Sunday, April 30, 2017

The Tough Guy Back at Home

April 21, 2017
by Goldie

Dad wasn’t the only one who was shocked to find out he had a heart attack. Despite being 92 years old, none of us would have automatically thought, “what about his heart?” This is the first time he’s ever had any heart issues. It wasn’t chest pains that had us packing him off to the emergency room, it was constipation. He was severely constipated and in a great deal of pain because of it. Hospital docs are pretty smart and they tested for the heart enzyme, troponin, and the elevated level showed he had some damage from a very recent heart attack. Seems he has one artery almost completely blocked and, even the exertion of going to the toilet and trying to go was enough to stress his heart.
He didn’t think he needed to go to the hospital. Said the pain would go away in a few minutes.  This had us fooled the day before, but the pain waves were coming back within minutes on the morning we decided he needed to be seen. Jokingly, we told him he now knew what it was like to be in labor. The pain was intense cramping which he felt in his lower abdomen and back, down by his tailbone. What was embarrassing for me was I had been with him the day before and I missed how serious this was. So, backing up a bit, it was Wednesday evening when Mom called and said they were supposed to go to the clinic in the morning and the bus was supposed to pick them up, but she didn’t think Dad should ride the bus. His tailbone was hurting him too much. I reluctantly agreed to drive them to the clinic.
Reluctantly? Yes. They do not like riding on the bus provided by the clinic. Mom still calls before nearly every appointment to see if she can find a way to have me drive them. I balked. I didn’t want them to become dependent on me to drive them all the time, but I agreed to do it this time. The next morning, I panicked. I’m caring for puppies again and I couldn’t just leave them for hours without a sitter. Neither my husband, nor my daughter would be home that day.  Clinic appts mean lots of waiting; it’s usually a full morning. Desperate, I put the tiny three-week-old pups in a large bag, along with a bottle of formula, a pee pad, and a towel to cushion their makeshift bed, and hoped they would stay quiet. I wasn’t sure whether they’d be welcome, but hey, I was only the transportation. I could wait outside.
What happened that morning could have been made into a slapstick comedy. I wanted to be discreet about wee pups. Dad told everyone he saw. We had groups of people stopping to peek at the pups. The dentist insisted on holding one. Tiny pup peed all over her. Official looking woman came over to tell me I couldn’t have pups in the clinic. Dentist said, no problem, she’s just leaving. While I waited outside, various staff persons ventured out with clients who wanted to see the puppies. The dentist came out and offered to sit with them if I needed to go back in. By the time Mom and Dad had both seen the dentist and Dad had seen the audiologist, they were ready to go home. Somewhere in there, I assumed the check-in with the triage nurse happened, but it didn’t. So, yeah, I felt guilty about being distracted and distracting others. Fatigue plus stress does not bode well for decision making. On the other hand, the pups also distracted Dad from his pain.
That evening, both my brothers came into town. On Friday morning, one brother called to say they were taking Dad to the emergency room. As soon as I arrived at the apartment, I saw Dad was in much more distress than he had been the previous day. There was no doubt now. I will say, the staff at the facility missed it, too. They do not have an RN on staff at the moment, and haven’t had one for the last six months. This is at a facility which does not have a skilled nursing unit.
At the hospital we found out just how dangerous it can be for elderly folks to get severely constipated. Dad was dehydrated. The stool was hard and impacted. What to do first? Get heart stabilized, then clean him out, which meant leaving him with his painful cramps. Getting his heart stabilized meant being on blood thinners. Getting the stool cleaned out meant going off the blood thinners because of the risk of excessive bleeding from his rectum. Eventually both were accomplished and Dad was approved to go back home to his assisted living apartment the next day. One of Dad’s arteries is mostly blocked, but other than medication, they won’t do anything about it. He’s 92. No cardiac diet, either. The person in charge of educating us about this came and gave her spiel, but the cardiac doc said, no, let him eat what he wants. That was good because that’s what will happen anyway.
We found out something very interesting. Occasionally, in older people, when there’s a blockage like Dad’s, the heart will find some way of rerouting the blood flow. Doesn’t happen all the time and we can’t count on it, but knowing Dad, if it’s possible, his is that kind of heart.

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