They can turn on a dime

Watching and waiting and clearing things up continues.  How long will this continue , no one knows. I am writing this so that someday when her other relatives want to know something they can read my blog.  That assumes they really will be curious, doubtful, but never know. One niece (her  granddaughter) is in Japan and called to talk with Jerry and say "Thank you Uncle Jerry for all your years taking care of Grandma."  That meant a lot.   

Last week,  on Thursday, April 4th,  Jerry's mother, Florence aka MIL seemed to be rallying.  She was up in her wheelchair, ate a good breakfast, had therapy sessions, and was out in the  dining room, eating somewhat slowly (nothing new for her ) at the noontime meal.  She added an  extra sugar packet  to her strawberries and really poured the salt all over her food eliciting a comment from  Jerry who is another salter (is it genetic?) that  he had already  salted it for her.  She wanted no help eating, fed herself slowly as we sat and waited and watched, helped cut her food a chicken cordon bleu meal. Really everything looked delicious.   She ate nearly all her boiled redskin potatoes, half her roll,  a bit of chicken and all the strawberries, drank all her water and ignored her tea.  She adamantly refused the apple juice  proclaiming that she had read that  it is not good for you.  Her voice was low but she is only recently out of the woods off the Tramadol that had reacted so badly with her.  What's with that but we did not  question her , merely looked at each other, she is likely back to her normal self now or as normal as normal is for her. The aide who pushed her wheel chair into the dining room mentioned she was a bit peevish, he is new so we assured him "that is her normal attitude."  

 I snapped a couple photos from my phone when she was not looking at me, unaware they would become her last photos.  After her meal she returned to her room, and used the call button for assistance going to the bathroom.  This despite her disgust that we insisted on her doing so, "I can go to the bathroom" and Jerry responded that she could not move out of that chair with out help, reminding her she had broken her hip.  She could not retain that information at all.  She was in good spirits and joined the group for afternoon bingo in the hall, that was something she had not  done yet. She was tired and had to return to her room after a short time, but still,  good signs we thought. 

Friday, morning  April 5 she refused to eat breakfast and was hallucinating terribly and trembling just as she had on the  Tramadol causing us to wonder if someone at the SNF had screwed up and  mistakenly given her another dose.   I sent Jerry to ask immediately thinking I should have done so because  I get an immediate sense of  truth or not and the SNF staff pay more attention to me, they know me and word abounds about my prior professional background and connections. . The nurse said  definitely she  was off  it and had not been given any,  well then what is going on now?  She was not the same one day later.  We watched her almost violently  refuse her noontime meal that they brought to her room, waving her arms, shouting almost, "I don't want to eat. I am not hungry."  She was so agitated that we summoned a nurse who attributed the behavior to her  oxygen level  so she immediately inserted the oxygen tubes and called an aide to help get her to bed.  Florence continued to ramble loudly on and on but finally we did get her somewhat calmed, whew  hours later. 

No sooner had we walked out into the hallway to leave  than I spotted another elderly lady, Joann from the church, a friend to Florence although Florence has not remembered her for many months now.  "Oh please,"  I whispered, "not Joann now."  Joann is in her 80's, another shaky elderly, walks with a cane, has dementia and/or Alzheimer's diagnosis and is on Aricept, but still drives and still lives alone.  Long story short, I question her family's lack of  sense perhaps inability to face and argue with an old woman.  Too late as she looked into each room along the way, spotted me and made her way down the hall.  I asked if she was going to see Florence and sure enough she was.  We'd closed the door partially and I explained that Florence  was having a rough day and we had just gotten her settled and sleeping.  "Well I will just say hello,  I won't stay."   "No,  Joann you cannot go in now." "Oh won't she know me." "Joann I'm sorry but she is sleeping"  "Well I won't wake  her I will be quiet."  "No Joann, I am sorry but no".We tried to help escort her back down the hall when she spotted the room of someone else she knew and stopped in.  We left, because it had been an exhausting spell of hours again culminated with further exasperation.  

