Filed under: Alzheimer's, Government, Health, Hospice, movies, Sleep, Society
I sat, my back to the fireplace, feeling the heat from the fire, listening to the pop and crackle of the fresh log I had just placed there. Across the room, the hospice nurse and my wife were sitting at my MIL’s feet, the nurse doing her routine examination for the second time in a week.
This is new. Previously, we’d only been on weekly visits. But as it is clear that we’re in the final days of my MIL’s life, we decided to schedule an additional time. And, thanks to how hospice works, we’ve the option of calling for additional visits as needed, or adding in more regular scheduled visits each week. Just knowing this resource is available is comforting.
Lisa, our regular nurse, listens, touches, looks. I am struck by just how much good medicine is still based on these simple techniques, when it all comes down to it.
As it does when you are dying.
* * * * * * * * * * * * *
“What do you need, MIL?”
“I need to call my mother.”
I go get her cordless phone, dial the number and hand it to her while the phone is still ringing. Someone answers on the other end.
It is a brief conversation. She just wants to let her mom know that she is all right, not to worry. The voice on the other end reassures her, tells her to wait until she comes for her. She hands the phone back to me, and I disconnect. She is happy.
My wife and I had set this up weeks ago, in the event that the occasion would come that we needed it. Simple, really – an incoming call to my wife’s cell phone from my MIL’s number would be the cue that her mom needed this kind of reassurance. No need for me to say anything, contributing to the illusion.
* * * * * * * * * * * * *
We watched Waking Ned Devine the other night. A quirky, offbeat little movie that I love. The central theme is about love/friendship, played out in the story of a small village in Ireland where a local lottery winner has died before he can claim his winnings, leaving no heir. The villagers band together to claim and share the money, but as much out of memory and fondness for the departed Ned Devine as their own greed. It’s the sort of movie that always leaves me with bittersweet tears.
And after, surprisingly, my wife got to talking with her mom about MIL’s own situation. From an email my wife sent her sister following this:
When the movie was over Mom was obviously tired but also looked like she wanted to talk. I’m not sure what made me do it, but I started talking to her about her own death much more directly than I have before. I did so as carefully as I could, but I really felt like I needed to be very direct and clear (probably also influenced by the conversation with you). I told her that the nurse that comes every week does so because we think she may be dying, that we are caring for her the best we can and will continue to do so for as long as necessary. I mentioned that she often talks about people who have passed on, and told her that it would be OK for her to do so as well. That we love her very much but we want her to be happy, and if her parents come for her it is OK for her to go with them. She actually seemed to understand what I was talking about, though now and then, she seemed a little unsure, so hopefully the permission part (at least) will sink in.
Permission? To go. That it is OK to die. Often people who are in hospice need to hear this, one way or the other.
* * * * * * * * * * * * *
Lisa is surprised at just how cold my MIL’s legs are. “They’re like ice!”
You don’t usually get that kind of reaction from a seasoned hospice nurse. And, perhaps a bit out of embarrassment, she shifted over into more clinical terminology. Blood pressure. Indications of reduced lung capacity, congestion, observation of ancillary breathing mechanisms. Compromised circulation. She asks about appetite, kidney and bowel function, signs of pain or distress, coughing. Clinical terminology or not, her voice is always concerned, compassionate. “I detect a number of changes.”
We nod. My MIL is worried with whether her lap shawl is straight.
“When she is showing signs of breathing difficulty, or coughing, use X or Y medicine as necessary.”
She looks at my MIL for a long moment. “We want to make sure she is comfortable.”
Indeed we do.
* * * * * * * * * * * * *
They usually won’t tell you this beforehand, but there comes a point in hospice care where the usual restrictions about medicine dosage and usage becomes, let us say, somewhat more casual. The rules are in place to control the abuse of very dangerous and addicting drugs, after all. But when the end comes, no one in their right mind is going to be worrying about addiction, when there is comfort to be given.
We’ve reached this point. My wife and I had realized it last week, but were reluctant to act too much on this knowledge without confirmation from our nurse. No, she didn’t tell us to exceed any prescriptions, but was willing to answer our questions about what medicines were suitable for what problems. So, in response to anxiety, or breathing difficulty, or coughing spasms, we add in a few drops of this solution, another one of those pills, maybe a small shot of whiskey.
