Thursday, April 29, 2010

Better day today

Dad was doing much better today. First I stopped by around 10:30 to say Hi, offer him a banana and also to give him an Advil prior to the physical therapy scheduled for 11am. (Dr. Park, ortho doc, had said the Advil would be fine and worth a try in addition to the Tylenol he gets each day.) He went right for the banana, and took the pill with a cup of water. The caregivers reported that Dad had stood for several minutes earlier in the day during his morning hygiene.

I went on a brief errand to deposit Dad's homestead hills check in his account (Wells Fargo now, not Wachovia) and then returned to meet the new physical therapist. Her name is Lucinda. Dad seems to like her. She developed a fairly good rapport with Dad (she asked him about NC...when she asked him what city, he responded "Winston-Salem". Lucinda had done some work at Baptist Hospital and commented on how big that hospital is.)

She proceeded to start with some leg exercises while seated in the chair and Dad participated, even counting. He required some prompting, including physical help with the leg lifts, and also to keep his eyes open, but a definite improvement from Tuesday. We then proceeded to working on standing, which we did utilizing the electric chair to raise him up significantly. He did it 3 times total, but he was leaning a great deal on his right side (onto Lucinda...I was helping him on his left.) He didn't seem to want to stand up straight. After the last stand, we sat him in his wheelchair and again he went right for his lunch at the table with the others. Note that the therapist doesn't think Dad is feeling a lot of pain, and her initial assessment of his reactions when attempting to move him is more fear-based, which she said is quite common.

I returned around 2pm to meet with Haydee with whom I have arranged a schedule of 2 hours (1:30-3:30) Tues/Thurs in the afternoon (she works close by from 8 to 1pm so this works well for her.). When I arrived, she had Dad playing cards on a lap-style table in the recliner and he seemed quite engaged with the activity. I proceeded to show her the same leg exercises the therapist had shown me in the morning. We asked Dad if he wanted to stand, and he said yes. I used the chair, but didn't raise it to it's max. When starting, Dad again expressed concern, but it was more like "Do you think I can do this" as opposed to "I can't do it!" --- with Haydee's reassurance, he did it. This time he stood much straighter than he had in the morning, and even wanted to initiate some steps. He moved a couple of steps forward, and then we had to prompt him backwards to get back to the chair. We did it a 2nd time, and this time he was standing quite well---I went to get the wheelchair (replacing it for the recliner), so he could sit there for awhile. About that time, the home health nurse arrived to do some basic follow ups (BP, oxygen, etc. ) BP was good and his O2 was 99%. She said she will probably come one more time next week and then discharge him. Before I left, I asked Haydee if she would take Dad outside for some fresh air, so that was her plan. I had also brought him some choc chip cookies to hopefully enjoy.

During the leg exercises, by the way, I watched Dad watching Haydee, with a grin on his face. I feel optimistic that her visits will be the right "medicine" for Dad. Also, I heard back from Dr. Gee who agrees with the increase in his prozac from 10mg to 20mg. I also like the new PT. I will try and be there to assist for all the therapy sessions. She is coming back tomorrow, and then we have MWF scheduled for next week.

I have posted an ad on sittercity.com to see if I can find someone to help with the morning shift as discussed in the previous blog.

Tuesday, April 27, 2010

Dad is "downcast"

I had my meeting with Janice at Emerald Isle this morning. She shared that generally the caregivers are able to get Dad to stand briefly when getting up from the automatic chair, but will not assist with getting up out of bed and other chairs. Thus, they are using the lift often. Also in the morning while in the bed, when Dad is having to be turned to remove his pants/diaper, etc, he will often reach out and grab the arm of the caregiver, rather strongly, and sometimes causing a scratch. We brainstormed a bit and set forth a plan to see if we'll be able to get Dad back to the point of assisting more with transfers. We are going to pursue finding someone (that Dad would pay privately) to be a one-on-one with Dad in the mornings, say from 7 to 11. Duties for this person would be first of all, hopefully a friendly face, devoted to Dad to encourage him to do the leg exercises in bed, encourage him and assist as needed to get Dad out of bed, morning hygiene, etc. After breakfast, this person could take Dad outside for a bit (warming up now), try to initiate games and/or just be there to converse with. If things improve physically for Dad, the person could try another session of leg exercises and/or walk attempts. Janice said the owner might know of some individuals I could interview. I also put a call into Haydee---she is not available in the mornings, but has a friend who might be interested that I can talk to as well. I also talked to Haydee about having her see Dad for a couple of the afternoons that she is free for a few hours, as another friendly face and someone who can potentially get more activity from Dad.

