Who Needs a Tub When You Have a Pool?!

Grandma E has always loved a good soak in the bath tub.  However, as she has aged - and her knees have begun to give her trouble - she has found getting out of the tub to be nearly impossible.  This was discussed a couple of years ago when my husband and his older brother supervised the remodel of Grandma's master bathroom and offered the option of a walk-in tub.  She opted for a shower with a seat and detachable sprayer...and she said, "I just won't take baths any more."

But a few months ago, a neighbor alerted me that Grandma had told her how difficult it was to get out of the tub in her guest bath...explaining that she had to turn over onto her hands and knees and crawl out, one leg at a time!  The neighbor had suggested she investigate walk-in tubs...and she wanted me to know this!

Even though the tubs were discussed at one point - and dismissed - my husband did his due diligence and investigated them thoroughly once again.  He presented the details to Grandma E and explained that, while they look like a great solution, there are drawbacks.

You must get into the tub, close the door, sit down, and wait while it fills with water.  This can take ten minutes or more.  The process is the same for the tub to drain after the bath.  You cannot open the door until all of the water is out of the tub.  While many models do include a heater in the seat, it still can get fairly chilly as you sit there...especially if you are wet and waiting for the water to drain.

The tubs must be thoroughly cleaned...or they can mildew.  For an older person, this can be a daunting chore, and not all seniors have housekeepers to do this for them.  Additionally, the price and quality varies greatly.  The "better" models can sell for upwards of $25,000...yes, twenty-five THOUSAND dollars!  One reviewer said that he went to the trouble and expense of installing them in his senior living condos...only to remove them later because they were not being used - or people were using them as storage hampers!

But the kicker for Grandma E was when she said, "I just want to sit and soak in warm water up over my shoulders."  Even in the best walk-in tub, this is not going to happen!  So I suggested that perhaps she should come with me to our city's Aquatic Center and sit in the therapy pool.  Heated to a balmy 94 degrees Fahrenheit, this pool has a built-in bench along one wall where one can sit and enjoy the jets (or not). Depths range from just over 3 feet to 5 feet, so there are plenty of spots along the wall where a person can soak in warm water up around their ears!

Grandma participated in senior water aerobics classes a few years ago at this pool, but she was reluctant to return now. I had tried to get her to go with me several times, and she would always say, "I look horrible in a bathing suit now."  I told her I should hope to look so good in a bathing suit when I am 90!  We talked some more about the pool, and I mentioned several selling points...I would pick her up and take her home...and she could soak while I did my aerobics workout.  There is even a motorized "lift" if she felt she was unable to use the steps to walk into the pool and get back out. I would handle everything with regard to a membership. Finally, she agreed to give it a try.

It took one trip for Grandma to be hooked!  We now go at least three days a week.  The "lift" has never been used...and Grandma never just sits and soaks. She walks around, bounces to the music that is piped in, and visits with others who happen to be soaking/swimming in the therapy pool. We stay about an hour. She has a new swimsuit and swim cap...and with insurance discounts, her "membership" fee was a whopping $25 for the year...with unlimited use!

Aside from the benefit of getting to soak in the warm water, Grandma's knee is much better.  She had been receiving a cortisone shot in her knee every three months.  In February, she was hurting so badly that she counted nearly every minute of the last week before her shot date. She started going to the pool right after that injection, and when her scheduled appointment rolled around in mid-May, she canceled it!  She says she is sleeping better and feeling better all over...and she will be 91 in three weeks!

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I made a point to set up overnight stays for Timothy, Zola and Nathan on consecutive Fridays, so that they could swim on Saturday mornings with Grandma E and me.  While the child and I play in the Olympic-sized swimming pool, Grandma watches us from her bench in the therapy pool.  This makes for a great interchange on the ride to and from the pool, and it gives Grandma something to do while she sits and soaks for an hour.  We plan to do more of these trips this summer.

As always, there are some interesting parallels between the children and Grandma.  I watch both carefully as we get in and out of the car...the child to make sure he/she does not dart into traffic and is securely fastened into the car seat while traveling...and Grandma to make sure she doesn't slip and fall - and that her seat belt is securely fastened before we depart!  I watch all of them get in and out of the pool - and keep a close eye on them as they "swim".  The children become more brave and confident in the water with every visit to the pool.  Grandma becomes a little more bold with her moves, also!  The children are always eager to go to the pool for a swim.  Most days, Grandma eagerly agrees to go "get her swim on", also!

We are blessed to have a wonderful Community Center and Aquatic Center in our town.  The fee for unlimited use of all facilities for our family of five is $25/month...and as I noted earlier, Grandma's fee is $25 annually.  That is a tremendous bargain. We can swim year-round in this indoor pool...7 days a week, usually. The pool rarely closes, unless there is thunder in the area!  For those who are more adventurous, there are water aerobics classes, water Zumba classes...and a wonderful class that meets several times a week in the therapy pool that is geared toward seniors with arthritis.

The only drawback I have found for the little ones is that they are not allowed in the therapy pool unless they are taking a swim lesson with a certified instructor...and the "big pool" is four feet deep at the shallow end.  None of my children are that tall yet, so they cannot touch bottom...and this has affected their confidence level.  They are all three still wearing life preservers...but I am seeing progress and hoping that soon, they will be swimming like fish - all on their own.

I realize that not all communities have indoor pools.  And I am sure that walk-in tubs have their place and are great for some folks.  But this did not seem like a viable solution for our situation...and in doing our homework, we came to the conclusion that these tubs may not be all they're cracked up to be!  Thankfully, we had a "Plan B"...at least for a while.  I know people who are well past age 95 and still using this therapy pool...so hopefully, Grandma E and the kids and I can all make the frequent trek to the Aquatic Center for many years to come yet!

