9-12-2021 Extreme fatigue, followed by another fall

 (Tricia)

We knew it was going to happen—an NHC nurse called me at about 8:00 this morning to let me know that Linda had fallen again, trying to get out of bed on her own. She has cut her right knee, and they are ordering X-rays of her right shoulder and right knee to look for fractures. We hope, of course, that the X-rays come back clear, but she still could have sustained a muscle injury or bad bruise, which also will slow her recovery. She had just healed from the injury to her right shoulder from her previous fall, so this is particularly disheartening. Nursing homes are prohibited from restraining a patient (which makes perfect sense), or even putting a bed rail in place, so keeping patients from falling is a constant battle.

Otherwise, this week had been quiet. Each night, Linda has been more and more tired, likely because she has been more active during the day. On most evenings, she has often been in bed already by the time Ed and I arrive around 6:00. Normally, she is still talkative, but last night she was like we have never seen her before. She was sitting up in her wheelchair with her dinner on the table in front of her, but she was so tired, she could barely lift the spoon to get food to her mouth. (This comes after Friday night, when we saw her lifting plates of food off her tray easily and feeding herself with a fork without spilling.) Eventually, the process proved so difficult that she gave up. I was relieved when Linda agreed to let me help her eat, so that we could make sure she had enough food for the night.

After dinner, she closed her eyes and slumped over to the side in her wheelchair—we asked her if we could help her into bed, but she shook her head just slightly. She was so unusually unresponsive that I called a nurse in to check her sugar levels. Her levels were fine, at least for Linda (209), but that left us so puzzled as to why she seemed nearly unconscious. Never before had we found her asleep in her wheelchair, and when she is so obviously tired, we certainly have never seen her refuse to allow us to help her into bed! However, according to the nurse who checked her blood sugar, the day staff had reported that Linda had had “a really good day.” In other words, she was active, conversational, and more coherent than usual. Unfortunately, it seems that Linda’s brain injury means that the price of having a really good day is being hit by this kind of “can’t-lift-a-spoon” full-body fatigue.

(Ed pointed out, however, that although she was asleep in the wheelchair, it was good to see that she was strong enough to hold herself up in a sitting position. Two weeks ago, if Linda was in that state, she would have been slumped forward with her head between her knees, about to topple onto the floor! Small progress.)

The same nurse who checked her blood sugar came later to give Linda her medications—in actual pill form for the first time that we have seen. (Normally, the nurses have been giving her meds in the form of a paste, which Linda takes from a spoon; the fact that she can now swallow them as pills is another small “graduation,” of a sort, to note.) When the nurse saw how tired Linda was, she quickly shooed us out of the room so she could help Linda into her pajamas and into bed. By the time we returned, Linda was fast asleep once again.

Of course, Linda’s “really good day” had to be followed not only by debilitating fatigue, but by a fall the next morning. That just seems to be how this whole frustrating process works. Linda is at a really dangerous time right now—she has gotten mentally strong enough to want to get out of bed and physically strong enough to get herself part of the way. But she isn’t strong enough to get out of bed successfully, and she still lacks the cognitive awareness to know why she shouldn’t try. Add in the fact that she is telling herself that her body is able to do things it still cannot do, and she is the very definition of a “fall risk.” 

Unless we can figure out how to station someone at her bedside 24 hours a day, falls at this stage seem almost inevitable. However, I’m going to do some research today to see if there are any solutions out there that might help send up an alert if Linda tries to get up on her own—although my guess is that if such solutions existed, NHC would be using them.