Archive for August, 2011|Monthly archive page

The foot doctor

The social worker at the Alz center called me last week to tell me the podiatrist was scheduled to be at the center on Tuesday of this week. She had seen in my blog that I thought it might be helpful for me to be with Mom during that appointment to see if I could distract her while the doctor worked on her calluses. I had been told by an aide recently that Mom resisted when the doctor had tried to work on her feet during his last visit. I was grateful to the social worker for noticing that and giving me a call. It’s hard for the staff to keep track of the wishes of 100 patients’ families, so I really appreciated her effort.

I arrived at the center at around 9:15. The staff has a list of names of residents to be seen by the podiatrist, and I let an aide know I was there to accompany Mom whenever it was her turn. I found Mom at the end of a hallway, talking to herself. She turned around to look at me and I was stunned by what I saw. “Mom, it looks like you’re having an allergic reaction to something,” I said. A nurse was standing nearby and she said, “Oh, she has pinkeye. She’s on antibiotics.” This also stunned me. The center is usually quite diligent about informing me of anything like that – especially if it involves the addition of a new medication. I had just been to the center on the Thursday before to check on Mom and there was no sign of a problem. But on Tuesday, she looked like this.

I've never had pinkeye, so I don't know what it's supposed to look like. But this strikes me as a severe case. Poor Mom doesn't know not to scratch, so she just rubbed and rubbed at her eyes repeatedly. Poor honey.

I sat with her at a table and chatted with her until it was her turn. She had food all over her pants – it kind of looked as if she had spilled milk into her lap. The aide stopped by to tell me she’d be changing Mom soon. A nurse came to give Mom her antibiotic drops. Mom resisted, and the nurse asked me to hold onto her hands so Mom couldn’t pull at the nurse’s hands. Mom didn’t like it, but she did OK. Soon, an aide told me I could bring Mom back to see the podiatrist. He introduced Mom to one of the two health care workers who had come along with the visiting doctor. One of them confirmed that I was the daughter – she had a note that I was supposed to be there. I love it when the proper messages get communicated.

Mom sat to face the doctor and put both of her feet up for him to examine. He clipped her toenails. I told him I was there to see if I could assist if Mom squirmed as he worked on the calluses. “Oh, I remember these,” he said as he took a closer look at the bottom of Mom’s feet. She had one on her left foot and two on her right. The skin was really tough. He tried to work on them a little bit with a surgical blade, but he thought it would be easier to cut away the tissue if it were softer, so he asked for a pan of water to soak Mom’s feet for awhile. I told her it was a spa day. She did a great job of keeping her feet in the tub. She crossed her legs a time or two, which is a very natural position for her, but I would just coax her leg back down and put her foot back in the water. She really was very cooperative and sweet.

Warm water and a little bit of soap. I hope it felt good. Mom was ambivalent but agreeable to keeping her feet still.

While Mom and I waited and her feet soaked, another resident was treated for a very sore toe. I couldn’t get all the details, but he was given a shot of a numbing agent and he did not like it. He called the doctor a “dumb fuck” and yelled “goddammit!!” about four times. The doctor was expressing concern about the condition of the toe, and the resident was able to articulate how sore that toe had been. But he also was able to strongly protest the treatment. Mom sort of glanced his way with a worried look. “He’s having a bad day,” I said. I hoped Mom wasn’t going to have a similarly tough time.

When it was her turn, she willingly placed her foot on the towel in front of the doctor. I started rubbing her back and talking to her, and one of the health care workers held her leg still. She was talking off and on, and the third health care worker was asking me questions about Mom. I was talking about Mom and to Mom at the same time, trying to keep the mood light. She was happy, and then she would wince if something hurt. “Ow!” she said once or twice. The first foot was easy. The second foot required a little more attention. Mom squirmed and complained. “I want my foot,” she said. We told her it would be over soon and it was. The doctor rubbed some lotion on her feet to finish. Mom stood up and shook his hand. He seemed to go with the flow of the unusual behaviors he encountered. I was beaming with happiness that Mom had done just great, and I thanked them all for their work.

I walked her back to the program area. She had had only one sock on since my arrival. I went to her room and found another, unmatching, sock, and put it on her other foot. I looked at what was left and the callus spots had been reduced to red patches. I guess you could call what he did a debridement of the calluses, but I’m not sure. It didn’t seem to bother Mom to walk. She should wear socks, at least, until they heal. That might be a tall order if she’s not in the mood.

