CONTACTS
SUBJECTS
Bob Visit Arroyo Grande Community Hospital Recover Knee Replacement
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 11 0000. ref SDS 10 0000.
040502 -
040503 -
040504 -
040505 -
040506 -
040508 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - Bob does not sound well.
040902 -
040903 - Bob initially explained task to mail an envelope today. While we
040904 - talked, found the letter on the banister ledge at the enteryway from
040905 - the front door to the dining area, and wedged between a small sutffed
040906 - animal and a post projecting up to the ceiling.
040907 -
040908 - [...below on 111103 0709 at 0929 mailed Bob's letter in a
040909 - post office box on Teft street about a block West of Von's
040910 - grocery store. ref SDS 0 9P4G
040912 - ..
040913 - Bob then reported that the latest lab shows HGB (hemoglobin) is so low
040914 - that the doctor prescribed a blood transfusion today.
040915 -
040916 - [On 111111 0802 at 0915 Bob getting care to recover from
040917 - infection and rehabilitate from knee surgery; Mission View
040918 - Care Center not aware Bob had blood transfusion, nor that
040919 - he has rare blood type. ref SDS 14 O462
040921 - ..
040922 - Bob's temperature went up from 99.2 to 100+ last night.
040924 - ..
040925 - These are not positive signs of recovery.
040926 -
040927 - [...below on 111103 0709 at 0828 telecon with Doctor Fow
040928 - indicates low HGB and getting blood transfusion normal
040929 - protocol for 33% knee surgeries, and is not related to
040930 - rising temperature nor discovery of infection in lab
040931 - yesterday prior to surgery. ref SDS 0 FI84
040933 - ..
040934 - Doctor Fow visited Bob last nigth. Bob said that he agreed to go into
040935 - a rehab facility for 3 days. His brother is coming up on Saturday to
040936 - stay with the dog while Bob is treated in rehab.
040937 -
040938 -
040939 -
040940 -
040941 -
040943 - ..
0410 -
0411 -
0412 - 0713
0413 -
041301 - Called and left message for Robin on Bob's progress, per above.
041302 - ref SDS 0 EI7V
041303 -
041304 -
041306 - ..
0414 -
0415 -
0416 - 0738
0417 -
041701 - Bob called back.
041702 -
041703 - A nurse told him rain is forecast for tonight.
041705 - ..
041706 - Bob explained a procedure to clean Sandy's feet with a rag in the
041707 - garage before letting him into the house. This will minimize dirt he
041708 - drags into the house.
041709 -
041711 - ..
0418 -
0419 -
0420 - 0743
0421 -
042101 - Called Doctor Fow...
042102 -
042103 - 805 473 0700
042105 - ..
042106 - Got message the number has been disconnected.
042107 -
042109 - ..
0422 -
0423 -
0424 - 0745
0425 -
042501 - Allen, Bob's brother, called.
042502 -
042503 - Allen related receiving a call from Bob this morning with plans to
042504 - undergo care in a rehabilitation facility for 3 days. Allen feels
042505 - this is a good decision by Bob based on living alone with a big dog,
042506 - like Sandy. This aligns with Allen's call a few days ago, reported on
042507 - 111101 0930. ref SDS 10 7Q4K
042508 -
042509 - [...below on 111103 0709 at 0848 visited Bob at the
042510 - hospital; he related planning for his brother to come to
042511 - Nipomo to take care of Sandy for 3 days. ref SDS 0 FM6H
042513 - ..
042514 - Explained that Bob also called me on this issue this morning.
042516 - ..
042517 - Started to discuss concerns about complications Bob has suffered with
042518 - temperature from rare infection, per above. ref SDS 0 EI7L
042520 - ..
042521 - During the call, there was a clicking sound on Bob's phone indicating
042522 - another caller is on the line.
042524 - ..
042525 - Allen said he plans to come up on Saturday, and then hung up.
042526 -
042528 - ..
0426 -
0427 -
0428 - 0747
0429 -
042901 - After disconnecting the call with Allen, Bob came on the line.
042902 -
042903 - He needs his walut and change purse. He has gone through his
042904 - clothing at the hospital and cannot find it.
042906 - ..
042907 - Bob said to check the top drawer in the kitchen next to the stove,
042908 - where he has documents and mail pending for his review, noted
042909 - previously on 111101 0930. ref SDS 10 8M4T
042911 - ..
042912 - While we talked checked the drawer. There is no walut and change
042913 - purse.
042914 -
042915 - [...below on 111103 0709 at 0848 visited Bob at the
042916 - hospital; he found his walut and change purse in his pants
042917 - at the hospital. ref SDS 0 WF9W
042919 - ..
042920 - Told Bob not to worry his walut will show up. For the moment, he has
042921 - forgotten where he put it, but will remember later.
