Thursday, December 23, 2010

Lessons in Frustration

You would think that Medicare Part D would become easier to navigate after six years... NOT!  I thought we had everything set.  We got the formularies from our 2010 provider - Arkansas Blue Cross/Blue Shield - in the fall... and of course, not all of Mam-ma's medications were going to be covered for 2011.  So I began a search for another provider.  We have changed every single year so far.  The "winner" was Health Spring, headquartered in Nashville, Tennessee.

I have to say, from the time I enrolled with Health Spring, the customer service has been superb.  I have gotten right through to a representative, my questions have been answered quickly and thoroughly, and I have even been wished a Merry Christmas!  I got the new membership card in the mail and tucked it into my wallet to show to the pharmacy staff, so that they could record the new numbers when I picked up Mam-ma's medications last Friday for the month of December.

When I arrived at the pharmacy, the clerk said, "I hope you brought Ms. Polly's new card."  I proudly said, "I surely did!" and she added... "That's good, because we need to try to run it - her other insurance provider has refused payment."  "What?"  It seems that Arkansas Blue Cross/Blue Shield went ahead and stopped providing coverage for my grandmother a month early - even though she was supposed to have coverage with them through December 31, 2010.  "Will Health Spring go ahead and pay?" I asked, adding that their information indicated coverage began on January 1, 2011.  "We don't know - we're going to try," the clerks told me.

I was astounded... and frustrated.  The clerks told me this happens all the time, although it's never happened to us before.  And, since there was no insurance coverage, the refills I had called in to the pharmacy the day before had not been filled, so there would be a time issue.  To further complicate things, one of the prescriptions had expired.   We had just seen the cardiologist a week earlier, and he said, "Tie a knot in this rope and hang on," so I knew he wanted to continue this medication.  Luckily, his name was on speed dial in my phone, so I made a quick call, and almost before I could hang up, the nurse had faxed over a new prescription.

I decided to go ahead and do a few other errands... get Mam-ma to the beauty shop... and return for the medications.  When I got back, the new provider was agreeing to cover all of the drugs... except for a name brand on a thyroid medication.  "It was on the formulary," I told the pharmacist.  "Yes, but the insurance provider wants you to use a generic."  We've never used a generic, and it might be fine... but at 98 with all going well, I would rather not rock this boat. 

So, I called the family physician's nurse to see if the doctor could authorize use of the name brand drug.  She was unavailable and would return my call.  She did... about an hour later as I shopped for Mam-ma's groceries.  I explained the problem, and she said, "Well...why can't she just take the generic?"  I explained further that she is 98 and doing well, and we want to keep things the same.  She said, "You'll have to fill out a form."  I told her no... the pharmacy said all it took was a verbal authorization from the doctor, with a notation in my grandmother's file on HIS end, in case the auditors ever checked.  She said, "I'll have to talk to the doctor about that and call you back." 

Thank heavens for small towns!  It was late on a Friday afternoon, and the nurse did not return my call, so the pharmacist "spotted" me a week of the name brand medication.  He said I could get the rest the next week if the authorization came through... or he would fill the generic at that time and I could pay for the seven pills.

On Monday morning, the nurse did call back, and all was well... the name brand was authorized.  She added... "And we need to see Ms. Polly for a 6-month checkup."  I told her we had not been for a "6-month checkup" in years.  She said, "I know... it's been July of LAST year... and we really need to see her.  We're supposed to see her every six months for insurance purposes."  I explained that I do not like to expose Mam-ma to the potential illnesses in the clinic... she is 98 and frail, and it's not worth it.  She said she understood and offered us a late-January appointment - first thing after lunch with the promise of getting her directly into an exam room and a short wait time.  So I agreed.  At this point, I'm picking and choosing battles.

On the way home from the beauty shop, Mam-ma told me that her teeth were really bothering her.  She said that the new liner the dentist put in when he put them back together was "not right."  She added, "They're too full."  I didn't say much... sometimes she has to wear them a few days before they feel right to her.  She did not mention it to my mother, who was out of town celebrating Christmas with her husband's family.

But over the weekend, Mam-ma continued to tell me that she needed to go back to the dentist... and she planned to call Monday morning.  I had a full week of activities and preparations for the Christmas holidays, so Monday morning, I called Mam-ma and asked her if she had contacted her dentist.  She had not, but she wanted to.  I decided to cut to the chase and call the dentist myself.  We secured an appointment for the following afternoon at 2:00.  Later that morning, someone from the dentist's office phoned and said, "I'm confirming your appointment for tomorrow morning at 11:00."  I told her no... it was at 2:00 p.m.  She said, "That's Ms. Polly's appointment... your annual cleaning and checkup is tomorrow morning at 11:00."  I had totally failed to write it on the calendar and had no clue.

The gracious receptionist offered me a 1:00 p.m. appointment... with Mam-ma's appointment to follow at 2:00.  That was great!  So Tuesday, I picked Mam-ma up shortly before 1:00 and we drove to the dentist's clinic.  I got right in, and Mam-ma was put in a room next door soon afterward.  The hygienist and I overheard Mam-ma tell another assistant that she was not ready for Christmas, because "they won't let me cook any more."  Now, for the record, last week Mom called one afternoon to see if Mam-ma took her noontime medication, and her friend Ruby answered the phone.  She said, "I don't think Polly took her medicine - we're making peanut brittle."  Mom was so flabbergasted and upset that she just quickly said "Goodbye" and hung up!

Monday morning when Mom called, Mam-ma said, "I'm in the middle of something."  Mom asked, "Are you getting your bath?"  Mam-ma replied, "No, I'm making sugar cookies.  Mary (the housekeeper) is here."  Mom said she felt sure that Mary was not helping with the cookies!  Every time I go to my grandmother's, there is no evidence of any of this baking.  I've not seen as much as a peanut.  I did see a jar of sugar cookies tucked away on a lower shelf of the telephone table today, and I pretended they weren't there.  Mam-ma took peanut brittle to her hairdresser last week and tried to brag to me about making it.  I would not acknowledge her comments... and I could tell that really made her mad!

Meanwhile, the teeth are still not right.  I asked Mam-ma if she was eating better, and she said, "No, not really.  These teeth are still not right."  Now, in the dentist's chair, she said they were fine.  I asked her why we left the clinic with teeth that don't fit right, and she said, "Well, he was busy."  I told her... "He's been busy every time you are there, and he would prefer you get this right and not have to keep returning."  She said, "Well he said, 'Now, if these give you any trouble, you know what to do.'"  I asked what that meant, and she said, "Well, he means for me to come back!"  She added (as always), "You just don't understand, because you've never had dentures!"  I told her, "I understand you don't leave the clinic until they fit right!"  So now the holiday weekend is upon us, and her teeth are not fitting right, and there is nothing to do except muddle through the next few days.

Honestly, we're not sure there is anything to do.  The dentist has worked and worked on these dentures... and Mam-ma absolutely has no jaw bone left to anchor them.  The dentist says it is eroding faster than he can adjust the liner.  If it gets to the point where nothing can be done, I believe it will take a toll on Mam-ma's overall health and speed along her general decline.  I'm hoping when her mouth heals a little and settles down, the teeth will settle into place again, as has happened before.

Meanwhile, we still have not heard anything about the room at the assisted living facility.  I visited friends who live there last weekend, and I reported to Mam-ma about how nice the facility was and how happy these folks were living there.  She had very little comment.  However, an older cousin told me tonight that he had a long phone conversation with Mam-ma last night, and she is ready to move.  He said, "I honestly believe that if I told her right now there was a room ready, she'd start packing."  He added, "She told me she can't wait to move there."  Of course, that is news to me... so we shall see.

So another Christmas is upon us. Mam-ma has made new baby quilts for my great-nephew, Timothy, and his sibling who will arrive next May.  She asked me to buy her white glue last week at the store, and Tuesday, she sent home two large white shopping bags that contained the quilts.  She had glued Christmas cards to the sacks for decoration... a clever idea... and a much safer use of her time and energy than baking or making candy!  My mom and her husband will pick up Mam-ma and bring her to our house for the day.  She will be exhausted when she returns home... and she won't hear half of what is said while she is here.  She told me today that she plans to wear her long underwear under her clothing so she won't be cold.  There is no way we could keep our house warm enough for her and stay in it ourselves!

Our family opted not to exchange Christmas gifts this year... for a variety of reasons.  Santa Claus has left filled stockings for everyone, and we will enjoy sorting through those goodies.  But our day will be about eating a good meal and enjoying each other's company - and watching Timothy play with his gifts. 

