Saturday, February 24, 2018

Diary of a Hospital Stay at Bay Medical: Complications with Shunt for NPH

Meet the love of my life. Yes, choose Robert Redford or Ryan O'Neal. They looked like Joe. 

And as this attorney aged, he has only became more handsome. 

This adventure began with the diagnosis of Normal Pressure Hydrocephalus. After a spinal tap and several days of imaging to follow, with proof of NPH, we set about finding a neurosurgeon to insert the shunt that would drain off the extra cerebra spinal fluid in Joe's brain. Dr. Cyril DeSilva performed the surgery on February 8th. Joe loved the results. He could stride instead of shuffle once more. 

And then...

February 19, 8:00 am. 

Joe had night sweats Sunday night. I took his temp and it was 102, but down when morning came. He looked in the mirror to shave and his right eye was nearly swollen shut. We headed immediately to Dr. DeSilva's office. Unfortunately, he was on vacation and the receptionist sent us to the overflowing Emergency Room. Dr. Doug Scott (our neighbor) was the doctor on call. He and the consulting doctor ordered a CAT SCAN  and though we thought they would just send us home, he told us that Joe had a subdural hematoma. That sounded scary. 

And so began my FACEBOOK posts: 

Feb. 19, 7:56 am
Back in Bay Med with Joe. They want him in ICU when room becomes available. Subdural hematoma, low grade fever chills.

Feb. 21, 8:23 am
We have now been camped out at Bay. Still in intensive Care. Returned from feeding Gigi Tuesday and found social worker in here and Joe shaking enough to shake chair he was sitting in! Said Look how he is shaking! What are you thinking!" She disappeared by the time I got nurse. Asked if it could be blood pressure. She took bp. 193 over 103. I climbed in bed with him to warm him up. Temp 104. Nurse called doctor. Med administered. Now 165 over 97. He is now sitting up. Still shaky. Better. Memory. It is now Wed. Joe went back to surgery this morning to draw fluid from brain to test. Infected. Must grow samples to find out what is going on. Contaminated shunt? If so must remove. Temp continues to shoot up as does BP and blood sugar regardless of antibiotics, BP meds etc please continue prayers. We appreciate your prayers so very much!

Feb. 22, 8:33 am
Joe has gone into surgery to remove the shunt. Not sure if that is cause of problem but probable. Thank you for your prayers. I read your comments to Joe. He is grateful as am I. We serve an awesome God.

Feb. 24, 11:04 am
These are the rudest people in this hospital! I come back from Joe having brain surgery. The potty where he did a bm and I cleaned him up was still full, the floor needed cleaning where he peed over the catheter. We asked to have it clean before coming back. I cleaned out the pot as best I could. The dried poop in the bottom made me angry so I took the pot and put it in front of the nurse's station.

 "He is coming back," I said. "The room should be clean. He has a fresh incisions!"

Near tears, I find the cleaner up the hall and tell her that I will sweep and mop myself and all hell broke out. The housekeeper says under breath I will get to you there are others here whose rooms need cleaning. A nurse named Tim ( wouldn’t give me last name) told me he was calling security. When I tried to calm down and thank them for all they do no one smiled back just glowered. Margaret, ICU director, then threatened to have us (Brooke and Cecily thrown out) for being so noisy. AND by the way," she said, "it is hard to clean with shoes and suitcase on the floor."

By then I was furious and in tears. If I did not have my suitcase on rollers that I had brought him changes of clothes in, pillows for me and blankets to try and make that hard sofa and chair bearable, he would not have had the care I gave that they neglected to provide. 

 One male RN brought the pot back with a lecture on spreading contagion. My point exactly!

It is not too much to ask for a room to be clean when you bring patient who has had brain surgery into the room. Cecily asked a male nurse several times when the cleaner was coming to clean up. "She's making her rounds," he told her. 

The cleaning lady, Sylvia, near tears herself because she wanted to do a good job, came to the room and said if someone had told her she would have been here! That Rude Director should have been in top of that! She knew Joe was going for surgery and as Director that cleaning disinfecting the room should have been her concern! The cleaning lady was very nice and did a good job when she got here. I will buy her a gift for being kind to me when I needed kindness.

