Gritman ER Visit - Sunday April 11, 2021

 These entries will be a bit odd as I (Jess) will be transcribing text messages from Dusty of the events as they happened and he had time to reach out to myself and the family. I will have him come back and edit/add more when he can. 

9:46 a.m. Dusty: Ambulance summoned following Joyce abruptly announcing she thinks she was dying, reported trouble breathing, and had severe chest pain, they are taking Joyce to ER. 

9:48 a.m. Connie: Are they going to Moscow or Pullman?

9:54 a.m. Dusty: Moscow to start with. I am heading to ER now.

10:10 a.m. Dusty: On-site at Gritman, they are still getting Joyce admitted and checked. I'm in the ER waiting room and will get access to her when they come get me. 

10:37 a.m. Dusty: In ER with Joyce, waiting for doc to update on Joyce. BP 150/68    Pulse 93.

10:43 a.m. Dusty: Nurse Kim reported doc is now reviewing PRH records that just arrived are "working backward." Kim said there are "notable EKG changes"

10:51 a.m. Dusty: Nitro pill to be administered. Blood samples taken for lab work by Kim. Joyce confused about why she is in ER again. 

11:33 a.m. Dusty: BP 109/60    Pulse 95    O2 @ 86%, O2 flow rate increased to 4 liters.

11:46 a.m. Dusty: BP 119/62    Pulse 95

11:47 a.m. Dusty: Still waiting on doc and lab results.

12:09 p.m. Dusty: Dr. Howe stopped in, says right now it does not look like a heart attack but possibly something wrong with her heart (not enough blood flow occurring due to something else, to be determined). Still working through the data PRH sent over and comparing to test results taken today. Low blood oxygen levels still a concern. 

12:10 p.m. Dusty: Dr. Howe departed after confirming Joyce's calcium levels appear normal so no indicators of heart damage, will be back once more news is available. 

12:16 p.m. Dusty: BP 119/61    Pulse 75    O2 @ 94%

12:18 p.m. Dusty: Joyce currently napping off and on. 

12:31 p.m. Dusty: BP 121/61    Pulse 75    O2 @ 95%

12:47 p.m. Dusty: BP 107/79    Pulse 76    O2 @ 94%

12:59 p.m. Dusty: Dr. Howe arrived, spoke with Craig via Dusty's cellphone.

1:01 p.m. Dusty: Dr. Howe following up with PRH's cardiology department to determine their decisions about not exploring/pursuing further on Joyce's heart situation (like doing a heart catheter/stent)

1:06 p.m. Dusty: BP 107/70    Pulse 86    O2 @ 93%     Joyce reporting chest feels "hurty"

1:08 p.m. Dusty: Joyce reports eyes work better (didn't previously report vision trouble, at least to Dusty)

1:13 p.m. Dusty to Jess: She just wants to hold my hand. 


1:17 p.m. Dusty: BP 115/62    Pulse 74    O2 @ 94%

1:46 p.m. Dusty: BP 122/63    Pulse 76    O2 @ 94%

2:16 p.m. Dusty: BP 118/71    Pulse 80    O2 2 93%

2:26 p.m. Dusty: Dr. Howe arrived, Joyce will be admitted to Gritman. Spoke with PRH cardiologist and Dr. Greheb, they felt it was a blood pressure issue as symptoms in Joyce alleviated when treated for that. Gritman will put her through a stress test tomorrow and try to get better idea about the heart. Might need to pursue potential to do a "heart cath" if the treatments and tests they do tonight/ tomorrow lead to that as needing to be done. 

2:27 p.m. Dusty: Other Gritman doctor will follow up with Dusty on tests and treatment plans to be done once Joyce is in a Gritman room. 

2:30 p.m. Dusty: Dusty called and updated Craig.

2:31 p.m. Dusty: BP 134/67    Pulse 83    O2 @ 94%

2:33 p.m. Dusty: "I sure would like to be home at the farmhouse," said Joyce. Joyce asked if she was in Gritman and Dusty confirmed that to be correct. (Joyce had read it off some signage instead of knowing it)

2:34 p.m. Dusty: Tech arrived to draw additional blood samples.

2:35 p.m. Dusty: Dr. Howe arrived to confirm Joyce does not have a DNR order. Dusty confirmed no DNR on Joyce. Process initiated to move Joyce into a room upstairs. 

2:39 p.m. Dusty: Joyce spotted her clothes where the ambulance team deposited them on the counter and begins negotiating with Dusty for them to be given to her so she can leave for home. 

