Tuesday, December 27, 2011

The Sights and Sounds of Christmas Shouldn't Include Blood and Sirens

The Christmas Eve meal was pretty well prepared and in the oven. We were planning to eat at 3:30 p.m. My mother-in-law arrived early, and she visited with my husband as I finished up with last-minute kitchen preparations. I glanced at the clock – 2:10 p.m. My mother and her sister were to pick up my grandmother at her assisted living facility at 2:00, so they should be arriving any minute. I glanced up and saw Mom’s Jeep pull into our driveway, and I told my husband, “Mom is here with Mam-ma.” He and his mother started for the door to greet them, as I searched for something in the pantry. Then I heard my mother scream for my husband to come quickly. My grandmother had fallen. I rushed outside to see her lying lifeless on the driveway. We thought she had had a stroke. My husband rushed to call 911 as I hurried toward my Mam-ma. That’s when I saw the pool of blood forming under her head and trailing down our driveway.

In a panic, I ran inside and told Greg that Mam-ma was bleeding. He told me to get a rag and apply pressure to her wound. I ran inside and got a wet rag. Looking back, I don't know why I thought it had to be wet, but in my panic, I ran the rag under the faucet to dampen it! I knelt beside Mam-ma and pressed it tightly to her head. Her eyes were fixed, her mouth was open, and she was totally unresponsive. I thought she was dead.

I applied pressure, and asked, "Mam-ma, can you hear me?" A few seconds later, she said, "Yeah." We covered her with blankets. Thankfully the temperature had risen into the fifties and the day was sunny, so the concrete driveway was cold, but dry. As I applied pressure, the blood soaked through the rag and poured on to the concrete underneath. Greg brought me even more rags, as the pool of blood continued to grow on the concrete. We kept assuring everyone that head wounds bleed a lot and often look worse than they are. But since we didn't dare move Mam-ma to look, we had no clue exactly where she was wounded... or how bad it truly was.

The ambulance arrived after about 10 minutes, and my grandmother was placed on a back-board and fitted with a cervical collar. She was transported to the hospital emergency room, which is maybe two minutes from our house. A few hours later, CT-scans indicated no internal head or neck injuries. Once the bandages were removed and everything was cleaned, only a small puncture wound inside a larger hematoma sat behind her right ear. The only pain she complained of was from the back stabilization board. The ER staff said that this necessary precaution is "one of the worst things we do to people." She begged me, "Please, please... get me off this thing." But I was unable to do so until the results of the scans were read. I would guess she was strapped down about two hours.

When we could see that this was going to take a while, my husband came to the ER and sat with my grandmother, while I hurried home and finished heating our Christmas dinner and got it on the table for everyone. I ate with my family - Mom, her sister, my mother-in-law, my sister and her husband - knowing it might be my only chance to eat for the rest of the night. Then I returned to the ER and traded places with my husband. By this time, the doctor had given her a shot of something called Nubain for pain.

Greg said he asked Mam-ma, "Are you hurting?" and she said she was not. But when the doctor came in, he asked her if she was in pain, and she said "Yes." So he promptly ordered pain medication and gave her 5 mg of Nubain. He also wrote a prescription for pain medication for the next 2 days and said we needed to hurry to Wal-Mart to get the prescription filled, because the pharmacy would close early on Christmas Eve. It was now about 5:30 p.m.

This prescription should have been a "red flag," but in our shock and confusion, we didn't think to question it, so Greg headed to Wal-Mart to get the medication. Meanwhile, the doctor prepared to discharge my grandmother, declaring that he had “no medical reason” to keep her.

I could not believe it... and I tried to plead my case with him... Wasn’t it enough that she was 99 years old and had just had such a nasty fall? Didn’t her high blood pressure and her “loopiness” from the pain medication he had just administered qualify her to stay? Could he not consider that she was dismissed from a six-day hospital stay only 12 days earlier? He insisted his hands were tied.

The assisted living facility was contacted, and the nurse said they were understaffed and they could not perform “neuro” checks every 2 hours, as prescribed. I did not feel my grandmother was steady enough to stay in her apartment alone anyway.

The doctor suggested perhaps Mam-ma could stay with a family member. I just looked at him and said, "She fell trying to get into my house. Do you really think that's a good idea?" He agreed this was not a great option, but he said he was just trying to offer me some possible solutions. His final suggestion was, “I guess you could take her to apartment and stay with her there overnight.” I just walked away from the desk.

I was at my wits’ end. I didn’t know what to do. I called my husband and told him this while he waited at Wal-Mart. He was not a happy camper, but he told me the choice was ultimtately mine. I told him I guessed we would have to pray hard and take our chances in my grandmother’s apartment. Greg suggested I call my mom and relay all of this information to her and see what she thought. I looked up and saw a sign beside a door where I was standing. It said “Chapel.”

I stepped inside the chapel to call my mom, and as we talked, I started to fall apart. I looked at plaques that hung on the wall. They were scriptures, and the first thing I saw was Philippians 4:6-7..."Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus." Then I read Lamentations 3:22-23..."Because of the LORD’s great love we are not consumed, for his compassions never fail. They are new every morning; great is your faithfulness."...followed by Psalm 23, and finally... Jeremiah 29:11..."For I know the plans I have for you,” declares the LORD, “plans to prosper you and not to harm you, plans to give you hope and a future." All scriptures are from the New International Version (NIV).

My mother insisted that she would stay with my grandmother at her apartment, and I reluctantly agreed. I knew that I was physically stronger and more able to manage Mam-ma, but neither of us had any business handling a 99-year-old injured woman who was spaced out on pain meds. Then I said a prayer before I left the chapel and asked God to handle this… to take my worries and fretting and give me peace about this situation.

When I stepped back into my grandmother’s exam room, I was visibly upset… and so was the charge nurse who had been treating my grandmother. I am not sure she hadn't been crying, too. Her face was red and she was sniffling. She had spent an hour cleaning Mam-ma's head wound, and I have to say, every single staff member - including the attending physician - was absolutely wonderful with Mam-ma. I expressed again my concerns and frustration… and the nurse agreed that I was right to be concerned. Then she asked which doctor my grandmother had seen when she was hospitalized earlier in the month.

I told the nurse name of my grandmother’s last hospitalist, and she said, “He’s on duty all weekend. I can ask the ER doctor to call him if you want and see if he will admit your grandmother - at least overnight.” She didn’t make any promises, but it was worth a shot. Of course I wanted her to ask! I thanked her for doing this, and she left to talk with the attending physician. A few minutes later, she returned to tell me that the attending had indeed agreed to call the hospitalist, who had agreed admit my grandmother for overnight observation.

I cannot tell you the overwhelming peace and relief that flooded me when the nurse offered to talk with the doctors. I cannot begin to express how I felt when she returned to tell me that the hospitalist had agreed. I was so grateful to God for working out what I could not… and for directing me into that chapel for a few minutes. There, as I read those scripture passages, God gave me what I needed… hope, peace, reassurance that He was in control… and love overflowing.

