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.

Learning to Let Go...a Difficult "Life Lesson"

My mother pointed out an article in the Sunday edition of the Arkansas Democrat-Gazette that was reprinted from the Washington Post.  Written by hospital internist Craig Bowron, the article dealt with our efforts to prolong life... often at the expense of the very ones we vowed to protect and nurture.  We have a difficult time of letting go.  To read this insightful article in its entirety, click here.  I share below an excerpt I found particularly profound.

This physical and emotional distance becomes obvious as we make decisions that accompany life’s end. Suffering is like a fire: Those who sit closest feel the most heat; a picture of a fire gives off no warmth. That’s why it’s typically the son or daughter who has been physically closest to an elderly parent’s pain who is the most willing to let go. Sometimes an estranged family member is “flying in next week to get all this straightened out.” This is usually the person who knows the least about her struggling parent’s health; she’ll have problems bringing her white horse as carry-on luggage. This person may think she is being driven by compassion, but a good deal of what got her on the plane was the guilt and regret of living far away and having not done any of the heavy lifting in caring for her parent.

With unrealistic expectations of our ability to prolong life, with death as an unfamiliar and unnatural event, and without a realistic, tactile sense of how much a worn-out elderly patient is suffering, it’s easy for patients and families to keep insisting on more tests, more medications, more procedures.

Doing something often feels better than doing nothing. Inaction feeds the sense of guilt-ridden ineptness family members already feel as they ask themselves, “Why can’t I do more for this person I love so much?”

Opting to try all forms of medical treatment and procedures to assuage this guilt is also emotional life insurance: When their loved one does die, family members can tell themselves, “We did everything we could for Mom.” In my experience, this is a stronger inclination than the equally valid (and perhaps more honest) admission that “we sure put Dad through the wringer those last few months.”

At a certain stage of life, aggressive medical treatment can become sanctioned torture. When a case such as this comes along, nurses, physicians and therapists sometimes feel conflicted and immoral. We’ve committed ourselves to relieving suffering, not causing it. A retired nurse once wrote to me: “I am so glad I don’t have to hurt old people any more.”  ©2012 Craig Bowron via The Washington Post

I found so much of this familiar.  Don't many of us know that "white knight" relative who wants to breeze in and "fix" everything?  We primary caregivers have all experienced the "helpful" friend or relative who thinks we should be paying attention to details we have already deemed unimportant in the overall scheme of things.  And yes, some of us who are closest to our elders can see what my grandmother sees... that "they's worse things than dying."

A couple of days ago, I was talking with one of my dearest friends, and I said, "I am amazed at how far my grandmother has come since her illness and fall at Christmas time."  She replied, "Don't you mean how far she has declined?"  "No," I explained... "I mean how much she has bounced back and improved.  She is walking and moving well.  She is probably as clear mentally as she was before the fall - even though she still is not all that clear - and she is incredibly healthy for a woman halfway through her 100th year!"

Mam-ma Polly and Timothy in late
November 2011, just days before
she was hospitalized for six days. 

Given all of this, I am extremely reluctant to agree to any "routine" medical tests, medication changes, or anything else that upsets her apple cart.  My mother and a few others have been quite upset with her lately for taking her walks outdoors.  Mom is so afraid she will fall on the sidewalks.  She keeps telling Mam-ma... "You have vast hallways to walk indoors... why do you need to get outside?"  Mam-ma's answer... "I need fresh air."  I get that... and if she falls happily walking outside in the warm spring sunshine, so be it. 

This weekend, a fellow resident who is still mobile spoke to my mother at church about "really getting after" my grandmother for walking across the street from her ALF to visit a friend who is in the nursing home.  My mother had already admonished Mam-ma not to make this trip.  Mam-ma has not mentioned it to me.  Honestly, I am fine with it.  My grandmother is at a stage in life where she has very little that gives her a purpose.  If visiting her fellow Sunday School member friend and offering encouragement gives them both a lift, who am I to say she can't make that walk.  Is it rife with potential pitfalls and dangers?  Sure it is!  Is there a chance she could fall and hurt herself seriously... face a length hospital stay or worse?  Absolutely!  Is it worth these risks?  I believe so.

My mother's cousin, who is 88 and has a litany of ailments, is dying. He was placed in Hospice care last week.  It took his companion of almost a decade a long time to come to the conclusion that he had already drawn... he was dying.  She kept insisting, "He can't die... I can't live without him!"  He insisted, "I don't have much longer."  And with virtually no quality of life remaining, he shouldn't have to. 

 

So last week, he raised his hand and said "No!" to more tests, needles, poking and prodding.  No more medications.  No more procedures to drain fluid that is building up around his vital organs.  Nothing but a reasonably comfortable bed in his own home, with his own television and people who love him to watch and wait.  He told me Sunday, "It won't be long now."  I told him that was fine... I would see him on "the other side."  He and I had agreed a few days ago that we are both okay with this.