If anyone asked me what I want for Christmas this year, it would be for us to enjoy a good day together with no crises or catastrophes... and for a room to become available at the assisted living facility for my grandmother.  Whether she takes it is still up to her... but I'm praying that the timing will be right and everything will come together for her to find some semblance of happiness there.  At least I will know that she really is taking her medications when she says she is, and she is relatively safe and her basic needs are met each day. 

I'm realizing that I whine and complain a lot about things that I cannot change, and I'm earnestly seeking a deeper faith and trust in God to handle what I already know I cannot.  I'm trying to learn to let many things go in one ear and out the other... and to fully understand that we are now at a point where Mam-ma may not even be able to remember she isn't supposed to do certain things, like bake cookies.  This is a transitional stage, and for the most part, my grandmother is still functioning better than many who are a decade younger.  Still, she grows a little more tired and frail with each week.

I plan to treasure the time we share this Christmas... to collect as many memories, take as many pictures, and enjoy as many laughs as possible.  I hope that your holidays are filled with the same.

Thursday, December 16, 2010

Catching Up...

I know it has been a LONG time since my last post, and I do apologize. I could use the holidays as an "excuse," but honestly, I can't explain why I have not found time to share a few things with you. Perhaps I am like many people - I just need a break.  But life has marched forward, so here goes.

We celebrated Thanksgiving at my mother's home.  We had a good meal and enjoyed being together - I think.  Timothy was the star of the show, and he entertained us well.  I would have to say that much of the day, Mam-ma was very bored.  She didn't seem all that alert... and of course, she doesn't hear well... and she refused to bring her walker into the house.  So every time she stood, we held our breath as she reached for unfamiliar furniture and surroundings to "hold onto" as she toddled from one spot to the next.  My husband said he didn't know whether he was more nervous about Timothy getting into something he shouldn't, or Mam-ma falling!  I really think Mam-ma was the bigger liability!

Mom took Mam-ma to Wal-Mart to get more fabric for yet another baby quilt - this time for Timothy's new sibling, who will arrive late next spring.  Mam-ma has begun to tell a few people she is on the list to move to the assisted living facility. I have talked with the administrator, and she says a few things have changed, and there MAY be a vacancy ... but she has not returned my call to say we are on "Go!"  And if she does, I can't guarantee that Mam-ma will agree to move.

Last week was one for the books.  Mam-ma had told me the week before that her teeth were bothering her.  She mentioned it to Mom on Sunday over lunch, and Mom said, "Make an appointment to see the dentist, and I'll take you."  On Monday, Mam-ma said the same thing, and Mom told her again to make an appointment.  Mam-ma replied, "Well, they are a little better... if they start to bother me again, I'll call the dentist."  Less than an hour later, Mam-ma phoned Mom to tell her she had an appointment - for TUESDAY!  Mom was busy on Tuesday and didn't want to bother me with this, so she told Mam-ma to reschedule.  We had been keeping Timothy for a couple of days, and Mom knew I had a full week ahead with other appointments and obligations for Mam-ma and myself.

Mam-ma wanted to get a dental appointment on Wednesday, but Mom knew that we already had an appointment at our local hospital to get Mam-ma's pacemaker checked that afternoon.  So she told her the dental visit needed to happen on Thursday.  Now here's where it gets hairy.  Mam-ma had moved her beauty shop appointment to Thursday afternoon, so that we could do the rescheduled cardiologist appointment on Friday.  So... this meant that on Thursday, Mam-ma went to the dentist in the morning, then Mom whisked her to the beauty shop in the afternoon, where I picked her up afterward and took her home.

The pacemaker check went fine... we really were not gone very long at all.  The only real problem was that we have had very cold weather for early December, with lots of wind, and Mam-ma does NOT like wind!  But we persevered, and on the way to the hospital, Mam-ma told me that Ruby had fallen that morning in her front yard.  "Was she hurt?"  Yes, Mam-ma said her arm was hurt, but her doctor was not in his office on Wednesday afternoons, so she was going to tough it out until the next day.

The bottom line... Ruby's ankle gave way as she crossed her yard, and she fell and broke her wrist.  She has now seen her family doctor, an orthopedist, and has a cast on her arm.  She was trying to retrieve a box that had blown into the yard.  I would venture to say it was well below 32 degrees that morning.  By God's grace, a neighbor happened to be out and saw Ruby fall and helped her get back up and on her feet.

So Mam-ma told me that she had been taking her daily "walks" inside her garage.  I questioned her - wouldn't it be better (and warmer) to walk inside her house?  Well, there was more room.  And I surmised... "Oh... easier to maneuver your walker in the garage?"  "No...I don't use my walker in the garage."  This did NOT make me happy, and I tried to hold it together as I explained to Mam-ma that a fall in the garage could result in her lying on cold concrete for hours before anyone discovered her... and she could freeze to death!  "Well, that's right!" she replied.  But I have no doubt it went in one ear and out the other.

Thursday, Mom took Mam-ma to the dentist, where her dentures got yet another "liner."  The dentist explained to me that Mam-ma's jaw bones are disintegrating, due to age and the pressure of years of chewing, and there is really nothing for her dentures to fit around.  So he puts in a liner that makes them fit a little more snugly - for a few weeks/months.  If the dentures are loose, they rub very painful blisters on her gums.  We've probably had better than a half dozen new liners in the last couple of years.  The dentist is WONDERFUL with Mam-ma.  Since she is a former chairside dental assistant who has made a gazillion sets of dentures, they have a lot to talk about.

Mam-ma and the dentist she worked for made their own dentures, long before the advent of our dental labs of today.  The dentist would select the teeth from his tall cabinet of tray-like drawers... canines in one, molars in another, incisors in yet another... and he and Mam-ma would "set" the teeth in the soft "gum" form.  Then Mam-ma would take the teeth home and "cook" them in a big special pot on her stove (while supper simmered on the other burners), and this would "set" the teeth in the gums, and they would harden and become dentures.  I know there's more to it, but that's basically how it happens.

I spent many hours in this dental office as a child, and I was intrigued with the trays of teeth and thought nothing of that vat of dentures cooking on the stove at my grandparents' house.  So the dentist of today is fascinated by my grandmother - and her tales of earlier times - and he treats her like a queen.  I will be forever grateful to him for his kindness and love for her.

Since I had my own appointment Thursday mid-day, Mom took Mam-ma to the beauty shop at 2:00, and I picked her up there at 3:00, groceries in tow.  She'd made me a list the day before.  Of course, after her appointment on Wednesday, and TWO appointments on Thursday, she admitted she was really tired.  And it showed.  Her speech was getting loose and slurred... the thoughts didn't come very fast, and she was moving at the speed of a snail.  I dropped her at home and told her to REST!  She said she would.

Friday morning, my husband and I were there to get her at just after 10:00 a.m. to make a 30-mile drive to visit the cardiologist.  When I called Mam-ma the night before to make sure she took her medicine, she said, "I dread that trip."  She LOVES this cardiologist and always enjoys the trip to see him, so this was my first clue that she truly is realizing at least some of her limitations.  She continued, "I wish he came to our hospital, and I could see him there."  I told her one of his associates came to our hospital, and I was sure we could switch to him.  But I was afraid to do this, because I know how much she likes this other doctor.  However, she said, "I think it may be time to do this."  I asked if she wanted me to pursue it, and she said, "No... let's see how tomorrow goes."

The drives to the cardiologist are always interesting.  Mam-ma tells us all sorts of things about her childhood... and this trip was no exception.  The stories come S-L-O-W-L-Y, but she told of her dad working as a blacksmith... and a coffin maker.  She related how he would have her and her sister, Babe, hold the fabric and lace that lined the coffin while he tacked it into place.  She told of her school days and going to live with an older sister, Minnie, and her husband Ray, for about 6 months to attend school in another community.  I made notes, but I do plan to get to her house and get some of this documented better and in a more chronological order.

Once we were in the cardiologist's exam room, I asked Mam-ma, "What do you think... do you want to see about moving to another doctor?"  She replied with a sigh... "Well, I just believe we'd better."  So I asked the doctor, who was gracious and agreed that it was time for this change.  He gently reassured Mam-ma she was doing the right thing.  I told him she was on the list to go to assisted living, and he also agreed - and reassured her - about this decision.

We had lunch at Dixie Cafe before returning Mam-ma to her house, where three cousins from Oklahoma were just arriving to spend the weekend with her.  These "girls"... as Mam-ma calls them... are so good to Mam-ma, and they come to visit several times a year.  But Mam-ma always overdoes it when they are here, and she is exhausted when they leave... although she will not admit it!