There is something therapeutic about water...and water exercise.  It's good for the body, mind and soul...and we are living proof.  When was the last time you took a dip?

Who Is In Your "Sandwich?"

A childhood friend and I have been corresponding via text and e-mail for more than year now, and our conversations have involved several twists and turns.  But they keep circling back to what he refers to as "the elders" - namely, a handful of senior citizen family members that he attends to as time and needs arise. Indeed, we are at "that age" where there is no shortage of "elderly folks" who need our attention.  

Grandma E and her son (my husband, Greg)

My parents and grandparents are longer living...but my mother-in-law is still with us.  We are blessed that she is able to live alone in her own home, even 8 months past her 90th birthday.  She no longer drives, but unlike many children of seniors who have stopped driving, there are few requests for a ride anywhere.  My husband (her youngest son) takes her wherever she wants to go...which generally consists of a semi-weekly trip to the hairdresser and the grocery store - and maybe to church on Sunday.

My great-nephew, Timothy, with my Mam-ma Polly and
my mother-in-law, who the children call "Grandma E."

Even though I am not directly involved in the daily care of an "elder" at this point, many of my friends and loved ones are.  I listen as they voice their concerns and frustrations.  I hear their tales of parents who are stubborn and refuse to admit that they need in-home care - or to allow the caregivers to assist them with personal care, such as bathing.  I understand completely when worries about falls, mixed medications, and failing memories are voiced. I totally GET IT!

Just like countless others, I've "been there, done that."  And my mantra is, "You are not alone."  I know that eldercare can be incredibly lonely...and if you are caught in the middle of a "sandwich" that includes children AND seniors - well, your world is likely something of a circus on any given day!  This doesn't even allow for the fact that you may be juggling a job, a marriage, civic and church responsibilities, and more.  You may be dealing with your own health concerns.  It's enough to make anyone run screaming into the night!

This is partly why I started "The Deli" blog when my paternal grandmother was still living and in my guardianship.  I wanted this to be a place where I could "vent" and share my frustrations.  More importantly, I wanted this blog to be a venue where others could read about our experiences - and Mam-ma's antics - and see that "Hey!  I'm not the only one in this boat!  My parents/grandparents do a lot of the same things and have many of the same issues!"  I wanted those who are juggling several "balls" at once to see that we CAN survive these years...and even remember them with a bit of fondness - not in what was happening, but rather, that we did a decent job of surviving!

I have toyed with the idea of turning this blog into a book...and I may still do so at some point.  It would be great to be able to hand my friends and others a book that chronicles my journey and say, "Here...this might help you."

Meanwhile...a similar book does exist.  My late mother wrote a book about HER experience with my maternal grandparents, who both spent their last days in a nursing home.  Neither one of them wanted to be there, of course. NONE of us wanted this.  But sadly, this is sometimes the only alternative.  And Mother's book has helped countless people cope with this decision and the resulting experiences.

If you would like to order a copy of When Heads and Hearts Collide, I have plenty and would be glad to send you one.  I am asking the minimal price of $10 postage paid...and you can order via PayPal by clicking this link or the one on the sidebar.

New Day - New "Sandwich"...What's in Yours?

As I write this post, I am sitting in the parking lot of an "eye clinic" in a nearby city.  Greg is inside with his mother, aka "Grandma E", who is having another "field test" for her glaucoma.  This is the third such test since October, when the doctor saw something she did not like.  She hoped it was a fluke, so Greg returned his mother in November for a second test, but the results were still not where the doctor hoped they would be.  Testing in December was delayed twice by icy weather... so here we are today.  Hopefully the results will be satisfactory and no additional treatment or testing will be necessary for awhile. (Added note...all seems well for now.)

 

I realize it has been a couple of months since my last post.  The "holiday months" were quite busy for all of us. Greg and I celebrated Thanksgiving quietly with Grandma E...she joined us for a lunch that I prepared.  My mother and her husband were away in Kentucky on a Workamping assignment, and the "kids" opted to have their own Thanksgiving dinner.  So I cooked a turkey dinner for three...and then we watched the original version of The Secret Life of Walter Mitty!

With just a few weeks before Christmas, I got busy the following day turning our house from a warm den of autumn coziness into a festive celebration of Christmas.  Thanks to Greg's help and "brute strength" in carrying all of the boxes down from the attic and assembling the big Christmas tree, I had everything decorated in a record two days!  Then it was on to baking and sewing...cookies, holiday breads, and pajamas, doll clothes and more.

In between, we endured a major ice storm that virtually shut down the town for about three days or more.  This put a halt to scheduled activities like the children's Christmas program at church, the Christmas parade, and many other events that had to be rescheduled.

I took the children to church two different afternoons to practice for their program.  As preschoolers, their role was to dress as angels and "ring bells". Assembling more than a dozen 2-to-5-year-olds...each holding two bells...is something akin to herding cats.  But the veteran conductor patiently persevered, and by the end of the second rehearsal, the children had pretty well figured out what to do and when to ring - and when not to ring!  And the adults had learned that it really didn't matter what happened... it was all going to be cute. When we would talk about the children's program, Timothy would say, "Everyone will be so PROUD of me!"  And we were!

At one of the rehearsals for the children's program, we gathered in the sanctuary. Since our children attend their Sunday school class while we attend worship in the sanctuary, they had never seen this room before.  Now it was fully decorated...massively tall tree filled with Chrismon decorations...poinsettias lining the choir loft railing...almost life-sized creche and angels in the foyer.

