I'm grinning at you, Patty...
...primarily for the comment you recently left to which your name, above, is linked, but, as of this morning, the grin increased to include this comment. You keep me on my toes, grrrrl! My initial intention, resulting from the initial grin, was to respond to you personally, but, lately, personal correspondence seems always to be trumped by something else. Then, you left the second comment and I decided...hmmm...good idea to respond to you here, since I'll also be able to cover something interesting that happened last night and ties in with your first comment.
    First, though, I have to say, which is the reason for the initial grin...you are determined to get me teaching, aren't you!!!! I'm fairly laughing about this! I come, as you may have read, from a sturdy line of teachers of a variety of types, including within my own generation and the generation that immediately succeeds mine. I have, myself, taught, formally and informally. My first teaching "job" occurred when I was in the 6th grade at Wettengel Elementary on Guam. [I note, with chagrin, that Wettengel no longer hosts a sixth grade class.] In the fall of that year Typhoon Karen ripped through the island. Business on Guam came to a standstill for some weeks, including school. When all was in readiness for the school year to continue, a huge number of teachers from The States had left the island. In our school, teachers for the lower grades were recruited from the sixth grade. I was one of those students. Anyway, I'm not sure I have a natural talent for teaching...although I've taught, formally and informally, professionally and avocationally, in many capacities. Bottom line, though, is that I can't imagine anything I'd not want to do, at this time, considering all that's going on, more than training someone to care for my mother in my absence, even though this was one of my essential tasks when my mother was recently in the hospital, the intermediary care home and the rehab facility. My guess is that we could probably afford to do this. However, it seems that, if I decide to take a respite (which is no longer as clear a choice as it was a few days ago), I may have stumbled across someone to do exactly what you are suggesting. Let me explain.
    Last night while my mother was napping I made a quick trip to Walmart to pick up Depends and a few other supplies. I was clearly dragging, it had been a "flying below the radar" day for Mom, thus it was a "flying above the radar" (if such a thing is possible) day for me. I decided to make a quick stop at the local Starbucks drive-through on my way home for a little instant energy. The barrista waiting on me asked me, almost before I'd brought my car to a full stop, "You're a caregiver, aren't you?"
    I was astonished. "Well, yes, I am! How did you know?" Had someone, I wondered, stamped "Caregiver In Flight" across the side of my truck when I wasn't looking? Was it possible that I was more than right about something to which I referred, some time ago, as "care-dar", that, in fact, this sense is much stronger than I ever imagined?
    The barrista laughed and said, "The Depends next to you."
    It was my turn to laugh. Sure enough, the eight packages of Depends I'd bought formed a highly visible stack in the passenger's seat. "That's a relief," I said, "I was thinking you were psychic!"
    We struck up a conversation. Turns out, she's a professional caregiver who recently moved here from California. The topics of our conversation, which was extensive, despite it's quickness, revealed that she had quite a bit of experience not only with elders in a variety of health states, including those in the "hospice" stages of lung cancer (a pretty common development for my mother's generation, which shouldn't surprise anyone, as theirs was the generation of cigarettes distributed in WWII ration packs). She's worked in care homes and for individuals; her complaints about Medicine revealed to me that she was used to dealing with the vagaries of medical professionals and their recommendations at the same level as me. As well, professional caregiving is her chosen profession and she's looking for this kind of work here either privately or within a facility. She surprised me by telling me that, here, it's not as easy to get work as a professional caregiver as one might think...she is considered "over qualified" for the facilities (which lowers my confidence in facilities even more) and hasn't yet established a private network. She asked me to pass her name and number around to people who might be looking for someone with her qualifications. I promised I would. It didn't occur to me until after I drove away that I might have some work for her...naturally...I truly don't think quickly when I'm involved in conversation. But, if I should decide to seek out respite, even for a couple of days, Patty, I'm going to talk to her about the possibility of me hiring her to spot me at whatever care facility I choose. There's much more I'll need to know about her, of course, but I have a sense that it wasn't coincidence that this person appeared out of nowhere on the very day when I was considering your proposal, Patty, and shaking my head about having to train someone while I'm caring for my mother. There will, of course, be some training involved, but not nearly the amount that would be required with a newbie...with this woman, I'm sure it would be a matter of acquainting her with my mother's eccentricities, requirements and, of course, her character; and, of course, acquainting my mother with her and seeing if they hit it off.
    The reason why, over the last 48 hours, I've been reconsidering the possibility of respite is that it appears as though we're turning corners in the development of my mother's physical reaction to her cancer rather quickly, now. I'm hoping that what's going on is simply a spate of those "Bad Cancer Days", but I need to wait certain developments out, at the moment:

