Geriatric Care Manager: K. Paggi

Just When You Thought There Was No One to Help…Part 2 of 2

February 11th, 2008
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Beer Bottle

Recently, I wrote about a client of mine whose health was in decline. Read Just When You Thought There Was No One to Help...Part 1 of 2.

Hank moved into a permanent room on the nursing floor. The nurses there noticed that the wound on his arm was not healing and recommended that he go to a wound care clinic. In turn, the wound clinic sent him to a surgeon. The surgeon recognized that this was on the site where an artery had been taken to repair his heart. Somehow, the site had re-opened. It required two surgeries and frequent trips to wound therapy for it to heal. By the end of the summer, his arm was healed and he had the full use of his hand and fingers.

The facility van took Hank to the wound clinic because he was too weak to transfer into a passenger car. It was a big day in mid-July when Hank was finally able to get into my car. We celebrated by going to Sonic for a hamburger and a malt—his first meal outside of a facility in more than 6 months.

At my insistence Hank enrolled in daily physical therapy and occupational therapy. The OT taught him how to transfer from bed to wheelchair, and to dress, tie his shoes, and brush his teeth in a wheelchair. PT helped him relearn to stand and walk. Before he could begin walking I had a podiatrist look at his toes and feet. His toenails had not been cut since his heart attack; they curled around the ends of his toes. His feet were distorted with hammer toes, and were painful due to arthritis. But he could walk. By the end of the summer Hank could walk a complete circuit of the facility, using a walker and with an aide on both sides.

I gave him a pile of change and showed him the vending machines. Photographs and framed memorabilia covered the walls of his room. I asked the activity director to encourage him to play bingo and poker, participate in trivia and attend live music events. His cognition was much improved, and we had some good talks about his former business, the home computers that he networked, and his cars. Once I understood how drastically his life had changed on that fateful day in December, it was easier to understand the bouts of temper. Every time he had another urinary tract infection, he became moody and angry and confused.

Arlene and I had decided that I would be the primary contact for the nursing home. She had her own company and was often out of town, and she also managed Hank’s financial affairs. I was in frequent contact with the doctor at the nursing home, and with Hank’s daily companion. The facility staff called me frequently with behavioral issues. Out of boredom more than anything else, Hank often refused to take his medications, which threw the aides into a tizzy. Hank had frequent urinary tract infections, due to the permanent catheter, and was hospitalized several times. Each time I met him at the ER and stayed with him until he was returned to the nursing home or admitted to the hospital. By November he had developed two strains of antibiotic-resistant bacteria.

In August I arranged for Hank to have an appointment with a urologist to see if the catheter could be removed and his bladder retrained so he could toilet normally. Hank’s enlarged prostate was blocking his ability to void normally, but he was not a surgical candidate due to his other medical conditions. The urologist’s opinion was that removing the catheter would most likely lead to falls as Hank tried to get to the toilet (he still could not walk without assistance), and ultimately the falls would do more damage than leaving the catheter in place.

In September I arranged an appointment with a cardiologist. He had not seen a heart doctor since his bypass surgery. He had so many other problems that there was no time to work on any problem that was not causing major symptoms. The heart doctor found Hank’s heart to be in relatively good condition, and recommended an annual cardiac checkup.

During the fall Hank began to complain of back pain that was too severe for him to walk with the therapists. X-rays showed that his lower spine was grossly out of alignment and he had severe degenerative disease. I encouraged him to him to walk with the physical therapist when he could, to sit in a chair in his room rather than stay in bed, and leave his room during the day. I frequently visited Hank on Sundays so he would have weekend visits like most other residents. I enjoyed his spunk and his sharp wit.

In February Hank could not walk without getting out of breath. He lost another twenty pounds over the winter. He began using oxygen while he exercised, and then started using it even while he was in bed. He was treated for pneumonia with several drugs. Finally in April the doctor wanted to send him to the hospital again for tests. Hank was resistant; his experiences in hospitals had not been positive. Arlene and I argued with him for hours until he agreed.

The doctor called me after midnight the day he was admitted. He had very little urine, the blood tests showed that he had had at least one heart attack and was possibly having another, his liver was grossly enlarged, and his lungs were compromised. She did not think he would live long. True to form, when I saw Hank early the next morning, he was arguing with the aide about whether he would use oxygen. Arlene talked to Hank’s son, and they agreed on only comfort care. When the aides came to take him for another round of tests, I objected. I reminded the doctor that tests were not part of comfort care and the doctor agreed to stop them. The doctor also agreed to increase his pain medications. Hank’s arthritic back was very painful because he had been in bed for several days.

Arlene called his friends to visit him and say goodbye. Hank was alert, knew them all and was strong enough to talk with them. I left in the afternoon, and told him I would see him in the morning. Arlene stayed with him until bedtime, when the nurses sent her home. They called her shortly after she got home to tell her that Hank had died.

But that’s not the end of the story. Arlene called me to discuss funeral arrangements. I could not think of anything Hank would rather NOT do than attend a memorial service. I suggested that we allow Hank’s friends to meet him where they often had before his illness, the place where their memories of him were clearest. His memorial service was held two weeks later at his favorite bar, with drinks and appetizers on the house. His friends toasted his wit, his long and loving relationship with Arlene, and wished him a final farewell.

I miss him.

Read Just When You Thought There Was No One to Help...Part 1 of 2

Posted in Caregiver Burnout, Caregiver Support, Essential Resources, Geriatric Care Management: Kay Paggi

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2 Responses to “Just When You Thought There Was No One to Help…Part 2 of 2”
  1. savo_73 Says:

    i just found this blog and this story. this is a wonderful tribute to a person who you can tell is very real and complicated like most of us are.

  2. Kay Paggi Says:

    Dear savo_73,

    As for the “real and complicated” my response is “yes, both of us were.” I think of this story as a tribute to my guy who was a fighter—and to me who equipped him for the fight.

    Kay

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