Change of Scene

Clarke has been ensconced in the rehab unit at Marquis Mill Park for...a while....so here's an update.
He has his own room at the end of a hall, and a view to greenery. Nurses and aides are cheerful and helpful, but not hovering - there is lots of encouragement for him to move to more independence.

Nicholas' arrival was a surprise...

Food is OK - I took him some of Nina's marion-berry pie last night - that was a hit! He can order pretty much whatever he wants. Just day before yesterday he gave up eating in bed, and now wheels himself down the hall to "The Bistro" for dinner. He gets PT & OT sessions daily, and is working hard.
Nicholas came down for last weekend and spent time with Clarke - they shared some good laughs.

 And there have been many visits when I am not there with camera in hand, or when I am there and forget to snap a shot. Claire & Jim O, Barbara & Kurt, Collier, Bruce, Nina...these visits cheer him immensely

Moving On....

My apologies for the lapse in time - the transition from hospital to the rehab unit has distracted me! Yesterday Clarke worked with both Occupational Therapy and Physical Therapy, took off his hospital gown in exchange for T-shirt and sweats, and then sat in his bedside chair to wait for the transport people, who were scheduled to take him away at 3:30 pm. They arrived at 6:30, by which time he was a bit restless, but remained good-natured. The afternoon is not an easy time to navigate from NW to SE!

Tsering Dolmah surprised him be being there when we arrived at Mill Park - seeing her always cheers him up. She helped get him settled into bed, and then rounded up his shaving equipment and cleared the stubble he'd acquired. A nice nurse named Jordan came in to get a health history, and then Luke, another kind and pleasant nurse, was with him thereafter. It's a big change from the hospital environment, but he seems OK - it's peaceful and quiet.
Here's the information about his new locale:

• Marquis Mill Park Acute Rehab
• Room 117
• 1475 SE 100th Avenue
• Portland 97216

It is right behind Mall 205.

His physiotherapy sessions are somewhat unpredictable, so if you are planning to visit, they'll try to work around you. I'll be meeting with his social worker on Thursday, and will get a better sense of how this program will unfold.

Getting Better...la la la

Our Clarke may not be out of the woods, but he's better bit by bit. He still needs substantial pain meds, and the stab/grabs still break through often but they resolve more quickly/ Just now he's getting pain meds after a 10-hour span of not needing anything! That's a huge change. Collier & Sue came for a visit earlier, and yesterday Carolyn came and played some card games with him on the iPad, and Tom B came for a visit later.
Today he's worked with PT & OT, and seems pretty tuckered out now, dozing a lot since I've been here. The plan is for him to go to the rehab palace tomorrow. Claudette and I made a sleuth visit after dinner, and found him alert and cheerful and low on the pain scale. Slowly but surely....

A Peaceful Night

There's the smile after a good night's sleep! What a relief - the new pain regimen is working well. The stabs of pain still occur randomly, but far less frequently. Overall, he is most of the time comfortable and relaxed.
Nurses last night were helpful and kind, and carefully kept on top of the pain needs.
The IM docs have been in this morning, and both predict that he'll be discharged to a rehab facility in the next few days, most likely Monday. He's sleeping a lot, but with all the meds he has on board, it's not surprising...Also the exhaustion from hurting so much for so long. He ate a good breakfast, and is not back in dozing land.

Update

Whew...lots to catch up on...
Last night was tough. Busy unit, so calls were answered slowly is at all. Clarke had to wait for pain meds even after calling twice, and was cold and uncomfortable most of the night. Nurses were short on the kindness-and-compassion scale. He became anxious and even afraid, to the point that when he saw the day nurse come on, he said, "My pain decreased just seeing you here, and knowing you are here."
Physical therapy + CNA helped him into a bedside chair, where he spent a little over 2 hours comfortably, mostly dozing and listening. Getting back into bed was hard, and he inadvertently put weight on the injured ankle.
Pain relief continues to be a challenge, so the new routine is dilaudid + oxycodone. The pain tires him, and also makes therapy difficult. Jolts of pain just seems to grab him without warning, out of the blue.
OT was here this afternoon, and worked with him.
Nina visited this afternoon, and went with me to see the Patient Relations rep about not only last night, but also about his being discharged on Sunday. He will be investigating both events.
Clarke has just drifted off into a doze. Yay! This now drug regimen might work well!

Plates & Screws

The surgery took about 2 hours, longer than expected. After Jessie and I had a Bamboo Sushi time, she went home and I went back to the hospital. Bruce and Bethany arrived as I was checking in, and we asked the receptionist where we should wait during the surgery. They said to go to Clarke's room. As we paraded into his room on the 6th floor, we noticed the nurses (the NOC team) looking askance at us. I asked them where we were to be waiting, and Nurse Vanessa said, "in the waiting room down on the 1st floor - but its too complicated to explain how to get there." She asked an Aide to escort us down, and the cheery aide guided us about 50 feet down the hall to a grouping of chairs and tables where one alone woman in blue shorts was sitting reading an old newspaper. We questioned the aide, saying we understood that we were to be on the 1st floor. She said she would check, and turned back to the nurses station. She returned, and said, "Follow me - you're supposed to be going to the 1st floor waiting room." At which point, the woman in blue shorts called out to us, "that waiting room's locked, no one will let you in there." We went anyway, and found the door wide open to a large room with multiple clusters of sofas and chairs, an area absolutely empty of humans. We sat down, laughing at the "Who's-on-first" scenario, and Bethany ate her dinner out of a brown cardboard box. Suddenly a stranger arrived in the room, and sat directly behind us - there were probably 60 empty seating possibilities in this room but, for reasons that we cannot fathom, he wanted to be close to us.
There was no sign or sound of life for the next hour or so, when the surgeon called to say that Clarke did fine, the surgery was successful, and he's in recovery. About half an hour after that, a nurse called from the recovery room to report that he continued to do well, and they'd be bringing him to his room in about 20-30 minutes, and we could meet him in his room. As it was now close to midnight, Bethany and Bruce left. 
It was about 10:30 or later when two cheerful ladies briskly wheeled the patient into Room 641. He was alert and looked oh so much more relaxed. He said he felt some pain, but it wasn't the searing jabs that had tormented him since the fall. He urged me to go, so I took off once I felt OK with the people caring for him. 

