Ballooned, Befuddled, and Bewildered
Our dialysis story — chapter 25
Two weeks ago, Ben saw a doctor who had planned to remove his dialysis catheter but decided against it because his arm with the fistula (the joining of a vein and an artery to create a strong conduit for long-term dialysis) was so swollen and bruised. After two weeks of resting the arm, keeping it elevated, and alternating between ice and heat, he returned to the doctor on Wednesday to have an angioplasty of the fistula.
Ben gowned-up as you would for any surgical procedure. I wasn’t allowed in the surgical area. The entire process took about 35 minutes.
The doctor threaded a long, narrow catheter into his fistula and injected contrasting dye. Then, he took X-rays that are called angiograms or fistulograms. The above image on the left shows the narrowing (stenosis) in the fistula. The doctor said stenosis happens in about 50% of the fistulas. That narrowing caused Ben’s swelling, bruising, and pain.
Next, the doctor inserted a surgical balloon in the catheter and inflated it to open up the narrowed section of the fistula. About 40 minutes later, I was taken to see him in recovery.
Ben was in good spirits and said he didn’t feel a thing. His post-surgery nurse and assistant were very friendly and kept us engaged in conversation. The male nurse and I reminisced about Barnie’s Coffee, a café that used to exist in our mall before Starbucks took over the coffee world. We agreed Barnie’s was better than Starbucks and lamented its closing.
The above photo on the left shows Ben's fistula after the angioplasty. See how much wider it is?
Below are photos of his arm two weeks ago and today. A huge improvement!
The doctor sent orders to the nurses to start using Ben’s arm for dialysis on Monday. Ben is worried about that. Unfortunately, stenosis often reoccurs. The doctor said the nurses know what changes indicate narrowing has returned. If that’s true, why didn’t they notice when it happened the first time? They didn’t alert the doctor but kept saying the swelling, pain, and bruising were normal. I don’t blame Ben for not trusting them.
If there are no problems after using his arm a few times, we’ll be given another appointment to remove the temporary catheter ports. He really doesn’t want to lose those because they’re an option to his arm if future problems occur. However, the catheter ports have a very high risk of infection and cannot be kept in place indefinitely.
The other concern of the day was Ben’s befuddlement. I’ve written about his short-term memory issues, most likely caused by dialysis. On his dialysis days, his memory is sometimes worse, and he’s easily confused. I work in the evening on the days he has dialysis, and many times, he calls me — sometimes multiple times — because he’s confused about what I left for dinner. It doesn’t matter that his dinner is always in the same area of the refrigerator. It doesn’t matter that I told him what I prepared for him and where to find it before I left for work. It doesn’t matter that his meals are written on a dry-erase board.
Fortunately, that extra confusion evaporates by the next morning.
But his befuddlement this Wednesday was very odd.
Ben has a pill organizer with AM and PM boxes. Until his hospitalization last year, he handled his medications; now, I do. I fill the organizer every Saturday evening. He no longer remembers the names of all his pills, but he does know the number of pills he takes in the morning and at night.
Tuesday night at 8 pm, I reminded him of two pre-surgery instructions:
- No food after 5 am.
- No diabetes medication.
I told him I removed the two diabetes medications from his pill box, so rather than taking five pills Wednesday morning, he would only take three. I showed him the organizer and the three pills, saying:
Tomorrow morning, you take these three pills like usual. I have your two diabetes pills. You can take those after the procedure and before you go to dialysis.
I repeated myself before he went to sleep around 9:30.
In the morning, before leaving to walk Syau, I showed him the organizer again and reminded him that he’d only be taking three pills before going to the doctor and would take the other two after seeing the doctor.
I failed to check the pill box before we left.
At the doctor’s office, the pre-surgery nurse asked about Ben’s morning medications. I told her that he didn’t take his two diabetes medications but took the others. He disagreed:
No, I have them in my pocket. I didn’t take them. You told me not to.
What??
He was already in a hospital gown, so I waited until they took him to surgery to paw through the plastic clothing bag and check the pockets of his shirt.
Sure enough, there was a tiny aluminum foil packet containing pills. But there were five pills, not three. I could only guess that he had taken the five pills from the Thursday box since I had his two Wednesday morning diabetes pills in my purse.
I checked the pill organizer when we got home. He had taken the three pills from the Wednesday morning box and had stolen two diabetes pills from the Saturday morning box. I was bewildered.
Why??
No harm was done, but it’s occurrences like this that confirm I need to be at home more and working less. It also confirms that we need to have a conversation with his primary care doctor about his memory.
I’m doing everything I can think of to help his memory. I go over the upcoming day’s schedule before we go to bed and the next morning. On the dry-erase board, I write the day of the week and the month and day, beneath that is our schedule of appointments and daily tasks, and below is a list of what he will eat during the day. If I am not home for a meal, the food I prepared for him is always on the bottom left shelf of our refrigerator.
I rely on repetition and consistency, but that doesn’t always work.
Without instruction or reminders, he takes care of several tasks around the house. Each day, he remembers to get the mail. He walks Syau and doesn’t get lost. He remembers my cell phone number, although he sometimes forgets the house number; he calls me, but he doesn’t call the house, so that’s understandable. He reads the newspaper and his emails every day, and he does the paper’s crossword puzzle each day.
That’s why I am bewildered when he’s befuddled!
© Dennett 2023
Our Dialysis Story:
Chapter One
Chapter Two
Chapter Three
Chapter Four
Chapter Five
Chapter Six
Chapter Seven
Chapter Eight
Chapter Nine
Chapter Ten
Chapter Eleven
Chapter Twelve
Chapter Thirteen
Chapter Fourteen
Chapter Fifteen
Chapter Sixteen
Chapter Seventeen
Chapter Eighteen
Chapter Nineteen
Chapter Twenty
Chapter Twenty-One
Chapter Twenty-Two
Chapter Twenty-Three
Chapter Twenty-Four
