Monday, January 25, 2010

Learning to Read the Signs

Nobody can make you feel inferior without your permission. ~Eleanor Roosevelt~

I post this comment, because there are people who believe that I am uncaring or unfeeling toward my grandmother... that I don't do enough for her, or that I do not treat her well.  They base these assumptions on casual observations and claims of such from my grandmother.  I assure you, there is no basis for any of this.

See, I know my grandmother.  I have observed her behavior and her reactions for over 52 years now, and I am a pretty good judge of how she is really doing.  Last week, a dear friend of hers passed away.  This man was known to everyone as "Sis."  Don't ask why - I have no clue.  His brother - "Deb" - was my grandmother's constant companion for seven years after my grandfather passed.  Deb became a second grandfather to us, and we loved him dearly until the day he died in May 2000, of bladder cancer.  My grandmother was very fond of Deb's brother, Sis, and they visited often by phone, and sometimes in person.  So, when he died, my grandmother was naturally upset.  One of Deb's sons came for the visitation and took Mam-ma.  She saw lots of people, and when I went to her house a couple of days later, that was what she talked about.

During this same time, Mam-ma's blood pressure began to spike.  It worried a nurse's aide enough to call a nurse from Home Health.  The nurse supposedly told Mam-ma if she had pain in her neck and shoulder, to call an ambulance.  That was early in the week.  Friday when we went to the beauty shop, Mam-ma seemed fine, except she kept telling me she "just hadn't felt good for a couple of days."  Now, I recognized the tone and demeanor as a manipulative ploy.  If I would ask what was wrong, the flood gates of symptoms and ailments would open.  But I could see from her actions and the list of things she had been doing around the house that she was basically fine.

In addition to the loss of her friend, my mom and her husband left Friday for six weeks in Arizona. Mam-ma almost always has a medical crisis before Mom can get up the mountain and out of our little valley town.  So I was not surprised when we came home from the high school basketball games Friday night, and there was a phone message from my grandmother... "It's Mam-ma."  It was also 9:30 p.m., and I did not call her back, figuring she was in bed.  After all, she knows how to call my cell phone if she really needs me, and she had not done so.

Saturday morning, my husband, mother-in-law, and I set out to attend an auction.  On the way, I phoned Mam-ma and told her I'd seen her phone message.  Yes, she had called... "What am I going to do about this blood pressure?"  I asked if it was high, and she said yes, it was something like 189/85.  I asked if she had taken her morning medicine.  Yes, she had.  I suggested she take it easy and give the medicine time to work and we would see how she progressed through the day.  I told her we were on the way to an auction, and very quickly, she said (sarcastically), "Well, y'all go on and don't worry about me."  I reminded her I had a cell phone, and to call if she needed anything.  I did not hear from her again that day.

Sunday afternoon around 3:30, the phone rang - Mam-ma.  "What are we gonna do about my blood pressure?"  I asked if it was still high, and she read me some BP readings... 162/82 and similar readings.  I told her it sounded like it was coming down.  "Well something has got to be done!" she said.  I asked if she thought she was having a stroke.  She didn't know.  We bantered back and forth, and I told her our only option was the ER, and when she goes there, they always get her in a mess... screw up her medicine or worse.  Finally, I asked, "Are you wanting to go to the ER?"  She said no, but something had to be done.  I reminded her that a trip to the ER might likely result in a trip to the nursing home.  She said, "Well, I called Shirley (an LPN friend of the family), and she said I could take half a Lasix."  I did a quick search on the Internet of all of Mam-ma's medications and told her I didn't think she should take that until I found someone medical to consult.

So I called Shirley, and she said, "I did NOT tell her to take a Lasix.  In fact, I told her NOT to take ANYTHING until she talked with her doctor on Monday."  Shirley said Mam-ma heard what she wanted and would probably do what she pleased... and one pill would not kill her.  But Shirley asked, did I think this was about Sis.  I agreed that this had crossed my mind, and Shirley said, "I've been expecting a call from your grandmother ever since he died... she was so crazy about him."  We agreed the BP rise was from that and the absence of my mom. Shirley also said my grandmother's voice was strong on the phone and she didn't sound like she felt that bad... just "pouty."