As i mentioned in the last blog, I do sense withdrawal from Dad...more and more I'm starting to realize that Dad may truly be depressed, which is of course understandable. Today, after my meeting with Janice, I sat down with Dad. Started by trying to show him some of the numerous cards he has received (boy our cousins are sure good at sending nice cards!) He was in the mode of keeping his eyes closed for the most part, occasionally responding. Based on some of his responses, I again was sensing that he could definitely hear me, but didn't really want to respond. One time I asked him if he knew who I was. He said Yes and then I asked him if he knew my name, he responded "Suzie." At one point I had asked him how he felt and he responded "I'm a bit downcast." Tried to inquire more but go no response. Later I asked the same thing and he said "I'm downhearted." When I pressed for more, he sort of mumbled but nothing intelligible. At one point during the discussion, he even got angry, squeezing my hand tightly and saying loudly and repeatedly "Because of me, Because of me, Because of me!" In continued to try and console him, let him know I loved him, wanted to help him, etc. At one point he said he wanted to try and stand up to go eat lunch, but even with the automatic chair, he didn't want to attempt to stand at the walker, and even had another burst of anger when standing saying he's trying (though he's actually pushing back, not standing.) Eventually the caregivers needed to use the lift to move him into the chair. On one positive note, once he was moved to the table, he immediately grabbed the spoon and dug into the nice hearty bowl of soup in front of him (with a bowl of fruit on the side.)

I put a call into Dr. Gee to discuss this more (out of office until tomorrow pm) and I spoke this afternoon to my good friend's husband (Palliative Care doctor, head of the department at the hospital, heads the Hospice program), with whom Dr. Gee works with and knows well. My friend Glenn says of course to consult with Dr. Gee, but he thinks it's probably worth a try to increase Dad's prozac dose (he is currently on 10 mg, considered a low dose.) He also said to check with the doctor on the Aricept dose and consider increasing that as well. He pointed out that more than 50% of elderly that suffer a break like a hip or other die within a year of the accident, however, considering Dad's appetite and other things I mentioned, he didn't think that he would be considered eligible for "hospice" yet. Glen let me know that if Dad does take a downturn, first of all, we need to discuss whether we would want Dad to go into the hospital or not to be treated (for example, if he developed a UTI or a pneumonia, we can opt to provide in-home care, nurses and such that can offer oral antibiotics, pain management and comfort, as opposed to admitting him to a hospital for more aggressive treatment and IVs.) I'm assuming we would want to do the former, but of course want everyone's input on that.

Glenn also talked about the possibility of considering more intensive pain meds (given at really low doses---methadone is what he has done quite a bit in this kind of situation) at some point. If Dad continues to be less mobile, that would make Dad more comfortable for the caregiver routines of turning him, changing him, etc. He's suggesting we first try increasing the anti-depressant to see if that makes a difference. If we're not successful with that, he actually volunteered to come to Emerald Isle to see and assess Dad to help Dr. Gee in establishing the need/level/dosage of these pain meds.

I also heard from the PT today...the previous gal is still on a medical leave, so I have an appt with her/Dad for PT on Thursday.

Today in my conversations with Dad, I did ask him if he would like to see a priest a couple of times. I didn't get a response, but will continue to ask him that in the future. One of the cards, from Bobby Telesca I believe, had some prayers in it that I read aloud to him.