Timmy was in total awe. He kept pointing to the stained glass window over our choir loft that depicts a dove and the cross and saying, "Hey!  Look at that pigeon diving into the water!"  Even after I explained that it was a dove, he still called it a pigeon!  I explained to Timmy that this was where Uncle Greg and Grandma E and I come while he and Zola are in Sunday school.  He was impressed... but he still thinks there is a picture of a pigeon diving into the water over the choir loft!

The program was rescheduled, and the children stepped up to the plate and performed well.  Everyone enjoyed the production.

A few days later, the Christmas parade was held...having been rescheduled because of the ice storm.  I don't know who had more fun...the little ones or Grandma E.  The parade lasted about 45 minutes... and there was never a lull.  Our local courtsquare was fully lit and sparkled and glistened with brightly colored lighted trees, a nativity scene, a gingerbread house, and more. The two-storied courthouse glistened with lights outlining every window, wall and roof...and the children AND Grandma reacted as if they were walking through a fairyland.

Timothy had told us, "We won't see the real Santa. I don't think we will see the real Santa.  And we sure won't see Mrs. Santa."  A float came along with Santa - two of them - one on either side.  Clearly that was not the "real" Santa.  But THEN... a car came along with Santa... and MRS. Santa!  Timothy was so excited.

After the parade, we opted not to wait on the courthouse lawn to see Santa Claus and sit on his lap.  We headed up the sidewalk through an archway of lighted trees that Timothy had declared to be "magic" and we came face-to-face with Santa.  He walked up to Greg and Timothy and stuck out his hand and said, "Hello!  Merry Christmas!"  Timothy didn't miss a beat.  He said, "Merry Christmas, Santa!"

Then Santa came to Zola, Grandma E and me.  We had been told that Zola was scared to death of Santa, but he knelt and stuck out his hand and said, "Merry Christmas!" and she just grinned and giggled and said something we could not understand.

Timothy talked all the way home about seeing the REAL Santa and seeing MRS. Santa.  He loved the parade except for one thing... there was no Grinch.  He is hoping for a Grinch in the parade next year!

On Christmas Day, everyone gathered at our house for a big dinner and presents and stockings under the tree.  The children were so excited... Santa Claus had come to their house overnight, and now, they were getting to see not only their grandparents (my sister and her husband), but us, Grandma E, and my mother and her husband - just back from a nearly-four-month stay in Kentucky.  To say it was loud and crazy would be an understatement.  But it was also tremendous fun!

 

My point in sharing all of this with you is to make several observations:

• During the holidays, I found myself doing MANY of the things that my Mam-ma Polly did when I was younger...baking, sewing, filling the Christmas stockings for Santa, preparing the holiday meals, and more...and I thought of her...a LOT! 
• I also found myself juggling trips to take the children to rehearsals, attending Timothy's pre-K Christmas program, visiting Mam-ma's friends (and mine) at the Assisted Living Facility, and reaching out to people from multiple generations during the holidays.
• Most notably, I realized that Greg and I still are very much a part of the "Sandwich Generation" as his 87-year-old mother has assumed the senior role...and the three little ones still keep us hopping on the other end of the spectrum! These children could not love Grandma E more if she were their own flesh and blood.  The two oldest ones almost cry on Sunday if she doesn't go with us to church and out to lunch afterward.  And I'm noticing that she is always thinking about something to do for them...some little toy or trinket to give them.  It's a great relationship for everyone.

Grandma E's antics are not as entertaining - much less, challenging - as Mam-ma's grew.  Mainly, she is forgetful... and stubborn (like going to retrieve her paper in the ice after Greg expressly told her NOT to go outside)...and she would rather stay home and babysit a dog than do just about anything else in the world.  She is truly remarkable for a woman well on her way to age 88, and we hope she still has many good years of living alone in her own home and doing as she pleases ahead of her.

The best three words in the world from the kiddos are "I love you."  Timmy freely tells Greg, Grandma E and me that he loves us.  In fact, on the way home from lunch one Sunday, Timothy blurted out... "Grandma E... I love you!"  Melts the heart!  He also tells Grandma E nearly EVERY Sunday after lunch, "Thank you for paying for lunch, Grandma E!"

Our little ones are learning valuable lessons about life and relationships from the time they spend with my mother-in-law...and she gets just the right dose of being a great-grandmother in return!

In recent months, I've been asked more than once..."Now that Polly is gone, what do you do with all of your spare time?"  Clearly, that "gap" has filled in rather nicely.  Each "Sandwich" is different...but from the looks of things, we'll still be part of The Deli for several years yet!  I look around at others who are smack dab in the middle of their own "Sandwich", and I marvel at how some of them manage to "keep all the balls in the air".  For others, I offer three words of advice..."Hang in there."  We are not alone...this subset of the population grows by leaps and bounds every single day.  If you are not presently a member of the "Sandwich Generation", you very well could be next week or next year!

 

Knowledge is power, and for that reason, I am continuing this blog.  Please share your stories...your insights...what works for you - and what doesn't.  Ask questions, seek support...and know that there are people who can help.  Someone asked me last week, "What's next for you?  What are you looking forward to this year?"  I honestly do not have an answer... but I certainly know that life will be anything but dull.  What about you?

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."

A Barking Dog Never Shuts Up!

I have been so busy lately getting my niece and her family settled that I have not visited Mam-ma Polly often.  But I did spend some time with her one afternoon this week, and she was in her speech therapy session when I arrived.  I sat and watched as the therapist held up objects in a box and asked Mam-ma what they were... a ball, a sock, a comb.  She asked, "What do we use this for?" and Mam-ma would tell her... haltingly, in one-word answers.  This was so familiar to me... an activity I have done countless times as a kindergarten teacher... and more recently with Timothy as he learned to talk.  I was struck instantly by the parallel between two vast age groups who both utilize the same task to exercise speech.

