Help!
Posted by WhiteCoat on November 17, 2008
There was a sweet demented little old lady that was brought to the ED after she vomited at the nursing home.
Once.
Yeah. Emergency in the making. Don’t get me started.
She would talk with you and say “Hello, Dear.” She had this cute little giggle when she would tell you things, too. But as soon as you’d walk out of the room, she would yell “HELP! Help me!” You went back in the room and she’d just giggle and start talking to you again. No problems. Asked her if she needed anything. Nope.
She just wanted to talk more.
After the third or fourth episode, it started getting old, reminding everyone of that “Patient Who Cried Wolf” story. So we did what any other caring professional would do.
We turned on the TV and closed the door.
Didn’t work.
Patients and their families walked by the door and heard the patient yelling “HELP ME.” They would stop, look around, seek out one of the staff and tell them,
“Um, some lady’s yelling for help in there.”
“Yeah, we know.”
But these other people didn’t know what had happened up until that point. All they heard was some poor old lady screaming for help.
We don’t want to look like a bunch of heartless creeps, ignoring a patient who needed “help,” so the interloper’s involvement in the situation necessitated a staff member going into the room again to make sure nothing new had happened in the preceding 47 seconds.
“Everything OK?” the nurse said loudly so that everyone within earshot could hear her.
[Few second pause, then loudly]
“Good! You just sit back and rest, then.”
Then a police officer in the ED to make an accident report walks by. He hears the yells for help and pokes his head into the room to see what the problem was.
That actually got her to stop hollering for a few minutes.
After an hour or so of listening to her pleas for help, we figured out why the nursing home sent this little old lady in for an emergency evaluation of one episode of vomiting.
Obviously … she needed help.
And they needed some peace and quiet.
All at the expense of the Medicare National Bank.
scalpel said
Vitamin H deficiency.
Trauma Junkie said
It’s times like these that I wish HIPPA didn’t exist. I’d like to be able to tell visitors, “Yes, we hear her yelling. She is 93 years old and has dementia. She doesn’t know where she is at or what she is doing here, but she’s fine.”
Stacie Mc said
I gotta say…I’d have sent her to the ED too. (well maybe not, but it would have been awfully tempting)
rlbates said
So sad, all around.
Wanderer said
We have one of those nearly every night. It’s so much fun. Really.
SeaSpray said
Welcome to my life. No it’s not THAT bad for me personally but I see it almost daily at the rehab my mother is in and it breaks my heart. Oh heck… I think my heart is mostly broken at this point and the final sever will be when she dies… which hopefully won’t be for a while. If I hear one more person tell me her body is tired….
Well this is a first. Me crying in YOUR blog.
The humor in this post doesn’t escape me though. The whole sweet-manipulation thing is funny.
It is sad all the way around. And the last thing you want is a rep for being such a cold hearted bunch of … that you wouldn’t even help a little old lady. Gee! (might be good for the drug seekers though)
I just said to my son (who went with me last night) that I think it is so important to visit people in nursing homes because many of them are forgotten. It is predominantly filled with an elderly population, but really anyone could end up there with lasting damage from a stroke or car accident or whatever.
People that were once thriving and productive now left to roam the halls in belted wheel chairs, carrying baby dolls and stuffed animals. They’re the lucky ones. Or are they? The first time my husband walked through with me, as soon as we got on the elevator… he said he’d rather be dead.
While it is sad if you don’t have all your faculties…maybe it is better in a way if you are going to have to live out your days that way. You know…kind of have your own happy place to be in. Although… some of them have such hollow looks on there faces.
I was taken aback the first time I entered the facility – last month. There were so many people in wheel chairs lined up looking out the big picture window in the lobby. I would be too. I’d be wanting to escape!
My eyes have been opened widely to a population in our society that I had conveniently ignored. The nursing home population.
Ironically…for almost five years, I also worked for the Lifeline program and so I often went into these facilities. My heart would break with what I saw. But let me tell you… it IS a whole different ballgame when it is YOUR parent that may have to stay in one of these places.
Instead of cheerily breezing in and breezing back out, grateful I didn’t have anyone in that predicament… I now find myself obsessing over every little concern that could possibly come up and sometimes..they aren’t so little. I find myself vacillating between guilt and relief. Guilt that my mother is there and relief that she is there… all the while wondering if we are all missing something and maybe she really doesn’t have to be there. ?
Who wants to think about these things if they don’t have to? Now I do. And it scares me. It scares me for my mother. It scares me for everyone I love. It scares me for me.
It’s life. I know that. It is what it is. But it sucks. Sorry… but it does. I haven’t given up looking for the silver lining. Maybe after tomorrow’s meeting I will find it.
WC… even though it relates… I know I went off track. I would be curious to know of other people’s opinions on this subject. Parents in nursing homes.
And I would be curious to know from the family perspective and the professional perspective. Making that final determination.
