Sunday, September 28, 2008

Starry, Starry Night

Amy and I missed the sunset tonight. My daughter and I’d intended to be on the beach approach to watch the sun go down, but too many errands and a slow waitress for our last-night-at-the-beach-dinner meant that it was nearly full dark by the time we left the Chen’s Chinese Restaurant in Long Beach. We still had three stops to make, but between buildings on the ridge I saw that we hadn’t missed the afterglow of the sunset so we zipped down the beach approach where the sky was the color of ripe watermelon along the horizon and the sea was that icy blue it gets just before it disappears into the dark. Lights from three fishing boats twinkled like jewels against the velvet sea and the evening star hung above and to the south.

The day was warm and the evening remained so. I left Amy listening to Willie Nelson on the radio and got out to walk the dog across the warm sand. It did not feel like an Autumn Sunday. It seemed that Summer, who was so long in arriving, wanted to say “sorry” with the gift of a beautiful day meant, as my mother would say, to be tucked away in our memories. Far down the beach I could see a bonfire indicating that there were others as reluctant as we to let go of such a beautiful day. I was sorry that my mother missed this sight. It is exactly the sort of thing she loves and for which I hope she works hard to see again.

When we pulled into the barn at home Amy’s breath caught, “Look at the stars!” Here on the Long Beach Peninsula, so far from large cities and their ambient light, a clear night means a starry night the likes of which we don’t get even in Gig Harbor. On cue Willie swung into “Starry, Starry Night.”

Sewing Labels and Smuggling Pie

This morning I sat in my mother’s hospital room sewing name tags on a bag of her socks. “You sewed?” my husband asked incredulously. “I never told you I couldn’t sew, just that I don’t like it and used to smuggle my home ec projects home for my mother to finish,” I told him. “Besides, a few little hand stitches on the ends of name tags hardly constitutes sewing.”

My mother’s bags are packed and in the car, ready to head for Gig Harbor and Manor Care tomorrow. As Lorraine has observed it’s all rather surreal despite the fact that as an only child I’ve had to do more for my mother than those lucky Baby Boomers who have siblings. My husband will tell you that I’m not a particularly organized person so the pressure’s been on to think of everything I needed to choose, mark and pack for her and everyone I needed to touch base with before the ambulance comes to get her tomorrow.

I was hoping that they could be off right after breakfast tomorrow so as to arrive in Gig Harbor in time for lunch. It isn’t looking like that will happen. The doctor has yet to sign the orders for my mother to be transferred for rehabilitation at Manor Care and since his schedule for doing rounds is somewhat…well, random…they are likely to be on the road at lunch time. At least I won’t have to listen to the “I’m hungry.” Knowing my mother, she will suggest that they go through the drive-through at Dairy Queen in Raymond. In the movie version of this episode, not only will she suggest it, they will actually drive the ambulance through the drive-through and get Classic Grillburgers and milkshakes for all of them.

In the movie version they will also get lost. It is very possible that they will in real life. When my cousin was sent from Ocean Beach hospital to Vancouver Hospital in an ambulance that is exactly what happened. She had to sit up and tell them how to get to the hospital.

My last task before I can turn my thoughts to Amy’s and my things is to smuggle one more piece of pumpkin pie into the hospital. Fortunately she’s only a borderline diabetic and she said that she needed pumpkin pie.

Packing My Mother for Camp

Once I’d gotten my mother to agree to rehabilitation following a brief, but serious illness, I started making a mental list of things to do—get rid of the fresh food, notify her apartment manager, get her mail forwarded—and what to pack for her. It reminds me of getting my daughter packed to go to Camp Easter Seal in Vaughn, but without the sleeping bag. I called Manor Care to find out what I should bring for her. “Nothing too nice,” a nurse told me. “Comfortable things like sweats or moo moos.”

From her “Fibber McGee Closet” downstairs in the storage room I pried loose her suitcases without sending the stack of stuff in there cascading down on me. Back in her apartment I started going through her closet and drawers looking for clothes that were comfortable but not things we’d be upset over should they become, well, misplaced. Just like with my daughter I began marking things with her last name, all the while thinking about what would make her comfortable and what she was likely to want. I can make my list and check it twice, but undoubtedly there will be things I’ve forgotten, but hopefully nothing that cannot be purchased in Gig Harbor.

