When Your "A** Is in a Crack," Does it Help to Say You're Sorry?

Last weekend was rough.  Mam-ma spent much of it curled in a fetal position, gripping her bed rail and groaning with pain.  Friday and Saturday were the worst. She would begin moaning and begging for a pain pill an hour or more before one could be administered... and then it took another hour or more afterward for the pill to take effect.  I asked if anything could be done, and the nurse did try to contact the doctor.  But he was out of town for the weekend and did not answer his cell phone.  I later learned that in these situations, I can call Hospice, and they can help.  However, Sunday was almost totally different.  The pain seemed to be far less substantial, and Mam-ma seemed clearer.  Where she had been virtually unresponsive (except for the groaning) on Friday and Saturday, she was pleasant and clearly more comfortable on Sunday.  Saturday, she flatly refused a bath when the Hospice aide visited.  Sunday, she readily agreed to the same offer from the same aide.  Every day is different.

Monday afternoon when I visited, the aides told me, "She threw a huge FIT this morning... told us that 'I can make my own decisions, and I want out of here.'"  The aides interrupted an administrative staff meeting because the rant was so bad, and the facility administrator, the facility owner, and the nurse agreed to let the aides put Mam-ma in her wheelchair and roll her around - and they even took her outside on the porch for about 10 minutes.  I was not thrilled by this.  It wasn't that this really hurt anything, but Mam-ma is not thinking clearly, and just because she says she can make her own decisions doesn't mean she can.  This weekday nurse was not on duty over the weekend.  She and the weekday aides did not see how Mam-ma writhed in pain.  They did not hear her groaning through the night and begging for more medication.  They were not there when she was virtually unresponsive...and other family members and I were wondering if perhaps this was "the beginning of the end."

To make matters worse, the aides no sooner got Mam-ma back to her room from the wheelchair ride than she developed serious diarrhea... to the extent that she soiled her clothing, the recliner, the floor... everywhere.  The aides cleaned Mam-ma and put her to bed, admonishing me to watch where I sat or stepped ... that "we'll be back to steam clean everything and disinfect."  The Hospice nurse was there, and I noticed that Mam-ma's feet were still dirty, so the nurse put on gloves and got a packet of wipes and cleaned Mam-ma's feet and legs. 

The aides said a "bug" was going around the ALF, but they were also concerned that the wheelchair ride might have contributed to Mam-ma's diarrhea.  I hinted strongly that I would prefer there be no more wheelchair rides!  Before I left, I read a couple of Psalms to Mam-ma.  It occurred to me that she never gets to hear scripture any more... and she has always spent a lot of time reading her Bible.  However, while I read, she closed her eyes and I could not tell if she was even awake.  After I finished, she didn't say a word.

I guess I made more of an impression on Mam-ma about the wheelchair ride than I realized, because Monday evening around 6:00, the phone rang... and Mam-ma's number popped up on my Caller ID.  I answered, and her aide - also named Debbie - said, "Miss Polly wanted me to call you - she wants to talk to you."  Okay... I thought... this should be interesting... and I was right!Mam-ma was actually fairly coherent, and she said, "I'm so sorry."  I asked why she was sorry, and she said, "Well... I really got my ass in a crack."  I asked, "Are you talking about the ride you took in the wheelchair?"  "Yes," she replied.  I told her not to apologize... it's over and done... but I outlined WHY we didn't want her riding in the wheelchair... and reminded her of how sick she had been over the weekend.  "We just don't want you to start hurting like that again... and every time they move you for anything, you seem to have pain."  "Well," she continued, "I'm sorry." 

I went so far as to tell Mam-ma, "You know, we have signed papers saying that we are NOT going back to the hospital!  So if you fall and hurt yourself, you will have to lie in bed in pain, and I won't be able to do anything but watch you hurt."  She said she didn't know that.  Now she does!  Anyway, she ended the conversation by saying, "I needed to apologize.  I'm sorry."  I had to laugh... even in her "in-and-out" condition, she still can do the old "pull-a-stunt-and-be-sorry-later" routine!

Tuesday was uneventful, and I made plans to stay home on Wednesday and sew for Timothy and Zola.  I was trying to get a package ready to mail to them, and I wanted to include some new clothes I was making.  Late in the afternoon, I got a call from the nurse.  She was filing a report that Mam-ma had tried to get up out of her recliner and nearly pulled it over on her.  The nurse said, "This happened while I was at lunch, and the administrator and an aide got Polly up and left me a note about it."  Mam-ma was not hurt.  I asked if she was scared, and the nurse said, "She was more mad and frustrated."  I thanked her for calling me.

