General Update #10

Room service staff returned at 12:19 p.m. to see if Joyce was feeling up for ordering lunch. Joyce indicated that she was not feeling up to eating at the moment and so only requested iced tea. Room service staff confirmed that they could start with just the tea and always bring up something later on if her appetite returned. 

Joyce napped intermittently while sitting upright in her chair, sometimes passing out mid-sentence during conversation.

Nurse stopped by to check in with Joyce at 12:30 p.m. Joyce confirmed she is still "feeling yucky" when asked how she was feeling. Joyce told nurse that she thinks she would throw up if she got up and moved around. Joyce confirmed that she likes sitting upright and that her back is still hurting. Nurse will work to find a different chair, possibly a reclining one if available.

At 12:44 p.m. a replacement chair (recliner model) was brought in by nurse's aides and Joyce was prepped to be moved to it. Joyce confirmed with nurse's aides that she still felt like she might throw up but consented to being moved to the new chair. Nurse's aides confirmed that physical therapy said Joyce stood up well when they were in earlier. Nurse's aides attempted to place gait belt around Joyce, Dusty stopped them and relayed what the physical therapy team had said about not wanting to cause injury to spinal fracture. Nurse's aides checked with physical therapy team for how to move Joyce safely without gait belt. Joyce was moved to new chair with effort and made comfortable.  Joyce declared that it was harder than she thought it would be to move chairs.

An occupational therapist arrived at 12:52 p.m. to check in with Joyce. Therapist inquired about Joyce's current pain level which at the time was about a 6 out of 10 on the scale. Joyce indicated that she had just been placed into the chair and so that might be affecting things. Therapist stated that being in the chair is better for Joyce's lungs and is the preferred position. Joyce should be sitting upright for the next few days at least. Therapist explained that she was here to help teach Joyce how to get dressed and showered without exacerbating back pains, as well as teach Joyce how to twist and go through her life's activities without causing additional pain to her back. Therapist asked about Joyce's home environment and what she does at home for activities, what the home layout is like, if there are pets in the home, if a walker is used, if Joyce has a medical alert necklace, if she lives alone, if anyone assists her to shower or dress, if she washes her own dishes, if she washes her own laundry, etc. Occupational therapist left to meet with Joyce's nurse to verify pain levels being experienced. 

The occupational therapist returned at 1:08 p.m. after conferring with Joyce's nurse and put Joyce through some movement exercises and strength tests on her arms. It was determined that Joyce's arms were very weak over all and the therapist asked if Joyce had home exercises she should have been doing from previous PT. Joyce confirmed, Dusty clarified that they were not being done as they should have been. Grip strength was tested, good overall. Minimizing reaching and bending while healing from the back injury was emphasized to Joyce. Joyce's lower legs were deemed sufficiently flexible. Joyce was asked when the last time she saw a physical therapist occurred, Joyce cannot recall, estimating 3-4 years ago. Therapist would like to recommend that Joyce sees a physical therapist, possibly enrolling in a physical therapy program as home physical therapy often does not get followed. A "Fit and Fall Proofing" class as an example would be recommended, but might not have any openings right now due to COVID-19. Joyce confirmed no falls at home during the last year when asked. Confirmed loss of balance but no falls (with exception of most recent). Therapist asked where those loss of balance moments occur and it was confirmed that there was no regularly recurring place or location that loss of balance occurs for Joyce. Confirmed no throw rugs at the farmhouse. Therapist reviewed how Joyce uses the bathroom at home and Joyce relayed that she uses the sink mounted to the wall across from the toilet to pull herself up and lower herself down. 

For her time in the hospital, the plan is to look at getting Joyce a 3-in-1 commode for use in the hospital bathroom as she begins transitioning to walking around and taking herself to the bathroom as needed. This 3-in-1 commode model is preferred and recommended by the therapist for Joyce's family to obtain for home use for Joyce so she does not use the sink for lifting and lowering herself onto the toilet. It is a little bit bigger than a standard toilet and fits around the fixture itself. It is height adjustable, has the capability of using its included bucket so it could be setup in a bedroom if Joyce doesn't have energy to make it to bathroom toilet, or it can be used in the shower to provide a safe seating option if not used for the toilet. If space in the bathroom is a concern, which Joyce expressed, a smaller unit (called a "toilet riser") is available on Amazon for ~$20 as an option that may work.

Joyce was asked by the therapist if she has considered a re-hab stay instead of returning home. It is the therapist's recommendation that a rehab stay should be considered instead of a home health option. Dana, the case worker could review options with Joyce when she comes by later today. The therapist then stated that she will come by tomorrow to teach Joyce how to get dressed so as not to exacerbate her back injury. Dusty alerted therapist that the last plan which was shared with Joyce was to discharge later today. Therapist stated that the plan she heard at 7 a.m. was not for discharge today. Joyce's nurse and caseworker Dana should be consulted to clarify as the therapist might not have been made privy to updated information regarding Joyce's discharge from Gritman. Dusty confirmed he will ask them when they come through to visit Joyce.

Nurse stopped by at 1:34 p.m. to confirm that Dr. Clinton Morgan was Joyce's oncologist.

Nurse confirmed that Joyce is not appearing well enough to be discharged today. 

Dr. Brown concurred Joyce was not fit for discharge at this time.

Lab technician arrived to take blood sample from Joyce at 1:35 p.m.

Technician encountered difficulty in getting blood drawn. Took what he could draw and might return if what he collected is not sufficient for lab work.

