Wednesday, September 7, 2011

It's All Part of the Sandwich!

Give me a week, and everything can change!  I visited my grandmother last Friday (if you are counting, that was five days ago), and she seemed so-so.  Of course, I'm sure the death of her friend Geraldine - "MawMac", my Birthday Buddy - impacted her and made her sad.  But overall, she seemed a little more frail and subdued in general.  Her associate pastor and his wife had been there for lunch, hosting all of the ladies from Mam-ma's church who live at Southridge for a meal in the parlor.  I asked her if she planned to nap in the afternoon, and she said she really didn't know what was planned.  Then she added, "Gladys thinks she's having a birthday party, but it's not her birthday!"

In the meantime, she casually mentioned that the doctor had been there that morning - her first visit with him since we switched and made him the primary care physician.  I asked, "And what did you think?"  She replied, "Well... I don't know.  He changed my medicine all up."  I questioned her further, and she said he had discontinued her lasix and reduced her B-12 dosage.  I looked down at her very swollen ankles and said, "I need to talk to the nurse about this."  I found the nurse, who confirmed that yes, the doctor had discontinued lasix, potassium, and he had decreased her B-12 shots from one every 2 weeks to once a month.  She told me the doctor and his nurse were still in the building... did I want to see them?  Yes, of course!  So she sent him to Mam-ma's room.

The doctor came in and explained that Mam-ma had told him she thought she had had a stroke during the week... and her speech was difficult and slow - as were her thoughts.  She wagged her bony finger at me and said, "You know this... I've been a tellin' you that I can't get my words together to talk right."  I agreed... but I reminded her that this had been going on for at least a couple of weeks - maybe longer.  She insisted it was since our trip to the ER the week before.  I told the doctor how she would not stay inside out of the heat, and the nurse piped up and said, "Oh, believe me, I know... I chased her halfway around the building this morning to get her back inside out of the heat."  I explained to them that Mam-ma doesn't believe she is overheating, because she doesn't feel warm, and she doesn't perspire.  They said they understood.

Still, the doctor said he wanted to temporarily make these changes, do some lab work to test blood counts and her thyroid, and see if the dizziness subsided.  He said if she felt like she was having a stroke - or might have just had one - she was to tell a nurse, who would administer an aspirin and call an ambulance to transport her to the ER for a CT-scan.  This would tell him whether to prescribe something stronger, like Plavix.  I am still not sure that I understand all of this for a nearly 99-year-old woman, but he did mention preventing a fall... and if the medication will do this or prevent a stroke that leaves her in a vegetative state, I am all for that.  It's just a gamble, in my book, to change anything at this point.  But this doctor is supposed to be a specialist in geriatrics, so we will trust his judgment... after all, I have signed for him to handle Mam-ma's medical care!

I did mention that we discovered at the ER that somewhere in the last 5 years, Mam-ma has had a documentable stroke on the right side.  The doctor confirmed this.  We had never been told this before... and it is not a TIA... one of those mini-strokes Mam-ma has felt like she experienced a few times.  This was a bonafide, measurable stroke... and one the ER doc said was common in older folks.  So she is prone to more of them, given her history and her age.  So we agreed to discontinue the meds and do the tests... and to monitor Mam-ma's blood pressure and overall condition for at least a week and see what happens.  The doctor shook my hand and went on his way.

Soon, there was a knock at the door, and Gladys' daughter-in-law, Margaret, appeared.  "Do you want to play Chicken Foot with Gladys and the other ladies this afternoon?" she asked Mam-ma.  "It's Gladys' birthday, and your Sunday School teacher and friends are coming to play dominoes."  "Of course she wants to play!" I interjected.  Mam-ma sorta shrugged.  I looked at her and asked, "You want to play dominoes, don't you?"  "Well, I guess," she replied.

Margaret explained that dominoes began at 2:00 p.m., followed by sandwiches and birthday cake at 5:00.  A former nursing home R.N., Margaret is a "take-charge" type, and she had already notified the kitchen that these ladies would be dining elsewhere that evening.  She said she would be back to help Mam-ma to the parlor and left.

I had taken a new bird feeder to replace Mam-ma's old one, which broke, and she was very tickled to have fresh birdseed and the new feeder. She also sent home a couple of items of clothing for me to launder.