* * * * * * * * * * * * *
My wife smiles slightly, amused, as I add another log to the fire. I know what she is thinking – she is remembering my protestations earlier in the season that we didn’t want to be too profligate with the wood I had stockpiled.
Yet it is very cold out, and my MIL does so love a fire.
* * * * * * * * * * * * *
Jim Downey
(Cross posted to Daily Kos.)
With all the dignity and presence of a southern lady, my MIL held her self erect, looked at me and said “I’ve had a very nice time this evening. And dinner was lovely. And your performance, though I’m a little ashamed to admit that I can’t remember exactly what you did.”
“Well, thank you!” I answered. Then I helped her finish up on the commode next to her bed, and carefully laid her down for a nap.
It was 12:45 in the afternoon. She had just finished lunch consisting of a peanut butter & jelly sandwich, Pringles, and some chopped pears. Needless to say, there had been no ‘performance’ by me or anyone else.
* * * * * * * * * * * * * *
“I don’t know how you guys manage it,” said Lisa, the hospice nurse. She had just finished her examination of my MIL, and had been going over what she saw as we talked after. She’d mentioned the option to have an aide come over to sit with my MIL while we got out for a bit.
After my wife and I exchanged glances, I (or maybe it was my wife – these details start to slip away) said that we preferred to not both be gone at the same time at this point. Why? Well, because it feels like the end. We want to make sure one of us at least is here with her.
And it’s not just us. Lisa commented that my MIL had never before looked so ashen, so grey. We agreed that she would come again on Monday, unless we called her sooner.
* * * * * * * * * * * * * *
Her fever spiked about 4 degrees higher than normal last night, just as my wife and the overnight aide we have in three nights a week were getting her to bed. I was washing the dishes when my wife came into the kitchen and told me, on her way to getting a Tylenol tablet for my MIL. I dried my hands and followed her back to the bedroom. We got the extra pill into her, I checked her pulse and the color of her fingernails, had her look at me to see whether she could focus or not.
She couldn’t.
I wondered whether she’d make it through the night.
She could.
* * * * * * * * * * * * * *
“My mother has passed on, but Auntie has taken over for her.”
“Auntie?” asked my wife.
“Yes, Auntie. She has taken over for my mom. I was waiting for my mom to come for me, but she’s passed on, so Auntie has taken over . . .” a pause, uncertain look around the room. “. . . everything.”
“Well, OK.” My wife looked at me. We’d been waiting for this. Together, almost simultaneously we said, “MIL, if she comes for you, you can go with her. It’s OK.”
“It’s OK?”
“Yes, when Auntie, or your mom, or your dad – when they come for you, you can leave with them.”
“I can?”
“You can indeed. Until then, we’re taking care of you here.”
“But if they come, I can go?”
“Yes, you can.”
* * * * * * * * * * * * * *
We met with the social worker for an hour or so yesterday afternoon. She is kind, intelligent, insightful. She offered a lot of suggestions for us to consider, from a respite break (which would take my MIL to a skilled nursing floor at the local hospital for five days), to advice on how to better manage the stresses we’re under.
None of it was useful.
Oh, it was, in the sense that had we not considered those things, it would have been very beneficial to bring it up. And neither my wife nor I were aware of the option for the five-day respite break.
But we’ve managed through these things long enough that I think, honestly, we’re doing about all that can reasonably be done to handle the stresses, to give ourselves (and one another) what breaks we can.
And right now we’re not willing to see my MIL off to the five-day break. Not right now. If she rallies again, and seems stable, then we’ll consider it. But not when things are so shaky with her health. After all we have been through, after all we have done, to let her slip away now in the care of someone else in a strange environment would be just too painful, would feel very much like we had failed to see the thing through to the end.
Neither of us wants that.
* * * * * * * * * * * * * *
As I got the safety rails and straps on the bed in place, my MIL looked up at me, concerned.
“Something wrong? Something bothering you?”
“Well, like I said, I have had a very nice time tonight.”
“Yes, thank you. It is kind of you to say so.”
“But I think I should be going soon. My mother and father have been on a trip, and they are looking for me.”
“And when they come, you can go with them.”