I told my dear cousin what I would tell my grandmother or anyone else in this position... you don't have to stick around for anything or anyone who is here.  You have fought well... lived well... and now it's time for your big party.  Rest, relax, drift off to sleep and let the angels carry you to heaven when God has your mansion ready.  Hug your wife, my dad, and a few others for me... and save me a seat!

The longer my grandmother lives and the more time I spend in the presence of elderly people who are being somewhat artificially kept on this planet, the more convinced I am that Dr. Bowron has it right when he quotes the nurse who said, "I'm so glad I don't have to hurt old people any more."  There is no shame in recognizing that sometimes, we go too far.  In certain instances, we do more than is necessary... and we fail to recognize when enough is enough.  I pray that God would grant me wisdom to stop short of this... in the lives of those for whom I am caregiving - and that the same dignity would be afforded me if/when I reach this stage of life.

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Meanwhile, I do think my grandmother is still having little mini-strokes, and in the effort to provide information of the "you-just-described-what-is-happening-in-my-world" variety, I share the following:

My grandmother had company recently - cousins from another state who drove over for the day to visit with her, bring her KFC (her favorite), and maybe play a game or two of dominoes.  The night before they arrived, Mam-ma phoned me, upset... she was worried about how she was going to get ready for her company.  I was in bed with the flu - and she knew this.  I told her that she didn't have to do anything to get ready - her room was clean... they could go to one of the common areas and eat their meal and play dominoes... everything was set. 

After a long difficult conversation, I was able to determine through the brief words and a few tears that Mam-ma was worrying about how she would "clean up the mess" after the company left.  I finally said, "Mam-ma!  We're talking a couple of boxes and a sack from KFC!  There won't be a mess.  Besides, those girls would never leave you with trash and expect you to clean up after they were here."  What can I say?  Maybe it was the flu talking.  I was probably too curt.  But she sniffled and said, "Well... okay."

The company came and went, and the day afterward, Mam-ma called again... asking how I was feeling.  I was still sick and in bed... the flu really took it's toll on me, and that is never a good thought for Mam-ma!  I asked how her visit went, and she told me, "Terrible!"  She proceeded to cry and tell me she had grown tired and asked the company to leave, and she just felt awful about doing so.  I assured her that they probably were not offended... they had only planned to stay a few hours.  She was not convinced.

I spoke with the cousins later, and they said they had a wonderful time.  They arrived around noon and stayed until approximately 3:30 p.m.  They ate KFC... visited... and walked all over the ALF.  Mam-ma really showed them around.  They told me was talkative, but apparently she never suggested playing dominoes.  One of the cousins told me, "Polly started nodding off around 3:30, and we were needing to leave anyway, so we told her we thought we should head for home."  They were clueless that Mam-ma felt she had insulted them... in fact, leaving had been their idea - and they felt they had all had a wonderful visit. 

I am quite certain that Mam-ma enjoyed the day.  I am also quite certain that she had a mini-stroke that probably began the night before when she called and was worried about clean-up.  The nurse told me a few days later that she mentioned to Mam-ma, "I hear you had company over the weekend," and Mam-ma did not remember the cousins had been here.  She has never mentioned their visit to me again... and I have not mentioned it to her.  This is the pattern of the mini-strokes... confusion, even agitation and a sense that things are all awry, followed by extreme fatigue, maybe a little more confusion... and then the forgetfulness.  It's as if none of it ever happened.  Or... as in the case of a convoluted phone call a month or so ago, she will remember that something happened - and she was not herself - but she can't put it all together.

Last week, Mam-ma called twice.  For the woman who used to call several times a day, two times in one week is now a lot... and there is a lot of silence and struggle to find words when she does call.  The first call came at 9:00 p.m., and she asked (remember, this took several minutes to accomplish)... "Do you still have light bulbs?"  I determined that the bulb in Mam-ma's bedside lamp had burned out when she said, "Oh... I've turned on my bathroom light... maybe that will help."  I suggested she have an aide get the bulb from her other bedside lamp and swap them for the night.  She agreed to that.  I asked, "Are you okay otherwise?"  She replied, "Well, I'm just all shook up."  I (stupidly) asked, "What's got you 'shook up?'"  She answered, "Well, my light bulb in my lamp isn't working."  I reminded her to call an aide to exchange the bulbs... and she said she would.  I went to visit the next day (and take more incandescent bulbs I had rounded up from my own lamps - she will not use the new energy-efficient variety!), and she had done what I suggested.