No family should be treated like that!

Nurses Hwahi and Max have been stellar. New nurse Michael is working on redemption.
Joe is back and looking better!!! After 8:00 to 9:30 surgery. Much more coherent! Girls are in waiting room. Thank God.

Nothing may come of this blog post. But, whatever happens, I do feel like a sort of "secret shopper." This was our experience. Perhaps it can help improve hospital policies and make them safer. 

Looks like the shunt may be the source of introducing bacteria into Joe’s brain. It is gone now. He still has subdural hematoma as well. He continues to spike fever, BP high as is sugar. He desperately wants to go home. I have only left him for a brief period. He does not do well without me. 48 years. So blessed with friends and family. Please keep praying.

Friday, February 23, 2018  10:44 am
Joe will be moving out of ICU to another room on the Neuro Ward but must stay at least until Monday. After that he will need antibiotics for weeks either by a type of port or hopefully by mouth. Dr. DeSilva says he remains a very sick man. They have begun respiratory and physical therapy. They are still determining exact type of bacteria. Physical therapy has given him a new lease on life!

Cecily Ramsey Butterworth writes: 
It just gets better (NOT)! They just did the nurses day to night handoff, which they attempted to do inconspicuously without my mom or I involved, during which the day nurse reported to the night nurse that Daddy was much improved and “alert & oriented times 4”- which my Dad is CLEARLY not, because after they left, he asked my Mom, who were those women, what did they think, this was the parade of homes? He had no idea they were even nurses. I know my Dad, and I knew that was not an accurate assessment of his mental clarity. But because he looked at her and stuck his tongue out when asked, during her brief neurological assessment, she firmly believed he was coherent. So when I told her she needed to bear with us as we tried to build some trust with this team because of our poor care to date and explained that we had on multiple occasions needed emergency assistance and gotten no response to the nurse call button, she told me that the red button labeled Nurse Call on the bed doesn’t work. Only the red button on the tv remote calls for assistance, and the patient (my dad), who is alert & oriented x 4, would have had that explained to him when he was admitted. Except neither my mom or I had ever heard that, and Daddy was incoherent when he was admitted to the ICU AND the Nursing Director whom we spoke to earlier today also agreed with us that pressing the nursing call button which DOES activate a light outside the room when pressed (or at least it always dinged when I pressed it ALL WEEK, and certainly did this afternoon), but was immediately deactivated with no response to the room at all. I’m tired, frustrated, and very angry. I feel pretty much like they are trying harder to do him harm than to help at this point, and truly DO NOT TRUST THEM TO CARE FOR HIM a without me or my mom there to oversee his care. I know my Daddy, and he is NOT alert like they claim and they haven’t spent enough time or energy caring for him to make that assessment accurately. AND, neither my Mother or I was malingering in his room agitating him and undoing the “care” he was given in the ICU, as Margaret the ICU Director accused as she threatened to have security remove us!

Friday, February 23, 2018

We are taken to a room on the Neuro Ward around noon. I left to get bathe and change clothes. Took only about an hour. Cecily called. “Mother Daddy is shaking and throwing up and I cannot get a nurse in here!” She slapped that Nurse call on the side of the bed over and over again. 

Fortunately, Cecily who has gastroparesis had a barf bag in her bag and was able to help her father. There was not even a barf basin in the room. We searched. 

You see, we are reminded of Joe's cousin Dick. Dick had Muscular Sclerosis. He went into the hospital to have knee replacement before moving down to South Florida to live with his twin brother, Doug. During the night he started choking apparently and called the nurse for help. Thirty minutes later she arrived. Dick was dead. Immediate response to a Nurse Call can be critical. 

Without Cecily lifting Joe enough to throw up in the barf bag, he could have been a similar casualty. 

Cecily left to get Lily and of course Joe had to go to the bathroom. They removed the catheter when he left ICU. But fortunately I had brought the walker that we once gave Daddy, shared with Judge Larry Smith, then with Cecily and then brought home when I had the hip replacement.