“But if I am sleeping,” she said, that worried look on her face again, “how will I know?”
“If they come looking for you, I will be sure to tell them where you are. I promise.”
And I keep my promises.
* * * * * * * * * * * * * *
Jim Downey
(Cross posted to dKos.)
Filed under: Alzheimer's, Book Conservation, Health, Hospice, Predictions, Preparedness, Sleep
(This is something of a follow-up to yesterday’s post.)
My MIL made it through the night. And seems to be holding her own today. But her fingernails are still blue, breathing noticeably labored. To be perfectly honest, I hope the end comes quickly and with ease for her. If that sounds horrid, or cold, or heartless – well, I’d say you haven’t been paying attention. I am none of those things.
We’re trying to keep things as ‘normal’ as we can, to maintain our usual schedule, get my MIL up at her usual time, have meals as planned, all the normal routines. This might be a bit absurd – it feels like it to me – but consistency really does give comfort to someone with Alzheimer’s. And while other health factors are now in action which will likely end her life soon, she is still very much an Alzheimer’s patient.
But I am changing my schedule a bit, canceling meetings with clients, postponing this or that activity to make sure either my wife or myself are always here. We had our usual ‘respite’ break scheduled for this Thursday afternoon, but I worry about leaving the respite sitter here alone with my MIL. My clients have all been understanding about this, which is good. As I told a friend this morning, there are advantages to being a skilled craftsman in an unusual profession.
So, we wait, pretending that things are normal. Until they’re not.
Jim Downey
It’s hard to say when the end will come. But we must be getting close.
How close? Days. Perhaps just hours.
Why do I say this?
Instinct. Well, that and lots and lots of small clues, details that add up to one probability, details that probably most wouldn’t notice.
But among the little things are some big mile-markers. The last few days, my MIL has slept between 18 and 20 hours per day. When awake, she breathes with some labor, and she regularly shows signs of cyanosis. Her confusion is noticeably worse.
Couple that with what Lisa, the Hospice nurse, noted on her last visit, and I’ve been mentally reviewing what we need to do, what we need to look out for, what I will need to tell the family. I worry that I have cried “wolf” too many times, in my effort to keep everyone informed. Well, better that than a misguided attempt at secrecy, I suppose.
So, I re-read all my posts on this subject. And went through, once again, Dying at Home.
I’m about as ready as I can be.
I hope.
Jim Downey
“She’s a strong woman,” said Lisa, our regular hospice nurse. We were standing out in front of the house, talking the way people do at such times, in spite of the 11 degree temperature and bit of cold wind. Neither my wife nor I had coats on. But it didn’t matter at that moment.
* * * * * * * * * * * * *
I came downstairs this morning, noted that there wasn’t a time marked on the blackboard in the kitchen. I went into the front room, where the health aide who stays here overnight three nights a week was waiting. I glanced at the monitor, heard my MIL snoring lightly.
The aide, Ruth, glanced at it as well, and then back at me. “She never called to get up to use the toilet.”
“Not at all?”
“Nope. She’s turned over or shifted around a couple of times, but never seemed to wake up at all.”
“Huh.”
“She done that before?”
“Not in recent history.”
* * * * * * * * * * * * *
We made it through the holidays. I kept thinking that I would write about how my MIL was doing, but everything seemed so unsettled, I wasn’t quite sure what to say. First Christmas, with my wife’s brother and his family over for a big meal and to exchange presents. That went fine, and my MIL seemed to enjoy herself, enjoy the company. But after her nap she had forgotten entirely that anyone had been to visit.
Then she had good days and bad days. Days when she mostly slept, days when she seemed to be tracking things around her pretty well, days when even simple words escaped her understanding. Fever would spike for a day, then back to normal for two. There were no trends that were easily identifiable.
New Years eve we mostly ignored. My MIL wasn’t aware of the date, and my wife and I weren’t up for doing anything. With the home health aide coming to stay overnight that night, we just did the usual routine, went to bed as normal – and I was asleep by 10:30. A friend teased me about it by email the next day, said I was getting old. I was grumpy, somewhat resentful in my reply. I’m often grumpy these days, due to the stress. I’m glad most of my friends understand.
