Wednesday, August 11, 2004
All urinalyses have been entered.
The unexpected storm this afternoon was a good time to do this. They are all listed on the Mom's Tests.
I talked to Mom this afternoon. She's beginning to sound lonely and is definitely ready to come home. I promised her that I'd question those in charge of her care at the facility tomorrow to find out how she's progressing toward her goals. I'm anxious for her to return, too, and I cautioned her that it's also important that we take advantage of this opportunity for her to strengthen herself. At the same time, the tone of my voice, I noticed, is changing when I talk to her. I'm ready for us to continue here at our home in Prescott. I'm curious to see how much she is motivated to strengthen herself at home by sleeping somewhat less and moving around and out somewhat more. I trust the therapists' and the medical director's opinions on her renewing suitability for her normal life but at the same time I'm ready for that normal life to be reinstated. I'm being very careful to continue to assure Mom that this stay is short term and temporary, but, you know, I think sometimes she's not sure of that.
She reported that she is eating popcorn and drank a can ("not a whole can," she informed me) of V-8 juice so I guess I'm being taken seriously by the staff. Good. It's important on this particular bowel issue. As well, she's active enough at the facility so that her bowel movements should, if she is capable of detecting them, signal her to the bathroom before they begin and should be fairly easy to evacuate.
I cautioned her as well to be sure and call an RN, LPN or CNA to help her if she decides to move from one place to another. I reminded her of where her call button is. She isn't the type to use it much, though. I noticed yesterday that they've taken away her bed monitor so they must be more sure of her as far as her moving around on her own is concerned. Those damned hospital issue beds and conveyances, though, are such clunkers with all kinds of attachments within which to tangle oneself.
I miss her on the days I'm up here even though I know it is best for both her and me for me to stagger my visits. I think this SNF stay is good for both of us. I'm now beginning to understand the subtle emotional consequences of nursing homes for both the patients and their loved ones. I'm now even more determined to do everything in my power to take care of Mom in her home right up to the end of her life, if possible. It's not that this temporary stay is unpleasant but there is an insinuating tension surrounding her welfare that is not present when she is here with me even during the worst of times, even when I'm doubting my ability to "do right by her" as I care for her. The most important part of loving someone, I think, is simply knowing what that person's state is, regardless of the quality of that state: Being able, at will, to check in on the person, listen to them breathe, subconsciously absorb the miniscule detail that reports on how they are, what the person's states of body, mind, heart and soul are at any particular time. I know that long term professional care facilities can be a great relief in many circumstances. I hope that those circumstances skirt our home for the duration of my mother's life.
Again, here I am sitting on the floor, writing and thinking about my mother, who has become the love of my life, wishing I could wrap her crumpling frame in my arms so she will know she is well loved and well protected.
Regarding the conversation the Facility Administrator and I had about the commercials devoted to the recognition of elder abuse: Since my stumble into over hydrating my mother I've begun to look askance at the bluntness of these commercials. I understand that heightened awareness is a good thing right now in our society, considering how little aware we are, generally, of our Ancient Ones. I mentioned the commercials to the FA, though, because I wanted to address one point.
"What makes me uneasy about these commercials," I said (paraphrased, although representative of what I actually said), "is that I've always been aware of how tenuous the dehydration issue is with the elderly. Over the last few weeks I discovered I'd been accidentally over hydrating her. It was, unfortunately, easy to do. Now I have brand new guidelines about how to judge her hydration level, guidelines which, frankly, fly in the face of everything I knew. Such a fine line exists between over and under hydration and it seems that even those of us who are trained and meticulous are constantly crossing back and forth."
The FA responded by telling me that the commercials anger her. She explained that they make it appear as though the hydration issue is an easy one to negotiate.