All weekend MIL continued to decline, refusing to eat, nothing but water as the oxygen dries her out.  Sunday the charge nurse wanted to send her to the hospital but we refused, what for? An ambulance ride for what?  Acute, skilled care no longer working it is time for palliative.  Her vitals remain good, but she is agitated and  moaning.  One very exceptional nurse, Kathy, who is on duty on weekends and who has 34 years SNF experience besides seeing her own father  decline and pass at 92 knows her  stuff and  got Florence to drink some Ensure.  I asked Kathy if she thought it time for hospice and she agreed, "why fight this?"  She noted and said they could request that  Monday along with sub lingual morphine, because  Tylenol was doing naught although MIL maintained she had no pain.   It was a long weekend and Florence remained in bed, moaning and jabbering.  By Monday they no longer got her up and dressed but she was more delirious.  Yes they had  contacted hospice but cautioned  this means she will be back on non covered room and board,  private pay, but we are thinking so what, use up what remains of her $$. And I well know Medicare would have dropped  their few days payment anytime now because she was not progressing in therapy or ADL (activities of daily living). She has been private pay anyway, what's new?  Monday the SNF got orders for Atavan and I was most skeptical of giving her that, I have seen it counter act badly in frail elderly, worst example the mother of a friend in PA.  I cautioned the SNF nurse about it  reminding her that Florence had reacted badly to the Tramadol but she said it was less than a half dosage.  I said we would stay to watch any effect, and luckily we did.  Within 15 minutes she was worse, more agitated, babbling constantly, incoherent,  and then thrashing about in bed.  I went immediately to the nurse and said "come see this."  To which she  said, "well give it time..."  NO  20 minutes more that's all. I was able to calm MIL a bit with cold wash cloths to her forehead which caused her to relax and close her eyes.  After an hour I again grabbed the nurse who was waiting for the orders on morphine.  "Waiting?  Well who must I call?"   Within 5 minutes we had a dose sub-lingual and although the jabbering continued, the thrashing stopped.  Her most common phrase repeated, "I don't know,"  but sometimes the comical "Bingo, bingo"  followed with a low chuckle.   She had complained that her back hurt so Marissa, a young concerned aide,   called another to help change her position.  That evening I returned to be sure all was being done right  and just in time to observe the night nurse give her evening morphine.  I verified that no Atavan was ordered.  

Tuesday, yesterday, she  was babbling less, but still some and recognized us.  We met with the hospice team and I felt like the weight of the world lifted from my shoulders.  Today Wednesday, April 10 she is bed bound but calm.  The hospice chaplain was with her as we came in, he said he had used her hymn book,  one I'd given her to use when she played the organ at the SNF in the back room, and that she had opened her eyes for some choruses.  I told him she knew those hymns by heart.  Sure enough he and I sang "it is well with my soul' and she opened her eyes.  We think she is off somewhere.  Little recognition, some coughing but when we tried to swab her mouth, she is no longer drinking water, she screeched. No one knows how long this will continue.  This is her 6th day without food and second sans water.  Such a slow, miserable way to die.  I am thankful my family went happily, peacefully and some without warning.  The weather turned wintry mix thunder, lightning and hail last night.  Surely the heavens are not pleased either.   

Waiting for other outcomes

Bird watches the berries   by the lampost
photo taken on one of my walks

Two days ago, Thursday, MIL appeared to be on the recovery trail.  The SNF nurses had determined that Tramadol, the pain meds were making her worse, more confused,  we agreed that they discontinue and within two days she was improved, color better,  up in a wheel chair, able to eat and being herself, which is not all that pleasant under normal circumstances but we are all used to it.  However yesterday and today is another story. This is the second day she has refused to eat.  She continues to need oxygen, her lungs will not work without it, she is very delusional with out constant oxygen, yet it  dehydrates her.  She sits in her wheel  chair when they get her up and simpers.  It is not even a whimper, but a simper, it makes no sense, it is a noise a  very high pitched whining of sorts.  It is pitiful.  Once in a while she says, "97 years old!" she is 96.  She knows who we are, "Jerry  and Pat"  but otherwise, she knows nothing, cannot remember  she has broken her hip, had surgery let alone what day it is, she cannot communicate.  The  pros say, "  Mortality and functional outcome in hip fracture patients are significantly related to the presence of neuropsychiatric comorbidities. The most frequent ones in elderly are delirium and depression."  Yes indeed MIL has both delirium, depression and pulmonary episodes.  If this is her final stage of life it is miserable, a bad way to die, nothing peaceful.