I helped Mam-ma change her sweater, comb her hair, and she put in lipstick and some rhinestone earrings that matched her blouse.  I then walked her to the parlor for dominoes and the party.  Margaret gathered the rest of the ladies, and I greeted those who had arrived from their individual homes in town as they came through the door, including Mam-ma's dear friend, Ruby.  It looked like a lot of work had gone into planning these events, and I'm sure the ladies all had a great time that afternoon.  I was thankful Mam-ma had so much to do to occupy her for the rest of the day and evening.

Later, Mam-ma phoned me to say she was "home," and that she had had a really good time, but she was too tired to return to tea. She said Gladys went back to her apartment at 6:00 p.m., because she goes to bed early but that... "Some of the rest of us stayed until 6:30!"   The next day, Mam-ma phoned me again, with some excuse for calling that didn't make any sense.  Basically, she just wanted to talk.  And if I remember right, she did that again on Sunday, too.  It was fine... I certainly didn't mind... but all of a sudden, she became more needy for several days.

Saturday afternoon, I picked up Timothy at my sister's.  Our plan was to take him to church Sunday morning, and keep him Monday while my sister worked, then take him to daycare for the day on Tuesday.  My sister would pick him up there after she finished working.  That was the plan.  When I picked up Timothy at my sister's, his nose looked a little runny.  I questioned her, and she said, "It was running "green" when I picked him up at daycare on Thursday, but he's been fine since."  Honestly, I didn't notice a runny nose again that evening, but he did seem to have a slight cough.  I turned on the vaporizer, hoping to help with any possible congestion when he laid down for the night.

In the middle of the night, Timothy awoke - just before 3:00 a.m., pressed his little nose and said, "Nose!"  He was stuffed up and coughing.  We were awake 2 hours, watching Jack's Big Music Show, before he was able to settle in and get back to sleep at 5:00.  He slept until nearly 8:30 - there would be no getting to church by 9:30!

Sunday afternoon, Timmy laid down for a nap, and after sleeping for an hour, I heard him crying.  I went to check on him, and he was drenched... clothes, hair was literally dripping wet... bed linens were soaked.  I put him in our bed under a fan and cooled him down... and he slept another 2 hours.  When he awoke, his cough seemed to increase gradually. We played outside for just a bit late Sunday afternoon. A front had come through bringing cooler temperatures and a breeze, and Timmy enjoyed playing on the driveway with toy trucks - and running in the grass in our front yard.  It's been so hot in Arkansas for weeks that we have not had many chances to play outside.  When it only "cools" to a humid 85 at night, that's not much fun for outdoor play.

I figured Timmy would be up half the night after his 3-hour nap, but he went to bed around 10:00 p.m. with no fanfare. I ran the vaporizer again... just in case he had trouble with congestion in the night. He slept fitfully - was all over the bed - but he didn't wake up until almost 7:00 a.m.  He sat up in bed, pointed at the TV, and said, "Jack!"  I turned on the TV, and he said, "Milk!"  I went to the kitchen to get him a cup of milk, and before I could return, I heard him coughing... and wheezing... then gasping for air.  I got him up and started trying to prepare a steamy washcloth with eucalyptus oil... something I have done in the past for him.  I put a few drops on a steamy hot washcloth and held it to his face for him to inhale. He would have none of that!

By this time, my husband had come to see about us.  He had been in his office upstairs, and he said he heard the wheezing from there.  He said, "That sounds like asthma!"  I agreed, and we both felt Timmy needed instant medical attention.  We threw on clothes and loaded Timothy into the car and headed for the hospital, which is only about 2 minutes away from our house.  Once there, Timmy was quickly admitted.  Then the fun began...

Everything went fine for the first temperature check and when the nurse put the pulse-ox clip on his finger.  But when that device was too large, she had to switch to a band-aid style device, and he was not having it on his finger.  She tried the band on his toe, with mixed results.  Then the nurse added the BP cuff... and when it tightened on Timmy's arm, he started to scream.  It was downhill from there.

Timmy was in hysterics, and nothing we did could console him.  Both Greg and I tried to reassure him, but he was having none of it.  The ER doc was great... and very patient.  But he could not hear anything in his stethoscope when he listened to Timmy's lungs except screaming and my hand patting his back to soothe him.  He almost never got the device into Timothy's ears to have a look.  The one thing that went well was looking into his throat.  With all of the screaming, there was a clear shot well past his tonsils!

The doctor ordered a breathing treatment for the respiratory distress.  A very nice therapist arrived with a mask that sported a cute little dragon face.  She tried to show Timmy how the mask would make smoke.  It took three of us to hold him down to put the mask on... no, near... his face.  The treatment was supposed to last 5 minutes... we might have made it 2 minutes before calling it quits.  But it was enough to greatly decrease the wheezing and gasping.