The cousins stayed all weekend, going home Sunday sometime.  Monday, I checked on Mam-ma, and she seemed fine... of course, she said, "I'm really not tired at all."  Not thirty minutes later, she called me again and said, "You or Greg needs to come get my teeth.  They just broke in two when I tried to eat my dinner."  I called my husband, who was out delivering Meals on Wheels, and he went to Mam-ma's, got her teeth, and took them to the dentist.
Monday night, Mam-ma still didn't have her teeth.  We surmised the dentist had sent them out to a dental lab for repair, as Mam-ma said they snapped into two pieces.  I asked her if she had any canned cream soups she could fix for supper.  She said, "Yeah, I've got soup, but I have to thaw it."  I said, "No, I meant a can of cream soup - like cream of tomato, cream of chicken... don't you have something like that?"  She replied, "Yeah, but the soup in the freezer is vegetable."  Vegetable soup is one of her favorite meals.  I just quietly asked, "Well, Polly... how do you plan to chew vegetable soup with no teeth?"  She started to laugh... "I don't know," she giggled.  In the end, she had cream of chicken soup, crackers, and applesauce.

The dentist repaired the teeth himself, apparently, and late the next day, they were ready.  Mom took Mam-ma to get them, and an assistant put them in for Mam-ma and sent her on her way.  Mam-ma told Mom she had had a terrible headache all day from not having her teeth, and we surmise it was from not having much to eat (and probably the effect of little food and her medications on a somewhat empty stomach).

Tuesday night, Mam-ma was much better when we spoke, although her speech was very slurred and halting...probably from being tired.  But she said she had eaten, and her headache was gone.  She added... "I tell you what, I don't think I have EVER gone three days without my teeth!"  I said, "But Mam-ma, you weren't without your teeth for three days."  "Oh, yes, I was!"  "No... Greg picked them up yesterday at noon, and you got them back this afternoon - that's scarcely more than a day."  "Well... WHATEVER!"  I laughed and told her I was sure it seemed like three days, and she said, "It sure did!"

However, this made me realize that Mam-ma, who is prone to exaggeration, really convinced herself that she had been without her teeth for three days... and that tells me how confused she is becoming.  And there's more... she has taken almost a week to tell both my mother and me that her Home Health nurses have been talking to her about a new program called "Personal Care."

Mam-ma called me Monday night to tell me that a nurse had visited her and "evaluated" her for "Personal Care," a Medicaid program that provides additional in-home care for those who need it, particularly the elderly.  Supposedly, this aide will come three days a week and do laundry, housekeeping, and other things for Mam-ma.  She said, "I'll be the laziest thing in town - I won't have anything I have to do."  She also said, "You'll probably get a call... that nurse said she was going back to the office and get the ball rolling to get this for me."  She told my mother, "I didn't sign up for anything - I wanted to talk to Debbie first."  So I have not gotten a call and really don't know what is going on with this.

However, I asked Mam-ma... "Did you tell them you are on a waiting list for the assisted living facility?"  She said she did, and the nurse said, "That's okay... if you go, we'll stop it."  Not wanting to tell Mam-ma I've made an inquiry again at the assisted living facility and expect a call soon from the administrator, I asked, "You know, the assisted living facility could call us any day and say a room is available.  So, if they call and have a room ready for you, don't you want to at least go look at it?"  Mam-ma changed the subject somewhat and said, "Well, that aide said, 'Don't you want to stay at home as long as you can?' and I said 'Yes, I DO!'"  So I am having my doubts that Mam-ma will be agreeable to even looking at a room at the assisted living facility... much less agree to move there.

I've done a little Internet research, and while this program looks good, I am not sure it will provide the level of care my grandmother may need and/or desire.  For one thing, these aides cannot handle any medications... the assisted living facility provides nursing care and will monitor all of Mam-ma's meds. The aides can also not provide any transportation, and that's a biggie with Mam-ma - having someone to drive her places now that Ruby is not able to chauffeur her to the store and such.  And... while this is three days a week, Mam-ma needs PEOPLE around her EVERY day.  As we approach winter and she becomes more housebound by the weather, she will become even more restless and lonely.  At the assisted living facility, she would be surrounded by people all of the time.

Still... this is totally my grandmother's decision at this point.  She is mobile.  She went to her Sunday School brunch at a local restaurant this week.  She continues to "show her spunk" at every turn, and for the most part, we've managed to make the adjustments that are keeping her relatively safe in her own home.

I say "for the most part," because... last week, Mom called one afternoon to see if Mam-ma had taken her noon medications, and Ruby answered the phone.  Mom said, "I just called to see if Polly took her medicine."  Ruby responded that she probably did not, "because we're making peanut brittle."  Mom said, "I didn't know what to say to that, so I pretty much just hung up!"  When I went the next day to get Mam-ma for her appointment, there was absolutely NO trace of peanut brittle, save an empty corn syrup bottle tucked in a corner on her counter.  But I could smell the cooked sugar of candy making... I know that aroma all too well!  The candy was never mentioned.

On Thursday, when I picked Mam-ma up at the beauty shop, we were leaving and her hairdresser stopped at her station and said, "Oh, what's this?  I wonder who left this candy?" It was a zip-loc bag filled with peanut brittle.  Mam-ma grinned like a proud school child and said, "I did!"  The hairdresser asked, "Who made it?"  Mam-ma grinned again, "Well, I did!" she said.  Behind her, I mouthed, "She's not supposed to make peanut brittle," and the hairdresser nodded in agreement, pulling me aside a few seconds later and saying, "She told me a couple of months ago that y'all won't let her make peanut brittle any more."  We both just sort of rolled our eyes!

I did not acknowledge any of this to Mam-ma.  We got into the car and started home, and she said, "Ruby said, 'Oh, I'm so glad we got that peanut brittle made before I broke my arm.'"  Again, I did not bite.  This irritated Mam-ma to no end, and she got short and curt with me afterward.  I changed the subject to something else, and I knew she was not happy - she wanted me to fuss at her and cause an argument.  I don't know how I held my tongue, but I did.  To her credit, she did not leave a bag of the candy for me to bring to my husband, or I might not have been so patient.

Clearly, as long as Mam-ma lives at home, she is going to test the waters... from making candy to walking in her garage without a walker to things I don't even want to imagine.  I pray each day that God keeps her safe... and that He gives me the strength to deal with whatever may happen next.  Meanwhile, I just chalk these incidents up as "fodder for the blog!"

On a side note, my mom has just written a new book about the history of the entertainment industry in Branson, Missouri.  Since so many people like to visit Branson, I thought there might be readers here who would find this information of interest.  My mom has now written five books... you can learn more about her work at her website...

Thursday, November 18, 2010

Fun With Bureaucracy...

My grandmother has a history of telling one person one thing, and another something else. So I was not surprised when my mom told me that Mam-ma was telling my cousins, "Debbie is taking me to look at a room at Southridge (the assisted living facility) next week." She had told me that she wanted to think about it, and that the room "was too small" and too dark. So I called her and asked, "Are you wanting to go look at Southridge?" She replied, "Well, I don't want to, but I think I better. I may not be happy there, but I'm not happy here, either." This was the first time she has flatly admitted to not being happy.

I told Mam-ma I would call and talk to the administrator and set up a time for us to take a tour. I called right away, and the administrator told me that there are now no fully-funded Medicaid rooms available. In the time since I first visited with her, she has "given them all out." I asked about a waiting list, and she said there was no one on the list at this point, but she didn't foresee any rooms coming available anytime soon. I asked to be placed on the list.

I explained to Mam-ma that we may have to move very quickly if a room comes open. There won't be time for her to waver back and forth... she will have to take a look and either say "Yes" or "No." The administrator did tell me that we could get one of the mid-sized rooms (which has 355 square feet vs. 248 sf for the fully funded room). This room currently costs the family an additional $500 per month, regardless of what Medicaid pays. That is in addition to any "incidental" expenses Mam-ma will have, which I am tallying at about $300 per month for such things as her medicine co-pay, getting her hair done, personal toiletries (toothpaste, mouthwash, soap, body lotion, etc.), toilet paper, candy, cookies and soft drinks, her telephone bill, and more. We have no guarantee that the $500 per month currently being charged might not rise at some point. Once we make the move and Mam-ma empties her house, where would she go if we deemed this to be too expensive?

