The "Good Dr." has some affect

It seems that after the meeting with the "Good Dr. " yesterday, she phoned the TLC to speak with the director.

Not really sure what happened, but at least the care has improved.

I have a feeling (after overhearing a conversation at patient records), that someone has asked for records of all of the Dr. orders at TLC. I am guessing, to see what orders have not been followed.

And, I delivered to the secretary of the Director of the facility ( well, she was on a conference call, but someone in the next office gave her the report), detailing the history of all (well most) of what has happened. I have great faith in secretaries, as they are great facilitators, but we shall see.

At least I feel that I have done something. I started out in my report all the positive things the VA has done, and ended with the comment that I want to help improve the care.

There are a few good people at the VA. The speach therapist has been amazing, doing much more than her realm, even offering to find out about transport options.

I am not giving up. It's just not in my DNA.

The work continues on my front porch. Not going as smoothly as one would hope, but that's the way it goes with remodelling.

The back story, Part 3

So when "G" got to the emergency room, the nurses and Drs. said "anyone who looked at this could tell it (the incision) was infected.

And yet, one nurse at the nursing home dared to say "when I looked at it it wasn't infected". Liar. Either she never looked at it, or didn't know what she was looking at.

So, another week in the hospital, IV Vancomiacin, and then back to the nursing home on a Monday evening.

They moved him much faster than I expected so I wasn't there.

He called me on the phone, to ask me to come. They did not take him back to the room he had before a(they were to hold his room for 30 days), and none of his stuff was in the room.

When I got there he was sitting in a chair, no walker around, no wheelchair.

Then the Director of the nursing home came in and started yelling at him that him was on the wrong side of the room. He started complaining that none of his stuff was there, and then tried to get up and walk without a walker or anything. I am trying to tell him not to walk, he is a fall risk.

But the director is yelling at him that he is in the wrong place (but yet, he was told that was his bed). So, he started scooting his chair, and she is yelling at him to not scoot the chair as it will scratch the floor. And then he got verbally abusive, and she said "If you don't stop this you will have to leave this facility tonight".... and he continues, and she goes out to the nurses station and calls the cops.

I go out to the nurses station and ask them to call the Dr. ( who thankfully was still there). The cops arrive, "G" doesn't want to talk to them. I talk to them, try to get them to back off, and thankfully the Dr. arrives.

He talks with "G" and I, listens to all concerns, says he was informed "G" had arrived the week before on a Friday and left on Monday (a lie), but anyway, the Dr. was great, stepped out into the hall to tell the cops they could leave.

And, we have not seen the director since.

I hear she was out doing "training".

I guess training people how to call the cops.

The back story, part 2

So finally on Monday they diagnosed an eskemic stroke.

"g" could not walk, could not even stand, had double vision, and motor control problems with his right arm.

They kept him in the hospital until Friday, when he got transferred to the nursing unit, where he would get rehab, etc.

But, there is non Dr. on duty on the weekend. And, the regular Dr. was on vacation, so someone was filling in.

On Sunday evening, I started complaining that his head was swollen, and his arm hurt.

Eventhough the Dr. never saw him, she put in notes that "the head swelling is due to the stroke". (which it was not)

We kept complaining, the nurses offered "G" pain pills for the arm which hurt (which was actually infected). Finally, by Wed., when the Dr. still had not seen him, but was suppose to come that nigh, but then, we were told she would not come, I threw a complete "hissy fit". (I stood in front of the nurses desk and just kept repeating "this is not acceptable".... and went wandering around for someone with a brain to talk to.

I was told where the office was for the Director, door closed, so I asked if I could leave a note. The secretary for the hospice unit was very nice, gave me a piece of paper, I wrote out all of my concerns. She read it and said "these are very valid concerns", tried to call the director, but no answer (the director was in "quality meetings".

Finally I got back to the nurse, who by then was on the phone with the Dr. saying "the girlfriend is very upset" (I had said I would take him to the ER myself if they did not do something).

