Sunday, July 25, 2004

 

So, I figure you're on that vacation you didn't take here...

[From an e written this evening to MFASRF]:
...but, I had to tell you about something that happened today, even though you won't get the message yet. I wanted to tell you before I tell anyone else and write about it on the web.
    The short version is: I lifted my mother off the floor today when her knees gave out in the bathroom. I was startled but it wasn't one of those "oh my god, there's a baby underneath that mac truck and the gas tank just exploded and I have to save the baby" moments where superhuman strength intervenes, whether from within or without. It was a "shit, my mother's knees just collapsed and she can't get up and I think I'll try to do it before I pay a paramedic $1000 to do it for us," moment. What was so startling was that I didn't realize I had the skills, the upper body strength or the leg strength to do it. I have told my mother many times in the last several months since her back injury, "Mom, you need to move because you need to stay as strong as you can because I may be able to sit you upright in your bed and get you out of a chair but I'm sure I can't get you off the floor." Well, as it turns out, I can get her off the floor. I can even get her off the floor when she's fighting me under the assumption that I can't get her off the floor.
    Once I got her through the hall, down the two steps into the living room and into her rocking chair, I was so startled I said, "Wow, I can lift you off the floor!" and sat down on the couch and cried. I must have cried for about 10 minutes, continuing to repeat, "I can pick you up off the floor, Mom, I didn't realize I was that strong."
    Her two responses (bless my mother's practical heart) were, "Why are you crying!?! It's good that you can do it!" and "I didn't know you were that strong, either, but I'm glad you are."
    I manuevered her into the position where her knees gave out in the first place. Last night, after spending the day trying to get her to move, trying to get her to hydrate herself in a timely manner, trying to get her to eat, and having her defy every try, I decided last night, I'd had it. I lay in bed on my back shaking my head and repeating in a manner designed to etch the words directly into my soul, "I can't do this anymore. I can't make her move when she doesn't want to. I can't make her drink fluids when she doesn't want to. I can't make her eat when she doesn't want to. I don't have the heart, or lack of it, whatever it takes, to abandon her to a nursing home. I'll just do the best I can, look out for my own sanity, and let the chips fall where they may, whatever that means for my mother."
    When I awoke this morning I was stoked with new determination. Today, I decided, I'm going to become her will (not her spirit, which is a different thing, I think). I awoke her using my "Gail is determined" voice at 1000, earlier than I've been able to (or wanted to face the assured battle to) get her up for awhile. I pulled her soaked covers off, cleaned out the litter box (the cat's litter box, that is, I haven't resorted to one for her, yet), gave her iron and vitamin C and got 8 ounces of water down her to help metabolize the pills. I answered her every-morning-question, "Why do I have to get up?" with, "Because, if you're alive and you're not comatose you wake up in the morning." I talked her into putting an arm over the edge of the bed, took her blood glucose, gave her a few more minutes to raise herself on the bed telling her that I'd "whup" her up if she didn't arise on her own in a timely manner, which, miracle of miracles, she did, herded her into the bathroom for her bath and told her, "Today, Mom, we're going to do it my way. You are going to begin hydrating yourself in the morning and you're going to continue throughout the day so that I don't have to force 3 glasses of liquid on you just before you go to bed like I did last night. You are going to eat everything on your plate at every meal. You are going to start moving a little bit, today. You're going to the grocery with me to pick up a few items. You got out of it yesterday because of the storm but you're not getting out of it today. We'll take both the walker and the wheelchair in case your knees give out but you're going to start moving. You've got some time, we'll do your hair, the whole meal deal. But you're getting out you're moving, even if it's hard."
    It was hard for her. We have a handicapped parking placard now. I got the closest spot to the store. She walkered maybe 20 feet and her knees started to shake so I sat her down on a bench and we waited until she regained confidence in her knees. She walkered maybe 20 more feet to the first perpendicular aisle in the store and her knees began to shake so I sat her down on her walker (which converts to a stool) and we waited. She walkered maybe 20 more feet down the frozen food aisle and her knees wobbled so I sat her down again and we waited. Once more, she walkered to the end of the aisle where there are usually benches but, for some reason, the store had gotten rid of them. I sat her down once again on her walker and told her I'd pick up the items we needed and she could wait there. It took me about 15 minutes. When I returned she felt confident about walkering back to the front of the store in shifts, she said, so we began again. After the first 20 feet I could see that she was really struggling (not that this isn't good, but I figured she'd had enough for the day). I sat her down and told her I was going to get the wheelchair, which I did. I wheeled her through the auto checkout, walker slung over one handle, oxygen slung over the other and we left. She was able to get into and out of the car quite well. I immediately took her to the bathroom when we arrived home, knowing that she'd probably soaked her doubled paper underwear by that time. No problem. She was pretty shaky, though, when she tried to get off the toilet. Once she'd used my arms to steady and pull herself up she insisted (with a touch of left over anger from my morning announcement) that she could get out of the bathroom herself (which she usually does) so I backed off. Well, her knees and the backs of her legs had other plans. While she was guiding herself out of the bathroom, clutching the vanity on one side and the towel rack on the other, she suddenly looked at me, said, "Oh, dear", and down she went. Her muscles just weren't strong enough to take as much movement as she and I had thought.
