Mom took a fall a week ago as she was getting up from her afternoon nap. Rather than pull the “help” string next to her bed, she took the “I can do this myself” route. About the same time her afternoon companion was standing outside her door, knocking, having arrived on schedule for their weekly scrabble game.
We surmise this much: Grabbing the bed frame and the night stand, which had a square of glass overlaying a favorite prayer, mom courageously pulled herself up, shuffled to the green apartment door, despite serious skin tears and abrasions to her right hand, and let Kathleen in.
I was out of town that afternoon, taking my special needs brother in law to nearby Estes Park for an afternoon of wildlife sight-seeing and lunch. When caregivers couldn’t reach me, they contacted my sister, who lives 4 hours away, who then contacted my husband, an RN. It will surprise some to know that the ambulance was not called. We want to avoid ambulance rides as best we can–not because we don’t love mom, not because we don’t want her to heal. We avoid ambulance rides to avoid admission to a hospital bed that, in our recent experiences, results in aggravating the complex suite of vascular dimentia behavior: increased anxiety, obsession about one thing or another; and symptoms that, to the unfamiliar caregiver, appear acute and emergent: complaints of stomach pain (where mom manifests anxiety), back pain (due to osteoporisis) incontinence.
Hospital admissions even increase mom’s risk for falling. Increased risk in a hospital? My 90 year old mother remains fiercely indepdendent in the face of the invasion of dementia, her own exile. During other hospitalizations, caregivers hooked her gown to a string, the goal of which was to keep her bedside should she need to get up. Mom viewed that string as encroaching on her ability to do things herself. Rather than call for help to get to the bathroom, she simply unhooked the string and miraculously trekked to the toilet on her own—without her walker. A stranger assumes that Mom will be compliant; she appears cognizant, oriented, and opinionated. But what a stranger misses is mom’s inability to take in and retain new information, including instructions about pulling the “oh, crap!” [my words] string when she needs help. (Mom would never say “Oh, crap”
The ER visit revealed no fractures. With right hand wound dressed, my husband returned mom to her apartment. I stopped in the next day to check on her and help her do some late Christmas gift shopping. Mom had removed the bandaging. No surprise. She says, “I’m sorry, but it hurts.” The facility does not carry the special dressing needed for mom’s wound, so I run over to Safeway and return with two rolls of no-stick tape. Green smocked caregivers re-dress and re-wrap the wounds–the worst appearing is a nickel-sized area of raw tissue.
Five days later, her hand wounds are infected. Thus our visit to urgent care today. Redness, tenderness, and oozing which I need not describe. More x-rays due to mom’s complaint about her back pain, but fortunately, no fractures. Time now for tending to the hand wounds, which would take up the bulk of our 4-hour visit to urgent care. Holding mom’s hand and lauding her for her toughness was all I could offer as the nurse and PA, using teeny tweezers and scissors, meticulously and mercifully cleaned the wounds.
Satisfied, the caregivers apply silver nitrate infused gauze to the wounds. Mom’s tough: take courage, endure, and “it will be better once we’re done” attitude.
Nurse Stephanie wraps mom’s wound not only with the special guaze but also with the goal of blocking mom’s ability to remove the dressing. She has a track record for this. Before dementia, mom would willingly comply with the discomfort of the bulky bandages. With dementia and having missed her mid-day anti-anxiety med because of our lengthly stay in urgent care, she immediately pulls on any free-end she can find. Frustrated by the discomfort of the Muhammed Ali-style fist wrap, she tugs, then tugs again. “Mom, I know it’s uncomfortable and may hurt, but you must leave it on, so the wounds can heal.” Looking me in the eyes, “You don’t know how much it hurts. My circulation will stop. I’ll lose all feeling in my hand. Look. Look. “ ” I’m sure it’s uncomfortable, Mom, but you must leave it on. We can trust Stephanie that there’s enough slack in the bandage to allow circulation in your hand. See.”
Nurse Stephanie shows her several times that there’s plenty of slack. Mom rebuts that there is not and begins again to tear at the bandage. This cycle repeats itself at least four times. Stephanie and the PA try to reassure her that the bandage will not cut off circulation, that it’s necessary to allow the wounds to heal.
Repeat. Repeat. Exasperated and imagining the infection take hold in her bloodstream, I move closer, get mom’s attention, telling her that she’ll have to tough it out for a couple of days. “Yes, it hurts, but you must leave it on to avoid a worse outcome. Mom, you have to leave it alone. You must.” Disgusted with the lot of us, mom replies, ”Well, OK, then.”
As we gather our things and line up her walker, she asks for the location of the bathroom. Normally, mom manages fine, but nurse Stephanie indicates–over mom’s head–like a parent talking over a young child–that mom should have a chaperone, just in case she tries to remove the bandaging. I plea, “Do you mind going in with her? If I go in, she’ll insist that she can manage by herself.” Not much of a reason to bow out of that task. Emotionally, I just couldn’t face running interference again. (I’ve rewritten this sentence five times because I didn’t want to acknowledge the heart pain that comes with getting tough with a loved one…after you’ve cheerily listened, affirmed, done everything you can think of to get agreement; diverted attention, re-phrased something to make it more palatable to the loved one…and then you have to give the bottom line. It’s one thing to have that exchange with a child of your own; it feels like treason when you have to wield the “you’ll just have to grin and bear it” card with your mother.
As mom wheeled her way up to her room with her box lunch, I visited with the nurse briefly, emphasizing the concern that mom might remove the bandaging. Surely, the Vegas odds are against us, but we’ll hope for the best.
I walked out into the chilly but sunny winter air, sat in my car and wept. What next? I had missed lunch also, but with no appetite, I headed for the bookstore to pick up a title mom had ordered for me for Christmas –Audobon Bird Guide for Western US. On the way home, I stoped for a long walk around the lake. With my head cleared and my heart soothed, I touched on the good news. The good news today is that there are wonderfully caring and gifted caregivers. The good news is that mom lives nearby. The better news is that mom is tough. The best news is that everytime I see her, I rejoice she’s still with us because she has much to teach me about growing old.