042923 - ..
042924 - After Bob's series of calls, took a shower, and drove to the hospital
042925 - in Arroyo Grande.
042926 -
042927 -
042929 - ..
0430 -
0431 -
0432 - 0828
0433 -
043301 - Arrive at Arroyo Grande Community Hospital.
043302 -
043303 - Walking down the hall, see Tanya alone in her office. She smiles and
043304 - waves hello, remembering from checking Bob into the hospital on 111031
043305 - 0800. ref SDS 9 Z969
043307 - ..
043308 - Discussed Bob's call this morning on his temperature going up, and
043309 - needing a blood transfusion, per above. ref SDS 0 EI7V
043311 - ..
043312 - Tanya said she cannot access the medical chart on the computer to see
043313 - what the doctor has said about Bob's progress. Tanya offered to call
043314 - the doctor on her phone, and give the phone to me for checking on how
043315 - Bob is doing.
043317 - ..
043318 - Tanya called Doctor Fow.
043320 - ..
043321 - Talked to Doctor Fow.
043323 - ..
043324 - Doctor Fow said that about 33% of patients suffer low HGB (hemoglobin)
043325 - and need a few pints of blood after knee surgery. This indicates that
043326 - Bob needing a transfusion is a normal part of knee replacement
043327 - protocol, and so does not signal a downturn in his health and/or
043328 - recovery.
043329 -
043330 - [...below on 111103 0709 at 1818 blood transfusion ordered
043331 - this morning delayed until late in the earling evening,
043332 - because Bob has rare blood type. for. ref SDS 0 M74O
043334 - ..
043335 - [On 111111 0802 at 0915 Bob at Mission View to recover from
043336 - infection and rehabilitate from knee surgery; Mission View
043337 - Care Center not aware Bob had blood transfusion, nor that
043338 - he has rare blood type. ref SDS 14 O462
043340 - ..
043341 - [On 111111 0802 at 1429 Bob's lab shows HGB 9, well below
043342 - target range of 12 - 14; Mission View believes this
043343 - indicates HGB rising and so does not require blood
043344 - transfusion. ref SDS 14 YU8F
043346 - ..
043347 - Doctor Fow seems more concerned about Bob's rising temperature above
043348 - 100, per Bob's call this morning, above. ref SDS 0 L45H In this call,
043349 - Doctor Fow indicated that low HGB and getting a blood transfusion are
043350 - not related to rising temperature nor infection, which seemed to be
043351 - the case in Bob's call this morning, per above. ref SDS 0 EI7V
043352 -
043353 - [...below on 111103 0709 at 1923 Doctor Fow advised that
043354 - Bob cannot be released from the hospital for outpatient
043355 - care at rehab facility while he still has elevated
043356 - temperature. ref SDS 0 Y15I
043358 - ..
043359 - Doctor Fow indicated this morning having received a report from the
043360 - Infectious Disease Specialist, Doctor Ritter, with findings and
043361 - recommendations from examination yesterday on Bob's infection,
043362 - reported, 111102 0718, ref SDS 11 HN5F, and which was initially
043363 - discovered on Monday from the urine sample taken prior to surgery,
043364 - disclosed by Doctor Fow after completing surgery on 111031 0800.
043365 - ref SDS 9 CS8H
043367 - ..
043368 - Doctor Fow seemed to say that Bob is being treated for a rare
043369 - infection caused by reaction to antibiotics medication he received
043370 - last month to treat infection diagnosed without lab evidence, and
043371 - based on clinical examination of scratches on Bob's legs, reported in
043372 - the record on 110919 1800. ref SDS 6 NM9M when Sandy, the dog, got
043373 - excited and jump up to be petted, cited again by Doctor Fow as a
043374 - complication after Bob's surgery on 111031 0800. ref SDS 9 N49H
043375 -
043376 - [On 111111 0802 Doctor Fow advises diagnosis that Bob has a
043377 - rare infection was a mistake; he has "e-coli" that is
043378 - highly resistant to antibiotics. ref SDS 14 623O
043380 - ..
043381 - Doctor Fow commented that his colleague, Doctor Ritter the Infectious
043382 - Disease specialist is not concerned about Bob's infection condition;
043383 - but, as Bob's surgeon, Doctor Fow is concerned about Bob's elevated
043384 - temperature signaling the body is fighting something, and so Doctor
043385 - Fow has ordered the most aggressive treatment for Bob to recover
043386 - quickly and thoroughly.
043387 -
043388 - [...below on 111103 0709 at 1823 Kirk takes vitals and
043389 - temperature 102 with modern skin surface thermometer, and
043390 - 99.7 with conventional oral thermometer; patient history
043391 - shows persistent fever past 2 days showing minimal response
043392 - to antibiotic treatment. ref SDS 0 HG6M and ref SDS 0 KU85
043394 - ..