So we are waiting for the fully funded room, and Mam-ma is managing. The lady in her Sunday School class who my mom felt would become a new "designated driver" did indeed drive Mam-ma to church last Sunday, since Mom was out of town. She also drove her to the Senior Center for lunch one day this week. And Mam-ma has not complained too loudly about being lonely or "looking at the four walls," although she does tell me often how much she misses going places with Ruby.

Last week Mam-ma told my mother that she had not seen anyone all day... except her deacon, the Meals on Wheels delivery person, and her Home Health aide! She is also continuing to forget to take her medication - or mixing it up some. She tells us she took it, but it's still in the compartments when I check on Fridays. Her response is always, "Well, I'm sorry." I've told her, "Don't apologize... just go take it!" This week, she said "I didn't take my noon medicine, because the box was empty. I may have taken more than one dose at a time." I told her to go to the Friday box and take the medicine in it, and I would fix it on Friday. She said, "There are three half tablets in Friday's box." I have pretty well decided she has dropped the container a couple of times and tried to replace the medicine herself... with mixed results.

Last week, Mam-ma called to tell me that her semi-annual pacemaker check had been set for Wednesday, December 8, at 1:15 at our local hospital. I made a note on the calendar. She said she got a letter about it. Then she called on Friday and said there was a telephone message and, "My pacemaker check has been changed to Friday, December 10, at 11:30 a.m. - in Searcy." (30 miles away) I called the number for the pacemaker technician, and she said that she could not explain the phone message about December 10th, but the appointment was for Wednesday, the 8th, at 1:15 - and it was at our local hospital.

Mam-ma was to have her semi-annual checkup with the cardiologist this past Wednesday at noon - in Searcy. As my husband and I dressed and got ready to make the trip, I decided that I should call and confirm the appointment. Now, I had done this two weeks ago when we went for an echo cardiogram. But nonetheless, I made a call. The receptionist said, "No, that appointment has been rescheduled." I said, "You have got to be kidding." She said... "Well... let me check. I'll connect you to the scheduler." She put me through to a voice mail machine for another cardiologist. I called again. She apologized and tried a 2nd time... this time reaching the voice mail for yet another cardiologist. I called a 3rd time. I explained that we were about to walk out the door, and we really needed to know about this.

The receptionist said, "Well, I know your appointment is not today, because the doctor is out this week!" She said she would check on things, and the next person I spoke with told me that Mam-ma's appointment was now scheduled for Friday, December 10th, at 11:30 a.m. It was all coming together. She said, "We spoke with you on November 15th." I assured her no one had spoken with me. She said, "And we sent you a letter." I told her if Mam-ma got a letter about the appointment change, she had not mentioned it.

I also told the girl that we already had appointments for that Friday, and she cut me off and said, "I don't mean to interrupt you, but we are booked solid through March. That is the only appointment we have available until then." I wanted to scream, "My grandmother could be DEAD by March - she is 98 years old!" But instead, I told her "Fine... we'll take it and I'll reschedule her other appointments." She said, "Now if that won't work, we could talk to the nurse and maybe work her in some other day." I know what that means... sitting for hours on end in the waiting area for a spare minute. Mam-ma is not up to that. Just going to the beauty shop tires her these days. So I assured the scheduler we would be there on the 10th.

As I had done with the pacemaker tech, I asked this person to make me the point of contact for phone messages and letters about appointments. She reviewed my address and phone number and said, "That's where we send everything already." I told her no... I had never gotten any of the messages... they all go to my grandmother. She said she would make the changes on Mam-ma's records... we will see.

With an unplanned day suddenly available, I decided to tackle enrolling Mam-ma in a new Medicare Part D Prescription Drug plan for 2011. You would think that after 5 years, I would have this down pat... NOT! I still had to call the Medicare office in Dallas to make sure I was understanding the information correctly... would someone with extra help be required to pay premiums and deductibles? The answer was no... and ultimately, my choice came down to finding the plan that covered all but one of Mam-ma's meds (an anti-anxiety medication that has never been covered) and had the lowest co-pay.

My frustration came not from the process itself... and certainly not from the extremely helpful Medicare rep, Anna. The problem resided in the website. More times than I can count, the site "timed out" on me, and I had to go back and re-enter my "code" to access my drug list and start the process again. I was taking time to compare plans... or talk with Anna on the phone... or look over the details of a particular plan. I would sometimes get a screen that "you are about to be timed out," but more often, when I tried to return to my list of plans, I had to start almost completely over. So even though I feel like I understand this process about as well as anyone, it still took more than two hours.

But we have Mam-ma enrolled, and I think we have her appointments straightened out... although I will be calling a few days in advance this time. What if we had taken off from jobs to drive her to Searcy? I have to believe that the staff knew 2 weeks ago when were in the doctor's office that he would be "out of the office" this week. Maybe not... but it's highly suspicious to me.

All of this makes me wonder... what do people do who have no one to help them? Mam-ma gets things so confused these days, and were she still able to drive, I seriously doubt she would think to confirm an appointment before driving 30 miles for it.

In fact, we've done this ourselves... early on in our caregiving. We drove to Searcy one day for the echo cardiogram, and no one had called to tell us that the "tech" no longer performed these on that particular day of the week. After Mam-ma threw a little fit and told them we had driven 30 miles, they were able to locate a "tech" who happened to be shopping in town, and she drove over and did the 15-minute test. I learned then to always call and confirm... and usually I call the day before an appointment. But having just been there 15 days earlier and confirmed, I let it get by me. And I realize now that Mam-ma confused the pacemaker check info with the rescheduling info, so in some ways, it was as much our fault as theirs in this instance.

So what does this all mean at this point? We are just taking things one day at a time. Mam-ma seems to have made a better adjustment to not using her stove for cooking than I would have ever anticipated. She has not fared so well with the fact that Ruby can no longer drive her around. Someone asked me last week how she was doing with this, and I said, "Not well. I have seen a noticeable decline in Mam-ma since the wreck." I believe this is mostly mental... a mindset... but it's there nonetheless. She seems defeated, tired, and much older in recent weeks. My hope is that she will remain healthy enough until a room does come vacant for her at the assisted living facility. My goal is still to avoid the nursing home.

This is all pretty much out of my hands at this point, and I've come to terms with this fact. We will all be gathering for Thanksgiving next week at my mom's, and I am looking forward to spending time with my family and enjoying this day with my grandmother and Timothy... watching the generations interact, and making memories in the process.

Each day is a gift at this point... and for the moment, Mam-ma seems to have mellowed a bit in her temperament. Last night when I told her to be watching for her new prescription drug coverage info in the mail, she started to cry and said, "I don't know how I'll ever pay you for all you do for me." I told her, "Your my grandmother... you don't have to." She persisted, and I said, "Look, if you had to pay me, you couldn't afford me, so just be glad you're my grandmother!" We both laughed, and she moved on to another topic.

I am grateful that I am in a position to help her... and I do often wonder how on earth other people manage. My husband says half the clients on his Meals on Wheels route are nowhere near as well off and able as my grandmother... and many don't have anyone to see about them, save maybe a Home Health aide a few mornings a week. Some don't even have that.

Our culture has not kept up with the issues that face aging Americans. And as a gerontologist pointed out to me last summer, much of this is because Americans now live far longer than they once did. People like to talk about how "We used to keep Mom and Dad at home and take care of them until they died." Well, Mom and Dad only lived to their mid-fifties. We honestly are not equipped, in many circumstances, to care for parents and grandparents who live well into their eighties and nineties. I know there are people who are working to bridge the gap and improve things, but some days, the process seems pretty darn slow. And when you factor in the bureaucracy and the bumbled schedules and websites that are not user friendly, it's hard to see progress.

In the words of Scarlett O'Hara... "Tomorrow is another day..." and for me, it's "beauty shop/errand day"... wish me luck!

Monday, November 8, 2010

Voting, Life Alerts, and Parties... All in the Same Week!

A lot has happened in the last 10 days. The Thursday before Halloween, we hosted my family for a chili supper. We invited my mom and her husband, my sister and her family (including Timothy, of course), Mam-ma Polly, my cousin and her two children, their spouses and two children. There were seventeen of us in all. We had a great time, and Timothy got to play with his two cousins, Owen and Olivia, which was fantastic. Mam-ma so enjoyed watching the children play and dance to NickJr. shows on television.

Mam-ma and Timothy

Timothy and his cousin Olivia.

Owen and Timothy

Mam-ma and my cousin watch the boys dance to a NickJr show.