I confirmed her perception and told her about how I thought my mother had been dehydrating while on a saline drip in the hospital during her stay for her blood transfusion. Now I'm not so sure. I went on to report that one of her doctors this time around counseled me to have her "drink when she's thirsty". "She's hardly ever thirsty, though," I added. "My mother's never been a water drinker, never. I've been, but not my mother. I didn't get my taste for water from her, I got it from my dad." Added to this has been the difficulty of factoring in her continuing weight loss when trying to recalculate her tenting scale so that I neither over nor under hydrate her.
We talked about bed sores and pressure bruises. I related my own experience involving the typical pressure bruises on the inside of my mother's knees, particularly her left one, because she insists on supporting herself on that knee when she sleeps. "I even tried knee pads to prevent the bruising," I told her, "and she'd wake up in the morning having taken off the pads because they were uncomfortable for her when she was settling into position."
The FA nodded, knowingly.
We talked about my growing medical assertiveness, my habit of learning about and controlling her medication dosages on the spot as we go and my frustration over not being taken seriously in this effort by health care providers.
She told me about an incident that occurred some years ago when she was 23. She was visiting her grandfather who was receiving treatment in some sort of facility, I can't remember if it was a hospital or a residential facility. During the visit an attendant brought in an IV bag on a stand and began the process of hooking it up to her grandfather. Quite by accident the FA noticed that the name on the bag was not her grandfather's. "At 23," she said, "I wasn't nearly as assertive as you, or as I am now but I immediately alerted the attendant. She took note and left to retrieve the proper bag, mentioning that "it's all the same stuff, but he should have his own bag."
Whew, I thought. All the same stuff. How, exactly, could that attendant have been trusted to be reliable, especially considering the mistake over to whom the bag had been prescribed? Suppose the FA hadn't noticed and the attendant had been wrong about the ingredients in the "stuff"?
Take note, Medical Establishment. You have a long way to go before you deserve the trust to which you think you are automatically entitled by dint of your training and your financial outlay. One way to work to achieve this trust is to heed those of your patients and patient advocates who are as dedicated to preventing medical mistakes by their observations and questions as we are asked to assume you are.
Time to fill the gas tank up for tomorrow. I don't know whether I'll be writing any more tonight. Either way, I'll be back...
...later.
I talked to Mom this afternoon. She's beginning to sound lonely and is definitely ready to come home. I promised her that I'd question those in charge of her care at the facility tomorrow to find out how she's progressing toward her goals. I'm anxious for her to return, too, and I cautioned her that it's also important that we take advantage of this opportunity for her to strengthen herself. At the same time, the tone of my voice, I noticed, is changing when I talk to her. I'm ready for us to continue here at our home in Prescott. I'm curious to see how much she is motivated to strengthen herself at home by sleeping somewhat less and moving around and out somewhat more. I trust the therapists' and the medical director's opinions on her renewing suitability for her normal life but at the same time I'm ready for that normal life to be reinstated. I'm being very careful to continue to assure Mom that this stay is short term and temporary, but, you know, I think sometimes she's not sure of that.
She reported that she is eating popcorn and drank a can ("not a whole can," she informed me) of V-8 juice so I guess I'm being taken seriously by the staff. Good. It's important on this particular bowel issue. As well, she's active enough at the facility so that her bowel movements should, if she is capable of detecting them, signal her to the bathroom before they begin and should be fairly easy to evacuate.
I cautioned her as well to be sure and call an RN, LPN or CNA to help her if she decides to move from one place to another. I reminded her of where her call button is. She isn't the type to use it much, though. I noticed yesterday that they've taken away her bed monitor so they must be more sure of her as far as her moving around on her own is concerned. Those damned hospital issue beds and conveyances, though, are such clunkers with all kinds of attachments within which to tangle oneself.
