Chapter 597 - Another Trip to Emergency
On getting her up at 0720 Monday 24th May there was a big turd in her pull-ups. Then after she had been on the pedal machine another large and some small in the pot. Late that morning her dyskinesia was bad so I returned her to the pedals which seems to alleviate her kicking, and several minutes later found her asleep. Then about 1400 dyskinesia bothered her again so another short period on the pedals until she began dozing again so I transferred her onto her bed where she slept for about an hour. To bed by 1900, laying on her back without dyskinesia, listening to an audio book until 2230 when she woke me to stop the book reading.
The next day, Tuesday 25th May, she was hard to wake when I asked whether she wanted to get up, saying "Yeahh" without moving. I stripped my bed, for the day was Domestic Cleaning Day, then I asked her again "Do you want to get up? Go to the loo?" "Yeahhh" yet her eyes did not open. Then she said "Cold" so I pulled her sheet and quilt back over her, her eyes remained closed and mild dyskinesia began then stopped Then at 0730 and 0745 I asked "Do you want to get up? "No" was the answer; this was unusual because most mornings she is eager to urinate, even though her pull-ups may already be quite heavy. So I showered.
At 0800 her eyes were open and there was mild dyskinesia, still not wanting to get up, she said she "had aches and pains everywhere". Her tummy was sensitive when I pressed low on her left hand side. She wanted to be rolled over, vaguely indicating her left hand side. As I moved her I felt that her pull-ups were very wet. Comfortable on her left hand side she began returning to sleep. Using her small wrist BP monitor a reading of 183/94 and 140 pulse rate was taken on her left wrist. The oximeter measured 92% and pulse rate of 100 on her left index finger. She still did not want to get up but "Feel alright, just want my legs to stop".
I rang the Home Care Supervisor at Wild Dog to ask whether their nurse could have a look at her before I rang for the ambulance. By 0830 her eyes were open, said she felt "Alright" before closing them again. She was more awake by 0840 when I again checked her BP at 146/78 69. I gave her some tissues because her mouth had excessive thick spit. She remained on her left hand side without dyskinesia. Then at 0850 she wished to get up, so I transferred her onto the commode, where she piddled but no poop, then onto the pedals. The nurse arrived at 0900 when the "patient" was about her usual self. The nurse left as a carer arrived, along with a trainee, to give her a shower and to dress her. Just after the Carer left the interstate volunteer rang to have the weekly video chat with her over Skype. I did not bother ringing for an ambulance. The day continued with its normal hum-drum activities. At 1830 I discovered that in the morning's activities I had not replaced the Duodopa cassette, which I found to all intents and purposes empty, there being only a small blob of white fluid left in the cassette.
Wednesday 26th May began at 0100 when she woke me because she wanted the toilet. Dyskinesia. I transferred her to the commode using the Sara Stedy, so that lowering her pull-ups was a little easier. After piddling, no poop, I transferred her back onto her bed where I rolled her back and forth to raise the pull-ups then left her on her right hand side without dyskinesia. At 0630 she had dyskinesia which stopped after I placed a soft pillow between her feet. The pump was set to Day Rate 7.0 from Night Rate of 2.0. At 0730 she only grunted when I tried to wake her. By 0755 she seemed awake enough to move her onto the commode, saying "Yeah" when I suggested doing so. After wheeling the commode into the bathroom I tore off her pullups and removed them into the pot, my normal procedure. I wiped spittle from her chin with a tissue. She had piddled a little but no poop. Her eyes were wide open, staring straight ahead, not responding to my suggestions to poop if possible. By 0815 she began to "wake" a little, responding with "Mmmmm" when I suggested putting her feet on the pedal machine. Once I had done so, needing to put her feet into the slippers glued to the actual pedals, her eyes remained open, but was unresponsive to questions. I put her knitted poncho over her shoulders. Several minutes later I offered her the small drink container in which a cachet of Molaxole was dissolved in about 100ml of water, which she raised to her lips the pushed it away. Then she shut her eyes, her feet continuing to move with the powered pedals, she sitting up right without a suggestion of slumping. At one point she quickly moved her right hand to her ear, then lowered it again. About 0900 I rang a caring help line in Big Smoke and I left a message since I seemed to have called before anyone was in the office. She dribbled spit down her chin. She said "Mmmmm" whenever I asked "Can you talk?" Just before the Wild Dog carer arrived to shower her there were a few round pebbles in the commode pot. Since she was sitting so upright on the commode I decided we should give her a brief shower after which I pressed the emergency button for an ambulance, and before they arrived we dressed her in pull-ups and a nighty. Remembering the day before, I replaced the Duodopa cassette and checked her BP at 124/66 78, oximeter 94% 82 and temperature 36.After the ambulance took her to Emergency I made several phone call then after placing some medication items and information into a small case I drove to Emergency. Needless to say, of the suite of tests completed upon her, none showed any serious anomalies and there were no recommendations other than to arrange a visit to her favourite neurologist in Big Smoke next week. One positive thing to come from this escapade to Emergency was that the attending doctor took me aside to speak about Advanced Care Planning, I sometimes retaliate by asking whether they themselves have put their own house in order, but this time I didn't say that. Anyway, the doctor must have contacted a nurse who handles such advice matters, for she arrived at the bedside, and after appropriate introductory chatting proceeded to give my dearest one of those brief verbal cognitive tests so loved by geriatricians. I had been completely unaware that a person existed in the system to give assistance with finalising documentation after one has ticked all the appropriate boxes of web based forms listing questions about dialysis, organ donation, when the plug can be pulled etc etc. So I have made an appointment for us to see her this coming Tuesday.
Anyway, last Tuesday I cancelled the Wild Dog care visit scheduled for 1800 and the ambulance returned her home at that time to bed. There is much more that could be described that happened this past week but at this moment, who really gives a damn.