Have you ever had a RN do a 180 when you said, “Oh, great, I am so glad you are here! He needs to go to the bathroom!” 

My very weak husband was barely able to stand as I helped him up just as the RN came in —and ran out. "I will send another nurse," she said. Now an hour later no nurse. Again, I slapped that Nurse Call on the side of the bed over and over again. 

I took care of Joe and managed to get him back into bed. Brooke brought a thermometer. His temp is 101.3. I think the RN with the 180 specializes in pricks and she has headed for the hills. So now Joe has no meds and no fluids and we are at least 2 or 3 hours in this room! I am using these posts as journaling.

Notice where this remote is I was balancing my husband on the other side of the bed. 
Daughter Cecily tells me she double checked on whether that symbol for Nurse's call actually works. Contrary to what we were told it actually turns on a light outside the door AND IT DINGS. She hit the call five times and each time the light came on just to check and listened to the ding to see if was inactive as we were told. Someone had to turn it off. Did it not dawn on that person that we were in distress? Just not procedure I guess. Like the nurse that could not hang the meds until the CNA (purple outfit) came around to take blood pressure and temperature. Being an RN means you hang meds and chart these days, apparently.

Notice the center symbol. This says Nursing Call. 
Several days later he's up reading the paper while hooked up to the IV Antibiotics. 

By 4:30 I am so concerned at how long he has been without his meds. People specialize here. Asked his nurse sitting at desk and computer if she could come get his meds started after specialist IV Starter (RN who ran out earlier) got IV in. 

“No” she said. "I have to wait until the tech who registers temp and blood pressure gets around to him first. Then I can come in."

I said, "You are an RN. Do you not know how to take blood pressure and temperature?" 

I asked his nurse to call the Director about 3:30. How does the patient know which specialist nurse to call! I am still waiting. Called a friend who suggestes that I call the CEO.

Saturday, February 24, 2018

I did call the COO. Heath Evans, to no avail. I actually spoke to the secretary who told me he was in his office with a rep from corporate. I told her the rep from corporate was welcome to come down as well. As 5:00 on Friday p approached I called for the 3rd time and got an answering machine.

“My name is Sharman Ramsey. My husband is Joel Ramsey. On February 8 my husband came to Bay Med and got a shunt for Normal Pressure Hydrocephalus. On February19 he came back with a subdural hematoma and an infection we now know was caused by bacteria on the shunt that was inserted here in your hospital.

I come from a family of doctors and nurses so I appreciate all they do. My husband practiced law. So we both appreciate professionals. I need to talk to you about my husband’s care.”

No call. No visit! But the “house” director came down. I guess the floor director had already left. But the house director said this floor director was her best. When I told her about our trouble in getting any response she told us “every nurse on this floor has a telephone. Their names and numbers are posted on the board.” She looked and they were not there. We told her how we had pressed the nurse call over and over with no response and I read to her my Facebook posts so I would remember. She assured me she would be available. Her name is Diane. She has all the personality Margaret (ICU) does not have.
After she left a tech came in and told us Joe would be transferred. Cecily freaked out knowing the rest of the hospital and feared we would be shuffled off to one of the rooms in the older parts of the hospital and into a room and floor where his care would be even less.

I called the one number on the board thinking it was Diane’ and got this floors secretary and asked about the move and was informed they thought we had requested a move. I told her Joe did not need another move and we wanted to stay here on the neurological floor. 

On the pass off of shifts I asked for the new nurse’s number. She told me that in the 7 years she had worked on the floor she had never given out her number. (Why did house director say that was required?) I told her how we had repeatedly hit the nurse call button with no response. She informed me that button did not work. The only call button that works is the one on the remote — that is usually lost or on the other side of the bed! So why did the blood pressure tech not tell us that when I asked if the bed was plugged in and that might be why the nurse call bottom on the side of the bed doesn’t get any response.
By the way Diane felt it was important that I know that each specialty in the hospital wears color coded clothing. I suggested posters throughout patients' rooms so patients might have a clue whom to ask to do what. 

I finally gave up. They were merely trying to placate me. 