Orders were written, and Mam-ma was wheeled upstairs by the charge nurse. I continued to thank her for being there - for helping me - for caring. She said, "My hands were tied until you asked..." It was then that I realized... I had to ask to speak to the hospitalist. Since Mam-ma's primary care physician is the nursing home staff doctor (and practicies in another city and does not have admitting privileges at our local hospital), we had to find someone who had treated her and could vouch for the necessity of admitting her. Once I recognized her hospitalist's name on the white board, we had a chance!

Upstairs, the nurses on the floor - some of them childhood friends, and all of them good "new" friends from 2 weeks ago - jumped up and began to get Mam-ma settled. To a nurse, they were appalled that there had been any question about admitting my grandmother. One dear LPN said, "Were you supposed to pour her into your car after this shot of Nubain?" For the record, this is not a necessarily bad pain medication - the concern was my grandmothers size and age - and the dosage administered.

Every time they stood Mam-ma up or moved her in the least, she vomited. The nurses agreed to watch her and hold off on giving anti-nausea medication, in case the sickness was related to the head injury. Mam-ma was settled in bed by about 7:00, but she seemed restless. She kept saying, "Debbie, you go on home." I decided she might rest better if I left, so I returned to my family gathering for a while.

When everyone had eaten and visited, we declared our "Christmas" over and done, and all of the family members went home around 8:30 p.m.. I returned to the hospital to sit with Mam-ma for a while. The LPN asked me, "What are you going to do... are you staying?" I asked her if she felt it was necessary, and she said, "No... but I want your phone number written on the white board." I placed my contact information on the white board and reminded the nurses I was less than 2 minutes away any hour of the night or day. I also reminded them that my grandmother is a DNR - Do Not Rescusitate - patient. Be sure you remind the staff of this, if you have such directives as a DNR and/or Living Will. Apparently it does not always transfer on the records!

I sat with Mam-ma until about 10:00 p.m., kissed her goodnight, and returned home. Christmas morning, I was back about 9:30 a.m. - the nurses had said the doctor would make rounds by 10:00, they hoped. And he was pretty well right on time. Before he even examined her, he said, "We'll monitor her today, and maybe she can go back to her apartment tomorrow." I was thrilled by this news. But at the same time, I had to ask myself... how did we so quickly get from "We have no medical reason to keep her," to monitoring her for two nights in the hospital? The only answer I have is the grace of God and His divine countenance to put the right nurses - and this hospitalist - in the key places Christmas Eve.

Amazingly, Mam-ma is doing very well. She was dismissed to return to her apartment the day after Christmas, and we had her back in her own bed by about 1:00 p.m. The hospitalist told me that this will be mostly a "behavior modification" issue... helping my grandmother remember to ask for help when getting up for the bathroom, to go to meals, etc. In talking to my mom and her sister, we have determined that Mam-ma got out of Mom's car under her own steam and did not wait on Mom to come around and help her.

While Mom got the walker from the back of her Jeep, Mam-ma got out, closed her door, and was inching along the side of the vehicle. Mom's sister, who is probably 4'10" and about 85 lbs., saw Mam-ma wobble and tried to grab her coat. She says she quickly realized if she hung onto the coat, she would be pulled down atop my grandmother... so she let go. We are assuming that Mam-ma's blood pressure dips when she first stands, and she must wait and count to 5 before taking a step... giving her body time to catch up. We think this explains the other 2 falls, both of which occurred when she bent over or turned too quickly while standing.

The nurses at the hospital admonished me that Mam-ma was going home as a "full one-person assist" when getting up for anything. She is weaker than ever now. In talking with the nurses at the ALF, we agreed that she truly doesn't remember to call for help... and she doesn't mind well, to boot! So the R.N. and I both talked to Mam-ma about calling for help. I asked Mam-ma, "What are you supposed to do when you need to get up?" "Call for help," she answered. I told her that was right and asked, "Where is your 'call button'?" She answered, "I don't know." I reminded her it was in the chest pocket of her pajamas.

The R.N. printed ten signs that remind Mam-ma to call for help before getting up. She taped them all over Mam-ma's apartment - the walls, every door and drawer, and above her bed. Even as she did this, Mam-ma started to get up out of bed unassisted. "This is good," I thought... "she will see first-hand how Mam-ma does." We reminded Mam-ma to call for help, and she said, "Well, y'all was both here." We agreed, but after the nurse helped Mam-ma to the bathroom, she turned her back for a few seconds, and Mam-ma was trying to stand on her own. She said, "I can see that this will not work."

I asked what else could be done besides 10 signs on the walls and doors, and she said, "I'm going to talk to the aides right now and order room checks every 30 minutes. If that isn't enough, I will put an alarm under her bed." Somehow, I have a feeling we will have that alarm before the week is over. The nurse said surely if an aide came in every 30 minutes and tried to second-guess what Mam-ma might need - bathroom break, something to drink, etc. - we could prevent her getting up unattended. We are all shocked that nothing was broken in this latest fall, and we are so worried that she will break something the next time.

Meanwhile, the ALF nurse shed some light on why the ER attending physician was so reluctant to admit my grandmother. Medicare has tightened the reins on admits and discharges and what they will cover. It is possible that this doctor felt that the hospital would not be reimbursed for Mam-ma's stay, because it occurred within 30 days of her last visit. The nurse told me, "I could have easily given you a dozen or more viable reasons to admit your grandmother," but apparently this doctor chose to go strictly "by the book." I want to give him the benefit of the doubt... but I'm struggling, given her age, high blood pressure (193/118) and her general condition.

The ALF nurse was also less than pleased that a woman weighing 113 lbs was given such a strong dose of pain medication - and a "take-home" prescription for Hydrocodone. She could not understand why someone with a history of falls would be prescribed narcotic pain medication and dismissed. I don't get it, either... and my grandmother will never see the Hydrocodone!

I feel that the staff at the ALF is doing everything possible to help me keep my grandmother safe. Physical therapy will begin later this week to strenghten her physically and cognitively. The goal is to get Mam-ma up on her feet again... with the help of a walker, of course. I asked the hospitalist if he could order a wheelchair for her, but he explained to me that this needs to be a last resort - and he does not want her in a wheelchair 24/7, because her skin tissue can deteriorate from sitting, and she would be at risk for infection. I am so glad this guy is so thorough. That had not occurred to me... and some doctors would have said, "Sure!" and written this order, just to placate me.

From what I have been reading, part of the new Medicare initiatives involves encouraging hospitals to do a better job of treating the patients while they are there... AND sending the proper care directives home with them to prevent a return stay and better rehabilitate the patient. I understand this completely, and for the most part, I've observed more detailed discharge directives for my grandmother. MY JOB is to follow through on these and make sure they are all communicated properly and nothing falls through the cracks!

