So, I was settling into my Monday routine this morning, looking at the four phone interviews scheduled on my calendar. It would be a busy, draining day, but those four interviews would help me get two articles written this week and help get me back on my deadline track – still underwater, but at least seeing the surface. Then I heard a thudding crash from the downstairs bathroom, and my day’s schedule fell to the floor and broke into a thousand pieces.
I rushed downstairs to find the bathroom door closed.
“Dad? Did something happen?”
Weakly, from the other side, “Yeah. I fell.”
I opened the door to find him sitting on the floor, in boxers and a tee shirt. He had been sitting on the closed toilet for a moment or two, as he’d been feeling lightheaded while brushing his teeth. While reaching for one of the several bathroom grab bars, he missed his target and fell. I could see a big abrasion on the top of his left hand, like he’d dragged it across the bead board wainscotting, or maybe the porcelain, slate-patterned floor. I made one brief attempt at pulling him up by his hands, but realized his extremely weak legs would make the effort futile.
“I can’t get you up, Dad. I’m calling the EMTs”
So the three amazingly nice EMTs show up (all the EMTs here are amazingly nice – and very calming), get him seated on a chair in the living room and we all noticed he also had a cut on his eye – not his lid, actually on his eye.
“O.k., we’re going to take you to the hospital, sir – you need to get that eye looked at.”
“Well, just give me some gauze.”
“Dad, you’re going to the hospital.”
So the routine from two weeks ago, and a month ago, and the month before that played out all over again. Dad gets driven off in his big, red limousine, and I walk purposely throughout the house, gathering clothes, in case he’s released, packing laptop into backpack, because the hospital’s WiFi connection is much better than it’s cellphone service, letting the dog out one more time and heading to Cape Cod Hospital, where I set up my satellite office in a stackable plastic chair at the foot of Dad’s bed. Unfortunately, this time around, we didn’t get one of the little room-ettes; instead, his gurney is pushed against the nursing-station counter in a busy hallway.
The plus side of this location is that Dad can stay engaged just watching all the activity around him. And it gave me a chance to reflect on the oddness of the ER universe. It’s Monday morning, around 10:30 or so, and the place is jammed. The center of the room is a big, open-office style arrangement of desks, outlined by an oval-shaped arrangement of counters, broken by 3- to 4-ft. wide passages for nurses and doctors to pass to and fro. Patients in gurneys are pushed up against the counters’ outside walls in the four surrounding hallways, which are, themselves, lined with the room-ettes.
Within the nursing-station oval, nurses, doctors and aides circle around each other like the swirling pieces of rock in an asteroid belt. They are each individual, but they’re also interacting with each other as though it were any other office space – a newsroom, say, or an open-plan consulting firm floor. They roll their chairs over to an adjacent desk to ask a colleague a quick question, poke their heads up to check the day’s staffing schedule on a whiteboard, yell out a question or a sarcastic remark, all as though not surrounded by patients wrapped in sheets and distress. When they cross through the counter and walk through the patient spaces, there is no eye contact with those bodies on gurneys, except with any particular patient to whom they might be tending. The same lack of eye contact also is the case between patients and their family members and any other patient group, though they may be mere inches apart from one another. Each seems surrounded by its own gravitational field, holding itself intact by not recognizing the existence of the surrounding chaos.
Eventually, after x-rays and a CAT scan, we find out that Dad’s badly dehydrated, and his blood pressure is even more orthostatic than usual – that is, it drops precipitously when he goes from lying to sitting to standing. At standing, it was 68/32. Yes, I said 68/32. And he didn’t feel dizzy. Talking Dad through the event of falling, it turns out he doesn’t remember the fall itself, so it’s quite possible he simply passed out in the process of standing up. The eye is a bit concerning, but it’s in the white, not the retina, and his sight seems to be obstructed only by the small dab of antibiotic ointment placed on the wound.
The dehydration/blood pressure issue gets Dad checked in, yet again. It’s a maddening situation, because I don’t know how to get more fluid into him, short of setting up his own in-home drip line, or sitting by his side all day to hand him a glass of water to sip every 15 minutes. We’ve been dealing with low morning blood pressures since January, at least, but it seems, now, to be affecting him more. Sitting in his hospital room, waiting for the hospital doc to show up, I’m starting to wonder if we need to get someone in every morning – not just his twice-a-week shower days – to help him through the getting-up process. I do the math – $25-$30/visit, times 7 days a week, and we’re looking at $800/month. Sure, it’s cheaper than a nursing home, but an extra 10 grand a year does have a financial impact. We could go the drain-the-assets Medicaid nursing home approach, but I’m pretty sure he’d misery himself to death in that environment in pretty short order.
My mind feels both resigned and spinning at the same time. Two weeks between this admission and the last. Three weeks between that admission and his week-and-a-half stint in the rehab center. Three weeks between that rehab-center stay and his previous hospital/rehab-center round. Maybe another med shift could help – the hospital doc suggests moving to only one Flomax a day could help the blood pressure, but then he may not pee as easily, or have to get up and down more often, which both pose their own risks. This isn’t a maintainable pattern, but I don’t know how to break it without breaking his health, my heart, or both at the same time.