Later, Joe could not sleep during the night after being in the same position for hours upon hours during the night. He was trying to let me get some sleep and tried not to complain. I felt guilty and got up off the torture sofa. I asked if someone could change his sheets now wet with pee from him and me trying to get him into the urinal in time. No use trying to get someone to help get him to the potty. 

"We don't do baths at night," the RN told me. I guess the color coded bather comes in during morning hours. He was miserable in wadded up wet sheets. I told her, "Please just get me clean linens and I would bathe him." Which I did. And shaved him. Hearing wheezing I requested a breathing treatment and that happened. The CNR, Lucas, made the bed after I stripped it. Joe was then able to get back into bed and fell asleep immediately.

I shiver at the thought of ever being in the hospital without your advocate.

I remember how our last nurse on ICU commented on how they “all” meaning the staff were close and made decisions. The chaplain came and as I tried to tell him all we had gone through, he said, "I must stand up for our...." I interrupted him, saying, "I think it is time to pray."  I get it. This is their turf. We were mere guests in their domain. 

Joe is impatient, often rude, and still very sick. He thanks me constantly.

His temp is down and signs are good. Dr Obid says they must get the cultures back before he can leave so they will know whether or not he will be able to take antibiotics by mouth or will need infusions.
Joe does not do patience well. 

I pretty much only expect administration of proper meds from the hospital now. I hope I do not expect too much. Perhaps we can go home soon. He is improving. 

Praise God. And thank you for your prayers.

Our doctors are Obid (Internist), DeSilva (Neurosurgeon, Jeff, PNA, Dr. Hedstrom on call during weekend), Khan (Neurologist) and Bone/Hawk (Infectious Disease, David, PNA). While they all confer, we are now down to Dr. Hawk (on call) studying the cultures to tell us whether Joe will be able to handle the infection with oral antibiotics, or whether they will have to be infused.  Whatever, Joe wants to handle this with Home Health Care. Encompass helped me after my hip replacement and Paul Kearns impressed us both with his personality and physical therapy. I have called him and he will be working on things from his side. I have had a wonderful housekeeper, Kim Holloman, who is headed to our guest house (all on one level) to do a deep cleaning before we get there and then she will come several times a week afterwards.

God is so good. I had been looking for someone to help me clean. Then a couple of months ago, I ran into Kim Holloman at Piggly Wiggly on 15th Street.  She had been the server at the Captain's Table in St. Andrews that we always requested. And then one day she wasn't there. So, I was delighted to see her again. As we chatted, she told me that she was now cleaning houses. A God thing, I know. So she started with me twice a month. I called her and she is going to work it out to be available to us several times a week. Only He knew all of this was coming up and I would need help. 

We are blessed with praying friends who continue to lift him up for complete recovery. We are blessed with all of our family.

Sunday night February 26
The continuing saga of the hospital stay at Bay Medical. We have had sweet nurses, Candy, Julie, and Robbie. And some wonderful CNAs, Laura, Rebecca, Bailey (and the one on the last night there whose name I did not catch) and room cleaners, John Robbins and Sylvia Jones, who have made our experience much lighter. Tibitha and Roberta from the kitchen food services stand out in their kindness in trying to bring Joe his requested Diet Dr. Pepper and more grapes than cantaloupe and honeydew in the fruit. With their smiling friendliness, help us immensely. HIs doctors are still working on getting the right combination of antibiotics so he can GO HOME!
Unfortunately, Heath Evans, the COO of Bay Medical has not returned my call. 
Nursing has surely changed through the years. Nurses barely touch a patient. Mother, a nurse who won a battle ribbon for tending patients on hospital trains that went to the front and brought our young men back to Cherbourg to board a boat to England, always thought bathing a patient was important. You see whether there are bedsores, rashes, etc. You learn a lot about a person through touch.