043395 - Asked the doctor about Bob going into rehab?
043397 - ..
043398 - Doctor Fow said he spoke with Bob last night and hold him he is making
043399 - great progress toward recovery given his age and scope of knee
043400 - replacement surgery this past Monday. The doctor recommended Bob move
043401 - to a rehab facility to get concentrated medical support for 3 days
043402 - that will expedite recovery.
043403 -
043404 - [...below on 111103 0709 0848 met with Bob and explained
043405 - discussion with Doctor Fow on getting support in a rehab
043406 - facility to expedite recovery. ref SDS 0 E25J
043408 - ..
043409 - [On 111105 0853 at 1620 Francis, Bob's physical therapy
043410 - nurse at Mission View, reported that Bob was very
043411 - discouraged on being told he would need 2 weeks of physical
043412 - therapy at Mission View for rehabilitation to recover from
043413 - knee surgery. ref SDS 13 D86I
043415 - ..
043416 - [On 111111 0802 at 1822 Laura physicial therapyst reported
043417 - Bob walked 150 steps with walker and physical therapyst;
043418 - still has long way to go to walk 150 steps that demonstrate
043419 - rehabilitation to function indepently; patients usually
043420 - require 4 weeks, and some take months to be ready for
043421 - discharge. ref SDS 14 FH5W
043423 - ..
043424 - [On 111112 0838 at 1732 Bob showing better signs of
043425 - recovery with less pain, and with appetite, energy, and
043426 - enthusiasm for life increasing, ref SDS 15 PRSV; Bob did
043427 - some rehab walking with the walker on his own initiative
043428 - without assistance from physical therapyst, ref SDS 15
043429 - RV8W; Bob reports he feels much better about prospects for
043430 - successful rehabilitation. ref SDS 15 NL5K
043432 - ..
043433 - The doctor's discussion with Bob about going into rehab aligns with
043434 - the request this past Monday, for the doctor to assist Bob on this
043435 - issue, reported on 111031 0800. ref SDS 9 FS6F
043437 - ..
043438 - He related in the call that Bob agreed to this, which aligns with
043439 - Bob's call this morning, per above. ref SDS 0 EI79
043441 - ..
043442 - Asked the doctor if he expects Bob to be ready, i.e., sufficiently
043443 - mobile and strong, for going home and taking care of himself, living
043444 - alone with his dog?
043446 - ..
043447 - Doctor Fow said probably not, and that he expects Bob will likely need
043448 - 3 - 5 weeks of therapy in a rehab facility prior to going home. He
043449 - said generally a knee replacement patient is not released to go home
043450 - until the patient can walk 150 feet without a walker.
043452 - ..
043453 - Thanked Doctor Fow for taking time this morning to report Bob's
043454 - progress.
043456 - ..
043457 - After hanging up, thanked Tanya for facilitating the call to Doctor
043458 - Fow.
043459 -
043460 -
043462 - ..
0435 -
0436 -
0437 - 0843
0438 -
043801 - Walked over to Bob's room B29.
043802 -
043803 - Walking into the room, Bob was straining and struggling very hard to
043804 - lift himself vertically with the overhead grab bar.
043806 - ..
043807 - Initially, considered offering help, or to get a nurse to help.
043809 - ..
043810 - Bob wanted to do this himself, so just watched.
043812 - ..
043813 - He continued with about 5 or so lifts and finaly gave up, still
043814 - sitting partially sideways in the bed.
043816 - ..
043817 - He explained trying to lift himself from a sitting position on the
043818 - side of the bed back to a horizontal laying position in the bed. This
043819 - requires lifting his led that had surgery on Monday.
043821 - ..
043822 - Bob's strong effort showed good determination to recover, and also
043823 - underscored Doctor Fow's comments that he has a long way to go before
043824 - being ready to take of himself at home, per above. ref SDS 0 EX3F
043825 -
043827 - ..
0439 -
0440 -
0441 - 0848
0442 -
044201 - After getting himself somewhat settled in bed, Bob said he found his
044202 - walut and change purse in his pants.
044204 - ..
044205 - Bob then asked to take his clothing home, including his walut and
044206 - change purse.
044207 -
044208 - [...below on 111103 0709 0929 put Bob's walut and change
044209 - purse in the top drawer left of the stove in the kitchen.
044210 - ref SDS 0 WV5I
044212 - ..
044213 - He has not eaten much breakfast.
044215 - ..
044216 - Bob explained that the new medication he is getting to recover from
044217 - infection has reduced his appetite. For now, food is not appealing,
044218 - so he doesn't feel like eating.
044220 - ..
044221 - Bob reported talking to Doctor Fow last night and deciding to go into
044222 - a rehabilitation facility for 3 days to expedite recovery from knee
044223 - surgery.
