The Road to Recovery - Week 15 (St. Michael's Hospital Toronto)

Remember that it's consistency in the small things 

that make the biggest difference. 

November 5/12
Alysha drinks from a water bottle.
      Today was a nice day for mother and daughter.  They shared some chicken noodle soup.  Alysha ate the broth, while Lisa ate the chicken and noodles (kind of like Jack Sprat and his wife.)  Alysha also drank water from a water bottle that Lisa tipped to her lips.  Alysha's swallowing seems to be coming along quite nicely.   Alysha practiced standing again with the tall walker.   Once more, she wanted to get walking  but was encouraged to be content with standing to build up her leg strength and stamina.

modified walker/ tall walker

November 4/12
Alysha takes some steps.
      A lovely social Sunday under the care of Ron with visits from Memere, Auntie Shell, Brycen, Aarren and Nana King.  Ron was happy to help Alysha from bed to the commode or wheel chair.  During each of these transfers, Ron supported Alysha to take a couple steps before she sat down.  Ron figures all of this standing and stepping will help strengthen Alysha's legs, "so that she can run out of this hospital."  

Dad and Daughter

Alysha, Ron and Memere

November 3/12
Alysha drinks through a straw.
     Alysha had a happy day with many visitors.  Justin came to see his sister along with Nana, Lisa, Abby, Jason, Chrissy, Noah and Jacob. Ron was with his daughter for the day.
     Alysha sucked up some cold beverages through a straw.  She was going to town sucking and swallowing until finally Lisa commanded the drink holders to, "get the straw out of her mouth."  Lisa was worried that Alysha was going to overwhelm her stomach with these fluids after it has had nothing of any volume in 15 weeks.  Lisa feels more comfortable with Alysha increasing the volume of food and fluid she consumes slowly.  Alysha on the other hand, is wanting to speed through this process. Bring on the hamburgers!

Brother and Sister

November 2/12
Alysha has a shower.
      What an exciting day. The morning started off with Alysha having a fit of laughter at her mother's expense.  After Lisa had taken, the train, walked to and through St. Michael's hospital and walked around in the care unit that Alysha is on, Alysha looked at her mother and started to laugh.  Lisa couldn't figure out why she was laughing,  and Alysha was so hysterical with laughter she couldn't focus enough to communicate to Lisa the cause of her amusement.  Finally Alysha pointed to Lisa's coller where her tag was sticking out at the front of her neck because her shirt was on inside out and backwards.  Mother and daughter shared the laugh and Lisa switched her shirt around.
      Lisa thought it was time for Alysha to have her first shower, so off they went.  Lisa put Alysha on the wheeled commode chair and brought her into the shower.  Lisa washed Alysha's body and hair.  Alysha loved the warm water and the wash-up.  She leaned her head back and let the water run down over her face.
      Today the physiotherapist planned to help Alysha to STAND with the assistance of a modified walker.  Alysha got excited when she saw the walker.  They instructed Alysha to stand up straight which she did and then suddenly standing wasn't enough so she tried to take a step.  The therapist reminded Alysha that she was just supposed to stand.  But since she was so keen, they suggested that Alysha stay in one place but lift her legs in an alternating pattern.  She had no problem lifting her leg and balancing on one leg.
      Through some vocalizations and gestures, Alysha communicated to Lisa that she wanted something to eat.  They headed to the cafeteria. Alysha chose a strawberry yogurt and Lisa and Alysha shared the yogurt.  Alysha ate 1/4 and Lisa ate the remaining 3/4's after Alysha indicated that she had had enough.
      Wow. Alysha is rehabilitating herself so efficiently as of late.  It is soooo exciting to see.
 

November 1/12
A Hallowe'en Horror Show.
More inappropriate care after Lisa Leaves for the night.

   Before Lisa left her daugter for the night on the 31st,  Lisa explained Alysha's toilet successes to the staff and the routine she has used with such favourable outcomes for the last day.  Lisa told the staff that she places a blanket over Alysha's lap in an attempt to give Alysha some privacy while on the bedside commode and this seems to help her go. 

      I am so sorry to report that in Lisa's absence, the staff drained Alysha's bladder by forcing another catheter into her infected urinary tract.  A Hallowe'en night Horror Show!! The staff claimed that they tried to sit Alysha on the commode but she wouldn't void.  Lisa was horrified to hear what they had done to her daughter.  She asked if the staff had placed a blanket over Alysha when they were helping her toilet and the staff reported that they didn't.   

     After another vociferous round of advocacy for  appropriate and sensitive care for Alysha, the staff will want to exhaust absolutely every other option before even thinking that a catheter be used again on Lisa's daughter.   In the afternoon, Lisa made information signs for Alysha's bedside to teach the paid medical staff how to support her daughter's toileting successes. 

     Alysha went on to have a fantastic day with her mother.  They shared some laughter and both delighted in Alysha's toileting success.  There were no bathroom accidents during the time that Lisa was there and the catheter didn't make another appearance. 

     

October 31/12 and November 1st.
Alysha sucessfully controls her bladder and bowels.
     Alysha got dressed up in themed clothing to celebrate Hallowe'en at St. Michael's hospital.  See picture below.  Please notice how little support is needed to help her maintain a sitting position at the side of the bed.
     After much confusion by staff it has been confirmed that Alysha does in fact have a urinary tract infection.  There are two infecting bacterial strains and Alysha's medications have been adjusted to eliminate both of them. 
     On arrival to the hospital, Lisa and Jeanne heard Alysha screaming and crying as they walked down the hall to Alysha's room.  The staff were pressing on Alysha's bladder with an ultrasound probe to confirm that her bladder was full.  Lisa could tell that her daughter was in pain.  The staff told Lisa that they were going to put in a urinary catheter because Alysha hadn't voided all night.  Lisa suggested that instead, they get Alysha up onto the commode where she proceeded to void a volume of 1200 mls of urine.  No kidding she was in discomfort, a normal large void is 500mls.  It took a combination of willpower and coordinated withholding for Alysha not to have voided when her bladder was so distended and the staff were pressing on it with a probe. 
     Using the signal that Ron and Alysha worked out, Alysha successfully voided and had bowel movements on the commode all day on the 31st while her mother was there.  There were no accidents all day long, not even when Alysha was napping.  This triumph represents a huge step forward for Alysha's rehabilitation.
     
    

October 30/12

The urinary catheter is removed.

     A therapist from the 9th floor was up to see Alysha today and was very impressed with the progress that she has made with her arms over the past week and a half.

     Alysha had some unpleasant gastrointestinal sequelae including/ but not limited to vomiting.

      I don't know where to begin to tell you of the confusing day we had today regarding whether or not Alysha has a urinary tract infection (UTI).  Ron reports that a resident came to assess Alysha today and told Ron that they didn't think Alysha had a urinary tract infection because of the results of a urine culture that was taken on October 25th.  A nurse told Lisa yesterday that there had been no previous, recent urine cultures and yet we learned today that one was done on the 25th??  We were  under the impression that a urine test and culture had been taken yesterday but Ron reports that there is no record of a urine culture being initiated on October 29th. Regardless of the vanishing and appearing urine tests, and their questionable results, the staff took Alysha's indwelling catheter out which effectively accelerated Alysha's initiation of bladder control rehabilitation. Ron and Alysha worked out a signal for Alysha to communicate to her family and staff that she needs to urinate. They practiced urinating on the commode.
      I am not sure whether or not Alysha is still taking the antibiotics that she was prescribed yesterday for the urinary tract infection she may or may not have depending on who you speak to.