So by then the Dr. had put in the order for the CT with contrast (which she did on Monday, but did not enter it as STAT, and they are booked out 2 1/2 weeks).
So "G" had the CT scan..they had to call in people on overtime, and then went to the ER.

The back story

I realized I had not started blogging when everything started, so here is some of the backstory.

"G" had a stroke when they placed a stent in his arm to clear blockages. This was after the surgery to do a "transposition" of the veins where they were trying to get a fistula going. He has been using a catheter for dialysis for the last 1 1/2 years, which is not good, as it's prone to infection(which has occured 4 times or more), plus, the dialysis is not as good when through a catheter.

When they did the stent, he had a stroke. Through the entire procedure, he was nauseous, and as I know from my Mother, this is how a stroke displays. But, the medical staff only thinks about a stroke in terms of the after affect, which did not display for a day or so, because he was still having the stroke.

In some way I kick myself for not being more pro-active, because I saw him after the procedure, he could not tolerate light. But, I also didn't know what could be done, and if they tried to do something.....well, sometimes that just makes it worse.

So they just shipped him off to ICU, and they treated him for the nauseous.

This was on Friday. On Sunday he called me and said he needed help feeding himself.

When I got there, they were moving him to the floor because the ICU was in temporary quarters (due to a water line break), and all patients had to go somewhere.

So he was sent to the general hospital. But once there, he had trouble swallowing his dinner, I called for the nurse, who called a Dr., who examined him, and said he had a TIA (LOL).

This got him sent to the telemetry unit of ICU, where they monitored him closely for the next 24 hours.

to be continued...

Meeting with the good Dr.

"G" had an appt. today with the good Dr. It was very nice, last for 45 minutes or more, but the first 1/2 hour she could not get into the computer, so that was some of the reason for the length.

"G" had not been given his high blood pressure meds in the morning, because he was out for therapy, and the nurses can't get it together to give him his meds when they should.

At least when the Dr. finally got into the computer, she could see he had not been given his meds, and she said she would put a call into the manager at the nursing unit.

We advised her we had mentioned this problem many times to the Dr. at the nursing unit, but as the nurses don't report to him, they just say "yes I will do it", and then they walk away and don't (as was the case with changing the bandage).

There is also a problem that although the p/t and o/t have given "G" a note with the times they will do his therapy, they have not put it into the computer, so others who are scheduling appts., etc. don't know he already has something booked. The speech therapist was the one who put me onto this, because when I told her they had given him a note with his times for therapy she said "I hope they put it in the computer".

At least the speech therapist is going over and above her job. She has already arranged for appts. for hearing, and podiatry, and has discussed with "G" getting him a device which reminds one 4 times a day to take meds. She will also get him an i-pod.

People like her gives one a little hope that there are good ones around. Just like the "good Dr.".

I phoned and spoke with the patient advocate about trying to get the appts. in the computer. It is becoming apparent that she doesn't like her job, isnt' very good at it, and told me that today was her 53rd birthday, and she is counting down until she can retire at 55.

But, I am not giving up.
Perhaps I can convince her she can make a change in the care which is given, in these last 2years of her career.

We shall see.

Good and Bad Drs.

At least the Dr. at the nursing facility has restored my faith in Drs., a little bit anyway.

I have asked him to coordinate the care for "G", and he seems to be doing so. The dietician should see "G" tomorrow.

But, we had the "care plan" meeting at the dialysis place today. Just a joke.
The Dr. was totally unprepared, had her facts wrong, etc. If I sat in front of a client so unprepared, I would be embarassed, and lose a client.

At least "G" will be seen by the "good Dr." nephrologist at the VA.

It's all so frustrating, but at least we have made progress on getting therapies scheduled.

Tonight "G" and I went to a seminar on how to make a rain barrell. He saw the notice in the paper, and asked to go.

It's a way to keep life somewhat normal.