By 6:30, a friend of my grandmothers was calling.  "Jerome (another friend who is a resident) told me that Polly wanted to see me," she said, "so I went to her room, and she said, 'Call Debbie.  I've never hurt as bad as I'm hurting now.'"  I told Bessie that I knew about the fall in the afternoon - I had received a call.  I debated whether to go to the ALF, but after finishing dinner and taking a shower, I threw on some clothes and drove down.  It was about 7:30 when I arrived, and Mam-ma was asleep.  I laid my car keys on her little bedside table, and she roused.  I asked, "What are you doing?" and she said, "WELL!  I'm trying to get these bowels to move!"  She said the nurse had given her a dose of Miralax.  She was complaining of pain and discomfort and said, "They won't do anything." However, a few minutes earlier she had been sound asleep!

I asked about the "fall," and she said, "Yes... I thought I could get up."  I told her, "Mam-ma you have not put any weight on either foot since you had surgery almost a month ago.  You are not able to walk!"  She said, "Well... I forgot."  And maybe she did.  However, that raised a huge concern about her getting up out of her chair... or falling out of the wheelchair.  And twice last weekend, the nurse and my sister (who is a weekend nighttime aide there) found Mam-ma in bed with both legs between the bed rails... trying to get out!

Two aides came into the room, and we all reminded Mam-ma that two days earlier she had been sick with diarrhea... and she had eaten very little since then.  She probably did not need to worry about her bowels... and she did not need more Miralax.  I told her I didn't know what else the staff could do for her... that she needed to try to sleep and rest.  The aides assured her that they would return soon with night-time medication and another pain pill.  I left... there was nothing more I could do, and my husband was waiting at home to watch a movie we had rented.

I set in on Thursday to pursue options for keeping Mam-ma safe... and to avoid another fall.  When I arrived, she was sitting in her recliner... and the foot rest was closed.  She could have easily leaned forward and fallen out.  I don't think she had been that way very long, because as I began to question her and the aides, I determined that a Hospice aide had just been there to bathe her.  This aide had not only left the foot rest down... she had also put Mam-ma's little pink house shoes on her feet - leaving the protective "boots" to help prevent pressure wounds in Mam-ma's bed underneath the bed sheet!  The nurse came in and switched the house shoes for the boots... and I hid the house shoes in the closet!

I called the Hospice nurse who is our caseworker and complained to her... and ultimately, I asked that this aide not be assigned to Mam-ma any more.  I hated to do that, but I have to consider Mam-ma's safety and well-being.  The nurse wholeheartedly agreed, and she filed an incident report on my behalf.  The more I have thought about it, the more I am certain this was the right thing to do - for Mam-ma and for other patients who might have similar experiences.  This is not the time to always "play nice."  Too much is at stake!

So after talking with the facility administrator, who in turn consulted the facility owner, I learned that physical restraints are 100% NOT allowed in the assisted living facility.  When my maternal grandmother was in the nursing home, she wore a "vest" that tied her to the wheelchair.  It kept her from falling out - or getting up - until she took her little sewing kit scissors and politely cut the straps! This type of device is not allowed for Mam-ma Polly.  So I asked the administrator... "What do you suggest we do to keep Polly safe?  I've run out of ideas." 

The administrator said that she and the facility owner both felt that Mam-ma is going stir crazy in her room.  "She needs to get out in her wheelchair... maybe sit on the porch outside."  I don't feel comfortable allowing Mam-ma to go outside.  I am afraid that she will be left unattended there, and who knows what might happen.  So I conceded... "Okay... what if we agree to take her to the dining room to her table for LUNCH ONLY.  I know she might be the last one fed... after her friends have eaten and left the table... but at least she can visit with them and have some time out of her room.  Other than that and being up for a bath, she should spend the rest of the day in her bed.  If she absolutely insists, perhaps you can get her up in the recliner for a few minutes... but hopefully the trip out for lunch will be sufficient."  The administrator felt this was a good compromise. 

I am assuming that this started today.  I did not go... I stayed home and cleaned our house.  The Hospice social worker advised me earlier this week that I should not feel as if I have to visit Mam-ma every single day.  "That's why you have us and the facility looking after her," she reminded me.  My mother did stop in this afternoon, and she said Mam-ma could not stay awake to visit with her... and Mam-ma did not know what she ate for lunch.  My guess is that the trip out to the dining room for lunch wore her out, and as I hoped, she napped most of the afternoon.  I am hoping that the daily bath and lunch trip will be enough to satisfy her - and tire her sufficiently - so that she naps in between and stays safely tucked into her bed.  The bed adjusts to a sitting position... and she is turned every two hours... so this should be enough stimulation to prevent further pressure wounds - the continual justification for Polly being "up and about."

