A New Year? Really? Already?

In response to a diminishing number of requests, I'm pushing past whatever it is that has kept me from writing to post an update about Mom, starting where we left off.

September '08 was a difficult month for both of us. We'd settled into an acceptable routine of my part-time care giving coupled with my full-time job and help from Linda, when Mom suffered a fall that changed everything.

As was my custom on weekends, I'd checked to make sure that Mom was sleeping comfortably before going out to the den to watch CBS Sunday Morning. I enjoyed the show, as always, and decided to spend a little more time watching TV and drinking coffee before going back to her room to see if she was awake. When I finally tore myself away from my comfy nest on the couch, I walked back to our room and found Mom curled up on the floor at the end of her bed, resting her head on the step that separates her part of the room from mine. She'd managed to pull a blanket over herself but was clearly, not surprisingly, distraught.

"Mom! What happened?"

"I don't know. I'm not sure. I wanted to go out. Help me up. I don't like it here."

I felt confident that I could get her up as she weighs just a little over 100 pounds, but when I tried to move her, she gasped in pain. I sat down next to her while I decided what to do next. I was a bit shaken and feeling more than a little guilty to have discovered her lying there, fearing that she'd suffered a broken hip, or worse. She smiled and held my hand and waited for me to get my act together.

Any position seemed to be painful for her but I decided that getting her past it and into bed was the best course of action. I moved a padded foot stool close, rolled her onto her back, and had her try to sit up. Although it was painful, she gave it her best effort and I was able to lift her enough to get her on the stool, then into a standing position long enough to get her to grab the bars of her walker and take a few halting steps to her bed. I was very concerned but reluctant to call an ambulance if we could manage on our own. Past trips to the emergency room have left her so distraught and created so much pain for her, with uncomfortable exam tables and IVs and long waits, that I made the difficult decision to skip it unless she began to show clear signs of a catastrophic injury.

Once I got her settled under the covers she seemed to have forgotten that she'd fallen and was puzzled as to why she was in pain. She couldn't tell me what had happened, but it seemed clear that she'd been trying to get to the bathroom when she got out of bed and had walked in the wrong direction and fallen trying to maneuver up the step where I found her.

I called Linda, who stays with Mom for several hours during the day while I'm at work, and she came over to help me evaluate Mom's condition. There were no obvious bruises although there was some reddening around one hip. Mom could move her legs and arms enough to make it clear that nothing was broken, although we couldn't be sure about her hip at that point. As it turned out, we still don't know if she broke her hip.

We called Mom's doctor, who agreed with Linda's suggestion that we get a hospital bed to make it easier to care for Mom during what we hoped would be a speedy recovery while realizing that being confined to bed can lead to severe complications. Mom's doctor made a surprise house call within a few days (bless her) to try to determine what, if any, injuries had been incurred. She understood my reluctance to take Mom to the emergency room and reassured me that even if they had diagnosed a broken hip, the usual treatment is bed rest, which Mom was getting at home. The doctor also did an evaluation of Mom's overall health and concluded that Mom's advanced age and congestive heart failure qualified her for Hospice care. That changed everything in terms of obtaining help for Mom.

We enlisted a local agency--a fairly straight forward process--and began to work out schedules with aides to supplement what Linda was already doing, making it possible for me to return to work after a few days off to get things organized. The hospital bed turned out to be a significant improvement over the bed we had been using. We were able to raise the height of the bed to make it much easier to care for Mom and the side rails gave me an extra sense of security when we were away from Mom's bedside.

The fall and subsequent changes in Mom's routine left her disoriented and exhausted for the first couple of weeks, to the extent that I felt we were facing a rapid decline in her health. I contacted family members to let them know that it might be wise to schedule visits sooner rather than later and to prepare for the likelihood of Mom's death. In retrospect, I realize that I may have been over reacting, but at the time my caution seemed justified.

Family flew and drove in from distances reaching from Paris, France to Stuttgart, Arkansas. I had had a tearful conversation with my daughter, Alison, in Maryland and she, too, decided to fly home to spend time with Mom and me. Although everyone in the family was willing to drop what they were doing to fly to Mom's bedside, I encouraged some to wait a couple of weeks so that we wouldn't end up overwhelming Mom at a time when she needed rest as much as she (and I) needed the many expressions of love and concern.