Saturday, April 24, 2010

Dad this week

Overall, it appears that Dad has regressed a bit in this 2nd week back from the rehab unit...he is wanting to participate less and less in therapy and helping with transfers and such, thus the caregivers are needing to use the hoyer lift. This then becomes a bit of a vicious cycle in my opinion because I believe Dad is uncomfortable with that as well as when he needs to be lifted by the caregivers (sensitive and sometimes crying out with even the slightest touches), and thus he resists even more, making it all the more difficult to move him.

Here is a brief summary of my experiences for the week with Dad since last Friday when I was there with the therapist and we had fairly reasonable success doing exercises with Dad (while sitting) and getting him to stand up with walker in front of him (using electric chair that lifts him.) At that point, the caregivers may have used the lift once or twice during that 1st week.

Sunday---brief visit to deliver medication. Caregivers reporting that Dad would not stand for transfers so needed to use lift.

Monday--therapy with PT...PT reports that Dad seemed to have more difficulty with the standing and less willing to participate.

Tuesday--PT called me in the morning to say she had to cancel with Dad for the day to personal health issues. She mentions that perhaps Dad needs stronger pain meds. I was contacted in the morning by administrator Chris who is concerned that Dad is not participating because he is in pain and that's why he's not participating. She's suspicious of problems with surgery site and is anxious for Dad to follow up with ortho doctor and have an xray. He has a scheduled appt for Friday but I put a call into the doctor I went to the house around 1pm and was there with other administrator, Janice. Dad is more receptive to me and Janice at this visit and we were able to get him to participate in some leg exercises while in the chair, as well as coming up to stand at the walker 3 times. When he is standing, he is only bearing weight on right leg...he has difficulty shifting to put any weight on left leg and wants to sit back down.

Later after I got him, the doctor returns my call and is doubtful there is a problem with the surgery site. He mentions that it doesn't seem too unreasonable that Dad is still experiencing some pain just a little more than 3 weeks since surgery, particularly since he was not that active before. Says it's not necessary to push him too much with therapy at this point, though obviously good to get him using his muscles as much as possible. We also talk about the trade-off between going with stronger pain meds vs the narcotic effect. Suggests tylenol should be adequate (note tylenol with codeine is prescribed and available as needed...caregivers have given it once or twice and no noticeable differences were noted.)

Friday--I went to meet the wheelchair accessible taxi at Dad's house around 9:15 for his ortho appointment. At the appt he required 2 big guys to help lift him onto the xray table. On the table they were trying to put a wedge on one side of him and we were trying to ask Dad to roll a little to his side---when he didn't do it himself, as the technician (and I) tried to help move him, Dad went into his "resistance" routine...He pushes back in the direction of what you're trying to do. Also his face clenches and he sticks his tongue out in an odd way from his mouth. Everyone was doing their best to calm him---it appears to be a very defensive maneuver as if he's dreadfully afraid of something. It's very disheartening to see it. Xrays showed everything was fine. When doctor came to see him, Dad was pleasant, but for the most part would open his eyes to speak to the doctor and/or respond to his questions or to me when I talked to him, but then he would just close his eyes, fold his hands and rest. Doctor and I discussed that we obviously want to continue with as much therapy as possible, but understands the difficulty for Dad to participate with his dementia. He still thinks tylenol is adequate (and better than narcotic if not needed) but also said we could Advil in between if desired.

Upon the return to the house, Anna the caregiver was mentioning how difficult it has been for the transfers and that the morning routine is quite difficult, particularly on Thursdays when it's Al's day off. She said they really don't have the time to do the leg exercises that the therapist had left papers on to be done daily, particularly when it's difficult to get him to participate.

After our discussion, I spent some time with Dad again trying to do exercises, focusing first on just trying to get him to lean forward. His pattern is that he sits in the chair, often leaning to his right side and just digs his back into the chair. Any touches to his arms or back to encourage the leaning forward invokes an "ow" or facial clench described above. With a LOT of verbal encouragement, I was finally able to get him to come a little forward and then finally he was successful coming to a stand at the walker.

