It's seemed like a Friday-bordering-on-Saturday, today.
    Thus, it was with some surprise that a recent caller reminded me that it's Thursday and we have one more day of warm, muggy weather before the temperature drops about 10 degrees. Nonetheless, Mom and I have had a great day. I'll cover movement over at Life After Death Sentencing but, so far, it's been a good, fun day. Mom was sitting up on the bed when I entered her bedroom, almost ready to arise. She took her breathing treatment well, was chatty although not interested in bathing but, then, she never is until she settled down on the toilet and realizes how warm and cozy it is in the bathroom. While we ate I read interesting articles from the paper since it seemed like she would be interested and zoned in. She was. One article in particular, about "brother" movies, is fashioning our entire day. Two of the movies, The Godfather and Rain Man are in our collection and shared favorites. As read the mentions of both Mom nodded and interjected how "enjoyable" both are. I asked her if she'd like to see them today. She was more than enthusiastic. We just polished off an extended "morning" with the first. Mom was fully into it, as I was I. We paused the movie several times to talk about various scenes and bits of Cosa Nostra philosophy. About halfway through Mom decided that it would be proper movie watching conduct to have popcorn, so I won't have to worry about her blood sugar tonight. She's napping, now, and we're planning on watching the second of the two movies tonight. She went down at 1800. "Don't call me any later than eight," she directed. That's a change!

    Regarding the "issue" we've been having the last three days (hinted at in the immediately previous post) that I finally confronted yesterday: Mom is never particularly fond of either her treatments or her pills so we tend to make them into a joke, i.e., talking about how she "can't do anything without taking a pill, first," or me telling her it's time for her to morph into "The Masked Woman" (she uses masks for her breathing treatments). She is least fond of the breathing treatments and, unless I keep a sharp eye on her, she is liable to pull the mask down to her neck or hold it away from her face to keep from breathing the stuff. Since the breathing treatments are obviously doing her good, at least for the time being, I generally and simply replace the mask, remind her to keep it in place, and we continue. Usually, too, during two of the three treatments which last well over about seven minutes, a long time for youngsters and lightly demented oldsters, I move in and out of her view doing chores, setting up whatever we have planned for after the treatment, etc., but I keep my eye on her.
    During her two "weak" days she decided she was not going to tolerate the treatments. Although I was pushing my limits I remained in good humor and just replaced the treatments about twice as much as is normally required. Yesterday, though, I was well past my limits and not in anything close to good humor. Mom was still intolerant of the treatments. With each of her attempts (and there were many throughout the day) to hijack the treatments I became more exasperated. Finally, some time in the early evening, after she's awakened from her nap, was taking one of the long treatments and was attempting to remove it, in front of me, for the fourth time, I reached the end of my rope. I suspended the treatment, took the mask off her and faced her down.
    "Mom," I said, "these aren't 'at your pleasure' treatments. Let me explain why. Do you understand that you have lung cancer?"
    "That's what I keep hearing," she said dismissively. No one talks around her when her health is being discussed and her lung cancer comes up fairly frequently when Hospice People are here, so she's privy to this a lot.
    I ignored that it sounds like she doesn't believe this. It's okay with me if she continues to consider it a fact outside of her reality. I went directly for the heart. "You were diagnosed on May 21st. At that time the doctor gave you six months to live. Do you remember this?"
    I doubt that she does but, now fully on her high horse, she responded, "Ohhh, yes. I remember."
    "Okay," I continued. "It was July 21st three days ago. That's two months down. Now, I'll tell you, I expect you have somewhat more than six months in you..."
    "Well, of course I do!"
    "...but the bottom line is, lung cancer is fatal and you're not being treated because treatment, at your age in your condition, would very likely kill you after rendering your quality of life into shit. So, many people are working very hard, primarily me, to see to it that for the rest of your life the quality of your life remains high. My perception is that your quality of life is pretty much as it was before you went to the hospital. Do you agree?"
