With advice for anyone who may use, or know someone who may use a hospital… sigh… 

For the honour and elevation of all the departed, including my grandparents Abraham and Chaya… And towards a better world for the living…

Grandpa died after a valorous fight with abdominal cancer 17 years ago. 

Being so in love, and married for more than 50 years, grandma suffered tremendously. We all tried to take care of her as best as was possible, visiting whenever we could, offering her to move to the city with one of us, but she just couldn’t leave their home. So ever since, she lived out in the country, by herself…  

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Knowing the dangers and risks for a 95 pound, 80 year old woman living alone, we tried to mitigate as best we could. We got her a pendant button, which was connected to the emergency services. We put up sturdy railings and posts at strategic places around the house. We slip-proofed things. We automated what we could, and arranged service providers for regular household up keeping, the lawn, the driveway, the septic tank, etc.

Everything was going well for many years, until grandma began to develop Alzheimer’s. Thanks to her old love of reading, music, and her bilingualism, the disease progressed relatively slowly, but progress it did. For a few years we monitored her food and medicine intake, and made sure she had company often. But there came a time when we realized she could no longer stay on her own. So with great effort, we convinced her that over the next couple of weeks, she would move in with me. In the meantime, I would get my place ready for her, while she, my dad and my uncle would pack up and move her necessities.

This plan was not to be... 

We got a call at one in the morning. Grandma had fallen and broken her hip, and they were minutes away from operating. Thank goodness she pressed the pendant button…

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At first, the doctor said the surgery went well, and grandma seemed to improve for a couple of days after she woke up. One or two of us visited her in the hospital for 4-8 hours everyday, and it looked like she was eating ok. But her scheduled rehabilitation sessions were really seeming to hurt her, and she wouldn’t do any of the exercises on her own time. She therefore supposedly required extra pain killer, morphine, which we accepted as good advice, and as the usual procedure. (Couldn’t it be timed to correlate with her rehab though?)

Perhaps it was a week and a half after the surgery when someone realized they should X-ray to check that the rod, or pin was setting correctly. Sure enough, they could see that things were not as they should be. We were then told that the reason grandma wasn’t healing very well was because of her advanced osteoporosis, which according to her doctor; 

"had made her bones as soft as sticks of hard butter...” 

And so, the reconstructed joint wasn’t setting properly, and there was nothing they could do. (It may have been good to know how soft her bones were a week ago?)

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We weren’t prepared for it, but over the next 2 weeks, 

and thanks to the morphine, her appetite fell dramatically. It was a fight to get grandma to eat anything other than a couple of tiny sips of some juice, or a “meal replacement” drink every hour, which we had to literally bring to her lips. It was so heartbreaking to see the change. She could barely stay awake, but when she was, she’d be hallucinating, and in her more lucid moments, asking over and again; 

“Where is my purse so we can pay, and go home..?”  

We began to understand that grandma probably wasn’t coming home. For me this realization came late, because I spent so much time with her before the fall, and knew her strength as well as her usual appetite. I got it into my head that if only the nurses would wean grandma from the morphine, she’d begin to eat, and maybe go for a bit of rehab. I felt sure we could at least get her out of the hospital in a few weeks in a wheelchair. So, we asked if they would slow the morphine and if they could at least give her some nutrition intravenously. They agreed about the morphine, but not the IV. A small, partial victory that was too late…

We tried the new plan for a few days, and it seemed ok. Even with less morphine she didn’t appear to be in any extra pain. But with no increase in appetite, and only a few calories each day for the past weeks, being virtually pushed into her, and dehydration despite our best efforts, the doctors realized that grandmas kidneys were shutting down.

After thankfully getting to say goodbye, forty eight or so hours later, grandma Chaya died in her sleep with my father holding her hand… Our whole family owes everything to grandma. We will always miss her, and have in our hearts the many happy times we spent together. I remember the cookouts and the laughter most…

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Thank goodness she lived a happy and long life...

And hindsight is 20/20, but we should have fought the hospital about the IV, and noticed the need earlier. We appealed to authority. You just trust that the doctors and nurses know best, and that they follow the correct procedures. It all happened so fast… I’m not blaming the hospital or it’s staff for grandma’s death, things just got out of control... But I can’t help but wonder if in this economically driven world, in hospitals without enough staff, and too much morphine, if it is just one of the easier ways we deal with the sick and elderly. Morphine is dirt cheap, drugged out people don’t ask for much, and the problem soon goes away… I’m sure it goes even faster for people who are given high dose prescriptions or their own morphine pumps… Omg…

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(Though grandma's death would not be considered from morphine, these numbers illustrate the problem...)

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Questions towards the improvement of public hospital systems: 

• Why downplay or fail to mention at all, any complications during the surgery?  
• Why is it not standard procedure to X-ray soon after the surgery? 
• Why would staff drop off the meal tray, leave, and have no one return to check if it is being eaten? 
• Why no IV for someone who barely eats? 
• Why so much morphine? 
• If grandma didn’t have a visitor everyday to make her eat something, would you have just let her not eat at all?

Common sense, but good to be aware of, lessons I learned:  

• No one loves the patient more than me and our family. We must be their advocate. 
• I should pay close attention to my loved one’s general health, breathing, eating and expulsion, as well as any specific symptoms.
• Learn about any medicine being given.
• I should visit as often and as long as possible. Stay during shift changes. Get to the know staff. Make friends and break the visiting hours “rules.” 
• If I think something is wrong, I should politely, firmly, immediately say so. 
• I shouldn’t be embarrassed to feed family or friends. It’s uncomfortable at first, but I’ll get over it… 
• Trust my instincts. 
• Bring in the patient’s favourite music and family photos. This is especially important for people with dementia or Alzheimer's. 
• Bring in my loved one’s favourite foods! (There’s usually a fridge and microwave somewhere on the floor.) Eating happily and as much as possible is the ticket out of the hospital…!

Thanks for reading and please, if you think this can help someone, upvote and comment to make others aware of these, and your own hospital tips or related experiences too...

Melech ben Chaya, @inphiknit