kitchen table math, the sequel: how I spent my summer vacation

Monday, August 31, 2009

how I spent my summer vacation

Yesterday my mom transferred to the nursing home for rehab. Amazing.

Turns out she did break her pelvis after all; she broke it twice, in fact. Two fractures finally showed up on a bone scan.*

The fractures were the least of her problems, though. We've had two harrowing weeks dealing with spikes in potassium, drops in kidney function, tachycardia, bradycardia, "afib," elevated white blood cells (2 episodes), an unexplained bout of extreme abdominal pain, and a memorable episode of apparent heart failure.

All this along with extreme pain, which my mom rated '9' on a scale of 1 to 10 when someone finally asked. The pain prevented my mom from sitting up, standing, or walking, all of which she critically needed to do.

And now she's in rehab.

* When my mom's primary care physician called to report the results, he said, "Sometimes the primary care physician is right."


Catherine Johnson said...

If I ever get a full night's sleep again, I'll tell you all about Soap Doc.

Anonymous said...

Is she nearby?

I have a friend who works at one out west in Elk Grove Village.

Wow. How did they manage to miss a fracture during all that time?


ElizabethB said...

It sounds like there way no vacation in your vacation.

I'm glad she's doing better. Her primary care physician sounds like a good guy, and funny.

Catherine Johnson said...

Susan - she's at Alden Estates. Same place she stayed the last time.

The fracture misdiagnosis is interesting.

The test that finally showed two fractures is a "nuclear"-something or other, which doesn't show a fracture the way I think of tests showing fractures, but instead shows areas of high metabolic activity, which is then presumed to indicate an injury the body is trying to repair.

However, the diagnosis of fractures by this means apparently isn't 'absolute' or cut-and-dried the way a diagnosis by means of X-ray is.

At least, this is what the medical student (aka "Soap Doc," so named for his fantastic level of handsomeness) explained to us one afternoon.

otoh, Soap Doc knows everything about textbook medicine - the nurse said he was the most knowledgeable medical student she'd ever seen - but almost nothing about clinical medicine (which isn't a criticism: that is what he is gaining there in a teaching hospital).

Apparently there was a disagreement between the big-gun doctors (hospital radiologists &, I think, the cardiologist) and the primary care physician, and Soap Doc appeared to be under the sway of the hospital team. It was Soap Doc, in fact, who first told me, flat out, "Your mother doesn't have a pelvic fracture." This was after we'd gone back and forth for days, and I had accepted that she did have a fracture. (My mom kept insisting she didn't, while her primary care physician said she did.)

My point is: I imagine a good medical textbook may say that a nuclear-whatever doesn't indicate a fracture **for sure** while a primary care physician with years of experience probably sees things differently.

Obviously I'm surmising a lot here: good thing I know how to MAKE INFERENCES!

Catherine Johnson said...

I also assume - though I didn't confirm this with anyone - that her fractures are relatively 'small' or 'minor.'

The docs could all see something on the X-rays & CT scans (I think those were the original tests) but they all thought those anomalies had probably been there all along, which is why they didn't diagnose fracture.

Last but not least, pelvic fractures - and this is something I didn't know - are fantastically dangerous but not something the doctors can do anything about. They're in the same category as broken ribs. One of the docs explained to me that you can walk with a pelvic fracture immediately, or could if you could stand the pain. The broken parts of the pelvis just grind together and support your weight.

As the doc said, "There's no place for the bones to go."

Catherine Johnson said...

The fractured pelvis situation brought up another question: when is a test unnecessary?

Everyone was harassing my mom about getting out of bed. The first week especially, Soap Doc was basically threatening her: Walk or die.

This was a huge trauma for the family, because it placed the entire burden of living or dying on my mom: if she didn't rise up and walk, the heart and kidney problems she was having would progress, and there would be nothing they could do.

But she couldn't rise up and walk; the pain was too great.

I responded by campaigning for pain management as opposed to pain treatment, which meant simply that instead of having my mom's pain meds given to her "as needed" the nurses would bring them in every 6 hours & give them to my mom whether she was currently in pain or not.

This was a good idea, everyone finally agreed, but I only managed to get it ordered a couple of days before she left the hospital.

We all calmed down a lot on the Walk-or-die front a few days later when I found out that Soap Doc was not a physician, as I had assumed, but a medical student. Our entire family had been thrown into panic by a STUDENT. This wasn't crazy; Soap Doc always presented himself as a doctor, although in fact he never introduced himself as Dr. So-and-So, and one day, when I asked his name, he gave me only a first name.

