We check her into the hospital, and it looked like it was going to be a long weekend.
I could see it in her face. There was no color in her cheeks, her eyes were dull, and her mouth appeared to be fixed permanently in a grimace as the nurse went about hooking up the Baxter so they could begin giving her an IV plus more anti-nausea drugs. The nurse didn’t say a word to either of us, which struck me as strange.
Right about then, Joanie starts to throw up, and I jumped up to hold the basin that sat on the bedside table for her and to give her tissues. The nurse just stood there and didn’t say a word. Then she said something about getting the anti-nausea drugs, and I said, “She’s throwing up right now.” She didn’t react at all. I think it went right over her head. I began to think this was not going to be a pleasant stay.
Then, before they could get to the business of the anti-nausea drugs, the nurse sat down and proceeded to go on with her check-in report, which included listing all of the drugs Joanie was taking, plus the dosage numbers. I had the list ready for her, and I had brought all of the drugs with us to the hospital. She told me the list wasn’t enough, she had to see the drugs herself, so she could write them down. She obviously didn’t trust me, or know me at all. If she did, she could have seen me beginning to get angry, but trying to not let Joanie see it.
The nurse told me Joanie couldn’t take her own medicine while she was in the hospital. I told her Joanie had just been in the hospital two days ago, and Dr. Thomas had written orders she could take them during that stay. This news didn’t seem to phase this nurse, and I was doing my best now to keep my mouth shut. Joanie didn’t like it when I would get upset, and right now, the only concern I had was getting her comfortable so they could get the nausea under control.
All the while this is going on, Joanie still isn’t getting the relief she needs. Later, when she is still sick to her stomach, we called a nurse. The nurse said no one told her about Reglan or Marinol. Somehow she got the word, and gave Joanie some Reglan, and said she’d call Dr. Thomas about giving her Ativan. We are now well into the five o’clock hour, and have been her for about three hours. Joanie remains agitated for about ten minutes after the Ativan is put into her IV, and then seems to relax and doze off. I waited for about half an hour and then left to go home and pick up some things for her.
Before I left, I couldn’t help myself, I stopped by the nurses station and called for the nurse who had checked Joanie in, and asked her why they wouldn’t let her take her own drugs. She said, “It’s a safety issue.” The meds she would get form the hospital are packaged by the pill so they know what they are getting. She told me she wouldn’t know what was in the bottles we had brought with us. I said, “Joanie’s been taking these meds for some time now, and I know what’s in these bottles is what’s supposed to be in these bottles.”
Then she said something that astounded me, she said, “We could get in trouble and be on 60 Minutes with Mike Wallace. I did have to restrain my smile at that one. My response was simple. I said, “Look, I know that by packaging drugs individually, the hospital can charge us more for the meds.” To which she replied, “The insurance company would probably pay more toward them because they are given in the hospital.”
By this time, I had cooled down sufficiently to let the issue go. I had let off my steam, most of which, I’m sure had built up because of Joanie’s situation over the last two days. Still, it didn’t hurt to do that. Later that evening, I had stopped to see Orell and Cathy Schmitz for a cocktail and to bring them up to date on what was happening with Joanie. Of course I had to regale them with the tale of the meds.
As a caregiver, you will find there are times when you are going to be so frustrated, angry and worried, you need to safe place to vent, and since you can’t vent to the patient, it is important to have some friends you can do so with. Orell, Cathy and Wayne Tanous were such friends for me, and I found it did help me a lot.
The next morning, a Saturday, I got to the hospital about 8:00 a.m., and Joanie was sleeping. I stopped at the nurses station, and the nurse on duty told me she had thrown up about 3:30 a.m., and they gave her some more Ativan.
She woke up about a quarter of nine, and I went to get her some ice chips. She is agitated and nervous. There hadn’t been a doctor or nurse into the room since I got there. I asked her what she needed, and she said, “I just need some sleep.”
She got up to go to the bathroom, and when she got down, she said the colostomy was full of gas. I told her it wasn’t surprising since the only thing she had to eat since Wednesday was a grilled cheese sandwich, and she hadn’t eaten much of that.
She got back into bed and drifted off to sleep. It was now just after nine o’clock, and we hadn’t seen doctor or nurse yet. I let her sleep, and snuck out for a quick smoke.