I miss her on the days I'm up here even though I know it is best for both her and me for me to stagger my visits. I think this SNF stay is good for both of us. I'm now beginning to understand the subtle emotional consequences of nursing homes for both the patients and their loved ones. I'm now even more determined to do everything in my power to take care of Mom in her home right up to the end of her life, if possible. It's not that this temporary stay is unpleasant but there is an insinuating tension surrounding her welfare that is not present when she is here with me even during the worst of times, even when I'm doubting my ability to "do right by her" as I care for her. The most important part of loving someone, I think, is simply knowing what that person's state is, regardless of the quality of that state: Being able, at will, to check in on the person, listen to them breathe, subconsciously absorb the miniscule detail that reports on how they are, what the person's states of body, mind, heart and soul are at any particular time. I know that long term professional care facilities can be a great relief in many circumstances. I hope that those circumstances skirt our home for the duration of my mother's life.
Again, here I am sitting on the floor, writing and thinking about my mother, who has become the love of my life, wishing I could wrap her crumpling frame in my arms so she will know she is well loved and well protected.
Regarding the conversation the Facility Administrator and I had about the commercials devoted to the recognition of elder abuse: Since my stumble into over hydrating my mother I've begun to look askance at the bluntness of these commercials. I understand that heightened awareness is a good thing right now in our society, considering how little aware we are, generally, of our Ancient Ones. I mentioned the commercials to the FA, though, because I wanted to address one point.
"What makes me uneasy about these commercials," I said (paraphrased, although representative of what I actually said), "is that I've always been aware of how tenuous the dehydration issue is with the elderly. Over the last few weeks I discovered I'd been accidentally over hydrating her. It was, unfortunately, easy to do. Now I have brand new guidelines about how to judge her hydration level, guidelines which, frankly, fly in the face of everything I knew. Such a fine line exists between over and under hydration and it seems that even those of us who are trained and meticulous are constantly crossing back and forth."
The FA responded by telling me that the commercials anger her. She explained that they make it appear as though the hydration issue is an easy one to negotiate.
I confirmed her perception and told her about how I thought my mother had been dehydrating while on a saline drip in the hospital during her stay for her blood transfusion. Now I'm not so sure. I went on to report that one of her doctors this time around counseled me to have her "drink when she's thirsty". "She's hardly ever thirsty, though," I added. "My mother's never been a water drinker, never. I've been, but not my mother. I didn't get my taste for water from her, I got it from my dad." Added to this has been the difficulty of factoring in her continuing weight loss when trying to recalculate her tenting scale so that I neither over nor under hydrate her.
We talked about bed sores and pressure bruises. I related my own experience involving the typical pressure bruises on the inside of my mother's knees, particularly her left one, because she insists on supporting herself on that knee when she sleeps. "I even tried knee pads to prevent the bruising," I told her, "and she'd wake up in the morning having taken off the pads because they were uncomfortable for her when she was settling into position."
The FA nodded, knowingly.
We talked about my growing medical assertiveness, my habit of learning about and controlling her medication dosages on the spot as we go and my frustration over not being taken seriously in this effort by health care providers.
She told me about an incident that occurred some years ago when she was 23. She was visiting her grandfather who was receiving treatment in some sort of facility, I can't remember if it was a hospital or a residential facility. During the visit an attendant brought in an IV bag on a stand and began the process of hooking it up to her grandfather. Quite by accident the FA noticed that the name on the bag was not her grandfather's. "At 23," she said, "I wasn't nearly as assertive as you, or as I am now but I immediately alerted the attendant. She took note and left to retrieve the proper bag, mentioning that "it's all the same stuff, but he should have his own bag."
Whew, I thought. All the same stuff. How, exactly, could that attendant have been trusted to be reliable, especially considering the mistake over to whom the bag had been prescribed? Suppose the FA hadn't noticed and the attendant had been wrong about the ingredients in the "stuff"?
Take note, Medical Establishment. You have a long way to go before you deserve the trust to which you think you are automatically entitled by dint of your training and your financial outlay. One way to work to achieve this trust is to heed those of your patients and patient advocates who are as dedicated to preventing medical mistakes by their observations and questions as we are asked to assume you are.
Time to fill the gas tank up for tomorrow. I don't know whether I'll be writing any more tonight. Either way, I'll be back...
...later.
