Swollen arm

Steve's left arm swelled suddenly this afternoon. In the past few months it's become scrawny from lack of use. Today it was puffy and huge.

Steve said it looks like he has a leg for an arm. So we've started calling it his l'arm.

The nurse paged the resident, who ordered a sonogram to check for a blood clot.

And Steve and I giggled. Because, really, how many more clots or other problems could he endure? Laughing seemed to be the best response.

So a transport tech wheeled Steve in his bed to the second floor, where a radiology tech checked his neck and arm.

I studied the imaging and scrutinized for clues. I was a clueless.

A few minutes ago, the night nurse told us that the report shows no clot. Whew!

So what could be causing the sudden swelling? The next guess is an infection. So Steve is back on an IV antibiotic. I don't know yet how many doses he'll get.

Early this afternoon we visited with the new team on call. Dr. V wants to be sure that we're comfortable going home and have everything in place before we leave.

Now I need to explain our on again, off again relationship with hospice.

When we decided to head to the emergency room and consent to treatment Wednesday, we were also deciding to discharge from hospice.

The idea of hospice is to make patients comfortable until they pass away. Hospice does not provide "aggressive treatment." Going to the ER, getting IV drugs and being admitted to in-patient care is considered aggressive.

(When Steve is enrolled in hospice, our insurance company pays a daily rate to the hospice group. So any care provided during Steve's enrollment time must be paid for by hospice. Hospice doesn't want to pay for hospital visits.)

Our social worker met us in the ER on Wednesday afternoon, and I signed papers that discharged Steve, with the understanding that we would re-enroll upon release from the hospital.

After we learned today that Steve is ready to go home when we are, I spent some time on the phone with our hospice social worker.

The current plan is for a hospice nurse to visit Steve in the hospital tomorrow to evaluate for admission to hospice. (They have to do this every time we request service again.)

And then by Monday, assuming that Steve is stable (and the whole l'arm thing is taken care of), we should be able to go home with hospice re-instated.