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.


Mizu Sugimura said...

Stephanie -

My prayers and thoughts will be will you. We had a chapter with my mom about two years ago which shares many elements - with exception of that one doctor who is in a class by himself. These sorts of hurdles are totally unnecessary, but seem to be commonly, all too frequent. However just by themselves add all the more to an experience that would be "trying" all by itself.


Stephanie Frieze said...

Thank you, Mizu. For hospital staffs things like nurses snapping over a cup of water are minor pebbles in the road of their days, but as you say, that pebble can be tossed on the back of a patient or family member and become the pebble that collapses the load.

Lorraine Hart said...

I'm so thankful to have two sisters who live very close to my parents in Toronto. When my mum was in hospital they could spell one another on shifts and kept me up to date on the phone. It's an awful lot for one person to deal with, Stephanie, and my heart goes out to you.

I'm so glad she's going to be in Manor Care and that she's happy about being closer for visitors. Anna used to volunteer there, as a teenager.

I understand that nurses have a lot of work to do...but kindness is the best medicine for the patient, the family, and ultimately, the nurses themselves.

Stephanie Frieze said...

With the exception of childhood Christmases, there's nothing to be said for being a singleton, especially when parents need tending to. Fortunately my father had a wife who kept him at home during his illness and death, but my mother never remarried. My husband has six brothers. They have committees! I am the committee. Well, I know siblings who've quarreled over things like care and wills. My mother has nothing and there's no one to quarrel with so that has be a plus.