As we left the hospital, I told one of the nurses, "I learned several new things this trip." She replied... "You will learn new things every time you come. It's not always things you would wish to know, but you will be better for it." What did I learn this time?

  1. Do not be afraid to advocate for your patient. I told more than one nurse, "I know you are sick and tired of looking up at the desk and seeing me standing there to ask you something." More than once, I was told, "If you don't advocate for your grandmother, nobody will. Do not ever back down or hesitate. We understand completely."
  2. Do not be afraid to question or challenge the medical staff. Now I know to ask to speak to the hospitalist if we are in the ER. Had my grandmother's doctor been one who had hospital admitting priviliges, I would have asked for him/her. But now I know to ASK! Question medications... What is this?... Why is it being given?

    My grandmother will often say one thing one minute and another the next, as in "No, I don't hurt anywhere," followed by "I hurt all over." And because we are not sure which is true, I would rather she be given something for pain on the off chance she really was hurting. But you still should know exactly what is being administered, what procedures are being performed, what the ramifications are of these... and WHY they are being done.
  3. This was not a new revelation, but I need to remind you that the medical staff does not know your loved one like you do. On Mam-ma's last visit, the doctors kept wanting to tinker with her blood pressure medications, because one day her BP would be extremely high, and the next it would be very low. I explained that she has done this for years now... several days of high blood pressure, followed by a day or two where it bottomed and she could barely move. Once they understood that this is "just Polly," they left the medications alone and let her body level out on its own.
I also made a point to "prove" to several nurses just how poorly Mam-ma follows instructions. While making sure she was safe and didn't fall and hurt herself, I let more than one nurse see how she gets ahead of you and will not wait for assistance. It didn't take long for them to get the necessary alarms and precautions in place.

Finally, I have been monitoring my grandmother's weight gain. When my mom and I visited a few days before Christmas, Mam-ma's ankles were swollen again - and I was alarmed. I questioned this and was told, "She's only gained seven pounds - but she is eating well." I pursued this and got the nurses to understand that "a pound a day" is too much weight gain... and it was not from eating well! Now the ankles are once again little and bony, and the hospitalist and I made sure that orders transferred that no more than a 3-lb. weight gain is acceptable. And I will be checking!

I was prepared to lose my grandmother on our driveway Christmas Eve. I felt God’s peace and calm there in a way I cannot begin to describe. But I am grateful that He chose to wait for another place and time for this inevitable event.

Meanwhile, I am reminded once again that God is in control… that I am His, and He blankets me with His love, grace and peace. I am also reminded of His perfect timing. Our little Timothy returned to live with his mother on December 3rd after being with us and my sister for nearly 4 months. Mam-ma entered the hospital on December 6th. I had little time to grieve the departure of Timmy. At the same time, I was so thankful that I was not trying to balance his care with that of my grandmother.

I had been pretty sad about celebrating Christmas without our babies. After all, the joy and excitement of children truly "makes" the holiday. But one of my first thoughts as I sat on the driveway holding Mam-ma's head and watching the pool of blood increase was... "I am so glad Timothy is not here watching this!" I have no doubt that my husband and other family members would have helped me care for the baby while I bounced back and forth to the hospital and ALF. But I thank God that he put Timmy back with his mom, where I am confident he is safe and happy... and I can concentrate on my grandmother. It's her "season" now. The other benefit is that I can truly rest and rejuvenate when I am not with her, instead of having to immediately focus on the care of a toddler.

I do not know what lies ahead. I felt quite certain another fall was imminent... I just didn't know it would happen like it did. Christmas Day as my mother sat beside my grandmother's hospital bed, Mam-ma told her, "I wish I had died." I know she is so ready... and I am trusting God and His timing. I am resting when I can, and talking to Timothy on the phone every few days. In a somewhat weary voice, his mother told us Christmas night, "Timothy was so excited about Christmas that he would not go to bed last night, so we opened gifts at 1:30 a.m. He finally conked out about 3:30 and slept until noon!" Imagine if I had come home to THAT! The best blessing of my Christmas Day came when that little guy said, "I opened presents, Aunt Debbie and Uncle Greg!" God gave Him a happy, "normal" family Christmas... and that in itself was my best Christmas gift.

I hope your holidays were less eventful. I pray that you find a good balance in the coming year, and that you trust God to meet your needs. Trust Him to work things out even when you cannot see a solution. Believe that He will give you the right questions to ask... and the perfect answers, as well. I know it's a little late, but Merry Christmas!

Monday, December 12, 2011

What do Six Days, Five Doctors and Fifteen Pounds Have in Common?

The answer to this question can be answered in two words... Mam-ma Polly! 

When Timothy went back to his mother in Texas, Greg asked me, "What will you do with your spare time?"  It didn't take him long to get an answer!   Tuesday, December 6th, the nurse at Southridge phoned me at 4:00 p.m. to tell me that Mam-ma's blood pressure was high.  She said "I am going to give her the five o'clock blood pressure pill now and check her again in an hour, when it has time to work.  If she still has a high reading, I told her she has to go to the ER."  A little before 6:00 .m., the nurse phoned and said, "It's not as high, but it's still up there, and I think she should go to the ER.  She doesn't have any chest pain, but this reading is too high."  The top number had dropped from 167 to 142.  I don't know what the bottom number was, but it had been 104, I think, at 4:00 p.m.

So I gathered my purse and jacket and headed to Southridge to get Mam-ma. The nurse would have called an ambulance if I'd asked, but I figured I could get her there faster, and she seemed well enough to get in and out of the car.  It was "spitting snow," but we didn't have far to travel - less than 2 miles.  I drove Mam-ma to the ER, and I helped her get inside.  There were a few patients, but not many, and we were in an exam room by 6:30 p.m.  Her blood pressure now was something like 198/112, which didn't surprise me... but it stayed that high the rest of the evening.  The doctor assured me she was not having a stroke or a heart attack, but when asked, she did say she had shortness of breath.

The doctor ordered an EKG, a chest x-ray, blood work, and a urinalysis.  Sometime around 11:00 p.m., he said the x-ray showed fluid around the heart and a little in the lungs.  His diagnosis was mild CHF (congestive heart failure), and he said, "I'm going to give her IV Lasix and admit her.  She will need a catheter so she doesn't have to get up... we don't want to risk a fall."  I really liked the ER staff... especially this doctor, who we have seen before. He seemed to totally "get" Mam-ma - the fact that she is 99, and how delicate the balance is in her system.  I was quite surprised at how swollen her legs were.  She has had swollen ankles off and on for six months, but now her calves and even her knees were swollen.  The calves were red and shiny and looked like bratwursts that would burst if you stuck them with a pin!

Mam-ma's wonderful nurse got the catheter in and collected 400 ccs of urine.  Then she started the IV Lasix.  By the time we took Mam-ma upstairs to a room, it was midnight - and there was another 1300 ccs of urine in the bag.  The ER doctor said, "She is in incredibly good health for someone 99 years old, and we want to get her back to that and keep her there."  It looked like we were on the way.