Every time that my grandmother does something like demand to get up and out... or to call me on the telephone... the aides say, "Oh, Polly's coming back!"  I don't see it.  She still sleeps a LOT.  Most days she might make a couple of lucid comments... then the rest is one or two words - or gibberish. The Hospice social worker called her comments "social pleasantries" - answers like "I'm fine," and "Hello," and "Thank you" - simple answers to general questions.  Anything more complicated most often gets a confused answer - if that.  As Mam-ma takes less pain medication, and we get farther from the surgery date and the anaesthesia, she has more lucid thoughts... hence, the phone call and the "ass in a crack" comment that is so classically "Mam-ma Polly."  But she was not putting many sentences together before she fell and broke her leg... so any hopes that she will do so now are not reasonable, in my opinion.

I am still hopeful that things will smooth out somewhat... that for a while, at least, I truly will not feel I have to pop in every single day.  I want to learn from the experience with my maternal grandparents.  I don't want this to make me completely neurotic and disrupt my relationships with my husband and other family members and friends.  I want to keep this all in perspective and not micro-manage - OR compromise my own physical, mental, and emotional health.  I don't think Mam-ma would truly want that, either. 

Last night Greg and I went to dinner with one of Greg's best friends from high school, and his wife, who also went to school with us.  We had a great time reminiscing and catching up... and it was great to think about other things and other people for a few hours.  My grandmother's name came up, because someone stopped by the table and asked about her.  Both of our friends rode the school bus when she was driving... and we marvelled that she is almost 100 years old.  But we did not discuss her fall or her subsequent decline.  We didn't need to... I didn't need to talk about it!  And that felt great!

I have to admit... I was not really upset about the phone call Monday night.  In fact, I was somewhat amused.  For just a moment, I got a glimpse of the "Old Polly," and it actually felt pretty good.  I knew it was a manipulative ploy... whether she realizes it now or not... but at the same time, her colorful language and the clarity of her voice was a welcome treat.  I'm looking for blessings and positive notes in the most unusual and extraordinary places and events... and sometimes I'm finding them!  Saying "I'm sorry" didn't fix a thing... but the phone call was still a little treat... and I'll take it!

I Think I'll Try the "Sink or Swim" Method

I know it's been a few weeks since my last post... and I have no other excuse except to say that I've been busy!  My 88-year-old cousin who was dying was laid to rest on March 21st, so I spent much of that week with cousins and other family members.  This was a bittersweet time... we will miss my cousin, but he is at peace and died as he lived - on his terms, and with dignity.  I got to visit with cousins I have not seen in years... and some old connections were re-established, hopefully.  At the same time, this was one more reminder for my grandmother that her day is coming... and that somebody else got to go before she did.
Some of the cousins did spend quite a bit of time visiting with my grandmother, and she thoroughly enjoyed listening to their stories.  Since she can hardly get out a sentence these days, she likes for us to gather and visit in her presence.  She can soak in what we are saying... and every once in a while, she gestures, smiles, or interjects a word or two.  But mostly, she sits and smiles and enjoys our company.

Lately, my visits to see Mam-ma have centered around rearranging her closet and taking my latest sewing project to share with her.  The latter seems to be the one thing that truly energizes her these days... the "common thread" (no pun intended) that we can share and enjoy.  My grandmother was an amazing seamstress, and I still marvel at her tailoring skills and the ability to create tiny clothes for our Barbies - by hand!  But she is impressed with the work I am doing, and she obviously takes great pride in my accomplishment.

Five pair of shorts, two onesies and matching pants,
one dress, one appliqued tank, and a burp pad... all in
coordinating prints of Groovy Guitars, Urban Zoologie, and more!

Darling Diva outfit created from ladies cardigan sweater
in animal print.  Note the beading detail on the pants hem
and the little jacket pocket!  This was really fun to create!

Orange dream created from ladies beaded knit top.

Baby bolero jacket created from vintage embroidered
dresser scarf with crochet lace trim.  I love repurposing old linens!

Our little friend Ada Jane models her fake fur zebra print
bolero shrug jacket!  Is she a darling diva or what?!

