Archive for July, 2011|Monthly archive page

Emergency, emergency!

I woke up this morning to the sound of my cell phone ringing. It was 5:41 a.m. I didn’t get to it in time to answer. The call-back number: Mom’s nursing home. My heart started beating very rapidly. I stopped to pee before I called back. The nurse had left a voice mail to call back about Mom. They always do that when there is something specific they need to tell me about her status – they just say, “Call back for an update about your mom.” While I was dialing, Patrick’s cell phone started buzzing. He is the backup emergency contact. The nurse answered and started talking right away. Mom had fallen and hit her head on one of the wooden railings along the wall in the center. She had a cut on her head that wouldn’t stop bleeding. They had called the squad, and wanted to confirm that my hospital of choice was Ohio State’s Medical Center. I told the nurse I would meet Mom at the hospital. I warned her that Mom had rejected a squad ride months ago when she was going to get a ride for a dermatology appointment. She didn’t seem worried – Mom was lying in the hall with her head on a towel and had remained calm. I hoped for the best.

I got dressed, put on deodorant, put water on my hair and brushed my teeth. I left the house, feeling determined to drive safely. It helped that there was very little traffic. I found my way around construction to the emergency room, where I had to wait for what seemed like way too long for someone to acknowledge my presence. It was 6 a.m., so it made sense that there weren’t many people up front. There weren’t many people waiting, either. A nurse I checked in with gave me a visitor sticker and told me to wait until Mom was checked in. I sat down for about 30 seconds and then was allowed to go back. The paramedic was still in the room, taking notes. Mom looked pathetic, lying with her head held forward, with blood all over her face and hands and a bandage over her left eyebrow. I started rubbing her head and arm. I asked the medic how she did on the ride, and he said she was fine. Quiet. “You’re a great guy,” she said to me. This got the medic’s attention. “I look like a boy with this short hair,” I told him. She was talking about “him” being OK. I think she was talking about herself.

A nurse came in to take Mom’s blood pressure with an automatic device. As it was squeezing Mom’s arm, she was trying to put a thermometer in Mom’s mouth. Mom was saying, “Ow. Ow. Ow!” about the squeeze on her arm. She wouldn’t open her mouth. “I guess I shouldn’t try to take her temperature while I’m taking her blood pressure,” she acknowledged. She never did get Mom’s temperature. Mom’s BP was 105 over 55. This nurse left. An admissions rep came in to take Mom’s info. Thankfully, the Alz center had all of her info – Medicaid number, date of birth, etc. But I had grabbed Mom’s driver’s license and Medicare card on my way out of the house. A doctor came in to take a quick look. Mom yelled at him because he pulled her hair removing the tape from her head. Her cut was pretty bad, about an inch long and half an inch wide, maybe so big and mushy from landing on a dull surface. Later another nurse came in. My favorite person. She asked a few questions about Mom’s diagnosis. “Bless her heart,” she said a few times. The doctor had ordered supplies for sutures in Mom’s head. A CT scan was planned, too. She was given an Ativan to relax. The nurse and I strategized to get it into Mom’s mouth. She doesn’t understand instructions, so we tried to get Mom to open her mouth and then toss in the pill. Mom ended up chewing the pill, without complaint. She did drink a little water, too. Shortly after taking it, she was sound asleep, snoring.

The CT scan came back normal – or as normal as it can be for a person with dementia. No bleeding in the brain. When the doctor came in to do the stitches, he asked me to help. He put cloths over the top of Mom’s head and over her face to keep the wound exposed and the area clean. Mom pulled the cloth off of her face. I rearranged it so it covered one eye and her mouth. And then I firmly held her head with one hand and her hands with the other while the doctor gave her a long shot of lidocaine. “Ow!” she said. She squirmed. She screamed once. Before he was done, though, she relaxed. He cleaned the wound and that was messy, and she complained. He had to do two stitches in the tissue underneath the surface. Mom did pretty well for those. But once he started the external stitches, she winced a few times when the needle went through. “What are you doing?!” she said. And the string tickled her face, and she tried to brush it away. “This will be a very good result, cosmetically,” the doctor said. I certainly do not care about that, but I think he was doing his best to find a bright spot. He thanked me for helping him. I thanked him for being as gentle as possible. And I said, “I’m glad I can help. I often feel helpless when it comes to Mom.” He felt along Mom’s body to check for other injuries. He put his hand behind her neck and asked if it hurt. “Bonnie Caldwell,” Mom replied. They were both doing their best under the circumstances.