By the time I left the hospital, it was just after midnight, and over 2" of heavy, wet snow had fallen... and it was still coming down hard.  Fortunately we live less than five minutes from the hospital, so I did not have trouble getting home - once I got all the snow scraped off my car windows!

I was back early the next morning to wait for the hospitalist.  I had been told they were on duty from 8:00 a.m. to 4:30 p.m., and I didn't want to miss this doctor.  He arrived somewhere around noon, due to icy roads, the nurses said.  I did like Dr. Quintinar, and he said Mam-ma was doing well - progressing.  About 3300 ccs of fluid had been collected.  Dr. Quintinar told me that he would not be back this week... his associate would see us on Thursday.

We did see a new doctor on Thursday - I was there at 10:00 a.m. - Dr. Lewis arrived around noon and started making rounds, getting to Mam-ma's room around 1:30.  He said he was ordering oxygen, and Mam-ma would have to wear it permanently to help with breathing.  No oxygen was ordered, and the next day, I asked him, "What about the oxygen?"  "Oh, yes... " he answered... "Oxygen... we will have to see if she qualifies for it."  This meant a test to see how she walked up and down the hall with and without oxygen.  The nurses said she did great... she did not need oxygen. 

Each day, the doctor would say, "Maybe tomorrow you can go home."  Mam-ma got daily physical therapy, which included walks in the hallways.  On Saturday, we saw a very kind Dr. Ruiz, who was quite intrigued with Mam-ma.  He gently stroked her face and hair and was very attentive and thorough.  He said, "You can go home Sunday or Monday."  Mam-ma told him, "You've disappointed me... I want to go home today!"  He replied, "Home is a wonderful place to be... but for now, this is your home."  He told me that the numbers were trending downward, but Mam-ma still had a little CHF. Also on Saturday, Mam-ma developed a little bit of a problem with getting to the bathroom in time.  I think it was probably all of the green veggies she had been eating all week... it seemed nearly every meal included a hefty serving of broccoli or mixed vegetables with broccoli.  Mam-ma told me, "I just LOVE broccoli!" which was news to me!

Sunday, we saw Dr. Konero.  If you have lost count, that's five doctors, counting the ER doc.  He ordered a stool sample to evaluate the bathroom issue before he would agree to dismiss Mam-ma.  This morning, all the stars aligned, and we got discharge orders.  Along the way, one doctor doubled one of Mam-ma's blood pressure medications.  Another came along and cut the other BP medication in half.  One discontinued her Lasix altogether after she lost almost 10,000 ccs of fluid and about 15 lbs... another reinstated it. 

In the end, we went back to Southridge with tiny ankles and a slender face and tummy... and the exact same medications and dosages we arrived with last week!  Dr. Konero said that Mam-ma seemed to be regulated on these dosages, and he ordered a daily weighing to monitor the fluids and a daily check of her blood pressure to determine whether or not she should get her Lasix pill.  As I helped her dress, she said, "These pajamas are gonna be too tight."  I told her, "I bet they aren't now!"  As they buttoned with room to spare, I added... "That's what losing 15 pounds will do for you!  I was reminded of all the times in the last months/years I have dressed Timothy as I helped Mam-ma into her pajamas and robe.

A nurse wheeled Mam-ma downstairs to the building entrance, where my wonderful husband had brought the car and parked it for us.  He helped us get her in the car, and two aides met us at Southridge with a wheelchair and got Mam-ma into her room and settled into bed.  She sank into her pillows and was almost instantly dozing.  I asked if her bed felt good, and she said, "Heavens, yes!"

So hopefully we will have a few days of quiet, rest, and recovery.  The RN at Southridge said she would order physical therapy for Mam-ma to help her regain her strength.  I am so, so grateful that Mam-ma is at the ALF and could return to such care and attention.  Had she been living at home alone, I am not sure what would have happened when she was discharged.  I know she was in no shape today to return to a home to live alone.

This afternoon, I counted my blessings and marveled at God's timing.  He allowed me time with Timothy before his return to Texas - time without having to dash back and forth to a hospital to check on Mam-ma Polly.  When Timmy left, God gave me a couple of days to collect myself - and finish our Christmas decorating.  Thankfully, while spending big chunks of each day at the hospital, I was not having to worry about Timothy - or leave him at home with Greg.  And now, I will hopefully have time to get things ready for Christmas - and Mam-ma will have time to regain her strength so that she can celebrate with us.  I even found time while sitting at the hospital to get all of our Christmas cards signed and addressed!

The one caveat I would offer about this week's experience was how CRUCIAL it is that you stay with a loved one who is in the hospital.  It was not necessary for me to stay with Mam-ma 24/7... due in large part to the fact that this is a very small town, and I literally grew up with many of her nurses and therapists - some of whom refer to her as "Aunt Polly" - so I trusted them to look after her in my absence.  But even with that, I did have to make several trips to the nurses' desk to ask for things she needed, and to check on lab reports, etc.  And I spent a great deal of time sitting and waiting for a doctor to make rounds. 

Had I not been there to get the reports, I would not have known that the changes in medications were being made... that one doctor said he was ordering oxygen and then apparently forgot.  I am not sure the order to weigh Mam-ma daily at Southridge would have ever made it onto her discharge papers if I had not stepped to the nurses' desk Saturday night and asked about it.

At the end of the day, things fall through the cracks, even with the best medical staff in the world.  I really, really liked the nursing staff.  I actually liked every single hospitalist and felt comfortable with each of them.  They were attentive and took plenty of time to listen to my concerns and answer my questions.  And this was important, because Mam-ma can barely get her thoughts together these days, so she would not have remembered anything the doctors told her.  And when they asked her questions most days, she would look at me in frustration and say, "Debbie, you tell him."

So please do not leave your loved ones unattended in the hospital for more than a short nap or perhaps at night when you are certain they are settled and ready to sleep.  Too much happens... too many details can slip through the cracks. You would want someone to be there for you... do the same for your loved ones.  "Hospital sitting" is the most tiring activity in the world.  But it is also one of the most important when someone you know and love has to stay there.

When I left Mam-ma's apartment at Southridge today, I begged her to please call an aide for help before she got up for anything in the next few days.  I told her, "The last thing in the world we want to have to do is go back to the hospital!"  And I meant every word!

Monday, December 5, 2011

Saying "Good-Bye" Was Harder Than I Expected...

This past week brought some of the most difficult experiences I've had in a long time.  Our little Timothy has been spending time with us and his grandparents for the last 3½ months.  I would say he has probably spent at least 1/3 of those days and nights with us... maybe closer to half.  We have grown very attached, and Timmy truly bonded with us.  My sister said he got up every morning he was at her house asking to come to ours... and every evening when she picked him up at daycare, he asked, "Go to Aunt Debbie's?"  So I knew it would be hard to say "Good-bye" to him when he returned to Texas to live with his mother and baby sister... I just didn't know how hard.