3:08 p.m. Dusty: Joyce became emotionally upset when the nurse's aides took her shoes and put her clothes in the plastic possessions bag for transport. Dusty calmed her. Joyce does not know where she is (without reading signage) or why she is here. Joyce is grasping the hospital bedrail and informing Dusty "they can't take everything from me, I have this rod!"

3:09 p.m. Dusty: Dusty was informed by the nurse that hospital visitation rules are 1 person per day, once that person leaves, they can not return till the next day. Waiting in the ER for transit to room upstairs. 

3:10 p.m. Dusty: "If they take me away from you, try to find me again," said Joyce.

3:14 p.m. Dusty: BP 141/69    Pulse 86    O2 @ 94%

3:17 p.m. Dusty: Joyce administered Covid-19 test.

3:34 p.m. Dusty: Joyce admitted to room 203, Don (CNA for this ward) in to collect vitals.

3:38 p.m. Dusty: BP 134/72     Pulse 83    Temp. 98.4    O2 flow rate set to 4 liters.

3:40 p.m. Dusty: Respiratory tech (Terri) came in to review Joyce's O2 use history, possible COPD, treatment over at PRH. 

3:51 p.m. Dusty to Jess: She is trying very hard to not yank out the sensor wires again. 

3:52 p.m. Jess to Dusty: Go Mom! The longer she keeps them on the faster she will get out. 

3:52 p.m. Dusty to Jess: Joyce self restricted herself from pulling at them actually. 

4:03 p.m. Dusty: Jill (nurse) reviewed what brought Joyce to ER today, why O2 level was different at home compared to PRH (2liter vs 4 liter flow rate), etc.

4:25 p.m. Dusty: Jill spoke with Craig via Dusty's cellphone and confirmed if it is a heart attack all reasonable procedures would be undertaken (life flight to Sacred Heart or Kootenai) and stent insertion attempted. 

4:26 p.m. Dusty: Room service took Joyce's dinner order and should bring it up around 5pm, Joyce realized she was hungry.

5:19 p.m. Dusty: Dr. Standley arrived to perform physical check on Joyce. Protein tests from today showed no damage to heart. Plan is to do an EKG tonight and stress test tomorrow. Possibly discharge Joyce tomorrow afternoon after stress test results reviewed by specialist at Kootenai.

5:20 p.m. Dusty: Joyce reporting tenderness in belly area, pain in legs when touched (some swelling).

5:29 p.m. Dusty: 2 liters O2     Blood Glucose @ 177

5:39 p.m. Dusty: Joyce setup in room's recliner to eat dinner (mac & cheese, Mashed potatoes with gravy, and applesauce)

6:41 p.m. Jess: Dusty's phone battery draining. I will transcribe and send out updates once he arrives home. 

6:45 p.m. Nightshift (Lucy) arrived to collect vitals. Remembered Joyce from June 2020  visit. Confirmed Joyce's sleeping preferences. BP 140/61     Pulse 88     Oxygen @ 94%     Temp 99.4F BP and slightly high. 11p.m. and 3a.m. next vitals check. Joyce weighed 155.2lbs taken by Jill at check in. Adam is Charge nurse tonight. Virginia Nurse and Lucy the Aide. Dusty "Good thing you like water." "It's better than beer." Joyce replied.

7:00 p.m. Virginia (nurse) arrived. Concerned with Joyce's elevated temp. Spirometer work with Joyce. Joyce unable to get disc to rise. Toileting, walking, balance, etc. reviewed. Insulin/metformin. They plan to control with sliding scale insulin while at Gritman. Temporary walker brought in. (Dusty bringing in Joyce's tomorrow) Reviewed "observation" plan. 

7:15 p.m. "What did I do to get here?"  Dusty went over the days events for her.

7:19 p.m. Bathroom. Urinary incontinence. Early bladder release. New diaper. Floor and recliner cleaned. Diaper weighed for output. 

8:45 p.m. Bathroom. Urinary incontinence.

8:50 p.m. Lucy arrived to check blood glucose and finished toileting Joyce. BGL @ 289

9:00 p.m. Lab tech - Blood draw for tests. Oxygen @ 93%    Pulse 82

9:20 p.m. Dusty helped Lucy tuck in Joyce and headed to farm to pick up mess left from sudden departure. 

10:00 p.m. Dusty sanitized Joyce's shoes, packed clean clothes and her wheelchair into Subaru. Cleaned up kitchen. Closed  up farmhouse. 


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