In May my mother-in-law experienced a syncope episode while shopping at the outlets. Luckily she felt dizzy and sat down before she passed out.
My father-in-law became paralyzed with fear, but gracious bystanders came to his aid. The emergency medical service arrived as my mother-in-law regained consciousness. They took her vital signs and determined her blood pressure was low and decided it was best to transport her to the local medical center.
Completely flustered by the incident, my father-in-law scoured the parking lot but was so worried about his wife that he couldn’t find the car. He meandered around for nearly an hour and was then unable to find the hospital on his own. Nearly two hours after my mother-in-law was transported by ambulance, my father-in-law arrived at the hospital.
The CT scan revealed that my mother-in-law’s known benign meningioma had doubled in size. Though this was not determined to be the cause of her fainting episode, the hospital staff recommended she be transferred to a bigger hospital for evaluation by a neurologist. Two days later she was advised to have the tumor removed from the frontal lobe of her brain.
My in-laws have been married for 55 years. They have a co-dependent relationship. My mother-in-law (age 73) is a strong woman totally capable of taking care of herself, but heavily relies on my father-in-law to meet her daily living needs. She never learned to drive, rarely works in the yard or empties a trash can. He makes all the phone calls and does most of the grocery shopping. My father-in-law has also relied on my mother-in-law for three square meals a day, clean clothes, his medication and instructions on how to move through his day. Together they have clearly defined roles. Apart they can’t seem to function independently. It was a scary realization for my husband and me.
Thankfully the surgery was successful. The neurologist called us with an update and said if all goes well she could be discharged in three to four days. However, he was a bit concerned about discharging her to the care of her husband. The neurologist commented that my father-in-law was clearly frazzled by the situation and unable to focus on any medical information given to him. We quickly determined I needed to help them through this difficult time.
Upon arrival I was shocked to find my father-in-law disheveled and exhausted. His color was not good and he looked like he had lost quite a bit of weight; clearly he had not been coping well over the past few days. He admitted he had been overly stressed by Mom’s sickness and felt he was unable to take care of himself without her. I said that now was not the time for him to feel sorry for himself, that he needed to be there for her, which meant he had to take care of himself. A harsh reality, but something he needed to hear.
Fortunately I was able to help my mother-in-law through the discharge process. Shortly after we arrived home, I realized that she had been sent home with another patient’s discharge information with completely different instructions and no follow-up orders. I had to call to clarify her orders.
Deciphering the steroid tapering instructions was tricky for me — a well-seasoned nurse — and nearly impossible for an 81-year-old poorly functioning spouse. In an attempt to divide the pills into doses, I noted the pharmacy had put 10 extra pills in the bottle.
I share this story because I worry that this medical scenario may be commonplace in the geriatric population. It bothers me that the neurologist and ICU nursing staff were aware and documented that my father-in-law was not functioning well and yet no one really made any attempt to help him. He is a heart patient and wears a medical bracelet. How easy would it have been for a nurse to take his blood pressure? Or ask him if he has been taking his medication properly? Would a social work consult have been appropriate in this situation? I shudder to think how my father-in-law would have coped with my mother-in-law’s discharge had I not been there.
I think back to my excellent training as a student nurse at The University of Texas at Austin School of Nursing and remember how the teachers embraced the concept of family-centered care. This was especially important in my field of neonatal care. As primary care nurses for babies, my colleagues and I cared for the entire family and often identified parenting issues and financial burdens, and worked hard to seek the proper outside resources for families to ensure that their baby was safe and healthy upon discharge and beyond.
As nurses we inherently understand that new parents often need assistance, but when it comes to the aging population, we tend to feel they have a lifetime of knowledge and experience to help them cope. We take for granted that the elderly have the physical, emotional and sometimes mental capacity to cope with a major life-changing event, such as illness.
This experience made me realize that as a nurse it is important to remember to not only treat your patient, but to take into consideration the patient’s support system. Recovering from open brain surgery is difficult at any age, but imagine experiencing this event in your 70s.
Although hospitals may consider a quick discharge a successful case, the entire hospitalization is pointless if the patient fails to safely transition at home. Often, older spouses do not have the mental resources, cognitive flexibility and physical stamina to cope with an unexpected health situation. Their entire world changes in the blink of an eye, and they become paralyzed.
It behooves nurses to explore beyond a patient’s physical well-being and determine what needs must be met for both spouses during the hospital stay and upon discharge.
By “seeing the bigger picture,” you are not acting as just a caregiver, but truly a lifesaver.