So I called my grandmother back. When she answered, her voice was strong and solid.  Once she heard my voice, hers changed to a very faint whine.  This happens often, and she used to do the same thing to my dad.  It was all I could do not to laugh out loud.  I told her NOT to take anything extra - that Shirley said "No!" and that when her aide came Monday morning, if she felt the BP was high, she would call the nurse, and we could go from there.  She asked, "Well what am I gonna do about this headache?"  For the record, my grandmother has had "the headache" all of my life.  The last week or so, our weather has been totally unseasonable and erratic, and most of the people I know have had a headache at some point from the continual changes in air pressure, etc.  So I tried to explain this to Mam-ma... she still thought it was her blood pressure.  I just let it drop.

By 10:00 a.m. today, I had not heard anything from my grandmother, so I called.  She sounded extremely strong and well.  I asked what her aide had said, and she said, "Nothing.  She was in such a hurry, she didn't say anything."  I asked, "Did she take your blood pressure?"  Yes... it was 148/70.  Now that is a very good reading for my grandmother... and of course, she sounded disappointed.  I told her it sounded like she was on the mend, and she said, "Well, I guess."    We talked a few minutes and hung up, and later in the morning she called me to verify a phone number... she was already on to the next project.  It seems the "crisis" has passed for the moment... and hopefully we will have a smooth week.

Back to the quote.  There are those who would think I am horrible for not rushing my grandmother to the ER with such high blood pressure.  At one point yesterday, she yelled at me, "Well if I die tonight or in the morning, it don't make any difference!"  I've heard those sorts of threats before... and to some that would sound cruel, but I know her!  The last time we took her to the ER for high blood pressure was a couple of Easter Sundays ago, and we sat in the ER for probably 6 hours - some of that without the monitor even connected because they took her for an X-ray and forgot to reconnect her upon returning.  They finally gave her a blood pressure medication that her cardiologist said she is NEVER to have again, and after not eating or having any of her regular meds all day, she bottomed out, nearly passed out, and threw up!  We were several weeks getting her totally regulated after that little episode, so I am less than eager to go dashing to the ER when my instincts and assessments tell me we are not in a crisis... and certainly not an emergency situation.

But I have seen the looks from others.  I've heard the "I hope you know your grandmother is really sick!" (as if I was not checking on her and had no clue) comments, and I've felt the daggers from those who believe Mam-ma when she tells them, "Debbie is too busy to fool with me."  And Eleanor Roosevelt is right... only I can let those things make me feel inferior or inadequate... or guilty!  I have made a conscious decision not to "go there."  I'm pedaling as fast as I can, and I'm doing my best to keep my grandmother safe and well cared for... and to love her as much and as often as possible!

Meanwhile, our nephew Timmy is coming to spend a few nights with us... his regular two, plus an extra because his grandpaw is sick. So we are going from one end of the spectrum to the other - from high blood pressure to teething and crawling!  Life is certainly anything but dull and boring... and most days, this "sandwich" is pretty darn good!

Sunday, January 10, 2010

A Lesson in Patience

We have had record-breaking bitter cold this week, along with some small accumulations of snow and ice.  Friday, the high was forecast to be in the lower twenties, with a morning low in the single digits - and wind gusts of 25 mph and upward.  I called Mam-ma - did she want to brave going to the beauty shop in the cold?  She said, "Well, I look like Phyllis Diller.  I'm not going to church or anywhere, but I sure need to get this hair done."  I told her it was her decision... that I was coming to her house either way to bring her medicine and re-dispense it.  I knew that my mom had taken her shopping last Saturday, and that Mom got her milk and groceries again on Wednesday in preparation for a winter storm.  In fact, Mom said she was at the check-out line with half of our county when Mam-ma called and said, "I forgot to put buttermilk on my list."  Mom said she had bought buttermilk for herself, and rather than get out of line and travel to the back of the store for more, she just put her jug in Mam-ma's pile of groceries and made do without on her own account.  But I did ask... "I guess you don't need any groceries?"  Yes, she needed dishwasher detergent and dishwashing liquid soap.