• Over the last week it seems that she has advanced to a stage where 4/lpm O₂ when sitting is no longer adequate;
• The much more frequent occurrences of pain, particularly the incredible pain she experiences when her O₂ supply is temporarily cut, are, clearly, in a state of development, even though we haven't yet had to use the morphine (more on this later);
• Her needs are changing, particularly her need for food, and I am reluctant to hand her over to anyone else while I, myself, am unclear about where we are with these;
• Her emotional dependence on my presence has increased dramatically over the last few weeks and I feel the need to more fully observe and evaluate this before I make any decision on taking respite from her.

    Your other comment about how to evaluate the food my mother eats in relation to my mother's appetite, Patty, well, the reason I'm grinning about that is because I actually report both the food she eats and the food she doesn't over at The Dailies. I used to report all meals and snacks. I'm no longer quite so meticulous over there. I primarily report changes in her breakfast menu (since breakfast is almost always exactly the same from day to day), now, but I continue to delineate the contents of her dinner, sometimes listing ingredients if I think I might want to remember these. Most of the time I report amounts eaten as well as amounts not eaten, although the reporting of amounts not eaten is relatively new. Since that section of the journal is primarily a tick to my memory, it's not a problem for me to drop amounts, here and there, because just listing the ingredients reminds me of how much she usually eats; thus, when I list what she doesn't eat, it already exists in context for me.
    Quickly, since I'm coming up on time for Mom's nap, regarding the "more later" mention regarding pain, Mom had an episode last night (which was primarily responsible for a Bedside Evening) that likely was not related to her lung cancer directly. After she arose to a sitting position on the bed, she experienced hard, steady pain across her upper back about four to five inches below the tops of her shoulders. Although it wasn't what I would consider "incredible" and her breathing was not affected by it, it appeared, after a good half hour, that 500 mg of acetaminophen was not going to do the trick, so I decided to go for the morphine, as she was clearly in distress from the pain. I was going to, as our Hospice RN suggested on Tuesday, go ahead and administer the morphine according to the morphine manual and inform Hospice during the next business day, which would have been today. The syringe, though, had a tricky little top to it which disallowed me putting it into the bottle to draw out the medicine so I had to call Hospice, anyway, for directions on the mechanics of morphine administration. Turns out, the syringe attachment operates as the bottle top, once it is inserted into the neck of the bottle, and the syringe closes the top when not in use. Anyway, while I was consulting with the RN on call, Mom's pain vanished. Chances are it was probably caused by either a compression fracture of a vertebra or something just worked itself into an out of joint position while she slept then popped back in later.
    If I hadn't already hopped Mom up on acetaminophen I probably would have given her an ibuprofen in an attempt to head off the use of morphine. Thinking about this, later, reminded me that I'd been wondering if it might be time to consider ibuprofen instead of acetaminophen for hard, steady pain and, if so, might it also be better at reducing possible inflammation of her right lung from the life that tumor is leading inside it and allow her to breathe more easily overall. So, this "morning", when she complained of some fairly minor (at the time) lowernback pain (which has been common for her for a long time), I decided to give her 200 mg of ibuprofen at breakfast, instead of 325 mg of acetaminophen. It's probably too soon to tell, but during her 1st up time today her breathing has been somewhat easier, although she continued to be fairly tired, today, so I didn't try dialing her back to 4/lpm O₂. Depending on how her evening goes, even though her initial ibuprofen has worn off and she may not need anything for pain during her second up period, if she is breathing easily and is more alert, tonight, I might try dialing her back and see how it goes.
    Anyway, Patty, I'm sure I've overwritten myself, here, in response to your always appreciated comments. And, it's time to see how easy it will be to shake Mom out of her nap. Thank you, Patty, and thanks to all of you, who continue to visit and comment even though my activities online have been lately circumscribed and I don't get around much, online, right now. No matter what any of you has to say, it is always a pleasant surprise and always perks me up to get a comment!
    Later.

P.S.:  I've been trying to do a better job of editing when I initially publish, as I've notice I'm making quite a few mistakes, sometimes confusing ones. For those of you who subscribe to a feed on this journal, forgive my incessant going back and editing, of late...although my intentions are good I usually don't find the time to edit myself until several hours after I've initially published a post. THANK YOU FOR YOUR PATIENCE!
- posted by Gail Rae @ 21:40   email  this post