Late Afternoon Musings on More Than One Subject
    Not sure how many will be included. Depends on how much time I have and how many of today's musings I recall.

1. Today has been an extremely lethargic day for Mom. I think the monsoon is contributing, but of course, that's not the main reason. In the bathroom while we were bathing, right after her breathing treatment, she coughed quite a bit and quite productively, which is usual after these treatments. Today, though, the amount of coughing irritated her. She gave me a look that I think I read accurately as her conveying, "Once I get rid of this coughing, I'll be all right."
   "Mom," I said, "normally, I know, coughing like this is something you expect to get over. This isn't normal coughing, anymore, though. It's because of the tumor in your lung. It's still good for you to cough, believe me, but the chances are excellent that you'll be coughing like this permanently, until the end of your life. I know it's troublesome but, when you can no longer cough, well, that'll be a signal that you're close to not being able to breathe, anymore. So, you know, all this coughing is something we've just got to accept. It's a good thing, now. We want you to be coughing daily as long as possible."
   Mom was quiet and alert as she listened to me. She didn't respond immediately, so I returned to our bathing routine. As I was washing down her left leg she said, "Well, I guess we have to expect this sort of thing, don't we." She was looking at me intently.
   "Yes, I guess we do. Life can sure throw some interesting curves, can't it."
   "That's right," she said. Then, she surprised me by picking up on my baseball analogy and continued, "We'll just have to adjust and learn to bat them out of the park."
   I remembered that she told me, a long time ago, that when she and my father were first married he was addicted to baseball. In the tradition of many thrilled young wives, then and now, she decided it would be interesting and fun to share his addiction. She learned everything she could about baseball and compiled charts of stats so they could discuss players and games with authority. When she told me about this, many, many years after the fact, some years after my father had died, she related it without shame or a sense of silliness. She seemed to remember this period with minor delight. "Yep," I said, "we'll just bat as many out of the park as we can."
   "You bet," she said.
2. I decided to do some weeding today. I encouraged Mom to join me in the chair, as it has been an overcast day and I thought she'd enjoy supervising me, but she declined, saying she'd watch me from the dinette window while she enjoyed her licorice tea. I promised her I'd check in with her every 10 minutes or so and I kept my promise.
   While pulling weeds I thought about how she will probably die. Astrology came into play...a standard rule-of-thumb I learned when I was tutored by an astrologer: The only thing the 8th house (which is traditionally called "the house of death") has to do with the "native's" own death, usually, is that the planetary ruler of the 8th house often described the manner of the native's death, in a forensic sense. The ruler of Mom's 8th house is Neptune. This planet rules death by suffocation (a variety of types of suffocation, internal and external). How interesting, I thought. We're definitely on our way with that one. My thoughts continued, when she is no longer able to cough, I can probably take that as a sign that Death is sleeping in our house. I began rehearsing what sort of conversations I would initiate as we acknowledged the presence of Death...you know, the "It's okay, you can go" kind. Suddenly I realized that, considering Mom's character, I probably won't be initiating those conversations, she will, simply because it will surprise her that Death has become our house guest. I can't even imagine what we'll talk about when she becomes aware of the fact that she's no longer interested in immortality. I suspect that some, if not all, of those conversations will be wordless, mostly eye contact, sublingual understandings passed back and forth. At any rate, I decided, I'm going to give up on forecasting how her final days will unfold for us. I'll just live in the moment and see what occurs to and for us in those days. Why try to interpret by the rule book what may happen for us when I'm not even sure which rule book applies to us?
3. Speaking of living in the moment, it seems, within the last week and a few days I've so perfected the technique that I'm not even remembering what may lie in a path I recently traversed and have caught myself almost falling over things, like my mother's wheelchair this morning, for instance, which is so prominent when it's sitting in the hall outside the bathroom you'd think I wouldn't be able to miss it or forget it. I think this refinement of living in the moment is good and helpful. I also think it has its dangers. I guess I need to negotiate the dangers without abandoning the refinement.
4. I've been muddling through making sense of my mother's hospital chart that was copied for the various facilities and, somehow or another, made it into my hands between the "respite" stay and the rehab stay. Reading it is maddening because it was compiled out of order and putting it into order is close to a fool's task. I've discovered five interesting things, though.
   1. The first is that the Emergency Room actually got almost everything right, including her medication list. They also didn't classify her as "failure to thrive"; they did note a "failure of activities of daily living" but expanded on this by classifying it as an adjunct to her dementia and that this was being addressed by my "presence in the home". The ER also noted that she was "speaking in full sentences" upon arrival and in "no apparent distress". Her lungs were noted as "coarse bilaterally", so the ER was on the right track regarding the possibility of pneumonia, too. The only thing they got wrong was that she "no loss of...bladder function". I'm not sure why they came up with that because I was clear that she is incontinent, especially when I noted after a couple of hours in the ER that she wears paper briefs and probably needed to be changed because I was sure she wouldn't be able to make it to the bathroom. They noted that she was unable to "ambulate" to the bathroom. So, all the mistakes in treating her happened after she was transferred to the ward.