The therapist then read a few common adages to Mam-ma - hoping to elicit the punch line.  "You can lead a horse to water, but you can't make him ....."  "Blood is thicker than ..."  and others.  Then she read one I had never heard... "A barking dog never..."  The last word is supposed to be "bites," but without missing a step, Mam-ma interjected... "shuts up!"  In other words... "A barking dog never shuts up!"  We all laughed heartily, and the therapist said she was going to add this as an acceptable answer in the future!

Then Mam-ma was given a printed sheet of phrases to read aloud... "I'm hungry"... "I need to go to the bathroom"..."Where have you been?"... "I'm glad to see you" and others.  She read them aloud quite well for someone who can barely speak.  It seems that the disconnect is more in remembering what to say and how to say it than the words themselves.  So the therapist will make a little notebook for her of common phrases that she can point to as she communicates with family members, friends, and the facility staff.  This should help tremendously in her ability to express her thoughts and feelings.  Photos of people who visit her frequently - accompanied by their names - will also be put into this notebook.  I hope this helps.  Time will tell.

 

Meanwhile, I have started the ball rolling to have a little cake and coffee party for Mam-ma the day before her 100th birthday. I've invited family and just a few of her closest friends - and we are at nearly 100 people!  It will be overwhelming for her, but we're rolling with it.  There are still two weeks to go, so anything could happen.  I won't order a cake until the last minute.  Cards are already beginning to come in the mail, and I have promised to read all of them to Mam-ma.

At the same time, my husband and I have embarked on a new endeavor... moving my niece, her husband and three children back to Arkansas.  We purchased a house for them to rent, and we drove to the Dallas area earlier in the month with a U-Haul trailer and gathered them and all of their belongings.  We have been busy getting them settled, searching for jobs for both of them - and daycare for the children - and handling all of the little day-to-day business matters, like taxes, insurance, utilities, address changes, and more.  For two people who never had children, this is totally uncharted territory!  But God placed this on our hearts, and we are trusting Him to work out any "kinks"!  We are so happy to have our "kids" home... and to be able to see the little ones - Timothy (age 3), Zola (17 months) and Nathan (11 weeks) any time we wish! Life is full!

Caring for all three of the little ones at once is daunting... and I am happy to report that there are no pets included in this adventure!  The noise and activity level of three small children is enough... and as my grandmother aptly put it, "a barking dog never shuts up!"  More than ever before, I am learning that every day is different... and that God is faithful to meet our needs.  I hope that you feel His presence in your neck of the woods, as well.

My Sandwich Just Got Bigger!

A lot has happened since my last posts.  Three weeks ago, my husband and I offered to help my niece, her husband, and their three children (ages 3, 16.5 months, and 10 weeks) relocate to our home town.  Living in the Dallas area, this young couple discovered that they needed the support of family members to adequately meet the needs of their recently expanded family.  So in two hectic weeks, we managed to secure housing, furniture and appliances, and make all necessary plans to move the family home.

Last weekend, we rented a U-haul trailer and headed for Texas.  We loaded the trailer early one morning and returned... my niece, her husband and the two youngest babies in one car... us and Timothy in the other.  My mother and sister have filled in the gaps with Mam-ma Polly, along with several friends who have also visited her.  We all have apparently survived... at least so far!

As things unfold and I regain my wits (and get some sleep), I will write more about our experience and how we are all managing.  Friday, I looked in my back seat at the three - yes THREE - car seats and their accompanying passengers, and I thought, "What on earth have we gotten ourselves into?!"  But everyone survived the day unscathed, and I love my niece and her babies more than anything in the world, so we shall tackle this sandwich and forge ahead!  Stay tuned!!!!

What Do Old People Talk About?

Someone was talking to me recently about visiting a nursing home resident, and she said, "I don't want to go... I don't have anything to say."  The resident was much like my grandmother... expressive aphasia, meaning she can say very little beyond the "social niceties" of "Hello," "How are you?" "I'm fine," etc.  Lately Mam-ma has gotten out some pretty long sentences and some big words... but on any given day, she opens her mouth to say something, and all she can muster is "I don't know."  OR... the words are not appropriate, as in telling my husband her sweet tea was "precious!"  I think she probably meant "delicious."

So I told this person, "Don't talk TO the resident... talk with someone in front of him.  Carry on a conversation about your previous shared experiences... kids and grandkids... mutual acquaintances, the weather, or whatever comes to mind... and let him listen.  When we do this with my grandmother, she lights up and becomes engaged.  I visit with the other ladies at her dining table, and she listens... and she enjoys that.  She feels as if she is participating without saying anything.

I've not spoken with my friend yet to see if she has visited her nursing home resident, but if she followed my advice, I am quite sure that the visit was positive for both of them.

As for my Mam-ma Polly, she is best described as "up and down."  Friday, I found her in the parlor, having donuts and coffee with several residents.  Ladies from my grandmother's church had come to visit and host a get-together.  Apparently they do this about once a month, which is great!  The ladies from the Sunday school class that hosted mingled with the residents and visited with each one, and I could see that Mam-ma enjoyed this immensely. 