Sewing has taken up much of my spare time in recent weeks. It keeps my mind off of how much we miss Timothy and gives me a positive focus. I've made dresses, shorts, burp pads, appliqued onesies, and even a fake fur jacket for the little friends, nieces, nephews and cousins in our family. I've even made matching clothes for an American Girl doll! The children all enjoy their one-of-a-kind clothes, and the moms are beyond thrilled. I know that the day will come soon enough when these little ones are teens who wouldn't be caught dead in one of my creations. But for now, they love their new duds... and I get such a kick out of creating them!

A couple of weeks ago, my husband's brother and sister-in-law visited for the day. Over lunch, my sister-in-law reported the latest news about her 95-year-old mother, who fell in November and broke her arm in two places. She required surgery, a lengthy hospital stay, and rehab at a local skilled care nursing facility. Each week since mid-November, my brother-in-law and his wife have traveled some 3+ hours to spend several days attending to the needs and business of this woman. Usually they would go on Thursday and return home on Sunday. Some weeks, my sister-in-law has stayed longer, as needed.

March 31st signaled the end of Medicare coverage for my sister-in-law's mother. She had the choice to continue her stay at the skilled care nursing facility and pay out-of-pocket. She could also move to an assisted living facility. Or she could go home and have continual care. Of course, she opted for Door #3. My sister-in-law had toured a local ALF and loved it. She hoped her mom would, also. She did not. She found all sorts of reasons to derail a move there... she had to take her own furniture (not a problem, she was assured). She would have to change therapists (also not a problem - she won't have therapists at home!) People would not come to visit her as often (the visits have already dropped to a trickle).

Every excuse she thought of was readily addressed, but she still insisted she wanted to go home. Weary of the argument, my sister-in-law told her, "Fine... then make it work." She left her mother to her own devices. Her mother arranged for part-time in-home care. She has severe macular degeneration and cannot see, but she refused Meals on Wheels, insisting she will cook for herself. Doctors and therapists determined that she was better walking unassisted than trying to use a walker, because she could not see to maneuver it... and her arm, weakened from the fall and surgery, would not adequately support her weight.

A few days before she was to leave the nursing home rehab, this woman fell in her room and sprained her ankle. My sister-in-law thought this might get the wheels back on the bus for going to an ALF. It did not. So this weekend, she and my brother-in-law moved her mother home... and then they returned to their home. In essence, my sister-in-law has said, "Sink or swim."

While I cringe at the thought of this, I get it. I remember the week before my grandmother moved into her apartment at the ALF and we argued over a folded envelope she had wedged behind a wireless doorbell apparatus plugged into the wall receptacle. She insisted it was not a fire hazard... I insisted it was. In frustration, I finally said, "Fine... if you burn yourself and this house down before you move next week, so be it!" Then when she was not looking, I removed the envelope. I don't know if my sister-in-law will get the opportunity for such an action or not... but I know she will take it if she has a chance.

We do this often with our children... we try to protect them as much as possible... tell them "don't touch that hot object" ... or "you won't like the taste of that!" But sometimes, they have to discover these things for themselves. The tricky part is allowing them to sometimes sink a little...without drowning! This is an extremely slippery slope with both age groups, and often we have to pray hard and trust God to protect our "little ones" of all ages.

My grandmother and I have come a long way on this journey, but we still have some "sink or swim" moments. She fell again recently... hit her neck on the edge of her night-stand. She admits she stood too quickly and lost her balance... and her walker was across the room. She explains that she uses the night stand and her bed as braces as she inches along the floor toward her walker, which she leaves parked across the room beside her television. Efforts to get her to pull her walker over beside her chair are futile.

Also fruitless was my attempt to get her to remember to count to five before taking a step. I reminded her that this was "the doctor's order." When she stood, I chided, "Count to five... count to five... Mam-ma, STOP and count to five!" Three or four steps later, she stopped and stared at me like I was from Mars. I realized I had just wasted my breath... and I've not reminded her again to "count to five." I know she will probably stand again, take off without letting her blood pressure regulate, and fall. And I am prepared to deal with any resulting injuries. She will either sink or swim... and I probably won't be there to rescue her if something goes wrong. Making peace with this has also been a journey... and a huge lesson in patience, surrender... and faith.

I applaud the determination of the human spirit to become independent - as with children... and to keep that independence when we age. The challenge for those of us in the middle is to learn to handle the bumps, bruises, and disasters that ensue. For this, I pray for strength and courage for each of us.

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What's happening with your "sandwich" these days?  Do you have a story to share... insights or success stories?  What's bugging you?  Can we offer you some possible solutions or encouragement?   Please leave your comments, or e-mail me directly using the link on the sidebar.

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...