For example… twice of the 3 times my mother was brought to the ED… this doc (and I worked with him for years)recommended nursing home. But her PCP agreed with me regarding the psychological perspective (giving up independence, apt and cats) and we instead were hopeful to work out some of the physical logistics that would aid her in living independently. I was grateful he took me seriously. We both know my mother.
But it didn’t work out as planned.
What is your experience or that of other doctors/med professionals when dealing with this population in terms of recommending long term care? What do other families do?
I am not looking for advice. My mother’s path seems set. But perhaps there are other bloggers out there who are faced with this same situation who have gone into denial as I did. ?
It might make for an interesting post that can help someone out there.
I will say this. It is so much easier on a professional level because now that it is my own mother… I feel like I can’t see the forest for the trees.
I know that at tomorrows meeting …they (the dept heads and social worker) are all going to hit me with why they are stopping PT and why she should be converted over to full time status. My experience in working with medical professionals and frankly…pure logic tells me that they are probably right… but something in me keeps telling me that they don’t know her like I do and they should give her more time.
Every time I walk in there I make it a point to cheerily say hi (talk a little when I can) to the residents and staff there. Sweet little Elvira who always scoots around in her wheelchair supporting an infant baby doll nestled in her arm greets me warmly. I’m glad when I see her.
The staff works hard. I think it is a calling to work in a facility like that. Our society seems to discount our elderly population. I find myself wondering what kinds of things they used to do, their jobs, family, habits. Every person has worth and we can learn from each other. And I do know that even in these seemingly dark times…good can and will come from it. It is the getting there that is tough.
And if anyone has free time… find a nursing home to visit. Bring them a children’s program (nothing like children to breathe life into people), or projects to help other needy people… or even a tray of cookies. Or get students to make Christmas cards to give out personally. Their recreation director must have things lined up but it never hurts to have more.
EEJ said
Re: Seaspray- Just make sure you check with the management of the nursing home you plan on bringing crafts and other items to. They usually want/need to ensure that everyone will benefit equally (or at all) from whatever you bring in. With food, you need to be especially conscious of food allergies, and sugar/salt levels, as many residents can be on diets.
My grandmother has been living at a retirement home for several years now, although she has her own apartment there, and is not part of assisted living (yet). It’s essentially a combination apartment/dorm living arrangement for her. She can eat at the cafeteria or participate in things on-site, or she can go about living as if it were an apartment, not using the facilities for much.
I do highly recommend visiting a nursing home or retirement center and just walking around being friendly. Although it can be troubling to see older people in poor shape, I’ve never felt better than on some of the occasions I have visited with the residents and just listened to them talk, or shared a memory, or whatnot.
SeaSpray said
Thanks EEJ. Agreed. All things would have to be cleared through the staff. I was generalizing.
I have concern that my mother’s mental status has DECLINED since going there. Except for her sitting in urine for THREE hours on her first day there… I believe they have been good with her. I am also there frequently (at intentionally mixed up times)and have made it a point to get to know the staff and they can see I am involved. I brought in a box of Dunken Donuts for the nurse’s station last week because I wanted to let them know they were appreciated. I know I have been… um… hypervigilant ever since that first episode. It was a dinner time mix up… supposedly.
She just can’t seem to get the strength back in her legs and so needs assistance. But I see her as improved because she walks better, can lift her legs up onto her bed from the wheel chair. She couldn’t even lift them up on the hassock at home. (I didn’t know that until the end) And now she seems to be confusing things. ???
But she didn’t before…at least not to the degree I am seeing now.
I can’t help but to wonder though if it has anything to do with disorientation/lack of stimulation, e.g., if one is removed from their environment where they make moment by moment decisions/have routines interrupted where they decide to feed the cats, get the mail, whatever… I wonder if they begin to go into themselves because they are having everything done for them and their autonomy is gone?
She did not go in this way. Yes… even last winter she talked about my grandparents being at my wedding and I corrected her and she stated they were. then I reminded her how long they had been dead. But I saw that as a momentary glitch in an 84 year old brain. And yes…she has mixed details of stories up but again… that does not mean she’s not processing appropriately.
She IS lucid. She reads, does puzzles etc, but now refers to that room as her apartment. the other night she was going to get up from her wheel chair to get coffee from HER kitchen. They now have her belted in her chair..which she hates.
Last night we were watching the Godfather II together and she then told me that she was staying there tonight and would be back in the states tomorrow. I didn’t correct her.
I have been wanting to get her out of there for the day and she hasn’t been jumping at the opportunity, stating she has to get stronger first. I reminded her that she is NOT sick and she can leave with me to go somewhere if she is willing to make the effort to go out.
I am familiar with the type of setting your grandmother is in and that is a nice set up. And there must be a certain security for them when they are in these environments, providing it is quality care.
I had an idea I share with one of the dept leaders last night.