Sunday morning, I went to see Mam-ma, and she wanted to go outside and sit on the porch.  It was already 93 degrees in the shade, so I suggested we go to the dining room. “Would you like to hear me play some hymns?” I asked. “YES!” she said enthusiastically. I positioned her beside the piano in the dining room and began to play some of her favorites. Soon, several residents had joined us, and one lady sang virtually every hymn I played. She sang strongly and knew all the words. I tried to play each hymn through at least twice to give her time to really recognize it and sing along.

As I played the hymns, I considered how some of them remind me of Holy Communion, as they are often played during this service. “Nearer My God to Thee,” “Blessed Be the Tie That Binds,” and “Faith of Our Fathers” come to mind as some of the “Communion hymns” I recall. So I asked my grandmother, “Would you be interested in taking Communion again?” The answer was “Yes!” and I talked with her and a table-mate, who belongs to my church, about receiving Holy Communion.

When I rose to leave, a man at a nearby table motioned for me to come to him. He asked, “If you are going to have Communion, are you going to serve it once a week, like the Bible says?” Another man at his table looked at him, perplexed, and said, “Where does it say that in the Bible?” The first man said he didn’t know the exact verse, but the Bible says that they gathered once a week at the church to “break bread.” “What else could that mean?” he asked. Man #2 and I almost simultaneously replied, “… to share a meal!” Man #1 retorted to us, "Well, you're full of CRAP!"  Needless to say, he was not happy! I wished them a good day and left as the two men continued to argue.  I felt like I might have started a religious World War III!

The Hospice nurse had done a urinalysis on Mam-ma last Friday, and the report was that everything was clear.  By Sunday, her urine looked "milky" - like watered Milk of Magnesia.  So the nurse did another urinalysis, which showed a UTI.  I don't know of the first round of antibiotics did not totally wipe out the infection, or if another one promptly arrived.  Either way, Mam-ma is on another round of antibiotics.  However, she told the nurse she didn't like taking so many pills.  So the nurse talked with Mam-ma's doctor, and he removed virtually everything not absolutely necessary... multi-vitamin, Claritin, fish oil, and more.  I think he cut the number of pills she takes daily by almost half! 

The nurse also discovered that many of Mam-ma's symptoms... confusion, frequent urge to urinate, and more... were side effects of her new pain medication.  Thanks to her research on the Internet and her initiative to pursue this with Mam-ma's doctor, we are now back on a lower, regulated dose of Hydrocodone for pain... and Mam-ma does seem mentally clearer at times.  We have actually had some decent conversations this week - interspersed with some bizarre ones, of course!  Nothing is simple - or consistent - at this age and stage!

So today when I visited, Mam-ma told me she was "fussy!"  And boy, was she ever!  When she saw me talking to the Hospice nurse, she summoned her and said, "I don't want you a tellin' Debbie about me."  The nurse told her, "I was just telling her you are good today... but I also tell her when you are bad!"  Mam-ma didn't say anything else to her!

I'm thankful that we have a Hospice team we know - and who know and love my grandmother so.  They treat her as if she were their own grandmother... and that also means they take no guff!  I'm also grateful for such a loving staff at the ALF.  They, too, treat Mam-ma like a queen.  She is spoiled rotten on a daily basis. 

I hear about trips to the garden to pick fresh vegetables - as evidenced by the tomatoes in her room.  I see how one of her favorite aides, Josh, fusses over her hair each day before taking her to meals.  I've heard her speak of him and the maintenance man, James, as if they were gods!  I actually think they may walk on water! 

I'm also thankful for the occasional moment of clarity that Mam-ma has... the times she lovingly fingers something I've sewn and says, "I tell you what!  I'm so envious!"  Today she asked, "Are you not sewing today?"  I told her no... but I plan to soon, and I will bring new things the next time I come.  She grinned widely.

Mam-ma Polly and Timmy,
sometime in the fall of 2011.

I'm grateful that our little Timothy is with his mom, stepdad, and sister... but golly, we miss him!  I can't believe it's been seven months since we've seen him... and I'm struck by how my world has changed from diapers and wipes, car seats and toys to adult diapers, wipes, rubber gloves and wheelchairs with "lap buddies" to prevent falling overboard.  Things can change in a hurry... and I've learned to roll with the punches.  Maybe next time one of the residents tells me I'm "full of crap," I won't be so totally stunned!

Waiting for "The Next Big Thing"

I don't have a whole lot to report this week, except to say that my grandmother seems to be in a "holding pattern."  She was doing fairly well when I visited her on Sunday - having lunch at her regular table with her friend, Evelyn.  She could not communicate, and she ate like a bird, but that is nothing new on either front these days.

Monday, my mom visited and found Mam-ma sitting in the dining hall, listening to gospel music by a couple from our community who come regularly to sing for the residents.  Mom said Mam-ma was doing well... singing the hymns along with the others, and apparently pain-free.  She was dressed in one of her new house dresses - a sleeveless number the aide had put on OVER her cardigan sweater!  Mom questioned the aides about how long Mam-ma had been up, and several rushed to her side right away to assure her that they were not letting my grandmother get overly tired... that she wanted to be up and out.

One aide in particular - one of my favorites - told Mom that Mam-ma had insisted on getting up and out one day the week before, and this aide had taken her to the garden to survey the peppers, squash and tomatoes growing there.  She said the planned to take her again that day, but Mom told her she thought Mam-ma had had enough activity.  She had been to breakfast, lunch, and now the singing.

I really don't know if Mam-ma went to the garden or not, but the next morning when I arrived, she had done a total 180-degree turn.  She was curled up in a fetal position in bed, moaning... and both she and her aides told me she had serious diarrhea and had required a shower just to get her cleaned up well.  The aides appeared in Mam-ma's room to tell me about Mam-ma's morning. One of them confessed that he did not know how the sleeveless dress worked - over or under the sweater. I told him under, and he apologized, despite my insistence it was okay. He began to tell me how he worked hard to smooth Mam-ma's frizzy bed-hair before taking her out of the room... and he asked if I would bring some mousse, so that he could do a better job.