Saturday--I went to visit Dad this afternoon and try to do a little therapy again. It was a struggle...my approach as always is to verbally try to get him to be willing to participate in the therapy. He often will agree, but as the attempt is made to move to a stand, he resists and then pushes back. Note that I NEVER force him to do anything, but am offering a lot of verbal encouragement. Today he would start and then say "I can't do it" several times. I respond that I know he can, he is strong, he did it yesterday, etc. At one point I asked him if he was giving up and he said yes. Eventually he did stand up, which was helpful as Al then brought the wheelchair behind him so he could eat his dinner.

I clearly have concerns and questions about the best way to move forward and am fearful about Dad's future and the best way to care for him. I do fear that Dad is giving up and if that's the case, how do we care for him?

I had left a message with Janice, the administrator who called me back a little while ago. We both agree that the ideal minimum goal is just to have Dad willing again to at least stand and support his transfers to make his care easier, and also to avoid the vicious cycle I mentioned above. She did not mention that assistance was necessarily needed, and also wants to talk to the caregivers about doing more with the exercises so Dad will get stronger and at least stand. But she said if he doesn't do that, they will have to use the lift and seemed to be taking full responsibility for caring for Dad no matter what. It eased my mind a little bit because based on some of my prior conversations with the other administrator Chris, I had concerns that perhaps Dad was too hard to handle. I did mention to Janice that I am willing to pursue hiring additional help that could be an extra set of hands that are dedicated to Dad to hopefully give us a better chance of having Dad meet this minimum goal. In my opinion, it does require the right personality, particularly someone with patience as again I think motivation is the key here and it's more important to take the time to get Dad to agree to help himself than just another set of hands to help lift him from point a to point b. Anyway, Janice and I agreed to meet on Tuesday at the house, talk to the caregivers about what they are seeing and the difficulties they are having and try to develop some strategies for moving forward.

Note that It has been a little confusing with me as far as which administrator is responsible for what (Chris vs. Janice) but Janice let me know today that she is the main point of contact for the residents, so she is the one I'll be dealing with (which I'm happy about.)

i'm sorry to be reporting these difficult circumstances. Perhaps Dad just needs more time and things will look better next week...I certainly hope so, but am not that optimistic. Everyone's input and/or suggestions welcome and appreciated.

Saturday, April 17, 2010

Dad's Recovery at Emerald Isle

I have been to see Dad every day this week since his discharge from the rehab, all the while coordinating with the doctors and Emerald Isle administrators, filling prescriptions, and working with the physical therapists and caregivers on Dad's rehab and hopeful return to pre-fall abilities.

As Justine reported for me, Dad is looking so much better since returning to EI. I'm usually seeing him in mid to late morning, after he has received his morning shower and breakfast. He just seems so much more comfortable and relaxed and has been much more alert and responsive than how he was in the rehab. I really like the physical therapist (Lauri Malloy) ... from the 1st day of therapy (Tuesday), we identified the need to ensure Dad's "buy-in" so to speak in participating in the therapy. I believe that in the rehab, despite the best efforts of the PT Kristen, Dad just was not comfortable with all the shifting, adjusting, poking, prodding that typically goes along with 3 shifts of workers a day, and he developed a fear of moving (understandably due to pain that he had experienced) and truly resisted most efforts to get him up and around (in fact would push back any attempts to even lean forward for example). Furthermore, he seemed to want to sleep all the time, or at least keep his eyes closed (shutting out the world in my view).