The plan was for my sister and her husband to leave on Sunday, December 4, and drive Timothy to Texas.  However, a scheduling conflict at work caused my sister's days off to be changed.  My brother-in-law called me in a panic around noon on Thursday and said, "We have to leave tomorrow... do you want to go get Timmy and keep him tonight so you and Greg can have some time with him?"  I told him that we did, and I stopped in the middle of decorating for Christmas, grabbed a quick shower, and headed to the daycare to pick up Timothy.  Both the daycare owner and her aide cried when we left.  They walked away so Timmy would not see them.  He happily told them "Bye!" and "See you later!"

We thoroughly enjoyed every minute of the afternoon and evening with Timothy.  We took a walk down the nature trail - taking turns pushing his stroller, and calling it a "big adventure."  We played with toys and rode the tricycle.  We read books, colored, and watched Timmy's favorite TV shows and videos on YouTube.  And we tried not to count the minutes.  My mother came for a visit, and she had a hard time saying "Good-bye."  She had visited Mam-ma before coming over, and she told me that Mam-ma was not doing well... could not put sentences together... and that she had asked about Timmy and cried when Mom told her that he really was leaving.

Friday, we continued spending time with Timmy - doing everything he wanted to do and making the most of each hour.  I knew my sister was planning to pick him up in the afternoon... we had made plans to attend a Christmas dinner with friends that evening. My sister phoned around 3:00 to see if Timmy was awake, but he was about halfway through what I thought would be a two-hour nap.  I assured her I would call her when he awoke.  Greg sat nearby and "listened" for him while I took a shower.  I had just turned off my hair dryer when I heard him whimper.

Greg went to Timmy's crib and tried to console him.  He was crying for his Aunt Debbie.  Before I could soothe him, the phone rang... it was Mam-ma.  I don't know how on earth she does it, but she always seems to sense when I am really busy with Timothy - or even when he is here.  At any rate, she was upset... her glass bluebirds were "missing," and she just knew someone had stolen them.  I assured her they would show up, and I tried to be patient as she complained and disagreed with me. She said, "I've cried more over them than anything... Timmy loved playing with them so."  I told her Timmy was two - tomorrow he would love something else!  Finally, I told Mam-ma that I would come on Saturday and look for the bluebirds, and we hung up.

I returned to Greg and Timmy, and we sat and held him together for several minutes.  He was not good and awake, and he whimpered and sat snuggled against us.  Greg decided to grab a quick shower, and I called my sister to let her know Timmy was awake.  She said they were packing the car, but they would come soon and get him.  By the time Greg finished with his shower and dressed, my sister and brother-in-law were here. 

While Greg showered, I sat with Timmy and talked softly to him.  I told him how much we loved him... that he was going to have a good time in Texas... and that he had to go home with his GaGa and get a good night's sleep so they could leave early the next morning to go and see his mommy and his sister Zola.  I also reminded him that he could call me... every day... more than once.  I reminded him that every time he saw the moon, he would know that Uncle Greg and I love him... and I told him, "Make your mommy read your 'God books' to you and Zola every night!"  He would nod his head in agreement each time.

Timmy was still grumpy, and when he saw his grandparents, he started to cry again. He did not want to go.  Greg and I sat with him and tried to assure him it would be a good thing.  We all just sat for a while... until there was really nothing left to do but gather his belongings and say "Good-bye."  My sister and I were already in tears, and Timmy began to cry loudly.  He clung to me and didn't want to go.  I carried him to the car, screaming and clinging to me.  I put him in and strapped him into his car seat.  Then Greg and I both kissed him one last time, and I shut the door.  My sister said, "You know he will stop crying in a little bit."  I did know that, but it still broke our hearts to stand on our driveway and wave good-bye and blow kisses, knowing it will be months or more before we see our little guy again.  A part of me also cried because I knew he had missed his family... and he would be so thrilled to see them again.

I think God knew we needed a diversion, so he scheduled things in such a manner that we had this dinner party to attend.  He definitely shielded me from the prolonged agony of Timmy's departure.  I didn't have time to burst into tears and wail for hours, like I would have liked.  I had to finish dressing and get my food together for the potluck dinner, then get in the car and drive to our friends' house.  Greg and I both went into the "get-ready" mode and didn't say much to each other.  I told my mother today that I know God shielded me all night, because I slept fairly well, and it wasn't until the next day when reality truly began to sink in and I had time to be sad and grieve a bit.

Even then, I didn't have much time for sadness, because I had promised to go to Mam-ma's and look for the bluebirds.  I entered her room, and she was in a tizzy... they were still missing.  I started looking... under the bed, I found one.  She always keeps the birds atop the heat and air unit underneath her window, so I started systematically looking in that area.  The first object I came to was a decorative hat box on the floor.  I removed the lid... there were the other 3 bluebirds.  Mam-ma became irate... "Now those were not there 30 minutes ago!" she exclaimed.  She said that the maintenance man, James, had come into her room and assured her that he would find them.  I told her, "Maybe he put them in here for safe keeping."  She didn't believe me... but she insisted I bring the bluebirds home with me for safekeeping. 

It was almost time for lunch, so I put the birds in my car and went back inside to walk Mam-ma to lunch.  We sat for a while and visited with the other ladies at her table.  I noticed a tall young man walk through the dining area with bags of lab equipment slung over his shoulders.  I thought, "He's here to draw blood from someone."  In the next minute, a nurse was coming toward us, "Ms. Polly... the man is here to draw your blood."  She explained to me that the doctor had made monthly rounds on Friday, and he had ordered a Urinary Analysis and blood work... "because Ms. Polly is so confused.  She is accusing people of stealing from her, and she can't put sentences together coherently." 

I explained to the nurse that Mam-ma was upset because Timothy was leaving.  The nurse did not realize that this was happening, and she understood and agreed that this probably was contributing to the confusion.  She had seen Timmy and me there visiting Mam-ma the previous Sunday.  I told her that I knew all about the bluebirds, and she said, "James went into Ms. Polly's room and found them this morning."  I told her that I now have the bluebirds.  I asked if she would notify me before the doctor changed any medications or did anything differently, and she said, "Oh, absolutely!" 

I explained that we have seen a rapid decline in Mam-ma in recent weeks, and that she is praying to die.  I told her, "We really don't expect to have her much longer."  She seemed surprised, but she agreed that Mam-ma is definitely declining rapidly.

I added that Mam-ma could live another ten years, but I feel like she is beginning to lose her ability to function mentally, and the nurse agreed, adding that Mam-ma comes to the nurses' station several times a day and cannot remember why she is there.  I stayed a little longer with Mam-ma and left her in the dining room eating her lunch.

When I got home, my sister called to say that they had made it to Texas, and I could hear Timmy squealing and laughing in the background.  She said his reunion with my niece was amazing... that when he saw her, he began squealing "Mommy!  Mommy!"  Then my niece sent me pictures of our happy little boy, and I knew we would all be just fine.