After he left, I toweled off Mom’s bloody hands and the rest of the blood that had dripped behind one of her ears. I told Mom I would be taking her home soon. She had done a lot of talking, sometimes speaking just plain gibberish. But considering the stress, I think she really did great. She sat up, and said, “I’ll be a goddamn son of a bitch.” And I laughed really hard. I went to get my car and came around to pick her up. I had the air conditioning blasting, and she said, “I don’t like the cold.” Not the Bonnie I remember, who loved air conditioning. I turned it down and put on classical music. She crossed her legs and sat completely silently for the ride back to the center. When we got there, I tried to lure her out of the car, and she was just sitting there. So I grabbed her legs and pulled them to the side and out the car door, and she said, “Well, just wait a minute.” She was a little stiff, so she might have pulled a muscle or something. She also had socks on, so she walked gingerly to the door. It was a little difficult convincing her to walk into the building. Once we got in the lobby, she plopped down in a chair. I gave a nurse the discharge instructions and told her I thought Mom could use a nap. They planned to have aides take her to her room with a wheelchair. I thought I might just confuse the situation, so I left. Everyone was interested to see how Bonnie was doing, so I knew she would be in good hands.

I went back to check on her later in the afternoon, and found her napping on the couch in the lobby. I hoisted her legs onto my lap and sat on the end of the couch. She slept off and on, and I rested my head. I could see serious bruising around her eyebrow and on her cheek. We sat like that for about half an hour. And then Mom perked up, and sat up. I took a photo of her stitches.

The bruising extends from around the stitches, down around her eye and to her cheek. Poor girl took a hard fall.

We walked around for a bit, and then I encouraged her to sit at a table and wait for dinner. I kissed her goodbye. I hope she sleeps through the night and doesn’t take any late-night walks for awhile.

18 minutes

I visited Mom on Tuesday – a habit now after a haircut, because the Alz center isn’t too far from my hair salon. I found her sitting on a couch alone in the hallway leading to the program area. I like this spot – there are a few couches and a glider at this halfway point in the hall, where there are extra windows so lots of sun shines in. I sat next to her, and she didn’t really move to make room for me at first, so I squished her a little. And it became clear to me that she was somewhat out of it. Her eyes were sort of droopy. She was moving very little, but in slow motion, almost. She talked a little bit, but was fairly quiet and spoke softly. I put my arm around her and gently rubbed her head. Her hair was clean and looked nice. I hoped in a way that she would just fall asleep. My interpretation was that she was exhausted. But she said, “Where should we go?” And then I was sort of sad that I had disrupted whatever this part of her day was going to be because in my opinion, she needed to rest.

Her feet were bare. A nurse came by and said, “You took your socks off, I see.” Mom does that routinely. I looked at her leg, where the cellulitis infection had been. There were still signs of it, but the circle of redness was smaller and the center lesion was less intense. The swelling was down. I was relieved about that.

Mom expressed interest in taking a walk. I noticed the flooring is being changed – the carpet had been pulled up and faux-wood flooring was in its place, except for in one unfinished area. This is a good change, I think – not necessarily good for Mom’s feet, but very good at reducing the smells associated with the inevitable bathroom accidents on the carpet. Mom and I started walking, and when she got to the unfinished part, where the floor was concrete, she stepped very carefully. She was walking slowly, as if her feet might be sore. We got to a couch in a far corner, and I encouraged Mom to put her feet up, which she did. I pulled up a chair. I was trying to talk her into lying down so she could rest. In fact, I told her I had to go back to work – I was working from home on this day, because we had had a plumber in for repairs. I leaned down to hug her. And she got up with me as I started to walk away. So we walked some more, and held hands. We stopped again at the couch in the hallway. Mom sat, and I pulled her legs around to put them up. And she protested. I also tried to lift her foot so I could look at her calluses, and she complained that I was hurting her. So that is good, in a way, that she can tell me that. But it wasn’t good that I was being so bossy with her.

The activities director passed by during our walk through the hall and I said I thought Mom seemed exhausted, and she said that the heat has posed a problem for some residents. The staff tries to keep the center cool, but apparently the AC isn’t necessarily powerful enough to handle this Ohio heatwave. I also think they don’t want to keep it too cool since I imagine many residents can chill easily. She asked Mom who I was, and Mom said, “I don’t know,” with a laugh. And the activities director said, “Oh, yes you do, it’s Emily.” And she said to me that she and Mom had been chatting the other day, and Mom said, out of the blue, “You’ll have to talk to Emily.”