044225 - ..
044226 - Mentioned talking to Doctor Fow this morning, and that he feels Bob is
044227 - making progress toward gaining mobility, per above. ref SDS 0 R55O
044229 - ..
044230 - Bob said he called his brother, Allen, earlier this morning and that
044231 - Allen is driving up from LA on Saturday to provide care for Sandy
044232 - during 3 days while Bob gets continuing rehabilitation care to recover
044233 - from knee surgery this past Monday. This aligns with the call from
044234 - Allen earlier this morning, per above. ref SDS 0 ID3I Bob said his
044235 - brother has stayed at his home before and so knows Sandy. Bob is
044236 - still worried about Allen leaving the LA area while his son in the
044237 - hospital being treated for spinal meningitis, discussed yesterday on
044238 - 111102 0718. ref SDS 11 MQ9L
044239 -
044240 - [On 111104 0952 discussed revised plans so Allen need not
044241 - drive up from LA and stay for 3 days to care for Sandy.
044242 - ref SDS 12 4G9J
044244 - ..
044245 - Discussed prospects that Bob may need more than 3 days to rehabilitate
044246 - his knee?
044248 - ..
044249 - Bob was adament that he will only need 3 days rehabilitation, and
044250 - then can go home to take care of Sandy, so his brother needs to stay
044251 - in Nipomo only 3 days.
044252 -
044253 -
044254 -
044256 - ..
0443 -
0444 -
0445 - 0920
0446 -
044601 - Josh came in the room to begin Bob's physical therapy.
044602 -
044603 - He began orgainzing to setup the equipment that bends Bob's knee.
044605 - ..
044606 - Josh asked Bob about his pain level?
044608 - ..
044609 - Bob said he just took pain medication and so pain is fairly low about
044610 - 3 at the moment.
044612 - ..
044613 - Told Bob will see him later this afternoon.
044614 -
044615 -
044617 - ..
0447 -
0448 -
0449 - 0929
0450 -
045001 - On the way to Bob's place from the Community Hospital in Arroyo
045002 - Grande, stopped at a mail box on Tefft street about a block West of
045003 - Von's grocery store, and mailed the envelope Bob requested earlier
045004 - today, per above. ref SDS 0 L45H
045006 - ..
045007 - At
045008 - the house, put Bob's walut and change purse in the
045009 - the top drawer left of the stove in the kitchen, as he requested at
045010 - the hospital this morning, see above, ref SDS 0 WF9W, where Bob
045011 - thought it might be when he called this morning, per above.
045012 - ref SDS 0 HS6K
045013 -
045015 - ..
0451 -
0452 -
0453 - 0952
0454 -
045401 - Called and left message for Robin relating discussions with Doctor Fow
045402 - on Bob's blood infusion, which seems related to the infection issue,
045403 - per above, ref SDS 0 OI84, and that Bob needs care in a rehabilitation
045404 - facility probably for 2 weeks or so, but will start with 3 days, and
045405 - assess progress toward walking 150 steps, per above. ref SDS 0 EX3F
045406 -
045407 -
045409 - ..
0455 -
0456 -
0457 - 1003
0458 -
045801 - Glass shelf has been on the couch in the living room for at least 6
045802 - months, when Bob released his contractor from further work on his
045803 - kitchen upgrade project.
045805 - ..
045806 - During the visit on 110917, Bob said that he had agreed to install the
045807 - glass shelf in the kitchen skylight window. He said the work has been
045808 - delayed by a defective shelving clip. The reason for not holding the
045809 - contractor to perform this work is not clear in the record, reported
045810 - on 110917 1420. ref SDS 4 6C4G
045812 - ..
045813 - Inspected the kitchen protrucing window. Removed everything on the
045814 - bottom projecting window sill to make room for doing the work to
045815 - install the shelf.
045817 - ..
045818 - There are two small window screens not installed for each end of the
045819 - protruding window. They are sitting leaned against the South end and
045820 - inside of the protruding window. After examination, took them outside
045821 - and installed in the small moveable windows at each end of the
045822 - protruding overhead kitchen window.
045824 - ..
045825 - Checked the shelving clip that presented a worry on 110917 1420.
045826 - ref SDS 4 S94T
045828 - ..
045829 - Seems the only problem is that clip has not been pushed into the
045830 - bracket. This is awkward and so particularly difficult for Bob.
045831 - Found a step ladder in the laundry room. Climbed onto the sink and
045832 - then reached back and pressed the clip into the slot.
045834 - ..
045835 - It seemed to connect correctly.
045837 - ..
045838 - There is a beige envelope with about 8 or so shelving clips. Decided
045839 - to replace the one clip with one from the inventory in the envelope.
045841 - ..