I was touched by his care and concern... and later, the nurse told me that this particular aide goes to great lengths to make sure Mam-ma is presentable each day before taking her to meals.The Hospice social worker had requested a visit with me, so when she arrived, we moved outside on the porch to visit.  It was an unseasonably nice summer morning, so we sat in rocking chairs and talked about my grandmother and her care.

The social worker talked to me about moving Mam-ma to a skilled care nursing facility across the street from the ALF.  I quickly said "No!"  This has been the suggestion of several ... and I did back-pedal enough to allow the social worker to outline her reasons for this suggestion. At the forefront was, "I can tell from your conversation - and from what the nurses have told me - that you are frustrated... that you feel some of the ALF staff are not listening to you and your wishes.  You deserve to be heard."  I listened to all she had to say, and then I told her that I felt that a move at this point would be disruptive and upsetting to Mam-ma.

My mom and I had talked on Monday after her visit to the ALF.  Mom said... and I agree... "Your Mam-ma is driving them crazy.  She will not stay in bed or in her room, and they don't know what else to do except get her up and take her out for a while."  My sister confirmed that - at least on weekend nights when she is working - Mam-ma "sits" on her buzzer continually.  The "favorite" aide told Mom that whenever anyone passes Mam-ma's room, she hollers for them.  I have experienced this myself... if Mam-ma senses movement past her open door, she yells, "Hey!" until someone comes to see what she wants.  Often, she can't tell them when they arrive.  I know... it's frustrating for everyone!

So I told the Hospice social worker that I would reserve the option to change my mind, but for now, I am just riding this pony!  I fully expect that there will be a "Next Big Thing"... Mam-ma will try to get out of bed - or stand and fall... she will develop another skin tear, pressure wound, or infection like the UTI... or her overall decline will catch up with her as she eats less and less and continues to have diarrhea almost daily.  When the "Next Big Thing" happens, we will deal with it.  I know the administrator at the skilled care facility, and if it should become apparent that Mam-ma needs to move, I will

I also told the Hospice social worker that *I* have to own the frustration... that a lot of it is on me.  I have to learn to let some of this go and move forward.  These staff members dearly love my grandmother.  They are doing what they feel is best for her, based on their daily relationship with her, my input, and my grandmother's requests and demands.  I have to trust God to take care of these situations... and to give me the strength and capacity to handle whatever happens next.  After all, something will happen eventually.  My grandmother will not live forever, and something has to facilitate her demise at some point.  And the entire family - and Mam-ma - are all okay with this!

So we agreed to let this go for the moment... to try to relax and take deep breaths... and wait for "The Next Big Thing."  I don't know if Mam-ma overdid it on Monday and the result was her diarrhea and inability to get out of bed the next day - or if it was just "one of those days."  But on Wednesday and every subsequent day this week, she was up, dressed, going to meals, and she appeared to be pain-free.  Maybe the antibiotics and the new time-released medicine are working.  Maybe she just had a string of good days.  Maybe she will actually rally for a few weeks/months - and even try to walk again.  I really cannot say, and it doesn't matter.  We are taking this one day at a time... until the "Next Big Thing."

As part of my attempt to chill out and not over-manage things, I stayed home a couple of days this week and did not visit the ALF.  I sewed... made darling dresses and shorts for some little friends... I worked out, wrote, and read.  My husband and I actually went out of town to attend the wedding of our dear friends' daughter.  And the sky did not fall!  I took the outfits I had made to show Mam-ma one day - and she smiled a GREAT BIG smile and gave me several "I tell you whats!"  A week earlier I had taken sewing, and she looked at it blankly and didn't respond.  So I count this as a good week...and I will take it!

As I have said before, I'm learning to find God's goodness, grace and mercy in the little ordinary things of the day... like time to work out, a few hours to sew or write... and time spent with my husband.  In truth, these are not little ordinary things at all, but rather, wonderful gifts we take for granted.  I know one thing is for certain... in all of this "Sandwich journey," I have received far bigger lessons than anyone... and I'm still learning!

Just How Sick Are You If You're "Sick as HELL"?

This has been yet another interesting week.  Over the weekend, I found Mam-ma Polly dressed once again in pajama pants and her little pink house shoes.  Someone apparently dug them out of my hidey hole in the closet!  Beyond frustrated, I gathered up every single pair of pants and pajama pants and brought them home... along with the pink house shoes.  As I mulled this over, it dawned on me that the facility policy manual states that pajamas and robes are allowed in the dining room for breakfast... but the residents are expected to dress for lunch and dinner.  I fully understand that.

I thought about Mam-ma and her trips to the dining room in her pajamas, covered by a blanket, and I realized that this was not only uncomfortable... it was demeaning.  So Monday morning, I went to Fred's and Wal-Mart and purchased five new house dresses for her.  Since I had removed the pants and pajama bottoms, I labeled her new dresses and grouped them in the closet with matching sweaters and jackets.  I then told the nurse and every aide I saw that I wanted Mam-ma dressed in THESE outfits.  A couple of the aides got pretty excited over the bright colors... and the ease of dressing Mam-ma in something with snaps and zippers.  I showed them where Mam-ma keeps her camisoles in the drawer of her dresser and suggested they put one of those on underneath - for modesty.