We went to the lobby and Mom sat on a couch there. I encouraged her to get some rest and told her I had to go to work. I leaned down and hugged her and gave her a kiss, and she went, “Mmmm.” She still likes a kiss. She said, “Thanks.” I told her I’d see her in a few days. I noticed when I signed out that I had been there for only 18 minutes. It just wasn’t a good day for a visit. There was a time when I could walk Mom to her room and put her in bed when I thought she was tired, and she’d just lie down and go to sleep. But she doesn’t respond now to that kind of encouragement, and I am no longer necessarily someone she is going to look to for guidance. That’s just how this is going to go. But I did find myself feeling discouraged after this visit. I am going to have to be prepared to find Mom like this more often, I fear. Not just tired, but more out of it. That is also just how this is going to go.

Skin infection

I’ve had a couple of good visits with Mom since the difficult day with Bino. Later that week, a nurse called me about completing an annual assessment. I could do it over the phone or in person. I opted to do it in person so I could also have a visit with Mom the same day. The assessment took just a few minutes. It was a series of questions gauging how important a number of things are to Mom. For example, how important is it for her to keep up on current affairs? Not at all. How important is it for her to have a pet? Not at all, I had just learned. How important is it for her to select her own clothes? Not very important. It’s a state-mandated assessment, I assume for all nursing home residents. Not too applicable to nursing home residents with advanced dementia.

After the assessment, I found Mom’s roommate and her daughter in the program area. I caught up with the daughter, who I hadn’t seen for awhile. Her mom is still with us, and she still visits her twice a day every day to help feed her. Across the room, another daughter from support group was giving her mom a manicure and pedicure. Her mom is still pretty with it. An activities staffer went and got my mom from a distant chair and encouraged her to come over to me. So then the six of us sat together and chatted. I tried not to leave Mom out of the conversation too much. I think she can still be sensitive to that, and she certainly was earlier in her illness.

A few days later, I got a call from a nurse that Mom had been diagnosed with cellulitis, a skin infection. The nurse practitioner had been in that day and noticed a red, warm area on Mom’s leg and determined that it was cellulitis. So Mom was going to start taking antibiotics. I asked if Mom seemed to be bothered by the sore spot on her leg. The nurse said no, Mom was just carrying on as usual. When I mentioned this in support group a day or so later, the doctor who runs group asked how advanced the infection had gotten before it was discovered. I wasn’t sure and said I didn’t know. I know urinary tract infections can cause changes in behavior in dementia patients, but until the doctor asked questions about this skin infection, I hadn’t given thought to the potential for Mom’s behavior to be affected by her infection. I looked up cellulitis online, and it can be accompanied by fever, chills and joint pain in addition to soreness at the site of the infection. But apparently if she had any additional symptoms, they weren’t affecting her enough for her behavior to change.

I visited Mom this afternoon, the first time I’ve seen her since that diagnosis. She was sitting in the lobby when I arrived, bopping her head to the oldies music playing on the stereo. I pulled up a chair and sat down. The receptionist said she had just tried to give Mom a piece of candy, and Mom had taken one bite and then set it aside. Mom started talking to me about food, so I wondered if she was regretting passing on the candy. I got a can of root beer out of the vending machine. I took a couple of sips and gave Mom the can, and she took a big drink. “Ah, that’s good,” she said. She talked off and on, and at one point she rattled off a series of large numbers. I said, “Wow.” And we both started to laugh – she had a big belly laugh. I’m so glad she can still have a good laugh. I looked at her leg, and the site of the infection was easy to see. It was a big circle about three inches across on her left calf, with a raised purple lesion in the middle. No broken skin. The skin was tighter in that region, and raised. I touched the outer areas of the circle, and it was warm. I asked Mom if it hurt. She didn’t seem affected by my touch.

An aide came into the lobby and sat on the arm of Mom’s chair and whispered in her ear: “Do you want to go to the bathroom?” Mom said, “I’m tired.” The aide said, “I know. And you told me your feet hurt.” She coaxed Mom out of the chair. “Are you coming?” Mom asked me. The aide said I would sit there and wait for her to come back. And I did. Another resident came and sat in Mom’s chair while she was gone. I said hello to him. When Mom returned, I dragged my chair away from him over to another chair so I could sit with Mom. He didn’t seem to notice.