My mother is NOT a joiner, can be quite stubborn and should never be presented with an opportunity for a yes/no answer if you want to encourage her to do something.
I told her she loves to cut out coupons for me to shop with. I suggested that perhaps they could create some activity where they ask for her “help” to cut out coupons that will be given to people “in need” through some organization. Maybe get her and others out to the recreation area to do this…with safety scissors.
She liked the idea. She also told me she wish she had known because they just had a pastor there who asked for volunteers to help him fill the Christmas shoe boxes for needy children. What a marvelous idea!
I think asking the residents for THEIR help to “help others” validates the resident’s worth, demonstrating to them that they are appreciated for their contributions. We all need that. To know we have value…that we make a difference for the better. And for those that won’t even remember they helped…they are still participating in the moment.
My aunt always said that if you are ever depressed…go help someone else and you will forget all about your own troubles because you will feel good about helping someone else to feel better. I think that is so true.
ee said
Stick a bored EMS crew in there with her. The nurses that are on break could spend a little time with her. Same for the CNAs and such.
brighid said
Ah, come on, Whitecoat, give the nursing home a break. Old people can get sick very precipitously. When my father was in his mid-80s, I once took him to the emergency room because he didn’t eat dinner — said he didn’t have any symptoms he could name, just felt a little anxious for some reason — then finished the evening off by having a chill. His forehead was cool when I bundled him into the car and drove to the hospital. The triage nurse was unimpressed; anxiety and one chill? Really? Three hours later, when the doctor came in, Dad’s temp was up to 101, he had developed a persistent cough and was hard to rouse. Blood tests and xrays showed pneumonia. By dawn the ED had given him IV antibiotics and Dad was clearly better. They sent him home on oral antibiotics. A few days later he was good as new. If I’d just gone home that night because Dad didn’t have any real symptoms, the pneumonia would have had time to get established. What would have been the chances it could have been successfully treated in the ED? Sending a 40-year-old to the hospital with one episode of vomiting is silly. Sending an 80-year-old to the hospital with one episode of vomiting may be proactive.
Also, physical symtoms exacerbate dementia. An elderly woman who’s just a little vague and forgetful when she’s healthy can turn into a frenzied, wailing, full-on nut case when she’s sick. My mother had Parkinson’s. The neurologist she went to on a routine basis saw an entirely different patient than did the ED doctors who treated her for UTIs, gastritis, falls and other acute conditions. The nursing home knows about this phenomenon. They may have sent her to the hospital not just because of her vomiting but because her change in behavior clued them in that there might be something serious going on.
ERP said
Yeah – they must have missed her daily Respridal dose.
Nurse K said
This must’ve happened on a Friday evening, the official Nursing Home Dump Day. Weekend off from the hollerin’ for the staff.
Annon said
SeaSpray, I’ve been where you are – with first a demented grandmother and then a stroked-out but not demented mother. It truly is a sad state of affairs to say the least. It may not help the dementia, but have you had her vitamin D level checked recently? If it’s low, getting it up to 75 or better may help with her leg weakness. Did your mom ever use the computer? Perhaps you could get her one in her room to use since she’s not the participatory type. My mom is the same way. Only thing I could find for her to do that she can do aside from watching tv is playing solitair on the computer.
Bianca Castafiore said
So, with a case such as this, what is the onus on the ED physician — a full workup? Observation for X amount of time? Referral (to a GI doc or an emergency call to gerontology!)?
SeaSpray, I’ll be thinking of you and your mother. The situation you both are in is nothing but *hard*.
Twice I have been very close to being placed in a nursing home and I will never forget the abject terror I felt. Beware — when people begin to nod sagely over your head, when people start to PAT you, when you hear that cheerful, chirpy, singsong kind of voice… because suggestions of nursing home (or rehab) placement won’t be far behind. There is nothing like it for firming up one’s end-of-life resolve.
Anony said
I have volunteered at a few nursing homes and noticed residents who would yell “help” although they weren’t in dire danger or anything. Everytime I would go to her, she was fine and resumed talking as normal. The first time I encountered something like that, I really thought she needed help too, but then the nursing director told me that it’s a common thing for residents in nursing homes to do that. They only do it because they lack companionship, attention or that social aspect that’s always neglected when one enters into a nursing home.
EEJ said
Oh, and the reason I meant to comment in the first place was to mention that this same thing happened when my sister was recently in the hospital here in the Tampa Bay area.
Old woman in hospital room two doors down would plead “Help me” to anyone passing by. They would go tell the nurses, who were about 10 feet away, and they’d go check on the lady so the person didn’t think they were ignoring her (in reality, they were, but for good reason).
She never said anything more than “help me”, but it sounded so pitiful it almost broke your heart. I gained a lot of respect for hospital staff that day. I know I couldn’t listen to that all day and feel helpless to provide assistance.