Anyway, he is now participating in the PT, thus far standing up from a chair (they have an electric one like Mom's, so they are using that to boost him quite a bit) up to his walker (with arm support on either side helping him up), standing for a period of time, and taking some small steps. The caregivers are reporting that he is usually assisting similarly when going through his various transfers during the day, including shower time, though sometimes he is doing the "ow ow" thing and is getting more of a lift from the caregivers. When I saw him yesterday with the PT, he clearly was showing difficulty or at least not wanting to put much weight on his left leg (same side as broken hip). We are trying to sort out the use of medications to ensure minimal pain, while at the same time not wanting to knock him out. For the most part, he is on a regimen of Two 500mg regular Tylenol, every 6 hours. He was also prescribed Tylenol Codeine as needed for pain, so we (therapist, EI administrator, myself) have been talking about using that 1st thing in the morning to help with the morning hygiene routine and subsequent therapy session to see if it makes a difference, Note that the caregivers (Al, Juana) are fully engaged while the PT is there as well and Lauri has been instructing them on exercises to do with Dad, as well as reinforcing the idea of being patient with Dad, communicating with him what they want/need him to do, and getting him to participate, which seems to be going well.

Also when I was there yesterday I tossed the ball with Dad....therapist was trying to get Dad to raise his arms over his head and he wasn't quite getting it so I showed her this activity which we've been doing with him for the last year. She was pleased to see how engaged Dad was in that activity and encouraged it. We also tried putting it at his feet and asking him to kick it, which he did very slightly with his right foot. He also participated in raising/lowering both legs, both with knees bent and legs extended. We witnessed evidence of more pain in his left leg, particularly when trying to raise the bent knee.

In addition to the PT, who will be seeing Dad 3x/week, the doctor prescribed a home health nurse to come out to administer an injection called Zestril. This is a precaution against clotting which can be common in post-surgical patients. Dad is on a fairly small dose, 2.5 mg, and he will receive it for 7 days.

Thought I'd post a separate note describing Dad's remaining meds to serve as an easily searchable as needed source of info in case needed for the future for whatever reason.

Dad has a follow-up appointment with the orthopaedic surgeon next Friday which I will take him to.

Finally, got Dad's taxes submitted (after having to recreate since having my computer stolen...much easier though as I had documented quite a bit and had some printouts done as well.)

Wednesday, April 14, 2010

Dad returns home to Emerald Isle

I spoke with Barb and got an update on how Dad is doing. Barb saw Dad on Sunday, and saw that there did not seem to be significant progress in his recovery. On Monday, the doctor at TCU recommended discharging Dad from their care and Barb agreed. It just seemed that Dad was very unhappy and confused there. He was not able to understand what was happening so seemed to be resisting any attempt at therapy. Barb reports that since his return to Emerald Isle, things are looking up considerably! The home is more familiar and much calmer than the rehab centre. When they arrived in the evening, they had saved dinner and he quickly dug in to the meal when seated at the table. The caregivers are adjusting to his new needs but still able to manage getting Dad to the toilet and to shower for cleaning. When Barb visited on Tuesday he was sitting in his wheelchair and looked much fresher and responding to her. She worked with the new homecare physical therapist, who reported after the first visit that she was confident that Dad will be able to progress and eventually walk (with assistance). The PT will visit 3 x a week for the time being. She said when she visited this morning he was even more alert. Barb will post more details later. She is very busy right now, not only with getting Dad settled, but with finishing off his taxes, and attending to other business after her holiday. She certainly enjoyed the vacation, but sadly had her computer stolen which has added more tasks to her 'todo' list the past few days!

Saturday, April 10, 2010

Friday update

Today I spoke with the nurse who does the afternoon/evening shift. She told me that yesterday they saw that Dad had not eaten a lot and woke him up at 8 or so, reheated his dinner and he ate it. They are still feeding him most of the time, though. The doctor was in on Friday (Dr. Sheedy) and ordered the surgery staples removed. I also spoke with Kristin, who told me Dad was very sleepy both times that she went to do therapy. He kept his closed most of the time and didn't really talk to her. She discovered that yesterday he didn't actually get the stronger medication. He was given it today, and she thinks it may indeed have made him sleepier. In any case, she wasn't able to get him to do much in terms of moving himself. She says he will start to move his legs, but then stop and not respond when asked to continue. I asked about the next Team conference and she said it is scheduled for Thursday. I do find it rather confusing trying to get a good sense of what is going on, with different people reporting. I know that Dad's state would of course be different at different times of the day - and I guess that can be the difficulty with a facility - there isn't much of a true overview. All they can do is read the reports from others. It's good though that the same PT does see him every day - even though it is only for a short time.

