Monday, August 29, 2011

A Day Full of Changes

Today was a day of changes. I took Timothy to a local in-home daycare facility to "test the waters" and see how he would do. He did better than I expected. I decided a few days ago that he needed the company and stimulation of children his own age. I told my mother, "Timothy is bored." She countered, "How could he possibly be bored at your house with all of the toys, books, and you and Greg to entertain him?!" I replied, "He's done it all by noon - twice!" I talked with moms of small children and others and decided that a few days a week at a local daycare would help him... and give his grandmother and me a breather, too.

So this morning, we visited, played, had lunch, and came home. I slipped into in another room a couple of times to see what he would do, and always, he came looking for DebDeb... "Where are oooo?" And he was not having any of the lying down on rest mats for nap time. So rather than cause a scene, we left. The teachers assured me that when I am not there, he will mimic the others and lie down without incident... something I experienced myself as a kindergarten teacher. And I hope so, because he is going back for the day later this week.

While we were there, my husband phoned to tell me that my dear friend, my "Birthday Buddy," Geraldine McCurry, whom I call MawMac, died last night. She was 93 on our birthday, July 4th... and she told me then that she was ready to go to heaven. Sadly, her almost-60-year-old daughter, Mary, died Saturday. Mary was born with cerebral palsy that crippled her body... and her family valiantly cared for her at home until she was well into her adult years and MawMac and a live-in caregiver both became too old to continue in-home care. This entire family treated Mary with love and respect in a time when most families put disabled children into group homes or facilities and treated them much differently. Mary had a bright mind - communicated clearly with her family members - and even played a mean hand of bridge! She was always amazing to me.

Everyone suspected that when one died, the other would not live long. We just didn't know it would be only a day apart. I saw MawMac yesterday, but she was sleeping and I didn't wake her. I last saw her awake on Tuesday, when I returned from the ER with Mam-ma. She was in the hallway, and aides were rolling her to the dining hall for dinner... her medications in one hand, a can of Coke with a straw in the other! I will forever remember the infamous "chicken livers" conversation of a month ago, when she informed me that "Someone needs to tell the kitchen you fry chicken in flour, not batter!"

This evening, I pondered the irony of this day - my angst at taking 2-year-old Timothy to daycare... would he feel I had abandoned him? Would he be frightened and confused? Would he have fun, as I hoped? On the other hand, I thought of my dear friend MawMac, who gave me such joy and wonderful advice... who never met a stranger, but could get to the heart of the matter and demonstrate Christian love and dedication like no other. She is no longer there to visit when I visit Mam-ma at the ALF. No more funny stories of life as we knew it in our small town when I was a child. No more great recollections of seeing my mother before I was born and suggesting she wait and have me on her birthday (and she did!)... no more shared cakes and Happy Birthday phone calls... and no more days of pain and suffering for her in her tiny body shrunken by osteoporosis some four plus inches.

A week ago, MawMac's two surviving daughters were struggling to juggle the care of their sister and their mother... wondering who would go first... wondering how the other would handle the passing of either daughter or mother. And now, in the course of a weekend, both women are gone. And just like that, their lives are changed forever. Last week, a minister in our area was preaching a funeral and fell dead in mid-sermon. He was fifty-five.

I called Mam-ma this afternoon to see how she was doing. She said, "Kindly sad." She then said someone had asked her how she was feeling about her friend's death, and she said, "Relieved." She knew MawMac was not well... and that she would be so grieved over her daughter's death. At the same time, it's hard on these older folks when their friends pass away... a harsh reminder of how brief the time is that they have left on earth.

Celebrating Geraldine's 90th - 3 years ago
 On days when we wonder how we will manage... how we will get it all done, we would do well to remember how quickly time passes... how fast babies grow... how soon our elders are gone... and how fragile life really is. Today was one of those days for me... a day to cherish the time I have with Timothy as he experiences milestones and growth spurts... a day to check on my grandmother, make sure she was doing okay, and encourage her to spend time with her remaining dining table mates and encourage one another...and a day to reflect on the blessing of my dear friend Geraldine, whom I called MawMac.

