I'll Make Do...

My sister and I shared a Thanksgiving lunch with Mam-ma Polly the Tuesday before Thanksgiving. A few days after Thanksgiving, Mam-ma told my mom, "I don't know WHEN I've seen Suzanne (my sister)."  Mom tried to remind her that Suzanne and I ate lunch with her the previous Tuesday.  She argued that Suzanne was not there.  I snapped pictures of my grandmother and my sister... here is one.

A few days later, Mam-ma fussed that I didn't come often or stay long enough... and that "I'm seeing quite a bit of Suzanne."  I reminded her that yes, Suzanne works as an aide at the ALF on weekends, so she is there Friday, Saturday and Sunday nights.  That did not seem to register.

Last Tuesday, I went to visit Mam-ma.  She was in the hallway near the front door.  She said, "I'm lookin'... I'm lookin'..."  I asked who she was looking for, and she replied, "For YOU!"  I asked how she knew I was coming.  She couldn't tell me.

We returned to Mam-ma's room, and nothing was right.  She needed gloves from home.  I opened a dresser drawer and produced half a dozen pair.  I left some gloves and ear muffs on her table... was she wanting to go outside?  She shook her head, "No!"  I commented that it was realy too chilly anyway, but whenever she needed her gloves, they were there.

Mam-ma cried quite a bit, and told me, "I'm so lonesome."  She then told me, "I've tried to explain that I'm working on it... not being lonesome."  I told her being lonely is not something we overcome easily or at the snap of a finger... that I was sorry she is lonely, and I don't know what to do about it.  She replied, "You don't come often enough."  I tried to explain that I have a lot of responsibilities now... new ones with my niece and her husband and three children... my 86-year-old mother-in-law who had a mini-stroke this fall... my husband and my own household to run.  She cried and said, "I don't begrudge you these things.  I'm just lonesome."  It was a really, really bad visit.  Mam-ma spent most of the time I was with her telling me how I don't come often enough or stay long enough.  She was simply miserable.

The next evening, my mother took Timothy to see Mam-ma.  She had been asking for him and his siblings, who have been sick and unable to visit.  Mom said Mam-ma was overwhelmed... and overjoyed to see Timmy.  They didn't stay long, but Mam-ma was beaming.  Mom said, "It meant so much to her."

Friday, my husband and I collected Timmy and his 18-month-old sister, Zola, and brought them to our house for the afternoon.  We played with toys, looked at the Christmas decorations, and watched Frosty the Snowman and other videos.  Late in the afternoon when the temperatures warmed, we took them to a local park to play.  We had not been there long when my phone rang.  It was the nurse from the ALF reporting that Polly was having difficulty breathing.  She and the facility owner (who is an RN) had both listened to her chest and heard a rumble.  Hospice had been contacted, and the nurse said she thought the doctor would be consulted about an antibiotic.  Mam-ma was also retaining fluid... level 3 to 4, the nurse said.  She told me, "We'll see if the doctor wants to send her to the hospital for that."

I questioned the antibiotics for someone on Hospice and told the nurse we had agreed NOT to send Mam-ma back to the hospital.  She assured me that I did not need to come to the ALF...that she had given Mam-ma an Ativan to calm her, and everything was fine.  A few minutes later, the Hospice nurse called to tell me that the doctor had ordered a seven-day round of antibiotics, cough syrup, and a steroid shot.  Again, I questioned this, and the nurse said even if the problem was congestive heart failure (CHF) and not something bronchial, the medicine might help with her cough - and in that regard, keep her comfortable.  She also told me it would be fully understandable if I refused further medication.

So I visited on Saturday.  The nurse and I talked, and we both agreed that Mam-ma is - as she put it - "ready to go Home."  Mam-ma was coughing terribly, and wheezing audibly.  She complained that her pants were too tight, so I helped her change them.  These were also too tight.  I surmised she was retaining fluid in her mid-section.  An aide came in with a basket of freshly cleaned laundry, and I grabbed a stretchy sweatsuit.  The aide changed Mam-ma into the suit, and as I put her shoes back on her, I said, "I think I may need to buy you some more sweats."  She shook her head, "No!" and started to cry.

I questioned... what was wrong?  She cried more.  I finally asked, "Do you not think you will be here to wear the sweats?"  She stopped crying and took my hands and said, "I'll make do."  I took that as her way of saying she was done, and I nodded in agreement. I stayed a while longer and got Mam-ma settled for lunch, with the understanding that she would nap in the afternoon.  She had worn herself out changing clothes and coughing... and in fact, she coughed so hard at the dining table I thought she might trigger a heart attack.  The nurse had insisted that this is CHF... and if she does have something bronchial, she indeed does have CHF as well.

I struggled with this all weekend.  Mam-ma is like a doll that falls over, and we prop her back up with medication for a while.  She doesn't want to be here any longer.  We are not honoring her wishes.  So this morning, I spoke with our Hospice nurse/caseworker, and then I called the ALF administrator and told her that this will be my grandmother's last round of antibiotics.  She has indicated that she does not want further treatment, and I am representing her wishes... serving as her advocate and speaking for her, because she can no longer speak for herself.  I will sign a "compliance" paper that says that this is what we desire on my grandmother's behalf.

Late this morning, my mother visited again and found Mam-ma doing well.  Mom said her conversation was fairly pleasant, although Mam-ma cried about a few things.  She coughed some, but Mom did not think it was all that bad.  However, my sister attended an inservice this afternoon, and the administrator told her that I had requested that no more antibiotics be administered, and she advised... "She won't last much longer."  She went on to say that Mam-ma had a serious coughing spell this morning in the lobby, and a staff member had to dash to get a drink of water for her to get it stopped.

My sister also told me that Mam-ma has suffered from diarrhea since sometime Saturday.  We agreed that we are not ready to say "Good-bye" to Mam-ma... yet we know she is ready to go to heaven.  It's been a really rough week.  I have struggled with these decisions, knowing fully that my grandmother is tired of living.  I know that we could go to her apartment and ask her point blank, "Do you want to keep taking medicine?" and she might say "Yes"... then turn right around and say "No."  Her answers are no longer dependable... but her demeanor is.  And I am ready for her to be at peace.

My mom said that when she and Timothy visited a few nights ago, Mam-ma kept looking at him and saying, "I tell you what..."  Finally, Timothy said, "Tell me, Mam-ma!"  When Mam-ma Polly gets to heaven, she will be able to tell everyone what again... and that will be the best medicine ever for her.  Meanwhile, we'll handle whatever lies ahead... and do our best to "make do."