The next day, everything went well when we went to the beauty shop and ran errands... until I got home. My phone rang around 4:30 p.m. - Mam-ma. "Go look in your car and see if my life alert button is there. My pants pockets are shallow, and it fell out somewhere." I looked. The life alert was not in my car. Mam-ma will not wear this device around her neck - she insists it bothers her. She had called the beauty shop, and one of the hairdressers had scoured the building - and even the parking lot. No button! I told Mam-ma not to worry... it would turn up. Frankly, I'm not sure how long it had been missing.

Mam-ma did worry... and she searched every inch of her house and stewed over the missing device all night. When I called her at 7:00 p.m. Friday night to see if she took her night-time medicine, she had not eaten - she had searched for the device since 4:30. I told her to STOP... to eat and take her medicine, and quit worrying. She said, "Well, I worry about everything these days." I gently suggested she try to stop worrying. Saturday morning, she called the company and reported that she had lost her life alert button and needed a new one. The company delivered her new device on Monday. The cost was $30.

Tuesday, Greg and I drove Mam-ma to her cardiologist's office, 30 miles away, for an echo cardiogram in preparation for her 6-month check-up in a couple of weeks. We stopped and had lunch at a restaurant in town, then drove to her appointment. When we returned, we took Mam-ma to a church in her neighborhood to vote in the mid-term election. I had to read the names to her on the voting machine, but she cast her own votes. While Mam-ma was voting, we visited with some of her peers... three more folks in their 90s. It was a humbling experience to see these little people make such a monumental effort to participate in the election process.

"MawMac" - my birthday buddy

Funny story about voting... one of the other "seniors" voting was my birthday buddy, who I call "MawMac."  She is 91, and we share the same birthday.  The volunteer got MawMac set up on a machine to vote, and I was standing with Mam-ma.  The volunteer left the room.  MawMac's daughter, Marsha, had said she was going to let her mother do her own voting.  Everything was going well, when I heard MawMac say, "No! No! No!  I don't want that.  Oh, WHY did it do that?  That's not what I want!"  I said, "MawMac, hold on... I'll come help you in a minute when we finish."  Mam-ma finished and walked back out to wait with Greg, and I walked over to MawMac's area.  She had advanced to a screen with a lot of text and only a couple of voting boxes, and I said, "This is the page to vote for unopposed candidates and start voting on the issues."  "OH!" she said, "Well, I DO want to do that!" 

I showed her where the section was for the unopposed, and then I pointed to the first issue up for vote.  She said, "I do want to vote on these, but I want to read them first!"  There were four long issues, and I said, "Let me get Marsha."  I walked out into the common area and told MawMac's daughter that she wanted to read the issues (I learned later she had already reviewed them at home), and she was on her own!  The daughter rolled her eyes and went into the voting room to see if she could help.

Mam-ma always enjoys having Greg around, and she was on her best behavior Tuesday. She insisted on buying lunch, and she was kind and sweet and cooperative all day. She really didn't complain a single time about anything.  We always get a "history lesson" on that drive as we travel through the country back roads where she lived as a child and young woman.

The "Birthday Girl!"
Friday was Mam-ma's 98th birthday. My mom hosted a party for her and the other ladies in her Sunday School class after Mam-ma got her hair done. Mom said she underestimated the ladies... she had set out her glass snack trays and cups for cake and punch, nuts and mints, thinking the ladies could fill their plates and step out onto the sun porch to eat. The median age of this group was probably 90, and these ladies were not able to navigate steps and carry glass trays and cups. So Mom asked my sister and Greg to place the cake and punch on the table for the ladies and help them get seated, while I took photos.

All of the ladies enjoyed sitting around my mother's dining table and having refreshments while visiting. They even stopped after everyone was seated, held hands, and "said a blessing," led by their Sunday School teacher, who is quite a bit younger than the class members. She is a wonderful lady who cares deeply for these senior matriarchs of the church... and it shows.

Mam-ma and her friend, Ruby
Mam-ma got cards and more time with Timothy, and the accolades of her friends for making it to 98. Someone said, "Polly, you have to hang on to 100 now," and Mam-ma replied, "I'm not sure I can." This was a humbling day for me. I've grown up with many of these ladies... and many more in Mam-ma's class have already gone to be with Jesus. I honestly don't know how many of these ladies will be with us next November 5th. They really enjoyed the party... and they LOVED having a tall, handsome man (Greg) help them get seated at the table and out to their cars afterward.

Before we left for the beauty shop, Mam-ma had asked me to hang her electric blanket outside on the clothesline to air. When we got home, I got the blanket off the line and told her I would hook it up for her. She drug herself into the house, totally exhausted from the activities and excitement of this day. She made an attempt to help me with the blanket, but I insisted she sit in a chair and rest, and she did not protest at all. She was spent! I hooked up her blanket and turned it on for her... the evening was cooling off quickly, and I knew she would want a warm, snug bed to get into very soon.

Saturday evening, I called to remind Mam-ma to take her medicine. I asked if she had slept well, and she said, "Well, I was warm!" Then she said she turned her blanket off when she went to bed. I asked her why she did that, and she said, "Oh, I never leave my blanket on all night... you know, that takes electricity and costs money!" I fussed at her and told her to leave her blanket on... it doesn't take that much energy.

Then she totally surprised me and said, "I've been thinking about moving to Southridge (the assisted living facility). What do you think?" I didn't know what to say... I told her, "It doesn't matter what I think... it's totally your decision." She said, "Well, now that I can't ride with Ruby, I am just stuck here. I've been thinking, maybe I should move." We talked about the positives... being with people, having everything covered, being safe and cared for if we have bad weather this winter, and more. I pointed out the negatives... "It's a small room... probably the size of your living room. You can't take everything with you... we'll have to pare down your clothes and things." She replied that "I don't need a big room. That's all I need." She seemed to understand all I was telling her.

I assured her that I would handle everything for her, if she chose to move... and all she would have to worry about was picking out what to take with her. I would make her room nice and comfortable, handle the moving, and handle disposing of the other things afterward. She said she was going to think about it. I offered to take her to the facility to look at a room and see firsthand what it was like. She said she would consider that, as well. Mom's husband rang the doorbell... he had come to change Mam-ma's clocks for her... and she said she'd give this some thought and hung up. I learned later that she discussed Southridge with Mom's husband... the advantages, as well as how hard it would be to make the change.

Sunday, my mom took Mam-ma to church and back, and she never mentioned the assisted living facility. That night when I phoned her to make sure she took her evening meds, she didn't mention it. Finally, I asked... "Have you decided if you want to go tour Southridge?" She replied... "Well, I've thought about it, and that room is gonna be really small." I agreed, but I suggested she go check it out in person to decide for sure. She asked, "Is the room dark?" I assured her that the room I previewed was nice and bright, with one wall of south-facing windows. I can't guarantee she would get a room in that wing, but I feel sure all rooms are light and bright.

I am hoping she will decide to go this week and preview the facility. This is not going to be quick... or easy. And I realize that for every "pro" about this choice, there will be a "con"... and in the end, this move might even mean more work for me. For one thing, this facility is right down the road from my house, so Mam-ma may feel she has more ready access to me and I should drop everything and run when she beckons me. Then again, she may become so busy and involved with fellow residents that she doesn't have time for me... and she hasn't moved yet!

So changes are in the air. I think Mam-ma is working her way into this move... as well she should. The clock is ticking, somewhat, but there is still time for her to adjust to this concept. I'm praying for a good outcome - not necessarily the move itself, because this is not my "call" - one that makes sense for Mam-ma and will be right for her. An elderly cousin told me last month that "anyone in their right mind would wonder why she isn't there already," and I know he is right. But I also know that the slightest nudge one way or the other from me will result in future claims that "Debbie made me do this," and at this point, Mam-ma is still able to make this choice for herself.

I'm "resting in the Lord" for now... trusting His timing and influence, knowing that my grandmother is on her knees, too... if only figuratively. The next few weeks may be busy and challenging, but we'll get through them. I realized after Friday that the clock is ticking for my grandmother and her peers... and I'm trying to "chill out" and take her antics in stride... and savor the time I have left with her this side of heaven. Some days are easier than others... but every day at this point is a treasure - even those that test my patience!

Sunday, October 24, 2010

Apparently We Still Don't Understand!