I called my Grandmother on Sunday to assure her that Timmy is safe and well... and to remind her that I have the bluebirds.  She said, "Well, we'll see... there are still about three birds missing."  I told her that we only moved into Southridge with five birds, and I think one got broken several months ago.  Last Sunday, there were four birds for Timmy to play with... and I brought home four birds.  I told her, "Nobody is stealing from you... I have all of your bluebirds, and no one is taking anything else."  She said, "Well, I'm not so sure."

So the changes have begun. It's been so quiet around our house, and it seemed strange to finish the Christmas decorating this weekend, knowing Timmy and Zola will not see it.  But it gave me something to do to keep busy... and I was already more than 2/3 decorated, so it seemed silly not to finish.  Mam-ma has not called again... and I did not call her today. 

Mam-ma did call early last week to ask Greg why we didn't come to her birthday party.  It took her forever to get out her questions... and Greg wasn't even sure she knew who she had called.  We finally determined that Southridge had a collective party for all who celebrate birthdays in November.  Greg assured her that we were not invited... that the party was for her and her friends there at Southridge.  He reminded her that we did have a party for her... we took her to lunch at a local restaurant.  But he was really bothered by how confused she was... and how difficult it was for her to speak on the phone.

Today, Mam-ma's long-time housekeeper, Mary, phoned me and asked if Mam-ma is sick.  I told her no, and she said, "Well, I just talked to her, and she didn't sound well."  So I explained what has happened and Mary said, "I've made sugar cookies using Ms. Polly's recipe, and I wanted to take her some tomorrow if you think it's okay.  She is like family to me."  I assured her it was fine... that I can't promise Mam-ma will eat them, but please go and take them.  Mary said she would not stay long, but she would take cookies and some chocolate drop candy that Mam-ma enjoys.

People are so kind and loving to Mam-ma... including the staff at Southridge.  I told Mary today that I think Mam-ma is losing her mind... and if that is the case, I hope she doesn't linger.  It's not my call, and I know that... but I remember how hard it was to talk to my maternal grandmother and visit her after dementia set in.  She always seemed to recognize me and my mother... but she had a baby doll she thought was a real baby, phantom "thieves" and ne'er-do-wells who visited her room, and she insisted my grandfather (who had been dead for several years) was living in the nursing home with another woman - she saw them dining together in the dining hall.  I do not want my Mam-ma to suffer those indignities.

My husband asked me tonight what I plan to do with my spare time, now that we are not keeping Timmy several days/nights each week.  I told him I have a stack of projects I've set aside.  I am sure I will have no trouble finding something to do.  I am also sure that there will be more to attend to for Mam-ma in the coming days/weeks, as well... and this time I will not have to juggle the care of a little one in order to get it all done. 

The changes continue...and there will be more hard "good-byes" to come.  But for now, I am resting... in more ways than one... and resting in God's promises that He will never give me more than I can handle - and that He will truly supply every need of mine and my family.

Sunday, November 27, 2011

Change is Hard at Any Age

It's been a busy month.  I know I say that a lot, but this one has been especially busy.  We've had Timothy every weekend while my sister worked, which usually meant picking him up either Friday night or Saturday morning, and keeping him until Sunday afternoon or Monday morning when he returned to daycare.  Meanwhile, Mam-ma has done pretty well.  She had about a week of celebrating for her birthday, including a visit from beloved cousins in Oklahoma who spent an entire Saturday playing "Chicken Foot" dominoes with her and taking her to her favorite restaurant - KFC, or "Kentucky Colonel" as she calls it.

My sister and her husband have decided that it is time for Timothy to return to live with his mother, baby sister Zola and Zola's daddy (who Timothy calls "Daddy," also).  So this coming weekend, the plan is for my sister and her husband to drive Timothy to Texas, spend a few days visiting, and return home without him.  After three months of spending so much time caring for this little guy, the thought of him leaving for an indefinite period of time is truly stressful.  I am trying to stay positive.  I know that Timothy needs to be with his family... but I am going to miss him madly!

And Mam-ma is convinced that Timothy will never see her again... which could be very possible.  Today, we visited her apartment, and she said to Timothy, "I hope you don't forget me."  I assured her we will never let that happen.  When we left, she asked, "Will I get to see him again before he leaves?"  I told her we will try to come and see her next weekend while he is with us, but I couldn't promise.  There were lots of tears and hugs and kisses when we left, and I felt badly, but this is not something I can control.

Thursday, we had Thanksgiving lunch at my mother's.  My sister filled Timothy's plate while I filled Mam-ma's.  I carefully cut up her ham and made sure to get the things I felt she would want to eat.  I think there was more thought required for her plate than Timothy's.  However, after a few bites, he wanted down from the table, and he ended up sitting in my lap, beside Mam-ma, finishing his lunch.  We brought him home late afternoon, so that he could wind down and get settled before bedtime.  Friday, he returned to my mom's for most of the day, while my husband and I hosted a football watch party.  We're all trying to make the most of these last couple of weeks before Timothy leaves.

I will admit that I am struggling with my feelings.  Last week, I said as much to my husband, and he said, "You are blue because Timmy is leaving."  I told him it's more than that.  I feel like my life is on the verge of a major change.  Having part-time care for Timothy these last 29 months has changed our world in ways we never expected and brought us both tremendous challenges and immeasurable joy.  And when his family moved to Texas in August and we didn't see him for six weeks, I was pretty lost.  At the same time, I have (gladly) put a lot of my own projects on hold since Timothy was born... never sure when the phone would ring and he would be coming to stay for a day or two - or a week or more!  Now my niece says it will be at least the end of February before they return for a visit.

And then there is my grandmother... she continues to decline overall, and I feel like some morning the aides are going to find that she drifted away in the night - or she will contract some illness or infection and be gone in a matter of days.  I know she has lost her drive and determination... and she is basically "waiting for the LORD" to take her home.  So there is every possibility that the next few months will find me with two less people to care for, and honestly, I am going to have some adjusting to do!

Clearly, my situation pales in comparison to those of you who have full-time care of either a child or a senior - or both.  But I am also certain that some of you know exactly what I'm talking about - you've "been there, done that!"  So I ask that you remember my family in your prayers... that you ask God to make this reunion of Timothy and his family a good one - and that He equip the rest of us with whatever we need to handle his absence.

My niece needs prayers, too... she will be caring for her six-month-old daughter and 29-month-old son while living over seven hours from her parents and the support system she has relied upon for all of her 21 years.  She is also dealing with the reality that she could lose her great-grandmother in the coming months and not be able to get home.  In a recent phone conversation, she said to my sister, "If something happens to Mam-ma, someone will come get me, won't they?"  My sister had to tell her that this was not likely, for a variety of reasons. 

So this will be a challenging week.  We will keep Timothy over the weekend until my sister and her husband get the car packed and are ready to head to Texas.  I have given this situation to God, and I am trusting He will guide my steps over the next few weeks/months... and keep me sane.