* * * * * * * * * * * * *
Lisa came into the bedroom, set down her things, handed over the package of Depends for my MIL. Hospice covers everything, even that. My wife helped her mom sit up on the edge of the bed as I opened the drapes for the large double window.
Lisa pulled the wheelchair over to the side of the bed, settled herself, and began going through her usual exam, chatting pleasantly with my MIL all the while assessing her condition, asking us questions about how she had been doing the past week. As usual, she found it difficult to get a solid pulse when taking my MIL’s blood pressure, then her brows knit together for a brief moment. “78. Only number I can get.”
She looked from MIL to me and my wife. “Has she been sleeping long?”
“No, she just laid down after breakfast and getting dressed about five minutes before you got here.
Lisa nodded, continued the exam. But she was being a little more thorough than usual, checked my MIL’s fingernails closely, then her toenails. Listened carefully to her lungs, timed her heartbeat for a long time, tested the elasticity of the skin on the back of her hand. Asked about how much my MIL was drinking, kidney and bowel function. All the while smiling and interacting with my MIL, keeping her happy and engaged.
“How much is she sleeping each day now?”
My wife and I looked at each other, calculated a moment. “About 16 hours a day, give or take an hour or so.”
Lisa nodded. She looked at my MIL, asked “Are you feeling OK?”
My MIL continued her smile. “Well, I think so.”
“Any questions?”
She looked to me and my wife for some assurance. “No, no, I don’t think so.”
“Good, good,” said Lisa, packing her things.
“MIL, do you want to lie down again for a while?” I asked.
“Yes, I think that would be nice.”
My wife got her tucked back in bed safely as I escorted Lisa out.
* * * * * * * * * * * * *
Part of my difficulty in writing about my MIL these past days has been confusion about not just what to say, but about how I felt about it.
I’m tired. So very, very tired. As I’ve mentioned, this time of year usually carries something of a depressive element for me anyway. With the lingering uncertainty about where we were at with my MIL’s condition, I’ve felt a certain confusion about what I want, what to do. It is easy to understand how a care-provider will become exhausted by the process of doing what we’ve done for the past four or five years. It is even easy to understand how they might look to the end with a certain anticipation – not wishing for their loved one to be gone, but knowing that with the end will come release from the burdens of care giving.
What may not be easy to understand is how the prospect of that is a little frightening. No, I’m not talking about the mechanics of death – that is fairly easy to understand when you are a mature adult with the experience of losing friends and family. Rather, it is fear which comes from a change of definition of who and what you are.
And it is fear of guilt, at least in my case. Guilt over whether I could have done more, guilt over wanting to be free of the burden of care-giving.
* * * * * * * * * * * * *
“Are you finished with lunch?” I asked my MIL, as I came into the kitchen. I had been in my office, writing this entry.
“Yes. But I need someone to unblock the wheels.”
We have to keep her chair secured with a 2×2, otherwise she’ll try and leave the table. I set down her after-lunch meds on the table after I removed the plate for her lunch. “Oh, I can take care of that. Here, you need to take your pills.”
“Oh, OK.” She took her pills.
“Ready for a lie-down?”
“Yes, I am.”
I got her away from the table, removed her bib, and wheeled her into her bedroom. She used the toilet in there, then I helped her into bed. As I was tucking her in, she looked up me and said, “thank you for that delicious lunch!”
“You’re welcome. Have a good nap and call when you are ready to get up.”
And as I walked out, closing the door softly behind me, my eyes filled with tears.
* * * * * * * * * * * * *
I escorted Lisa out, after the examination. “I take it you see something?”
We walked down the front steps. “She’s declined. There’s congestion in the lower lobes of her lungs, and they sound rough all throughout. The low blood pressure and high pulse rate – it was over 110 – is not a good sign.”
“How was her heartbeat? Same irregularities as before?” I asked, as my wife came out to join us.
Lisa looked at my wife. “Yes, but hard to tell, her heart is beating so fast it kind of covers it up.”
“What do you think?”
“She’s close. The end could come at any time. Hopefully in her sleep.” Lisa said it in a way that was plain, honest, but sympathetic.
I nodded, looked back up at the house, the flags waving on either side of the front porch. “We were surprised she made it to new year, frankly.”
“She’s a strong woman.”