Her daughter does not care, obviously and will not come to visit her mother, big deal she lives in another state, there are planes today, shame on her, someday she may regret her neglect.  Her younger son, I believe, feels he did his duty by appearing this past August with his family.  Well at least he made an effort after four years.  These are my simple opinions, very sad for them, they have not a clue what lies ahead.  Maybe I selfishly want them to participate for our relief, they have not and will not now. Jerry ignores it, says, " why would they change now?"  and he reminds me I  expect too much. 

I have a friend in PA who said caring for her elderly mom that she was an only child until the will would be read.  Well here is a flash to Florence's other children, the cost of the care in the SNF has all but diminished your mother's money.  We have bought  her personal care items and clothes the last years while you were never interested nor asked us what she needed.  You went along your merry  way. Do not appear with your hands open and out when she passes to collect your share, there is nothing $$. And beware the cold winds of karma that blow your way.  I find these people most irritating.  What goes around comes around, something like that, I don't know if the Hindus, Buddhists or whoevers have it right. 

"  .. As my life today....has been determined by the way I lived my yesterday,......
So my tomorrow is being determined by the way I live my today.        Ralph Waldo Trine

The daily SNF visits leave us both very tired.  It takes a hunk out of our days, but what else can we do?  So until something  very unusual happens or MIL passes on, we are tied to a circular duty, one that was not our choice, but one that we assumed,  catch, here comes another curve ball in the game of life.

Some PA came back to MN

We are home safe and sound although coming  along on I 94/80  near Gary,IN  I was as close as I ever want to be to  a semi that was drifting into our lane, my passenger side,  to go nowhere as the traffic was heavy and all lanes were filled.  Fortunately the truck driver came to his senses or heard Jerry laying on the horn; when we finally got past him in our own lane to his  left, he glared as if we'd done something. I said a loud thank you to my "people" and guardians.  The trucker appeared to be in his 40's, skinny pointed nose and looked stoned, but don't ask me how I determined that as he was wearing those reflector mirror sun glasses.  Most often the truckers we have met along the road are decent folk who want to avoid accidents too, this character looked hell bent to crash.  This part of the highway has had lots of construction and likely will have forever.  Generally we go farther south in IN, but decided to take the shorter route.  The mad trucker veered off toward Chicago and proceeded to terrorize other motorists.  I was glad to be sitting high up in our coach, still did not want to share a seat and a tiny car would not have had a chance.  Another bump on the road was on  I 80 which was shut down to a stand still in IL while more construction occurs, which made for a long drive.  When we return to PA in July we will avoid I 80 as it likely will not be completed. The  funny thing was we veered farther north, to MI on 31, missing our Hwy 20 connection to I94. We have always wanted to go north along the Lake in MI and return down the WI side and sitting in the  traffic stop, Jerry said, "we should have kept going north."  Ah well, all's well that ends well. 

All is unloaded at home and the laundry is in full force.  I picked up MIL's clothes from the  SNF today to add to the heap.  She refuses to allow them to do her laundry while we are gone, my fault for doing her laundry while we are here.  Although I mark her clothing and it could have survived the facility laundry which is done by a local woman whom I  well know, MIL gets her hackles up and refuses.  She has plenty of clothes to last over a month, but the underwear is another story.  Her solution besides not changing daily (eeyew) is  to rinse them out in her sink.  I am tired talking to her about this and Jerry refuses to discuss further too.  You can imagine his reluctance,  how would you like to tell your 94 year old mother that she is not clean?  What I do not understand is how the SNF allows her to get away with this, rinsing them in her sink in her room and then hanging them over the back of a chair to dry?  She does have a private room and other than ensuring she is up and around and well, I suppose they  find so much going on that this is a minor thing.  Leave it to her to find something bizarre to do and to invoke her obstinate streak.  

