Saturday

I called the nurse station and spoke to Amena (sp?). There is nothing unusually to report on Dad's status. Vitals are fine, he is eating (but still needs assistance to do so. I couldn't get much on his mental state or alertness. He is still on oxygen as well. She transferred me to the therapy office, where I spoke with Abby. Although Abby had not worked with Dad, she read the report to me, which indicated he still required 2 people to assist him to get to the edge of the bed and to stand and transfer. They took him to the gym to the gait trainer (parallel bars) where they did some 'pre-gait' exercises, which seem to involved stepping forward and back. The report indicated that he is confused but cooperative, and that he does exhibit signs of pain still. Ken was to visit this afternoon, so I look forward to his report.

Friday

Saw Dad today from around 10:30 to Noon. He was more alert today. Nurse said he ate all of his breakfast. When I arrived, PT was just about to start therapy. Dad still cries out a bit with moving...we moved him to the edge of the bed, then we helped move him into a wheelchair. We headed to the "gym" area...we discovered Dad had not yet received any pain meds (new medication nurse had not gotten to him yet, even though his order says he should get Tylenol at 8am and 1pm). She came to give him the meds and PT suggested I walk Dad around a bit and then return for the therapy. He seemed to enjoy the stroll around the place--kept his eyes open. I left him with the therapist to begin therapy, but I had to leave (kids have short day today.)

When strolling we saw the Doctor who was pleased with Dad's alertness. On my way out I asked her if she had any medical concerns (reminding her I was leaving for the week.) She said not anymore having seen him more awake today. Said Dad would be in good hands while I was gone.

I brought in our family beach photo to leave by Dad's bedside.

Thursday

Went to Transition Care Unit at 11am today. There was a planned "team meeting" that the doctor had mentioned yesterday. Each therapist (speech, Physical, Occupational) provided some status on where Dad was with respect to therapies. I had not yet met the OT so I had the opportunity to speak up about Dad's pre-fall capabilities (e.g., could feed himself). Goals were discussed, and doctor (not the same one Justine and I had met the day before) indicated that Dad seemed to have a ways to go, so would definitely not be leaving before Monday the 12th, though they will re-assess at next week's meeting. PT mentioned that she had been unable to arouse Dad earlier in the morning to perform any therapy.

After meeting I went and checked in on Dad and he was sleeping. I tried rousing a few times, got an occasional verbal nod or response with eyes closed, or he would open his eyes for a moment or two...he was definitely not as alert as he had been the morning before when Justine and I were there. I inquired about how he had slept the night before. The nurse said there weren't any notes to say he had been awake in the night. I spoke to the bedside nurse who reported that Dad ate breakfast well. Note that they had removed the catheter, apparently earlier in the day.

Occupational Therapist (not same one who was at meeting) came in a little later and I went over Dad's history with her. She tried doing some grooming with Dad...handed him a wet washcloth and prompted him to wash his face, which he did. Speech therapist arrived shortly after, and lunch arrived. OT left and I worked with Speech to help Dad eat lunch. When Dad knew lunch was in front of him, he did perk up enough, to indicate readiness to eat. Most of the meal though, his eyes were slit and he only opened to find the food. Like the night before last, we would give him the spoon and he would fill the spoon, needing help to ensure spoon was loaded properly, and he also needed help guiding spoon to mouth (he would get it just shy of his mouth.) Towards the end, he was doing better with his aim and was pretty persistent to work through his entire meal.

Dad was doing a lot of complaining when being moved in the bed today...after lunch the bedside nurses needed to change the sheets and with each roll, Dad cried out...not sure how much is pain or just irritation with the process, though I'm sure there is some pain. Today, the dressing had been removed and I could see his sutures on his left thigh. Another odd thing was it appeared he had a bruise on the top of the penis....perhaps from the catheter?

I left around 1:40pm. Around 4pm I got a call from the PT (who offered to call me after doing the therapy)...she was able to move (with help) Dad to the edge of the bed like the day before, and said he stood again a few times, also taking a step to one side. She also mentioned that he was standing straighter than the day before.

At 4:30pm I returned to meet Haydee and show her the place and see Dad. Had Dylan with me so could only stay for a short time, but left Haydee there who was going to stay for a couple of hours. I had brought some magazines and cards as options for her to engage with Dad, when he gets to that point. Spoke to Haydee later this evening who said Dad did eat all his dinner, though still not overly alert. Note that while there, I discussed with Haydee the need to ensure Dad is adequately swallowing with each bite per the instructions from the Speech Therapist.

I will return again tomorow. Spoke with Ken who plans to visit the next two Saturdays. Haydee will be able to spend a few hours with Dad Tu/Th/Fri, and perhaps Mon and Wed as well (if she's not too tired from other job, said she would stop by.)

