I'll Go Graciously...

It's been two weeks since my mom and I started calling my grandmother each morning and evening to remind her to take her medicine, and she hasn't missed a single dose.  She seems to be enjoying the daily phone calls from each of us, so she has not complained about the reminder - so far.  However, she has complained that she lacks energy - and she did cut back to walking every other morning in the brutal summer heat we have been experiencing.  Even though she walks around her block at 6:00 a.m., the humidity level has been high enough to pester her breathing.  So pacing herself and taking a break every other day is a good idea.

During a conversation with my mom, she noted that she feels Mam-ma's transition to an assisted living facility - of not a nursing home - is inevitable.  I've fought tooth and nail to keep her in her own home as long as possible, but after the incident a few weeks ago where the gas was on under a stove burner with no flame, and the numerous missed doses of medication, I realize that this run at home may be ending.  So I called a local assisted living facility and inquired about accommodations, pricing, and possible financial assistance.

I am still vague on some of the details, but apparently there are two options - a one-room "suite" that has living area and bedroom together with a separate bath for $2600 per month, or a two-room "apartment" that has a living/dining area with "kitchenette" (refrigerator, sink, and room for microwave and coffee pot), plus a separate bedroom and bath ... for $3000 per month.  There are four tiers for Medicaid assistance ... the higher the tier, the more Medicaid will pay.  This is based on an evaluation by authorized nurses and personnel who decide how much help the client needs and assign him/her a tier level accordingly.  So it's possible that Mam-ma could afford this facility, even though her monthly Social Security income is about one-fourth of the "suite" rate.  I thanked the person who gave me the info, made some notes, and set them aside.

That same evening when I talked to Mam-ma, she said she and her friend, Ruby, had been to this facility to visit two of their friends who live there.  Both of them have suites, and Mam-ma said, "Oh, they are NICE ... and real spacious."  I asked, "Do you ever feel like you might to live there?"  She replied, "Well, I just might."  I know that one of her friends who lives there has encouraged a move ... and the friend's daughter-in-law has talked to Mam-ma several times about moving there. 

Mam-ma said that there was an area where she could do her sewing - that in fact, her friend was working on a painting there the day she and Ruby visited.  She said, "Well, it would just be nice to have people to visit with and be around."  But she also added that she didn't think she could afford the facility fees.  I told her I'd done some checking, and I thought maybe she could.  But I assured her it was her decision, and one that didn't have to be made now.  Should she decide she was interested, I'd do more investigating and get the ball rolling for her to be evaluated.

On one hand, I can see how this would be great for my grandmother.  She loves people and having lots of folks around.  Her meals would be prepared, she would have her meds dispensed, and she would be far safer, hopefully, than she is in her own home.  There would be a level, safe place to walk outside around the facilities and plenty of activities to occupy her time ... with her own room to which she could retreat for privacy.  On the other hand, she would not have flowers or a garden to water and tend - at least not as many - or her own cooking to enjoy. 

She could not take all of her "stuff" with her, and while she doesn't have all that much ... she would want to take much of it along.  My mom thinks she would expect to keep her home, much like she did 22 years ago when she "traded" houses with my husband and me.  Her thinking at that time was that she would get "a little apartment" in town and still use her farm house like a giant closet for all of her things.  That didn't happen.  I think she understands that she lives in a home my mother provides, and that the move to assisted living is complete and not a temporary thing.

Anyway, nothing else was said about the assisted living facility.  Mam-ma's cousins from Oklahoma came for a weekend visit, and she was on Cloud Nine, planning and preparing for their arrival ... cooking a meatloaf and other dishes, even though the women assured her they would go out to eat... and getting her hair done.  She had scheduled a much needed perm for last Friday, but when she learned the cousins were coming that afternoon, she called me and wanted to cancel.  I told her that she needed to get it done, and she said, "Well, I really don't feel like it."  I asked, "So you don't feel like the girls coming to visit?"  "Oh, yes!  I feel plenty well enough for them to come." 

Sounding very much like my mother when I was a teenager, I said, "Well, if you are well enough for the girls to come, I think you're well enough for a perm.  It will even make you feel better... you need it!"  It was shades of a parent telling a child, "If you are well enough to play outside, you are well enough to go to school!"  So she relented, although she wanted to go early.  I told her that we didn't know if her hairdresser could take her early, and Mam-ma said, "I don't know why not ... she's always just sitting around when we get there."  That is not true, and I pointed out that the hairdresser takes her lunch break shortly before Mam-ma's 2:00 p.m. appointment.  And I felt quite sure she had arranged for a babysitter to watch her 4-year-old grandson while she stayed late to do this hair perm. 
So I told Mam-ma I would not take her early unless she called the hairdresser and confirmed that it was okay.  She did ... we went at 1:30 p.m.  The hairdresser had forgotten she scheduled an extra blow-dry client at 1:30, and she squeezed in someone else while Mam-ma's perm processed, and we still didn't get done until 4:00 p.m. (which would have been the original time to finish).  This was fine with me, but I could tell Mam-ma was anxious to hurry home.  The cousins didn't arrive until 5:00 p.m., so we had plenty of time to spare.