Last Monday, my grandmother called my mother and asked, "Do you want some turnip greens?"  Mom told her no, and asked, "Where did you get greens?"  Mam-ma replied that a church member had left them on her doorstep.  Mom told her to leave them there, and she (Mom) would get them later.  Mam-ma replied, "I've already got them in the sink, and I'm washing them. Mom sorta lost it and said, "I'll be right there."  She called me and told me about this and said, "I'm going right now to get those greens.  I may put them down the disposal."  I somehow knew she would not do this.

There are two versions of this story - Mom's and my grandmother's.  And amazingly, in most spots, the stories parallel!  Mam-ma's version is that "Your momma chewed my butt but good.  She talked awful to me."  Mom's version is that "I did talk pretty strongly to her, but she screamed at me... 'Just what am I supposed to do?'"  Mom told her she was supposed to cooperate.  To make a long story short, Mam-ma had started to wash and de-stem the greens, which she says she "loves to do."  Mom says nobody in their right mind likes to wash turnip greens, which is a long, tedious process in cold water.

This really is not good for my grandmother - she has to stand hunched over the sink, and she has problems with her neck and shoulders as it is.  This is not the best posture for her.  But she absolutely loves turnip greens.  They are like gold to her, and she assumes everyone else feels the same.  Never mind that her deacon has brought them to her recently - fully cooked and seasoned and ready to eat.  She was doing these for us, she said.  She told me on the phone, "I aimed for you to have some of those greens."  Mom said she even telephoned later and gave Mom's husband the message to "save some of those greens for Debbie." 

Mom finished washing the greens and sorting them - and some did indeed go in the disposal - and then she cooked them.  She said, "I will probably gag trying to eat them."  Now she feels badly that she let something as seemingly insignificant as a bag full of green leaves cause such an argument between her and her mother-in-law, but as she put it, "Your Mam-ma just knows how to push my buttons."  And I understand that... she pushes mine, too!  But Mom says that next time - and there probably will be a next time - she will just go get the greens and keep her mouth shut.

I think another thing that upset Mom is that this is the one man in her church who she knew took raw produce to my grandmother - and Mom had not found time to contact him and let him know we're not allowing Mam-ma to use her stove any more.  So she was mad at herself... and upset with Mam-ma... and it just was not pretty in the end.

It has now been about 10 days since the infamous car wreck, and and other than being upset that she can no longer ride with her friend Ruby, and her "life is over," Mam-ma has seemed to do fine.  In fact, by mid-week, she was not even mentioning her chest when we spoke.

All of this changed on Thursday.  Apparently Ruby mentioned that she was changing her closet and removing the summer clothing and putting in the winter clothing.  While she was at it, she was going to do some cleaning, and she would be taking some discarded things to the thrift store.  Mam-ma decided she had some closets that needed cleaning, too.  Ruby said that she told Mam-ma to place her things on the spare bed, and she (Ruby) would fold them and put them into plastic bags and take them to the thrift store for her when she went.

First of all, Ruby is recovering from broken ribs as the result of a fall last month, as well as her own jarring from the car wreck.  She really doesn't need to be hauling my grandmother's things to the thrift store for her. And secondly, Mam-ma doesn't need to try to clean her closets by herself.  Nonetheless, when Ruby went to get the clothing, it was already sacked and in my grandmother's garage.

I took Timothy to get a hair cut on Thursday morning, and while we were out, we went by Mam-ma's for a visit. She was so glad to see Timothy, but she said she had worked hard all morning cleaning closets, and that Ruby had taken "a ton" of things to the thrift store.  Ruby's story is that it was three very small shopping sacks of clothing.  Mam-ma asked me if I thought my mother-in-law would like to have some feather pillows.  I told her I did not think so... why was she getting rid of feather pillows?  "Well," she replied, "I don't need them, and I'm a gettin' rid of things." She also called my mom and asked her if she would like to have a lamp she was no longer using.

Thursday evening, Mam-ma called me about 8:30 and said, "I am going to take two Tylenol and go to bed.  My chest is killing me.  I hurt so bad."  And she sounded awful.  I asked her... was it her heart?  No, it was her chest... that breast bone above her breasts.  I told her it sounded like she over-did it with the cleaning. She agreed.  She indicated she had worked cleaning closets all afternoon.  I asked if she planned to take her anti-anxiety medication, too, and she said, "Not now... maybe later in the night."  I deduced that she must not be that bad, or she would have taken it, too.  She seldom hesitates to take one if she is feeling anxious. 

She also said to me, "You know, when Ruby fell, they didn't find her broken ribs on the x-rays at the hospital."  I knew where this was going.  The broken ribs were determined four days later in the clinic of Ruby's primary care physician.  I told Mam-ma, "If your ribs were broken, we would already have been to the doctor.  You were not even complaining until you over-did things today.  You've strained something."  She replied, "Well, you just don't know how bad I hurt!"

I told Mam-ma, "I have the baby tonight - I cannot come stay with you."  She said, "I know... I'll just have to tough it out.  I'll make it somehow."  I phoned my mom to alert her that Mam-ma was not having a good night and she might be calling.  But she didn't.  And the next morning, she indicated she was better, though not by much.

When I arrived to get Mam-ma for the beauty shop, she seemed a little slower and more confused than usual.  We looked at her grocery list, which was mostly household things like laundry detergent and Lysol for the housekeeper to use for cleaning.  She did need candy bars and milk.  She didn't have that much to say on the way to the beauty shop, but on the way home, she told me, "Ruby just can't understand WHY I hurt so in my chest. I told her, 'Ruby, you have no idea how bad I hurt.'"  I know that she told Ruby, "I hurt like HELL!" 

I did not comment.  I really didn't know what to say.  We got out of the car at Mam-ma's house, and she said, "If I'd a thought last night, I'd a taken that pill the doctor give me instead of them two Tylenol.  And I may just take it tonight."  She was referring to the one Flexeril (which is a muscle relaxer) that the doctor handed her in the ER to take when she got home the night of the wreck.  When we got home, she said, "Now I'm not taking that... I'll just take two Tylenol."  However, she made me leave it with her, and I knew it was only a matter of time before she took it.  I reviewed all of this medication's side effects with her on the discharge papers, and I told her, "Greg's mother had virtually every single one of these when she took the same drug for her back trouble a few weeks ago."  She said, "I know all about that!" Again, I just dropped it.

But I knew that at some point, she would not be able to resist the temptation to take this muscle relaxer.  So when we she said she might take it Friday night, I reminded her, "It will make you woozy."  She retorted, "Well, I'll just take it and go to bed."  And apparently she did.  My mother's husband was there to repair something the next morning, and he said she was weak and wobbly, and Mom said she probably had a hangover.  This morning she overslept and was unable to go to church.  But she did go to lunch with my mom and her husband, and she went to church with them this evening, so the fog is apparently clearing somewhat.

Friday, I refilled all of Mam-ma's medicine compartments, and the noontime medication for two consecutive days of the previous week was still in the boxes.  I showed it to her, and she said, "I know about that... that was for last week."  I said, "Yes, but you still didn't take it."  She said, "I know, and I said, 'Debbie is going to chew me out good over that."  I didn't say anything, but then I opened up the current week's compartments, and there was noontime medicine for Wednesday, Thursday, and Friday.  I said, "Mam-ma... look here.  You have not taken your medicine at noon today."  "No, I haven't," she said.  I added... "And you didn't take it yesterday or the day before."  "Yes, I did," she said.  "No, you didn't," I countered... "It's still here."  "Well, I don't know what to tell you.  I always take it!"  I assured her that it doesn't miraculously just reappear in those compartments.

She countered... "Well, those meals (Meals on Wheels) come before I'm ready to eat, and it just makes me forget."  I told her, "The arrival of your meal should be your reminder to take your medicine.  That doesn't make sense."  She answered, disgustedly, "Well, I guess I'll just have to go to sittin' out that medicine to remind myself."  I told her whatever worked was what she would have to do.  I also told her to go ahead and take her noontime medicine for that day.  She made a HUGE production out of it... moaning and coughing and saying, "Oh! Oh! Oh!  That hurts so bad. Oh, you don't know how bad that hurts."

Mam-ma also told me that the hairdresser "liked to killed me."  Apparently it was not comfortable to lie back for a shampoo, and she said, "I told her, 'Now I can't do this.  You're a killin' me.'"  That poor hairdresser.  Mam-ma said she told her, "I don't know what we are going to do with you," but she was somehow able to finagle the chair height and finish the shampoo.  The hairdresser never let on to me at all that anything had happened.  We are so blessed to have such loving, caring people who exhibit tremendous patience with my grandmother... like her hairdresser, her deacon, and her housekeeper, as well as many others.