As I worked, other items kept popping into my mind, distracting me like shinny objects. I got the major things organized as well as some of the smaller things like the mittens she likes to wear to bed to keep her hands warm and stationary so that she can write letters if she feels like it. She’s not even watching much television, normally her constant companion. She did read the Chinook Observer, her little local weekly newspaper, but magazines that had come in her mail don’t interest her. My mother seems content to lie in her hospital bed staring off into space and thinking what?

Dealing with the aging and end of life issues of parents makes those of us of the generation behind examine what our own mortality and how we will deal with it. How can we make our own transitions through life as gentle as possible for our own children? Will we be able to remain active or give up as my mother-in-law has and sit in a darkened living room watching Judge Judy? “Just shoot me,” I told my husband once.

I called and left the housekeeper a message that she needn’t come next week. When I’d poured out my mother’s two week old milk and gathered up her fruit to take to my cousin and aunt, I quit for the day. There’s still another day to tie up any loose ends. For now. She’s had two illnesses in three months. Is her relative good health taking a turn? Will she work hard at rehabilitation and be able to return to her apartment or is she, even as I pack her bag for “camp,” packing her mental bag with no intention of returning? Is she planning her own escape?

Saturday, September 27, 2008

Taking Care of Mother

The City of Ilwaco where my mother lives has a volunteer fire department made up of awesome men and women. For whatever reason in 2007 the city made the decision to hire Medix, an ambulance company based in Warrenton, Oregon, to serve Ilwaco. Having dealt with both, I prefer the volunteers. On Monday my mother fell and activated the medical security system I installed this spring. Getting it had eased both my mother’s and my mind knowing that she could get help easily. We didn’t allow for her being out of her mind with a temperature or for unobservant ambulance attendants.

Medix arrived at my mother’s apartment and hoisted her back into the recliner that is where she likes to spend most of her time—waking and sleeping. To be fair, they offered to take her across the street to Ocean Beach Hospital to get checked out. “No,” she told them, she just needed to get up and would be fine. They did not take her vital signs. If they had they might have realized that she was running a 103 degree temperature.

A little while later my mother fell again and again activated her medical alert system and again Medix arrived. Once again they got her up into her chair. This time my cousin and aunt had arrived and realized that my mother was acting peculiarly. They and my mother’s neighbors attempted to get the attendants to take my mother across the street to the hospital, but they said they could not force her to get help.

My cousin called me to say that she thought my mother had had a stroke since she couldn’t walk and was having difficulty processing what was said to her. She, my aunt, and the little old ladies that live in my mother’s building were very upset with the Medix people. I got my mother on the phone and realized even from 150 miles away that my mother was not okay. I persuaded her to have the Medix people return and take her to the hospital. It turns out that it wasn’t a moment too soon.

My aunt and cousin stayed with my mother while my husband, daughter and I packed and made the three hour drive to Ilwaco. My mother’s condition was shocking. She was able to tell us who is the president—okay, that was unfair because who CAN forget that. She knew everyone, but answering questions took more processing than normal and we were informed that she had a terrible infection that was causing the confusion. Her speech was odd, as though she had lock-jaw. It turned out that he was dehydrated from the fever and having spent the day in her chair unable to get up. We will never know how long my mother had sat in her chair because she remembers none of it. I spoke with her on Sunday and she seemed fine then. Whether the infection had struck in the night or sometime after she woke Monday we don’t know. What we do know is that the doctor says that had she arrived at the hospital any later than she did she would have died.

Okay, she was at the hospital. Now they’d take good care of her and get her straightened around. Many tests were made and she was hooked up to a bag of antibiotics—but no fluids to replace those that she’d lost. The nurses were telling her to drink, but if you didn’t stand next to her with the cup to her lips she just lay there, staring blankly. I couldn’t understand why no fluids and stayed until 11:30 that night after the nurse told me that she’d see if they couldn’t do that. A urinary infection meant the need to hydrate the body to flush out the infection and bring down the temperature. A no brainer, right?

The nurse had advised me to return to the hospital at 8 AM in order to get to see the doctor. I gave her my mother’s medical history including list of medications and went to our beach house to try to sleep. I was at the hospital the next day before 8 AM. My mother was more lucid and her temperature was down, but she was cold and clammy. She was still not hooked up to fluids. I sat and chatted for two hours with her. At 10 she told me that her housekeeper would be coming at 10:30 so I went across the street to let her in. I did her dishes and straightened up and laughed at myself for cleaning up for the housekeeper.

