Sunday, January 8, 2012

Are You Smarter Than a 99-year-old?

It didn't take my grandmother long to outsmart some of the efforts to keep her safe and prevent another fall.  So it came as no surprise to me when the facility R.N. called on Friday and said, "Ms. Polly is a smart woman.  She has figured out how to turn off her bed alarm, rendering it virtually ineffective as a safety device.  Is it okay with you if I take it out of her room?"  I laughed and told her yes, that was fine.  Clearly, if she can disarm it before aides arrive, we all know she can be off and running (so to speak) and into a whole heap of trouble before help arrives.  And bending down under the bed to turn off the alarm is enough to make her fall in the first place!

The nurse also noted that my grandmother is FAST, which also came as no surprise to me.  On Thursday morning, I had spoken with Mam-ma and reminded her that I was picking her up later that day for a 1:45 p.m. appointment at the hospital outpatient clinic with her cardiologist.  Telling me anything on the phone takes her forever now (and it's not much better in person), but she managed to convey that she was not happy with what she was wearing - that the aides select her outfits each day, and she didn't approve of this one for a trip to the doctor. 

I told her, "Don't worry about it.  I will come at 1:00 and help you dress - and I will fix your hair."  She was scheduled to see the hairdresser when we returned from her doctor visit, but I knew her hair looked awful, and I had taken my curling iron once before and worked on it.  I could at least make her presentable.  So shortly before 1:00 p.m., I loaded my hot curlers and curling iron into the car and headed to the facility.

When I knocked on Mam-ma's door and tried the handle, it opened, and I stepped inside.  "Knock! Knock!" I called.  No answer.  I started looking around.  Mam-ma's call button was on the TV table.  She was not in the room.  I even looked over on the floor between her bed and the window.  She wasn't there.  I looked in the bathroom... not there, either.  I realized that her walker was gone, too.  GREAT!  She's loose in the facility, without even a call button if she falls and needs help!

I stepped back out of the room and walked to the dining area, where several residents were still eating.  No Mam-ma.  I saw the maintenance man, James, and asked, "Have you seen Polly?"  "Yes!  She was just here eating."  He stepped toward her table and realized she was not there, just as an aide said, "Polly's gone to the doctor."  No... I had come to get Polly to take her to the doctor.  The aide continued... "Mary Lou took her already."  Mary Lou is the driver for the facility.  The aide suggested I ask the nurse.  I went to the nurse's office, and sure enough, a phone call to Mary Lou revealed that she was already at the hospital with Polly and another client.

We surmised that the cardiologist's office had phoned the facility instead of me to remind us about the appointment.  When the facility got the call, they placed the appointment on the driver's calendar.  I didn't realize I didn't get the call... and I didn't call the facility to tell them I was taking Mam-ma myself, because I didn't figure it mattered.  Next time - if there is one - I will call.  I utilize the driver for routine things like trips to have her dentures adjusted, a routine pacemaker check, and more.  But when I feel I need to be with Mam-ma and hear what a doctor has to say, I will drive her myself.

So I hurried to the hospital, where I found Mam-ma, the driver, and the other resident sitting in the outpatient waiting area.  Mam-ma looked up at me, grinned, and said, "Well!  I didn't know you was a comin'."  I just laughed.  The driver began to apologize, and I assured her it was not her fault.  However, she had fed both ladies their lunch early and brought them both to the hospital before 1:00, because the other resident had an appointment at that hour.  This meant that Mam-ma was sitting a full 45 minutes before her appointment time.  We didn't ultimately get in to see the doctor until about 2:15 p.m., which meant Mam-ma sat and waited over an hour.  This might not seem like a big deal - and it's not for you and me.  But for a 99-year-old who tires easily, this is an eternity.  Think sitting and waiting with a 2-year-old for over an hour, and you sorta get the picture.  Mam-ma got stiff, and her ankles began to swell a bit from sitting and dangling her legs. 