Friday, August 26, 2011

I'm So Dizzy... My Head is Spinning...

It almost never fails.  Timothy comes for a visit, and Mam-ma Polly has a "spell!"  So I should not have been surprised when my phone rang Sunday evening... "I tell you what," Mam-ma began... "I've got to go to the doctor.  I'm can't take much more of this being dizzy."  Mam-ma's dizziness had first been reported to me on Thursday, when the nurse arrived for work that morning to find Mam-ma sitting on the porch, overheated and wearing a thick sweater fastened tightly up to her chin.  The nurse made her go inside.  She also discovered that Mam-ma had not taken her night-time "sleep aid" because, as she told me later... "I don't want to get hooked on drugs."

I asked Mam-ma if she had spoken to her nurse, and she said she had.  I told her I would speak with the nurse, also... at least by Monday morning.  She then asked, "Have you got the baby?"  "Yes," I answered... "but I will still talk with your nurse."  We hung up, and I phoned the nurse at the ALF.  It occurred to me that when I first moved Mam-ma to Southridge, I took all of her meds from home... and there was a scrip for Meclizine, which is prescribed for vertigo.  When I spoke with Peggy, the weekend nurse, she said that all vital signs were good.  I asked about the Meclezine, and she said, "You are right!  She does have some... I will give her one."

So Monday morning, Timothy and I went to check on Mam-ma.  She was dressed, but lying down on her bed, covered with an afghan.  She said she was still dizzy.  I spoke with the daytime nurse, Lola, and made sure that she was aware of the dizziness problem persisting... and she said she would keep Mam-ma on the Meclizine - and let her doctor know what was going on.  I thought all was well.

So we had chalked up her dizziness to the heat and lack of sleep. All vital signs were good. I visited her on Friday, and she seemed fine. I returned on Saturday, and she was still well. When she called Sunday night, her first words were, "I bet you don't have time to talk to me." "Why would you think that?" I replied. She couldn't say. But she told me she needed to see a doctor for her dizziness. I reminded her that we no longer see a doctor - the doctor comes to see her now... every month. If there is a problem in between times, we need to report it to the nurse, who will talk with the doctor.

Tuesday afternoon, the phone rang... Lola.  She said Mam-ma was still dizzy, and that she was not able to put her thoughts together well.  She said, "It's worse than yesterday.  I've spoken with her doctor, and he either wants her taken to our local ER... or transported to the hospital where he is in Jacksonville (some 50 miles away), so that he can do a total work-up on her.  Now, while I am having this conversation, Timothy has picked up the extra phone in our bedroom and is talking to Lola... "Un-huh...oooohhh... yeah, yeah, yeah..." mimicking me and my responses to Lola!  I got him off the phone and told Lola that I thought we would opt for the ER, but I would talk with my husband and get back with her shortly.

My husband said he would watch Timothy while I went to the ALF to check on things.  When I arrived, Mam-ma was confused and dizzy, and we all agreed she needed to be transported to the ER.  An ambulance came almost immediately, and off we went.  I was not comfortable driving her there... and I knew that if we walked in, there was every possibility she would be made to sit up and wait in the waiting area for who knows how long.  This way, she was wheeled immediately to a room.

Immediately an IV port was inserted, and Mam-ma was hooked to the machine to monitor her vitals.  Her blood pressure was 114/69 - a very low reading for her.  I was doubly glad we came and that I had her transported by ambulance.  I handed my print-out to the nurses that contained all of Mam-ma's data - insurance/Social Security numbers, medications and dosages, prior surgeries and medical history, contact info for emergencies, allergies, and more.  They were all extremely impressed!