045842 - Brought the metal shelving brackets into the kitchen from the coffee
045843 - table in the living room.
045845 - ..
045846 - At each end, there is a cut out so that shelving clips will fit inside
045847 - the bracket housing. This provides a more stable fit.
045849 - ..
045850 - Was concerned this might be a 2-man job. The glass shelf is about 6
045851 - feet long and so not strong enough to hold its weight length wise.
045852 - Holding it with both hands and guiding it into the bracket side casing
045853 - is delicate work. Doing this at the back of the protruding window
045854 - above the sink is very awkward and so highly risky to slip and break
045855 - the glass shelf.
045857 - ..
045858 - Thought of asking Robin for help after work tomorrow (she has church
045859 - activity this evening afer work), or on Saturday.
045861 - ..
045862 - Further inspection showed that both brackets can be installed with
045863 - only a gravity connection, simply dropping on the shelf clip like most
045864 - shelving. The glass shelf then slips into a covered slot on the back
045865 - side and simply drops onto an open slot on the front side. Top of
045866 - glass is then even with the top of the front bracket, so that items
045867 - placed spanning across the joint sit flat, rather than have a
045868 - dangerous tilt, and can be slid without bumping into a ridge. This
045869 - design makes installation more manageable for 1 person.
045871 - ..
045872 - Cleaned the glass shelf, and then lifted it into place. It slipped
045873 - easily into the covered slot in the rear metal bracket, but failed to
045874 - fully seat in the open slot at the South end of the front bracket.
045875 - For some reason the last 10 inches or so would not fit correctly.
045876 - Initially considered the contractor may not have layed out the
045877 - brackets parallel, or the glass could be mis-manufactured (less
045878 - likely). Further manipulation and slight pressure caused the front
045879 - bracket at the South end to self-adjust and the glass shelf slipped
045880 - correctly into place, leaving a smooth, even plane between top of
045881 - bracket, and top of glass.
045883 - ..
045884 - Cleaned the bottom marble window sill.
045886 - ..
045887 - Restored a large copper pot to the new top shelf, and a small
045888 - porcelain element, to provide an esthetic visual, intended by the
045889 - design of a protruding large kitchen window.
045890 -
045892 - ..
0459 -
0460 -
0461 - 1146
0462 -
046201 - Bob's brother, Allen called.
046202 -
046203 - He needs Bob's cell phone number.
046205 - ..
046206 - Will get it for him this afternoon when I visit Bob about 1700 -
046207 - 1800.
046208 -
046209 -
046211 - ..
0463 -
0464 -
0465 - 1148
0466 -
046601 - A month or so ago, Bob won a door prize at a social event. The prize
046602 - was a large 16" x 20" wicker basket filled mostly with plastic and
046603 - paper to make an exciting presentation. This basket is wrapped with
046604 - cellophane and a big ribbon. The handle stands 20" high or so. Bob
046605 - has stored this "prize" basket all this time at the entryway from the
046606 - front door to the kitchen dining area and in front of the previous
046607 - entertainment center, that was removed and placed in the kitchen
046608 - several months ago, and which was moved to the garage on Monday,
046609 - reported on 111031 0800. ref SDS 9 VB9G
046611 - ..
046612 - Today, removed the cellephane wrapping and ribbon from the "door
046613 - prize" basket.
046615 - ..
046616 - Found two bottles of wine buried with confetti in the basket. Put
046617 - them on the window sill of the kitchen garden window to privide an
046618 - asthetic look to the kitchen.
046620 - ..
046621 - Found 3 or 4 shirts, and put them in Bob's room. They have a lot of
046622 - promotional advertizing, so he may not want them.
046624 - ..
046625 - Put cashews in the cupboard where other nuts and crackers are stored
046626 - on the right side of the sink.
046628 - ..
046629 - This left a huge pile of wrapping confetti. Put this in plastic bags
046630 - and put it all in the recycling waste box in the garage.
046632 - ..
046633 - Put the basket in the garage.
046634 -
046636 - ..
0467 -
0468 -
0469 - 1322
0470 -
047001 - Bob called and said he is being moved to another room.
047002 -
047003 - Mentioned that Allen needs his cell phone number.
047005 - ..
047006 - Bob said it is in his walut on top of his driver's license.
047008 - ..
047009 - While talking to Bob went into the kitchen and opened the drawer next
047010 - to the stove. Got his walut and looked for cell phone number.
047012 - ..
047013 - Advised Bob that his cell phone number is not evident looking just at
047014 - his driver's license. Bob said to look through the walut - he is
047015 - sure the cell phone number is on a paper in the walut.
047017 - ..
047018 - Decided not to look through Bob's walut. Told him we can call Allen
047019 - from the hospital this afternoon and give him the cell phone number.