At 1:44 p.m. Dana arrived to discuss Joyce's condition it is apparent that she is not going to be immediately capable of being independent and is going to need help around the clock as she recovers from her injures. A plan needs to be discussed with pros and cons assessed among Joyce's family members. Dana would help with whatever direction the family decides to go through. Joyce indicated that it should be left up to the family up to a certain extent. Dana noted that Joyce's Medicare observation status will be changed to "in-patient status" (Joyce will be fully admitted into the hospital).

Dana let Joyce know that the Gritman staff is making adjustments to Joyce's pain medicines to try and alleviate the nausea and still provide adequate pain relief. Dana said that they are estimating that maybe by tomorrow the plan will need to be settled on:  

1. If someone from the family moves in with Joyce (or Joyce moves in with a family member) for 24-hour care until Joyce recovers and is able to function independently again. If this option is selected for home care then a nursing and physical therapy could be arranged to arrive once per week to check in on Joyce. Family member(s) would then provide bulk of care and assistance to Joyce as she recovers. 
2. Joyce temporarily transitions into a facility that provides 24-hour care until she can take care of herself (example, Good Samaritan or Aspen Park)
1. The traditional Medicare requirement for this process is a 3 night in patient stay at a hospital but due to COVID 19 there is now a waiver out there being used that allows patients to transfer after only 1 night in patient stay at a hospital. A referral will be made by Dana this afternoon to see if a bed is available at Good Samaritan or Aspen Park and if the COVID-19 waiver can still be used. If so, then Joyce's stay at the facility for the first 20 days would be covered by Medicare. For days 21-100 there would be an 80/20 split with Joyce's secondary insurance. If a waiver is not approved and the stay at the Good Samaritan or Aspen Park facilities is not approved, the cost would be $300/day out of pocket. Dana thinks that the waiver would be approved as Joyce has a confirmed skilled nursing and skilled rehab need and is a good candidate for return to independent living.

 Timeline for option 1 or 2 above would depend on how long Joyce takes to recuperate (potentially 2-4 weeks). Dana informed Joyce she will return later in the afternoon with information about option 2.

Jessie from the physical therapy team stopped by at 2:15 p.m. to check in, verify if Joyce was feeling up to walking. Informed Joyce he and Mark would stop by again in a few minutes to see if she is up to try walking around. 

Message(s) from Joyce:

One time Joyce's family went into Coeur d'Alene because the circus people were coming through and they arrived just in time to see the elephants unloaded from the train. "Isn't it strange that your brain can remember things like that? Those elephants are vivid in my mind!" It was the first time she had ever seen live elephants. They kept the crowds back out of safety concerns, but "that didn't matter at the time, it was so awesome to see them that it didn't matter." June didn't seem as excited about the elephants, almost like it was boring. Skip and Kathy weren't born yet at that time, so it was a long time ago that Joyce and June saw those elephants. The elephants were unloaded from train cars, but they were plain old train cars and weren't decorated, no fancy paint on them. They had bigger doors because of the size of the elephants. Joyce cannot recall the occasion, but the elephants were the stars of whatever was going on at that time in Coeur d'Alene. Vernon wasn't there, he was building roads in Dakota. Alice was the one who took them as a treat. Joyce cannot recall Alice remarking about the trip, though she does recall that she liked it. Alice wasn't one to get overly excited or enthusiastic about things.

Joyce and Phil went to see the ocean one time while she was taking graduate classes on dyslexia (the Moscow School District at the time didn't believe in it). She "had a Lincoln car and drove in Seattle, isn't that amazing?" It was hard for her to find the actual ocean, it took several attempts, as she guesses she wasn't very good at reading a map or got confused over the roads. They had lots of adventures together on those trips they would take. They also went to Pike's Place Market one time and had a good day there. It was a neat day, being at Pike's Place, a place that was prominent and important and you heard about it and finally got to experience it yourself. Phil got a kick out of the flying fish and found a comic book shop there. He had been collecting Hulk funny books at the time, and got distracted. We got a few comic books out in the cook book office that he bought there that are older versions, early editions, real treasures for him. 

Joyce had brought over a specialist from Seattle to give a lecture at the time to the school district and they still wouldn't bend to believe that it was a real thing. It was frustrating. They figured that if there was one person with it, there must be more people with it, and they were trying to work to get the school district to recognize that and get help. There was some guy who was some kind of consultant at the time for the Moscow School District and he set Joyce down and looked her straight in the eye and told her "anybody can read if they want to, if they try!" and "there is no such thing as what you are trying to put over." He was very dismissive of the idea of dyslexia being real. To him there weren't kids with disabilities struggling, there were kids who were in his opinion just not focusing, goofing off, or such. Joyce doesn't know what happened to that consultant but wonders if he ever changed his views as more research came to light. Loyal was very active and supportive in trying to get people to become educated about it. He paid for people to come and give talks (covering travel expenses and speaker fees) and teach community members to see dyslexia was real. At the time Joyce and Loyal couldn't get enough arousal from the Moscow community to get behind the dyslexia is real movement they were trying to get before the school district. If they had tried it in today's world maybe things would have turned out differently and it would have been taken more seriously? Joyce still has the paperwork and background research on dyslexia down in the cookbook office that she and Loyal gathered. Why the school district wanted to listen to that guy, instead of people with research will probably never be known. 

Current location:

Gritman Medical Center, Room 226.

Current pain level:
3-4  on a scale of 1-10 at 2:14 p.m.

Visiting information:

No change from previous.

Confirmed with nurse's station shift leader at 8:54 a.m. - currently only 1 visitor per day for Joyce, no exceptions. Once current visitor departs Joyce's room, no further visits for the rest of the day. No swapping out visitors (example, Dusty cannot remain on hospital grounds while Craig goes to sit with Joyce for an hour and then Dusty returns to room).