Wednesday Update

Barb and I got to the rehab centre around 9 this morning. Dad was being evaluated by a speech therapist, who identifies any issues with eating and swallowing. Dad does have a little difficulty still, so he is on a chopped food diet for now, and an eating assistant will be with him for meals to prompt him, or help with feeding and drinking if needed. She mentioned that Dad's CT scan had shown some evidence of 'hematoma' or bleeding. We hadn't read the report yet, but the doctors had never mentioned this. Later the rehab doctor came by and we discusssed Dad's conditions in more detail. He said it is possible that the fall could have caused some temporary brain issues that are affecting Dad's speech and coordination, though it could also still be the after effects of surgery and anesthesia. (FYI - the scan report also mentioned evidence of chronic small bleeds, not unusual in the elderly). Dr. Sheedy went over medications with us, and also the expected course of therapy. Generally, patients with hip surgery take 2 weeks in the rehab centre. Dad's morning medications came around 10:15. He takes pills with a little applesauce, one at a time. There are a couple of medications that were ordered from the hospital, but mainly just the ones he has been taking before. The doctor agreed that he will not get any sedating medications unless we are called. He will get tylenol twice a day to manage pain. If this is deemed not sufficient, they will call us. After the meds and finishing off a dish of applesauce, Dad went to sleep. When the PT came for evaluation at around 11:15, it was difficult to get him to wake up. Nonetheless, we did get him to sit at the edge of the bed and even stand up. He had had another bowel movement as well. The PT felt that Dad was too sleepy for more work, so he was put back to bed. The CNA came to help clean him up. Barb and I left around noon. I will be returning to Vancouver tonight. Barb will visit again tomorrow, as well as Friday morning. We decided to see if Haydee might be able to come by a few times while Barb is in Costa Rica (for a week starting Saturday). While his care is fine, when he is awake he does like to have company and interaction. The staffing at the nursing centre does not allow the caregivers to spend much time with anyone. I plan to be in touch with the centre on the phone daily to get a report of progress and can continue to post any news. Please let us know if you have any specific questions to ask the doctor or therapists.

Dad moves to Transition Care Unit

Dad continues to make slow but steady progress. He is eating more, even though he is still not very wakeful most of the time. He seems to have difficulty talking (very soft and not clear) when he is awake. He is on Tylenol for pain now, no narcotics. He was able to work with the PT a bit more (moving his legs), but still cannot sit up long without support. He was also repositioning himself on his own though. He was given a suppository and successfully had a bowel movement, which is why the doctor said he was ready to be released from the hospital to the rehab centre in the afternoon. During his 2nd PT session at the hospital, he was helped to a standing position. He didn't seem to experience as much pain during this, but couldn't yet stand on his own. He was transferred around 4:30pm. The new facility is just a couple of blocks from the hospital. Barb obtained copies of all the hospital reports so that we have a complete record for the future.

At the new centre, we began the process of helping the new staff get to know Dad. We made sure to review the medications as it seems his record includes quite a long list of things which we are not sure when they were ordered (many are just 'as needed', but even so we want to minimize the different drugs if possible). His vital signs are all very good. He is on oxygen for the moment, and was diagnosed with pneumonia so he is receiving antibiotics. At dinnertime, we tried to get Dad to feed himself for the first time. He was as usual VERY hungry. He held the fork/spoon and tried to feed himself, but is not able to lift it all the way to his mouth. Barb and I helped him with each forkful and he ate 100% of his dinner: beef/vegetable stew, lentil soup, pears, chocolate pudding.

We will return this morning, hoping to catch the therapists when they come to do his initial evaluation. I will be returning to Vancouver this evening.

Monday

When we arrived this morning (after 9), the physical therapist was just finishing with Dad. He wasn't responding very much. They said they would be back later. Dad actually started to wake more a bit later, so we were very relieved. He was able to eat some oatmeal and drink some juice. He responded with nods or yes when asked if hungry, and started opening his eyes much more. Both Dr. Park (ortho surgeon) and Dr. Lai came by. Dr. Park said that his leg was fine to stand on and from that point of view he was ready to leave the hospital for intensive therapy. Dr. Lai told us his blood count was still a little low. During his exam, Dad cried out when the doctor was palpating his stomach area. Not sure what the reason for that was. Dr. Lai came by after we had seen Dad waking, so he said he would come back later and maybe he would be able to be released to the transition care unit (therapy). PT returned around 11:30, and saw that Dad was now more alert. They began with leg exercise and noted that he was resisting (flexing muscles) and responding to commands to move sometimes. Unfortunately, not having had any pain meds for over 24 hours, when they moved him to the side of the bed to sit up, he cried out quite a bit. He remained sitting for a while, but he was looking down and it was difficult to get him to hold his head straight. After they finished, we asked the nurse to get him some pain meds. we decided on vicodin instead of morphine and gave it to him crushed in applesauce. He finished the applesauce, but after that became quite sleepy. Barb and I left to have lunch, and when we returned he was quite sleepy still. We could get him to rouse a bit, but not really eat or drink much. Clearly the drugs were making him sleepy, plus perhaps the effort of sitting up. Barb had to return home for Dylan, but I stayed through the afternoon until after dinner. He was mainly sleepy all day. He would occasionally rouse (I would talk to him and gently shake him every 15min or so). By 5 he was a bit more awake and I fed him some more applesauce which he took well. At dinner, he ate several bites of pulled pork, some cheddar potato soup, and mashed potatoes. We discussed with the nurse to admnister tylenol for pain instead of vicodin if he requires it, and we will ask that he get some before the next PT. We are hoping he can move to the transition care unit tomorrow.