The weekend apparently went great.  The ladies played Chicken Foot dominoes both nights.  They ate Mam-ma's meatloaf Friday night.  Saturday night when I called, the cousins were frying okra and cooking fresh peas and other veggies from the farmer's market (purchased early that morning), and another Chicken Foot game was planned for afterward.  Ruby came over and joined them, and they had a ball.  The ladies took Mam-ma to church on Sunday and then to lunch somewhere (maybe leftovers at home?), before leaving about 2:00 p.m.  When I talked to her Sunday night, she said, "I'm not tired at all." But she had not been up to returning for Sunday evening church services, and I'm betting she slept like a rock!

During our conversation, Mam-ma said that Ruby had said to her, "Polly, someone told me you are thinking about moving to the assisted living facility."  I don't know who could have told Ruby that, but Mam-ma thinks it was the daughter-in-law of her friend.  I asked, "Did you tell Gail we had looked into this?"  She said no, but she must have said something.  Anyway, Ruby told her, "You won't like it there without me."  Mam-ma said she told Ruby she had no plans to go.  And then she said... "I don't know if I would like that... those rooms are really tiny."  I questioned her ... a few days earlier she had declared them "very nice" and "spacious."  She said, "Well... they're not!"  She said she would want an "apartment" if she moved there, and I told her that might be possible, although the apartments were $400 per month more than the "suites."  That surprised her.   She said, "I'd need a place to have company."  I'm sure she is thinking the cousins could stay there with her, but I honestly don't believe this would be allowed - nor would they want to.  I'm sure they would gladly come to visit and get a motel room somewhere, but I know this is what is bothering Mam-ma.

I asked if Ruby ever considered moving there, also, and she said not really... but maybe.  I think they would be very happy there together.  But I also reassured Mam-ma that we do not have to talk about this - or even think about it - today... but we do have options.  She said, "Well, I told Ruby, when the time comes - if it does - I'll go graciously."  I laughed and told her I want that in writing!

We will see what happens.  It would be wonderful if both ladies would decide to make this move while they are still relatively healthy and able - and can enjoy the other residents and the amenities.  God will handle this, thankfully ... and I'll do the legwork if and when it is required.

On another front, my mother-in-law went to her family physician last month for a bout with vertigo.  She's had a few episodes of this ailment over the last 12 years.  This time, it had been long enough that the doctor wanted to see her again.  Since she almost never goes to the doctor, he drew blood and did a full lab work-up on her at the same time.  He also discovered her blood pressure is now high enough that she needs medication.  Since she is 84, we feel blessed that she has not required such medication sooner ... and the doctor gave her a sack full of samples.

Last week, someone called from the doctor's office and said that my mother-in-law needed to come back for a follow-up visit.  There was a problem with the lab report.  I went with her, and the kidney function numbers were all seriously out of whack ... to the point that they indicated renal failure.  She had no symptoms, other than high blood pressure.  The doctor promptly said he was scheduling her to see a nephrologist, told her to avoid salt and any anti-inflammatory drugs (including the Aleve she takes when her arthritis flares), and he drew more blood.  That was on a Tuesday. 

On Friday, I called the clinic to inquire about the lab results and schedule a follow-up appointment, and the nurse said, "We've not gotten the lab work back, but we've called the hospital to request it."  Meanwhile, she had scheduled a visit with a nephrologist for sometime in September.  I noted the appointment date and time and did a Google search for this physician, whose clinic is in another city 65 miles away.  No one called back about the lab work all day. 

At 5:30 p.m., the nurse called and said, "We've been looking at these lab results all afternoon, and we can't figure it out, but everything is normal.  All of her kidney functions are normal.  We don't know if there was a mistake the first time, or a mixup at the lab, or what, but everything appears to be normal.  And she didn't have any other signs of renal failure when we saw her on Tuesday."  She said the nephrology appointment had been cancelled, and they would see my mother-in-law for a follow-up visit at the local physician's clinic in mid-September.

So we are grateful that these results are good... and hoping they are correct!  Since my mother-in-law's bout with vertigo, she has seen an ENT to have her ears cleaned, she is scheduled to see a surgeon for a colonoscopy, and she was scheduled to see a nephrologist.  She said a friend told her, "Those doctors will find something wrong with you and make you sick!"  We are determined this will not happen. 