The Sights and Sounds of Christmas Shouldn't Include Blood and Sirens

The Christmas Eve meal was pretty well prepared and in the oven. We were planning to eat at 3:30 p.m. My mother-in-law arrived early, and she visited with my husband as I finished up with last-minute kitchen preparations. I glanced at the clock – 2:10 p.m. My mother and her sister were to pick up my grandmother at her assisted living facility at 2:00, so they should be arriving any minute. I glanced up and saw Mom’s Jeep pull into our driveway, and I told my husband, “Mom is here with Mam-ma.” He and his mother started for the door to greet them, as I searched for something in the pantry. Then I heard my mother scream for my husband to come quickly. My grandmother had fallen. I rushed outside to see her lying lifeless on the driveway. We thought she had had a stroke. My husband rushed to call 911 as I hurried toward my Mam-ma. That’s when I saw the pool of blood forming under her head and trailing down our driveway.

In a panic, I ran inside and told Greg that Mam-ma was bleeding. He told me to get a rag and apply pressure to her wound. I ran inside and got a wet rag. Looking back, I don't know why I thought it had to be wet, but in my panic, I ran the rag under the faucet to dampen it! I knelt beside Mam-ma and pressed it tightly to her head. Her eyes were fixed, her mouth was open, and she was totally unresponsive. I thought she was dead.

I applied pressure, and asked, "Mam-ma, can you hear me?" A few seconds later, she said, "Yeah." We covered her with blankets. Thankfully the temperature had risen into the fifties and the day was sunny, so the concrete driveway was cold, but dry. As I applied pressure, the blood soaked through the rag and poured on to the concrete underneath. Greg brought me even more rags, as the pool of blood continued to grow on the concrete. We kept assuring everyone that head wounds bleed a lot and often look worse than they are. But since we didn't dare move Mam-ma to look, we had no clue exactly where she was wounded... or how bad it truly was.

The ambulance arrived after about 10 minutes, and my grandmother was placed on a back-board and fitted with a cervical collar. She was transported to the hospital emergency room, which is maybe two minutes from our house. A few hours later, CT-scans indicated no internal head or neck injuries. Once the bandages were removed and everything was cleaned, only a small puncture wound inside a larger hematoma sat behind her right ear. The only pain she complained of was from the back stabilization board. The ER staff said that this necessary precaution is "one of the worst things we do to people." She begged me, "Please, please... get me off this thing." But I was unable to do so until the results of the scans were read. I would guess she was strapped down about two hours.

When we could see that this was going to take a while, my husband came to the ER and sat with my grandmother, while I hurried home and finished heating our Christmas dinner and got it on the table for everyone. I ate with my family - Mom, her sister, my mother-in-law, my sister and her husband - knowing it might be my only chance to eat for the rest of the night. Then I returned to the ER and traded places with my husband. By this time, the doctor had given her a shot of something called Nubain for pain.

Greg said he asked Mam-ma, "Are you hurting?" and she said she was not. But when the doctor came in, he asked her if she was in pain, and she said "Yes." So he promptly ordered pain medication and gave her 5 mg of Nubain. He also wrote a prescription for pain medication for the next 2 days and said we needed to hurry to Wal-Mart to get the prescription filled, because the pharmacy would close early on Christmas Eve. It was now about 5:30 p.m.

This prescription should have been a "red flag," but in our shock and confusion, we didn't think to question it, so Greg headed to Wal-Mart to get the medication. Meanwhile, the doctor prepared to discharge my grandmother, declaring that he had “no medical reason” to keep her.

I could not believe it... and I tried to plead my case with him... Wasn’t it enough that she was 99 years old and had just had such a nasty fall? Didn’t her high blood pressure and her “loopiness” from the pain medication he had just administered qualify her to stay? Could he not consider that she was dismissed from a six-day hospital stay only 12 days earlier? He insisted his hands were tied.

The assisted living facility was contacted, and the nurse said they were understaffed and they could not perform “neuro” checks every 2 hours, as prescribed. I did not feel my grandmother was steady enough to stay in her apartment alone anyway.

The doctor suggested perhaps Mam-ma could stay with a family member. I just looked at him and said, "She fell trying to get into my house. Do you really think that's a good idea?" He agreed this was not a great option, but he said he was just trying to offer me some possible solutions. His final suggestion was, “I guess you could take her to apartment and stay with her there overnight.” I just walked away from the desk.

I was at my wits’ end. I didn’t know what to do. I called my husband and told him this while he waited at Wal-Mart. He was not a happy camper, but he told me the choice was ultimtately mine. I told him I guessed we would have to pray hard and take our chances in my grandmother’s apartment. Greg suggested I call my mom and relay all of this information to her and see what she thought. I looked up and saw a sign beside a door where I was standing. It said “Chapel.”