Tuesday, November 8, 2011

A Good Look at Caregiving in the Sandwich Generation... Please Read!

A friend of mine posted this link on Facebook today... it speaks volumes to the circumstances for those in the Sandwich Generation. The stresses, challenges, and emotions described in this post as they relate to fostering/adopting children are strikingly similar for caring for an elderly person. I highly recommend you read this post and share a link to it with everyone on your list.

MomLifeToday.com - How to Help an Adoptive Family

Saturday, November 5, 2011

The Distance from 2 to 99 is Shorter Than You Think...

Today was my grandmother's 99th birthday.  My husband and I took her to eat catfish at a local restaurant she likes.  We invited other family members to come along.  Joining us were my sister, my cousin and his wife, and of course... Timothy, who was probably Mam-ma's favorite guest.  Actually, it was probably a toss-up between him and my husband, and she sat between two of her favorite fellows.  Having my cousin across the table made her day complete.

Mam-ma is tired.  She looked well and ate fairly well, but when I phoned her this morning, she said she was going back to bed for a while.  She said, "I think it's all downhill from here."  Of course, in true "Mam-ma fashion," she told Timothy a couple of minutes later, "I feel purty good," when he asked her "You feelin' good?"

Timothy spent the night with us last night.  He was so exhausted from a full week of early mornings and long days at daycare.  Since my sister works the 6 a.m. to 2 p.m. shift at a local nursing home as a nurse's aide, he has to be dropped off at daycare at 5:30 a.m.  He does take a 2-hour nap (sometimes longer) each day, and he goes to bed early, but it's still tiring for a 2-year-old.  So he came to our house tired and cranky yesterday, and he spent the first hour or so alternating between playing with toys and standing at the window and crying, his lower lip protruding... saying, "I sad."  Broke my heart.

I finally persuaded him to take a bath, and after soaking and playing with his toys for a while and watching "Jack's Big Music Show," he was rejuvenated and actually played and sang and was a very happy little boy until bedtime.  Thankfully, he has begun going to bed without much fanfare... three stories, two songs, lights out, and he was asleep.  Thank you, LORD!  However, he did awaken this time at 2:00 a.m. and was unable to settle himself back to sleep.  So we had to watch some more "Jack" and "Wonder Pets" and snuggle for awhile.  I put him in bed with me, and he finally went back to sleep before 4:30 a.m. and slept until 8:30.  But just before he succumbed to a second round of slumber, he leaned down from watching "Wonder Pets" and planted a big, spontaneous kiss on my face.  How can you argue with that?!

Today, my husband and I juggled tending to Mam-ma and Timothy throughout the meal.  My husband is such a blessing, and I couldn't manage without him.  He took one vehicle and drove to the ALF to pick up Mam-ma.  The car seat was in our larger SUV, and we decided Mam-ma might not be able to climb into it at this stage.  So I drove Timothy to the restaurant.  After lunch, Timmy went home with my sister, so I swapped cars with Greg and drove Mam-ma back to the ALF.  The maneuvering of a walker into the back of the car is not the same as fastening a toddler into a car seat, but the amount of finagling and rigamarole required is about the same for both.

Once settled back in her room, Mam-ma sat on her bed and talked of resting.  I figured she would have afternoon company.  Morning visitors had happily disrupted her plans to "go back to bed," and as I suspected, she had several guests this afternoon.  She complained that she is not able to make the walk to her friend's apartment in the evenings for tea and have any energy left to enjoy herself.  She also complained that her pants were too tight and she was miserable.  She changed pants, and I took her sharp sewing scissors and snipped some elastic loose from those she wore to lunch... giving her needed breathing room for next time!

I told Mam-ma she needed to rest in case company came, and I gave her a hug and a kiss... and she cried - just as Timothy had cried at the restaurant when I hugged and kissed him and told him he was going home with his grandmother.  They cried for different reasons, but at the end of the day, "I sad" would pretty much cover both of them.  And just like I was unable to console Timmy as he cried and couldn't get back to sleep, I have no answers for Mam-ma at this stage, either, except to tell her that the LORD clearly is not ready for her and she must still have things to do here!

Mam-ma may very well surprise me and live to see her 100th birthday, but I have my doubts.  Life is just beginning for Timmy... but for my grandmother, it's winding down fairly quickly.  He is tired from so much play and the daily absorption of tons of new knowledge.... she is weary from 99 years of learning and living.  So many similarities exist between a 2-year-old and someone who is 99.  The number of years that distance their ages may be vast, but the span of emotions and reactions to them is shorter than you think.
Mam-ma will probably tell others she had a wonderful time, but her limited attention span and hearing loss keep her from fully engaging in conversations and interactions with others now, and it didn't seem like she had all that much fun from my vantage point.  Truly her favorite part of the day was feeding the mountainous plate of chocolate cake and fudge-topped ice cream the restaurant bestowed upon her to Timothy...one gooey spoon at a time.  And that's good enough at this stage, I suppose.  We were together... we celebrated and gave cards and gifts, hugs and kisses, and shared a meal.  What else is there, really?  I'm glad we had this day... and that we got to share it as a family.  Time will tell if we get to do it again next year.

Sunday, October 30, 2011

Where Has Another Month Gone?

I knew it had been a long time since my last post, but almost a month... really? That should tell you something about how things have been going. It has at least seemed like an unusually busy month, and certainly there has been no time to get bored! But isn't that the life of all of us who are members of this Sandwich Generation?!

My sister finished her CNA classes and began a job at a local nursing home, working the 6:00 a.m. to 2:00 p.m. shift. Thankfully (and to my amazement!), the daycare that Timothy attends opens at 5:15 a.m. I asked his teacher, "Do you really have children come that early?" She nodded her head and said, "Oh, yes!" So Timothy arrives at 5:30 a.m., and my sister picks him up in the afternoons, sometime after her shift is over. So far, he is doing well... he certainly enjoys that late morning nap for 2 hours or more! But he is thriving at the daycare and really loving his teachers and his new friends.

When I last posted, my grandmother had just had her monthly visit from the facility physician. She had given him the same complaint she has given me for years, "I can't pee." If you have followed this blog for a while, you know that we even made a visit to her previous family physician for this once, and he tried to explain that she takes Lasix and does not need to go on the hour, every hour, all day long. But still, she continues to complain. So in an effort to appease her, the new doctor ordered an "in and out cath" to see how much urine she retains after going to the bathroom... and to show her that she is really emptying her bladder.

When I arrived for a visit, she said, "The doctor has been here, and he told that nurse they would do surgery." I questioned her... "Surgery? On what?" "Well, on my kidneys... I can't pee." That's when I found the doctor in the facility making rounds, and he assured me it was not surgery - just this "in and out" procedure.