In the ICU, Max (Cecilia) from Dothan who was once Dr. Moffett's nurse and Daddy's patient, treated Joe with such infinite kindness and care. She bathed him gently and gave him a back rub that made him feel so much better! He thanked her profusely. Other nurses and particularly the CNA (see I am even learning the names of the specialties) act as if the human body they are nursing is repugnant. Some quickly answer the call for help with bodily functions, others drag around so you cannot wait for them. It is a wonder there are not more slip and fall accidents in hospitals just for that reason. (Probably most of those accidents go unreported and are charged off to the patient.)
Hospital policies that would help: 
NURSES CALL BUTTON: Having the only nurse's call button on a remote that comes unplugged, lost between the bed and the side bars or in the covers makes absolutely no sense. The side bars have the picture of a nurses call that Diane told us does not work. For family members who did not get the talk upon arrival (that they assume the patient understands and recalls) spend vital time hitting the button while balancing the patient. In addition, emergencies happen inevitably on the opposite side of the bed from the remote. 
ROOM ACCOMMODATIONS: It is obvious family is expected to attend to loved ones in the hospital. Basics of personal care are left up to their advocates within the hospital and some members of the staff seem unwilling to attend to those needs. Would he be shaved if I were not here? Would someone wipe him or even know when he needs someone to hold the pail for him to vomit?

Since family is so necessary in the rooms of very sick people, couldn't the hospital provide a sofa long enough for someone to lie on instead of a loveseat with wooden arms? The chair provided for the patient to sit up in and family to relax on has no way to lie back and kick up the feet, though they do have a stool in some rooms to prop your feet on in the position of an airplane seat -- semi lying, semi sitting. I would think such a chair would benefit patient and family. In designing the room shouldn't the door to the bathroom swing so that the patient could more easily maneuver a walker into the bathroom? Shouldn't the bathroom be less slippery for bare feet since the whole room constitutes a shower that does not drain well? Maybe patient and caretaker should have flip flops in the shower to take care of that possible hazard. 
FOOD: Hospital food is notorious and Bay Med is no exception. I do find it odd that a patient in the ICU that is very sick and also diabetic is given two blueberry muffins, two cups of apple juice, and a sausage patty for breakfast. Also, since family dare not leave their loved one for fear of an emergency happening while they are gone, couldn't the cafeteria send up something to those staying with the patient upon request (and personal reimbursement)? The hospital food is pretty expensive.

I am reminded of how years ago someone came to my Sunday school class whose son was in the hospital. She, of course, had to stay with her child. Who, thankfully, was fed. Her husband was in jail and her funds were scarce. She could not afford to buy food for herself at the hospital and for the children at home with her mother caring for her children. We of course helped her. I am grateful that I can afford to purchase the food downstairs. 
We are hoping that tomorrow the doctor will say he is fine to go home with oral meds and we can leave. What the long term recovery will entail, there is no telling! Had the shunt been sterile he could be continuing his long strides in taking Gigi to walk and other promised advances. But it wasn't sterile. It had bacteria on it that has almost taken my husband's life and has surely robbed him of its potential benefit.


Before we left the hospital, I brought a rash on Joe's back to the attention of the nurses. I was told it was caused by the soaps used to wash the sheets to make sure they were clean. One of the CNAs brought a pee pad in that had stains on it. I suggested she take it back and replace it with another.
The rash on Joe's back was so bad it could have become infected if he were not heading home. Two days later with home sheets, it cleared up. When I was in the hospital with my hip replacement I wore my own knit gown and had no problem. I understand the patient does not need a problem brought into the hospital. Perhaps his problem came from sweating and being in one position for so long. It is a good thing I was there to bathe him. What happens to those who do not have someone to take care of those personal needs?

 As Lynn, a friend, points out, that is part of what used to be nursing care, "One of the truly frustrating things for nurses is that our training is all about hands-on care but our work experience is less about patients and more about paperwork and charts."


One thing I noticed was the constant use of telephones. Do those telephones get sterilized between rooms? Since Pseudomonas and Staph are two common pathogens in the hospital has anyone considered personal communications devices as a carrier?

