My Crazy Month

[elizabeth8503RN, MSN, EMT-B, NP]

Over the past month my grandmother has been sick, really sick. About 7 weeks ago she started to cough. She thought it was a side effect of one of her medications, and brushed it off. The cough didn't go away, and she kept getting more tired. One night she went to bed and as she described, she started to "squeek." The following morning she went to the doctor. A chest x-ray and lab results later, she was diagnosed with pneumonia. She goes back home, and over the next week she takes the antibotics as percribed, but does not get much better. On her week follow up she goes back in, and her WBC count which had been at 20, was now up to 23. She was admitted to the local hospital.

(Little bit of back-ground on gma: slightly obese, diet controlled diabetic, recently diagnosed with advanced renal disease--found because of high potassium levels, over last couple of months have been well controlled with diet and meds--, history of MI nearly 3 yrs ago, numerous TIAs some of which have resulted in to small strokes, luckily none have affected her at all...thank the Lord){at home she is completely independent, able to do all ADL's by herself}

She was started on IV antibotics, breathing treatments, and the usual pneumonia protocal. Expected to go home in a couple of days (this is on a Tuesday). Noticed over the next few days that her feet are swelling more - so that usual. The coughing is not getting better, and her WBC's are bouncing up and down, and her renal function is slowly declining. On Sunday she is still not getting better, they do a thoracentesis and get around 480mL off of the opposite lung that she has the pneumonia on, and recieves 2 units of blood. She starts to feel better. Monday she gets worse, requests that I and my mother become her POA's because she knows that my mother and I will follow her wishes. Tuesday I get a call from her case worker (all patients in this hospital get a case worker) stating that she is being transfered to a Mercy because she has gained 5 lbs in water weight over night which is a grand total of aprox 30 pounds in one week. She has CHF, and her kidneys functions are worsening. The local doctor is unable to handle the case anymore and is sending her to the specialists up at Mercy.

GREAT.....

Arrive at Mercy on the telemetry and she is admitted under a nephrologist who is working with a pulmonolgist, infectious disease doc, and a cardiologist. The team combinds, sees her, and the plans are set into motion.

Over the next week she starts to improve, she has aquaphoresis to remove some fluid off of her because the diaretics are too hard on her kidneys, she is on IV antibotics, recieves 2 units of blood. She is seeing physical therapists to get her up and moving, and then things start to go downhill, AGAIN.

The aquaphoresis line clots off, they do ultrafiltration, great, 19 pounds of fluid off, but the problem starts with the Heprin that she was getting. Her body decided that it didn't like it, and started in on HIT (Heprin Induced Thrombocytopenia). Her platelet count is 38.

CRAP......

Do scans and x-rays and ultrasounds, to make sure she has not started to bleed out. Okay...were good. Not so fast... She spends a night, all night bleeding because her platelet count is down. After all that is done, I find out much much later that she has a blood clot in her leg.

Kidney Doc states she is okay to go home as far as he's concerned (this is last Tuesday) but the other doctors have to sign off first. Platelet count is only up to 48. Thats a no go. WBC is finally doing good, Kidney functions start to look like they might be on the mend.

Ok...so we wait for the platelets to come back up.

Monday I go in and visit her, she is lethargic, doesn't know who I am or who my mother is (gma is a/o x4, is always happy). Nurse states that she was up and went to x-ray and that she was ok this AM, and that she just had a really busy day. OK, that could explain it. Mom and I go out for a while, come back, she wakes up a little bit, but is still really sleepy, and not herself. I make a note to call and check on her before I go to bed.

Not 2 hrs later I get a call from the same nurse telling me that gma has been transfered to CCU that her BP has dropped to 70 over nothing and that she probably has sepsis, her kidney functions have declined, and that her potassium had sky rocketed.

OH ****

Now she is on continous dialasys, she is able to maintain her BP by herself without meds, her labs are starting to even out some, she is on IV antibotics, has had an additional 2 units of blood (this makes 6 units in the month that she has been in the hospital) and she is slightly starting to improve.

Problem is....

She told me last night....she is ready to go (to the Lord). I told her to give the dialasys a couple more days, and see how she feels, but she is tired of the constant battle going inside her body.

Our family has been gathering around. My mother, my three sisters, my gpa, my aunt, my uncle, and now my cousin is taking emergency medical leave from the air force to be with her.