Meltdown

I’m strangely happy – or maybe relieved is a better word – to report that I cried, really hard, for about half an hour last night. I think I really needed it.

I thought my lowest points with regard to Mom might be behind me: the loneliness in January 2009 that led me to start this blog, or the serious stress of getting her on Medicaid and simultaneously finding the right nursing home for her two summers ago. Those were two very difficult times. I think I just decided those had to be the lowest points, which was a mistake, and which set me up for being totally unprepared to experience emotional upheaval all over again.

Mom is stable. She is safe. She is funny. She is in a good mood most of the time. All of these things make being her caregiver so much easier than it was when she was unstable, living alone or still needing me in assisted living, when she went through spells of being afraid and irritable earlier in the illness. But it doesn’t mean I don’t still grieve the steady loss of her abilities and get stressed trying to manage what little bit of money she still has.

I think the emergency room trip could have prompted this latest episode of grief. It was a short and tolerable trauma for Mom and for me, but a trauma all the same. There was this intense day of caregiving – and providing actual health care, sort of – followed by what I guess you could call a letdown. A quick return to what my normal is with Mom. That was good. No lingering pain, no complicated treatment plan, no memory for Mom that anything had ever happened. But slowly, a number of things started happening to and around me – a series of things that sound like petty things to complain about for the most part. But as they accumulated, and with the inclusion of a few very sad events for my friends, I began to feel the potential for some serious emotions brewing just under the surface – perhaps all wrapped up in stress from the worry associated with the emergency room that I didn’t have time to process then.

My first spurt of tears occurred at work yesterday. I received an email from the Alz center about Mom’s Medicaid account. I have made some mistakes with regard to her bank account and the business manager emailed me to tell me how to get it all sorted out with my case worker. It was both a relief but also an embarrassment, and I was already feeling low because of a misunderstanding with Patrick in the morning. I wept a little, quietly, and then Patrick called, and I did some minor blubbering here at my desk on the phone with him.

And then I went to support group last night. I have never cried there when talking about Mom or myself, but I have had a few tears in response to others’ stories. I thought last night was the night that I just might cry. And then we had a newbie at the meeting, and she ended up holding the floor for an hour. Others, including me, were able to respond to some things she said, but she never “passed” to the next person to speak, and I was at the end of the line. As the minutes counted down, I became frustrated and could tell I was going to cry no matter what. With about five minutes to go, I walked out of the meeting and was sobbing before I hit the parking lot. I cried in the car, sitting there, for about 10 minutes. I cried on the drive home. I cried in the back yard, heaving and hiccuping while describing my woes to Patrick. He later told me that when he saw how upset I was, he thought for a brief moment that Mom had died.

I felt much better today, except for that crusty feeling in the eyes and puffy eyelids that follow a major cry like that. A lot of the petty, pesky things are behind me now. And intensely feeling that deep sorrow for a sustained period seemed to have provided the relief I needed from the tension I was carrying around. I think I go through life trying not to let Mom’s illness consume me. I have to make a living after all, and carry on and enjoy my own life, and I just have this stubbornness about not letting it get the best of me. But I hope I have learned that I can’t forget to let myself grieve sometimes, maybe in smaller doses, so I don’t have to reach a breaking point before I let myself really feel how sad this whole situation can be.

Mean Mr. R

When I last saw Mom a few days ago, she had shoes on her feet. These were brown Crocs I had ordered for her awhile back when both her pink and baby-blue Crocs had either gone missing or fallen apart. And then these were also missing for awhile, but now Mom has a couple of pairs of shoes in her closet. But she rarely wears them anymore. It sounds to me like the staff might try every day to put shoes on Mom as part of her morning routine. But she frequently removes them. And if she has socks on, she takes those off, too. On this day, she was wearing Crocs with no socks.

The Crocs make a comeback.

Mom’s face also looked really good – almost no bruising left from the fall. Her knee was still a little swollen, but the residual bruising near the bottom of her leg was gone.