Tomorrow we will probably go to the movies. The cheap movie place is even cheaper on Tuesdays. $1.00 for a movie. Can't beat that.

And anyway, they are prediciting snow tomorrow morning, so a movie will be just the thing to do.

My front porch is in the process of getting rebuilt. The concrete guys have dug footings, inspector came by and told them to dig it deeper, so they probably won't get done as fast as planned, but at least they are making progress.

Also heard the wheelchair ramp has been approved. Should be here in a couple of weeks, about the time my porch gets finished.

Little by little.

Problem with the Dr...part 2

So, when my b/f ( I will now refer to him as G), got hooked up for his dialysis, I went into an office to continue the discussion about the meeting for the "care plan". They were all anxious to get these done, as it is required by their contract with the VA.

I explained to them that (as per G), there is no point in these meetings, because nothing gets done.

They told me of "G'" reluctance to talk to the Drs., and I told them, yes he does not " suffer fools gladly".

Then I pointed out to them that the PA for Dr. C. would say to him "your head is swollen", and he would reply "yes, maybe we should ask a medical professional about this", and she would walk away.

And yet, when he saw Dr. B. at the VA, and she saw his head was swollen, she immediately sent him for a CT with contrast, saw all the blockages in his neck, and admitted him to ICU on a heparin drip.

I just shugged my shoulders as I said this. As if to say "why do you think he doesn't trust the medical staff here?"

They didn't say anything.

Then I repeated a saying from one of my old bosses "if you see a pencil falling off a table, do you try to catch it? Or just let it fall?"

I don't know if there will be any change, but perhaps they now understand some of the reason for the anger from "G".

Problem with the Dr.

Friday my b/f was at the dialysis center. I went over to take him lunch and pick up blood samples.

We found out a week ago that the "green top" blood sample needs to be spun down in an hour, or it's no good. Well, his dialysis time is 3 1/2 hours, so there is no way he can take it back in time, so I started playing messenger (good thing I am not working)

Anyway, I get over there and he tells me they want to have "care plan" meetings, as required by the VA. And, they are behind on these meetings, so they want to do 3 in one day.

Well, he tells them it is all total b/s (which I agree), that what's the point in having meetings when they don't accomplish anything.

Then, as he is telling them all this, it escalates to the the point he says " I am going to die, and it is Dr. C. who is the reason".

The problem was Dr. C. is the "contract Dr." who is in the partnership which runs the dialysis center.

When my b/f had an appt. with her last year, he had all the test done for a kidney transplant, but when he saw her, she had not reviewed anything, and just blew him off.

This was when I decided to try to see to VA Dr. whom he liked very much.

To be continued...

It's Days Like This

So, Thursday night I picked up my b/f to go out to eat. We had a nice dinner, and then he wanted to go to Olive Garden for espresso.

I dropped him off at the front door, he insisted walking in by himself with his walker, which he accomplished very well. We had our espresso, but as we were getting ready to leave, I realized I couldn't find my keys.

Long story short, I had left the keys in the car, with the car running. Guess I was just a little stressed out.

He called for AT& T roadside, which he has had for a number of years, but when he got hold of them. they said he didn't have that coverage. Well, my fault, because a couple of months ago I convinced him to change the plan so we would get Internet at my house, and he probably lost the coverage then.

Luckily I had AAA, but it wasn't a very pleasant experience.

Darn it all, even after his stroke and everything, he is still smarter than me.

Well, we got through it.

And now I will carry his set of keys with me also.

Funny thing, when I repeated this story to one of the guys at the nursing home, who is missing one leg, one side paralyzed, I said " I have never done this before", and he replied "but you just did!".

Smart ass Vet

Gotta love them.

The Patient Advocate Helped!

Finally some good news to report.

At 4:45 this afternoon when I went to pick up my b/f to go out to eat, he showed me a card with the list of his appointments for p/t and o/t for the next 2 or 3 weeks.

So, I guess the Patient Advocate has at least accomplished that much.

