Thankfully, though, it wasn't.

Things have changed a bit in this past week. Monday was awesome, still able to carry on good conversation that made sense. He was talking to me about his mother, siblings, and then more about the kids. He said the one thing he wanted was for his kids to know "the real me." I took that as the sober him. On Tuesday things started to go downhill. He could only say "yes" and "okay". Very difficult to wake him. Sometimes I'd shake him so hard or do a very hard sternal rub that I was worried I'd hurt him. He still wouldn't wake up. Spent Tuesday afternoon, all day Wednesday and all day Thursday in bed. I had the nurse tell the CNA to get him up on Friday. He needed it.

The speech therapist and I talked to the nurse practitioner on Wednesday (I think it was Wednesday) and thankfully she saw him. Ordered a check for ammonia levels and a UA. Both came back negative.

On Friday things were a little bit better. When I came in and woke him up on Friday morning he asked me "how are you?" and when I asked if he knew my name he said "Cara" which was close enough to make me happy. Both the nurse practitioner and the doctor were in the building that afternoon. I kept stealing a look at the desk to see which patient charts were in their stacks. There's only one red chart on that particular station -- J's -- and I didn't see it. When I stopped at the station to get the restroom key I noticed that the red folder was missing from its place on the rack that holds the chart and noticed the chart right in front of the doctor. A little while later I came back to get the Guardian Angel book so I could write my daily entry for J and another lady. I noticed J's chart with a new doctor's order. I also saw that the Dr visit book was open and saw "HOSPICE EVAL?" written by J's name. I kinda got panicky for a second. I opened his chart to the flagged page and saw the new order. Nothing about Hospice. Only a diagnosis along with doxycycline and low protein diet. I noticed this bitchy nurse that fills in sometimes was staring at me so I quickly left.

J's nurse told me that there was a possibility of hospice getting in. I was nervous about that because the last man with cirrhosis I saw in the building was picked up by hospice and died a few days later. And he was better than J when he went on hospice.

I was worried. I'm about to go on vacation and all I could think about was J dying while I'm on vacation. The selfish side of me wants him to hold on cause I'm not ready for him to go. Anothe part of me wants him to just let go because I can't stand the idea of him being in pain. I don't want him to be uncomfortable in any way.

I stopped by the nursing home yesterday and very likely I'll do it again today. I was talking to my mom about it and told her "I really shouldn't go. I don't need to go" and she told me "Yes you do. You know you need to go for you. And for him." So I went.

I noticed that Brandy, the supervising nurse for that station, was working yesterday afternoon along with Debbie, my favorite nurse on that station. I thought that for sure Brandy would know about the hospice referral and she said that they were going to see if the doctor thought he needed hospice... and doctor said no he didn't need hospice yet! thanks, Dr P, I don't hate you as much anymore. Instead, he put him on an antibiotic and a low protein diet and said J had "hyperammonia anemia."

He's better already. Every time that he goes on an antibiotic he's great! I don't get it. I wonder if they can put him on one indefinitely...

That's all for now. I can breathe again! 

A good bit has happened since I last wrote here. I've had several people message and ask how my special resident is doing and I really appreciate everything.

A few weeks ago things startedgetting really strange. He was being EXTREMELY inappropriate with both employees and residents. There were numerous instances of publicly... well... self-pleasing acts. It was causing quite a disturbance to everyone on that particular side of the building. When people would try to stop him he'd get very angry.

 So often when I'd talk to him he'd call me by his ex-wife's name and he'd curse me, saying how it was over and he was done and for me to "get the f*** out of here!" I knew something wasn't right. I didn't, however, think it was a UTI like most other times of extreme behavior.

Well last Sunday the 17th was the final straw. More and more self-pleasing behaviors and inappropriate comments to staff and residents. No one could stop it. Finally the nurses just parked him at the station, put a large blanket over him, and let him take care of business. Itwas rather disgusting and everyone tried to hide it from visitors as much as possible. The reason they kepthim at the nurses station was because he kept trying to stand. Well as we all predicted, he tried to stand up and remove his pants so of course we all jumped over and tried to keep his clothes on and sit him down. Bad idea. He went crazy. Yelling, kicking, hitting, everything. Finally the nurse decided that the CNA should take him to his room. He resisted her, too, so we had to hold his arms and legs while the CNA rolled his chair down the hall.

