Her stay there is only brief before I get a call that she has a fever. Naturally, it's when my brother is out of town - it's that vacation magic again. They tell me her chest x-ray looks clear, they've drawn blood and the fever seems to be responding to treatment, and I will be kept apprised. No further updates. We visit the next day, I ask the results of the blood work and get simply "an elevated white blood count, but her fever is down and she seems okay." We carry on.
Less than a week later, I come home from work to a message from the rehab. The fever is back, they've taken her to the emergency room. I speak to the attending, he recommends admission to the hospital and I grant permission. It is September 29th.
By October 1st, the infection is affecting her cognitively - during my evening visit, she rants that she "just has a little fever" and that they are keeping her there for no good reason. "It's BULLSHIT!" she yells.
The next day, I see the doctor. They have determined that she has enterococcus causing bacteremia and endocarditis...in layman's terms, she has an infection in her bloodstream that has migrated to her damaged heart tissue. She has periods where she's lucid, and periods where she isn't, and the intravenous antibiotics keep going. Her doctor brings up the option of palliative care, which I take back to discuss with my brother. How do we know if it's time?
On the 4th, I decide to work from her hospital room for the afternoon. As I shut the car off in the hospital parking lot, the palliative care coordinator calls me. I'll be up to see her momentarily. When I arrive on the IMCU floor, Mom has company - and is awake for it. Seeing two of my cousins there with her makes me so very happy, and I drop my bag off before heading off to meet the coordinator. Because the mention of palliative care the day before had been on my mind, I had re-read Mom's advance health care planning workbook* to be sure I understood what her wishes would be. As a result, we were able to have an honest and productive conversation, and we left palliative care on the table when we (the family) decided it was time. I came away thinking about the statement the coordinator made to me: "There isn't ever a sign that comes down from above, telling us it's time for palliative care. We all just do the best we can." We agree on an initial plan of pain management, since narcotics are being avoided only to try to keep her lucid, and even without them, she isn't very.
On the 5th, I plan to work from her hospital room for the day, in the hopes of being present for any lucid moments she may have. There are none, but she whimpers and moans in pain, and I talk to the nurse about dilaudid, and she gets a dose. Her whimpering ceases, and she seems to be comfortable. Then, the respiration line on the monitor goes flat, the monitor itself alarms and I end my phone call with a frantic "gotta go, gotta go, goodbye". Before I can get to her bedside, she takes a hitching breath and says "gotta go......gotta go......goodbye". Unnerving? You bet it was.
The benefit of parking yourself in the hospital room for the day is getting to see each and every specialist as they do their rounds. Infectious Disease comes in, Nephrology, Hospitalist...updates make more sense when you talk to each of the specialties. Infectious Disease says they can find no source for the infection, they want to take another look at her hip, this time an CT - the prior x-ray and ultrasound were inconclusive. Nephrology says they don't like the cell count in the dialysate they've tested from her, and the Hospitalist asks what we think about the palliative care option, telling me that the white blood cell count isn't going down. I leave for the evening as they prep her for her CT scan.
On the 6th, I take the morning off to collect her belongings from the rehab. We agree that it's highly unlikely she'll be going back for physical therapy any time soon, and I coordinate pick up with the admissions director. From there, I head to the hospital where my brother is headed as well. He arrives before me, texts me that she woke up as soon as he walked in. I arrive less than half an hour later, and she's able to talk to us, the most alert she's been in some time.
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