In the course of my day at the hospital I come in to contact with a lot of people and I come into contact with a lot of loving family members.

This little paragraph is about the wives...

I am in awe of the real love, attention, loyalty and total dedication I see coming from these often-diminutive women... there to give it their best shot on behalf of their husband. They may not know all the nuances of health care but collectively they represent a solid base of support in rocky seas, complete with a solid portfolio of care skills, learned on the front lines of the quest to raise a good family in times when money was tight and jobs scarce. The following story is fictitious, but written to illustrate some of the issues that confront family member when a loved one is hospitalized.

AGNES ...

Agnes is a pleasant lady in her early eighties, her husband is also a friendly guy mid eighties, retired plumber. She is concerned because he is in the hospital and it is in general, getting to the point where he needs his wife's help to mobilize..This alone would be a challenge for all of us, but more particularly a lady of this vintage. She needs to begin to look at her options, what should she do first ? Let's see...

1.Review the state of her own health?

2.Figure out where the other family members fit into the scene?

3.Ask at the hospital about how long her husband is expected to be there?

Hmmm...well, let's say her husband Bill is there because he slipped and fell, it's his first day in the hospital and he came in through the Emergency Room last night. In my first meeting with her I am struck with two things. She has a lively buzzing energy that keeps her in touch with all the things going on in the world immediately surrounding her and she is totally focused on her husband's well being. Let's go back to the immediate questions on hand. Good decision making is based on good information, the first thing that needs to be accomplished is for Agnes to gain insight into the process that now confronts her.

Bill is now within the protective care of the hospital so his immediate welfare is in the hands of professionals. The most useful information for Agnes at this time would be a sense of time frame. Is Bill going to be undergoing surgery? When? How long do people usually stay after such a surgery? What is the most common post surgical course of treatment for this procedure? A caution here: We must take into account that people are individuals, with unique characteristics that will influence the rate of their recovery and their particular response to treatment but having said that, there are general guidelines that a physician is aware of and able to apply to each of his patients. The key question here is how can Agnes best find out what she needs to know?

In the hospital setting the course of treatment is coordinated by the Attending Physician. This doctor may not be the same one that takes care of Bill in the community, the community Doctor is usually called the Primary Care Physician and is the doctor in charge of the patient's overall welfare, wherever he may be. So sometimes the doctors are one and the same person, sometimes not..Depending upon the particular relationship the patient's primary physician has with the hospital. So to follow along with the theme, Agnes' first mission is to have a chat with the Attending MD. How? Well, here are some ideas: Most people think that if they go to the hospital to visit their loved one that they will naturally have contact with the doctor just as a part of being there, when in fact the opposite is often the case. True, they may actually be there at the time of his daily visit but what happens quite often is that the busy MD is not there at the same time as the family for a multitude of reasons. My point here is that a quick phone call to the Doctors office can really help identify a likely time Doctor makes his rounds in that particular hospital ward. Meeting the MD in or around the patients room allows the doctor to give his opinion based upon immediate data, both observed and from the recording in the medical chart which will give such information as results of recent tests and current lab values and vital signs such as patient's temperature, pulse rate and blood pressure. It also saves Agnes a trip to his office and has more of a personal touch than a phone call. However, calling the doctor in his office is certainly an option if a personal visit is not feasible.

Ok , Bill is now in the process of being diagnosed. Using the example of a fall at home he will almost certainly have an Xray and maybe some other diagnostic imaging tests depending upon the initial results (findings). Let's say for the purposes of this example that he has fractured his hip and will be needing it to be surgically repaired. In many cases, especially with the elderly, a decision has to be made as to the patient's ability to tolerate surgery. Among other things Bill's breathing and heart function and medical history will be looked at to determine the degree of risk.

Once Agnes has discussed with the attending MD the general schedule she can step back and take stock of the situation. Here are some points she may find it useful to think about:

How much physical strength does she have to assist in her husband's ability to get out of bed? Out of a chair? Use the restroom? All these functions will come into play as Bill progresses through the system and plans are made for his recovery. Many families attend their loved ones in the hospital under the impression that the patient will remain in Hospital until completely recovered and back to their previous level of function. In fact, while this may occur in certain cases, there very often is a time where the patient is well enough to leave the general medical/surgical level of care but not able to bounce right back to where they were before the event that bought them into the hospital in the first place occurred. It is this gap that Agnes will need to think about as things move forward.

This would also be a good time to look at resources. Who is around Agnes? Friends? Family? Is she a member of any groups, churches, and senior programs? Where should she go to look at her resource options? The place to start while Bill is in the hospital is the Social Work department of that hospital. This may be called "social services" or a similar name.

Finally, some thoughts may be directed towards the home that Bill and Agnes live in.specifically, the suitability of this environment to their continued welfare. Is their home an apartment on the second floor with no elevator? A single-family house at the end of steep driveway? Perhaps the home was purchased many years ago when mobility concerns were not a consideration. All these aspects need some thought, and even if a move to a more mobility-friendly environment may not be feasible, there are some steps that can be taken to increase the general safety of the home environment and reduce the risk of falls. Very often, as a part of the discharge planning the MD can order a service through the Home Health Nursing aspect of patient care. This is called a "home safety evaluation" and is usually conducted by a physical therapist. This service may not be available to all but it is a common way to reduce the risk of future falls. With this service the home environment is reviewed and suggestions are made as to such items as where safety guide rails may be installed or perhaps a suggestion regarding floor coverings that reduce the risk of accidents.

So, to summarize: In the above example, Agnes should:

1. Gain as clear an idea as possible how long Bill may be in hospital and what the general plan is.

2. Take stock of her abilities, resources, family and friends.

3. Utilize the expertise of all the professional medical personnel that are involved with her husbands care in order to gain a clear idea of the best course of action.