I nodded, looked at my wife. “She is, indeed.”
* * * * * * * * * * * * *
Jim Downey
(Cross posted to Daily Kos.)
Filed under: Alzheimer's, General Musings, Health, Hospice, Religion, Sleep, Society
I walked into the dark room, stepped up to the bed. My MIL looked up at me, and said “I don’t like these rails and straps.”
There are the standard ‘hospital rails’ on the side of her bed. And since she’s several times attempted to climb over them (and broken bones in the subsequent fall), we put some nylon straps across from one rail to the other in a sort-of cargo net arrangement. It allows her to move freely in bed, but stops her from trying to climb out on her own. “Well, I’m sorry, but they need to stay on.”
She smiled. “Doesn’t matter – I’ve decided that I’m going to leave today, go back home to Missouri.”
We live in Missouri. But I didn’t want to contradict her, not that early in the morning when there would be little point to it. If she went back to sleep, she’d likely forget the conversation completely, anyway. “That’s fine. But for now try and go back to sleep – you don’t get up until 8:00.”
“OK.”
* * * * * * * * * * * * *
While I am not religious (hardly), I nonetheless enjoy some aspects of the holiday season. Working in small-market radio for four years between college and grad school forever traumatized me in regards to Christmas songs of every stripe, but I enjoy gift-giving, feasting, some good Christmas cheer with family and friends. Yesterday afternoon during our ‘respite’ break, my wife and I went out and selected a tree from the family farm – cedar, the traditional family tree – and brought it home. Now that it is settling, we’ll get it decorated some time this weekend.
That’s late for us, and we got a smaller tree than usual. Simple reason for this: it’s less work. And right now, just about anything that’s less work is the default position.
* * * * * * * * * * * * *
Our regular hospice nurse was on vacation this week, so the agency made arrangements for another nurse to come by and check on my MIL. She arrived on time, bringing supplies and meds, and went in to chat with my MIL.
“I read that nice article about you!” she told my MIL.
“Article?” asked my MIL.
Out of sight of my MIL, I shook my head at the nurse, mouthed the words “She doesn’t remember it.”
She nodded.
I spoke to my MIL “She’s just talking about a nice article that was in the paper, about people who care for their loved ones at home when they get older.”
“Oh, did you write it?”
It surprises me sometimes the things that she remembers. I used to write a column for the paper. “No, I didn’t write it.”
“But you used to write such nice things.”
* * * * * * * * * * * * *
I’ve never obsessed about getting presents to people “on time” – most of my friends and family have busy lives themselves, and understand how things stand here with us. But this year we’ve really been caught short on planning, and our shopping has been sporadic, at best. I’ve been able to take care of a lot of routine things, and gotten a couple of special gifts. But for the most part I just haven’t had the energy and focus to try and find the right gifts for others. And the shopping we usually do for my MIL just hasn’t gotten done at all this year. That’ll be a disappointment to some.
* * * * * * * * * * * * *
I walked out with the hospice nurse when she was done checking over my MIL. Either my wife or I usually do this, so we can go over info we didn’t necessarily want to discuss in front of my MIL, the other staying and helping get my MIL dressed or back into bed.
“Anything to add?” she asked.
“No, not really. We’re just unsure of where we are. Not knowing is difficult.”
“Well, I can’t say for sure. But the end could come fairly quickly. You’ll just have to let us know if you see a sudden downturn, so we can be here every day rather than just weekly.”
I nodded.
“You know, you guys are doing just an incredible job in caring for her. I wish that half of our patients got even half as good care as your MIL is getting.”
“Thanks.”
And as I turned to go up the stairs, back into the house, eyes watering, she repeated: “You guys are doing an incredible job.”
Then why do I feel guilty? Like I should be doing more?
* * * * * * * * * * * * *
“I hope I’ve made the right decision.”
“What decision is that?” asked my wife, as she helped her mom sit up on the side of the bed.
“Well, I think it’s time I went home. I’ve enjoyed my stay, but I think that I should be getting back.”
“That’s fine,” said my wife, putting slippers on my MIL’s feet. “But how about some breakfast, first?”
“That sounds nice, dear.”
* * * * * * * * * * * * *
Jim Downey
(Cross-posted to dKos.)