Monday was Memorial Day, and James, the maintenance man, grilled burgers and hot dogs for the residents and guests.  So I ate a FEAST with Mam-ma and her friends at her old table.  Over the weekend, I had discovered that the aides were placing Mam-ma at another table in the dining room, so that one aide could help both her and another resident eat at the same time.  This was not great for Mam-ma's socialization, but I realized that she might eat more... and I couldn't count how many people came to the table to speak to her and give her a hug.  So I didn't fuss.  But Monday, we sat with her friends.  And honestly, I realized then that it didn't matter, because Mam-ma only ate because I pretty well fed her... and she did not interact with her friends and me in the least.

Tuesday was not a good day.  Mam-ma became very confused and complained of burning when she urinated... the nurse told me, "I'm pretty sure she has a UTI."  The Hospice nurse came and a urinalysis was done... with positive results.  Mam-ma saw people in the room who were not there, and she was just generally sick all day.  Wednesday, she seemed a little less confused, but I still spent quite a while with her... straightening her room, handling some laundry issues, and consulting with nurses and aides about her care.  She had not gone to the dining room on Tuesday, since she was so sick.  But Wednesday, she told me, "Debbie, I want to go to lunch in the dining room."  So I asked the aides to dress her and take her for lunch, and they did.

My mom visited in the afternoon, and she said she sat by Mam-ma's bed for about 45 minutes and read a book... and Mam-ma slept.  She said occasionally, Mam-ma would wake up a little and say, "I wish I could stay awake."  Once, she raised up and clearly and distinctly spoke a man's name.  Mom said, "Yes, he's the man who wrote 'Singing the Blues,'" to which Mam-ma said, "I don't know."  Now, this man is someone who has been dead since 2004... and my grandmother really did not know him!  Why she spoke his name so clearly is a mystery to us.  Did she see him in the room?  Did someone mention him to her in passing conversation?  We seriously doubt the latter... but we will never know!

Thursday, I did not go to visit Mam-ma, and around 6:30, the phone rang... caller ID showed it was her number.  I answered, and the aide said, "Polly wants to talk to you."  She put Mam-ma on the line, and I asked, "Hi, Mam-ma... what's wrong?"  She said, "Well... I'm sicker than HELL!"  I told her I was sorry, and she said, "I thought I'd drive over, but..." and she trailed off.  Then she started to cry and moan, "Oh... oh... Debbie... well, Sugar, I ..."  Then she said, "Call me sometime."  I told her, "I'll be to see you tomorrow, okay?"  More moaning and crying, and then she mentioned a cousin and a photo.  "Did Carolyn come to see you again?"  "Yes."  "Did she bring a picture and leave it for me?"  "Yes." 

I told Mam-ma SHE might like to have the picture, and Mam-ma said, "No... I want you to get it... I don't want anything to happen to it."  That was her only lucid comment.  Next, she said again, "Call me sometime."  I assured her that I would see her the next day - and that her aides would come soon and give her night-time medicine to help her sleep.  We hung up, and I told Greg, "Mam-ma is sundowning*."

Today, I arrived at the facility a little before 11:00 a.m., and as I entered the building, I heard throat clearing that sounded all too familiar... it was Mam-ma.  I looked around... where on earth could she be?  There she sat, in her wheelchair in the hallway, along with a long line of residents.  It was "rounding" day for the facility doctor... and Mam-ma was in line.  I have no idea how long she had been sitting there, but she was slumped in her wheelchair... her feet dragging the ground.  I went and got a folding chair from her room for myself - and the foot rests for her wheelchair.  I stopped to speak to the duty nurse, who told me that Mam-ma was really sick this morning with diarrhea.
 
I tried to show Mam-ma some sewing I had brought to share with her... she was not interested.  She was tired and weak.  The facility owner (who is also a nurse and was attending the doctor during his rounds today), came out between patients and assessed the group.  I waved to her, and she said, "Polly is next."  Sure enough, we were next in line to see the doctor.  I thought the doctor did a thorough job of examining Mam-ma.  He was gentle and kind and extremely attentive... and also assertive.  He spent a long time on his hands and knees looking at Mam-ma's pressure wound on her heel... even measured it.  The nurse asked if it should be debreded... he emphatically said no... that it should be left alone, and if it needed any treatment in the future, he would handle it personally.

The doctor also explained to me that we can expect more skin breakdown as things progress, along with the possibility of more UTIs and even pneumonia.  Even though an antibiotic was begun earlier in the week for the UTI, he prescribed 10 days of a different antibiotic, based on her lab cultures.  He also changed her to a time-release pain medication that should stay in her system all the time and prevent these hours of pain in between pills that she has experienced.

The attending nurse asked the doctor about getting Polly up and out more... did he want her more mobile?  He said that getting out of bed for a short time would help with pain, skin breakdown, and even possibly the sundowning.  The nurse said, "So we want to get her up 3 times a day - for meals?"  I mentioned that we are getting Mam-ma up for lunch now, and the doctor said, "Lunch is a good start... and then if she builds up to it, she could add breakfast or dinner."  The doctor and nurse finally agreed to write orders to get her up "as tolerated."

I questioned the nurse... "This means meals only... right?  You won't have her out playing BINGO and going to activities, will you?"  She looked at me and said, "Listen, Polly pretty well rules the roost around here, and when she says she wants to do something, she's gonna do it! "  I reminded her that lately, Polly says one thing one minute... and the next minute she is asleep!  Her "yes" is "no" and vice versa.  She replied, "Yes, well, they're all that way."  I reiterated that I did not want Mam-ma to be up and out so much that she is in pain.  The nurse assured me that "We're not going to leave her sitting somewhere slumped over asleep and go off and leave her unattended."   And I don't think they would... intentionally.  But I know how busy the aides are... and things happen... and I'm just looking out for my grandmother.