The doctor wanted to rule out pneumonia... and the only way to do this was with a chest x-ray.  He said, "I do not want to draw labs unless I absolutely have to... so hopefully the x-ray will tell us what we need to know."  The x-ray tech, a woman who attends our church, arrived.  Timmy was still in hysterics.  She said he would have to sit on the end of the table, but that I could hold the film between him and me and hold him.  We tried to accomplish this, but Timmy would not let me put the film between us.  The tech clearly got exasperated and irritated, and at one point, she quipped, "Where are the parents?"  "They're in Texas," I shot back, equally irritated - with her!  This was not the time to explain family dynamics and who we were and why we were there with this child!

The tech said, "I think you two are going to have to leave the room, and we'll call in nurses to hold him."  Now, this sent me spinning.  I asked if there was any other way... could we not just get some medicine and leave?  The nurses said there was no way the doctor would prescribe anything without at least a chest x-ray.  The nurse and respiratory therapist arrived and assured me they would hold him and not let anything happen to him.  Reluctantly we walked out, and I told Greg, "I'm giving her 2 minutes!"

Almost instantly, Greg saw the light come on signaling that one x-ray had been accomplished.  The screaming subsided... but only slightly.  I was in tears, and now Greg had TWO babies to console!  Poor man!  The door opened, and the tech asked me to come back in and help hold up Timothy's arms for a profile shot.  I tried... as he protested... and we got an x-ray of arms - I think mine, the respiratory tech's and the nurse's... perhaps the baby's!  They decided to roll with the one good x-ray, which the doctor gave me the "thumbs up" on and declared all clear - no pneumonia.

So the doctor determined this was probably allergies or viral... but he ordered a workup at Timothy's pediatric office to rule out asthma.  He wrote an optional prescription for a steroid syrup for the wheezing... and he recommended an OTC antihistamine to control the symptoms and the cough, plus children's acetaminophen for the fever.  Greg and I loaded our exhausted, sweaty little boy into the car and drove home.  We started him on children's Zyrtec, and he seemed to improve throughout the day... although he took another 3-hour nap.

Tuesday, Timothy was out of sorts from whatever ailed him, plus the medications.  He was a typical 2-year-old for much of the day and had a fairly short fuse. I did not send him to daycare, because he was irritable and may have still had a slight fever. He slept three hours again in the afternoon.  Today, his grandparents took him to the pediatrician, who says this is allergies, not asthma.  He gave them an inhaler and said to keep using the OTC antihistamine.

To say I am somewhat drained is an understatement.  I am trying to take these things all in stride, but it's been a crazy two weeks.  I have made two trips to the ER, been to two funerals for dear friends, and tried to console a 99-year-old and a 2-year-old... all while trying to continue to have some semblance of a life!  I know from previous experience that this is really small potatoes in the scheme of things... and no big deal compared to what others are dealing with!  But I, like many others, have been thrust into circumstances I never expected... this "sandwich" life... and momentarily, it can throw me for a loop!

In an attempt to cope, I am reading the book Boundaries... When to Say Yes... How to Say No by Henry Cloud and John Townsend.  I have also downloaded a couple onto my Kindle... one recommended by a dear friend and young mother of 2... Shepherding a Child's Heart by Ted Tripp... and another that looked good... Don't Make Me Count to Three by Ginger Plowman.  I have learned a lot from the Boundaries book already and even found a matching workbook at a yard sale last weekend, so I plan to really study it in-depth (did I mention I have issues with boundaries?!).  I will be sure to report and give a review of the other two when I finish.  I also did a Google search about 2-year-old tantrums and found some great links...
Finally, I have to say that I'm looking for ways to cherish every moment with both my grandmother - and Timothy.  Honestly, I don't know how long we will have Mam-ma with us... and Timothy's visit is supposed to be short-term.  So I want to treasure this time with both of them.

When I took Mam-ma to the ER, I had grabbed my Kindle as I went out the door.  I had downloaded a really great short story written by my friend, John Sykes, called Shirley Takes the Shot.  It's about a hog killing in the South.  I knew my grandmother would love it, so while we waited for labs to be processed, I read the story to her.  She laughed and chuckled... and she recalled a hog killing or two from her past.  It was a good time... one of those really neat, precious moments that we don't have often enough these days... and one that will be treasured for a long time.

When you can find a way to make lemons out of lemonade even while sitting in an ER exam room, things can't possibly be all that bad.  I hope you are finding treasured moments of your own these days.

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