The first to arrive was Mom's younger sister, Helen. Helen's daughter and son-in-law had driven her up from Stuttgart and Helen, thankfully, decided to stay for nearly a week. She was a tremendous help, both physically and emotionally and contributed to our well-being, in many ways, with her loving spirit and generous heart.

Next to arrive was my nephew, Brooke, who flew in from Paris along with his girlfriend, who was seeing the states for the first time. They were both very attentive to Mom and would sit for hours holding her hand and singing "Alouette" and other French melodies. All of Mom's visitors bolstered Mom's spirit considerably and gave me the support I needed to face what came next.

...to be continued...

Meds

We've discontinued the patch that was apparently the culprit at the root of Mom's recent bouts of dizziness, confusion, and hallucinations (none of them fun!). She is feeling much better and I'm thankful that this episode had a relatively easy resolution.

Needless to say, we won't be writing any testimonials for that particular medication--

Saturday morning

Yesterday morning Mom gave me a real scare--I thought there was a very good chance we could lose her at any moment.

At about 7:30 I heard her call out and immediately went to her. She was disoriented, frightened, and felt, as she said, "like I want to get the hell out of here." I pulled a stool up to her bed and held her hand and tried to find out what was going on. It took some convincing to get her to believe that she was at home in her own bed. She was so happy to see me, but in quite a bit of pain--first her ear, then her chest, and wondered why her doctor would "do this to her." I'd told her a day or two ago that she was on some new medication (a patch that has the potential to slow down her dementia) but that I was going to discountinue it as it might be causing her dizziness--she's had several episodes of feeling very dizzy and unable to get out of bed or out of her chair in the last few weeks. At any rate, she connected that to the idea that her doctor was responsible for how she was feeling.

I reassured her that the doctor has kept her alive this long by prescribing the right medicine, and Mom finally seemed to believe me. I told her that her heart is in very bad shape but is doing the best it can, and that it is the reason she sometimes feels uncomfortable--sweaty, confused, weak, etc.

She was very distraught for about an hour, although she had a few moments of levity--she said, after about 45 minutes,"I feel like singing." I asked her what she'd like to sing and she said, "Guess!" I correctly guessed How Much is that Doggy in the Window and we sang a couple of verses.

During the worst of it, she wondered what we should do and I asked her if she wanted me to call the doctor. She asked what the alternative was and I said, "we could just sit here awhile and see what happens." She said she'd like to do that--she didn't really want to go anywhere--so that's what we did. I honestly thought that she might close her eyes and be gone at any time so I told her that we loved her and put a cold cloth on her head and kissed her and waited. After awhile, she opened her eyes and asked if she'd lost her trade-in value, I told her I thought we'd gotten a pretty good deal since she'd given birth to the four of us and had wonderful grandchildren and even great-grandchildren and that she'd been a great wife to Dad so she'd earned her keep.

Earlier, she'd asked me if I remembered her husband. I reminded her that he'd made quite an impression on me, what with being my Dad and all, and she laughed and said, "Oh, yeah! I'd forgotten that!"

She slept, with me standing guard, until about 4pm when she said she felt like getting up for awhile to watch TV and eat some dinner. Needless to say, when I asked her what she felt like eating the answer was....chocolate! I gave her soup first, but then loaded her up with chocolate and she went to bed happy at about 8:00.

She slept until 11:30 this morning and has being dozing in her chair during episodes of Murder She Wrote and Perry Mason. She's still dizzy when I help her to the bathroom, but has color in her cheeks and a ready smile when the occasion calls for it, so it looks as though we've dodged another bullet for the time being.

Naptime

7:00pm on a Thursday. I'm watching a re-run of Next Food Network Star while Mom sleeps in her recliner. She sleeps a lot these days. She dozes off, opens her eyes to see what's going on, lets me know that she's "only resting her eyes" and goes back to sleep. In some ways, I find that it's a relief when she sleeps because I'm free to go in the other room to cook or visit with my roommate or check out what's on TV. I may spend a little time watching something Mom and I wouldn't normally watch (that would include anything that isn't Andy Griffith, Little House on the Prairie or Murder, She Wrote).