When I left home around noon, the temperature was about 18 degrees and there was a sharp wind.  I stopped at the pharmacy and got Mam-ma's medications.  When I arrived at her house, my plan was to fill the medicine compartments before we went to the beauty shop.  She had also complained that she was losing a thumbnail after mashing her thumb some time back, and I had brought some acrylic glue-on nails.  I planned to attach one to her thumbnail in hopes it would grow on out without coming off and snagging on something or being uncomfortable.

When I got inside Mam-ma's house, she had a grocery list on the kitchen table... dishwasher detergent, dishwashing liquid soap, buttermilk, and "ointment."  Atop the list was a prescription tube of some sort of ointment that was about three-quarters empty.  I looked at the tube and said, "Mam-ma, I've just come from the pharmacy."  "Oh, you have?" she said meekly.  "Yes... and I don't think I'm going back today."  Her shoulders slumped, and she frowned and said sternly, "But I NEED that ointment!"  I asked what the ointment was for, and she said, "That's for them blood vessels on my legs that have come to the surface, and they itch.  I didn't know you was goin' to the drugstore."  I reminded her that I had told her that morning I was going to pick up her medicine and fix it for her... and I had asked, "Is there anything else you need?"  She didn't remember that conversation, but she continued to pitch a fit that "I've GOT to have that medicine!"  Fine, I said... I would call and order some.

I called the pharmacy, and that prescription was so old that 1) there was no longer a pharmacy label attached to the tube, and 2) the pharmacy could not refill it.  The clerk said, "You'll have to call her doctor." When I told Mam-ma that, she said, "Just forget it!" (her favorite phrase when she is disgusted and wanting to lay on the guilts)... and I asked, had she tried some hydro-cortisone cream?  No, she had not.  I suggested I get a tube of that at the store, and I added it to the list.  She got up and walked into her bathroom.  I sat down at the kitchen table to fill her medicine compartments.  She returned and threw a tube of hydro-cortisone cream onto the table in my direction.  "I've got some of that... you don't need to buy any more."  I told her that was fine... and I suggested she try using it and see what happens.  For the life of me, I don't recall ever hearing of this blood vessel in the leg ailment... and neither do my mom or my sister!  There is no telling how old this tube of ointment really is... or when it was prescribed.

I filled the medicine boxes, and then I applied the acrylic fingernail to her thumb.  She immediately began fiddling with it, and I am not sure how long it will last, but hopefully it will protect the nail bed until her dead thumbnail can grow off.  She got her coat, and I helped her get out the door... where was her scarf for her head?  She had forgotten it.  Where were the new ear muffs I got her for Christmas?  On her spare bed.  I went back and got the scarf and ear muffs.

I questioned the buttermilk on her grocery list... didn't Mom get her a carton?  Had she already used it?  I checked her refrigerator, and there was a full quart... that was the problem... "Well, your momma only got me a quart!"  (I usually get a half gallon.)  I explained WHY my mother only got a quart - that it really was HER buttermilk, and she was being nice...  but Mam-ma still wanted another quart of buttermilk.

Then she asked, "Did I offend your sister?"  I didn't know what she was talking about, and she said, "Well, I called her to come get some food from my freezer, and she has acted funny - and she still hasn't been over to get the food."  I was really at my wits' end by this time, and I said, "Mam-ma... she is busy.  She has the grand-baby and a sick husband and a job and a daughter... and she has not been able to get out of her driveway in several days because of ice and snow.  No, she is not offended or upset.  And... she has not eaten the two big sacks of food you gave her a couple of weeks ago." 