The doctor kept reiterating that our goal here is to keep Mam-ma comfortable. The nurse also asked about physical therapy.  More to the point, she asked him, "When can Polly start bearing weight on her feet?"  I reminded them that she has not put ANY weight on either foot since she fell... and the doctors in the hospital told me she would most likely never walk again.  The doctor concurred... but he said that some gentle physical therapy could help with stiffness and pain and overall well being.  The nurse said, "I've already talked to PT... she's at the top of my list!"  I later learned that there is a good chance that Medicare will not cover physical therapy, since my grandmother is on Hospice... and the doctor did not mention it in his orders.

The visit concluded, and an aide came to whisk Mam-ma to lunch in the dining room.  I had gotten her a hankie from her room, because she had a runny nose.  When I got to the dining room, I noticed the hankie was covered in something... and it looked gross.

I gave Mam-ma some paper napkins and retrieved the hankie and put it in her dirty laundry pile.  Thank goodness her apartment is only a few steps from the dining room - and nurse's station!

When I got back to Mam-ma, her lunch had arrived... spaghetti, broccoli, and garlic bread.  She was eating the bread while her aide fed another resident.  I noticed something on her dress, and as I looked closer, I realized that Mam-ma had spit up all down the front of her clothing.  I told the duty nurse who was standing nearby, and she immediately flew into gear helping pass out lunch plates so that the aide could help me get Mam-ma to her apartment and get her cleaned up and into fresh clothing.  Two aides actually came to do this, and soon we were back in the dining room, and one of the aides was feeding Mam-ma chicken noodle soup.

I gathered Mam-ma's best blanket/throw to toss into my washing machine, and headed home.  While the blanket was in the clothes dryer, ran errands and bought groceries... and more wipes for Mam-ma.  Then I returned to the facility with the clean blanket and wipes.  Mam-ma was sleeping comfortably in her bed.  She roused enough to say, "I feel a little better."  Some very dear lifelong friends popped in to say "Hello," and Mam-ma tried to talk to them, but every sentence was truncated midway as she drifted back to sleep.

I clasped her hand and wrist as I prepared to leave and told her that my sister would be there soon for her weekend night shift... and that I would see her later. I was struck by how thin and frail Mam-ma has become.  I wonder just how much weight she has lost in the last month.  I spoke with the Hospice nurse later, and she was pleased with the doctor's report.  My mom had visited while I was running errands, and she was pleased with how she found Mam-ma.  In fact, a close friend of Mom's who Mam-ma has not seen in probably a decade was with her, and Mam-ma called the friend by name and even asked her about her own sons.  Mom was amazed at that... and the friend was thrilled.

I told the Hospice nurse this afternoon that sometimes I feel like I've been through a battle by the time I get home from the facility.  For the most part, everyone seems to be on board with keeping Mam-ma comfortable and allowing for moderate activity each day.  But some are still hoping for the "old Polly" to emerge... and I just do not see this happening.  And as I pointed out to the doctor and owner/nurse today... "that's not what she wants at this stage."  I also stressed that I am not wanting to tie my grandmother to her bed... nor am I trying to expedite her passing.  But I know her... I know that she wants every minute she is alive to have quality and be comfortable... and so far, we can't say this is always happening.

Let me hasten to add that I am truly pleased with the ALF where Mam-ma resides.  I couldn't ask for a staff to love her more... and cater to her every whim.  This is not about the ALF.  Just yesterday, Mom lunched with two of her oldest friends who both expressed that "Polly should get to do whatever she wants to do."  The first week Mam-ma was back at the facility after her surgery, the other friend said to Mom, "If Polly wants to go to BINGO and other things, I think she should get to... she should do whatever makes her happy."  The trouble is... Polly doesn't always know what she wants or what makes her happy.  She is not thinking clearly... and her answers are often irrational.  It is up to me as her caregiver to discern what is appropriate... and like any good mother, that sometimes means saying "No!"

Mam-ma is tired.  Tuesday, in the stupor of her UTI, she reached out and took my hand and said, "Oh, Debbie... what would you think about me going home?"  I wasn't sure what she meant by "home," so I said, "Well... Mam-ma... you are home... you've lived in this apartment for over a year now."  She shook her head.  I asked where she thought she was, and she said, "I don't know."  I learned that earlier in the day, she had told the administrator she was afraid.  The administrator had found her clenching the bed rail and looking very frightened.  When she asked, "What are you afraid of, Polly?" Mam-ma replied, "I just don't want to go back to the way things was."  Again, the administrator didn't know if she meant the hospital.  I have had more than one person who knows my grandmother say they feel she was trying to tell me once again she is ready to go HOME to Heaven... and I suspect they may be right.

I know this is a long, and probably dull and uninteresting post for some of you.  But for those of you who find yourselves in a similar situation, it may sound all too familiar.  What is the take-away from this?  For me, it was the visit I had with a dear friend this afternoon.  She and her husband cared for his mother in her last years until she died at the age of 101.  She was by then under the care of Hospice, and her grand-daughter was living with her fulltime.  But my friend said, "Remember... this is not forever - for either of you.  It will end... and you both will get relief."  I know this, but I needed to hear it.  "This, too, shall pass"... literally.

Meanwhile, I will keep doing the only thing I know to do... being a "bulldog advocate" for my grandmother and make sure that her wishes are respected.  In her case, she really isn't too old to rule the roost... and I'm doing my best to see that she gets to do exactly that!


*(Sundowning is also known as late-day confusion, often associated with dementia and/or Alzheimer's.)