The ALF doctor had suspected an inner ear problem, but Mam-ma's ears were clear.  The ER doc suspected a lingering UTI, since she was treated for one a month or so ago, and he said sometimes they can be hard to obliterate - and cause all sorts of troubles, including dizziness.  An EKG, chest X-ray, CT-scan, and lab work were ordered to rule out stroke, heart attack, renal failure, and a thyroid problem.  All came back as "normal."  The urinalysis was clear - no infection.  Kidney function was slightly diminished, but the doctor said, "I'll take it for 98 years old.  In fact, I'd take her labs any day of the week!"

The diagnosis was just unexplained dizziness... treatment was to continue Meclizine for a few days, stay off her feet and use a wheelchair to get around... and hope it subsided.  Someone from the ALF came and got her and drove her back to the ALF.  I followed, and we got her settled in bed.
James, the maintenance guy, had come to see Mam-ma as the ambulance personnel arrived, and he had promised her that "we'll get those cherries planted when you get back."  I didn't know what that was all about.  But later Tuesday night, my mother and her husband dropped in to check on Mam-ma, and she let it slip that she has been sent "to the house" several times lately for getting overheated.  In fact, Tuesday morning, she had asked James to lower the hanging flower baskets on the front porch so she could remove dead leaves, and she got dizzy and fell.  She told me this in the ER... but she had not told her nurse or the aides that she fell.  Luckily, she was not hurt.

She told my mom that while cousins visited recently, they purchased fresh cherries at the store, and Mam-ma saved the pits and dried them to plant.  She said James told her he would dig a hole and help her plant them... and that "we'll never see them," meaning she won't live enough to see a tree grow from those cherry seeds!  Lola, the nurse, told me later that Mam-ma told James that she needed to dig the hole herself!  I told Lola that I had experience with Mam-ma and hole digging - and I had wrestled a shovel from her once, and she cursed at me!  Lola was stunned.  I told her, "I'm just warning you... she can be a stinker!"

Anyway, I talked to James, and he assured me that he would take good care of Mam-ma and make sure she was "happy, but that she doesn't get hurt."  Because he is a man, and Mam-ma adores him, he might have a shot at making that happen!  While Mom and her husband visited Mam-ma, an aide came in with clean laundry and put it away in the drawers.  Another aide came in to retrieve Mam-ma's dinner dishes... and Mam-ma had already been up and returned them to the kitchen!  So much for staying off her feet and in a wheelchair!

The bottom line is, we are pretty certain that Mam-ma is overheating, despite her protests that she is not.  She claims she is cold and doesn't sweat.  The nurse has tried to explain to her that just because you don't feel hot and sweaty doesn't mean you are not overheating.  She was also told in the ER that she needed to drink more fluids throughout the day... something she does not do.

When I got back home, Timothy had slept 2.5 hours, so his Uncle Greg had really had a fairly easy time of it, thank goodness.  I had alerted my mom and my sister, and both were on standby, should I need them.  But all worked out well in that regard.

I have cautioned Lola that my grandmother is stubborn and fiesty... and she doesn't listen.  She will probably get overheated again... and that's just the way it is.  My sister took Timothy to visit on Thursday, and she was already out of the wheelchair and using her walker again.  My sister said the wheelchair was parked in the hallway outside Mam-ma's door... as if she were done with it!  She pushed Timothy up the hallway in her walker... actually quite a distance.  So I assume she is feeling better and the Mecclizine has worked.

The other concern I had at the ER was what might be done for - and to - my grandmother.  I could see she was not "right," but based on my experience with her, I felt this still was not all that serious.  And I questioned the doctor about all of the tests... were they really necessary?  What would they do should a problem be found?  After all, she is almost 99, a DNR (Do Not Recuscitate) patient, and she does not want any heroic measures taken to prolong her life.  The doctor agreed... no surgeries, nothing invasive.  But he said, "If it is a stroke or her thyroid, we might adjust her medications.  If it is a UTI or a heart attack, we would give appropriate medications to treat the problem."