    Coda: second paragraph.
    Her knees didn't "go out". Nothing like that. She's just refused movement to the point where her muscles are severely atrophied. After all this happened and she was comfortably in her rocker, fed, hydrated, etc., I swung her around to meet my eyes and told her I wanted to talk to her. This is, in paraphrase (as is most of everything in quotes above) what I said:
    "Mom, listen. I may have pushed you a little further than was wise today, but I'm not going to apologize. The only excuse you have for your legs buckling is that you have refused to move for the last few months. It's been such hell to try to get you up in the morning and get you moving that morning after morning, day after day, I give up. You cannot continue to sleep 12-14 hours a day and expect your legs to work. You cannot continue to spend day after day sitting, only moving when you go from table to rocker, bathroom to table or bathroom to bed, and expect your legs to work. I've been way too easy on you. I'm sorry about that but, you know, I'm not apologizing for it either. MFS and MPS know how impossible it was to get you out of bed and moving around a couple of years ago, and it's a hundred times worse, now."
    This time, she was startled. I responded to this, too. "Look, I know," I began, "everyone's supposed to be nice to you and let you do, or, for that matter, not do, what you want because you're old. Well I'm done with that. I've been unsuccessfully battling that attitude in you for more than a few years now and look where it got you. You can't depend on your legs. There is absolutely no reason why you can't walk except that you've been refusing to walk for way too long. It's not your back. You were bedridden for two months and in January you were up and around like a champ. It's not your anemia. You've walked through most of that. It's not your urinary tract infection. It's that for the last few months you've decided you don't have to move any more because you're old, and, I think, because you need more oxygen than you used to and that means fewer cigarettes and you're angry about that. So, you're taking your anger out on yourself by refusing anything else that life has to offer. How long did you think you could get away with not moving and retain the use of your legs?
    "This stops here, now. I've babied you for way too long and you've fought me for way to long. I'm not apologizing for giving in to you. You're hell's child when you've got your mind set. It's been torture for me to try to convince you that you need to move, you need to keep yourself hydrated all day long, you need to eat better, you need more oxygen, I've felt like shit when I've given in to you, I've felt like shit the very few times you've given in to me, and now, after having gotten your way too many times, your legs don't work.
    "The bottom line is, you don't want to be in a nursing home, I don't want to put you in a nursing home, but if you don't start taking your body seriously and putting some effort into doing some of the things that will keep you up on end, neither of us is going to have a choice. You're going to get to the place where I simply don't have the skills and the tools necessary to take care of you. You can't just sit back and let me take care of you anymore while you mourn the loss of a few cigarettes. You need to put some effort into this, too, not effort into fighting me but effort into fighting for yourself. Do you understand?"
    Her eyes had been glued to me, flashing surprise and anger the whole time I talked. Now, they turned dark. "Yes," she said, very somberly (not apologetically).
    "Do you get that I can't be your body? You have to be your body?"
    "Yes."
    "Do you get that if you don't use it you will lose it, and if you lose it, you may lose me as your caregiver because I won't have the ability to take care of you?"
    "Yes."
    "Do you get that mourning the loss of some of your cigarettes is a stupid reason to become an invalid, especially since I haven't asked you to quit and I don't intend to?"
    Whoa. This took awhile but, finally, she said, "Yes."
    We sat there staring at each other for a moment of silence.
    Suddenly I understood something. "No one's ever talked to you this way, not in your whole life, have they?"
    "No," she said.
    "Well, I'm talking to you this way now, and you need to listen. Are you listening?"
    "Yes," she said.
    "Good. I want you to know, Mom, I gave up on you last night. I gave up on this ridiculous situation of fighting you tooth and nail, then caving in and letting you have your way, then cleaning up after you. I decided, to hell with this, I don't have the spiritual strength to try anymore, she can do whatever she wants and I'll just move the fallout aside and plan on calling the gravedigger earlier than I'd figured. This morning I woke up with new determination because I love you and I can't just let you continue to think that you can live to be 120 without eating properly, drinking properly, moving some and abandoning your mourning for the loss of a few cigarettes a day. It's possible that my determination to get you moving and as healthy as possible might kill you but I can guarantee you that if I let you do it your way one second longer that'll kill you even faster. I once told you that when you were ready to die I'd protect you and let you go however you wanted. Are you ready for that?"
