Taking Care of Dad - To go, or not to go (to the hospital)

Friday April 23, 2010
108 days since accident,
85 days since dad moved to Colorado

It was a very cold and wet day in Northern Colorado; actually it has been raining heavily now for the last three days. Ah, we need the moisture − but for people who suffer from arthritic-like conditions, like my dad and me, this kind of weather, we could do without. Therefore, while I was taking more of my medication to deal with my symptoms dad was contemplating vodka to ease his. He actually has been much better about not demanding his "medicine." I think he realized that he better walk a straight line (no pun intended) with me after the incident two weeks ago when he abused his alcohol privileges*.

Dad is a hypochondriac, for as long as I can remember, he complained about one thing or another. However, if dad were distracted with liquor or a deck of cards, his symptoms would miraculously disappear. Therefore, you have to understand, even at the age of 89, when dad complains it usually is related to boredom or anxiety. That being said, today for the first time in 2 ½ months, dad started complaining of chest discomfort. The nurse in me had my cell phone in hand ready to dial 911, but the daughter in me, knowing dad’s history for the dramatic, held off making the call.

Flashback Moment:
As a young adult going to college out-of-state I felt an obligation to call my father once a week, to sort of check in, I guess. Those conversations were never pleasant, dad would usually say something to upset me and I would hang up feeling terrible. During many of those brief chats dad would casually, either mention that he had suffered chest pain and the ambulance came or he took himself to the doctor. Dad was notorious for being in the hospital over the holidays too – The guilt trips were awful – “if you only hadn’t moved to California (I went to college) or to Colorado (where I ended up after college), I wouldn’t be alone and so sick,” he would say.

He hated being alone, but every time one of his daughters would invite him for a visit he would end up causing problems. That daughter would be the topic of gossip for months and then another daughter would do something to trigger his angst and she would become the topic of gossip. I can recall plenty of Thanksgiving holidays when he would come to Colorado and leave the family in ruins. He always knew how and what buttons to push to cause trouble and then would sit back and judge everyone.

Flash Forward - Present Day:
Back to dad’s current complaint − Remember the story of the boy who cried wolf? I didn’t want this particular episode to be a wolf moment. So I retrieved my nurse-bag and checked dad out just to be on the safe side - his blood pressure, was a little elevated at 140/90, but within his normal range. His pulse was 74 and his heart rate was strong. When I asked him to describe the pain, he said it felt like an ache and he pointed to the center of his chest. The pain was mild (a 2 on a scale of 1-10), and it was localized, which meant it didn't move down his arm or up his neck, etc. I think to myself for a minute that dad suffers from occasional digestive upset – it could be the orange juice (OJ) I gave him this morning. I meant to buy low acid juice and forgot – I know that regular OJ does not agree with me and I get terrible heartburn.

Dad startled me out of my deep thought when he asked me, “Am I going to die?" I looked up at him and said, "Eventually dad, but I don't think it will be today." He began to cry, “Dad I was only kidding with you,” I said, while he motioned for me to bend closer to his face. As I moved closer to him he blurred out, "You are not going to let me down?"

I didn’t quite understand the question. “What do you mean let you down? Do you mean, send you to a nursing home?” I asked. He nodded “yes.” He is so afraid that he is a burden, and that we will get tired of the stress and responsibility, and decide to put him in a nursing home. He hugged me tightly and stroked my hair, crying, he said, "You are the only one who cared about me, you take such good care of me, and I love you very much."

He calmed down and then said to me, I kept calling for you I thought you were not at home. I pointed to his cell phone and asked why he didn’t call me. I explained that I was in the shower, had he called me I would have noticed the missed call. "I don't know how to use this fancy phone," he says in frustration. What to do, I thought. Then I remembered that I had bought two small dry eraser boards. I have one in his bedroom that I use as a daily reminder for the day of the week and the date. I figured the second one would come in handy to write the directions for placing a cell phone call. I had dad practice with me about 4-5 times, first he would place a call to me and then I would call him. The first time he spoke into the phone but forgot to open it. The second time he dialed the number correctly but forgot to press the send key. After another 2-3 attempts, he was successful.

After lunch dad felt better. His blood pressure came down as well, 130/82 and the chest discomfort went away. I think that laying flat is also problematic for him, especially if the problem is acid indigestion. So, I brought him another pillow and demonstrated how he should use them. I put on a movie for him and reminded him to call me if he needed anything. I went upstairs to my office to do some work. I checked on him an hour later and he was sleeping comfortably.

Closing Comments:
The question of when to call an ambulance or take a loved one to the hospital can be difficult to assess. As a nurse, I feel confident in my decision to forego calling an ambulance. It was an easy decision only because I know my father, his medical history, and the pain he complains of has been an on-going battle for a number of years. Nevertheless, would I suggest that you or anyone else reading this Blog withhold medical intervention? The answer is most definitely no - it is always best to err on the side of caution. If at any time you think a loved one might be having a heart attack or stroke for example, don’t even bother driving to the hospital, instead call 911 immediately and follow the directions of the 911 operator – you might just save a life in the process.


*(medicine = vodka)when he decided to drink himself into a drunken stupor (12 oz of straight vodka)and I told him I was looking into nursing home placement because I took on more than I could handle with him.