A couple of nights later, Mam-ma phoned.  My husband looked at the clock - 6:45.  He knew immediately why she was calling.  It took several minutes to confirm that she was unable to locate "Wheel of Fortune."  It's March... the SEC college basketball tournament was in action, and the local station was broadcasting the games instead of regular programming.  I tried to explain that "Wheel of Fortune" would not be on that night - nor the next night.  "No!" she said, "I'm a lookin' at Ole Miss and Tennessee."  Exactly!

Mam-ma kept saying, "You don't understand!"  Finally, she got out, "Well!  Where is ABC?"  I told her again, "ABC is not on your TV right now because the ball tournament is being broadcast.  You will have to watch another channel tonight and tomorrow night.  I'm sorry."  "Oh... okay," she said, in a disappointed tone.  Honestly, I was just glad to hear her television blaring in the background - for the first few weeks of January, she never turned it on.  This tells me how much improvement she has made in the last month or so.

So while my grandmother is well enough to walk across the street and visit a sick friend at the nursing home, she may not remember that she went... nor be able to say more than three words to her when she gets there.  She still has trouble conversing, and on any given day, she may have a little mini-stroke.  She has become more "clingy" when I go - reaching out to pull me close for a second or third hug... crying and saying, "I've just missed you so bad," even though I visited two days prior.  The general decline continues.  She very well might fall and hurt herself badly while walking outside... and I might be making my next posts from her hospital bedside. 

But I am beyond trying to stifle any efforts she makes to stay active and engaged, short of her suggestion that she might like to drive a car one more time!  That, I think, is where I draw the line!

You Messed With The Wrong Bulldog!

Every six months, my grandmother visits her cardiologist.  Every three months, her pacemaker is checked by nurses who visit our local hospital.  In between THOSE visits, her pacemaker is checked by telephone, using a device she keeps at her apartment. The "heart clinic" has always sent letters to remind us of appointments... and they were sent to my address.  This worked great, because I could make notes in my calendar - and on Mam-ma's. They also called the day before to remind us of the appointments.  The only "fly in this ointment" was when the tech mistakenly called my house a few times for the telephone check, and I had to explain that he was to call my grandmother at her apartment instead.

This "system" worked fairly well... until December 2011.  Mam-ma was scheduled for an appointment with her cardiologist on December 14th - at our local hospital, where he maintains an out-patient clinic.  Since Mam-ma was hospitalized from Dec. 6-12, I telephoned the clinic nurse and told her that I was not going to bring Mam-ma back to the hospital for an exam on the 14th.  In fact, when I talked with the  nurse, I wasn't even sure that Mam-ma would be discharged from the hospital by the 14th, and we agreed that the doctor could walk upstairs and see her, should she still be a patient.

On December 15, a nurse spoke with me by telephone and said, "If we can't get your grandmother to the hospital, let's at least do a telephone check of her pacemaker."  I agreed to this, and I got the nurse at the ALF to help Mam-ma get her device out of the drawer and hook it all up at the appointed time.  The call to check the pacemaker never came.  When I made some calls to inquire, a tech said, "Oh, I saw that on the schedule... and her scheduled appointment on the 14th, and I decided that since she had just seen the doctor, this must be a mistake - so I didn't call."

We rescheduled my grandmother for a visit to the cardiologist in January, and as I described in a previous post, the "heart clinic" notified the ALF instead of me, for some reason, and when I went to get my grandmother for her appointment, she had already been transported to the hospital with another resident - an hour early, so they could ride together.  I arrived at the hospital and thought I got it all straightened out... all correspondence was to come to me... the phone calls for pacemaker checks went to Mam-ma at her apartment.

So a couple of weeks ago, I was looking for something in Mam-ma's apartment that she insisted was "stolen" (a recurring theme with her these days), and I discovered TWO letters notifying Mam-ma of upcoming appointments... one for a telephone check of her pacemaker, and another for an in-person check.  I noted the dates on Mam-ma's calendar, then brought the letters home and made notes on my calendar.  On the day we were to have the phone check (January 26th), I arrived at Mam-ma's apartment 30 minutes early, got her all hooked up to the machine... and the phone call never came.  I made several calls to nurses/techs/the clinic itself, and I could never get anyone in person.  I left many messages... to date, no one has returned my phone calls.

I let the ALF know that we had an upcoming appointment for an in-person pacemaker check, and that I would personally take Mam-ma, because I wanted to try to straighten out this confusion. Yesterday was "the day."  Bless her heart, Mam-ma has been so excited about "seeing the doctor" that she has called me nearly every day for over a week... "Is today the day?  Aren't you coming to get me?  I'm dressed and ready!"  "No, Mam-ma... it's NEXT week.  I'll let you know in plenty of time."  I didn't even address with her that we were not seeing a doctor... this was an "in-and-out" pacemaker check.

