My Plan...

"Just pee."

"mumbles..."

"No, you can't get up. Your hip is broken. See? They've arranged that you can just pee. This will suck it all away."

"I can't I'm not there."

"You don't need to be there. Just pee. Right here."

This was the conversation on repeat yesterday. With the woman who needed to pee getting more and more distraught as the nurse calmly told her they had a device that would suck the pee out and her husband getting more and more frustrated that she wouldn't listen. 

Emergency rooms are not great for patient privacy. 

The woman who was in that room before the woman who needed to pee had abdominal pain. Lower right side. Some nausea. I diagnosed her with appendicitis and when she didn't come back after her scan I figured they took her right to surgery. The room on the other side was a possible concussion from her symptoms though she wouldn't say how she had hit her head so I am guessing also a possible case of domestic abuse. 

I never saw any of their faces but we heard a shifting array of medical conditions through the morning. There were also a couple of codes called out over the intercom including a very calm call to the stroke code area. I guess they didn't want to sound alarmed for all of us? Or maybe they deal with so many emergencies every day they don't get really worked up about it anymore. 

Since Brent wasn't an emergency emergency there were long stretches where we just waited for the next person to check on him. The intern came in, then later the doctor who was supervising the intern, but not together which I thought was odd. A few different nurses. The guy who came in to set up his IV port and do the blood draw. An orderly who came to wheel him away for his CT scan and then bring him back and hook him back up to all the monitors. Though he didn't put the machine on mute like the early morning nurse did so that was annoying for the forty-five minutes we waited for the next nurse to come in to check on him and to turn it off. Then the doctor again. Then the intern again. Then the IV guy again to hook up his antibiotics in an IV drip. Then we waited for someone to notice they were all gone and let us go home. 

The whole time listening to the coming and going of the rest of the ER. The moaning guy who came in while Brent was off getting his scan sounded really bad. Brent said that he saw the EMTs wheeling out a cart on his way back so we are guessing that was him. Brought in by ambulance and in bad shape. Also a few people who were loudly protesting that they were fine. Not sure why you are in the ER then, but I'm guessing you aren't really fine at all. 

But the one that stuck with me the most was the older woman in the next cubicle room who was so upset about having to pee. She broke her hip Wednesday they kept saying, so I am not sure why it wasn't until Friday that she ended up in the ER. She did not understand that because her hip was broken they would not let her get up. She didn't understand why her husband was there when he got there. She didn't understand why she couldn't pull the IV out of her arm, or why she needed to keep that arm straight so the drip would go in better. 

She sounded so lost. So scared. So bewildered. 

Her husband told the nurse at one point, "It's the dementia." The nurse replied, "Yes, we understand."

And, again, the nurse was amazing. She was the soul of patience. Before the woman's husband got there she never left her side. She kept her calm (as calm as she could) she repeated the pee line over and over. And even after the woman's husband got there she checked in often. They were still there when we finally were discharged so I'm not sure if they were going to let her go home that day or if she was going to have to stay. She was very much not in favor of staying, but I have a feeling with her broken hip she was going to be there.

And still not understanding why.

I thought about her husband, how frustrated he sounded, how long he probably has been dealing with this, though she lives in a care facility now. (The walls are basically non-existent, like I said, no medical privacy at all) I wondered how long he tried to take care of her on his own. If the dementia came on slowly or quickly. If she knew what was happening. If she is still worried about peeing the bed or if she finally was able to understand that they had put some sort of catheter in her that just "sucked the pee away." I also worried about it giving her a yeast infection, because old ladies are prone to yeast infections anyway. (I was diagnosing and second guessing all the doctors yesterday, it was a long day and I needed to keep my mind occupied so I didn't get frustrated at how long it was taking them to help Brent)

As I drove Brent home I told him, "If I suffer from dementia, and if it's a slow enough onset, I am going to find a death with dignity out. I just want you to be aware of that."

He was very quiet for a moment then, "I will be very sad if that happens, but I understand that would be your decision."

We agreed that no matter which way it went it would make him very sad.

But I never want to be the woman in the bed who doesn't understand her hip is broken and she can't get up to go to the bathroom. That is scarier to me than just about anything I can think of. 

Brent is better today than yesterday, by the way. He's not all the way to great yet, but he's better than he was and so we are counting that as a win.