General Update #105

Maggie (nurse) called Dusty around 2:02 p.m. (8/6/20) to provide an update.

Maggie has been in direct contact with Joyce's primary care physician, Dr. Collins, about Joyce today. Aspen Park team still suspecting a urinary tract infection may be affecting Joyce's health. A new urinalysis (UA) is being conducted, with urine having been collected from Joyce via catheter (catheter was inserted, urine collected, and catheter removed) today. The UA has been sent to Aspen Park's lab and the culture is being grown. More information to be provided when available. Joyce was started on a general antibiotic treatment per direction from Dr. Collins in the meantime. 

More tests will be run if UA comes back negative for UTI. Dusty will be kept updated on Joyce's condition.

Joyce is still complaining of throat discomfort, mainly when swallowing. Joyce states to Maggie that her mouth is sore but as Joyce is difficult to understand or get clear information out of at times it is difficult to know if Joyce is meaning she has a sore throat or if she is meaning she has a canker sore where her dentures go. 

Staff has difficulty in interpreting what Joyce provides for information on her pain and discomfort levels. Dusty was asked to call Joyce and see if he can deduce any information as to Joyce's pain levels, pain locations, etc. as the Aspen Park staff think that Joyce might be more descriptive in speaking with Dusty, he might get her to open up more about what she is experiencing/feeling to Dusty, or that Dusty might be able to interpret Joyce's vague responses.

Joyce seems more alert today. She is ambulating and standing well, and eating her meals.

Joyce refused her dinner last night at dinner time. 

No therapy has been logged for Joyce at this point according to the charts, which means that either therapy was cancelled for Joyce, the therapy teams haven't gotten around to working with Joyce yet, or they haven't entered their logs for their sessions with Joyce at this point in the day.

Maggie asked Joyce about her hallucinations and if she was still experiencing them. Joyce was resistant to discuss them with Maggie, apparently concerned that she would be "labelled" by the doctors. Joyce seems to have taken on an air of suspicion toward questions she is being asked by Aspen Park nursing staff today but was "redirect-able." Maggie hopes that Joyce might respond more favorably to Dusty (with less suspicion about hallucination questions) and that he can then in turn provide insight to Maggie. Dusty said he would attempt to get information out of Joyce.

Maggie will be onsite today until 4 p.m. and then return at 6 a.m. tomorrow. Dusty will follow up with any information he can get out of Joyce to provide to Maggie 

---

Dusty attempted to call Joyce's room phone at 2:22 p.m. (8/6/20) but no answer.

---

Dusty managed to contact Joyce at ~4:33 p.m. (8/6/20).

Joyce was very alert, talkative, and cognizant during the conversation if a little slow to respond as she processed questions or worked to provide answers.

Joyce confirmed that her throat and mouth were sore but immediately stated that they had her on medication to deal with that issue. She enthusiastically stated that she "felt great and wonderful" at several points in the opening of the conversation and asked if the Aspen Park team had asked Dusty to check on her. Dusty confirmed they had asked him to ask her and she accepted they were worried about her condition. Joyce had to be asked a few times about where her pain levels were (on a scale of one to ten) as she frequently went back to "feel great" and "feel wonderful" and different iterations of this mantra. Dusty joked if she had been coaching herself to respond with those statements and they had a laugh. Joyce finally reported her pain levels to be around a 2.

Joyce asked Dusty if she was being discharged to some place. Dusty asked for clarification as to what Joyce meant. Joyce indicated that there was a board in her room that stated that Joyce would be transitioning out of Aspen Park on August 6. Dusty clarified that today was supposed to have been her discharge date to return home, but the potential UTI delayed that, and the staff most likely forgot to update the information on the board that Joyce was seeing. Joyce was thankful for the information clarification from Dusty and agreed that the staff most likely had forgotten to update the board. She did not recall she was supposed to have gone home today and did not express any sadness that it had not occurred. Later in the conversation she did comment that it was "too bad I keep getting these infections or I could have been at home today." 

Joyce stated that she knows she is being treated for an infection and that she is receiving orally administered antibiotics which were started today. Dusty praised her for sharing that information (and being able to recall it). Joyce stated that they collected "samples" from her today.

Joyce reported that she is experiencing no pain in her back or ribs from her fall in June and that she has no difficulty in standing up to her walker, and is not screaming in pain. Joyce commented that she thinks the Aspen Park people would kick her out if she were 100% good and fine (because she would be taking up space and resources others would need).

Dusty asked Joyce about her hallucinations and she became embarrassed, stating "that's going statewide!" Joyce is concerned that the staff brings that up too much and has "tattled" on her to the family. Dusty backtracked and attempted a different approach to discuss the matter, soothing Joyce's feelings. Joyce is aware that people are focusing on the hallucinations for some reason as she is being questioned often about them and so Joyce feels she has been labelled unfairly and thus people's views of her will change - concerned over a bias developing that people will now think everything she says or does is questionable, or that she isn't able to be independent anymore because the hallucinations will always be referenced as a sign she is going senile. She fears that they are going to define her now for the healthcare workers and the family. Dusty assured her that the concern and constant asking about the hallucinations is more because of their link to potential UTI and that they are a sign being used for reference and not personal judgement. Joyce, mollified, admitted that she did have hallucinations but is no longer experiencing them anymore. As the hallucinations have now ceased, she is aware they occurred, and has clarity about them, Joyce feels like they are nothing peculiar and should now be dismissed instead of brought up constantly. 

Dusty changed topics to discuss his COVID-19 testing this morning and how he can now empathize with Joyce and Jess over the discomfort of the deep nasal swab (as they both have had to endure that testing method previously). Joyce did not recall being tested either at Gritman or at Aspen Park for COVID-19. Joyce asked about Jess and how she was getting along with work, requested a status update on Craig, and what was new with Dusty. Dusty shared a brief review about his life since he last spoke with Joyce (productively) last Saturday, information about the conclusion of his psychotherapy sessions, and updates about the Scouting program from the training he has been participating in during the evening hours.

Dusty asked Joyce if anyone had called her recently to check in and she stated that no one had called her that she could recall.

Dusty reviewed Sunday's conversations with Joyce and she laughed about it, all of the details, apologizing for her behavior. She was unaware that anything "out of the ordinary" had gone on with her on Sunday or Monday. She didn't have any memory of those dates or things said.

Dusty asked if Joyce had seen the news about Oveta Franklin's passing and Joyce confirmed that she had and was sad about it. Joyce happened to have access to a copy of the Moscow-Pullman Daily News and saw the obituary notice.

Joyce had located the pencil and paper the staff had provided her last month (in the drawer where she previously thought it might be stored but never went to retrieve) and is making plans to write out her lists (of things she wants to bake, or make, or see, or eat as a celebration meal) when she gets home to the farmhouse. She confirmed making pies and a half batch of the Christmas rolls should be done, just to ensure the knowledge is passed on. She promised she would stop sabotaging the efforts of Dusty and Jess to document and preserve her recipes. Dusty and Joyce had a good laugh about this.

Joyce did not remember that there was a rainstorm earlier this morning when Dusty asked if she was awake to witness it but she took to the suggestion that she might've been sleeping in or working with staff at the time.

Joyce reported that she hadn't had any therapy work today but she offered that could be because they "were doing so many tests through the day" with her. Dusty concurred that was most likely.

Joyce commented that she "feels like she belongs" to Dusty. When asked to explain, she stated that she looks at her walker and sees her name written all over it, and it is purple, and it is her, and it gives her comfort to know it is hers and that it is her stuff. She "likes seeing her stuff."

Joyce ended the phone call somewhat abruptly around 4:56 p.m.