THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
S U M M A R Y
DIARY: January 6, 2007 05:51 AM Saturday;
Travel to Nipomo visit Bob and mother in hospital.
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Visit Nipomo Bob Mother in Hospital Very Serious Heart Attack Loss 7
0603 - ..
0604 - Summary/Objective
060501 - Follow up ref SDS 20 0000. ref SDS 19 0000.
060503 - Visited mother in the hospital. She does not look well, and her
060504 - chances seem low for recovery because of severe loss of heart function
060505 - with continuing emphasema. ref SDS 0 NV5K Patty and Pablito did not
060506 - come up for this visit, Patty plans to come tomorrow. ref SDS 0 TG6H
060507 - At the hospital, met Robin's brother, Rick. Mother was very pleased
060508 - to see all of her visitors, especially Rick. ref SDS 0 485N At lunch,
060509 - we learned more about Robin's and Rick's early life with Beverely,
060510 - overcoming difficulties, and becoming outstanding people. ref SDS 0
060511 - RR50 Mother had some success eating near normal food fed with a spoon
060512 - by a trained therapist. This was an experiement to test her ability
060513 - to eat without a feeding tube. ref SDS 0 CM5G Tried this again for
060514 - the evening meal, and encountered administrative snaufs, but got
060515 - things worked out. ref SDS 0 XY8H Mother's heart doctor gave her pain
060516 - medication after the evening meal, because her stomach hurt.
060517 - ref SDS 0 XY66 She went to sleep, and we all met at Bob's place for
060518 - Pizza, delivered by Robin's friend, JR. ref SDS 0 SA57 Jerry called
060519 - Bob's place while were at the hospital. Millie took the call and
060520 - listened to Jerry's concerns about mother. ref SDS 0 L34K Had
060521 - delightful discussion well into the night hearing about JR's buiness,
060522 - and Rick's work as an entertainer in the music business. ref SDS 0
060523 - 9335
060525 - [On 070107 Jerry visited mother and Bob with his two children.
060526 - ref SDS 22 DS4J
060528 - ..
060529 - [On 070109 Patty asks abour visit, and reports on patching things
060530 - up with Bob. ref SDS 23 LK5G
060532 - ..
060533 - [On 070110 Bob reports that Eddie and Kathy drove down from
060534 - Sacramento to visit mother. ref SDS 24 GO6L
060539 - ..
0608 - Progress
060901 - Called Robin this morning while traveling to coorindate visiting
060902 - today with her brother, Rick, and Patty, and Pablito.
060904 - ..
060905 - Robin said that Pablito is not coming afterall. Patty called last
060906 - night and said she is coming up on Sunday, rather than today, and
060907 - Pablito is staying behind to care for their pets, changing plans
060908 - discussed with Bob yesterday. ref SDS 20 F18H
060910 - [On 070109 letter from Patty asks about visit with mother
060911 - and everyone. ref SDS 23 TG6H
060913 - ..
060914 - [On 070111 letter to Patty on visiting Nipomo. ref SDS 25
060915 - TG6H
060917 - ..
060918 - Arrived OA 0945. Bob looked well, and seemed in good spirits.
060920 - ..
060921 - He has dental work scheduled for next week to replace a number of
060922 - teeth, and so is a little aprehensive about starting major dental work
060923 - that will take several months.
060925 - ..
060926 - We visited for about 30 minutes, then drove to visit mother at the
060927 - hospital in Arroyo Grande.
060929 - Arroyo Grande Community Hospital
060930 - 345 South Halcyon Road
060931 - Arroyo Grande, CA 93430
060932 - 805 473 7650
060934 - ..
060935 - Mother looked pretty well under the circumstances. She has a feeding
060936 - tube through her nostril, the esophagus, and into her stomach. She is
060937 - also on oxygen, and has several senesors connected to monitor her,
060938 - plus several IVs.
060940 - ..
060941 - Bob said this is a lot fewer connections than when mother was in ICU
060942 - last week.
060944 - ..