I felt better knowing that we were on the same wave-length, and my point is that you must speak up.  You must advocate for your loved one and say, "Hey... no heroics here.  No unnecessary poking and prodding and making him/her uncomfortable.  We're not here to run a tab to Kingdom Come - even if Medicare and other insurances will cover it."  After all, my grandmother and I had just had "the conversation" on Saturday about the last days of her life and how she does not want to be a burden - or put through the wringer.

So for now, the "crisis" of the moment is averted.  Timothy comes again to stay with us for a few days on Sunday, so who knows what will happen.  One thing is for certain... it will never be dull!

Saturday, August 20, 2011

It's the In-between That's Worrisome...

As I prepared dinner a few nights ago, I asked my husband, "Did you hear on the news that Robert Redford is 75 today?"  He responded.  About 20 minutes later, we sat down to dinner, and during the course of the meal, I turned to my husband and asked, "Did you hear on the news that Robert Redford is 75 today?"  He looked at me like I had just grown a third eye.  "I asked you that already, didn't I?" I said as I shrunk down in my chair, totally embarrassed.  "Yes," he answered.  "What was your answer?" I countered.  It's the little things that make you wonder if you are really losing it ... or if you just temporarily tripped a breaker somewhere.  I'm hoping for the latter!

So when I visited my grandmother today, every other sentence she began ended in, "I don't know," or "I forgot what I was going to say."  This has not been a good week.  Timothy's family has been here for a visit (and that is a good thing), and when my niece took the babies to see Mam-ma on Wednesday, she was lying in bed and said she was dizzy and did not feel well enough for company.  I queried the nurse, who said all vital signs were good.  However, when she arrived for work that morning, Mam-ma was sitting on the front porch wearing a thick sweater that was buttoned up all the way under her chin.  We are still in the middle of an oppressive heat wave, with morning temps in the upper 80s and extremely high humidity, giving us some record heat indexes.

Lola, the nurse, asked my grandmother, "What are you trying to do - give yourself a heat stroke?"  I think she made Mam-ma go inside.  Then she discovered that Mam-ma was dizzy - and she said she had not slept the night before because she refused to take her Ativan (a prescription drug she takes in a very low dose for anxiety and as a night-time sleep aid).  The nurse told me, "I know what is happening... I overheard enough of a conversation in the dining room to know that the little ladies at Polly's table have convinced her she shouldn't be taking something at night to help her sleep."

When I talked with my grandmother later, she said she had tried to cut out her Ativan, because... "I don't want to get hooked on drugs."  She also claimed her sweater was a very light jacket over a very thin blouse.  I seriously doubt it.  I've seen her sweaters and blouses.  At any rate, I told her to take the Ativan and quit worrying about it... she needs a good night's rest.  Lola told her that overheating and not sleeping were enough to make anyone dizzy and feeling badly.

So today when I went to visit, Mam-ma was in the dining room listening to some live music.  However, she quickly told me she was not well, and we went to her room to visit.  She claims she is still dizzy.  We visited about a funeral I had just attended for a man who was a deacon in her church and a lifelong friend.  I told her neat things that had been posted on Facebook - recollections from former students who rode her school bus.  And I told her about delivering Meals on Wheels to an old friend of hers who worked at a local Piggly Wiggly "back in the day" with Mam-ma's sister.  Then we walked down the hall to visit my birthday buddy, MawMac, who is also a dear friend of my grandmother's.  She's not doing so well these days, but she enjoyed our visit.

When we returned to Mam-ma's room, she told me she was not going to go to tea ... that she had not been in over a week, primarily because she is not able to remember what she wants to say, and it's embarrassing to her.  MawMac had just told me how much she enjoys my grandmother's visits - and Mam-ma barely said a word while we were there.  I pointed this out and said, "You don't have to say anything - those ladies want you there... even if you don't say a word.  All you have to do is walk down to MawMac's room and hold her hand, and she is happy you came for a visit - and it's the same for your tea ladies."  I also told her I bet the tea ladies were missing her... and she replied, "Well, I'm missing them."  So she agreed to give it another try.