Now to the title of the post, today we have a hot humid day here in La Crescent; very unusual.  It is a flashback to the PA humidity that  ravages the summers there and makes me unhappy to be there.  In August 2004  when Mom died it was as humid as ever and I really thought we would perish in her home.  How did we kids of the  60"s grow up without air conditioning in those old two story homes and thrive?  I don't remember being all that uncomfortable as a kid so I suppose we were acclimatized and then we had no idea about  air conditioning.  A fan was rare.  All what we get used to.  I know that my southern friends in La. move very slowly in the humidity if at all.  I think that's where the southern drawl  generates, no fast movement and speech even slows down. 

I dislike heat except when in AZ in winter and I do not like humidity, no not at all.  Here in La Crescent we generally have beautiful summers, seldom humid and 80's, real Chamber of Commerce weather.  I suppose we can take a day of this, tomorrow it will be different.  The weather is ever changing here, day to day.  So , I decided to hose off  the rose bushes and  budding flowers because the predicted rain has not arrived.   The ground has enough water but I know that budding flowers appreciate a sprinkle on a hot windy day  That's something else we rarely do, water flowers or lawns unlike CA where it was necessary else be barren brown.  I also thought it would be  a good way to get some  sun myself.  This escapade lasted about  45 minutes and I had enough, thank you.  Jerry told me so, the sun is so hot here in the north with not a cloud in the sky and no pollution to filter it.   Our rose garden is about to burst into magnificent bloom as as are the peonies out back along the garden fence.  Right now all the salvia and Jacob's Ladder are sporting purple which along with the aliums is attracting humming birds.  Generally the hummers gravitate to the red flowers but since I did not plant the front flower box they seem to be settling for the flavor purple.  Tomorrow I may tackle that.  I so prefer the out doors to the paper work and tedium inside. 

I spent several hours on the phone today notifying various  entities  about Uncle Carl's passing and requesting estate packets, beneficiary forms, etc.  Much to do, like being at work again for the state; this is a different state and I have no staff, only my own  fingers to press the phone or keyboard and recite the litany repeatedly, date of death, estate, etc.     The strangest contact was with the Veteran's Administration about cashing in his WWII Life Insurance policy which he kept all these years.  Actually he has received annual dividends over the years that have exceeded the value of the policy.  Good for him.  After  providing the necessary data to the woman who will  process the claim and mail out the packet with more paperwork for me to do, she advised me to call another number,  the Veterans national call center and report the claim.  I thought that odd and asked her, "you mean I have to call another number and tell them you are sending me information?"  She replied "yes" as though it were the most natural thing in the world and I must be dull witted to question.  Well, consider this is the federal government at it's finest,  slogging away, churning.   I called the 2nd number which entailed a 15 minute hang on the line to talk, as if to say, "how dare you call here, don't you know we are busy?"  I am thankful to use my walk around phone and do other things, not just sit and wait for a human voice.  When the man finally came on the line he told me to call the life insurance number, the same number which had told me to call him. I  told him I had already spoken to them and the process was underway and they directed me to him.  I was nearing  the limit of my tolerance  for exasperation when he finally said, "well if he was receiving no other VA benefits there is nothing to report, she must have thought he was getting other benefits."  So ended that call.  Of all the entities, I have had to contact, the VA gets the prize for wasting time.  I think of the absolute frustrations vets and dependents must endure dealing with them and then I think how fortunate are the members of the local American Legions and VFW's who have access to local veterans services officers as we do here, the ones who facilitate the process and save lots of grief for individuals.  That is worth the membership dues.    

PA  will appreciate this as they grab their stolen share via inheritance tax.  Do I complain about that too much?  Likely so,  I could do without the hassle, the attorney fees and the paperwork.  I am fortunate to have the ability and skills to deal easily with this, many people would be upside down and sideways even attempting. Many would  not  make the progress as quickly as I do.   I have one more stock fund to contact via computer Monday and I must write a  nice letter to his  809th US Army Tank Destroyer reunion group to let them know, most of his WWII buddies are gone, but the widow of one has kept in touch with Carl and has been religious about sending cards to him, signing her self by name and "the one who always could dance a good polka."  I wonder if she had eyes for my handsome old uncle?   And with that I wander away from the keyboard and will find a nice chilled glass and pour some chardonnay.