I wonder now whether he had some identification on indicating that he was a student, not a doctor, but I wasn't wearing my glasses & he was always saying things like, "I'm going to order thus-and-such," which is the kind of thing an actual doctor says.


Plus he was never accompanied by a senior physician or even a resident. He was on his own.

Anyway, the pain issue was huge, and seemed to be the locus of Conflict, and finally my mom's primary care doc ordered the bone scan.

The test was awful; it wore my mother out & the liquid she had to drink beforehand made her sick. So my feeling was: why are we doing this?? There wasn't going to be any treatment; you can't set a pelvic fracture.

However, as soon as everyone agreed that she had not one but two pelvic fractures .... that seemed to be a good thing. There was less talk of a bad attitude on my mother's part, more comprehension that she really was in fantastically high pain that needed to be addressed as an issue in and of itself, and so on.

I may be reading into things a bit, but the 'reality' of a diagnosed pelvic fracture rather than a disputed pelvic fracture or a nonexistent pelvic fracture seemed to be good for all concerned.

When I saw that I decided I absolutely can't know whether that test was or was not 'necessary.'

Was it useful and ultimately helpful?


That's all I know.

Catherine Johnson said...

My mom's internist is absolutely in her corner. He is amazing. She turned 80 in the hospital, she has many, many serious problems, and he is in her corner. His entire focus is on helping her live - and on helping her live as well as possible, which means restoring her to the very good shape she was in before the fall.

The one and only time my mom got out of bed and sat up for 2 hours happened because he inspired her to do it.

In this situation you see exactly what the healing professions are about. His entire focus is on getting my mother well, and it doesn't matter that she has diabetes and heart failure. His focus is on getting her as well as possible.

All of the docs & nurses were focused on that goal.

I will come out of this experience with feelings of reverence for these professions and for the people who work in them.

Catherine Johnson said...

Elizabeth -- I sent you an email w/a question about your site!

Catherine Johnson said...

btw, I'm not sure whether I've sounded snotty about "Soap Doc" & I'm in no mood to re-read my Comments....

He was fantastically knowledgeable AND he spent lots of time giving me highly detailed short lectures on the heart & its problems; plus he was obviously very anxious about my mom (a good thing!) without the clinical experience to know what things he could relax about.

The problem with "Walk or die," as it turned out, wasn't that it was wrong. I knew it **wasn't** wrong; my mom's internist told me the same thing over a year ago. That's why I was panicked.

The problem was that Soap Doc didn't know, and I didn't know, what the parameters were.

Later on, when the head cardiologist finally told me that Soap Doc was in fact a student (he had an amused look on his face), he said that as you get older you get "more relaxed" about how much time you have to treat a condition.

High potassium levels are urgent; they have to be treated now & brought down now.

An elderly patient with heart failure not being able to sit up or walk isn't urgent. Yes, the patient has to sit up and walk again or her life will be substantially shortened.

But it's not an emergency.

Catherine Johnson said...


Can't beat it.

Anonymous said...

Yes, it's so nice when you get the professional with the knowledge and the right attitude, because in these cases it really does start to become all about the gut feeling after a while.

Maybe Hot doc learned something. Who knows?

The young good-looking one at our hospital came in and mentioned that that my mom couldn't understand us because she was really just "gone." I had just told her an in-joke a little earlier and she gave a little knowing laugh, so I knew that wasn't true. Yet, every doctor came in and loudly talked about her having no more time left. I'm sure she heard them all.

72 hours before my mother passed the physical therapists were dragging her out of bed for strength training, or some such nonsense. She was crying to the point that my sister-in-law's gut told her to put a stop to it. She just calmly told them that we wouldn't be needing it any more. It was an awful dilemma, but I'm glad she was there to make the call.

I'm glad you feel that you've got good people around you. That's so wonderful. It's a terrible feeling when you don't believe that you have either good people or caring ones.

You have the potassium problem. My mother had this mysterious massive sodium drop every other week that sent her into the emergency room every time. I've since heard from other people that their parents have the same thing, so apparently this kind of thing isn't all that rare.

I always think, "Well, eat more salt", but it's a tad more complicated than that.


Catherine Johnson said...

Yes, it's so nice when you get the professional with the knowledge and the right attitude, because in these cases it really does start to become all about the gut feeling after a while.


They have gut feelings that mean EVERYTHING.

I'm going to turn in, but I'll write a comment about that tomorrow.

I basically trust the tone of voice of my mom's internist. His **tone** tells me where things stand, and I can read his tone.

It's amazing.

And wonderful.