Also, one of Joe's nurses, Sel, poured his pills into her bare hand. Then she dipped the spoon into applesauce and put two pills in the applesauce and stuck the spoon in Joe's mouth. We know she meant well. She thought it would help him swallow the two better. Unfortunately, Joe (and granddaughter Lily) both gag at applesauce. So we had a near vomitous attack and that is not good with someone with a subdural hematoma. In addition, we have the question of a bare hand handling medication. Important? I do not know hospital cleanliness policies well enough to know. But perhaps it is worth mentioning.

Monday, EARLY 7:15 am.

Our CNA sits at a station right outside our door. They fiddle with their phones all night long. Joe needed a clean gown. His bed was wet with sweat and pee. I ask the one sitting at the desk if I could have a gown, his bed needs changing and the floor is wet with pee where he stood at the potty chair and peed getting up by himself trying not to awaken me so I could get SOME rest.

She gets a gown and hands it to me. Could you change his bed? It is so wet! That's _____ job. She has taken a break." "Well, would you ask her to come in here when she comes back?" I ask. She nods. Time passes. No CNA to change the bed. I look out the door and there is the CNA whose name is on our white board as being "our" CNA." "I guess you forgot to ask ________ to come into our room." I look at ________ and ask, "Could you come change these sheets and clean up the floor. I also understand that you are to measure his urine in the pot." She gives a look to the first CNA and then comes and changes the sheets and empties the pot, picks up the dirty linens and leaves.

Joe greets Dr. Obid this morning with  "I don't care what it costs. I am going home today."

Dr. Obid says, "Really all you are getting here at the hospital is the IV infusions. Let us check on the insurance. It could be we could put in a PICC line and you can go home. If the insurance does not pay, each of these infusions cost $3 to 5 thousand dollars." Joe is so determined to get home this tightwad is even willing to pay that! "I am going to die here in this hospital if I do not get home!"

He also said, "And I am NEVER coming back to this hospital."

I am almost afraid for him to get the PICC Line here at this hospital! But he is so weak, I am also reluctant to try to get him to another hospital. He just wants to be home!

I cannot see how being home could possibly be more exhausting than being in this hospital.

They have taken him to get a CT SCAN. Hopefully that subdural hematoma is shrinking.

Sweet Cecily is on her way.


Lynn Heffernan, nurse: 
One of the truly frustrating things for nurses is that our training is all about hands-on care but our work experience is less about patients and more about paperwork and charts. The least trained people spend the most time with the patients. One of the reasons so many nurses leave the profession after a only few years.

Stacy Sparks-Berger
I have been following this and am appalled. When Emily was in and out of the hospital over a course with misdiagnosed pseudotumor cerebri the staff including all care givers was wonderful. The only problem we had was with one of the rudest neurologists I've ever encountered. Complained to head of neurology and the head of department immediately took over her case. When mother was so ill here the head of department handled her case. I think the appalling thing is we had to make phone calls to people who knew people. I've always said what happens when one of your best friends is great friends with the CEO of a hospital. Now I'm hearing and it's scary. Sharman get mean. I've had to pitch fits before and it works.

Monday, February 26th

Joe woke up today determined to go home. Every doctor, CNA, housekeeper, housecleaner, temperature taker and blood pressure taker was told that he was ready to go home TODAY! 
Dr. Bone's PA, David, came and checked the reports on Joe to determine whether he could go home. They had been waiting to determine whether he could be given IV antibiotics at home. Some antibiotics must be given in the hospital. He mumbled, "Pseudomonas and staph on the catheter."

"What was that? You said the shunt had pseudomonas and staph?" The PA nodded. 

I googled that: 

What we know about Pseudomonas, the potentially deadly bacteria ...

Aug 9, 2016 - Like other frightening bacteria such as MRSAPseudomonas is waterborne and spread on the hands of hospital staff and on tainted equipment, but can be fought with handwashing and proper hygiene. 

Hospital Mortality for Patients With Bacteremia Due to Staphylococcus ...
by S Osmon - ‎2004 - ‎Cited by 197 - ‎Related articles
Staphylococcus aureus and Pseudomonas aeruginosa are common and important causes of bloodstream infection due to their increasing antimicrobial resistance and presence of virulence factors associated with excess mortality. Given the current trend of greater severity of illness among hospitalized patients, it can be ...

