So its been a whirlwind of 2 months with so many problems that after every day I was just so exhausted I couldn't even begin to start to post. So without further ado...
Family
So my grandfather's pneumonia finally resolved after the terrible cough he had continued for another 3 weeks, and we got a long 10day course of antibiotics, of course when one problem is resolved another emerges. So on Nov 24 my grandmother broke her hip (greater trochanteric fracture) after we're guessing semi-passing out and falling to the floor from low B.P (90/40) at 10pm while she was going for a late night snack (something which we kept telling her not to do...). So began a 3 week nightmare hospital stay....
To give some perspective, before the fall, my grandmother had 3 different B.P meds + was using a nitro puffer 5X/week...so she had major heart problems before everything. So, after a lot of deliberation, we decided to call the Amb. Everybody right away started looking at me and asking if its fractured or not, as if I'm the biggest expert, so from my complete lack of any experience, I did observe it was Externally rotated which is never good, and she couldn't weight bear and was in a lot of pain. I was hoping it was just dislocated, but alas x-ray determined large fracture.... Now the next adventure was actually getting to the hospital, since we wanted a better hospital, and I knew that if I didn't request it they would send us to the crappiest one in the city (already had a few nice visits there), so with the paramedics hint, we said that of course we were there already in the past month....yes the wonders of canadian medicine, you have to lie to get to a better hospital.
Of course the first thing they do in the ER? They give morphine for the pain of course because its not moral for the person to have any pain, what happens in an elderly person with many comorbidies? They go into withdrawl, complete with hallucinations, paranoia...yep, let's just say it didn't start well. We were lucky though since thankfully a bed opened and she was able to get her surgery only a day later. This is where the real problems started....First she had a loss of consciounsness--> ICU visit--> chest pain which I had to battle with nurse to get a little relief with nitro--> back to awful ward where they ignored us and any complaints including continuing chest pain, note my mom was there 24hr/day since my grandma was delirious and doesn't speak english, so needless to say she was exhausted. I was there on weekends and did lose it a couple of times with the nurses and their 'care'. --> MI...after basically 3 days of chest pain where we were giving nitro ourselves, they finally noticed elevated troponin, ST seg depression....and this is only after my mom made up that she was having chest pain for 3 hours and a smart nurse finally took her seriously. Of course being very lucky, they did not have a cath lab at this hospital so they had to send to another hospital and considering this was an 'emergency' she got into the cath lab 1.5 days after the initial dx of the MI and was stented at 11pm at which time she was extremely exhausted and barely keeping it together...very very frustrating.
I wish I could say our nightmare ended, but lucky for us 'protocol' always needed to be followed. So we spent a few days in the telemetry ward, then the ortho ward, and thankfully we were able to actually start going home at night and my mom was actually able to get some sleep. Now at this point, 2 weeks after coming in, she was able to walk short distances with a walker and we really really wanted to take her home...but alas there is the 'protocol' of going to rehab first. So we refused 2 places, even though we were being forced to choose 3 and were warned that we would go home if a spot didn't open in a few days, unfortunately for us a spot did open....
Now to give some perspective this was the same rehab place where I was doing my placement, so I assumed that it would be a good place to recover in...boy was I wrong. So she got place on an ortho unit, which was problematic since her major problem was the heart not the hip, and right away this unit almost completely ignored the MI and heart problems and only focused on the hip fracture. Now because we don't have private insurance and couldn't pay $300/day for a semi-private room, she was placed in a ward suite with 4 beds and 1 shared bathroom, did I mention that one lady was continuously vomiting? My grandma was not feeling well at this point, and we still weren't sure what meds should be used to stabilize her B.P which was still flcutuating madly, so we requested that like at the hospital they help her use a bedpan at night, since she is less stable and more disoriented, and she was using a commode at night. We verbalized this several times, and every time, we were told this is a rehab facility, and that to improve they had a protocol to help their pt walk to the bathroom and they would use their 'judgement' to determine if she needed assistance. Of course they refused to let us stay the night... So on the 2nd day, my mom arrives, to learn that she had a syncope episode after walking to the bathroom and they are sending her to emerg for more tests...oh oh. So my mom goes over to emerg, where they find nothing, except fluctuating B.P. which they can't do anything about until the heart calms down a bit, and send her home...after a 7hr wait for the ambulance to take her back.
At this point we were so frustrated at their lack of any kind of understanding and treatment (she wasn't getting any therapy because she wasn't feeling well) that we thought we wanted to take her home. At this, everyone basically thought we were nuts, and the doc refused, said that she is too unstable (not sure what they were doing to make her more stable), the nurse manager trying to defuse the situation (we were not happy) threatened us that if we leave AMA we will get no homecare, and can't get an ambulance to take her home because our house can burn down and she wouldn't be able to leave! but if we stay until monday she will convince the nice (spineless) doc to release us. Now after the last emerg you would think they would learn that she isn't stable and her fluctuating B.P means that it's prob not a good idea to force her to walk to the bathroom at night for 'therapy'..nope. So we tried to be proactive and explain our concerns to the her nurse about getting her up at night, and the nurse went nuts, started shouting that she has no right to a personal commode since it is a 'public room' and that if she can walk for 100m, she can easily walk to the bathroom.
Well guess what, at 4am the next morning, we get a call that the doc sent her back to the emerg after ANOTHER syncope episode following a walk to the bathroom. We were not happy. At this point we decided enough is enough and we will take her home whatever way we can because she was getting worse and we couldn't take this constant emerg visits every 2 days. So after again everything came back normal, we convinced the ER doc that since she is being 'released on mon' anyway, we want to take her home directly, which the previous ER doc refused. So after another hr wait for the ambulance, we couldn't believe our luck that we finally managed to escape from our medical rehab prison.
You're probably wondering, were we crazy going against the doc and the facility? was the doc right in wanting her to stay (in that awful place) and sending her to ER all the time? Well i think we were right. I won't lie, because she was very far from stable in the beginning, and she did have a couple more scary syncope episodes, and her B.P. did continue to fluctuate, which meant we had to constantly adjust her meds. It also meant that we had to stay with her 24hr/day, and we would take shifts sleeping on a mattress on the floor to make sure we helped her use a bedpan at night. But in the end, we did not once come back to the emerg, and we have been able to after 2 weeks at home get her fairly stable all the while reducing her meds. She is now able to walk on her own, watch tv, and I've started doing the regular hip exercises at home, we have even stopped constantly measuring her B.P, and she hasn't had a syncope episode in 1.5 weeks.
The most likely reason for the syncope? we're guessing it was orthostatic hypotension, which we told them she had before, and in addition a lot of weight loss. She was basically not eating for 3 weeks, because the food was so bad and was actually causing her indigestion.
After all that, we are basically labelled as difficult family members who left AMA and are putting her at 'risk' and are therefore denied home physio and probably more homecare. This experience has def taught us a lot, the most important lesson being to never be afraid to speak up, and that the 'professionals' don't always know best, and sometimes you have to go against the system which can be very frustrating.
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