I did not get any phone call the day before to remind me of the appointment, and I wondered as I drove to the ALF... "Will we get to the clinic and discover that the appointment was cancelled?"  Mam-ma was dressed and ready - hair combed, lipstick applied - she looked like a million bucks and was clearly excited.  It was a cold, raw, rainy day, but she was not deterred.  So we drove to the hospital for the appointment.

We waited only a few minutes in the waiting area before a very sweet nurse ushered us back to an exam room.  She attached the electrodes to Mam-ma's chest as I explained that we had a mix-up about who to contact.  She looked on her computer and discovered that the ALF was the "point of contact" - both address and phone number. I was listed as an "emergency number."  We were in the middle of changing all of this, when another nurse entered the room.  She heard me say to Nurse #1, "I spoke with someone named XYZ, but she never called me back."  Nurse #2 said, "I'm XYZ... and I did call!  I spoke with someone yesterday."  I asked who she spoke with, and she glanced at the computer screen and said, "It was you... I recognize the name."  "No, you didn't speak with me," I replied, "and my husband would have told me if you had phoned our house."  "I know I talked with you," she replied, her voice getting louder and more agitated... "we'll just look in the computer... I make notes on everything.  But I know I called you... I always return phone calls."

The other nurse completed the pacemaker check and changing the info in the computer.  My little grandmother sat quietly in her chair.  I tried to nicely explain to Nurse #2 that we had had three appointments since the first of December... and all of the notifications had gone to the ALF and caused major confusion... and two of the appointments never materialized.  She was still insisting, "I called you, I know I did."  Then she got her computer screen up, and she said, "HERE... I called you... December 15th... I KNEW I called you."

I just looked at her, and said, "You very well may have called me on December 15th, but we are talking about YESTERDAY!  We've had three appointments since that date."  "But you agree... I did call you, right?  Because I always return phone calls," she insisted  I just laughed and told her, "We were talking about yesterday - and January 26th, when the tech never phoned for a pacemaker check and no one returned my calls.  Yes, I probably did talk to you on December 15th, but we're talking about who was called yesterday."  Then she looked at Nurse #1 and said rather curtly, "You need to go ahead and complete the exam... we can work this out later...we have other patients waiting!"

Nurse #2 turned to me and said, "I can tell that you are upset... and I am upset that YOU are upset!"  I told her, "I am not upset... I just want to get the notifications, because my grandmother cannot read her mail nor remember to give it to me, and the ALF does not let me know when you call them about appointments - they just handle them, and that's causing confusion."  I felt like I was in a bad dream... or a three-ring circus.  FINALLY, Nurse #1 sweetly said, "I think the problem is that somehow the ALF got on the records as the point of contact.  I've changed that to your information, and deleted the ALF, so we should be all set."  I smiled and thanked her for all of her help.

Nurse #2 was still insisting that she always returns phone calls, and I did not call her.  I opened the call log on my phone for January 26th, and we went through the numbers... both nurses said none of them belonged to Nurse #2.  However, she gave me her number and said, "If this ever happens again, call me, and I will personally do the telephone check."  I entered her number into my phone.

I turned to Nurse #1 and inquired about the pacemaker check, which was why we were there.  She told me all was well, and the battery was good for another 3+ years.  She then said to Mam-ma, "You are lucky to have someone who cares so much about you.  Most people just let the facility handle these things, and we never see a family member."  Mam-ma nodded.  Nurse #1 turned to me and said, "You are sweet to care so much for your grandmother."  "She's worth it," I replied... "and I know you two think I am something of a bulldog, but I have to stay on top of this."  They assured me they didn't feel that way, and Nurse #2 even gave me a hug and said, "I'm sorry for upsetting you."  I told her again that she did NOT upset me... and I was sorry if I had confused her about the phone dates.

The bottom line is that we hopefully have this all straight now... and Nurse #2 must have been having a very bad day.  She burst into the room, got into the middle of a conversation, and went ballistic.  I thought I might need a pacemaker before it was all said and done!  I have a sneaking suspicion that she reacted as she did because this has happened before... and she was clearly defensive.  If there had not been such a pattern of ineptness in the first place, there would have been no need for such a confrontation.

Oh... and the telephone check on January 26th that never happened?  The "notes" showed that the tech DID phone the ALF later that afternoon and "rescheduled" for 2:00 p.m.  When he phoned at 2:00 p.m., the notes say the nurse told him that there was a staff meeting, and nobody was available to help Mam-ma with the test.  All of this was news to me. I didn't mention this to the nurse at the ALF... it wasn't her fault, and I'm sure that they do handle this sort of thing regularly for many of their patients.  The point is... we were there at 11:00 a.m. for an 11:30 telephone appointment that never happened, which is on the "heart clinic" staff, not the ALF nurses!