047020 -
047021 - [...below on 111103 0709 at 2138 found the cell phone
047022 - number in Bob's walut. ref SDS 0 W46H
047023 -
047025 - ..
047026 - Asked Bob when garbage service occurs.
047028 - ..
047029 - Bob said to put the garbage cans out Tuesday night, and they pick
047030 - everything up Wednesday morning.
047032 - ..
047033 - So, we missed service this week.
047035 - ..
047036 - Told Bob that Sandy has done a great job supervising work at the
047037 - house....
047038 -
047039 - 1. Entertainment Center that was blocking access to the
047040 - dining/kitchen area, has been removed and placed in the
047041 - garage, reported on 111031 0800. ref SDS 9 VB9G
047043 - ..
047044 - 2. Glass shelf that was on the couch in the living room has
047045 - now been installed in the kitchen skylight window, reported
047046 - above. ref SDS 0 LZ4H
047048 - ..
047049 - Bob seemed pleased long-standing tasks have been completed.
047051 - ..
047052 - He asked if the shelving clip in the window skylight was defective,
047053 - preventing installing the glass shelf?
047055 - ..
047056 - Bob said he bought some replacement shelving clips to fix this
047057 - problem.
047059 - ..
047060 - Explained I found the replacement clips, and was able to complete the
047061 - work.
047062 -
047063 -
047065 - ..
0471 -
0472 -
0473 - 1803
0474 -
047401 - Drove to the hospital in Arroyo Grande to visit Bob.
047402 -
047403 - On arrival, Bob was talking to Robin on the telephone.
047405 - ..
047406 - When he finished, I spoke briefly with Robin.
047408 - ..
047409 - She is not feeling well this evening. Has neck and other pain, so
047410 - Robin did not go to church services this evening, as planned last
047411 - night, reported on
047413 - ..
047414 - Bob was disappointed his cell phone number was not found in his walut,
047415 - reported in the call earlier today, per above. ref SDS 0 9W4I
047417 - ..
047418 - Said I will look further in his walut this evening by removing
047419 - various cards and things.
047420 -
047422 - ..
0475 -
0476 -
0477 - 1818
0478 -
047801 - Kirk, a nurse, arrives to change the dressing on the wound caused by
047802 - knee surgery this past Monday.
047804 - ..
047805 - This is an involved process, because the incision is protected by
047806 - several layers of medical dressing and equipment is attached to
047807 - maintain pressure on the leg that prevents blood clots. Another part
047808 - of the knee recovery equipment involves using ice in a container on
047809 - the floor to prevent swelling (just guessing). Evidently cold air is
047810 - pumped from the ice container on the floor through a tube to Bob's
047811 - knee incision. There was a problem with spillage this evening. Kirk
047812 - called a supervisor to bring more ice.
047814 - ..
047815 - As earlier this afternoon, Bob suffered severe pain grimacing greatly
047816 - when Kirk lifte his leg to remove and then replace wrapping on his
047817 - leg.
047819 - ..
047820 - Bob asked for a mirror so he can see the incision on his leg. Kirk
047821 - did not have a mirror handy, so Bob tried to pull himself into a
047822 - sitting position so he can see the incision and fastening holding the
047823 - would together on his left knee. This was very difficult for Bob.
047825 - ..
047826 - Offered to take a picture of Bob so he can see the incision that way.
047828 - ..
047829 - Bob said not to take a picture. He does not want pictures of him in
047830 - the hospital.
047832 - ..
047833 - Kirk noticed the blood transfusion has just completed, so he removed
047834 - the IV and equipment from the drip hanger.
047836 - ..
047837 - Kirk advised that blood transfusion did not start until an hour or so
047838 - ago, because Bob has a rare blood type, B negative. It therefore took
047839 - longer for the Blood Bank to find someone with Bob's blood type and
047840 - then to deliver the blood to the hospital. Blood transfusion was
047841 - ordered early this morning for Bob to recover from low HGB (hemoglobin
047842 - discovered in the lab yesterday), per discussion with Doctor Fow
047843 - above. ref SDS 0 FI84
047845 - ..
047846 - Kirk explains Bob's blood was not replaced with transfusion, but
047847 - rather he lost blood during the operation, which is normal. His bone
047848 - marrow is not creating new blood as rapidly as most patients, causing
047849 - low hemoglobin (HGB), and further indicated by low oxygen in his
047850 - blood, shown by vitals taken yesterday by Elizabeth, reported on
047851 - 111102 0718. ref SDS 11 R679
047853 - ..
047854 - Kirk commented to Bob that his face already looks better from
047855 - increased oxygen flow enabled by adding blood with more hemoglobin.
047857 - ..
047858 - Kirk asked Bob if he feels his breathing is easier, as well?
047860 - ..