    "No."
    "Well, then, I'm going to take that as an affirmation that you're ready for this."
    "O.K."
    Whereupon, after about 15 minutes she decided to take a nap, which I allowed. Her muscles, I figured, needed a chance to rest and incorporate what she and I had been having them do today. Her subconscious also needed a chance to process everything I'd said. She went to the bathroom, aided by me, went to bed, aided by me, settled in and promptly began vomiting up her lunch. She continued, both in the bedroom and the bathroom, until all of it was up.
    You know, MFASRF, I think it was a combination of physical shock and emotional shock, combined with some acetaminophen I gave her at lunch to negotiate any stiffness she might develop in her legs. The Mucinex I gave her this morning to help expel some minor lung congestion may have contributed, too, as I recall the second to the last time she vomited unexpectedly I had given her some in the morning (the last time she vomited, it was her final dose of Cipro XR that did it). I quizzed her continually about whether her back hurt (from me lifting her off the floor) or her legs (from the unusual amount of exercise they got today) and she responded in the negative. She's resting now and may sleep for awhile. I've been checking in on her and she is in what looks like a very defensive position, backed up against the wall, her eyes slit. I think it may take her a day or two to digest the fact that the proud, headstrong, beautiful WWII gunnery instructor who could out shoot anyone, who had her pick of any man and refused all but one, finally met her match in the daughter who, except for being a woman, is the spitting image of that one man.
    Tomorrow probably isn't going to be the best of days because we've got to show up for a blood draw. If necessary, and it probably will be, we'll use the wheelchair for that. I've been putting off activating the prescription for ambulation and strength training physical therapy because we've had several arguments about it which I've allowed her to win. This week we set up her first appointment. I decided tonight that if the therapists tell me I need to practice her exercises with her, I'm going to tell them that they need to extend the prescription to cover them practicing her exercises with her, even if this means several visits a week. She performs for an audience and she doesn't consider me an audience. For awhile, too, I expect her to continue to ply her habit of fighting me and expecting to win and I'm not interested in that, anymore.
    You know, MFASRF, I know that many people who are intense caregivers, as I am, would probably flinch at knowing what I did today. At sometime in their experience, though, they've probably done the same thing and will appreciate knowing that they are not the only ones who have, finally, taken their Ancient One firmly by the shoulders and said, "Look, this has to stop and that has to start or you're going to die for no good reason and you're going to end up doing it someplace where you wish you weren't." I also know that lots of people who aren't caregivers to Ancient Ones but think they know what it's all about would not only flinch but consider reporting me to the Elder Abuse hot line. I know that at least one of my relatives will probably be horrified at what took place today, especially since it led to Mom losing control of her legs and, later, losing her lunch. Frankly, if some Cassandra had prophesied this to me a few months ago I would have been horrified and refused to believe that I could be capable of what seems like the ultimate in uncompassionate behavior. But, today happened, I made it happen, and I'm not backing down. I've put up with vomiting, and shitting accidents, and loss of leg control because I've been weak and given in to her too many times. I may as well put up with them occurring as a result of me defying her and see if after all the spew is cleaned off the field there is some benefit to her which wasn't possible when I gave in to her.
    So, you know, MFASRF, the heavy rains finally began yesterday afternoon. It's glorious. I'm in my element. Hmmm...maybe that's the cause of everything that happened today and everything that is about to happen. Then, again, maybe sometimes caregivers and their charges are better off when the caregiver loses her patience. I guess I'm about to find out.
    So, where ever you are, however your vacation is going, I hope you are feeling properly vacated of whatever it is vacations are supposed to vacate and I hope you're having a delightful time being vacated. --Gail

P.S. I just spell-checked and read this over and, you know what, MFASRF, this is exactly what I wanted to say on the web. Not that hardly anyone will read it but I hope you won't be offended if I simply copy this, take it over to motherandmetoo and publish it. You'll probably still be the first one to read it. Anyway, you'll know that it was written to you. I'll use your favored acronym instead of your name, of course. And, I'll correct any mistakes I notice during the second reading before publishing it. MFASRF, thank you for being where you are in relation to me. That's all I ever really mean to say, through all the words and words and words.

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