Mam-ma is still complaining to my mom about her chest - and sometimes to me.  Last night I called to see if she had taken her medicine, and she said she had.  I asked, "Did you take it at noon?"  She replied, "Only after your momma called and reminded me."  I just don't know about this!  I told her I am having the entire family - even cousins - over for a chili supper on Thursday night, and she said, "Well, I hope I feel like coming.  We'll just have to see."  Do you really think she would miss it?  Mom says that she was the "belle of the ball" tonight at their church Fall Festival... and several men fussed over her and made her day!  Mom said she passed by as one man who was talking to Mam-ma pointed at her (Mom) and asked, "... and she is guilty?"  Mam-ma replied, "YES!"  Mom said she held up her hands and said, "Not me... I'm not guilty!" and walked away. 

Clearly, we still do not understand!

Sunday, October 17, 2010

A Full Plate

Sooner or later, many life-changing events for elderly people center around a car - and usually, this involves a collision.  Tuesday, I took my daily walk mid-afternoon.  I often use this as prayer time, and I spent this particular hour talking to God about a packet we had received in the mail that day from our church.  This packet contained a tabloid outlining ways that church members could serve in church ministry ... everything from serving as Sunday morning attendance or Communion steward to teaching a Sunday School class or Bible study.

I mentally checked off those ministries in which my husband and I already participate ... and there are several ... and those in which we have served in the past (even more).  I talked to God and expressed my concerns - that I have a full plate already with the care of my grandmother, my great-nephew and another baby on the way, and helping my husband with his mother ... not to mention life in general, the ministries in which we already serve, and more.  I asked Him ... "What do you want me to do?  Am I where you want me?" and I told Him... "I almost feel like I spend many days just waiting for 'the other shoe to drop' and don't need to add anything else in the meantime.  Am I right, or do You have other plans?"

I really didn't expect God to answer so quickly ... but if I have learned one thing in recent months, it is that I must be ready at all times for God to show me whatever He wants to show me.  So when I walked in the door and sat down to recalibrate my pedometer, I shouldn't have been surprised to hear the phone ring.  I glanced at Caller ID and saw the name of my grandmother's "yard man," so I answered. 

The voice on the other end was shaky and belonged to a woman ... "Debbie, this is Ruby.  Me and Polly went to Fred's, and on the way home, somebody hit us.  My car won't start ... can you come get us?"  My mind began racing...

"Are you hurt?"

"No, but my car won't start."
"Did you call the police?"
"Yes, they are here now.  We're at the corner by the church and the library."

I knew this location well - two blocks west of my mom's house, and just across the corner from the police department.  I told Ruby, "I'll be right there."  Is there a Murphy's law that says that 90% of the time when these things happen, your hair will be dirty and stringy, you won't have on any makeup or clean clothes, you'll be sweaty from working out ... and there will be no time to even think about those things?!

I grabbed my purse and told my husband what had happened. He offered to go with me, and I thanked him and told him that I would call him if I needed him, but for now, I was fine.  I wished later I had taken him - he thinks so much faster and more clearly than I in these situations.  But I had assumed from Ruby's conversation that it was nothing serious.

I arrived at the scene to find a wrecker loading Ruby's car on a trailer.  I rolled down my window and told one of the police officers I was there "to collect two little ladies." "Good!" he said, pointing to my grandmother and Ruby, who were standing to one side leaned against a minivan.  I pulled in beside it.  There was no broken glass that I could see, and I didn't notice any damage to Ruby's car.

An older woman, a younger woman, and a little girl were talking to the ladies and getting sacks of groceries out of Ruby's car and putting them into the van.  There was also a young man I recognized from my church, and an adult friend of this young man's mother, standing nearby.  There was also an ambulance parked beside the minivan, lights blinking, and I assumed this was a routine formality.  The policeman told me, "The lady in the white coat complained of chest pains, but she is refusing treatment."  I looked over, and both little ladies had on white jackets, and they waved at me and grinned.  I thanked the officers, and they left.

I turned to the ladies and asked, "Who has chest pain?"  Mam-ma said, "I do, but I'm fine."  "Are you sure?" I asked.  "Yes," she replied.  One of the EMTs asked her, "Are you sure you don't want us to take you to be checked out?"  She told her no... she was fine. 

By this time, the young man driving the wrecker was tapping on my shoulder, wanting to know if I could follow him to the Ford dealership to retrieve the rest of the car's contents.  I told him no, that I had two little ladies to take home.  I said, "Why can't we get the rest out here?"  "Oh, the police want this cleaned up quickly," he replied.  He also wanted to know who was going to pay for his services, and he said normally he got paid at the scene.  Ruby asked him how much it would cost, and he said he didn't know.  I assured him he would get his money, and I walked over to the car and saw that most of the groceries had been retrieved.  I grabbed the rest, along with Ruby's prescriptions from the Fred's pharmacy, and I told him we were good.  I gave him my phone number and again assured him he would be paid, and he left.

I returned to my two little ladies and the women and child with the van, still unsure what exactly had happened.  The young man and his adult friend were still there, too.  I asked him, "How do you figure into this equation?"  He replied, "It's all my fault... I hit them."  I was able to determine that the lady with the minivan was the wife of Mam-ma and Ruby's yard man, and she happened to drive up just after this accident occurred.  Recognizing the two ladies, she stopped to help.  She had planned to take Ruby home, so they were loading Ruby's groceries into the minivan.

We transferred Ruby's groceries to my Jeep, and I loaded the two ladies to head home.  We no sooner got in and buckled our seat belts, when Mam-ma said, "Can... you... take me... to the ER?  My... chest... hurts ... and I... can't get... my... breath."  I just looked at her.  "You need to go to the ER?"  "Yes," she said between short breaths.  "Do we need to go straight there, or do you feel like me taking Ruby home first?" I asked.  "Take Ruby home," she answered.

All the way to Ruby's, which was some 10-12 blocks, Mam-ma was saying, "Oh... that hurts so bad ...oh ... my chest hurts ... oh... oh... oh."  We pulled into Ruby's driveway, and Ruby said, "I don't have a house key... it's on the car key ring, and the police couldn't get my keys out of the ignition."  But then she quickly remembered that she had a key hidden.  She told me where it was, and I dashed to get it.  This was Ruby's first day to drive since having the fall and breaking 3-4 ribs a month ago, and she was in no shape to dash anywhere.

I got the key, grabbed Ruby's cold milk from the car, and unlocked her house.  I told her we would be in touch later and get the rest of her groceries to her.  I got back into my car, and Mam-ma was clutching her chest and moaning between short breaths.  I asked, "WHY did you refuse the ambulance?"  "I didn't know I did."  I told her the policeman had told me she refused, and she even told me that she was fine.  She said, "Well, I didn't know." 

We started across town - 4:30 p.m. - "rush hour" traffic beginning, and Mam-ma saying, "Oh... I can't get my breath."  I told her I was driving as fast as I could without speeding.  I thought, "If she passes out on me, she just does... all I can do is keep driving and stay calm." 

We arrived at the ER, and the waiting room was filled with patients.  I knew the admissions clerk... a woman from my church, and I quickly explained the problem.  She took information from me and asked us to be seated.  My cousin, who is an LPN, was in the ER with a patient from the clinic where she works, so she helped me get Mam-ma seated ... then to the bathroom ... then seated again.  More than 20 minutes went by before we were called back to an exam room.  We both pointed out to Mam-ma that, had she ridden to the ER in an ambulance, she would have been driven directly to the back entrance and placed in an exam room.  "Well, I didn't know that," she said pitifully.

While I was handling the insurance and admission forms, my cell phone rang - the guy with the wrecker service.  He wanted me to know he had stuck a bill in the car visor.  I told him that I would let the car owner know.  Sheesh!  This was the least of my worries at the moment!

In the exam room, more questions were asked, and Mam-ma was hooked to a monitor.  Her BP was 207 over 90-something.  The nurses went into high gear getting her in a reclining position and trying to lower those numbers.  I told them that her BP always goes up in the ER and at the clinic, and usually it comes down (and it did, somewhat).  She was also due for her night-time medications, which include Coreg for high blood pressure.  They made note of all of this, but no medications were given.

The doctor came in and asked Mam-ma what happened.  As she began to tell him, she started crying, which is something Mam-ma often does, but it was effective in garnering her sympathy from the medical staff.  The doctor ordered a chest X-ray.  A couple of hours later, he said the X-rays were inconclusive, and he ordered a CT-scan.  He said, "We're making sure nothing is cracked and there are no punctured lungs." 