Soon I will get my b/f to meet the Patient Advocate, and hopefully he can explain to her the problems he is having.

At least that will give him some empowerment, as I know he hates relying on me.

And, we are already seeing other patients in the nursing home feeling a bit more empowered.

My b/f's roommate heard my b/f refusing to have his blood sugar taken (his blood sugar is pretty much under control). He let's them take it at night, but not 3 times a day.
And so, he heard his roommate refuse to have his blood sugar taken (as his is pretty much under control also).

That is the one thing they know how to do in the nursing home, take blood sugar and dispense insulin.

So we have made some progress.

Speech Therapist

Well, I misunderstood my b/f on the phone. He was saying "speech therapist", and I thought he said "three therapist".

He asked if he would get p/t today, he was told the p/t therapist would try to get to him, but wasn't sure. I think the o/t said she would see him.

So, I called the patient advocate around lunch time and left a voice mail. Obviously my suggestion of them actually "scheduling" the therapy has fallen on deaf ears.

I think there is a problem with the physical therapist. I noticed it the first day, she has an attitude.

Either the work is not evenly distributed, and she is doing more work than others (which would be a good reason for a bad attitude), or, she just has a bad attitude in general.


But, the occupational therapy was very taxing today for my b/f. He said she had him stand for 5 minutes, just holding onto a towel (I think that's what he said). So he was probably too worn out to do p/t today.

Tomorrow is shot, as he has an early appointment with the surgeon, and then dialysis. Then it's the weekend.

Well, I suggested we go out to dinner tonight, so that will be good p/t for him.

Making Some Progress with the VA

I just spoke with my b/f on the phone to see how things are going.

I am not really sure what he said, but I think he said he has 3 therapists working with him, and that he was busy so he couldn't talk.

However, I asked him if they had changed the bandage this morning, and he said no.

Here's the background on the whole bandage thing.

They did surgery a few weeks ago to "transposition" veins in the arm to get access to a "fistula". A fistula is needed for dialysis. They join together a vein and an artery (I think) and this site grows large, and then they can stick a needle directly into it to do dialysis. Otherwise, they must place a catheter into the body, which is what my b/f has had for the last 1 1/2 years. However, because a catheter is a foreign object in your body, you are prone to infection (which has occurred at least 4 times).

The first time my b/f went from the hospital to the nursing unit, the incision got infected and no one did anything. He complained, and the nurses offered him pain medicine.

Finally, after the 3rd day of complaining, I threw a "hissy fit" and insisted he be sent to the ER, or I would take him there myself. So, they did, and the folks at the ER said "anyone could look at this and see it is infected".

One week in the hospital, back to the nursing unit, Dr. orders to change the dressing 3 times a day, and yet, 1 1/2 weeks later we are lucky if it gets changed once a day.

I thought this was corrected a couple of days ago, but yesterday evening I realized it was not. I spoke with the charge nurse, explained the importance of changing the dressing, asked my b/f to ask that it be changed this morning, and yet apparently it was not done.

So, since the Patient Advocate was apparently successful in getting the therapy going, I thought I would give her a chance to get the "wound care" problem fixed.

I just phoned her. She said she would call the assistant director, as she thought the director was not there at the moment.

I had one encounter with the director, which was not pleasant, and I haven't seen her since. Either she took vacation, or maybe after our encounter they put her on administrative leave. I can only hope.

Probably the pulled her out to work on the "quality program".

Patient Advocate Role is to keep you from suing

Patient Advocate's became popular in hospitals 15 years ago or so.

I first encountered one when my Father was in the hospital with pneumonia. They put in a central line, and afterwards, there was lots of blood all over the room. The next day he needed a blood transfusion, and the day after, the Patient Advocate showed up, and wanted to know how things were going.

Humm, I thought, funny I never saw her before this. They must have screwed up.

And, so it goes.