    I had her full, intent attention, now. She was even a little flustered. "Well, yes. I'd say so."
    "Okay. These breathing treatments are an important part of keeping your life going the way you like. They are important, to you and to me. They keep your lungs as clear as possible by making it easier for you to expel the secretions that the tumor is causing your lungs to create. With a little luck it's even possible, with these treatments, that something else will get you before that tumor in your lung suffocates you. So, you need to cooperate with these treatments. Not only because they help you, ah, ah, ah, no comments here, you're going to have to trust my judgment on this one, nope, I mean it! Silence! You need to cooperate with these treatments not only because they help you but because, when you don't cooperate, me having to remind you every 30 seconds to keep that damned mask on your face drives me to distraction and, believe me, neither of us likes that! Now, if you were so demented that you had no idea what was going on, that would be one thing. But you aren't that demented. You're annoyed with these treatments and you're allowing your annoyance to let your willfulness overcome your will power. I'm not going to be nice about this any more. You need these treatments. I need your cooperation. This is a joint venture here...this isn't just about you, it's about me, too. You need to allow yourself to remain as healthy as possible for as long as you want...and you need to allow me to go about the business of caring for you without unnecessary distractions. I can handle anything if it's necessary. There will probably come a time when you are no longer interested in the effort it takes to stay alive. But this isn't true, yet, is it?
    "No," she said, firmly and quietly.
    "...and I think I'll be a fairly good judge of when that starts to kick in. Do you think that's a fair statement?"
    "Yes," she said, without argument of any kind, voiced or unvoiced.
    "In the meantime your intolerance of these treatments is unnecessary and dangerous and it will stop now!"
    We've had no further problem with the treatments. She's had three since this confrontation. We may, again, here and there, between now and the time when she loses interest in prolonging her life (if that time occurs), but I have confidence in Mom's sub- and unconscious abilities and I know that a few appropriate words spoken here and there when she reaches for the mask, again, will do the trick as long as she's not in the dying phase.
    Does it sound like I was too harsh? This is what I mean when I talk about Drill Sergeant behavior and how well it works for my mother and me. In addition, I've discovered if I can rile my mother a little, and, believe me, Drill Sergeant behavior, especially when it involves long, dictatorial speeches like the one above, always riles her, I am not only successful in getting my point across but anger tends to stop her in her tracks and make her think [Would that we all reacted this way to internal anger!]. If she were a little more demented the Drill Sergeant routine wouldn't work. If she were a little less demented it wouldn't be necessary. If we were not as closely bonded as we are and as involved in each other's lives as we are both her thoughtless willfulness and my attempts to circumvent it would be moot. I saw this happen at the skilled nursing facility. The nurses and CNAs just apologized for what they were about to do to her, or make her do, especially if it was something they knew she considered unpleasant, and then got on with it, usually to plaintive cries from Mom of, "No, Gail, no!"
    Mom and I are where we are, though, and, sometimes, it takes a verbal push against her thoughts to move her beyond thoughtless willfulness and to move the two of us beyond a stalemate. There are times, as well, when her thoughtless willfulness isn't a problem and no action is required. But, yesterday, well, yesterday speaks for itself.
    So, why bother mentioning such an episode? I suspect I'm not the only 24/7 family caregiver who finds herself occasionally caught in such circumstances. I also suspect, from past experience when I was green at this, that many caregivers consider such methods "dirty little secrets" and harbor ambiguous guilt about the possibility that tactics like this are "abusive". If you know your care recipient as well as my mother and I know each other and if other circumstances of character and mentality correspond to mutual understanding in these situations, strageties like this are not "dirty" and they aren't "abusive". They aren't pleasant, surely, it's never fun to find oneself having to be confrontational. But if pleasant requests for cooperation, reasoning, cajoling and pleading don't work, at least with my mother, "Hut to!" usually does.
    Later.
- posted by Gail Rae @ 18:24   email  this post