In our childhood, we dream of marrying a prince (or, in my case, a Beatle: Paul McCartney was MINE!), or being a cowboy or cowgirl or being a sailor on a pirate ship. Or .... what was your dream?
In our young adulthood, our dreams have moderated, they have settled into something more realistic but more concrete. And we imagine, if we are an archaeologist, that we'll find the next King Tut's tomb; if we are a scientist, we hope to cure cancer. If we are in business, we will found - or be part of - the next mega-corporation.
When you're 90 years old and facing possible amputation due to a toe that does not heal, news of tiny incremental improvements bring great pleasure.
Yes, Mom's toe is ssssllllloooooooooooowwwlllyyyy getting better. Yes, it's pink, but at least it's not red. Yes, it's swollen but not uber-puffy as before. The pain is still there but the nail is almost now gliding over the top of the skin - 'just a week or two more, Roberta'.
During this time we've addressed some matters that should help with blood sugars. She is going to have yogurt as a midnight snack (80 calories) instead of the Ensure shakes (240 calories). (Diabetics as she is need a midnight snack to avoid overnight low-blood-sugar problems). She will have no orange juice at breakfast, or if they give it to her anyway, she will just have a few sips.
Sometimes we just need to settle. She isn't enjoying a 10th decade in robust health, but she is getting by, she will probably have both feet to help her with her beloved walks, and she has family and a home where she is well-cared-for. For now, for her, that's good enough.
Now if only her daughter (me) would visit for 4 hours a day. THEN life would be PERFECT. Sigh.
Saturday, June 25, 2011
Wednesday, June 15, 2011
Hospice services ... a delicate dance, a partnership, to support my mom
Things feel like they are going downhill in the hospice services that Mom is receiving.
We started out loving her hospice service when she started over a year ago (for congestive heart failure). We had Margaret who was a funny and sarcastic nurse with a gravelly voice but who was great communicator. (Margaret died, tragically). Then there was Sandy, whom we also really loved - quieter but solid and clear-thinking. (Sandy moved out of state).
But in between, we've had a number of interim nurses whose names have disappeared from my memory. Some who had less reliability, or who seemed disinterested, or who just disappeared, and on to a new one.
Right now we have a hospice nurse, Mike (whom Mom always calls a "male nurse"... sigh). He is one of the senior nurses in the hospice group, but he's a bit odd. OK, quirky is OK ... I actually really like quirky-ness. But he is a bit loud and quick to talk but not as eager to listen. My sister was creeped out when he came in and gave Mom a big kiss (on the cheek), saying "I gotta get me some sugar" or something similar. Today he described how much he likes my mother, and claims she pinched him on the butt one time. OK, that doesn't sound like her, but OK. Quirky.
Last week, I called him twice and asked for help with the infected toe. I never got a call back, which is odd, so twice I called the office and said I hadn't yet gotten a call-back. Finally we spoke, and he found he didn't have the correct number. I guess that happens (even though my number is all over the records there). Yesterday I called and asked (for the third time) for results on a test, and still no call-back. This guy is getting on my nerves, with no routine communication to me and not even the courtesy of a call-back.
C'mon, Mike. I'm patient up to a point, and try to be understanding about lost phone numbers and your days-off. I know you're busy. Maybe you view family members of hospice patients as a distraction? But I am your biggest ally - or I'll be calling your boss again. Please let me be your ally and partner in caring for this sometimes-difficult but weary old woman, OK?
FOLLOW-UP: Mike finally called back - several times with individual new bits of information. We finally had a good conversation about Mom's heart function and her blood sugars. He still hasn't yet been back to the office to get the results of the Holter monitor heart function test that occurred a couple months ago, but he will tell me tomorrow. And, he said that the doctor has ordered an echocardiogram on her in a month or two for pulmonary hypertension.
I just have a sense that Mike is overextended, and always in a rush. He throws out comments, like "just between us - be sure to keep on the facility on her blood sugars", but they ARE doing blood sugars 4x a day. It is he who has not looked at them! I know that hospice work is difficult, and that my mom is not one of the urgent very-end-of-life cases. Her needs are more chronic, but she too is dying. Her intake is diminishing. She is nearing death, presumably. I need to stay more connected with Mike. He may (or may not...) know exactly what is going on with Mom, but I want and need to know too. This is part of the package.
I also will accept on myself the responsibility to be the squeaky wheel. If I need more conversation with Mike, I need to persist in asking for that (as I've done before, and as I did today). We did have a good conversation finally this afternoon, and I expect more information tomorrow. In life, usually have a strong ability to ask for what I need, but sometimes I forget when dealing with emotionally-charged situations like this. I somehow was surprised that I'd need to do so with hospice - but though they are a caring agency, they are also very busy humans. An important reminder to myself. Just ask, even if I have to ask a few times.