To my grandmother's way of thinking, when she calls and says, "Come when you can," that means "come NOW!"  She has done this all of my life.  When we were children, Mam-ma would call my parents and ask, "Can you come help pick the peas (or beans, or whatever needed picking in the garden)?"  By the time my parents got off work, gathered three children, and drove the five miles of dirt road to get to my grandparents' house, the peas or beans or whatever were already picked and shelled, and supper was most likely on the table, with an admonition, "Well, I decided y'all weren't coming."

Additionally, Mam-ma has always said, "Now we need to eat up what's in the cellar and deep freeze to make room for the things we put up this next summer."  At 97, as my mother puts it, Mam-ma is no longer needing to feed the world.  She has a "deep freeze" so full of food that she can barely cram another package of chicken thighs in it, and yet she still is purchasing and "putting up" vegetables from generous church members.  And she is fussing that "we need to eat what's in that freezer!"  The other day, Mom asked, "What exactly is in that freezer?" and Mam-ma replied, "You'd be surprised."  Then she said, "Well, you know, Debbie brought me all them peas..."  If you have been following this blog, you know that two summers ago, my grandmother asked me to purchase her a half bushel of shelled purple hull peas... and before I could get them from the farmer's market to her house, she had accepted another half bushel from a church member!  We're talking a 118-lb. single widow who eats like a bird!  So, now she has made it her mission to feed my sister and her family - and the rest of us - from her freezer.

Mom took Mam-ma to buy some meat, and she said she saw some really nice looking pork ribs and roasts in the meat case, and she thought, "Oh, those are the ones I would select."  Mam-ma picked out the fattest packages she could see... they would be more tender.  Then she told Mom she didn't have room to put them in her refrigerator or freezer.  So Friday, she asked, "Would you like to have a pork roast?"  We don't eat pork or beef much, and I said no at first... but then I realized that was not a good answer. She sighed and said, "Well, I have so much food and I don't know what I'm going to do with it all."  So I brought the pork roast home, and it's simmering in the oven.   I'll remove as much fat as I can and we'll make sandwiches from it.

So we got the hair done, the dish detergents and buttermilk purchased, and the roast came home with me.  Saturday, Mam-ma called my mom and wasn't sure she could go to church because of the cold... she didn't have a good heavy coat.  Mom asked what was wrong with the heavy black wool coat I had given her?  She said it would barely button.  I find this amazing, as it was plenty big on her, but she also phoned me and asked me whether I thought she should go to church.  I asked, why was Sunday any different from being out for a hair appointment on Friday, especially since Sunday was forecasted to be warmer?  She didn't know, except she wore an old red down-filled coat she bought at a garage sale, and she didn't think that was nice enough to wear to church (it's not, especially since she has a wool dress coat!).  She also told me she had been to Fred's on Saturday with her friend Ruby to walk in the store for exercise.  So how was it okay to go to Fred's on Saturday but not to church on Sunday?  Reluctantly, she said, "Okay, I guess I'll get up in the morning and get dressed and see how I do."  Mom e-mailed me Sunday afternoon - her message said simply, "black coat."  I wrote back... "buttoned?"

After the events of Friday with my grandmother, our great-nephew Timothy came that evening to spend the night.  What a joy!  Teething, fussiness, and even a restless night were a welcome contrast to the stress and strain of arguing over ointment and buttermilk!  My grandmother is slipping.  She isn't remembering things for more than a few hours... if that.  Several times last week, she said, "I thought your sister would come by," and when I told her that the roads were iced over and no one was going anywhere, she would say, "Oh, is it bad out?  I didn't know."  We all told her how bad the weather was - and the roads - and still she would say, "I didn't have any idea it was bad out!"  Still, when I look at the challenges others are facing with their seniors, I count my blessings.

And as always, Timothy provides balance... and a breath of fresh air.  He is sitting up well now, and his Uncle Greg taught him to stand up and hold onto the side of his playpen.  He has new Michael Jordan leather basketball shoes - fifty cents at the thrift store (I haven't completely lost my mind yet!) - and he has learned a few new noises.  All of these milestones bring us great joy, and we realize how quickly they grow and change.  Maybe the challenges and tests of my patience that come with assisting my grandmother are good training for managing the challenges of an 8-month-old.  One thing is for sure... their temper tantrums are not all that different!  If only the solutions were more similar... and could all be solved with a bottle or a bounce on the knee.

