The Decomposition of Healthcare – Part 4 Discharge

My experience in the NRGH just re-enforces my resolve to push the federal Minister of Health’s position that “transformational change” is needed.  Our current system is broken beyond repair.  One has to question, at what point do you stop using body filler to keep your battered and beaten automobile looking good?  Healthcare is no different.

I grew up in a system that was more akin to the Cider House Rules kind of facility.  It was community and not tax dollar focused.  Today people expect at least a St. Elsewhere or better a Chicago Med type of institute.  People see these wonderful institutes on the weekly episode of their favourite show slowly letting the lines between entertainment and reality get closer together.  If we really want that level of health care run solely on tax dollars, that transformational change has to start happening quickly.  Anyway onward and upward…

Day six I made my first transfer into my wheelchair.  I was still getting IV antibiotics every six hours but each of those were over in fifteen minutes so by day six my leg had improved immensely.  It was still tender, rosy but not as red as when I was admitted and the swelling was down considerably (skin starting to scale and itch).  It was time to start planning for discharge and that meant initially building some endurance back in my wheelchair.  See how having the leg hanging would affect it.  My doctor agreed but also insisted on transfer supervision for the first while.  Fine with me.

Now here’s we get a little bit into the understanding of functional ability.  Like everything else I do momentum is an important factor but, I am learning, most people don’t noticed that, they just see the motion, not so much the action.  So for my first transfer I had the care aid lower the bed so it was even with the seat of my wheelchair and she would need to keep my leg from falling when I transferred.  I knew the momentum of the transfer would jump my leg off the bed at which point the care aid would grab the leg and let it down gently.  After all I don’t have the muscle to do that, part of the nature of someone with lower limb muscle control so we adjust our “functional ability” to accommodate.

So, to borrow a line from the Rocky Horror Picture Show, it was a “quick step to the left and jump to the right” would put me in my chair easily.  Apparently the care aid had thought I would tell her when to grab my leg while I had assumed she would know following my momentum shift from the bed, which left my leg flying through the air like a cowboy on a bronco at the Calgary Stampede, would be a hint as to that was the time to grab the leg.

Anyway it worked out and after exploring my freedom I realized right away I had to get home.  This was re-enforced when I saw the bathroom and realized I was still stuck on that bedpan (speaking of the Stampede above also shaped like a horseshoe).  I was able to go from 30 minutes in the morning to almost two hours that evening being in the chair so improvement was happening.  I had given up on transfer assistance after transfer three.  I could do it on my own, the staff was busy and the reality was there would be no one once I was home.  So it was time to put my big-boy pants back on and head home.

Monday I discussed the plan with the doctor.  This would mean discontinuing the IV meds and changing me over to an oral which was fine.  Pills don’t bother me.  He did make his concern known to me about lack of support services at my home.  I’m not aware of anything I qualify, I believe I had been through this once before when I hit 65.  I thought at the time it was like one of those 10,000 km check ups but it was, in part, to see if I qualified for any community services.  I don’t but I had to go through the motions to get a discharge.  We came to the agreement that I would talk with some person from discharge planning and that the IV meds would end with the 6am dose on Tuesday.

Later that day a social worker, I believe, came to discuss aftercare service.  She did a work-up on my home situation, was everything accessible, etc, etc.  I gave her the lay-out of the place and made her aware of how much I depend on my knees.  Bathroom, shower, etc are not wheelchair friendly at all in my place but I have learnt to adapt.  I explained how I use an old crutch of mine to get in and out of my chair.  I explained how I had a whole life to develop adaptive strategies to make the world work for me.  She seemed satisfied, now where there any services she might offer me.  When I identified house-keeping as a service that would be very helpful I was quite surprised to hear they don’t see that as a health related home service.  Anyway that’s a whole other conversation.  We did our polite good-byes and I jumped in my chair to go get a real coffee (another perk to being ambulatory, the coffee kiosk downstairs).

Tuesday, now going into day 8 and the last of the IV (it should be so simple).  The doctor comes by nice visit things are progressing, give them one day on the oral meds and would I mind showing the OT down stairs how I transfer in and out of my chair.  They want to make sure it’s safe and that I am capable of taking care of myself.  He was concerned that I might wind up back in hospital i the discharge planning wasn’t done properly.  I was tempted, but didn’t, ask him what the options were because I knew, they are really nada these days.

Not long after the doctor left the nurse brought me my first oral dose of what had been the IV meds.  I asked her if she would mind taking the IV injections site out since it had been there seven days and I kind of wanted to get rid of it.  Remember that “hospital minute” I mentioned in the earlier part of this series, well here’s where it really kicked in.  I got the “give me a minute response” and Wednesday, prior to going down to the physio gym to see the OR, they IV came out.

Just a short bit left here.  Got down to the physio area and was introduced to an OT who was going to evaluate my transfer ability.  Since I didn’t have my crutches the department lend me one of those ridiculous aluminum forearmed crutches (same as mine except mine were custom made in 1977 of sprung steel nickel plated…much more stable).  Anyway I use the one they supplied.  The first thing was when the OT suggested we do this on the tumbling matt for safety sake.  She was a little resistive to me doing it on the hardwood gym floor.  The answer to that is not give them time to think, I was out of the chair on my knees before she knew what to say until I looked at her and said “no tumbling matts at my house, just hardwood floors”.  Then I jumped back into my chair saying “next”.

Poster child
The journey begins

Forty-five minutes later I was sitting in the sun awaiting the handicapped van to take me home with a one week prescription for the meds and an agreement that I would be seeing my family doctor as quickly as possible.

I wrote this because I firmly believe transformational change is desperately needed in health-care and that means revisiting what level of health-administration we need.  I became involved with the Island Health’s Patient Network believing they sere sincere about citizen input for substantive reasons, not optics.  My days of being a poster child are a good fifty years behind me.  My days of being an agent of change are still ahead of me and I truly hope the Patient Voices Network is also about acting on what is being heard…

I want to be part of a solution…

Did I mention how nice it was to get home and “shower”…a week of laying around in a hospital bed can get a little grungy so before I even started throwing out food that had gone bad during my medical vacation, I had a long hot shower…





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