My sister just sent me this email:

I received a call Wednesday night around 11:30pm from Crystal, the nurse on duty. She called to tell me that Mom’s bed alarm went off and that when they got to her room , Mom was on her knees on the floor. She did not appear to have received any physical injuries, so they placed her back in bed and called Dr. Buck. Mom was very anxious and upset and crying nonstop. I came in to try and calm her down and stayed the night. Mom was very agitated when I arrived. Cheryl, the CNA on duty, was sitting outside her door and had been coming in to sit with Mom periodically but nothing seemed to soother her. I suggested they reposition Mom because it sometimes seems to help calm her down. She finally settled down, maybe sometime between 1 and 2am, and she seemed to sleep pretty deeply then. This morning I do not see any outward signs from the fall, no major bruising on her knees. There does seem to be a little red spot on her left knee that I will keep an eye on, but overall, I did not see any bruising or anything to indicate she fell hard.

The Physical Therapist came in at 8:30am and had to wake Mom up. (The Physical Therapists who were here yesterday – 2 of them – sat Mom up and helped her to her feet a couple of times, doing most of the lifting for her.) The PT today was alone and stretched out Mom’s legs and got her to sit up in bed. She had Mom kick out her legs a few times, as well. When I returned from the bathroom, the PT had Mom sitting in a chair. Mom was starting to get weepy. The PT left her in her chair, and I helped her with breakfast. She ate decently, feeding herself some and I fed her some. The nurse, Kylie, and I moved Mom’s chair by the window. She couldn’t relax and tried standing up a few times. She periodically was able to answer a couple of questions about what she was looking at outside, but she continued to be restless and upset.

Shawnta (CNA) got her back into bed, and it took her awhile to settle down. She ate some of her lunch on her own but continued to be weepy and anxious when awake.

Dr. Moore came to see her today. Because she has been so highly agitated, he has increased her Ativan from .25mg 2x/day and .5mg at night to 1mg 3x/day. (David, Dr. Moore does have an outside practice, but he says it is very small and getting smaller as his inpatient work takes up so much time.) Dr. Moore asked me what I thought. I talked about wanting to just snap her out of it, wondering if she just needed a zap to the head. Dr. Moore said that he and Dr. Buck had spoken about Electroconvulsive therapy (ECT) based on the curiousness of Mom’s condition. He said that ECT has shown to be useful with psychotic depression with side effects of some short-term memory loss, but she would need to go to Shands, Jacksonville, or Orlando. He said that if it is dementia, ECT could make it worse, but if it is a psychotic depression, then it could be helpful. He seemed to think that a teaching hospital might be more accommodating because Mom’s case is so perplexing. Dr. Moore also asked Pam, a Psych nurse from the hospital who worked with Mom while she was here previously, to come and observe Mom. Pam came and saw that Mom was much more anxious and upset than she had been. Mom received 1mg of Ativan around lunch time. When she was sleeping, she was sleeping pretty good, but when she wakes up, she has a minute of peace and goes straight to anxiety.

Dr. Moore was saying that maybe Mom needed to go back down to the Psychiatric unit for a bit, and I told him that I would take her home before letting back in there. He did agree that it did not seem as if they had been able to help her down there previously. He said that we should see how the increase in Ativan goes.

Dr. Buck came in around 7:30pm. Dr. Buck said that the Zyprexa had been increased, as well, to 15mg/day (if I recall correctly). Dr. Buck said that he and Dr. Moore had spoken briefly about ECT, but that it could be difficult to even consider due to the costs. He said that because Mom’s original admission need had been met, that we need to start considering her discharge and whether she can go back to Grace Manor in her current condition or if she will need a nursing home/rehabilitation home. Jan, will you be coming to do an assessment? She will continue to need Physical Therapy, but I do not see any reason why she won’t be walking again soon. Part of wanting to know about Mom’s return to Grace Manor is because if that is a go, I can pay May’s rent early, depleting her funds enough to be able to apply for Medicaid May 1st. Dr. Buck said that we will need to see how the next couple of days go with the Ativan increase.

When I arrived around 1pm yesterday, Mom was sleeping. When she woke up, I gave her some of her favorite Starbucks coffee. She had both eyes open and almost looked like she was going to smile. She did not stay awake for very long though. The nurse said that she had been weepy in the morning, but not as bad as her previous shift. When Mom woke up again, I helped her with dinner. She ate some of it on her own. Her overall mood seemed better, but she was not awake for very long while I was there. I am hoping to see some more improvement when I get there today.