Preoccupied

My Role as Caretaker

I haven't blogged for several days.  It's not my own stinky health (which remains as stinky as always) that is the reason for my silence but my mother's health.

My mother has been having bouts of dizziness, nausea and vomitting going back almost to Thanksgiving.  We were pretty sure she had had another stroke at Thanksgiving, but she has also had very sharp pain in her right side.  I think she was afraid it was a recurrance of her colon cancer, so she just decided to ignore it.  Certain foods she decided she was "allergic" to because they made her sick.  I wondered what the problem could be a few weeks ago since she kept saying she was having a headache and then vomitting, but I couldn't get her to go to the emergency room or to her doctor.

Friday night I was up most of the night with her.  I was sick myself from The Belly and a flareup of pancreatitis, but hadn't eaten anything all day so I knew it was not something we both had eaten.  I tried to get her to go to the emergency room.  The pain got better, she threw up, and then finally went to sleep.  Similar story Saturday night.  Sunday she slept until 2 in the afternoon, and then said she was having difficulty seeing.  I finally convinced her to go to the emergency room.  I did not go to the closest one because it is a very small hospital with limited imaging equipment.  I took her to one she had gone to in the past that had full laboratory and imaging equipment and full time emergency room doctors.

We arrived at the ER and were quickly sent to triage.  Her blood pressure was extremely high.  She appeared dehydrated (not surprising since I could not get her to drink any liquids for two days) so the nurses immediately put in an IV start kit and drew blood for tests.  The doctor saw her within 15 minutes of our arrival, did a physical exam, ordered a bolus of IV fluids, and a gallbladder ultrasound.  My mother was extremely tender in the gallbladder region and the nausea and pain had been starting withing 20 minutes of eating.

Her blood pressure and her heart rate dropped during administration of the fluids and she said her vision improved so I am sure dehydration was causing these symptoms.  Within an hour of having the gallbladder ultrasound done her doctor came back in and said she had a couple of problems that needed to be taken care of:  her gallbladder was full of stones and showed signs of inflammation so it needed to be removed, and she had a medium sized aortic aneurysm that might need to be looked at by a surgeon.  He told us he was going to admit her and had talked to a surgeon (whom I knew to be a good general surgeon) and he would come to my mother's room and talk with her the next morning.  The doc then left the room.

My mother started getting agitated.  Her blood pressure monitor alarm started going off again.  She kept saying (like a little kid) "I want to go home to my own bed!".  The more people tried to talk to her about how serious this was the more stubborn she got, the more agitated she became, the more paranoid she was, the more hateful she spoke, and the higher her blood pressure went.  I talked with her, three different nurses talked with her, the ER doc talked with her twice.  She insisted on leaving against medical advice, but the problem I had was that I don't think she even realized what the medical advice really was!

She accused me of conspiring with the nurses to put her "in the number 2" which is the old state mental hospital number two which has been closed for about 20 years.  She said I needed to be made inpatient because I needed the surgery not her.  She said the doctor was making all the results up.  She said she never saw a doctor.  She said a doctor told her once never to have surgery ever ever again.   She insisted on leaving.

She refused to sign the AMA paperwork because they "wrote" on it, although she couldn't read what was written, understand what was written, nor could she repeat it when it was read to her.  She said I had called ahead and arranged a room because they put an IV in her when she was triaged.  AUUUUGH!!  The doctor told her she could die from these problems, but I don't know if she ever understood what he told her.  The staff was all so nice and tried to get her to stay, but she was so upset she was shaking.  They finally just witnessed that she had had all her options explained to her, and I took her home.

I was flabbergasted.  My mother had been like this when I brought her home from the hospital after her surgery for colon cancer several years ago.  She had difficulties with anesthesia and ended up in ICU for a couple of days needing assistance to breathe.  She never really reconnected with reality until after she got home a few weeks, which was about a month and a half later.  This is more common than most people know, it is called ICU pychosis. It is a temporary break with reality brought on by ill health, tons of medications, drastic interventions like ventilator machines, and a disconnect from everything you know.  My mother most certainly had a small stroke at the same time, which I believe heightened the effect.  I just never thought about her doing this again!!!

I got Mom home, where my bothers and sister were also upset because she had refused treatment.  I said I just didn't know what else to do, the only other thing would have been to leave her there and I just didn't have the heart to do it, even with her accusing me of strange things.  I hoped getting her back in a familiar environment might get her calmed down and her blood pressure better.  I found out that she had not taken her blood pressure medication for at least the last couple of days - probably due to nausea - but hadn't told anyone.  I am monitoring her pill minder now, she has never missed doses like this before.

She slept most of the next day, but agreed to go see her PCP (the same as mine) who is a very nice young doctor on Tuesday.  I told her that he could read the tests and give her a second opinion (or first opinion in her mind because she said she never saw a doctor) about whether or not surgery was necessary.  Being in familiar surroundings did help, and getting her back on schedule with her blood pressure medication also was a good help.

We went Tuesday to the PCP.  Her gallbladder ultrasound must not have been very good, as he got her in to see a surgeon today (Wednesday) and the surgeon said it has to come out.  My mother is very passive and not agitated at all about having it out now.  Next Thursday the gallbladder will hopefully go bye bye without any scary complications.  She sees a vascular surgeon at the end of the month, as apparently the gallbladder was scarier than the aneursym so needed to be taken care of first. 

My mom complained today about having to see all these doctors and all the trips (since she has to go in for preoperative testing).  I told her if she had gone into the hospital Sunday, she maybe would have been home without a gallbladder already but now we had to go about it this way.  I am hoping she will not do the mental "disconnect" again when going in for surgery and presurgery testing.  She is oriented to time and place now, so hoping she will remain this way.  Maybe they will give her something to keep her calm?   Sigh.  Concentrating on keeping her well until then.  Getting old is not fun.

Friday is the deadline for this month's blog carnival for Headaches and Migraine Disease.  I have mine three quarters written, and need to get it posted!!!  Looking forward to reading everyone's entries!