***AND TO TOP IT OFF***

My grandpa on my dad's side (parents are divorced and not talking) is going to probably have his foot amputated here in the next day or two due to infection secondary to diabetes... he has been fighting the infection for two months, hospitalized a couple of days ago, and now this news...

I could really use some support now.

Thanks in advance for all your posts.

[AngelfireRN, MSN, RN, APRN]

Geez, honey! Don't know what to say but hang in there, and take care of you! You sure don't need a personal illness now. I'll keep you in my thoughts. Hugs to you and your granny.

A side note, if she's ready to go, it may be the best thing to just let her go. Good luck.

[elizabeth8503RN, MSN, EMT-B, NP]

She said she was ready to go. I told her that if she is ready to go, and she felt like it was time, then she could go. She would be able to see her son, (my uncle, who died from cancer 11 1/2 yrs ago) and that we would be ok. She asked if we were mad at her for being sick and a burden to everyone (staff at Mercy included). I told her we were never mad at her and she was never and could never be a burden. She then asked about gpa. I told her between my mom, my sisters and I we would take care of him. (he's 77, stubborn as all get out, and an ole farmer, never cooked a day in his life, well, take that back, he has made one batch of muffins when he was left to fend for himself when gma was in the hosptial a previous time) I told her we would take care of him if we had to duck tape him to a chair and make him listen (which made her laugh). I told her we would be ok, we would miss her, but we would always know that our gma loved us and would always be watching over us.

If she wants to go, she has all of our blessings to go.

[Chapis]

i guess the saying 'when it rains it pours' is true.

((((((((((((((((((hugs))))))))))))))))))) to you and your family especially your grandma♥

i"ll be keeping all of you in my prayers,

god bless

[Spritenurse1210, BSN, RN]

I can see that you're having a rough time. I hope that everything works out for the best. If you need someone to talk to, send me a private message anytime, and I will be happy to listen. You're incredibly strong, and I know it has to take a toll on you emotionally. *hug*

I think hospice services would do her a world of good. From your posting I can see that she's ready to go, and hospice will be there to support you and your family as well as helping her remain comfortable. Just a suggestion :) either way I still want to be there for you if you need a shoulder to cry on

[emidianeRN]

I hope everything turns out the best for your Grandma! It sounds like the HIT syndrome really took a toll ( it's wicked ). I have seen some really sick people bounce back though. I hope your Grandma is one of those people!!

[Tait, MSN, RN]

Poor thing! What a roller coaster for her, you and your family! Sad thing is it doesn't sound all that unfamiliar to me. Hospitals are sometimes the best and worst thing for a person all at the same time.

Keep your chin up, your heart and eyes open and warm hand to hold.

:icon_hug:

Tait

[nurturing_angel]

((((((((Elizabeth)))))))

Hugs to you! It's hard to watch a loved ones health decline. I know its hard to say to them "its ok to go home whenever you are ready" and I give you credit for telling your gma it was ok.

I will be thinking of you and your family, especially your gramma and both grandfathers. Keep us posted if you don't mind.

Blessing to you

:flwrhrts:

[pharmgirl]

My heart goes out to you. You are a beautiful soul who has had the courage to tell their loved one its ok to go. That is a wonderfully unselfish act. Being there with someone while they face end of life decisions is an honor and a privilege as difficult as it is. I'm sorry you are going through this but admire your courage and strength. Here's a hug and I want you to know I truly mean it (((((((((((((((((((((((((((((((Elizabeth)))))))))))))))))))))))))))))))

[PostOpPrincess, BSN, RN]

Prayers from me for you, GMA, and family...

JK

[Student2Registered]

I am so sorry to hear you and your family are going through this. Grandmas are very special people. My grandma has been gone now for 2.5 years and the one thing I have that feels good about it is that she was able to have the pass on "her terms."

It is very hard to loose the legacy and history of your grandma. But hold her had, tell her how much she means to you, let her tell you the same. And if she does come home, your relationship will be even stronger :)

[elizabeth8503RN, MSN, EMT-B, NP]

Gma is doing a little better now after the continous dialaysis. She is more alert, and was ****** that she couldn't remember what happened. Her times are mixed up, but she can't remember being moved into the unit, which happened on Monday. She doesn't remember Tuesday and most of Wednesday. But her labs have improved, so....who knows, she may be on the mend. But I am still waiting for the ball to drop....

THANK YOU ALL FOR YOUR PRAYERS AND YOUR POSTS