Have a great week... keep your balance and your sense of humor... your gonna need 'em!

Saturday, January 2, 2010

End of the Year Housekeeping

Happy New Year! Our year ended with two words... stomach flu! My sister phoned me three days before Christmas and wanted to know if I could come and get my great-nephew. She had succumbed to stomach flu (he was still recovering), and neither she nor her husband could manage the illness AND a baby. Timmy's mother was working long shifts as a nurse's aide at a local nursing home, so my husband and I were next on the list for baby care. We picked up the baby and brought him home, and we began to help him recover from his bout with this "bug" in time for our family holiday on Christmas Eve. We made it through our Christmas lunch, and then my husband began to feel sick. My mom and her husband and my grandmother decided they were already exposed, so they stayed until early evening.

The next morning around 3:30, I awoke so nauseous I could not move. I looked at the baby sleeping in his crib and thought, "I can't even get up to check on him." We managed until mid-morning, when the baby's dad arrived to get him. It was a long Christmas Day, and my husband began to gradually feel better, assuring me that within 24 hours, I would be better, too. And I was... but by December 26th, my mom's husband was down, and my grandmother was saying she was sick. She recovered the fastest of any of us, so we aren't sure if she really had the "bug" or if she ate too much rich holiday food. Either way, we were thankful she bounced back so quickly.

Meanwhile, there has been so much end of the year work to be done. I got Mam-ma re-enrolled in Medicare Part D coverage - a new provider, of course. I've begun getting the papers to apply for her supplemental assistance. I filled out several pages of information for one service, including a lengthy bank statement showing her auto-draft for utilities for the past three months. The application was returned, noting that I needed "proof" of her utility payments. Apparently highlighting her auto-drafts on a bank statement is not sufficient evidence. We determined that this supplemental assistance, which nets some $14/month, is not worth the time and trouble it takes to apply for it, so we are forfeiting. I realize that this is what the agency may hope will happen, and if my grandmother truly depended on this service, we would keep it. But we are in "divide and conquer" mode, and frankly, I just did not have the time and energy to collect - and copy - all of her utility bills, proof of her pharmacy purchases, burial insurance and more for $168. I'm something of a slow learner, I guess, since I've done exactly this for several years now. But I finally decided to cry "Uncle" on this one - and thankfully, Mam-ma agreed to it.

Meanwhile, I am very grateful that my 97-year-old grandmother is doing so well. Sure, she gives me a run for my money many days, but all in all, we're doing great. My sister-in-law lost her 90-year-old father on December 21st to a massive brain bleed. Her 91-year-old mother suffers from macular degeneration and other physical ailments. The family laughed that "together, this couple made a whole person." She couldn't see - he couldn't hear. Now decisions have to be made about how this mother will function alone - and IF she can manage in her own home with help. Mam-ma still sees well enough to embroider pillowcases, read the newspaper daily, and do routine household and personal chores. She still hears relatively well and can manage quite ably in her own home with the assistance of Home Health aides and family and friends. I realize this is a delicate, and precarious situation that could quickly change. And she does show signs of becoming more confused and forgetful. But for the moment, we are hanging on and making it all work.

I look at my little nephew and how dependent he is on us for virtually everything in his life, and then I look at my grandmother and the assistance she requires, and I realize that the two are different, yet somewhat similar. Timmy's needs are more physical - food, clothing, clean diapers - while Mam-ma's are more of the paper variety - forms to complete, errands to run, medicine to dispense, bills to pay, and more... at least for the moment. At some point, the needs may begin to look more and more alike. My sister-in-law said her prayer was always that her parents would be able to live alone in their own home until one of them fell over dead, and that is virtually how it happened. This is my prayer, too - that for as long as humanly possible, Mam-ma will be able to function in her own home, on her own terms. I'm doing all I can to make this happen... and for now, we're doing okay.