   2. The second is that the first social worker who visited us on Thursday, the day Mom was admitted to the ward, wrote a bizarre report. I want to note, here, that this is also the social worker who was going to discharge Mom to the rehab facility on Friday of that week without taking into account that Medicare requires a three "night" hospital stay before they will pay for rehab. When I questioned her decision on this she apologized profusely and that was the last we saw of her. I'm pleased about this because here's the curious item she wrote in her report after interviewing us and before setting Mom up for too early discharge: "Per chart, relatives dropped pt. at ER, unable to further care for pt." There is nothing in the chart that indicates this. In fact, there are several places in the chart where it is stated and obvious that I brought Mom in, we live together, I've been taking care of her, and I brought her to the ER for medical treatment of a specific problem. I have a clear memory of parts of our interview with her, as well, and there was nothing in the interview that would have indicated to this woman that my mother had been "dropped off" nor that I was "unable to further care for pt." However, since this interview took place very early in her stay, I suspect this woman's evaluation had a lot to do with the "failure to thrive" diagnosis, as well as the decision to put Mom on Effexor and Aricept without consulting me.
   3. Speaking of Effexor, the third item is that the first Hospitization doctor mentions in one of his reports that I told him that Mom had been on Effexor prior to coming to the hospital. Not only did I make no such assertion, when I was finally allowed to view my mother's chart, after a pitched battle, and discovered the Effexor, I didn't know what it was and asked after its nature. When I discovered it was for "depression" I clearly stated, "She's not depressed. She's never been depressed. I doubt she knows what depression is. She's never taken anything for depression. Take her off it. Now!" She was taken off it, as I checked her med routine as it was reported every day, but the orders for Effexor were transferred to the rehab facility, anyway.
   4. Regarding the Aricept, I had pretty much the same reaction to this as I did to the Effexor, for different reasons, but concluded that she was to be taken off it, "Now!" Although this happened, this medication also followed Mom on the medication list delivered to the rehab facility.
   5. On a particular night during Mom's hospital stay she had a respiratory crisis. I was contacted very late before the crew working on her medicated her with one of three different medications to "relax" her (one of which was morphine, one was Ativan and was was Xanax) because I had expressed a desire, that was noted in Mom's chart, that before she be administered any psycho-active pharmaceuticals, at all, I was to be consulted. I discovered as I was reading through the chart that she was apparently administered all three at one time or another prior to this respiratory crisis during her hospital stay without me being consulted. The curiousity about this is that after a protracted disagreement with the Hospitization doctor and the head nurse on the floor that night regarding using any of these on Mom, they demurred, I stayed in her room, held her hand, talked to her, and within minutes she had settled down, was breathing normally, stopped sweating, tossing and turning and fell comfortably asleep. All of this episode was noted, with admirable objectivity, in chart notes. The final "treatment" was described as a decision to follow a "conservative approach". In conclusion, all I can say is, damn, no wonder the woman had so much trouble verbalizing during her hospital stay! And, the people attending to her care, except for the neurologist and his speech evaluator, continued, throughout, to consider these verbal difficulties "normal", despite my protest that they were not normal and, as well, despite the ER's report that my mother, upon arrival at the hospital, was capable of speaking in complete sentences and, as well, answering all manner of questions! Jesus!

    Mom got in all of her 12 in sleep, last night (actually, from early this morning on). She, of course, insisted on a nap at around 1730. No problem. I'm going to let her "sleep in"...it's just one of those days. I told her as she settled into her bed that it doesn't matter if she awakens late, "we don't have a schedule we have to follow."
    "I don't want to miss the chicken quesadillas," she said, "you've been promising those for the last few nights and we haven't had them, yet!"
    "Don't worry," I assured her, "we are definitely having them tonight, I'm not too tired to cook. And, you won't miss them. I won't make them until you're up."
    "Is that a promise?"
    "Nope," I said, "it's a threat."
    Time to check on her again, although I imagine she'll probably sleep for awhile longer.
    Oh, a couple more urinalyses have been entered from the hospital. And, as a note to myself, there's a "Vitamin D 25 Hydroxy Level" test I'm missing from the hospital, too. I have no idea what that is, but it sounds interesting.
    End of musings.
    Later.
- posted by Gail Rae @ 20:08   email  this post