On the upside, Mam-ma was thrilled and told the aides at the ALF that she had had a good "doctor visit," and that "he just wants to see me ever once in a while!"  I went to her mailbox and retrieved mail that had accumulated there for several days, including several Valentines.  I made a mental note to check her mail more clearly ... and hopefully this won't be an issue again for awhile.

I share all of this to demonstrate, sadly, just how convoluted things can get when it comes to medical care and paperwork...and managing the care of loved ones - especially the elderly.  There is no reason this has to be so complicated... but my grandmother can no longer manage any of this, so someone has to advocate for her... and that "someone" is ME!  As a nurse friend at the hospital told me back in December, "You are her only advocate, and do not apologize... if you don't see about these things, nobody will."  My friend who is the hospital administrator disagrees with this comment, because he says "Hopefully we are doing a good job of advocating for our patients."  But I am here to tell you... things fall through the cracks left and right... it's simply a fact.  And we know your loved ones better than the doctors and nurses.  So it's OUR JOB to stay on top of things.  And it we have to be a bulldog to get the job done, so be it!

We're All In This Boat Together

Several times lately (twice in one recent trip to Wal-Mart), I have commiserated with others who are balancing the care of an elderly loved one with their own lives and responsibilities... and to some extent, the care of grandchildren or other little ones.  Some are dealing with similar issues to mine with my own grandmother - the challenges of aging, dementia, depression, and grief over the loss of peers. Just since the first of this year, five residents of my grandmother's ALF have passed away... and four of those were her close friends.  Another dear friend who lived across the street at the skilled care nursing facility died last week.

Losing five friends in less than five weeks is enough to drag anyone into a deep depression.  So it comes as no surprise that my grandmother has not thought clearly in recent weeks.  One of her table mates sunk into a deep depression over the loss of their dear friend, Ruth, who had been a next-door neighbor to this lady when they were still living at home.  I visited with the grand-daughter of this sweet lady one afternoon at Wal-Mart.  She said, "We could write a book!"  I told her... "My mom already has!"  I also shared a link to this blog, and she has e-mailed me to say she read several posts, and she felt better knowing that others were having similar experiences to hers with her own grandmother.

So I thought this would be a good time to mention my mom's book again.  It's called When Heads and Hearts Collide, and it chronicles much of the journey with my maternal grandparents, both of whom lived out their days in a skilled care nursing facility.  I have shared this book with several friends, and to a person, they have all said, "This could be me!"  So many of the themes of the book are universal among those caring for elderly loved ones.

I would also like to mention a phenomenon that is quite common among the elderly, and that is something called "Sundowning."  Information found at www.mayoclinic.com says that... "the term "sundowning"  refers to a state of confusion at the end of the day and into the night. Sundowning isn't a disease, but a symptom that often occurs in people with dementia, such as Alzheimer's disease. The cause isn't known."  The website lists several contributing factors:  fatigue, low lighting, increased shadows, and disruption of the body's "internal clock".

An article at AARP.org defines "Sundowners Syndrome" as "a cluster of signs and symptoms that occur as darkness falls. The onset can be abrupt and the behavior can have a paranoid quality to it. The person may have delusions they are being watched. Very often they become severely agitated and argumentative. It is common for them to lash out at their caregiver as well. There also may be pacing, wandering, cursing, yelling and hallucinations."

Not all people who "sundown" are what I would consider "elderly."  The husband of my mother's cousin is experiencing this condition in his early 70s, following chemotherapy for lung cancer and other medical procedures.  But the symptoms are very similar...and one of the worst for caregivers is agitation - often to the point of beligerence.  My mom's cousin said that during a recent episode, her husband required medication to calm him... and it took more than one person just to administer the medication.  This can be extremely trying for the caregivers and other loved ones who are standing helplessly nearby.

There are a couple of things that we should remember...

1. Fatigue may play a big role in "Sundowners Syndrome."  Ask yourself whether your loved one has been unusually stressed... perhaps hospitalized and out of the normal routine... or overly tired or run down from an illness or injury.
2. Don't take it personally... even if your loved one lashes out and says it's your fault.  Remember, your loved one is not himself/herself for whatever reason.  This behavior is not deliberate... nor something either one of you can necessarily fix.

I am continually surprised when I talk with others and discover how amazed they are to learn that others experience much the same thing.  There are a lot of you out there who are lonely and isolated... and this is really sad.  Look around when you visit your loved one.  Find someone who is visiting another resident and strike up a conversation.  See if maybe you can befriend each other.  If you know of someone who is dealing with much the same situation as yours, reach out to them.  We really are all in the same boat... and somehow, knowing that we aren't alone is of critical importance.