We are not being cavalier with her health, but we've decided not to fuss when she salts her food at the table.  She is swimming every other day at our new Community Center pool, and if she wants to take an Aleve when her "bad knee" aches at night, we are thinking she should do just that.  This woman is the picture of health - you would look at her and think she was in her early seventies at best ... not 84.  Prior to taking medication for high blood pressure, she took an occasional Aleve, a somewhat daily B-vitamin, and two drops daily of an eye medication for glaucoma.  Contrast that with my grandmother who takes SEVEN medications daily in varying dosages, as well as a frequent anti-anxiety pill, Tylenol, and probably a few OTC things I don't know about!  In my husband's words, "I'm not going to let the doctors make Mom sick."

I've seen both sides of this equation.  My maternal grandmother had a pill for everything, and her favorite pastime was seeing the doctor for some ailment - real or imagined.  She ended up with Parkinson's disease, and I feel that it was at least partly due to the way she mixed and matched her medications.  Once when my mom was helping straighten up my grandparents' house, she found one of Grandmother's pills in the closet - atop a pair of shoes!  My Mam-ma will tell me of her family physician, "He needs to see me ... he's my doctor!" 

My dad had a "routine" arteriogram at age 61 that resulted in instant "cholesterol showering," which we found is more common with this procedure than most realize.  Within a month, he was in complete renal failure, and he spent the next 22 months or so on daily dialysis before suffering a heart attack and stroke that claimed his life at age 63.  This helps to explain why I recently went almost a month with a respiratory ailment that had probably turned into bronchitis at best ... or even pneumonia ... before I broke down and took an antibiotic, which helped me get well in a few days.  I have a healthy respect for physicians ... but also a healthy fear of creating problems where none exist.

So for now, we are in a holding pattern ... holding steady with my grandmother in her own home and taking measures to keep her safe there ... holding steady that my mother-in-law is healthy as a horse for her age and doesn't need a barrage of tests and specialists to tell her differently.  We know that things can change drastically in a heartbeat with older adults, and we are prepared for inevitable challenges down the road.  But for now, were taking it one day time.  I have total confidence that there will be many changes ahead, but I know of at least one who probably will not "go graciously" as promised.

Learning to Read the Signs

Nobody can make you feel inferior without your permission. ~Eleanor Roosevelt~

I post this comment, because there are people who believe that I am uncaring or unfeeling toward my grandmother... that I don't do enough for her, or that I do not treat her well.  They base these assumptions on casual observations and claims of such from my grandmother.  I assure you, there is no basis for any of this.

See, I know my grandmother.  I have observed her behavior and her reactions for over 52 years now, and I am a pretty good judge of how she is really doing.  Last week, a dear friend of hers passed away.  This man was known to everyone as "Sis."  Don't ask why - I have no clue.  His brother - "Deb" - was my grandmother's constant companion for seven years after my grandfather passed.  Deb became a second grandfather to us, and we loved him dearly until the day he died in May 2000, of bladder cancer.  My grandmother was very fond of Deb's brother, Sis, and they visited often by phone, and sometimes in person.  So, when he died, my grandmother was naturally upset.  One of Deb's sons came for the visitation and took Mam-ma.  She saw lots of people, and when I went to her house a couple of days later, that was what she talked about.

During this same time, Mam-ma's blood pressure began to spike.  It worried a nurse's aide enough to call a nurse from Home Health.  The nurse supposedly told Mam-ma if she had pain in her neck and shoulder, to call an ambulance.  That was early in the week.  Friday when we went to the beauty shop, Mam-ma seemed fine, except she kept telling me she "just hadn't felt good for a couple of days."  Now, I recognized the tone and demeanor as a manipulative ploy.  If I would ask what was wrong, the flood gates of symptoms and ailments would open.  But I could see from her actions and the list of things she had been doing around the house that she was basically fine.

In addition to the loss of her friend, my mom and her husband left Friday for six weeks in Arizona. Mam-ma almost always has a medical crisis before Mom can get up the mountain and out of our little valley town.  So I was not surprised when we came home from the high school basketball games Friday night, and there was a phone message from my grandmother... "It's Mam-ma."  It was also 9:30 p.m., and I did not call her back, figuring she was in bed.  After all, she knows how to call my cell phone if she really needs me, and she had not done so.

Saturday morning, my husband, mother-in-law, and I set out to attend an auction.  On the way, I phoned Mam-ma and told her I'd seen her phone message.  Yes, she had called... "What am I going to do about this blood pressure?"  I asked if it was high, and she said yes, it was something like 189/85.  I asked if she had taken her morning medicine.  Yes, she had.  I suggested she take it easy and give the medicine time to work and we would see how she progressed through the day.  I told her we were on the way to an auction, and very quickly, she said (sarcastically), "Well, y'all go on and don't worry about me."  I reminded her I had a cell phone, and to call if she needed anything.  I did not hear from her again that day.