I stepped inside the chapel to call my mom, and as we talked, I started to fall apart. I looked at plaques that hung on the wall. They were scriptures, and the first thing I saw was Philippians 4:6-7..."Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus." Then I read Lamentations 3:22-23..."Because of the LORD’s great love we are not consumed, for his compassions never fail. They are new every morning; great is your faithfulness."...followed by Psalm 23, and finally... Jeremiah 29:11..."For I know the plans I have for you,” declares the LORD, “plans to prosper you and not to harm you, plans to give you hope and a future." All scriptures are from the New International Version (NIV).

My mother insisted that she would stay with my grandmother at her apartment, and I reluctantly agreed. I knew that I was physically stronger and more able to manage Mam-ma, but neither of us had any business handling a 99-year-old injured woman who was spaced out on pain meds. Then I said a prayer before I left the chapel and asked God to handle this… to take my worries and fretting and give me peace about this situation.

When I stepped back into my grandmother’s exam room, I was visibly upset… and so was the charge nurse who had been treating my grandmother. I am not sure she hadn't been crying, too. Her face was red and she was sniffling. She had spent an hour cleaning Mam-ma's head wound, and I have to say, every single staff member - including the attending physician - was absolutely wonderful with Mam-ma. I expressed again my concerns and frustration… and the nurse agreed that I was right to be concerned. Then she asked which doctor my grandmother had seen when she was hospitalized earlier in the month.

I told the nurse name of my grandmother’s last hospitalist, and she said, “He’s on duty all weekend. I can ask the ER doctor to call him if you want and see if he will admit your grandmother - at least overnight.” She didn’t make any promises, but it was worth a shot. Of course I wanted her to ask! I thanked her for doing this, and she left to talk with the attending physician. A few minutes later, she returned to tell me that the attending had indeed agreed to call the hospitalist, who had agreed admit my grandmother for overnight observation.

I cannot tell you the overwhelming peace and relief that flooded me when the nurse offered to talk with the doctors. I cannot begin to express how I felt when she returned to tell me that the hospitalist had agreed. I was so grateful to God for working out what I could not… and for directing me into that chapel for a few minutes. There, as I read those scripture passages, God gave me what I needed… hope, peace, reassurance that He was in control… and love overflowing.

Orders were written, and Mam-ma was wheeled upstairs by the charge nurse. I continued to thank her for being there - for helping me - for caring. She said, "My hands were tied until you asked..." It was then that I realized... I had to ask to speak to the hospitalist. Since Mam-ma's primary care physician is the nursing home staff doctor (and practicies in another city and does not have admitting privileges at our local hospital), we had to find someone who had treated her and could vouch for the necessity of admitting her. Once I recognized her hospitalist's name on the white board, we had a chance!

Upstairs, the nurses on the floor - some of them childhood friends, and all of them good "new" friends from 2 weeks ago - jumped up and began to get Mam-ma settled. To a nurse, they were appalled that there had been any question about admitting my grandmother. One dear LPN said, "Were you supposed to pour her into your car after this shot of Nubain?" For the record, this is not a necessarily bad pain medication - the concern was my grandmothers size and age - and the dosage administered.

Every time they stood Mam-ma up or moved her in the least, she vomited. The nurses agreed to watch her and hold off on giving anti-nausea medication, in case the sickness was related to the head injury. Mam-ma was settled in bed by about 7:00, but she seemed restless. She kept saying, "Debbie, you go on home." I decided she might rest better if I left, so I returned to my family gathering for a while.

When everyone had eaten and visited, we declared our "Christmas" over and done, and all of the family members went home around 8:30 p.m.. I returned to the hospital to sit with Mam-ma for a while. The LPN asked me, "What are you going to do... are you staying?" I asked her if she felt it was necessary, and she said, "No... but I want your phone number written on the white board." I placed my contact information on the white board and reminded the nurses I was less than 2 minutes away any hour of the night or day. I also reminded them that my grandmother is a DNR - Do Not Rescusitate - patient. Be sure you remind the staff of this, if you have such directives as a DNR and/or Living Will. Apparently it does not always transfer on the records!

I sat with Mam-ma until about 10:00 p.m., kissed her goodnight, and returned home. Christmas morning, I was back about 9:30 a.m. - the nurses had said the doctor would make rounds by 10:00, they hoped. And he was pretty well right on time. Before he even examined her, he said, "We'll monitor her today, and maybe she can go back to her apartment tomorrow." I was thrilled by this news. But at the same time, I had to ask myself... how did we so quickly get from "We have no medical reason to keep her," to monitoring her for two nights in the hospital? The only answer I have is the grace of God and His divine countenance to put the right nurses - and this hospitalist - in the key places Christmas Eve.