This is a delicate partnership, a dance, a shared relationship to support someone - to support my mother - in the last days or weeks of her life. With effort, we can work it out, to her benefit.
FOLLOW-UP: Mike finally called back - several times with individual new bits of information. We finally had a good conversation about Mom's heart function and her blood sugars. He still hasn't yet been back to the office to get the results of the Holter monitor heart function test that occurred a couple months ago, but he will tell me tomorrow. And, he said that the doctor has ordered an echocardiogram on her in a month or two for pulmonary hypertension.
I just have a sense that Mike is overextended, and always in a rush. He throws out comments, like "just between us - be sure to keep on the facility on her blood sugars", but they ARE doing blood sugars 4x a day. It is he who has not looked at them! I know that hospice work is difficult, and that my mom is not one of the urgent very-end-of-life cases. Her needs are more chronic, but she too is dying. Her intake is diminishing. She is nearing death, presumably. I need to stay more connected with Mike. He may (or may not...) know exactly what is going on with Mom, but I want and need to know too. This is part of the package.
I also will accept on myself the responsibility to be the squeaky wheel. If I need more conversation with Mike, I need to persist in asking for that (as I've done before, and as I did today). We did have a good conversation finally this afternoon, and I expect more information tomorrow. In life, usually have a strong ability to ask for what I need, but sometimes I forget when dealing with emotionally-charged situations like this. I somehow was surprised that I'd need to do so with hospice - but though they are a caring agency, they are also very busy humans. An important reminder to myself. Just ask, even if I have to ask a few times.
This is a delicate partnership, a dance, a shared relationship to support someone - to support my mother - in the last days or weeks of her life. With effort, we can work it out, to her benefit.
It's just a toe...
Mom started complaining a few weeks ago about an ingrown toenail. A podiatrist comes to the assisted living center where she lives, so I hoped that doctor could take a look at it when she arrives, but it got worse quickly.
And - she is diabetic.
And - her diabetes is not in good control.
She is pretty good with her diet overall, but does indulge in desserts at times. When her sugars are high, she always says "Better high than low." That is true in the sense that she has had numerous serious low blood sugar events, and these are immediately life threatening. High blood sugars have long-term damage.
So, her ingrown toenail has become quite serious very quickly. When I took her to the podiatrist's office, it looked awful. I'll spare you the details, but over the last few weeks, we've been aggressively treating it with antibiotics, creams, cotton, her foot being elevated, and epsom salt soaks. She is being transported in her wheelchair instead of her preferred walking. Slowly, it is improving.
We went through this with my father. He was also diabetic, in poor control. He ended up with an amputation below the knee - but he was about 70 and much more able to rebound (prior to his death a couple years later). On a 91-year-old woman? Not so much....
Yes, just a toe. But it could end up being the greatest single influence in the remaining time of Mom's life. She has been really grouchy about the limitations and requirements to treat the toe. But I've reminded her of the inconvenience of living with an amputation. Now, that's a bummer.
So, back to Epsom salt soaks and elevated foot and creams and antibiotics. And, please Mom, hold the grouchiness. We're trying to save both your life and your quality of life.
And - she is diabetic.
And - her diabetes is not in good control.
She is pretty good with her diet overall, but does indulge in desserts at times. When her sugars are high, she always says "Better high than low." That is true in the sense that she has had numerous serious low blood sugar events, and these are immediately life threatening. High blood sugars have long-term damage.
So, her ingrown toenail has become quite serious very quickly. When I took her to the podiatrist's office, it looked awful. I'll spare you the details, but over the last few weeks, we've been aggressively treating it with antibiotics, creams, cotton, her foot being elevated, and epsom salt soaks. She is being transported in her wheelchair instead of her preferred walking. Slowly, it is improving.
We went through this with my father. He was also diabetic, in poor control. He ended up with an amputation below the knee - but he was about 70 and much more able to rebound (prior to his death a couple years later). On a 91-year-old woman? Not so much....
Yes, just a toe. But it could end up being the greatest single influence in the remaining time of Mom's life. She has been really grouchy about the limitations and requirements to treat the toe. But I've reminded her of the inconvenience of living with an amputation. Now, that's a bummer.
So, back to Epsom salt soaks and elevated foot and creams and antibiotics. And, please Mom, hold the grouchiness. We're trying to save both your life and your quality of life.
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