My  mom's book can help, too.  You can order it from her blog by clicking here.  Look on the left-hand sidebar for the order button.  And sometimes it helps to share your own story.  Please feel free to contact me and tell me about your experiences.  If you permit, I will publish some of them here.  Sharing your own frustrations and loneliness might be the turning point for someone else who is walking this journey... and maybe keep a few of us from jumping overboard!

Does Anybody Really Know What Time it Is... Does Anybody Care?

When I took my grandmother to the cardiologist last month, I wrote about the mix-up in scheduling and how the doctor's office contacted my grandmother's ALF about her appointment. So when I arrived at Mam-ma's apartment to help her dress for her appointment some 45 minutes later, she was already sitting in the waiting room at the hospital, where she had been transported by the ALF driver.  The end result was a very long wait... and an exhausted grandmother.  I spoke to the nurse and a couple of other people and told them that I was the only person they should contact about my grandmother's appointments.  I gave them my mailing address and my telephone number.  I told the nurse, "The only phone call Mam-ma should get is the one to check her pacemaker by telephone."  She assured me this was handled.

Last week, while looking for two letter openers that Mam-ma insisted someone in the ALF had stolen (yes, we're back to that again... and yes, I found them very near where she normally keeps them), I found some mail that had been delivered to my grandmother at the ALF.  In it was a letter from the cardiologist's clinic telling Mam-ma that her pacemaker would be checked by phone in a couple of days - at 11:30 a.m.  I brought the letter home with me and tried to call the person listed on the letter as a point of contact.  I got an answering machine and left a message, asking her to please telephone me.  She has yet to call.

The day of the pacemaker check, I arrived at Mam-ma's appointment about 30 minutes early.  I wanted to get her device out of the drawer, help her get set up, and be sure we were ready at 11:30 a.m.  We were ready well before this time.  The call never came.  At 11:40, I began using my cell phone to try and contact someone to determine why we were not called.  After three phone calls, several "run-arounds" and returns to the switchboard and messages to three separate "in-boxes," I still had no answer.  However, in these messages, I had stated that "We went through this last month, and someone on your end arbitrarily decided that my grandmother did not need to have her pacemaker checked and canceled the call.  It's now almost noon and time for her lunch, so unless you call immediately, the box is going back in her drawer."  To my knowledge, no one has called, and it's been three days.  I left my cell number for call-backs... no one has called.

However, while waiting, I did find another letter... this one telling of a physical pacemaker check on February 15th at our local hospital.  I told Mam-ma, "We'll deal with this then.  Clearly your pacemaker is working just fine.  Don't worry about it."  We put her testing device back in it's box and returned it to her drawer, and I walked her to lunch.  I cannot understand why something so simple has to be so complicated... and why there is such a level of ineptness that is so widely accepted these days.  At this point, I am picking and choosing my battle, and a telephone pacemaker check was not high priority to me, so I'm letting it go.

The last two weeks, Mam-ma has seemed to make steady gains, although she doesn't show them much to me.  Last week she spent a few days in bed, for the most part... or so she said.  When I questioned the nurse, I discovered that on at least one of these days, she had zipped up and down the halls all day, gotten her hair done, and had a pedicure from the visiting podiatrist... none of which she volunteered on her own.  And indeed, for the most part, her speech does seem slightly better.  At least she can get out a few sentences from time to time.  And Mam-ma is eating well, according to a table-mate and friend who is much younger and has taken quite an interest in her.  So we are coasting at this point... aware that all could change in a heartbeat.

* * * * * * * * * * * * * * * * * * * *

Meanwhile, my brother-in-law and his wife visited last week, and my sister-in-law is now dealing with the aftermath of a fall suffered by her 95-year-old mother, which occurred shortly before Thanksgiving.  The fall resulted in an arm broken at the wrist and above the elbow, and now this lady is in a nursing home for rehab while the breaks heal.  A couple of weekends ago, she became belligerent, upset and confused... and later it was determined she had suffered a mild stroke.  My sister-in-law is realizing that it may not be feasible for her mother to return home after rehab.  We talked at length about her options.

During the conversation, my sister-in-law mentioned the mountain of paperwork.  "Yes... I know," I replied.  She mentioned a Do Not Resuscitate (DNR), and indicated that her mother does not have one - nor a Living Will.  I was astounded.  I told her that even my husband and I have Living Wills.  And I learned recently that DNR is not the same as a Living Will, so now both are in place for my grandmother.  Given that, I still must tell every doctor and nurse, "Polly is a DNR."  Apparently this information does not always carry through on the records, and my grandmother would not want to inadvertently be placed on life support.  My sister-in-law reasoned that her father had neither of these, and "they just asked us what we wanted to do, and we told them."  However, she lives nearly four hours away from her mother.  I pointed out that she very well may not be there when something happens to her mother - just as with the stroke - and by the time she arrives, life support could already be in place.