047861 - Bob did not respond. He may not have noticed diminished breathing,
047862 - and so the improvement from adding a pint of blood to his system with
047863 - increased hemoblogin may not register as a direct physical sensation.
047865 - ..
047866 - Kirk took vitals...
047867 -
047868 - Temperature................ 102
047869 - BP......................... 128 76
047870 - Heart Rate................. 87
047871 - Oxygen..................... (not reported)
047873 - ..
047874 - Oxygen may have been reported, and did not notice.
047876 - ..
047877 - Kirk feels Bob's heart is working hard overcoming trauma from knee
047878 - surgery this past Monday, and the infection. Additionally, pulse
047879 - elevates when Bob suffers pain from staff lifting his leg to change
047880 - the dressing, and when Bob lifts himself with the overhead trapese
047881 - bar, as he did a few mintues ago trying to observe the knee incision,
047882 - when Kirk chagned the dressing, per above. ref SDS 0 Z18I
047884 - ..
047885 - Temperature 102 with modern forehead surface measuring device seems to
047886 - signal worsening infection problem, with patient not responding to
047887 - antibiotic treatment, discussed with Doctor Fow this morning, per
047888 - above. ref SDS 0 VM9J
047890 - ..
047891 - Kirk took Bob's temperature again, this time using a conventional oral
047892 - thermometer, and reported reading 99.7.
047894 - ..
047895 - Kirk said he will enter both readings into the medical chart to help
047896 - the team assess Bob's progress.
047898 - ..
047899 - Asked Kirk to read off Bob's recent temperature trend.
047901 - ..
047902 - Sounds like Bob has maintained an elevated fever situation with
047903 - temperatures above 100 all day. That does not indicate he is
047904 - responding to treatment.
047905 -
047906 - [...below on 111103 0709 at 1938 Doctor Fow seems to
047907 - indicate Bob cannot leave hospital until temperature comes
047908 - down toward normal, because he cannot get IV antibiotic
047909 - treatment at the rehab facility. ref SDS 0 TD51
047911 - ..
047912 - Asked Kirk how often such a wide disparity occurs between the surface
047913 - and oral thermometers, as occurred just now?
047915 - ..
047916 - Kirk seemed to say this is unusual.
047918 - ..
047919 - Bob's temperature still above normal at 99+ with conventional
047920 - thermometer, and possibly 102 with the new surface thermometer seems
047921 - to signal continuing infection despite several days on a strong
047922 - antibiotic treatment, per discussion this morning with Doctor Fow
047923 - above. ref SDS 0 WT4K
047925 - ..
047926 - After Kirk left, his supervior stopped back in the room. He offered
047927 - an interesting explanation of how blood banks work.
047929 - ..
047930 - Bob asked why he wasn't given an opportunity to draw blood a month
047931 - before surgery so the hospital would have it on hand if needed for
047932 - transfusions like today?
047934 - ..
047935 - The nurse said that blood only lasts about a month. He recommended
047936 - that Bob ask his friends to volunteer to give blood once or twice a
047937 - year. He said it takes the body about a month for bone marrow to
047938 - replace a pint of blood.
047940 - ..
047941 - Bob may not have been asked to stock pile blood for his surgery,
047942 - because he was diagnosed with infection a month ago, and so the blood
047943 - may not have been effective for transfusion. This issue is not clear
047944 - in the record.
047946 - ..
047947 - After Kirk left, showed Bob pictures taken with the cell phone and
047948 - showing his home organized and in good order, planned a month ago on
047949 - 110917 1420. ref SDS 4 U54I
047951 - ..
047952 - Bob smiled and said it looks good. He is worried he won't be able to
047953 - find things when he gets home.
047955 - ..
047956 - Bob also said that wine should not be exposed to light in the garden
047957 - window, per above. ref SDS 0 N55H
047959 - ..
047960 - Promised to put them in the cupboard below the counterop, where he
047961 - has other wine stored.
047963 - ..
047964 - Bob is very pleased with Doctor Fow's care. He commended the nursing
047965 - staff as well for attention to detail and for friendly, timely
047966 - response to his medical needs.
047967 -
047968 -
047969 -
047970 -
047972 - ..
0480 -
0481 -
0482 - 1938
0483 -
048301 - Met with Doctor Fow in the Control Center.
048302 -
048303 - He was sitting going through a loose leaf binder, and talking to a
048304 - colleague. When the man left, spoke with Doctor Fow for about 10
048305 - minutes.
048307 - ..
048308 - Doctor Ritter is the infection specialist. He has completed his
048309 - review of Bob's condition and concluded that Bob does not have an
048310 - "infection." He has a "skin culture" based on the urine sample taken
048311 - on Monday. The medical team believes this skin culture is causing
048312 - Bob's elevated temperature.
048314 - ..