060945 - Mother was sleeping when we arrived, but woke shortly. She was
060946 - suprised to see us and gave Millie a strong embrace. She was able to
060947 - say a few things. She dozed off while were there.
060949 - ..
060950 - Mother has lost a lot of weight. No one looks their best in the
060951 - hospital.
060953 - ..
060954 - Sophia, a speech therapist, was in the room when we arrived. She said
060955 - Doctor Sexton has planned to test mother's ability to eat solid food
060956 - today. This will occur around noon, and Sophia will assist mother in
060957 - this experiment to report progress, and provide immediate aid if
060958 - needed, for example if mother chokes, trying to swallow food with a
060959 - tube in her throat. Sophia said that she is going off duty, but her
060960 - replacement will feed mother at noon, and provide care for any
060961 - problems that might arise.
060963 - ..
060964 - Sophia explained that mother is doing pretty well, but gets
060965 - disoriented on medication, and tries to remove her IVs and feeding
060966 - tube. The past week mother was restrained in the ICU with her hands
060967 - lashed to the bed side bars. In the regular care unit, her hands are
060968 - not lashed. Mother was observed by a nurse through the night to
060969 - prevent her from removing IVs and tubes. Sophia said during the day
060970 - shift, the doctor has ordered that nurses check mother every 15
060971 - minutes to verify her treatment IV's and tubes are still in tact.
060973 - ..
060974 - Mother's doctor came into the room for an examination. He is a tall,
060975 - thin, elderly doctor. He mostly asked questions of the nurse about
060976 - mother's activity and diagnostics. He wrote a lot of notes in his
060977 - medical chart ledger. At this time, did not realize he was the heart
060978 - doctor, who Bob complained about not contacting him on 061227.
060979 - ref SDS 13 WJ7M
060981 - ..
060982 - About half an hour after we arrived, Robin and her brother, Rick,
060983 - arrived. Robin introduced everyone. Mother was very happy to see
060984 - Rick. She held his hand and said a few words. Robin was attentive;
060985 - she fixed mother's gown, and bedding to make her comfortable.
060987 - ..
060988 - A nurse came into the room to see how mother is doing, and check on
060989 - her IVs and connections, per above. ref SDS 0 RR5J Everything was
060990 - okay.
060992 - ..
060993 - Doctor Sexton examined mother. He is the house doctor on call for the
060994 - ward. Seems young, under 40, and very sharp.
060996 - ..
060997 - He discussed requirements for the family to begin making arrangements
060998 - for mother's long term care, including the need for an alternate
060999 - feeding system with a tube through the stomach. This would be hard
061000 - for mother to handle emotionally.
061002 - ..
061003 - The doctor asked about mother's history of emphasema?
061005 - ..
061006 - Bob said mother stopped smoking about 20 years ago, but had smoked
061007 - heavily for many years prior to that, and was diagnosed with emphasema
061008 - about 10 years ago, which has become progressivly worse. She now
061009 - needs regular breathing assistance.
061011 - ..
061012 - The doctor explained that mother's many medications for pain relief
061013 - increase the burden on her heart. Loss of lung capacity from
061014 - emphasema also makes the heart work harder. These compound, and
061015 - rising cardio-pulmonary problems caused the heart attack during
061016 - Thanksgiving that hospitalized mother for only a few days, as Bob
061017 - reported on 061226, ref SDS 11 TG6H, and then again the recent heart
061018 - attack last week. The doctor said that mother's 75% loss of heart
061019 - capacity is very serous, reported by Bob yesterday. ref SDS 20 U467
061020 - Since mother now has markedly less heart capacity than before, chances
061021 - of another heart attack are very high because rising loss of lung
061022 - function due to increasing emphasema and continuing pain medications
061023 - greatly overburden diminished heart capacity.
061025 - ..
061026 - The doctor reviewed planning discussed earlier by Sophia. The doctor
061027 - said that mother will be fed by a speech therapist with some specially
061028 - prepared soft food to monitor and report mother's ability to swallow,
061029 - and digest, essential for recovery, per above, ref SDS 0 RR4J, apart
061030 - from chances for another heart attack.
