were told we needed to talk to either the care coordinator to arrange it. I did that on Tuesday, and he said he'd write up an order for "the doctor" to sign. Of course Mom was seeing so many doctors, he wasn't sure which one that might be, but he assured me he'd get it done. He also indicated we'd have a sort of evaluation before she was discharged to assess what all she might need in the way of other equipment. (That never happened, at least not when any of us were around.)

Still, byFriday morning (when we initially thought they were going to discharge her), Mom somehow had acquired a walker with a wheel that didn't turn, a long shoehorn, a tube-like gizmo for putting on her socks and the grown-up's version of what my youngest daughter calls her "Galactic Grabber," a tool for picking stuff up without bending down.

But we also were told that Mom didn't qualify for a hospital bed because she was on Medicare. Never mind that the guy told me on Tuesday that as long as the doctor said it was a medical necessity, she would get one. (And the guy assured me that the doctor would sign anything he wrote up.) So my sister went out and picked up medical equipment on her own—bathtub seat, rails, etc.

Back at the hospital, I asked whether they'd checked if Mom's supplemental insurance would cover the bed, and was told I needed to talk to the care coordinator again. But of course it was his day off, and his assistant was nowhere to be found either. So we found a social worker who was covering for both of them, and thank heavens, she was actually willing to do some checking.

Turned out that no one had written up any order for a hospital bed at all. No one had actually checked with Medicare and cited my mother's specific circumstances, nor had anyone checked her other insurance. No one had done anything about it.

So we scrambled to get a bed ordered and delivered, thinking that Mom would be going home on Saturday, and since it was too late in the week (and the day) to get a real answer from either Medicare or her insurance, my sister had to agree to cover the rental costs if the insurance companies refused.

Meanwhile, it turned out that Mom had been asking her nurse to check her leg (the one where they took the veins for the grafts) since Wednesday. It was swelling up, the toes hurt, and now it was getting red and warm to the touch. We got the nurse's attention at the change of shifts, and she turned out to be the most efficient and diligent nurse I'd seen all week. Her name was Melissa, and she examined Mom's leg, made the appropriate noises and comments, and immediately called the surgeon. Within an hour Mom was on antibiotics again, with the surgeon coming in to check her leg first thing in the morning. Yep, it was an infection.

But of course that meant Mom wasn't getting out on Saturday either.

It also meant that we needed to figure out which doctor actually would discharge her: the surgeon, the cardiologist, the diabetes specialist or the "hospitalist." So we asked, and naturally we got two different answers: one said the hospitalist, the other said the surgeon. We decided to trust that it would be the surgeon because he actually was looking at both her and her chart on a regular basis, so we felt like he was in the best position to know what was going on. And the ever-efficient Melissa confirmed that. If only there had been 20 others like her.

Anyway, it all worked out in the end. Mom not only survived the heart attack and the surgery, she weathered some of the most indiffeent care I've ever seen and now is home (with her new laptop) and seems to be on the road to a complete recovery. In the end, the surgery probably made her better than she was, and with the artificial valve, there's a good argument for referring to her as the Bionic Mom from here on.