When I walked into the program area and looked around for her, Mom was at that very moment stealing another resident’s ice cream from his tray. He was so absorbed in eating his lunch that he didn’t notice. For that, I am glad. Mom sipped at the cup – the chocolate ice cream had melted. She and I walked to a couch to sit down. Shortly after that, Mom got up and walked into a room. I wondered if she was looking for a bed to lie in. From across the way came Mr. R. He went into the room and told Mom to “get the hell out.” He pulled on Mom’s arm, and I scolded him. “I wasn’t doing anything,” he said. Just like a kid.

He and Mom walked away from me, across the program area, and I just watched them. Mr. R was obviously having a bad day, and I thought it might be better if I just left. I followed behind them as they found a couch and sat down. Mom reclined and put her feet on his lap. I just observed briefly. And then I went over and told Mom it looked like she wanted a nap and that I would see her later. I leaned down to kiss her goodbye. Mr. R started talking angrily at me. He said, “I’ll throw you across this room.” I stood back and said, “That’s not necessary.” He stood up in a confrontational way. I don’t remember what I said, but I was mostly trying to sound soothing. There was no way to reason with him, but it is possible to escalate anger under these circumstances. Mom stood up and backed away a little bit. A maintenance man noticed what was happening, and came over to talk to Mr. R. Mr. R was saying that Mom was his, not mine. “They are mother and daughter,” the maintenance staffer said. Mr. R didn’t seem to believe it. He reached to Mom and pulled her toward him. Mom screamed. I was so glad she screamed. Mr. R won’t get away with much as long as Mom screams.

A nurse came running over and she and the maintenance staffer worked on calming Mr. R. Mom and I walked away. We held hands and walked to the lobby. We sat on a couch together for a short while. At one point I noticed Mom’s head tipping, and I assumed she was very tired. I stood up and encouraged her to lie down, and lo and behold, she followed my suggestion. I leaned down again to kiss her goodbye. I imagine she was asleep before I drove out of the parking lot.

Doing better

After support group last week, Mom’s roommate’s daughter, who is still visiting daily, said Mom had been taken out of the Alz center for a doctor’s appointment earlier that day. She asked me how Mom did with it. Based on what an aide said, she was under the impression Mom was having her feet treated. But I knew nothing about it, and I was surprised to think that the staff would have let Mom go to a doctor without telling me. I had tried to visit Mom before support group, but she was sound asleep on a couch, with her head resting on Mr. R’s lap. “I think she ate too much,” he said to me. I smiled. I noticed the stitches had been removed from her head. I let her sleep.

The next day, I went to the center around lunch time. A nurse saw me in the hall and said, “Those stitches came out beautifully.” And I said I noticed they were out, but hadn’t been notified about it. She said nurses tried to remove them, but they were internal stitches so they were a little tricky. So protocol is to return residents to the emergency room to have stitches removed. It was scheduled, so Mom was just in and out. I was relieved to hear that, though still a little surprised they hadn’t told me. Mom apparently did fine. But I wish I could have been with her. I didn’t say anything to the nurse about that, though I did mention that if they could inform me the next time the podiatrist visits, I might be able to encourage Mom to let that doctor work on her feet a little bit. So that might be in my future.

I found Mom on a couch in the program area, sitting next to a woman who was sound asleep and snoring, with her head tilted back. Mr. R was in a nearby chair. Mom’s cut did look like it was healing really nicely. And the bruising had turned to a greenish color. I asked Mom to smile at the camera and this was her response.

One day after the stitches were removed, and one week after the fall.

While I was sitting there and we exchanged pleasantries, Mom rolled up one of her pant legs. She didn’t really say anything. But I noticed she had revealed a huge bruise on her left knee. I took this as a sign that she was communicating to me. I touched the bruise and could feel a large raised area. I was not entirely surprised, considering that if she had hit her head, she probably had hit some other body parts on the way to the floor. I put my palm over the bruise, gently, and told her it would be OK. “Yeah,” she said. And she rolled her pants back down.

I'm pretty sure the reddish area represents the location of the impact. The bruising below is just residual broken blood vessels, I am guessing.

I had arrived before lunch, and I saw the cart of trays had come in. I wanted Mom to be able to be as focused as possible on eating, so I encouraged her and Mr. R to find chairs at a table so they could eat. He got up and came over to Mom, and they shared a kiss. They held hands and walked with me toward the hall leading to the lobby. I turned to say goodbye and they had drifted off, heading to a table. Which is what I had hoped for.