061032 - [...see doctor's orders not performed; patient suffers extreme
061033 - distress. ref SDS 0 RS62
061035 - ..
061036 - Bob suggested that everyone go to lunch to get acquainted, and he will
061037 - stay with mother until they feed her lunch, per planning by Sophia,
061038 - and Doctor Sexton.
061042 - ..
0613 - 1147
061401 - Went to lunch with Robin and her brother, Rick, at Coco's in Arroyo
061402 - Grande, a few blocks from the hospital. We all drove in Rick's car,
061403 - and new Afiniti. Robin pointed out a number of interesting features,
061404 - including a map that shows the car location and surrounding streets,
061405 - and can be zoomed out to show as far away as Canada and Mexico.
061406 - Millie complemented the roomy interior, and smooth ride.
061408 - ..
061409 - Enjoyed hearing about Rick's life and upbringing, as Beverly's son.
061411 - ..
061412 - Rick explained that Beverly and her husband gave up their children,
061413 - Rick and Robin, for adoption. Rick is 5 years older than Robin. He
061414 - is now 50, and Robin is 45, with a birthday coming up on 070115. At
061415 - the time of the adoption, he was only 5, and Robin was a new born
061416 - baby. After a new months, the father of the adopting parents decided
061417 - not to continue caring for Robin, so borther and sister were split up
061418 - and grew up with separate lives. Robin never new she had a brother,
061419 - and Rick forgot he had a sister.
061421 - ..
061422 - Mother and Bob, and/or Grandmother and Uncle Louie took Robin from the
061423 - adopting parents. Beverley was suddenly stricken with polio, and was
061424 - hospitalized for several years. Bev met another patient in the
061425 - hospital and married him. Beverly and her husband recovered enough to
061426 - be released from the hospital. They took custody of Robin when she
061427 - was about 3 - 5 years old. Evidently, the husbank though in a wheel
061428 - chair, molested Robin over several years. Eventually, mother learned
061429 - about this and she and Bob took Robin to live with them. Beverly's
061430 - polio worsened, and she was hospitalized again. Robin was mostly
061431 - raised by Grandmother and Uncle Louie. She knew her mother from
061432 - occassional visits over the next 8 years while Bev struggled in vain
061433 - to recover from polio.
061435 - ..
061436 - Mother and Bob knew the couple who raised Rick. When Robin grew up,
061437 - they eventually told her about having a brother, and facilitated a
061438 - meeting between brother and sister.
061440 - ..
061441 - During lunch today, told Rick a little about his mother being raised
061442 - by her sister, and living with us in Whittier, Glendale, El Monte,
061443 - Ontario with 6 kids, and was the leader of the pack when we were all
061444 - little. She was about 10 years old when she lived with us, and would
061445 - plan and direct us much younger kids, 4 - 6, building forts in the
061446 - backyard, swiping candy at the store, and similar small projects.
061447 - When she got older, about 14 - 17, she and her boyfriend stole our
061448 - car, and tried to drive to Mexico, but were arrested at the border.
061449 - Bev always had wild ideas and big plans. Maybe this was reaction to
061450 - her mother's deep religious bent. Somehow, Bev learned early, when
061451 - they pass the plate, drop a nickle and pick up a dime.
061453 - ..
061454 - Rick seems to have a normal childhood, and enjoyed loving parents.
061456 - ..
061457 - Rick was active in sports. He played running back in high school; he
061458 - was a champion wrestler, and competed in track. His senior year, Rick
061459 - gave up sports to concentrate on music. He got a scholarship to study
061460 - music in college. Rick now makes a living teaching music in a middle
061461 - school. Much of the past 30 years, he has performed professionally,
061462 - including with prominent entertainers, singers, and muscians on the
061463 - night club circuit, including Las Vegas. Trumpet seems to be his
061464 - favorite instrument, but he also plays the piano, and the guitar.
061466 - ..
061467 - Rick now lives in Whittier with his wife, Margaret, two daughters and
061468 - a son. The daughers are fraternal twins, and so don't look alike.