At 11 AM a neighbor reminded me that the previous week had been the housekeeper’s week to clean so I went home for breakfast. It was Tuesday and Tuesday is my Special Needs daughter’s day to rent movies and get a Subway sandwich. We stopped by the hospital to see my mother. We found her eating lunch, sort of. Her temperature and confusion had returned. We also spied the doctor, a huge man and difficult to miss, down the hall going into a door with a plate of food and a stack of charts. I asked if I could see him and was told that he was reviewing my mother’s chart and would be in to see us soon. So we sat down and carried on conversation with my mother the best we could, punctuated by long silences.

At one point my mother’s large cup with straw became empty and I went to the door to ask for some more. A nearby nurse snapped, “We’ll get there as soon as we can!” They expected my mother to drink lots of water, but seemed loath to make that happen and she still was not hooked up to fluids. A bottle of water from her lunch sat on her bedside table so I poured the water into the cup since she was having difficulty drinking from the bottle. About 45 minutes later a nurse came into the room and asked if my mother had drunk the bottle of water. “No,” I told her. “She spilled some so I put it in the cup so she could use the straw.”

“What! You put it in the cup? You can’t do that. We measure that water.”

“Look,” I said. “The cup was empty. She was given the bottle of water for lunch. You want her to drink but she can’t manage the bottle. I put it in the cup so that she could drink the water.”

“Well, all you have to do is ask us for more water. We measure the water in the cut carefully,” she replied.

“I tried that,” I said. “All I got was snapped at. My mother is dehydrated and I want her to drink any water she’s given.”

“Oh,” said the nurse, dumping out the cup into the sink unnecessarily. “I’m sorry if someone was rude. We are short staffed today. I’ll get your mother more water.”

Two hours from the time he was informed that I was waiting for him the doctor finally came in and informed us how near to dying my mother had come. I asked about one knee that she’d been complaining of pain in for a couple of weeks, but he brushed aside my query and told me that my mother’s inability to walk was because she’d sat in her chair to such an extent that she could no longer walk. Puzzled, I told him that although a certain amount of that was no doubt true, how had she been able to bake biscuits and attend the coffee hour at her building two days before the onset of the infection? “Oh,” was all I got in reply. All my questions were answered with condescension. As doctors are want to do, he turned and walked out of the room without a “goodbye” or a “nice to have met you.” I took Amy off to get her movies and lunch which was now heading toward dinner.

After dinner my husband and I went to the hospital to visit my mother. Her temperature was up and she seemed confused. The nurses were still encouraging her to drink, but she seemed to not know what to do with the straw when it was put to her lips. This time the snapping nurse was more solicitous whether because my husband was present or because she knew I’d complained didn’t matter. We asked why a woman who didn’t understand the concept of drinking wasn’t hooked up to an IV. She shrugged and said that it was up to the doctor to order an IV. Sometime in the night, after we had left at 7 in the evening, they hooked her up to IV fluids and she began to improve for real with no more yo-yoing of her temperature.

The next two days went fairly well, but my mother did not seem to be bouncing back as quickly as she had in June and a certain amount of fog seemed to over at the edges of her mind keeping her in that state one is briefly upon waking. She was not cooperating with the staff about getting out of bed and she was lying to me about why she hadn’t been up. Clearly her mind was foggy if she thought I wasn’t going to be asking questions. Those were not the only lies she told. She told the doctor that she would be coming home with me so the doctor thought he’d release her on Saturday. A conversation with the physical therapists confirmed my suspicion that my mother going home, even with support, was out of the question since her apartment is too small for even me to stay with her, never mind my daughter and dog. At home in Gig Harbor she would be alone during the day and has already fallen once in our bathroom trying to bathe.

It was with fear and trepidation that I went to the hospital Saturday morning, wondering how I could persuade her of the wisdom of going to Gig Harbor for rehabilitation. My mother, particularly when she’s tired or unwell, can unleash an acid tongue that cuts deep. I’ve heard all of it before and did not look forward to a tongue lashing and I resented that Dave had escaped. She behaves differently when he’s around.

The wonder of my prayer and a good night’s sleep for my mother. After getting up for breakfast with great difficulty she was able to see for herself the wisdom of getting some rehab and was delighted about going to Gig Harbor to be nearer to her grandchildren and great-grandchildren. For all the frustrations of her care at Ocean Beach the last few days, the staff was helpful organizing her transfer to Manor Care. But guess who’s taking her there? Medix. Stay tuned.