The catheterization showed little urine in the bladder. But in the words of the LPN who administered the procedure, "It looked nasty." A culture was ordered, and we were told that there would probably be medication forthcoming... but not until Monday.

Meanwhile, Mam-ma began to complain of burning and being uncomfortable. The nurses kept telling me, "The doctor cannot prescribe any medication until the cultures are conclusive as to which bacteria is involved... and that will take 3 days." It took roughly four, since the pharmacy that serves the facility did not deliver any medication until late Monday night, and somehow there were no orders from the nurse (or any that were seen by an aide) for the medications to be administered. I now have a box of AZO tucked away in Mam-ma's bathroom that the LPNs or I can administer for the burning, if she has problems again.

In retrospect, this is what has been dragging my grandmother down for weeks. She had a UTI in late July/early August and was on antibiotics. When she became dizzy and disoriented in late August and we transported her to the ER, the attending physician's first idea was, "She has residual infection." But the labs came back clear. Now we realize that this test was probably a "dip stick" in a cup of urine... and without a culture, the underlying infection was not discovered.

At any rate, injections of a very strong antibiotic were ordered for 7 days, accompanied by 7 days of oral antibiotics and something for burning. And... over the weekend, the nurse telephoned and said, "We think Polly has pink eye. Her eye is red and swollen this morning. It's either that or allergies... or she slept on it wrong. We're ordering an antibiotic for that, too!" For seven days, Mam-ma took THREE antibiotics. Now she says she feels better from the UTI, but she is still trying to recover from taking so much medicine.

During all of this, we continued to keep Timothy a day or two here and there. One Saturday morning, I took him to his first birthday party... for a fellow daycare attendee who was turning three. This was a "prince and princess party" - about four little girls in princess attire, and two little boys. Timmy did not go in costume. The party was held at a local playground, and the parents had added a "bouncy castle" and a pinata, as well as a craft project, a cake that looked like something from the Food Channel programming, and party favors that went on for days. The bar is set high for future parties!

My 2 favorite boys... Timothy's
first football game!
Timmy had a ball, but he came home exhausted and really cranky and ready for a long nap. We've also taken him to a couple of local high school/junior high football games lately, and he has loved that... especially the band. It seems that we're learning to take him along wherever we go and continue with our plans as much as possible... knowing full well we may be leaving early. One night we didn't make it to halftime... Timmy fell asleep in my lap during the 2nd quarter!

With the routine of daycare and my sister's job in place, we were actually able to take a few days to help with a conference that was held in our community by the company we developed and sold six years ago. We still stay in touch with the new owners and try to keep up to speed on what is happening with our "baby," and this gave us a chance to renew some relationships and see firsthand how the business is doing today. But it was a hectic, tiring string of days/nights, and then it was back to our "routine" with our own family and household.

After several days of bouncing back and forth between caring for Timmy and seeing about Mam-ma and the conference, I had a chance this week to finally work on our house and get it cleaned and back in some semblance of order. I realized that it had been several weeks since I had actually done laundry for us, so that in itself took a full day or more. When you are washing towels and baby clothes and pajamas every day or so, it is easy to lose track - until you don't have any clean underwear!

We kept Timmy for a couple of days last weekend while my sister worked, and all day Saturday, he was fine. Saturday night we were watching videos on the computer when he suddenly erupted... vomiting everything he had eaten for three days, it seemed. Greg helped me get him stripped and to the bath tub, then watched him while I changed MY clothes and cleaned up the mess. Yes, if you are following this posts, this is twice this month that we have had these events.  This little boy has had a rough few weeks!

After that, Timmy seemed subdued, but okay... until the next morning, when he was sick again. I watched him closely all day and monitored his food and drink, but by Monday morning, he was better and fever free, so I took him to daycare. He did pretty well all day, but that evening, my sister said he threw up all over HER... her first foray into this side of our precious charge! Bless his heart... he is so pitiful when he's sick... and it scares him - he does NOT understand what is happening. My sister had Tuesday off, so she kept Timmy at home and made sure he was feeling better.

I managed to get our house cleaned, laundry washed and ironed, and everything in place before the weekend. Greg had cousins visiting from out of state, and we were planning to spend time at with his family. I made a visit to the ALF to make sure Mam-ma was okay. I picked Timothy up on Friday afternoon at the daycare and brought him to spend the night with us. Greg's family came to our house for a visit and take-out pizza, which made it much easier with the baby. Yesterday we went for a brief visit at Greg's brothers... Timmy in tow... before my sister picked him up when she was finished working.

Today my mother has taken my grandmother for an afternoon drive to see the fall color, which will help her spirits tremendously. Tomorrow, Timmy will Trick-or-Treat at her apartment (I left candy there for her to give him), and next weekend, we will take her to lunch to celebrate her 99th birthday on Saturday. I am hoping that the days in between will be uneventful. The doctor will return for a monthly visit on Friday, and I anticipate that he will declare her to be greatly improved... if not completely well.

I feel like for the moment we are settled into something of a routine... helping with Timothy as needed while my sister works... checking on Mam-ma several times a week... and trying to have a life in between. My husband is so good to go and visit my grandmother, refill her bird feeder, and spend a few minutes with her - just the two of them. She loves that. I already know of at least two people who are planning to visit her from out of town on her birthday, and that will be huge, also. For now, we're trying to make the most of every day... savor the special moments with our little nephew AND my aging grandmother. So far, so good! Yeah, what am I saying?!

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On another note, I still have some checking to do, but it looks like I will not have to change Medicare Part D Prescription Drug Insurance providers for the first year since the program was implemented! Thank you, LORD!!! I think I have had five providers, so far...and that doesn't count the one that Medicare so nicely switched me to on their own the first year! (I got it switched back, since their plan covered virtually NONE of Mam-ma's drugs!) I am glad that at least once, it looks like I won't have to go through all of the shenanigans that are involved to transfer to yet another provider. I will make a call to the pharmacy to doublecheck this tomorrow, but it is looking pretty good at this point! Yippee! See how little it takes to make us Sandwich Generation "fillings" happy?!

AND... a cousin recently suggested to me that I needed to have a DNR order handy for my grandmother, so that no heroic measures will be taken to keep her alive, should something happen. These are her wishes, and I mistakenly assumed that the Living Will covered this. It does not! So... we now have a DNR (Do Not Resuscitate) order on file at the ALF, along with a copy of her Living Will. With both of these in place, no life-sustaining measures should be enacted, were she to have a stroke or heart attack, etc. If you do not have these documents for your aging loved ones, I encourage you to get them. You can download the forms online, or talk to your attorney and ask him/her to supply them.

I talked with Mam-ma about the DNR paper to be sure these were her wishes. She insisted they were, saying she did not want to be a vegetable. "And besides," she added... "the sooner I'm off your hands, the better!" I told her emphatically that she is NOT "on my hands," but I had assumed she was after a "one-way ticket." She said, "Well, I AM!" Gotta love my grandmother!

I hope things are well in your "Sandwich" this week!