So my admonishment to everyone is... get these documents signed and in place NOW!  We never know what is going to happen, and this could save tremendous stress and heartache in the long run.

* * * * * * * * * * * * * * * * * * * *

Speaking of paperwork, I got the re-evaluation papers to complete for keeping my grandmother in the ALF with Medicare/Medicaid coverage.  In essence, everything I provided last year had to be provided again... the investigation goes back five years.  So while I sufficiently proved last year that she qualified, I had to prove it again this year.  This meant that I had to fill out five forms and provide copies of a current bank statement, proof of her pre-paid funeral plan, and documentation that we had surrendered her life insurance policy.  The only thing I did not have to provide this year was receipts to prove we "spent down" her assets to under $2000, because we did that last year, and she doesn't have any money left!  If she makes it to this time next year, I will have to do all of this again, so I kept copies of everything.  Just so you know... this is an annual event! 

In the scheme of things, I cannot complain. I am so grateful to have my grandmother at the ALF, and it wasn't nearly as bad or as time-consuming as what we went through last year.  Additionally, the case worker who was so horrific last year is no longer evaluating admits to the ALF in our county, because of the volume and severity of complaints lodged against her.  So I am told that this process should be fairly smooth sailing this time around with a competent caseworker.  Let's hope so!

* * * * * * * * * * * * * * * * * * * *

As I visited with my sister-in-law, she expressed several frustrations, all of which are normal - and common.  In particular, she said her mother was complaining that she was not happy and wanted to go home.  I advised my sister-in-law that her mother may never truly be happy again, and the best thing she can do is to make sure her mother is well cared for and do what is best for her - and for herself.  Unless she plans to move back in with her mother, she has to do what is going to make sense long-distance... and ensure that her mother's basic care is well-managed.  An ALF may make the most sense in that regard.  And should her mother be placed where other friends from her community reside, my sister-in-law might find that she is happier there than she will admit.

At the end of the day, I told my sister-in-law, "Your mother is no longer in control... and quite frankly, neither are you!  You must do what is best for all concerned and be satisfied with that."  Believe me... I'm learning this the hard way.  I told my husband the other day after talking with my grandmother, and then her nurse - and hearing two conflicting reports - that I feel fairly certain that Mam-ma is "playing" me... but I'm not sure whether she even realizes it any more.  There was plenty of time when she knew good and well what she was doing, but now I am not so sure... and it really doesn't matter.  The worst of it is that I don't know when she is truly in need, so that makes it hard to gauge how to respond.  For the most part, I just sound sympathetic, pat her hand and hug her, and tell her I'm sorry... and it will all be okay.  So far, that seems to be working fairly well.

I'm also learning to make time for myself... and make no apologies for doing so.  I get in my almost-daily workouts.  I've spent several days lately sewing... making clothing for little nieces and nephews.  I've even read a few books in recent months... something that had slid way down my list for a long time now.  I miss Timothy and his family terribly, and keeping busy helps.  And I am actually making more frequent visits to my grandmother's apartment.  The difference is in my attitude.  I do what I can while I am there, and I "leave it at the door."  I've advised my sister-in-law to do the same, just as I was advisedby someone this time last year... knowing full well it is far easier said than done.

I have come to the conclusion that the only salvation we have at this point is to stay diligent about paperwork and preparation... to try our darnedest to stay one step ahead of the bureaucrats and our loved ones... and to work hard at maintaining some semblance of a life - and preserving our own sanity.  Some days are better than others!

Another Empty Chair at the Table

Last week when I took my grandmother to the doctor, she told me, "Ruth is sick."  Ruth was my third-grade teacher.  She and my grandmother became friends in the late 1950s/early 1960s.  They were in B&PW Club together - both "business women" in an era when there weren't very many women who worked outside the home.  Ruth had moved to the ALF several years ago, and when Mam-ma moved in, she was seated at a table in the dining area with Ruth and another friend, Ms. Evelyn.  I spoke to Ruth and Evelyn on January 2nd when I walked Mam-ma to lunch.  Both seemed well.


Ms. Evelyn, Mam-ma Polly, and my first grade
teacher, Ms. Ruth

By Thursday, January 5th, Mam-ma was telling me that Ruth was sick.  She sat at the table that evening for dinner... but she did not eat.  The next day, she was admitted to the hospital, where she died Monday morning from pneumonia.  Ruth would have been 97 on June 16th.  Mam-ma and Ms. Evelyn are heartsick.  Evelyn and Ruth were "kitty-cornered" neighbors for decades before both moving to the ALF.  Evelyn has told me over and over this week how long she and Ruth were friends - and how much she will miss her.