Sunday Update

Barb and I visited Dad around 5pm, Sunday. He was still sleeping, and the nurses said he had not really woken, although when moved he did sometimes groan or grunt. They were giving him blood, due to readings from a blood test earlier, and his face was flushed. He also still had a small fever (99). Barb and I tried to get him to wake by talking, gently shaking or rubbing him, even using a cold compress on his forehead and neck. We gave him oral swabs with water to help relieve his dry mouth, and with some prompting, he did suck on it. He seemed to rouse slightly sometimes, making facial expressions or moving his mouth, but did not open his eyes. We will visit again later this morning, hoping that he is beginning to rouse more.

Post-surgery update

Barb and I visited Dad yesterday around 11am. He had been moved from the recovery area to his regular room. He was having an ultrasound to look at his heart. Apparently there were some possible indications of an enlarged heart which the internal medicine doctor wanted to get more details on, to see if there may have been some congested heart failure. We spoke to Dr. Lai that morning as well and he explained what he was looking for. It appeared that there wasn't anything seriously concerning after the ultrasound. Dad came in and out of sleep while we were visiting over the next 3 hours. He was given some morphine to control pain, and seemed to be relatively comfortable and not complaining too much - although a couple of times when asked how he felt or was doing - he replied 'pretty bad'.

There is concern after surgery about digestion, so we first fed Dad a cup of ice chips to make sure he could swallow properly and that his stomach would tolerate intake. He was then only allowed to have a clear liquid diet, so lunch consisted of chicken broth, juice, jello, and sherbet. He was quite hungry and especially thirsty. Even though he was sometimes half-asleep, we could rouse him and he would usually respond yes when asked if he was still hungry, so he went through most of what was provided. He occasionally had some difficulty with sucking on the straw (chewing instead of sucking), but still managed several cups of juice/water. In fact he downed almost a whole can of Gatorade in one go (resulting later in quite a large belch!). Even though he was responding to us, it wasn't clear if he recognized us at all.

We asked about probable timeline of recovery care and were told that once the surgeon assessed him post-op, he would determine when PT would try to get him up and assess a course of rehab. Assuming all is well, he would likely be transferred to a transition care unit for PT/OT work. Difficult to know how long that would last until they see how he proceeds, and therefore when he might be released back to the care home (where he could still get some in-home therapy). We'll get more details as we see how he does.

We left around 2:30 or so, and then returned at 7:30, hoping that he would be able to eat more. However, at that point he was so soundly asleep that we really couldn't rouse him. The nurse said that they had been able to get him to eat some of his dinner (full liquid style - which means still all liquid but with cream soup and milk, instead of broth and juice). We don't know how much he took though. We stayed for about two hours, and although he opened his eyes once or twice, never roused sufficiently to respond much and so we didn't try to give him any more food. He had not had any further pain medication since the morning, so the nurse administered another dose of morphine. We assumed he needed to rest, being so tired from the surgery. Before we left, the assistant was taking the routine vitals (temp, pulse, oxygen, bp) and discovered he had developed a fever (101.6). He didn't feel exceptionally hot, but the temp was retested and he clearly had elevated temp.

We returned this morning just before 8, hoping that we might see the doctor doing rounds, and also assuming he would be more alert after the night and ready to eat breakfast (now a 'soft' diet, including oatmeal and custard). He was in pretty much the same state as he had been when we left - soundly asleep and we were unable to rouse him with talking and gentle shaking. We inquired if he had roused at all during the night and were told no. All of his other signs remained good (bp, pulse, etc.). His fever had continued, but just before we left when it was tested, it had reduced to 99.4. Because he has not shown any further signs of pain (even when his position is shifted by the nurses), no further pain medication has been given. The doctor had prescribed a single dose of vancomycin (1000mg) earlier in the evening for the fever. We decided to return home and asked the nurse to call us if he showed signs of being more alert, and also if either of the doctors visited.