Boy was he upset! The supervising nurse called the doctor because she was freaking out and didn't know what to do. "He's a danger to himself, other residents, and staff!" He was screaming and cursing at all of us, and when he looked at me, he started in on his ex once again. I tried to tell him that I was not her but it didn't work. Finally it was decided that he would be taken to the hospital for psychiatric evaluation. I knew that there had to be something chemically wrong with him for him to act like this. I also knew that it had been a very long time since his ammonia levels had been checked. Yeah, I'm just a therapist, not a brilliant nurse or a doctor, but I know enough to know that a man with a failing liver needs to have his levels checked.

I offered to sit in his room with him while the rest of the employees took care of everything else they needed to take care of and so the nurse couldget the paperwork ready for him to go the the ER, but Linda the nurse wouldn't leave me alone with him, saying "I don't trust him alone with anyone. He's a strong guy. I don't want him to hurt you." After a while his CNA came down to sit with me while Linda got the paperwork ready. Meanwhile, J had really calmed down, he'd actually nearly fell asleep. At one point I tried to ask him how he was doing and he was rather calm. But when I mentioned that he might be going for a ride on an ambulance, he got kind of upset. So I quickly changed the subject and he forgot about it. Well, when the EMT's showed up he was rather polite. They asked him wht was wrong and J said nothing was wrong, things were okay. They asked him to come for a ride with them to talk to the doctor and to see the pretty nurses. He said "Nah, I don't need to do that." They couldn't convince him. So finally I spoke up and said, "J, will you go for me?" He looked at me, kinda smiled, then looked back at them as he pointed towards me and said "I'll go for her, not for me. But I'll go for her." That proved to me that he still knew me as me, not his ex.

Against Linda's advice, I followed them to the ER and sat with J for over 4 hours. I answered questions for the nurses and the EMT's, kept J calm, managed him when he started to act a little wacky, and just reassured him that he had someone. I hated to leave before he got admitted, but I was exhausted and had to work the next day.

He was in the hospital for two and a half days, came back to the nursing home on Wednesday afternoon. And guess what it was... ELEVATED AMMONIA LEVELS!!!!! It's amazing the difference his hospital visit has made. His mind is soooooo much clearer! I had an hour long conversation with him Thursday night about his family, including the children. He has never been able to tell me so much about them. And he wants me to find them. He really wants to see them. So now I'm just trying to figure out what I need to do about that. I've found them, at least the 3 oldest and the ex, but I don't know if I should contact them. I don't really know what to do. He loves them. There's no doubt in my mind that he does care about them. I wish there was a way that I could make sure that they know that and that he could tell them himself before he dies.

Thats it for now...

... my special patient's behavior has been horrible for the past three days and I expect that its still going on. I nearly cried on Thursday after he told me to get the F*** away from him and thatit was over. He's been awful to everyone, and it amazes everyone that he's acting this way towards me. Thing is, I don't think he thinks he's talking to me, he looks at me like I'm someone else. When he's angry towards me, he calls me by his ex-wife's name. But when he's talking to Sarah, he smiles and tells me that I'm his girl and that he'll always be there for me. He even came looking for me on Thursday, thinking we were supposed to have lunch together. So obviously he knows who Sarah is but thinks I'm the ex sometimes, too. This is so weird. The behavior changed sooo fast. He was great on Tuesday. Something has to be going on with him medically. I think that his ammonia levels are up from the liver disease. They need to do something before he hurts himself, an employee, or another resident. He tried to hurt my friend who is a CNA last night. This behavior is so scary. I used to be able to stop the anger. All I'd have to do is say "J, it's Sarah. Calm down. It's going to be okay", look him in the eyes, smile, and he's calm right down and smile back. I don't know what to do... this sucks so much

my special resident is breaking my heart. he's being hateful to me which just hurts... i don't know what to do. i give up.

I had to go by the nursing home today because I promised J on Friday that I would. He looked so sad about not seeing me Saturday that I promised I would come on Sunday.