048315 - Doctor Fow is being conservative ordering aggressive treatment of
048316 - Bob's elevated temperature and Doctor Ritter's diagnosis of "skin
048317 - culture" as a virus, because he does not want his work performing
048318 - surgery on Bob's knee to become infected and delay recovery.
048320 - ..
048321 - Doctor Fow expects Bob's temperature to go down with continued
048322 - antibiotic treatment for the past 2 days, so he can be released
048323 - tomorrow for care in a rehabilitation facility.
048325 - ..
048326 - Reported to Doctor Fow findings this evening that indicate Bob still
048327 - has an elevated temperature 102 or 99.7, depending on which
048328 - thermometer Kirk used, per above. ref SDS 0 HG6M Kirk just now
048329 - seemed to indicate that Bob's temperature has been consistently
048330 - elevated, possibly indating no response to treatment the past several
048331 - days.
048333 - ..
048334 - Doctor Fow said that Bob cannot be released from Community Hospital
048335 - with infection, indicated by a high fever, that needs further
048336 - antibiotic treatment because rehabilitation faclities are not legally
048337 - allowed to perform IV treatment, as Bob is getting in the hospital.
048338 - Doctor Fow said that under these circumstances, he must rely on Doctor
048339 - Ritter to decide when Bob can be released from the hospital.
048340 -
048341 - [On 111104 0952 at 1946 Bob reports temperature 103 after
048342 - being taken to Mission View rehabilitation facility; this
048343 - increased significantly from 98 when he was released from
048344 - Community hospital several hours earlier. ref SDS 12 RX8I
048346 - ..
048347 - [On 111105 0853 at 1620 Francis, Bob's nurse for physical
048348 - therapy at Mission View Care Center reported there is no
048349 - change in medication that accounts for Bob's noticable loss
048350 - of energy, weak voice, groggy demeanor 1 day after leaving
048351 - care at Arroyo Grande Community Hospital, and that Doctor
048352 - D'Ambruoso is directing Bob's care to recover from
048353 - infection shown by temperature 100.3 on arrival from the
048354 - hospital. ref SDS 13 LM9J
048356 - ..
048357 - [On 111111 0802 at 1716 Mission View reported they did not
048358 - receive a copy of Bob's discharge documentation from Arroyo
048359 - Grande Community hospital disclosing Bob has infection
048360 - after surgery on 111031, that he required a blood
048361 - transfusion due to low HGB blood counts, nor that Bob had
048362 - temperature of 100.3; as a result, Mission View called and
048363 - requested a copy of discharge documentation prepared by
048364 - Arroyo Grande Community Hospital that notifies Mission View
048365 - on scope of work to provide health care services required
048366 - by Bob's patient history. ref SDS 14 TC6J
048368 - ..
048369 - [On 111111 0802 at 1752 Nurse Francis at Mission View
048370 - advised that if Bob needs blood transfusion for recovering
048371 - from knee surgery complications, then Bob will have to be
048372 - returned to Arroyo Grande Community Hospital, because
048373 - Mission View is not certified for this level of medical
048374 - care. ref SDS 14 GG6N
048376 - ..
048377 - This supplements discussion this morning with the doctor reporting
048378 - concern about Bob's persistent temperture and infection, per above.
048379 - ref SDS 0 VM9J
048381 - ..
048382 - [On 111104 0952 Kirk advises that Doctor Ritter is
048383 - considering implanting a pic catheter so Bob can be treated
048384 - with IV antibiotics after he is moved to a rehabilitation
048385 - facility, and or at home, to continue getting treatment
048386 - recovering from infection/culture. ref SDS 12 DH9F
048388 - ..
048389 - Thanked Doctor Fow for helping Bob transition to accept care in a
048390 - rehab facility, rather than insist on coming home before he is ready,
048391 - discussed with the doctor on Monday after surgery, reported, 111031
048392 - 0800 at 1732, ref SDS 9 FS6F, and further noted by the doctor this
048393 - morning, per above. ref SDS 0 R55O
048394 -
048395 -
048397 - ..
0484 -
0485 -
0486 - 2047
0487 -
048701 - Bob called and said he will be transferred tomorrow to a
048702 - rehabilitation facility, he thinks a house across the street from the
048703 - hospital.
048705 - ..
048706 - He will call his brother and ask him to come up on Saturday to take
048707 - care of Sandy.
048708 -
048710 - ..
0488 -
0489 -
0490 - 2138
0491 -
049101 - This evening, went through Bob's walut and found the little paper with
049102 - his cell phone written in pencil. This completes the task he
049103 - requested earlier today, per above. ref SDS 0 057C
049105 - ..
049106 - Entered cell phone number on a list of points for guide Allen taking
049107 - over on Saturday.
049108 -
049109 -
049110 -
049111 -
049112 -
049113 -
0492 -