These brief forays away from Mom's side have gotten to be habit-forming. I welcome the excuse to walk away for even brief periods of time, but am always drawn back to peek in and see if she's awake or if she's struggling to get out of her chair or if she's decided she wants to get ready for bed. I'll often sit back down with her, even if she's sleeping, just to be available if she needs me.

I'm amazed at how much rest she needs. She goes to bed anytime between 8 and 10 and rarely gets up before 10 or 11 the next morning. Linda arrives at 11:30 to serve Mom lunch, help her get dressed or give her a bath, do laundry (and many other household chores) and spend time visiting, laughing and watching a bit of TV. By the time I get home around 5:30, Mom's ready to visit ("what is it you do?") eat dinner and a couple of servings of chocolate ("what's a person gotta do to get some chocolate around here?") and watch a little more TV. And several times during the course of the evening, she nods off, sometimes for an hour at a time.

Her need for rest is most certainly a byproduct of her failing health. I talk myself into believing that she's conserving her strength which will, in turn, prolong her life. But the more realistic interpretation may be that she's slowly fading away from us, one nap at a time.

Mom likes to tell a story about a bus trip she made with my two brothers, traveling from Colorado to Arkansas in the early forties. As the bus crossed the state-line into Arkansas, she was asked to move to the front of the bus to make room for others to move to the back. She refused to move, and let the bus driver know that everyone should be able to sit anywhere on the bus that they chose. She recalls sharing the back seat with "a nice black lady" who helped her take care of my brothers as they traveled further South.

In February, 2008, in that same state, she cast her vote for Barack Obama.

Another Mama for Obama--February Primaries in Arkansas

A Good Doc is Hard to Find (Sometimes)

When Mom moved in with me, I started looking for a doctor to care for her. After some consideration, I made an appointment with a geriatric specialist who, I eventually realized, makes his living by referring patients to other doctors.

On the two occasions that we consulted with him, we followed a familiar routine. His very friendly, slightly condescending nurse weighed Mom on a fancy-looking scale that appeared to be designed specifically for elderly patients with walkers (a good sign, I thought) then had us wait in the “examining room” which was really just a small office with three chairs and a desk.

I could hear the doctor visiting with a patient in an adjoining room. He made some jokes, offered some recommendations, then moved on to us. He grasped Mom's hand, murmured a few well-rehearsed pleasantries, telling us how happy he was to meet us and how much he enjoyed working with old people, then launched into what was essentially the same conversation I’d just overheard.

I tried to steer the conversation in the direction of Mom’s need for a check-up and in particular my concern about her feet, her circulation, and some suspicious-looking moles (can't you just picture the tiny dark glasses, trenchcoat and pencil-thin mustache?). He glanced at Mom's feet from the safety of his chair (it was a small room, but I got the distinct impression that he wanted to stay as far away from her feet as possible) then gave us the name of a podiatrist who, he assured us, could “fix us right up.” I put her socks and shoes back on, which he had asked me to remove for the “examination”, then pointed out the small growths on her face, arms and back. Again, he kept his distance and recommended a nice dermatologist who could “take care of that.”

Since he’d run out of comments about elderly women being his “favorite people in the world,” I sensed that the visit had come to an end. As we left, the nurse asked when we’d like another appointment for follow-up. Believe it or not, we went back for one more visit, going through basically the same routine, but this time I peeked into several rooms as we walked down the hall to his office and saw several patients waiting their turns, but I didn’t see anything resembling an actual examination room. I felt as if we were participating in some sort of illegal scam. Medicare paid the bill—over $200 for the first visit, I can’t remember how much for the second—and we never went back.

Happily, after consulting with a couple of other general practitioners, we found the perfect doctor for Mom—the same woman I’ve been going to for several years. I don’t know why I didn’t start with her instead of taking such a convoluted trip looking for a geriatric specialist. She treats Mom with the gentle respect that she (and everyone) deserves. She’s told us that Mom is in pretty good shape, all things considered, and has essentially “outlived her heart,” which I attribute to Mom’s tenacious spirit, her low-key lifestyle, and the power of a daily dose (or two) of dark chocolate.