But when I mentioned leaving, she said, "I wish you would come more often," and she began to cry.  This was about the fourth time she had broken down and cried today, but usually it's over fairly quickly as she remembers something sad and then recovers.  This time was different.  I asked what was wrong, and she said, "Well, I know you are busy," and I laughed and said, "Mam-ma - you are busy, too!"  She said, "I know it, but things are changing."  I took that to mean her inability to string thoughts together well these days, and a general decline in her overall well-being.  I told her, "Mam-ma, I want you to live a long, long time.  But I will tell you, the day you go to heaven, I'm not going to be sad, because you will be a whole lot happier than the rest of us!"  She agreed... and said, "That's not it." 

It took her awhile, but she finally said, "I'm not afraid of dying... it's the in-between that worries me."  I told her I could understand, but we don't get to choose that.  I asked if she was worried about suffering, and she shook her head, "No!"  She was finally able to tell me that she doesn't want to be a burden.  I assured her she would not be - that she is not a burden now, and she never will be.  Whatever happens, we will deal with it.

I also explained that she can live out her days in her apartment.  The facility has Hospice, and barring something that would cause her to have to be hospitalized, she can stay right where she is for the rest of her life.  She said she didn't know that.  I assured her that she was surrounded by people who love her and care about her... she has a resident doctor, nurses, and there can be Hospice nurses if/when they are needed.  She will never be a burden.

Part of this is melodrama on my grandmother's part...her specialty!  But part of it is a genuine realization - brought home by almost a half dozen funerals for friends and acquaintances in rather short order - that her life is winding down.  Mam-ma will be 99 in November.  She sees the rapid decline of our friend, MawMac, who is only 93... and she has seen friends get sick one week and die the next.  She knows how quickly things can change.  On top of this, it bothers her greatly that my niece has moved her family to Texas, more than 7 hours away.  She even told my niece, "I will try to live until you come home for Christmas." (Yes, she is a drama queen!)

I assured Mam-ma that I would visit more often... and I will.  Timothy is here for an extended visit, and we will go and see her.  But I cannot stop the clock... or the aging process.  I have no control over my grandmother's last days/weeks/months on this earth - nor how the end will come.  I also know that I could die before she does. A business friend of mine died in a motorcycle accident just last week at age 55.  None of us is promised another day!

So I think my take-away for this post is that a lot of times we don't really know what is bothering our seniors... and they can't seem to put it into words.  But it just may be that they are wrestling with their own mortality.  I told Mam-ma today that I don't want her to spend her time worrying about what is going to happen to her - or how and when she will die.  I want her to be busy enjoying her life and being happy.  The rest will take care of itself.  I also hugged her tightly as she sobbed and told her that we have been through far too much already to fall apart now.  And I used one of her favorite phrases (with a chuckle) and told her to "dry it up!"  She laughed.

Tomorrow, my grandmother may not remember our conversation... and I have no doubt that we will have these teary encounters again... and I will once again reassure her that she will always be loved and cared for - and all of her needs will be met.  Meanwhile, I am going to make an effort to visit more often and hope that encourages her... and I am going to try to be patient and listen - let her vent her frustrations and worries.  I'm going to remind myself that knowing that the end of one's life is imminent is daunting... no matter how strong your faith is or how excited you are to get to Heaven and reunite with loved ones there.

When Mam-ma complained today of not being able to get her thoughts together and remember what she wanted to say, I shared my "Robert Redford" story and told her it happens to all of us... even those in our 50s instead of our 90s... and she laughed.  We still have lots of miles left in this journey, hopefully... and I want them to be happy, productive ones - for Mam-ma, and for us.  I just hope I can remember what I told her the last time I visited!