Subdural hematoma is shrinking.Thank God.

Terribly stressed, we made it home. I unloaded the car and started crying. Cecily popped two Tylenol and a surprise Zantac in my mouth and before long I was asleep on a couch I could stretch out on. Cecily took over from there. Somehow she got me to the bed and I got a good night's sleep. Joe can get around well here in the guest house. Praise God. 

 We finally got out of the hospital. 

In the meantime, we discovered the 238 (Guest House) refrigerator was on the blink and the Mark Hurst at the Appliance Center came to our rescue. It required a new refrigerator that they delivered immediately.  

Stacey Sparks-Berger Sharman Burson Ramsey obviously something is going on at that hospital. The CEO abruptly resigned on 2/18 with no comment. Heath Evans who was the COO is now interim CEO as they search for a new CEO. Sorry about all the initials but I have reached out to some contacts to see what they can find out. I'm still trying to get his contact info.


We are so blessed with our friends. 

Apparently Bay Medical has had quite a few complaints lodged against it:

I did not know this. Apparently others have experienced much the same as we have.

Thank you all for this information. We must make a change in health care.

 Joe was allowed to go home on infusion therapy.

The PICC line, was inserted in the hospital down in a special radiology section of the hospital.  they took Joe from the room to go to get the PICC line, Cecily and I asked whether we should go with him or not. We were told he would not be gone long. He had been given Lasix to drain some of the fluid accumulated in his body from the IV. Well, there was a line down in the radiology lab that inserted the PICC line. This very ill man told whoever had on the right color scrubs (or maybe the wrong color) that he had to go to the bathroom. They indicated the bathroom door. "There it is," he was told.

He finally got through to them that he was unable to make it to the bathroom unassisted and they brought him a urinal. After a while, it dawned on those people that he needed help and they assisted him to stand and pee. Fortunately, the man behind him was unconscious. Determined to leave, he refused to lose his place in line. Finally, the PICC line was inserted and he returned to the room.

That means daughter Cecily and I had to learn the fine art of giving those powerful medications. Encompass, the home health provider that I chose since they had given me such good care when I had a hip replacement, guides us through this process. The Encompass nurse, Krissy, comes by and instructs Cecily and me on administering the IV drugs that were delivered in the middle of the night Monday, February 26th, from Coram. The delivery person came all the way from Pensacola!

The secret, according to Krissy, is to never forget SASH, acronym for SALINE, ANTIBIOTIC, SALINE, HEPARIN. The green tipped outlet on the PICC line is the catheter tail through which we administer the medication (very high powered antibiotic). This process has been made very simple with already filled syringes that screw onto the catheter tail. After unscrewing the green tip of the catheter into which we are to administer the drugs and swabbing it with an alcohol wipe, we merely press the plunger slowly into the catheter beginning with SALINE to make sure the line is open. Then we screw on the antibiotic bulb, open the lock for the antibiotic and for the next 45 minutes the antibiotic goes through the line into his body. When the bulb is empty, we unscrew the antibiotic line wipe again with an alcohol swab and then administer SALINE once more to push the antibiotic into the artery and then complete the process with HEPARIN to lubricate the lines in preparation for the next infusion.

Our materials came with gloves, an important part of the process. Our hands are washed thoroughly and then we use a hand sanitizer. Joe's infusions come every eight hours: 6 am, 2 pm and 10 pm. In other words, our lives revolve around these infusions. We are grateful we can do this at home and not in the hospital of a doctor's office. You learn to do things you never thought you could.

Although I see there is a thing called a shower sock, we wrap his arm in Saran Wrap and pretty much steer clear of the arm when we give him a shower. That is such a welcome time of day. The hot water feels so good, he says.

Joe is shuffling again. So sad. He had enjoyed the positive results of the shunt that now are gone. He may shuffle again.  But at least he is alive.

So, what could have been the cause of bacteria on the shunt?;jsessionid=BFB3A6458965DF76D4F856FA3161D910.f01t04?v=1&t=jed4inmp&s=deadd0840d3bca7a2f2bf62251418ab3c6a69acc

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