Wednesday, November 26, 2008

Turning Points

I'm still running on adrenalin. After all, it's just after 5 p.m. and I've had less than 2 hours sleep in 36 hours. Why, you ask? Fall victims, especially those not seriously hurt, even those with dementia, do not have a high priority in emergency rooms.

My dad fell again last night. It must have been about 7:30 p.m.; I remember looking at the clock at 8:00, and the fire department first responders had already arrived. This time he hit the back of his head on the edge of a bookcase, and scraped the skin off two spots on either side of his elbow. It took three brawny fire fighters to get him from his bedroom to the car -- probably 40' total distance. Another team of helpful young men at the ER/Ambulance loading dock got him out of the car and into a wheelchair. I don't know who got him from the wheelchair into the ER gurney. Took Mother home just after 10 (it was going to be 2 hours before the CT scans would be read), and was back in the ER by 11:30. The ER doc (who looked like a teen-ager) called his own doctor at midnight, who asked that a Hospitaler (a doctor who treats primarily inpatients) admit him. It was 4 a.m. before we climbed to the top of the Hospitaler's priority list. He saw no clearly defined problems, although there was enough of a suggestion of pending pneumonia to justify admitting him. That and the fact that it was all two strong nurses could do to keep him standing upright long enough to take a blood pressure read. No way was I going to get him back home by myself. There was no evidence of major stroke, no concussion, no skull fracture. Just the goose-egg where his head hit the edge of the bookcase.

The admitting doctor ordered another chest x-ray later in the day, a physical therapist to work on mobility and check his ability to swallow, and evaluation by a geriatrician. We'd been unable to get an appointment with a geriatrician before April 2009, so this order was an welcome relief. We agreed that he should be kept comfortalble, but that no heroic measures should be taken to prolong his life. I left at 4:30; Daddy did not get to his room until about 6 a.m.

I learned about something called 'sundowning'. After dark, especially in unfamiliar settings, dementia patients tend to get more agitated than usual. The IV lines and monitors, all with associated cords and cables, often trigger agitation and aggressive behavior. So I became the bad guy, because I was the one who agreed to his admission as an in-patient.

Ian did the hospital visit thing today, arriving on the heels of the geriatrician. Did Daddy remember what happened? Of course. He was thrown out of his airplane seat. Did he remember being in the ER? ER, he wasn't in the ER. He was on an airplane, and didn't get home until 6 a.m. Who was that man standing over there (pointing to my brother)? I don't know, but he's been around for awhile. What year is it? 1986. Do you know where you are? Blank stare.

Our father is in an alarmed bed to warn the nurses when he tries to get up. When seated in a chair, he is connected to the chair with a mesh vest-like device to "remind" him that he cannot leave the chair. Today he had to be spoon fed before he would/could eat. When alone in the room he wears large mittens that look like boxing gloves to keep him from pulling out lines and monitors. He got pretty good at that trick in the ER.

The expectation is that he will remain at Queens until at least Monday. I think Mother is relieved. We meet with the social worker on Friday morning to discuss options.

Give thanks for the geriatrician. Look for those silver linings. Keep praying. ...

Thursday, November 20, 2008

Emerging from a Bad Spell

Going it alone. Not going well. Some of you manage life alone very successfully. You thrive. I wish I could. I recently read a letter written to my mother by her aunt mentioning my grandmother’s loneliness as a widow. Neither of them really understood. One of their mutual friends, a widow, had said, “I just need something alive in the house.” I find it is more than that. A pet qualifies as something alive; a pet you enjoy does make a difference. The radio and TV provide another human voice. I need something alive that can carry on an intelligent conversation, share things we both enjoy. I would appreciate someone who can walk all the way to the back of Home Depot without wearing out. I’m looking for someone who would enjoy a day in Yosemite or at Cherry Lake or exploring Hawaii Volcanoes National Park. Maybe even visit New Zealand and Scotland. Someone who can share the driving.

Maybe this most recent slump (which I am finally beginning to climb out of) has to do with the futility of care giving in my parents’ home. Very few people who have lived independently into their 90’s are willing to take direction from a child who has been only an occasional visitor in their home for 45 years. We haven’t “grown up” together. We haven’t shared an adult life or adult interests. They don’t know my interests, skills and competencies. I am just learning about their weaknesses. Our tastes are different. When did my parents start enjoying beets or split pea soup? When did they stop eating thick-crusted, hearty breads, or rocky road ice cream?

Then there’s the dignity issue. My father came to the lunch table today in obviously wet clothes. After lunch I stripped and re-made his bed and emptied his hamper, laid out a clean change of clothes for him, and told him I needed everything on his body for the washing machine before I could do the wash. He was insulted.
On what do you base your judgment?
Maybe I should just move.
Where will you go?

He called Mother into his bedroom where they could talk privately. I heard her say, “You are wearing them and you are still wet?” Then realization struck. He was wearing Depends. He does not understand that they only absorb a finite amount of fluid before leaking. He does not understand that it is not wasteful to change them several times a day. He did not want to hear that if he wears wet clothing all the time, his skin will break down and he will get sores – diaper rash with a vengeance.

Before he could even get them on his body, the fresh clothes were wet.

It’s hard to tell whether my dad’s willfulness is anger and vengeance, or if his dementia is cycling in again. Yesterday Mother told him his car is no longer insured and he cannot renew his driver’s license. Yesterday he was angry because both Mother and I told him to wipe up the bathroom floor after he peed on it. Today I think I am seeing dementia at work. Which means we are heading into another downhill slide.

Give thanks for the good times. Keep praying …