061469 - One named Robin looks like her Aunt Robin, which was very evident from
061470 - pictures of recent a skiing trip.
061472 - ..
061473 - Rick met his wife, when she was a singer and dancer at Disnyland, and
061474 - he was playing in a band. She is now a nurse pratitioner, who can do
061475 - most medical tasks performed by doctors, except surgery. So, she is
061476 - quite an accomplished woman.
061478 - ..
061479 - Rick looks in great shape. He recently lost 40 pounds with a new
061480 - exercise regimen, running and working out.
061484 - ..
0617 - 1245
061801 - Drove back to the hospital. Rick stopped at a florist along the way,
061802 - and picked up some flowers for mother.
061804 - ..
061805 - When we arrived, mother was sitting up in a chair, and Bob was trying
061806 - to get her to eat.
061808 - ..
061809 - We reviewed plans Doctor Sexton related for the speech therapist to
061810 - feed mother and monitor progress for deciding on removing the feeding
061811 - tube tomorrow. ref SDS 0 RR74
061813 - ..
061814 - Bob said nobody has come by so he had to feed mother.
061816 - ..
061817 - Mother started to cough and asked for some water to drink in order to
061818 - clear her throat. She seemed in great distress. Bob said that nurses
061819 - instructions are not to give mother water. This is why the doctor
061820 - ordered a professional to do the feeding in order to take immediate
061821 - action to relieve patient distress, per above. ref SDS 0 RR74
061823 - ..
061824 - Visited the medical assistants station. Doctor Sexton was in an
061825 - office in the back. Asked for assistance by the speech therapist to
061826 - feed mother, as the doctor planned this morning, per above.
061827 - ref SDS 0 RR74 Doctor Sexton recalled the earlier planning, and
061828 - apologized for failure to implement his doctor's orders. He said that
061829 - communications sometimes get mixed up when people are busy with a
061830 - hectic schedule, similar to the report at Kaiser on 061020.
061831 - ref SDS 9 TR47
061833 - ..
061834 - The doctor investigated the problem. He learned that speech
061835 - therapists only work one shift on Saturday, so the earlier plan cannot
061836 - be fully implemented. He feels that a trained professional should
061837 - feed mother to treat negative reactions, as just occurred, and to
061838 - report results for decision support. Doctor Sextion advised that he
061839 - would direct the work to correct the problem by getting someone with
061840 - required skills to feed and montor mother.
061842 - ..
061843 - About 10 minutes later, another nurse, actually a physicial therapyst
061844 - came into the room. She was excellent caring for mother, and
061845 - providing professional assistance with her eating, and noting ability
061846 - to hold down food. The therapyst was very patient, and persistent
061847 - getting mother to help herself by eating some food, even though this
061848 - was difficult with a feeding tube running down her throat and into
061849 - her stomach.
061851 - ..
061852 - When we left, Bob and mother embraced and they kissed, and spoke
061853 - softly for a about a minute to each other. They did this when we
061854 - arrived earlier, and Bob was continually attentive caring for mother's
061855 - needs and requests. There is the sense that the current crisis has
061856 - quickly put a lot old business between them to rest. Possibly,
061857 - Patty's phone message and subsequent letter reported on 070102 was
061858 - helpful. ref SDS 18 Z85V
061862 - ..
0621 - 1405
062201 - Drove home. Made plans to visit mother again about 1730, with Rick,
062202 - and Robin, then to have dinner at Bob and mother's place in Nipomo
062203 - with Rick, Robin, and her friend JR.
062205 - ..
062206 - Millie was tired from the long drive and stress of visiting mother.
062207 - She laid down to sleep.
062209 - ..
062210 - Bob took Thelma for a ride to the store to get some things.
062212 - ..
062213 - Watched some of the football playoffs on television.
062216 - ..
0625 - 1710
062601 - Drove back to the hospital to visit mother. Millie was still
062602 - sleeping, so we did not wake her.
062604 - ..
062605 - Robin and Rick were already in mother's room. Mother's eyes were
062606 - closed when we arrived, but she opened them and she smiled seeing
062607 - everyone there to visit.
