Saturday, February 6, 2016

Your Diagnosis, Please

Last Sunday was one firecracker of a day.

At breakfast my dad was extremely agitated--complaining about severe pain in his left shoulder and weakness in his legs.  He was shaking all over.  I took his blood pressure, and it was 210/104.

I was afraid he was having a heart attack.   I asked him if the pain in his shoulder was the usual pain from his arthritis or if it was different.  He said that it was different.  I told him that I was going to call an ambulance.  By his reaction, you would think that I had told him I had made an appointment for him to be castrated.   He got so upset, it scared me.

I asked him if he had already taken his blood pressure medication.  He checked his pill organizer and said, "Yes.  Looks like I took all my morning meds and all my evening meds too."

"Oh. My. Gosh," I thought, as my mind raced.  "What the heck is going on here?" I asked myself.  I mentally reviewed the medications that he takes in the evening and decided he would be ok.  It was just disturbing that he had done that.  He is usually careful about his prescriptions.

I was removing the blood pressure cuff when, before I realized what he was doing, he took a hydrocodone (pain killer and narcotic) and a Clonozapam (anxiety).

Because the idea of me calling an ambulance made him so much more upset, I decided to wait a little on calling 911 and focused on getting him calmed down and comfortable.  I put a Lidocaine pain patch on his shoulder and helped him get to his recliner.  With a little coaching on deep breathing and meditation, he soon relaxed.  I was happily surprised and encouraged by how receptive he was to this.  I'm sure the meds were beginning to kick in too.  He asked me to take his blood pressure again.  It came down about 40 points in ten minutes.  He was quite pleased.  He smiled at me and said he felt fine.

Much relieved, I sat down on the couch near him to observe and wait.  He was watching tv, like he normally does.  After about 30 minutes, he asked me to turn on some lights.  The only problem was, he was pointing at an area where there are no lights.  I explained this to him and offered to turn on the ones that were actually there.  Then he asked me, "Do you see those three columns over there?"  He pointed his index finger at the east wall.  I said, "No, Dad, I don't see any columns, just the two windows."

He began carefully describing the three columns to me, and I repeated what I saw: just the two windows.  I began to wonder if the combination of the evening meds, the hydrocodone, and Clonazapam were making him delusional.  They certainly made him cheerful.  And he assured me that he was feeling no pain.  I sat back down.

Emma, on her way to church, texted me to see how Grandpa was doing.  I told her the latest developments.

A little while later Dad asked me if I saw the numbers on the wall and the ribbon that was woven in between them.  I told him that I did not.  I noticed then that although he had the tv on, his headphones that allow him to actually hear it were in his lap.

"Dad," I said.  "Do you know what year it is?"

"2065?" he asked.

"Oh, dear.  That makes you very, very old," I replied.  Because you were born in 1933."

He smiled.  "I think you need to keep asking me questions like that," he told me pleasantly.

At that point I decided I could probably rule out a heart attack.

Emma called me and said that she had spoken with her friend, Angela, who is a nurse in a geriatric psychiatric ward.  Angela said it sounded like a urinary tract infection (UTI).

"Of course!" I thought, remembering a similar reaction by my mom several years ago when she was hospitalized for a stroke.  But I still wasn't sure.  Dad didn't have a history of UTI's and there was still the question of a possible drug reaction.

I told Emma that as soon as she got home to stay with Grandma, I would take Grandpa to the Urgent Care clinic we frequent.  He is much more amenable to going to Urgent Care than to the hospital emergency room.  I can't blame him.  The emergency room is a nightmare for the elderly.

Soon after Dad got up and walked to the bathroom, using his walker as he normally does.  He was in there a long while.  I went to the door several times to inquire if he was ok.  He assured me he was.

When he finally came out, I saw immediately that he was not ok.  He could barely walk, and he was panting heavily.  I told him to sit down on the seat of his walker.  He did.  Whereas he usually picks up his feet when I push him in his walker, this time he let them drag.

I knew my window of opportunity for getting him into the car had slammed shut.  I called 911.

To be continued...

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