Friday, April 09, 2010

Thursday update

I spoke today with Kristin. She reported that the doctor approved changing Dad's meds to Tylenol with codeine. This did not change Dad's alertness during therapy, but unfortunately it did not seem to make any difference in his willingness to move. She now feels that his cognitive state may be the biggest factor holding him back. She thinks he is afraid perhaps. At the same time, she says he enthusiastically engages in upper body exercise involving throwing/catching a ball, so I wonder if pain is in fact real. She did however raise the issue that they expect patients in this rehab centre to be progressing more quickly in their therapy - the average stay is 10 days. If he is assessed to be 'plateauing' (or not progressing), they will recommend moving him out. She is very sympathetic and wants to keep working with Dad if she can. She hopes the new meds will help in the next few days. She suggested that one of the issues is that the policy about 'plateauing' is governed by the insurance coverage. She suggested talking to the Case Manager (Suzanne - hope that's a good sign) more about this area, when I said I thought Dad's coverage would be better than most. Suzanne will not be available until Monday, however. I also spoke with Haydee tonight. She said Dad was more sleepy today than during her previous visits. He didn't finish all his dinner, and she had to help him eat most of it. She said he did take the ice cream and fed himself to finish it off though. She confirmed that he does not want to move much, and she thinks he may not be able to get back to walking on his own as before. If he does it will take quite a long time of therapy. I know this is not really what we are hoping to hear, and it is still early days yet. I think we need to take one day at a time and continue to work toward full recovery, but may need to accept that Dad could be entering a different stage of ability and consider mainly how to ensure he is as comfortable and happy as possible.

Wednesday, April 07, 2010

Updates for Tuesday/Wednesday

I wasn't able to call yesterday, so got an update today for both days. According to the nurse, Dad is now able to feed himself and eating 100% of his meals (no surprise there!). They have removed the IV needle, since he is no longer receiving the antibiotics. His blood work showed some improvement in levels of hemoglobin. He was transferred from the bed to chair today for a while. In speaking with the therapist she indicated that she is concerned that his pain meds are not working sufficiently. He is clearly in pain and not wanting to do the therapy because of it (although he does cooperate when asked). She talked to the nurse and suggested we consider something stronger. Dad is now very alert and she said he participates in throwing a ball quite willingly. I told her we had been concerned when he was so knocked out after surgery and receiving morphine, but now that he has become more alert would be willing to have the doctor try something stronger so that he is more comfortable during therapy. There will be a team conference tomorrow where this will be discussed. I will speak with the nurse or with Kristin tomorrow to see what they decide.

Monday, April 05, 2010

Monday

I spoke with Kristin, the physical therapist. She worked with Dad only once, after lunch. She says that Dad still has pain in his hip, notices it primarily when shifting him on the bed to a sitting position. Dad is generally confused and does not know why he is in pain. She thinks this may make him more anxious and resitant to moving. I asked if she knew if he was getting the Tylenol on time, and she said yes. She says he does have the strength, and when finally positioned (sitting or standing) is not in pain. He is unable to take steps, however, so today she put him in a standing frame, rather than go to the gait training area. With the standing frame he can hold himself up and put weight on his feet for several minutes at a time. I spoke as well to Carol again. She reported that he is doing well, eating and having regular BMs. He does sleep a lot of course. Dr. Lai saw him today and ordered an injection to reduce potential for blood clots (as he is lying down so much still). He will get more blood work done on Wednesday.

Sunday

The nurse said that Dad was up sitting in a chair today for a few hours. I asked about alertness and she said he was more awake, but had gone back to bed after lunch and was sleeping. There is no PT on Sundays, so nothing to report there.

Saturday, April 03, 2010

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, April 02, 2010

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, April 01, 2010

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.)