Sunday, March 31, 2013

Infections, Pain Management and Bad Nurses


It happened again.

About two weeks ago, Leslie started complaining about a sore ankle. It wasn’t horribly sore, just sore enough to be a nuisance.  That was Tuesday and Wednesday, week before last.  Friday morning she woke up and it had begun to swell, really swell.

Oh boy.

We’d been through this before.  It was about three weeks before my weight loss surgery last July.  I was worried then because her recovery took a long time, and my surgery was coming up quickly. But then, oral antibiotics did the trick, and this time they didn’t.

That Friday afternoon, a week ago last Friday, Leslie went to her ortho doctor, who confirmed it was a bacterial infection. He gave her Keflex, an antibiotic that targets bacteria specifically. All weekend Leslie was in excruciating pain. She kept the foot up and iced it, but as the weekend pressed on, her foot got worse, and so did the pain.

On Monday, the doctor gave Leslie a different antibiotic, this time Septra DS, with an order to halt the other one.  We had high hopes for success, but Tuesday morning, upon waking, the foot had gotten worse, and the infection was spreading. She had a doctor’s appointment that morning. Exercising good judgment, we went straight to the emergency room at Mills Peninsula in Millbrae.

It wasn’t busy that morning, and we didn’t have to wait long. The emergency doctor took one look at Leslie’s foot, announced they’d have to admit her, and started her on IV antibiotics right away. They took blood, and filled up six culture jars. They also took an x-ray to be sure nothing was broken. Despite the way it looked to be spreading, the doctor seemed confident it wasn’t in her joints, which would have been very, very bad. It wasn’t in her blood either, which was even better.  Still, it was Tuesday, and she’d be in the hospital until at least Friday.

I stayed with Leslie for the next few hours, as she got settled in her room and answered a million questions more than once.  They finally got her pain under control. There was a new nurse’s assistant there, a student, and he was a nervous wreck. When he went to move Leslie’s bad foot like it was a bowling ball, I asked that he not return.  He didn’t.

The next four days were about going back and forth between Millbrae and Pacifica, being there for Leslie, gathering up Elizabeth when it was time, cooking, and then fitting in my part-time hours at the art center. I’m so glad my boss is flexible and understanding. I rarely drive, so it was exhausting.  Being on the busy freeway was utterly nerve-wracking. I was running on nervous energy Tuesday and Wednesday, but I crashed on Thursday.  Friday, Leslie was to return home.

Leslie was having a less than wonderful time in the hospital. There’s always a new nurse to deal with, and some are better than others. For the most part they’re good, compassionate, and willing to go the extra mile. The bad ones are terrible. Leslie had one such bad nurse. She didn’t read anything in Leslie's computer file, screwed up medication, and then got super bitchy about it when Leslie corrected her. Then, she got paranoid when Leslie got stern with her.  Apparently, she was worried about being reported, and rather than help Leslie and redeem herself, she avoided her completely. They're all worried about being reported. Also, it occurs to me that perhaps the bad nurse thought Leslie was just another infirm old person (big, big mistake), and it made me feel bad for seniors that are infirm and hospitalized. What bad behaviors must they tolerate when they’re sick and confused?  The hospital bed was uncomfortable, the pain was hard to control, and Leslie hates to be alone. No one was there to fix the pillows under her leg the way she wanted it or to make a dinner she’d really like (although to my credit, my cooking isn’t half bad nowadays).  What’s worse, guarding her foot put incredible strain on the rest of her body, aggravating both the osteo arthritis and the fibromyalgia.

On Thursday, there was talk about whether Leslie could return home and be safe. The words “skilled nursing facility” or SNF (pronounced “sniff”) were kicked around. This made Leslie blanch. There was no need for a SNF, but still the mere mention was scary. Leslie’s mother had spent time in a SNF when she had cancer.  It was affiliated with CPMC in San Francisco, and for whatever reason, it was a dump.  We ended up pulling her out, of course. I know this was running through Leslie’s mind. That and how easy it is to be taken down by a completely random and arbitrary bacteria. Without the right support, someone to help you at home and run defense for you in the hospital, something like that can turn a robust 60 year old into a frail citizen overnight.  So, that Friday, the day Leslie was to come home, a physical therapist paid her a visit to assess how capable she was physically. She brought a small flight of stairs with her.  Leslie climbed up and down those stairs, despite the sweat and the pain, and got a green light to come home.

In Leslie's absence, the house felt really weird.  The dogs were out of sorts. Daizy seemed concerned but knew Leslie’s voice on the phone when she heard it. In fact, before the hospital, Daizy was extremely attentive to Leslie, particularly when she was in pain. Teddy was a nervous wreck. He’s very attached to Leslie. Any time of day or night, if the house got too loud, Teddy escaped immediately upstairs. Elizabeth is a real trooper, and was strong through the entire event. But little things, words and actions, revealed her worry and the way she felt. Such is the way of kids. Being busy with school and rehearsals was good.  I couldn't paint at all in Leslie’s absence. I was too distracted.

Leslie’s foot is getting better every day, but each night the pain gets very bad.  She climbed a full flight of stairs Friday night to sleep in her own bed, and it was work for sure.  

Trust me. The next time it looks like this is happening, if there is a next time, we won’t waste a moment with doctors or oral antibiotics.

Yesterday on Saturday, we all slept in until noon, which is unheard of for Leslie and I.  Elizabeth woke up with a sore throat, so skipped rehearsal.  My work as Florence Nightingale continues.

We needed the time together, all three of us.  No.  All five of us. 

We really needed it.

Read about the first time this happened to Leslie almost a year ago right here.


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