Amazingly, Mam-ma is doing very well. She was dismissed to return to her apartment the day after Christmas, and we had her back in her own bed by about 1:00 p.m. The hospitalist told me that this will be mostly a "behavior modification" issue... helping my grandmother remember to ask for help when getting up for the bathroom, to go to meals, etc. In talking to my mom and her sister, we have determined that Mam-ma got out of Mom's car under her own steam and did not wait on Mom to come around and help her.

While Mom got the walker from the back of her Jeep, Mam-ma got out, closed her door, and was inching along the side of the vehicle. Mom's sister, who is probably 4'10" and about 85 lbs., saw Mam-ma wobble and tried to grab her coat. She says she quickly realized if she hung onto the coat, she would be pulled down atop my grandmother... so she let go. We are assuming that Mam-ma's blood pressure dips when she first stands, and she must wait and count to 5 before taking a step... giving her body time to catch up. We think this explains the other 2 falls, both of which occurred when she bent over or turned too quickly while standing.

The nurses at the hospital admonished me that Mam-ma was going home as a "full one-person assist" when getting up for anything. She is weaker than ever now. In talking with the nurses at the ALF, we agreed that she truly doesn't remember to call for help... and she doesn't mind well, to boot! So the R.N. and I both talked to Mam-ma about calling for help. I asked Mam-ma, "What are you supposed to do when you need to get up?" "Call for help," she answered. I told her that was right and asked, "Where is your 'call button'?" She answered, "I don't know." I reminded her it was in the chest pocket of her pajamas.

The R.N. printed ten signs that remind Mam-ma to call for help before getting up. She taped them all over Mam-ma's apartment - the walls, every door and drawer, and above her bed. Even as she did this, Mam-ma started to get up out of bed unassisted. "This is good," I thought... "she will see first-hand how Mam-ma does." We reminded Mam-ma to call for help, and she said, "Well, y'all was both here." We agreed, but after the nurse helped Mam-ma to the bathroom, she turned her back for a few seconds, and Mam-ma was trying to stand on her own. She said, "I can see that this will not work."

I asked what else could be done besides 10 signs on the walls and doors, and she said, "I'm going to talk to the aides right now and order room checks every 30 minutes. If that isn't enough, I will put an alarm under her bed." Somehow, I have a feeling we will have that alarm before the week is over. The nurse said surely if an aide came in every 30 minutes and tried to second-guess what Mam-ma might need - bathroom break, something to drink, etc. - we could prevent her getting up unattended. We are all shocked that nothing was broken in this latest fall, and we are so worried that she will break something the next time.

Meanwhile, the ALF nurse shed some light on why the ER attending physician was so reluctant to admit my grandmother. Medicare has tightened the reins on admits and discharges and what they will cover. It is possible that this doctor felt that the hospital would not be reimbursed for Mam-ma's stay, because it occurred within 30 days of her last visit. The nurse told me, "I could have easily given you a dozen or more viable reasons to admit your grandmother," but apparently this doctor chose to go strictly "by the book." I want to give him the benefit of the doubt... but I'm struggling, given her age, high blood pressure (193/118) and her general condition.

The ALF nurse was also less than pleased that a woman weighing 113 lbs was given such a strong dose of pain medication - and a "take-home" prescription for Hydrocodone. She could not understand why someone with a history of falls would be prescribed narcotic pain medication and dismissed. I don't get it, either... and my grandmother will never see the Hydrocodone!

I feel that the staff at the ALF is doing everything possible to help me keep my grandmother safe. Physical therapy will begin later this week to strenghten her physically and cognitively. The goal is to get Mam-ma up on her feet again... with the help of a walker, of course. I asked the hospitalist if he could order a wheelchair for her, but he explained to me that this needs to be a last resort - and he does not want her in a wheelchair 24/7, because her skin tissue can deteriorate from sitting, and she would be at risk for infection. I am so glad this guy is so thorough. That had not occurred to me... and some doctors would have said, "Sure!" and written this order, just to placate me.

From what I have been reading, part of the new Medicare initiatives involves encouraging hospitals to do a better job of treating the patients while they are there... AND sending the proper care directives home with them to prevent a return stay and better rehabilitate the patient. I understand this completely, and for the most part, I've observed more detailed discharge directives for my grandmother. MY JOB is to follow through on these and make sure they are all communicated properly and nothing falls through the cracks!