Monday, I went to the ALF to check on Mam-ma, and we talked at length about dying.  She is so ready - and quite frankly, she is jealous that Ruth got the jump on her!  She said, "I prayed this morning about this.  I told the LORD I'm ready to go." Then she managed to get out... "Death... frightens... me."  I asked, "Are you afraid to die?"  No, she told me... and finally I managed to discern that she is afraid of lingering... becoming comatose or "like a vegetable."  She also managed to express that she worries about those who are left.  I assured her that we will be fine... we will manage... and without her to lean on, some might even have to step up to the plate and do better!

While we talked, I realized that the last few times I have visited, Mam-ma's attire has been a little strange.  January 2nd, she had on summer white pants and a light-colored shirt. Many other visits, she has been wearing the same drab olive green pants and a multi-colored blouse.  So I went through her closet and organized some "outfits".  I asked her why she wore the same thing all the time, and she replied, blankly, "I don't know."  My grandmother has beautiful clothes.  Now that she has lost weight, she fits into all of them well.  There is no reason for her to wear the same thing every day.  Either the aides are not paying attention - or she chooses to wear the same outfit.  I tend to think it is the latter. 

So, just as I selected Timothy's daily attire, I grouped ensembles for Mam-ma - pants, shirts and a jacket.  When I returned yesterday, I partitioned her closet, leaving notes on the summer things that said, "Summer Clothes - Do Not Wear Until After March 2012".  The outfits for this winter, I labeled... "Please Help Polly Dress in These Outfits for Winter.  Thank You!"  So far, Polly has worn a new outfit each day this week. As one staff member put it, "There are people here who get paid to do laundry - there is no reason she can't wear a clean outfit every single day."  It may not seem like much, but I think it makes a difference - not only in my grandmother's appearance, but also in her attitude.  Change is good...even if it's merely your clothing!

I've been visiting more often and spending more time with my grandmother this last week or two.  One day she is up and the next she is down.  She is staying in her room more... and sleeping a lot. She is bored and depressed.  My mother is traveling, and she said she hesitates to phone, because Mam-ma has so much trouble talking on the telephone - and even getting to it to answer.  She said she would write a letter.  However, I've been having to read Mam-ma's mail to her this week, so Mom is going to e-mail the letter to me, and I will read it to her.  Once again, I see a similarity - we read to Timothy, and now we read to Mam-ma.

I told my grandmother that I have no idea when the LORD will call her home.  I know it won't be until she has accomplished all she is responsible for here... and that may be something as seemingly small as smiling at an aide or working through the grief over Ruth's death with her friend, Evelyn.  But I assured her that when the day comes, we will all be happy for her... confident she did all she was supposed to do in her lifetime - and that she is reunited with so many who loved her and have gone to heaven already.

This is a challenging time... a hurtful time, in a way I didn't really expect.  Watching two ladies who are nearly 100 years old sit and stare through their tears is both a heartache... and a blessing. I've sat in Ruth's chair a couple of times this week when I visited.  The empty chair is a constant reminder to these ladies of her absence. To realize that they are so ready to go to heaven makes the thought of losing them a little easier.  It will be a sadness... but also a relief.  They, like Ms. Ruth, will leave a rich legacy of lives well-lived. 

In the meantime, the skills and tactics I use in nurturing a 2-year-old are coming in handy as I nurture my grandmother.  Much of the frustration and stress associated with caring for Mam-ma in the last decade or more is being replaced with a new-found level of patience, compassion, and empathy. I look at some of the things she can no longer do, and I realize that, like a toddler learning to do things for the first time and often stumbling in the process, she cannot help herself much of the time.  She has outbursts and expresses frustration and confusion, just like a toddler... and I have to respond the same for both ages.  

And maybe that's why God has kept her around.  I prayed for a number of years that my grandmother would not die with us at odds with each other... leaving me with bitterness.  She can still push my buttons... but no longer in the same way as when she was "up and at 'em."  Maybe God has kept her here and allowed this decline to soften the blow. 

I apologize if my last few posts have been depressing.  This is a bittersweet season in my life.  And I suspect from comments I've been receiving that many of you are in the same boat... or you just got out!  Right on cue, God blessed me last night with a phone conversation with Timothy that totally brighten my day and reminded me of the circle of life.  Timmy told me of playing with his dinosaurs and reading books.  Then he said, "Okay, honey, I'm gonna let you go and get some sleep!"  With a "later, gator" and an "after while, crocodile" - and even an "I love you!" - he returned to play with his toys, and I hung up confident that he was happy and content... and always loved. 

I don't know when I will get to see him again - and IF I will see my grandmother tomorrow.  But I do know that God is working everything out perfectly.  And for the moment, all is well.

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...