Out of IICU

    Dad has been moved out of Intermediate ICU again, this time we hope for good. It means a longer trip to dialysis, but hey, they have elevators. We still haven't heard further from the social worker about how long he's staying in the hospital nor where he's going next, but neither are we in any hurry.
    Yesterday was another good day. He was singing to Margaret a lot. I got to talk to the speech pathologists, who seem to have figured out finally that it isn't a good idea to feed Dad when he's trying to sleep. And we talked to the dietitian. She said that Dad's albumin levels are low, and asked if he wanted to go on a supplement or get more food. He said, "More food!"
    We also asked if there was any way his diet could be more varied, as he had gotten literally the same meal for lunch and dinner the previous day. She suggested that since he's on dialysis anyway, he probably didn't need to be on the renal diet anyway and went and checked with the nephrologist. She agreed, so his diet is a lot less restricted. We also asked if they could send the food closer to mealtimes instead of two hours before and she agreed. When supper arrived later his portions were doubled, and he pretty near demolished the whole thing. Huzzah!

Relief (again)

    Sometimes it's more pleasant being a broken record than other times. Yesterday was a good one. Dad came back from dialysis literally singing "I Feel Good." To say that this is unprecedented would be an understatement. There was no mention at all of dialysis being an ordeal, but necessary. He was cheerful, if tired, all day. (Tired after dialysis is normal. The previous day's tired before dialysis was what crossed us up.)
    Granted, he waited two hours to tell the nurses that the dialysis people had told him he needed to be cleaned up, which is either a lapse in attention span or in self-care, but he did tell them. And though he didn't pay really close attention to the national championship game, he woke up enough to side with Malcolm in a minor argument we were having about our starting pitcher's rest days. (I capitulated immediately, of course.) On the whole a good day, and we're feeling much better about the idea of him leaving the hospital.

Roller coaster day

    Yesterday the Palmetto Baptist social worker (or in any case Dad's social worker) Rachel called me saying that he is ready to move on to a nursing home for rehabilitation. The way she phrased it ("Medicare will pay for nursing home care") suggests that his Medicare coverage for hospital care is running out.
    Sunday had been so great that we figured that we were past every crisis, and rehab could proceed smoothly. It wasn't so much that yesterday was awful. He was just so incredibly tired all day. The speech pathologist tried to feed him lunch but he was pretty much falling asleep chewing. He eventually choked on the food in his mouth and didn't want to eat anymore. She tried to get him working on tongue exercises, but he fell asleep doing that, too.
    Cardell the nursing tech said that he had given Dad a bath and maybe that tuckered him out. Also it was day 7 of Dad's three times a week dialysis schedule. We were hoping that would be the best day (two days off of dialysis) but it didn't turn out that way. By evening, he ate his supper (with help from Malcolm) pretty normally, and he watched part of the ballgame. But generally he was still pretty sleepy.
    A doctor had come around in the afternoon. He turned out to be the head of internal medicine for the hospital (Dr. Emmer); he suggested that they had been planning to move Dad out of the IICU today. However, since he wasn't doing too well, this idea was shelved, and Dr. Emmer said he would keep poking around trying to find an explanation for this puzzling exhaustion. I never heard anything else from him, however.

What my cat taught me

    Amelia is a fraidy cat. She's afraid of everything and everybody. But at the old place, where the back door was a French one (or anyway looked like them), the outside kitties could come right up face to face with her. And Amelia showed them down every time. The bigger, meaner kitty never bothered to defend hearth and home; it fell to little, scaredy Amelia.
    I guess I had learned it already. When things in my life went totally sideways previously and I had to act like a grownup, I didn't like it but I did so. And I remember about that time we had a snowfall and the periwinkles were blooming, and the periwinkles stood up among the snow. The young woman I was seeing about that time who called me Periwinkle thought it was just because of a funny word. But it was because of the days when a man without courage showed courage. Like the cat he would know later.

"It's an ordeal, but it's necessary."

    The above is my Dad's attitude, stated often, toward dialysis. I like and admire this attitude, and am proud of his fortitude. Yesterday's bout didn't quite take as much out of him as the previous ones did, but he was still fairly tuckered out. Still capable of feeding himself, making his own phone calls, etc., so that's pretty neat.
    Brother Malcolm stayed over here yesterday afternoon for a nap and a shower. Amelia the cat didn't panic noticeably, possibly because Mal and I resemble one another (and our dad, not that that helps Amelia) strongly. I didn't ask if Amelia had pined for me as in the old days, but I'm pretty sure she didn't. She naps when I'm leaving and she naps when I come back; not a lot of scope for pining there. Hey, maybe even Amelia's growing up.

Common sense breaks out

    The physical therapists came around for Dad again yesterday and were all set to try to get him to stand again. Although I'm in favor of this idea all the way, I didn't want to have his rectal tube fall out again and have him have to go through another reinsertion. So I suggested rather neutrally that it would be neat if he could do exercises in bed that would simulate standing, and Tim, the head physical therapist, agreed and did them with him.
    Tim was very impressed with the strength in Dad's legs, so we are very well pleased with that. Tim also told us a funny/sad story about a guy on the sixth floor recovering from a knee replacement who wouldn't participate in PT due to crankiness from not being allowed to drink. Since the PT was essential to his recovery and had to be done immediately, the doctor wrote him a prescription for six light beers a day. Not an ideal solution, but it got the job done.
    Dad also got a visit from another specialist; I thought she introduced herself to me the other day as a speech pathologist, but regardless of title, she's the one who decides what he can safely swallow. She checked his ability to control his tongue and was also encouraging... but wants him to stay mostly on pureed foods. He doesn't seem to have any particular problem with this.
    The rectal tube stayed clean for over 24 hours. I mentioned this to the techs (student nurses) and they mentioned it to the nurse. After I left, she came and checked and found him to be rather clogged up. Not to be too graphic, but (brother) Malcolm reported that the situation was uh, rectified. At the moment, Dad is in dialysis so we don't get to see him until this afternoon.
    In general, his spirits continue to improve. He uses more and more of his hepcat catchphrases. Last night when I left, he went decidedly un-hepcat and told me "Good night, sweet prince." I told him same to you, most decidedly.

Mixed day

(Warning: WAY too much information)
    Dad's dialysis wasn't until the afternoon, which allowed him to have breakfast (though he said he had to fight for it) and lunch. He also had physical therapy again and was able to stand (a plus) but lost the rectal tube (a minus). And then of course the transportation guys showed up for dialysis and wouldn't wait for him to have another tube inserted, or even for him to be cleaned up. So he had to be fouled for the next four hours (since that's how long dialysis takes).
    Upon his return, he had to be cleaned and have the new tube inserted. Try to arrange your life such that you're never present for such an operation. Unfortunately, it took two tries and two nurses. But then he was able to eat supper. His spirits were quite good, especially under the circumstances. By the time I left, he was resting comfortably. On the whole, a good day. While we were very sorry about his profound discomfort, we were very happy that dialysis had no clammy aftermath like Tuesday. And while the physical therapy had unfortunate consequences, it was good to see him standing. So a mixed day, but positive on the whole.