In the exam room, I had Mam-ma prop up her feet.  The exam was fairly routine... the doctor listened to her breathing and we discussed her hospital visits and the treatments.  He looked at her ankles, and we discussed some of the medications she was given in the hospital and emergency room.  Then he asked Mam-ma if she had any questions, and she raised a bony finger and pointed it at him and said, "Yes... they won't let me leave my room!"  He looked at me, and I said, "Translation... she cannot leave her room without an aide accompanying her, because she is a fall risk."  The doctor launched into a dissertation on how at age 99, a lot more goes into walking than merely walking... balance, memory, muscle tone, strength, and concentration, to name a few.  He agreed that she needs someone with her.

"She wants to go outside and walk on the sidewalk," I added.  "Oh, no, Ma'am!" he said.  "You've already had a bad fall, and you are really very lucky.  Your fall on Christmas Eve could have been so much worse... so much worse."  She just looked at him.  He asked if there was anything else, and she said, "No, but your answer disappoints me."  He just laughed and said he would like to see us again in six months... or sooner if we need him.

By the time I got Mam-ma back to the facility, it was just after 3:00 p.m., and her hairdresser was waiting for her.  She called me later that evening, and she was exhausted.  I was not surprised.  However, the nurse assured me Friday morning that she was alert, clear, and transferring well from one place to another, i.e. chairs, her walker, and more.  The 30-minute checks by aides are still in place, but the alarm has been removed.

Then, Saturday night, I got a phone call about 7:30.  I saw on Caller ID that it was my grandmother, but when I answered, there was no response. I called her name, and finally, she said in a weak voice, "Well, I was calling for Greg (my husband)." I offered to get him, but asked what she needed. It was a 10-minuted convoluted conversation about something about trying to call my cousin Ricky and not being able to get him... then she couldn't get anyone on the phone - all she gets are busy signals... and then it was crying, and "I'm crazy."  She managed to tell me, "I called Ricky this afternoon... and he came over here."  Then why did she need to talk to him again that night?  "I don't know," she cried. 

We went back and forth - she wasn't hurt, she wasn't sick, she didn't fall - and finally I got her to press her call button and get an aide in the room, telling her, "Call your aide and stay on the line. When she comes in, put her on the phone, and I will tell her what you need."  The aide arrived, and she had a hard time understanding why Polly wanted her to talk to me, but finally she got on the line.  I asked her to give Mam-ma her Ativan and put her to bed. She said she would, and she handed the phone back to Mam-ma, so that I could tell her goodnight.  It took a few minutes of reassurance and "I love yous" to convince her that the aide would return and she would feel better in the morning. 

I called later to check on her, and the aide said, "She has been upset and confused like this since I came to work Friday night at 6:00." But she assured me she had put her to bed and given the Ativan and would keep an eye on her.  Based on previous experiences, I figured after a good night of sleep, Mam-ma would not even remember calling us.  That was not the case... she told my sister and her husband all about it today when they visited her - as best she could.  She told them that "I froze... I don't know what happened" and "Debbie talked to me and calmed me down."

I don't know what happened, either.  I just know that while I was talking to my grandmother and trying to calm and soothe her, I thought to myself, "I could easily be having this same conversation with Timothy... and it would make about as much sense."  The similarity was striking.  Mam-ma now has so much trouble thinking of what she wants to say - and saying it - that she actually is harder to communicate with than our 2½-year-old nephew.  As he learns so much each day and becomes more adept at manipulating objects, managing his own personal care - and talking - Mam-ma loses ground.  And that's how life is... for all of us.  I just happen to have a more poignant illustration right in front of me.

I don't know what happened.  I don't know if Mam-ma had a little TIA, or if she just got so tired on Thursday that she was still mixed up on Saturday night...or if she is starting to "sundown" - becoming disoriented and confused late into the afternoon and early evening, which is common with patients who have dementia or Alzheimer's.  This may happen repeatedly - or she might not ever become disoriented like that again.  Time will tell.  At times, I think the spunky little lady who can outsmart a bed alarm is still with us... and the next minute, I realize that time is slipping away - and taking her with it. My prayer is that, one way or another, she soon ceases to realize her limitations and be frustrated by them.  This is something we desire for our babies... and now we wish it for our elders, as well.  And the circle continues...

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