Pre-Op update

Clarke has been NPO since midnight (19+ hours), still waiting for surgery, which had been scheduled for sometime after 5:00. He's quite good-natured about it! The IM doc started IV fluids earlier, which also made him feel less dry-mouthed. He's now holding court while we wait for the the trip to the OR....Dolma, Sonnen, Jessie, Rachel...
and an array of amazing nurses and support staff coming in and out to make sure everything is set to go. I am so looking forward to getting those glass-like shards out of there!
I went down to the OR space with him, and we met the surgeon (Derek E Lamprecht, D.O.) and the anaesthesiologist (I. Rothman).
Jordyn update: The Clutch team has won their first 3 games in Chicago!

Breaking News...

Dr Lamprecht's PA just came in to let us know that they'll be operating tomorrow: open reduction & . . . . I didn't write it down....
Fixing the feet...

And today...

The patient was admitted yesterday...whew...after spending about 6 hours in the ER. Landmark Nurse Kim helped facilitate a review of his current history by Good Sam peeps.

He had a good night, but managing his pain has been a bit of a challenge. I have images of loose shards of bone jabbing into him with the slightest motion. :(
PT came this morning to do an assessment. They were unable to do a transfer with one person, and even with two, decided not to try it due to the breaks.
Still waiting for the ortho consult....

Discharge Home

Clarke and I both felt concerned about going back to the apartment. How would he move without injuring that ankle? which was already extremely painful. We were sent off with instructions to call the orthopedist for an appointment, and a prescription for Percocet. It was a bit bizarre. We drove down to the warehouse, and I went in and picked up the wheelchair that had belonged to Clarkes father, who died in 1975. And it weighs perhaps 2 or 3 times more than those being made today. In other words, clumsy and awkward to manoeuver.
By this time it was dark and nearing 10:30 pm. Once in the garage, I asked Roger to help me get him out of the car, and they somehow managed. We rolled him up to the apartment, and his first wish was to get into bed. Good idea, but the wheelchair did not fit between the bed and the wall...and that bed is not moveable except by demolition. So I got the walker from the office, backed up the wheelchair, pushed the walker through, and with a lot of backing and forthing and cries of pain, managed to get him to the edge of the bed. Finally he managed to get onto the bed. I gave him an oxycodone (he had them left over from the gum tissue transplant), but it provided little relief. At 2 am, he tried to get up to pee, and fell. He was wedged in between the walker and the wheelchair. Given his muscle weakness, his poor balance, and his exquisitely tender wound, it was a challenge to get him up safely, taking us well over an hour. His pain of course escalated, so a bit before 6, I called her for help. She appeared in minutes, if not seconds, bearing muffins baked by Claire, stronger pain relief, and all her nursing expertise. Whew!

Damage Report

After what seemed like a small eternity, Clarke got some medication for pain relief, but it only mitigated the hurt. He was taken off to X-ray to look at the evidence. Report:

• evidence of acute displaced left distal fibular fracture
• evidence of a medial left ankle collateral ligament complex injury
• evidence of acute avulsion fracture site

so....

• fractured leg bone
• torn ligaments
• damaged tendons

He was seen by a PA, who splinted the injury, and admonished him to put absolutely no weight on the injured (left) ankle/foot. I asked her how he could manage at home to navigate without injuring further the already compromised ankle. She was vague in her response. I asked (politely) to see a social worker to see about getting him situated in rehab; she said he didn't meet the criteria. In my mind:

• a displaced fracture
• torn ligaments & damaged tendons
• precarious  balance as a baseline
• muscle weakness
• history of multiple falls

How would he be able to manage to protect this wounded limb?

Not just any Sunday...

Jordyn is #21! 

Clarke and I joined Jim and Carolyn on Sunday to watch the first of two basketball games in which Jordyn was playing... (and playing magnificently!)
He decided not to stay for the second game, preferring to go to the warehouse on the bus. I was happily watching Jordie score. and taking pix of the game. The Clutch Team won (Yay!).
Getting into the car to start home, I got a call from Clarke. He said he couldn't walk, and when he couldn't reach me, he called Collier, who was with him, and had managed to get Clarke out and into his car. I met them at the Good Sam ER.
Apparently, Clarke had gotten down on his hands and knees, under a bench, and reached out to insert a plug into an outlet. As he reached, he fell to his side, but as he did so, his foot got stuck on something. And that's how the capers began...