As we left the hospital, I told one of the nurses, "I learned several new things this trip." She replied... "You will learn new things every time you come. It's not always things you would wish to know, but you will be better for it." What did I learn this time?

1. Do not be afraid to advocate for your patient. I told more than one nurse, "I know you are sick and tired of looking up at the desk and seeing me standing there to ask you something." More than once, I was told, "If you don't advocate for your grandmother, nobody will. Do not ever back down or hesitate. We understand completely."
2. Do not be afraid to question or challenge the medical staff. Now I know to ask to speak to the hospitalist if we are in the ER. Had my grandmother's doctor been one who had hospital admitting priviliges, I would have asked for him/her. But now I know to ASK! Question medications... What is this?... Why is it being given?
   
   My grandmother will often say one thing one minute and another the next, as in "No, I don't hurt anywhere," followed by "I hurt all over." And because we are not sure which is true, I would rather she be given something for pain on the off chance she really was hurting. But you still should know exactly what is being administered, what procedures are being performed, what the ramifications are of these... and WHY they are being done.
3. This was not a new revelation, but I need to remind you that the medical staff does not know your loved one like you do. On Mam-ma's last visit, the doctors kept wanting to tinker with her blood pressure medications, because one day her BP would be extremely high, and the next it would be very low. I explained that she has done this for years now... several days of high blood pressure, followed by a day or two where it bottomed and she could barely move. Once they understood that this is "just Polly," they left the medications alone and let her body level out on its own.

I also made a point to "prove" to several nurses just how poorly Mam-ma follows instructions. While making sure she was safe and didn't fall and hurt herself, I let more than one nurse see how she gets ahead of you and will not wait for assistance. It didn't take long for them to get the necessary alarms and precautions in place.

Finally, I have been monitoring my grandmother's weight gain. When my mom and I visited a few days before Christmas, Mam-ma's ankles were swollen again - and I was alarmed. I questioned this and was told, "She's only gained seven pounds - but she is eating well." I pursued this and got the nurses to understand that "a pound a day" is too much weight gain... and it was not from eating well! Now the ankles are once again little and bony, and the hospitalist and I made sure that orders transferred that no more than a 3-lb. weight gain is acceptable. And I will be checking!

I was prepared to lose my grandmother on our driveway Christmas Eve. I felt God’s peace and calm there in a way I cannot begin to describe. But I am grateful that He chose to wait for another place and time for this inevitable event.

Meanwhile, I am reminded once again that God is in control… that I am His, and He blankets me with His love, grace and peace. I am also reminded of His perfect timing. Our little Timothy returned to live with his mother on December 3rd after being with us and my sister for nearly 4 months. Mam-ma entered the hospital on December 6th. I had little time to grieve the departure of Timmy. At the same time, I was so thankful that I was not trying to balance his care with that of my grandmother.

I had been pretty sad about celebrating Christmas without our babies. After all, the joy and excitement of children truly "makes" the holiday. But one of my first thoughts as I sat on the driveway holding Mam-ma's head and watching the pool of blood increase was... "I am so glad Timothy is not here watching this!" I have no doubt that my husband and other family members would have helped me care for the baby while I bounced back and forth to the hospital and ALF. But I thank God that he put Timmy back with his mom, where I am confident he is safe and happy... and I can concentrate on my grandmother. It's her "season" now. The other benefit is that I can truly rest and rejuvenate when I am not with her, instead of having to immediately focus on the care of a toddler.

I do not know what lies ahead. I felt quite certain another fall was imminent... I just didn't know it would happen like it did. Christmas Day as my mother sat beside my grandmother's hospital bed, Mam-ma told her, "I wish I had died." I know she is so ready... and I am trusting God and His timing. I am resting when I can, and talking to Timothy on the phone every few days. In a somewhat weary voice, his mother told us Christmas night, "Timothy was so excited about Christmas that he would not go to bed last night, so we opened gifts at 1:30 a.m. He finally conked out about 3:30 and slept until noon!" Imagine if I had come home to THAT! The best blessing of my Christmas Day came when that little guy said, "I opened presents, Aunt Debbie and Uncle Greg!" God gave Him a happy, "normal" family Christmas... and that in itself was my best Christmas gift.

I hope your holidays were less eventful. I pray that you find a good balance in the coming year, and that you trust God to meet your needs. Trust Him to work things out even when you cannot see a solution. Believe that He will give you the right questions to ask... and the perfect answers, as well. I know it's a little late, but Merry Christmas!