Today, I made the mistake of trying to use the Patient Advocate. First, she informed me that the Durable Power of Attorney was not sufficient for her to release information regarding my b/f. She said he wasn't incapacitated (despite the fact he had a stroke), unless the Dr. certified he was.

However, I had the foresight to write down my current concern, which is trying to get him physical therapy. They aren't scheduling the therapy because he is "inpatient". So, I have asked if they could please schedule therapy for Tuesdays and Thursdays when he does not have dialysis. Perhaps after dialyis on m/w/f he could do speech therapy, but p/t would probably be too much.

She said she would scan my note and send out to the department heads, I guess.

I could tell she doesn't like her job, because of course she has to pass on patient's complaints, and probably everyone hates to see her coming.

She also isn't very good at her job. "Super Nurse" told me she called her and left 2 messages to call me, which the advocate claimed she never received.

Well, at least I can say I have tried.

I hope to eventually get to speak with the management of the hospital. I so much want to get things changed.


Not just for my boyfriend, but for all the other current and future patients.

Trying to get a wheelchair ramp

About 2 weeks ago when we spoke with the Geriatric Dr. who handles the nursing home, I told him my intention was to take my b/f home after he got sufficient rehab.

He said to me "if you take him home, you will eventually need a wheelchair ramp, because of his condition, which will only get worse".

I had already done some work researching getting a ramp, and was told the VA would pay for a ramp, even if the home is not owned by the Vet.

So, then Dr. sent an e-mail to the Social Worker at the nursing home to get me a wheelchair ramp. She didn't really know what to do, but forwarded it to prosthetics, whom I had been told orders the wheelchair ramps.

I went to see the manager at prosthetics, who told me there are 2 ways to get a ramp. One is the Dr. orders it, and the VA arranges for it to be installed. These ramps must be metal. As I do not have 32 feet in front of my house (the length needed due to the height of my porch), I didn't think I could have a metal ramp. But, I was informed they can do landings and turns with the metal.

I could have a wooden ramp built by applying for grant money under a program to retrofit a house to make it handicap accessible. However, the "ramp guy" told me I should save that money to use to modify my bathroom if needed, etc.

So, the "ramp guy" found the message from the social worker asking for a ramp, but he said he needed an evaluation from PT. So I thought he was going to send it to them, but honestly now I don't remember.

Anyway I think I went back and asked the social worker to resend it to PT. But I guess she didn't really know how to do it, because a week later there was not PT request for a ramp.

Oh, and another thing, the staff at PT was under the impression a ramp could not be ordered if the house was not owned by the VET.

I am so tired of getting the run around, and fighting with everyone, just to get them to do their jobs.

But, I went back to prosthetics, and found out the primary care Dr. is the one who needs to put in the order for a ramp. So yesterday the person I spoke to on the phone said she would put in the order for the ramp.

We shall see.

Here I Go Again

I haven't posted in a long time.

I realized I never really finished writing about my boyfriend's Mother, who died last year.

Now I have to write about my boyfriend.

He had a stroke. It happened when they were putting in a stent to clear a blocked artery.

He is at the VA in what they call the Transitional Living Center (TLC), which was formerly called the Nursing Home.

From there he gets transported out for dialysis 3 times a week, and they take him next door to the Physical Therapy room for physical therapy (p/t), occupational therapy (o/t) and I guess Speech Therapy, which is just called speech therapy.
(I guess s/t would be mistaken for shit, especially if you had a speech problem!).

Every day is a new adventure.

He has lots of health problems, but yesterday I saw on a print out that he has a diagnosis of sickle cell anemia, which I never saw before. If this is true, it would explain why he has had a lot of his problems.
At the moment the worse problem is continual blockages all through his neck area.
It blocks off the blood supply to his head.
Not good. His head will die.

They put him on blood thinners, but it's not really clearing out the blockages.

So, I will again start doing some investigation. Who made this diagnosis?
What is being done to treat it?

It's a really good thing I am not working at a full time job, because this care giving thing has become my full time job, again.

Later