I was outside, having a cigarette, and thinking that the nausea switch Dr. Thomas talked about hadn’t been turned all the way off yet, but it was getting close.
When I got back upstairs, nothing had changed, and I thought to myself, it’s not like this place is as busy as they’d be at Fairview-University Medical Center in Minneapolis, but then I gave them the benefit of the doubt, and chalked it up to the possibility they were short staffed this weekend. That didn’t make me feel any better, but gave me a reason to understand why we hadn’t seen anyone yet.
Finally, about 9:30, the same nurse we had seen yesterday when we checked in stops in the room, and tells us they are probably going to do the thoracentisis this morning, and that should help with her breathing problem. That was good news. However, Joanie told her she still felt sick to her stomach. When the nurse asked her to rate it, she said, “A little bit.” That didn’t seem to be a problem for them doing the procedure, which was to drain the fluid off her right lung, which they would do right in her room.
Shortly we were introduced to Dr. Kriengkrairut, he was the pulmonary doctor who would be performing the ultrasound guided thoracentisis. The wheeled in the ultrasound, and began to get things organized for the procedure. This wasn’t a large room, but I stayed, making sure I wasn’t in the way. The nurse came in, to help get Joanie ready. This was the same nurse I had words with yesterday, and little did I know I would change my opinion of her after this was all done.
The got Joanie to sit up on the side of the bed, and then she rolled the bed table over and put a pillow on it for Joanie to rest on. The doctor had her lean over on the pillow, and then began prepping her back for the insertion of the needle to drain the pleural effusion. It was a large one, and Joanie would have to remain still, and refrain from coughing or breathing too deeply while they were draining the fluid.
The ulrasound picture gave Kriengkrairut a good picture of the limits and location of the effusion, so they can see where to insert the needle, and it wasn’t long before they were draining the fluid. It came out and filled a drainage vessel, and I was surprise that it kept on coming.
All of this time, I watched the nurse and how she dealt with Joanie while the fluid was draining. What I observed was someone who cared about her patient, and I saw her gentle hands on Joanie’s arms, and the quiet tone of voice she used when talking to her, and I had to admit, she was a far better nurse than I had given her credit for when we were having our disagreement about the use of Joanie’s prescriptions the day before. That was okay, I didn’t mind admitting to myself I had misjudged her. I did tell her afterwards I thought she did a fine job comforting Joanie through the process. I didn’t, however, tell her what I had thought about her the day before. To me, it was all part of the stress we were all under at that time.
The fluid kept coming, until Kriengkrairut said that was it. They couldn’t get every last drop, but they got the majority of it. The total came to 850 cc of fluid, which I figured was about 25 ounces. Considering there are 32 ounces in a quart, it seemed to me to be a helluva lot of fluid, and would explain the problem she had breathing.
Kriengkrairut told me they would be sending the fluid to the lab for analysis, to see if there were any malignant cells present, and we should know in a few days.
After they were done, Joanie sat up, and said, “I feel like a different person already.” She lay back in her bed, sitting up and said, “I can’t believe the difference.” I could see the difference in her face, the tension that had gripped it for the last couple of days seem to have melted away.
At 8:40 this morning, she told me that all she wanted to do was sleep, and now she was. It was 1:00 now, and she can breath right, and seems sound asleep.
I am much relieved, even though I know this battle is far from over. It has really just begun, but at least now she can muster her energy to continue the fight rather than living with the fear and anxiety of not breathing well.
As I watch her sleep right now, I’m struck by the difference between early this morning and now. She looks fully relaxed and is now able to get the kind of restorative sleep she dearly needs.
I was just sitting there watching her, when Dr. Thomas came in. He sat on the side of the bed with her, but she didn’t even stir. He said, “She looks like she’s sleeping well.” I told him it was the best she had looked while sleeping in several days. He told me they were going to add another anti-nausea medicine, but would not wake her now. He said, “We’ll just let her sleep as long as she can, or needs to.”
Joanie woke up around 3:15 and took a few sips of apple juice. That was the first thing she’d had since 4:00 Thursday morning. I asked her if she felt nauseous, and she said, “I’m not sure.”
Things seemed to be going well, until just after six when she threw up. The nurse finally came, after I had searched for her and they gave her some Zofran and Marinol. She seemed to settle down, and around 8:00 that night she told me to go home.
I did. I needed a good night’s sleep myself.