“Well, I’ve enjoyed my time here, but I really should go.”
I sat on the couch next to her chair. The slight hiss of the oxygen cannula under her nose could still be heard over the sound of the concentrator in the other room. Her hands picked absently at the shawl we had over her lap and legs. “Well, we’ll be having supper in about an hour.”
“We will?”
My wife entered the room, sat on the floor by her mother’s feet. “What’s up, Mom?”
“Well, I was just saying that I thought I should be getting home, but he tells me that we’re going to have dinner soon. I don’t have any money for dinner.”
“It’s OK, you don’t need any money,” said my wife.
“Oh.” Pause. Look at me. “But I should still tell my mother. She’s been on a long journey, and just got back. She’ll want to know where I am.”
This has become routine. I answer, “She knows. Everyone in the family knows where you are. They know that you live here and we take care of you.”
“Are you sure?”
“Yes, here,” my wife grabs a nearby phone book, turns to the page we’ve marked during this exact same conversation previously. “See, right here is your name, and the address, and the phone number. Anyone who wants to find you can, right here in the phone book.”
“Oh.” Still dubious. “But does my mother know?”
“MIL,” I say, “she asked us to look after you, until she comes for you.”
“Really?”
“Yup. And you can stay for as long as you want, until she comes. And then you can go with her.” I’m impressed by the certainty and reassurance in my wife’s voice.
“Oh, thank you dear, that would be lovely. This is a very nice place you have.”
Indeed it is. It’s been her home for 53 years, and is just the way she wanted it.
* * * * * * * * * * * * *
She seems to be stable again. Following the events mentioned in this post, we weren’t sure which way things were going to go. But after talking with the hospice people, tweaking her meds some, a few days of increased sleep, and with long talks with her to help settle things when she got anxious, she settled back more-or-less into the most recent patterns we’ve seen. There’s little doubt that she suffered one or more TIAs, or a small scale hemorrhagic stroke.
But she has once again proven to be surprisingly resilient. I’m fairly confident that she’ll make it at least to Christmas, probably to the new year. But as in all things, nothing is certain.
* * * * * * * * * * * * *
I wrote this a couple of years ago, as a submission to NPR’s This, I Believe series.
The Power to Forget
I believe in the power to forget. On December twelfth, 1969, my world changed forever. My father was murdered. I was eleven years old.
In the middle of the night I woke to flashing lights from a police car. A knock at the door, and I heard my mom answer it. Then I heard a man say: “Marlene, Wil’s been shot.”
See, my dad was a cop. And as happens all too often, he was killed during a routine procedure, in this case a burglary investigation. They caught the man who killed my father that same night. He was tried and convicted, sentenced to die. That sentence was commuted in 1973 by the Supreme Court, and to this day he is in prison.
I think he is, anyway. I don’t know for sure, because I have tried my very best to forget him. It was that, or succumb to the hatred that threatened to define my life.
For a while I tried forgiveness, since that is supposed to be liberating. When I say for a while, I mean for years. But I failed. There are some things that cannot be forgiven, at least for me.
Instead, I have slowly, and carefully, excised his name from my memory. Now and then something will happen; I’ll come across a story in the paper about him being up for parole, or a family friend will ask “whatever happened to so-and-so,” and I’ll have to start again to forget.
It’s not easy. Much of our culture, much of our popular literature, is based around the theme of a son avenging the death of his father. The whole “find the bastard who shot my pa…” thing. You may not notice it, but I do. And every time I hear about another officer down, every time Father’s Day rolls around on the calendar, I think about my dad. And I think about his death. And I deny the existence of the man who killed him.
Even now, as I write this, his name tries to emerge, tries to struggle free from where I have buried it. But forgetting means that I don’t have live with a constant, aching anger. It means that I don’t have to be trapped in that moment of history. It means that I can continue with my life, never forgetting the love I have for my father, or what it meant for him to die, but not being possessed by a need for vengeance.
I believe in the power to forget. How many old grudges still fuel the fires of revenge in this world? How often have more people had to die because of a fixation on a memory? How much better would things be if we could just clean the slate, forget the offenses we’ve suffered and the ones we’ve inflicted, and move on?