Sunday afternoon around 3:30, the phone rang - Mam-ma.  "What are we gonna do about my blood pressure?"  I asked if it was still high, and she read me some BP readings... 162/82 and similar readings.  I told her it sounded like it was coming down.  "Well something has got to be done!" she said.  I asked if she thought she was having a stroke.  She didn't know.  We bantered back and forth, and I told her our only option was the ER, and when she goes there, they always get her in a mess... screw up her medicine or worse.  Finally, I asked, "Are you wanting to go to the ER?"  She said no, but something had to be done.  I reminded her that a trip to the ER might likely result in a trip to the nursing home.  She said, "Well, I called Shirley (an LPN friend of the family), and she said I could take half a Lasix."  I did a quick search on the Internet of all of Mam-ma's medications and told her I didn't think she should take that until I found someone medical to consult.

So I called Shirley, and she said, "I did NOT tell her to take a Lasix.  In fact, I told her NOT to take ANYTHING until she talked with her doctor on Monday."  Shirley said Mam-ma heard what she wanted and would probably do what she pleased... and one pill would not kill her.  But Shirley asked, did I think this was about Sis.  I agreed that this had crossed my mind, and Shirley said, "I've been expecting a call from your grandmother ever since he died... she was so crazy about him."  We agreed the BP rise was from that and the absence of my mom. Shirley also said my grandmother's voice was strong on the phone and she didn't sound like she felt that bad... just "pouty."

So I called my grandmother back. When she answered, her voice was strong and solid.  Once she heard my voice, hers changed to a very faint whine.  This happens often, and she used to do the same thing to my dad.  It was all I could do not to laugh out loud.  I told her NOT to take anything extra - that Shirley said "No!" and that when her aide came Monday morning, if she felt the BP was high, she would call the nurse, and we could go from there.  She asked, "Well what am I gonna do about this headache?"  For the record, my grandmother has had "the headache" all of my life.  The last week or so, our weather has been totally unseasonable and erratic, and most of the people I know have had a headache at some point from the continual changes in air pressure, etc.  So I tried to explain this to Mam-ma... she still thought it was her blood pressure.  I just let it drop.

By 10:00 a.m. today, I had not heard anything from my grandmother, so I called.  She sounded extremely strong and well.  I asked what her aide had said, and she said, "Nothing.  She was in such a hurry, she didn't say anything."  I asked, "Did she take your blood pressure?"  Yes... it was 148/70.  Now that is a very good reading for my grandmother... and of course, she sounded disappointed.  I told her it sounded like she was on the mend, and she said, "Well, I guess."    We talked a few minutes and hung up, and later in the morning she called me to verify a phone number... she was already on to the next project.  It seems the "crisis" has passed for the moment... and hopefully we will have a smooth week.

Back to the quote.  There are those who would think I am horrible for not rushing my grandmother to the ER with such high blood pressure.  At one point yesterday, she yelled at me, "Well if I die tonight or in the morning, it don't make any difference!"  I've heard those sorts of threats before... and to some that would sound cruel, but I know her!  The last time we took her to the ER for high blood pressure was a couple of Easter Sundays ago, and we sat in the ER for probably 6 hours - some of that without the monitor even connected because they took her for an X-ray and forgot to reconnect her upon returning.  They finally gave her a blood pressure medication that her cardiologist said she is NEVER to have again, and after not eating or having any of her regular meds all day, she bottomed out, nearly passed out, and threw up!  We were several weeks getting her totally regulated after that little episode, so I am less than eager to go dashing to the ER when my instincts and assessments tell me we are not in a crisis... and certainly not an emergency situation.

But I have seen the looks from others.  I've heard the "I hope you know your grandmother is really sick!" (as if I was not checking on her and had no clue) comments, and I've felt the daggers from those who believe Mam-ma when she tells them, "Debbie is too busy to fool with me."  And Eleanor Roosevelt is right... only I can let those things make me feel inferior or inadequate... or guilty!  I have made a conscious decision not to "go there."  I'm pedaling as fast as I can, and I'm doing my best to keep my grandmother safe and well cared for... and to love her as much and as often as possible!

Meanwhile, our nephew Timmy is coming to spend a few nights with us... his regular two, plus an extra because his grandpaw is sick. So we are going from one end of the spectrum to the other - from high blood pressure to teething and crawling!  Life is certainly anything but dull and boring... and most days, this "sandwich" is pretty darn good!