At 9:30 p.m., we were dismissed.  The diagnosis was a bruised sternum, resulting in pain when deep breaths are taken.  BUT... failure to take deep breaths can result in pneumonia, so she was told to breathe deeply throughout the day for the next week or so, regardless of how much it hurt.  The doctor gave her a muscle relaxer tablet to take when she got home - and a prescription for 12 more.  The doctor also said she would be woozy and would need someone to stay with her, at least that first night.

So I loaded Mam-ma into the car and drove her to my house, where I took my medication, grabbed some food to take with me and an overnight bag and a nightshirt, and off we went to her house.  I got her home and inside her house, and while I fixed her dinner, she called Ruby to give her the report.  By now it was nearly 10 p.m.  Mam-ma ate and took her night-time medications.  She said, "I'm not taking that pill (the muscle relaxer)" - fine by me.  She added, "I'll just take two Tylenol."  She did, as well as one of her Ativan tablets for anxiety. 

I knew from when my mother-in-law took this same muscle relaxer  a few weeks ago that the side effects would mean someone would have to stay with Mam-ma for several days, if she decided to take the medication.  I told her unless she needed the prescription, I was not having it filled. She insisted I leave the first tablet with her "just in case," but I brought the prescription home with me and have not filled it.  And clearly, she doesn't need it.

After I got Mam-ma fed, she went to her room to dress for bed while I called my mom (who was in Memphis visiting her husband's family) and gave her the report.  While we were talking, Mam-ma came into the living room and asked, "Are you gonna sleep with me, or do you want to sleep in the other bedroom?"  I told her I would sleep in the other bedroom, thanks!  She went right away to turn down the spare bed.  I followed her, assuring her I would do that, while Mom was laughing and saying, "No you won't, no you won't!"  Sure enough, Mam-ma turned down the bed.  She also made 2 more trips through the house to check her garage to make sure I closed the big door (I had), and she turned out most of the lamps, and then she told me she was afraid I would get hot in the night.  I assured her if I did, I'd move to the couch and turn on a ceiling fan.

Our nights are cooling off now, and on the way home, Mam-ma had declared, "When we get home, I'm turning on the fire (meaning she'd turn up the thermostat!)."  Her house is usually like an oven anyway, and I thought, "Great... this will be fun... NOT!"  She apparently didn't turn up the thermostat, because it didn't get unbearably warm in her house overnight.  And she slept like a baby - probably from the medications she took, all of the excitement, and a busy day she had experienced the day before that included afternoon company and dinner out.

I was up much of the night, and the next morning, Mam-ma was up before 7:00.  She seemed fine - was sore, but moving around well - and I left her getting a bowl of cereal and looking for her Home Health aide, who was coming for the routine check-up and morning bath between 8:00 and 8:30.  She insisted she wanted to keep her hair appointment that afternoon, so I told her I would be back to get her before 1:30 ... and I asked her to tell Ruby that I would drop off her groceries later. 

I swung by the Ford dealership and retrieved Mam-ma's remote garage door opener, which she always leaves in the pocket of the passenger door.  Ruby's passenger door was warped and would not open, so I had to slide in on the driver's side. 

I came home, regrouped and showered, and returned to town to run some errands and take Ruby her groceries before picking up Mam-ma for the hairdresser.  Ruby said she was fine... sore, but fine... and she was very worried about Mam-ma. I had heard Mam-ma tell her the night before as they talked on the phone that "Debbie will take you to the beauty shop tomorrow."  Ruby goes to another hairdresser about an hour before Mam-ma goes to her appointment.  Since she didn't have a car, I guess she didn't have a ride to her appointment.  Honestly, I assumed when Ruby was at home that she either didn't feel like going, or she had simply decided not to go.  So I did not offer to take her.

Again that afternoon, Mam-ma seemed fine.  We got her hair fixed and got her back home.  I had picked up some things she wanted at the store, and I put those away for her.  I talked with her later that evening to make sure she had taken her medication, and she still seemed fine.

Saturday morning, Ruby called me, and she was very upset.  Her son had told her that she can still drive - and apparently he got the car fixed enough to be driveable - but he does not want her to have passengers any more.  She did not know how to tell Mam-ma.  I assured her this was FINE... and we would make Mam-ma understand.  This is too much responsibility ... and potential liablility ... for Ruby, who is 91.  We talked at length about the whole situation and what will happen long-term.  Ruby said, "If I have to stop driving, my life is over."  I assured her it will not be, but I know she is scared of the future and potential changes.

I tried to reassure Ruby as much as possible, and when we hung up, she said, "You've helped me feel a lot better."  I hope so.  A whole lot of changes have happened to these two ladies in a very short time ... and it's a lot to digest.  Thankfully, both are relatively unscathed for the moment.  Ruby's ribs are apparently healing, and Mam-ma's bruising will subside in a few days, hopefully.  But it doesn't end there, and we all know it.  Ruby told me that Mam-ma told the policeman she was 79, not 97.  She often does this - transpose the numbers.  An 84-year-old friend was 48 one day, etc.

Last night, Mam-ma called me around 9:30 and asked, "Debbie, did your momma and Lee get back home yet?"  I told her yes... FRIDAY.  Then I reminded her, "You talked to Momma this morning, didn't you?"  I knew that she had.  "Well, yes," she answered... "I guess I did."  I told her again that they got home Friday night, which seemed to surprise her, and she said, "Well, I knew I talked to her this morning, but she never called me again."  I replied, "Was she supposed to?  When I checked on you after dinner, you said you were going to call her in the morning and let her know whether you were going to church or not."  She answered, "Well... okay..." and I started to say something else, only to realize I was talking to dead air.  "Mam-ma?  Hello?  Hello?"  She was gone - she had hung up on me, as usual.  Some things never change!

So I let my mom know that Mam-ma had called and was confused.  Mom said if she didn't hear from Mam-ma Sunday morning, she would check on her.  Apparently, Mam-ma was well enough to attend Sunday School and church today, have lunch with Mom and her husband, and then stop at Wal-Mart for cookies and bread.  She is devastated that she can no longer ride with Ruby and that "... my life is over.  I guess I'll just stay home and never go anywhere."  Mom assured her that this is not the case, but Mam-ma, of course, replied, "You just don't understand."

Truly, we don't understand, because our universes are anything but parallel to my grandmother's.  I am content for days on end to stay home and enjoy my hobbies and writing and caring for my household.  My prayer is that I always have interests and hobbies to fill my days - and the ability to enjoy them.  I also pray that I will be adaptable, and if arthritis renders my fingers unable to do some of the things I enjoy now, like playing piano and typing on a keypad and small handwork, I'll find something else to enjoy!  So much of life is just what we make of it... and I hope I'm learning this for the long haul.

Meanwhile, I have assured Ruby that none of these changes are her fault.  She feels guilty that Mam-ma can no longer ride with her.  She fears that we will place my grandmother in the assisted living facility as a result.  I have assured her that if/when Mam-ma goes to the assisted living facility, it has nothing to do with the car accident - or Ruby's ability to taxi Mam-ma around.  This was already being discussed.  It may never happen ... or she may go next week.  But regardless, it will be the result of a compilation of circumstances - and the best thing for Mam-ma.

My mom thinks Mam-ma has already picked out her next taxi driver - a little lady who has driven her to the Senior Citizens' Center a couple of times for lunch - and who hit the accelerator rather than the break a few months ago and plowed into the wall of a downtown bank!  I have no doubt that Mam-ma is in "preservation mode" and considering all of her options for finding new means to stay "out and about."  At two weeks shy of age 98, she is not ready to settle down and stay put... and maybe there's a lesson in that for all of us. 

The other night at the ER, my cousin asked Mam-ma, "Won't you let me take your shoes off?  You'd be more comfortable."  She replied, "NO!  Leave 'em on... I'm not stayin' - I'm going home!"  The later it got, with all of her symptoms and maladies, I felt certain the doctor might keep her.  But sure enough, he dismissed her, and she walked out under her own power.  The next time I bump into her with a friend at Wal-Mart or Fred's, I won't be the least bit surprised. 

Meanwhile, I have thanked God for his quick - and profound - answer.  I truly do have a full plate at the moment ... and I'm handling all that I can - and should.  There's a reality television show that begins with one of the stars saying, "It may be a crazy life, but it's our life," and that is a great description of my present world.  To an outsider, it may seem chaotic and insane - and some days it is.  But for the most part, we've learned to manage on the present "diet."  We just don't have room for another bite!