* * * * * * * * * * * * *
Now I am not so sure. Watching my MIL, caring for her as she slowly forgets even the names of her children, that she was ever married, I wonder whether the burden of forgetting is worth the peace. Certainly, she is at peace (most of the time), so long as we do not disrupt the carefully constructed cocoon around her.
I would not want that fate, even if I would be mercifully unaware of it, as she is.
Perhaps, as in most things, it is the matter of intent that makes the difference.
Jim Downey
(Cross posted to dKos.)
We’re currently under an Ice Storm Warning through noon tomorrow – the weather is bad enough that it’s even made the national news, and our Governor has declared a state of emergency. The last local report I saw indicated that we’d received over two inches of sleet and freezing rain. But by luck, there’s not a lot of accumulation on tree limbs and whatnot, so we’ve escaped the power outages which usually go with a big ice storm – so far. With more forecast through Wednesday morning, who knows what will happen.
Not that I’m terribly concerned for the short term – we’re set up to ride out these kinds of storms with minimal worries, thanks to a little advance planning and a working fireplace. Only if we had some kind of medical emergency would it be necessary to leave.
But I wanted to share something which happened overnight, while I was on-call: thundersleet. Not the fairly rare thundersnow – which I have experienced before. No, this was more like a regular thunderstorm – the sound of the thunder wasn’t suppressed the way that snow will do, and in fact I wonder whether it was augmented by the hard surface of the sleet on the ground, reflecting back more of the sound energy. And it was brighter than a usual thunderstorm, thanks to the white blanket of sleet on the ground. And it wasn’t just a few boomers – this went on for several hours (and meant I got even less sleep than I would have, being on call). Impressive!
Jim Downey
I wanted to follow-up to this post of yesterday, for anyone interested.
It seems likely that my MIL has had one or more T.I.A.s or possibly even a small full-blown stroke. This would explain her marked shift in sleep habits, increased confusion and much greater aphasia – and is really about the best explanation we can come up with, since there haven’t been any other changes in her diet or condition which would account for the rapid deterioration.
It is frightening, for both us and her. Clearly, she is confused and unable to explain herself and her worries to us, and frustrated by trying. She is completely lost in time and location, not aware of being at home, constantly fixated on “going home” and seeing her parents. But we know she still loves – every chance she gets when my wife is close to her, helping her stand or dress, she will kiss her, holding on tightly for a moment, letting that touch express her feelings.
I never did hear back from our hospice nurse, which is both disconcerting and disappointing, but since there didn’t seem to be a medical emergency to deal with, I didn’t want to keep calling her. This morning we will contact the hospice agency and see if they can help us out with some additional anti-anxiety meds for my MIL, since that seems to be the best thing for her at this time. Otherwise, we will do what we can to continue to make sure she feels comfortable, and safe.
Jim Downey
Those who dream by day are cognizant of many things which escape those who dream only by night.
— Edgar Allan Poe, “Eleonora”
A friend passed that along, from today’s Quote of the Day. It is very appropriate. Howso? Well, because for the last 24 hours or so we’ve seen a rapid deterioration of my MIL’s mental condition, including a lot of seeing people and things which are not there (at least in my perception). Further, she’s been holding conversations with these people and things, as though they are responding to her. And when you come into the room, genteel and considerate woman that she is/was, she wants to include you in the conversation, or explains what has been going on so that you don’t feel left out, and expects you to understand and participate. It is very disorienting, because there really is no logic or coherence to these visions, and the conversations are little more than word salad.
Further, her sleep habits have changed as well. She had been sleeping more and more, but all of a sudden yesterday afternoon she didn’t really nap, and last night she was awake more than she was asleep. My poor lady wife, who was on-call, had a very rough night of it (and I’ve sent her up to nap for as much of the day as she can).
We don’t know what is going on, and all my experience and speculation has been useless. I have a call in to our hospice nurse, and will discuss the situation with her, see if she has any thoughts on the matter. It could be as simple as a UTI (not that UTI!) , which is a common problem with dementia patients, and known to cause such symptoms. But we take prophylactic measures to limit the chance of a UTI in my MIL, so I would be surprised if that were the source.
Clearly, something is going on. Whether or not it is something we can or should try and correct, we’ll see.
Jim Downey
Communion Of Dreams 