Mom finished up the root beer. She needed a reminder each time she picked up the can of how to hold it so the hole faced her as she lifted it to her mouth. I touched the bottom of her socked foot and I could feel a raised area where she has a severe callus. I asked if it hurt. She didn’t answer, but she pulled her foot away. I asked her a few times if she wanted to take a walk. She didn’t really seem to understand. But she seemed happy to remain sitting. I wonder if her feet hurt all the time. At one point, she said, “Where’s the boy?” I assumed she meant Mr. R. But it’s hard to know for sure. On weekends, visiting is discouraged after 3 p.m. because there is no receptionist after that time. So as 3 o’clock neared, I told Mom I had to go to the grocery store. Which was true. I reached down to hug her and she puckered up, and I gave her a kiss.

No more puppy love

When our first dog, Cookie, died of lymphoma at age 4, Mom did a nice job of trying to comfort Patrick and me even as she felt a lot of sadness at the loss of her granddog. She bought us a stuffed black dog toy and got herself one, as well, to cuddle with during our sad moments. I still have that stuffed animal on my dresser. We got Bino (short for Bambino) just five days later, adopting him from a shelter just a few hours after he had been dropped off. He was a tiny beagle mix puppy, scared and quivering in the back of his kennel. Patrick tucked Bino into his jacket and drove him home. And every day after that for about three years, Mom walked from her apartment around the corner to our house around lunchtime to let Bino out for a bathroom break. When we got Spencer the chocolate lab six months later, she became Grandma to two doggies and visited them every day that we were at work. She would give them an ice cube treat to put them back in their crates, and she’d always refill the tray. We put dog treats into a dedicated ice cube tray to give to the dogs when we leave the house. In fact, one sign of Mom’s illness was that she sometimes left the ice cube tray on the counter, or even in a cupboard.

We got Bino at the end of 2003. Mom was diagnosed in November 2005. She kept trying to look after the dogs after that, though at some point I told her she didn’t have to worry about it anymore if she forgot or didn’t feel like coming by the house. She moved to assisted living in 2007. I still brought her to our house for occasional visits, holidays, stuff like that. She seemed to still enjoy seeing the dogs, and they loved seeing and smelling their long lost Grandma. The last Christmas that she was home, the boys were very glad to greet her even before she took off her coat.

I think this is so cute. And that was back in the days when Mom carried her yellow purse.

Bino in particular is always up for a cuddle with his favorite ladies.

The Alz center has always told me that I am welcome to bring my dogs in to see Mom and to cheer up other residents. So on Monday, the Fourth of July, I finally took Bino with me. Spencer is too big and unpredictable. But Bino is pretty manageable, and he had a stronger bond to Mom. Before I found Mom in the program area, I ran into a resident, a young woman who has been having a hard time lately missing her family. She speaks another language sometimes, but she stood in front of me and said, “Puppies.” And I said yes. I asked her if she liked it or if it made her feel scared. “Scared,” she said. But she seemed interested in Bino. She walked away, and I found Mom walking around. The residents were sitting in a circle for an activity, and the activities staffer asked me to show Bino to the crowd. Mom and I sat on a couch together. She didn’t seem interested in Bino. “It’s pretty sad,” she said. She talked about horses and cats. I wondered what could be going through her mind, if seeing a dog was stirring up some old memory, allowing for connections in the brain that don’t usually happen. I was concerned to hear her say something was sad. But she seemed pretty much the same, in a decent mood if not a great mood.

We walked to the lobby and sat down again. Bino jumped up and tried to cuddle Mom, and she cringed and shrank away. And he jumped down and landed on her foot, and she complained that it hurt. And though I was fighting the feeling, I realized Mom just doesn’t care for animals anymore. When Bino sat still, she’d say, “He looks happy.” The young woman came by again and stood next to the couch and said “puppies” a few more times. And then she was swept away by a gentleman friend, and they sat on a couch across the room. Mom did say at one point to me, “You’re just great.” I told her that she is great, too. But she was a little more subdued than usual, and did not seem to want Bino to get too close. I stayed only about 25 minutes. Before I left, I did manage to get a picture.

I just wanted one more photo of them together, for some reason. For me, not for Mom, because she obviously got no pleasure out of this visit.

So now I know. There is no need to take Bino to the Alz center. He was a little nervous anyhow. And Mom doesn’t like him anymore.