General Update #103

Dusty attempted to call Aspen Park nursing staff for an update on Joyce's condition around 11:08 a.m. (8/5/20). No one available to speak at time of phone call. Dusty's contact information and message taken by front desk staff. Nursing staff will be directed to follow up once available.

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Dusty received call from Sue at Aspen Park around 12:54 p.m. (8/5/20).
She was going through all of their resident's files and confirming COVID-19 safety protocols and patient/family decisions for COVID-19 treatment should facility's population become contaminated. 

Sue confirmed and reiterated that there were no active COVID-19 cases within the Aspen Park facility at the moment, nor concerns over exposure or introduction of the virus to staff or residents, and that this was merely a confirmation of existing information about Joyce.

Joyce is listed as "yes" for CPR.

Joyce is listed as "yes" for aggressive intervention (ICU) and ventilator use if available.

Joyce is listed for treatment on-site at Aspen Park (versus being sent to a hospital emergency room) - this means that Joyce would be treated for COVID-19 symptoms but as Aspen Park does not have on-site ventilators in their inventory Joyce would not receive access to one while being treated on-site. This "treatment on-site at Aspen Park" can be switched to "sent to hospital emergency room" for COVID-19 treatment at anytime should Joyce's family decide to make that change.

Sue commented that Aspen Park is reviewing and preparing plans for all residents so they can undertake immediate action on their safety protocols based on patient directives. She stated that Gritman has limited ventilators in their inventory (3, non-emergency room units, to Sue's knowledge) and should there be a surge of COVID-19 infections in the area that require ventilation care there may not be enough available to treat all cases. Dusty confirmed he was aware of this and that he understood the implications for Joyce should the virus move through the facility's resident population. Sue reaffirmed that Aspen Park's COVID-19 safety protocols have proven effective so far in preventing community spread of COVID-19 into their population. 

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Joyce's day nurse, Maggie, returned Dusty's phone call from 11 a.m.

Joyce is not agitated today, but is still tired and experiencing confusion. Joyce was reported to still be hallucinating from time to time. She was able to perform some work with occupational therapy and speech/cognitive therapy today. Both OT and CT teams reported that Joyce was unsteady, had increased confusion, and had to work at processing conversation/interrogatives, and time delays overall in interactions with her. Joyce also has standby assist from Aspen Park staff for bathroom use (though she continues to be continent). 

Joyce reported throat pain to Aspen Park staff, which was investigated. White spots on Joyce's tongue and tonsils discovered. Aspen Park team suspecting thrush (Candida fungal infection) or strep bacterial infection. Testing is underway to determine. Aspen Park staff is suspecting thrush.

Maggie reported that the urine culture completed and came back negative for a urinary tract infection with no signs of sepsis present. No bacteria or red blood cells present in sample collected and so nothing to grow. Dusty asked for clarification as yesterday it was believed Joyce had a urinary tract infection. Clarification was that it was suspected Joyce had UTI due to previous indicators and treatment of first UTI at Aspen Park and initial signs from urinalysis (UA) but end of culture growth did not produce any signs of a bacterial infection to be treated.

Dr. Collins was updated by Aspen Park staff on outcome of Joyce's UA and negative result for bacterial infection/UTI. Dr. Collins proposed the hallucinations could be simply dementia related but Aspen Park staff commented that previous treatment for UTI cleared up the hallucinations and so rejected the theory that the hallucinations were simply dementia related. There is potential that Joyce's cancer (if present) may be causing the change in overall health and mental state as her body's immune system may be fighting that? Unknown. Aspen Park team continuing to investigate causes of change in Joyce's baseline of health with Dr. Collins.

Maggie stated that Dusty would be kept updated as more information is made available. 

Maggie asked if Dusty had spoken with Joyce recently and Dusty confessed he had not been calling Joyce direct since Sunday evening as most reports received from Aspen Park staff since then indicated that she was drowsy or non-coherent and he thought he might only agitate or upset her by calling. Dusty confirmed he will try calling Joyce on his walk home after his shift at work concludes. 

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