Saturday, July 2, 2016

Just One Thankful, In Advance, Pretty Please?

Ever since I moved away from home at the tender age of 17, my mom and I have talked on the phone several times a week. Our talks progressed from boys and college and work to husband and kids and life, and I knew all about her friends and her friends' kids and grandkids. 

June 2014

The past year or two has seen a decline in my mom's health.  She had several skin cancers on her scalp removed which required what little hair she had on top of her head to be shaved off, and it has never really grown back. She walked like a drunken sailor and started using (not very well) a cane. She was also diagnosed with COPD, probably a result of her childhood asthma. Then this past October, at the age of 83, my mom fell, fell hard, flat on her back on the sidewalk of the town square, badly bruising her back and worsening existing arthritis there (including an old compression fracture that no one knew she had). Slight dementia-related signs she had been exhibiting for about a year were exacerbated by the concussion she suffered. To further complicate things, she was scheduled for, and had, her pacemaker removed and replaced four days after the fall.

And after all that, my mom stopped calling me.

I would speak to my dad often, checking on her progress (there wasn't much). And when I would talk to her, the conversations would be almost comical with all the dips and turns her stories took. Meanwhile, my dad took over the cooking, the cleaning, the laundry, and everything else my mom once did around the house (and he has done a bang up job of it, too).

The neurologist said it could take three to six months for the concussion to heal. He gave her a drug that improves brain function in patients with dementia, and perhaps the combination of that, along with the healing of the concussion, improved her cognitive function. By March or so, most of the cuckoo stories disappeared, but so had her short term memory. 

She couldn't walk unassisted after the fall, even though there was no physical reason why she couldn't, and she wasn't exactly stable BEFORE she fell. Her lower legs have been swollen with edema for many years (yes, she was supposed to take a diuretic every day, yes, she had blow up, squeezy boots she was supposed to wear every day, no she did NOT do these things, and no, my dad could not make her, that leading-a-horse-to-water thing, you know), and they grew worse and worse. "My legs look like stovepipes" she would say, and the skin, stretched as far as it could go, would crack and weep.

Not only could she not walk without a walker, she couldn't get up or down from a chair, the bed or the toilet without assistance, my 81 year old dad being the assistant. Her legs were so heavy with the edema that she couldn't lift them, so he had to lift them for her, into the bed, into the car for the many, many doctor visits, onto the foot rests of her wheel chair.

Memorial Day weekend, while we were all at the lake house to celebrate my parents' 60th wedding anniversary, I discovered there was more going on than the edema, the inability to walk, and the memory loss when I heard my mom crying out in the night from the living room. I jumped out of bed and went in there, where I found my dad trying to help her to bed while she was experiencing what appeared to be a nightmare from which she couldn't awaken. We got her to bed, and after several minutes of her thinking she couldn't breathe, she finally calmed down and went to sleep. Early the next morning, I awoke again to the sound of her crying out hysterically, this time thinking she was falling out of her recliner (she had had my dad help her there a few hours earlier). We don't know exactly what she did, but she had slid a little bit towards the footrest of the recliner and then panicked, and my dad and I got her to her feet and then safely back into the chair (footrest down this time). I went back to bed but couldn't sleep, instead Googling her symptoms and finding something called "sundowning," a period of increased confusion and agitation and a symptom of Alzheimer's and dementia.

My mom could stand a little, if she had something to lean on, so she was able to put on a little make up or comb what little bit of hair she had left. The weekend following Memorial Day, though, she was standing in their bedroom, leaning against the bed and folding some laundry, her walker next to her, when she decided to sit on the little seat on her walker without remembering to lock the wheels first. The walker, of course, shot out from under her and she fell onto her bottom. My dad had to call 911 to get her up, as (1) the edema has caused her to gain about 50 pounds of fluid and (2) he's 81 - enough said. Twelve hours later, she fell again, this time in the bathroom, and the fire department had to return to get her up. 

I was vacationing in Nashville with Emma when my dad called me to tell me about the fall times two, and we decided it was time to get her in a place where she would get the kind of care my dad just couldn't safely provide for her. He called their doctor the next morning, and June 6, the doctor admitted her to the nursing home. Two days later, alarmed by the edema in her legs that had moved upwards into her abdomen and arms, the therapist in the lymphedema clinic had her admitted to the hospital.

My mom spent a week in the hospital, where she was given IV diuretics and was catheterized. Her oxygen levels were monitored, and she was put on oxygen 24 hours a day. She was moved back to the nursing home on June 14. 

It's not a horrible place, really, although it's also not a place where you would necessarily WANT to live. Compared to the other patients I saw there, my mom had it together better than probably 70% of the others there. They got her up and dressed every day, and she went to the dining room for her meals. One of her table mates is 95 and darling, and they would sit and visit during every meal. She didn't say she wanted to go home. And she proved to be somewhat ornery, which was out of character but rather enjoyable to witness nonetheless.

But she didn't know what year it was. She wasn't entirely sure how old she was. Her short term memory was crap. She had no idea that her grandson turned 21 last week. And she couldn't talk on the phone, because she couldn't seem to hold it so that she could hear AND talk, both of which are essential for a satisfactory telephone conversation.

My dad has hung out in her room with her every day, which is killing his back and knees but is better than lifting my mom to her feet day in and day out; there are people to do that for her now. He's also pretty pumped that he can eat for free in the dining room. And he's also probably gotten more sleep in the past few weeks than he's gotten in the past 8 months.

She's exactly where she needs to be right now, but it's still hard. Hard. Hard. Hard.

Three days ago, my dad called to tell me my mom wasn't doing very well, and I drove up there that afternoon. When I arrived, I was shocked at the change in her from my visit less than a week earlier. My mom was in bed, asleep, mouth open. Her oxygen had been turned up from 2 liters to 3. My dad and I filled out an advanced directive for her while she slept. An aide came to get her ready for supper, and it took all of us to get her awake and into her wheelchair. She's lost over 60 pounds since she's been there, much of it fluid, but not all of it, and she is refusing food, only taking a few nibbles of her meals. Where a week earlier, she was about 95% lucid during conversations, she was now hovering at around 5%. 

So, Jesus, if you don't mind, as much as I don't want her to go, I think it's time for you to come and get her. She's not going to put up a fight. 

Thank you in advance....

June 2016