062609 - ..
062610 - There was again a problem getting a nurse to help mother eat, as
062611 - ordered by the doctor. The kitchen service had delivered food, but no
062612 - one was helping mother eat. Bob started to do this. On discussion he
062613 - decided to wait for the nurse.
062615 - ..
062616 - Visited the Medical Assistant's station. Mother's nurse said she
062617 - would perform the task of helping mother eat and write up the report
062618 - for the doctor to decide on removing the feeding tube. Another nurse
062619 - disputed the doctor's order to feed mother with a feeding tube also
062620 - installed. She said the hospital has never done this procedure, and
062621 - it is against policy. There was a debate for about 5 minutes, which
062622 - explains why there has been failure to carry out the doctor's orders
062623 - on feeding mother.
062625 - ..
062626 - Finally, mother's nurse said she would go ahead and implement the
062627 - doctor's order. About 10 minutes later, she came into mother's room
062628 - and helped her eat. This went pretty well. Mother was able to
062629 - swallow maybe 3 or 4 spoonfuls of the prescribe soft food. She had
062630 - several episodes of reaction attempting to cough up what she
062631 - swallowed, but the nurse provided assistance to relieve these
062632 - problems.
062634 - ..
062635 - Mother was able to experess strong apprecation for Bob, Millie, Robin
062636 - and Rick visiting. She was demonstrative with Bob, holding him fast
062637 - to her, and this was touching to see after all they have experienced
062638 - together.
062640 - ..
062641 - Mother seemed comfortable. She closed her eyes and seemed to sleep
062642 - for a few minutes, then opened her eyes and smiled at everyone. Robin
062643 - asked how she is feeling and mother said she is in pain. This seemed
062644 - conflicting with her comfortable demeanor a few moments earlier.
062646 - ..
062647 - Bob is concerned that mother has many painful areas in her legs, and
062648 - her back due to osteoperosus, which her mother (grandmother Baker),
062649 - also suffered, reported on 930405. ref SDS 2 365L Robin said that
062650 - mother uses a number of pain patches for relief. The hospital has
062651 - been giving her morphine. It is hard to tell when mother is actually
062652 - suffering pain, and when she is disoriented with beginnings of
062653 - dementia and complains of pain from false memory rather than actual
062654 - physicial symptoms.
062656 - ..
062657 - Visited the Medical Assistant's station again. Mother's nurse said
062658 - that the medical chart prescribes pain treatment for mother, and that
062659 - a nurse, Linda, was assigned to monitor mother and provide appropriate
062660 - treatment according to doctor's orders.
062662 - ..
062663 - About 20 minutes later, Linda had not arrived in mother's room.
062665 - ..
062666 - Mother was complaining of pain in her stomach.
062668 - ..
062669 - Robin commented about difficulty determining when mother is really
062670 - suffering. She said that mother sometims complains of pain when
062671 - there are no evident signs of distress.
062673 - ..
062674 - About 10 minutes later the doctor, who examined mother this morning,
062675 - per above, ref SDS 0 XW7N, was walking down the hall. Robin commented
062676 - that he is mother's heart doctor.
062678 - ..
062679 - Visited with the heart doctor.
062681 - ..
062682 - He was in a hurry on the way to treat other patients, write up his
062683 - reports, and go home. The doctor said he did not have time to talk.
062685 - ..
062686 - Explained mother complaining of pain for the past half hour, and that
062687 - the staff has not had time to address the problem.
062689 - ..
062690 - The doctor said this should be reported to the nurses station for
062691 - immediate application of prescribed treatments.
062693 - ..
062694 - Reviewed patient history with the doctor showing that Linda has this
062695 - assignment, per above, ref SDS 0 ZZ4F, but has not been seen for the
062696 - past 30 minutes. Asked how long the patient should suffer while
062697 - waiting for assigned staff to perform the work?
062699 - ..
062700 - The doctor said that pain medication needs to be administered
062701 - carefully to avoid stressing mother's heart, noted earlier today, per
062702 - above. ref SDS 0 OW5G
062704 - ..