The nurse was like "There she is!" when I walked in the door. They knew I was coming -- I always do. Right away his nurse, Linda, gave me the update. She said he was fine on Saturday, rolling around the building, possibly looking for me they think, but things went downhill this morning. Trouble breathing. Scary sounding cough. I mean scary. Like pneumonia, aspirating scary. No good. They called the nurse practitioner, did a chest xray, and started him on antibiotics and breathing treatments.  I'm not going to be able to sleep tonight worried about the results of the xray... The nurse told me that he was really lethargic, didn't seem to feel well. When I went to talk to him he didn't really seem to know it was me and if he did, he didn't seem to care. I didn't let it bother me, of course I didn't take it personally since I know he feels bad, and I went around the building to say "Happy Mothers Day" to some of my favorite residents. I came back in time to help him with supper. I went around and noticed that his hands were covered in mucous... so much that his hand was sticking to his face. His shirt was also covered in it. So of course I cleaned him up. Nurses seemed relieved that some of that icky stuff was coming out.

He really perked up once I came around that time. The CNA's and nurse Linda remarked on it several times. When Linda came to bring his medication, she says to him "You seem to be feeling better now that she's here!" and he smiled real big and said "Yes!"

I'm glad that I could make him feel better. It scares me to think that he's aspirating and might have pneumonia. Part of me hopes he does so they can treat it and make him feel better. But part of me worries that the slack-ass doctor won't give a damn and won't work hard to treat it and that this is the beginning of the end for J.

I'm not ready to give up. I'm not ready to let go...

What a relief!!! It IS a UTI!!!!!!!!!!!!! I knew it!!!!!!!!!!!!!!!!!!!!!!!!!! Thank god I decided to speak up for him since he doesn't have the mind to do so himself. I can't help but be a littleshocked that it took a girl from therapy, not a nurse or the doctor, to come up with the suggestion of testing for this. It makes me wonder how much they really care. It makes me want to scream. But right now all I can do is smile because I know that with the antibiotics attacking the infection, J should be feeling at least a little better soon. :-)

I am very relieved that FINALLY a urinalysis is going to be done on my special resident. What I don't get is why did it have to be ME that made it happen, why didn't the nurses notice anything? Yesterday I spoke with this really sweet nurse who's new to the facility and asked if J could be added to the doctor's list. She said she would see what she could do and asked what I felt was wrong. I told her that the pattern of behavior was very similiar to the last time he had a UTI. So she got him all prepared to take a urine sample and asked the doctor for his approval. Thankfully he said YES! You wouldnt think this would be any big deal, but this doctor is an interesting character...

It made me feel really good to know that something I did might be helping him get better. Still waiting on the results of the urinalysis but I find comfort knowing that at least steps are being made to try and help him. Whew, what a relief!

... except for me and i can't do a thing.  I'm not family or POA so I have no actual rights to get in the doctor's face about checking for a UTI or checking for insanely high ammonialevels. ARGHHH!! If only I could contact some family members and convince them to do something. I know I've found the children and I think the ex but freakin HIPAA won't let me. I could possibly get fired for trying to get in touch with these people. The only person I can contact is the loser power of attorney who has been stealing money from this person and writing bad checks on his account.

i'm so frustrated i could scream. if something isn't done soon, he's going to die... i just know it...

everyone who might read this, please keep JK in your prayers.

Today was tough. I'm having a hard time dealing with the fact that the person at work I care for the most is dying. The encephalopathy is getting worse. I don't know what to do. I feel hopelesssometimes because they just dismiss me, I'm overly concerned. But damn it, there's something to worry about. I know he can't be saved, but can't they do something? This destroys me. It's like "Let's see, we'll just kill him off." If I were family I'd have the right to fight for him. Damn it. If only I could contact them. And if only they cared. Maybe one of the kids does, they just don't know where he is or how to contact him. Maybe they secretly miss him and want to see him. If I were more than just a caring staff member, I could be involved in his care plan, help make some of the big decisions. I could also be a major pain in the ass and make sure things were done as they should be. But no, I'm just the little therapy girl who can't do a damn thing to help him.

T his sucks but it's worth it to see him smile. And thats what I have to keep reminding myself of. That smile is worth any bit of pain caring for him may cause in the end.