062705 - Considered advantage of the heart doctor examining the patient to
062706 - determine medication that relieves pain without damaging the heart.
062708 - ..
062709 - The heart doctor concurred, and examined mother.
062711 - ..
062712 - The doctor was very careful and professional ascertaining the source
062713 - of the pain. Bob explained patient history of advancing osterperosis,
062714 - other causes of pain, per above. ref SDS 0 XZ3H At this time, mother
062715 - seemed to complain about pain in her stomach.
062717 - ..
062718 - The doctor gave mother morphine to relieve pain in an amount that
062719 - minimized effect on the heart.
062721 - ..
062722 - This made mother groggy, and she fell asleep.
062724 - ..
062725 - Thanked the doctor for taking immediate action.
062727 - ..
062728 - We left the hospital.
062730 - ..
062731 - Robin said that JR would pickup some pizza for dinner.
062736 - ..
0630 - 1918
063101 - Arrived back at Bob's place.
063103 - ..
063104 - Millie said in an aside that Jerry called while we were at the
063105 - hospital, following up notice in the call on 070105. ref SDS 20 JS8O
063106 - He was angry and said he did not care about his mother, and did not
063107 - want to talk to her, because she did not care about him. Jerry said
063108 - he is living in Cupertino.
063110 - ..
063111 - Jerry being angry and curt with Millie, who he does not know, and who
063112 - has never done anything to him was disappointing, especially with
063113 - Millie's condition that is easily worsened by tension and stress. He
063114 - must have a lot of hurt feelings bottled up.
063116 - [On 070107 Jerry called get the telephone number for the hospital
063117 - treatment mother. ref SDS 21 TG6H
063119 - ..
063120 - [On 070108 Bob met Jerry and his children at the hospital visiting
063121 - mother; Bob commented on Jerry's kids being polite and well
063122 - mannered; he enjoyed a long discussion with Jerry. ref SDS 22 DT7V
063126 - ..
063127 - Had more time to get acquainted with Rick.
063129 - ..
063130 - Bob made drinks for everyone. Millie could not finish hers, because
063131 - her taste is affected by chemotherapy treatments.
063133 - ..
063134 - JR arrived shortly with Pizza and we all enjoyed good food, and good
063135 - discussion.
063137 - ..
063138 - JR's archictecture and engineering business is growing. They do a lot
063139 - business with Safeway stores and gas stations.
063141 - ..
063142 - JR mentioned a few problem projects that have taken more time. On one
063143 - project the contractor was not experienced constructing gas stations.
063144 - This leads to requests for change orders to make up for under bidding
063145 - the cost of the work. May have mentioned Welch vs. State of
063146 - California that involved this issue, reviewed on 000723. ref SDS 5
063147 - J26K
063149 - ..
063150 - Related a few case studies about challenges that arise from design
063151 - errors and omissions in contract work....
063153 - Santa Clara Jail.................. 891202, ref SDS 1 3W50
063154 - Broadwater Dam.................... 990316, ref SDS 4 3088
063155 - Oakland Harbor project............ 981027, ref SDS 3 9152
063156 - Case Study FAR requirements
063157 - contract management routinely
063158 - ignored........................... 020504, ref SDS 6 NS6F
063160 - ..
063161 - JR recently took the test to get a state professional engineering
063162 - license. The test occurs over several days, and allows engineers to
063163 - refer to sources for finding answers. We all wished him success.
063165 - ..
063166 - Rick told us more about his life in the performing and entertainment
063167 - arts. Rick explained the rigoruous test he took many years ago to get
063168 - a teaching certificate for music.
063170 - ..
063171 - Similar test was required for the A and B contracting license.
063173 - ..
063174 - We talked about movies, and Bob talked some about his life with
063175 - mother, concentrating on the good times.
063177 - ..
063178 - Robin has been a big part of their life. In recent years Rick, and
063179 - now JR have become very important to Bob and mother.
063181 - ..
063182 - Finally, time for bed and everyone headed home.