Sunday, August 22, 2004
Our home is back to normal with a twist...
This part started August 21, 2004, about 2330
...the twist being my mother's much improved physical, emotional and intellectual health. It's possible that her spiritual health and her will are improved, too, but I never noticed a drop in either of those.
It was a very good day for the wine of spirit. My trip down the mountain was uncluttered and fast. I felt very good, despite getting only about 4 hours sleep. I still feel top notch. As I drove the decline, winding through what were, centuries ago, the weave of continental drifts down to the abyss that is now The Valley of the Sun, I felt very proud about what Mom and I have accomplished over the last three weeks and realized that "the secret" to life and to a feeling of personal success in this world is to claim both life and the world as one's own then bury one's arms in it as far as one can reach, then reach further and go to it.
When I arrived at the nursing home Mom was reluctant to arise so several of the staff and her roommate joined me in joking and cajoling her out of bed. Her roommate reported to me that yesterday Mom spent very little time in a prone position after her therapy sessions, preferring to sit on the edge of the bed, gaze out the window and discuss life through the symbology of noticing and commenting on what lay beyond the window frame.
We left exactly on time. I checked my watch as we exited the breeze way of the SNF: 1100 on the dot. She had walkered herself to the car. Even though one of her favorite CNAs offered to help her into the car she refused, insisting on negotiating the low sedan seat on her own. I, however, needed help figuring out how to stow the walker in a back seat loaded with her possessions.
We had a wonderful visit at MPS's home. We ordered Filipino food, something we all love and hadn't had for ages. Mom ate heartily, including a can of V-8 juice and a dessert of German Chocolate Brownies. Left to her own sense of thirst, which seems to have returned she drank exactly enough throughout the day to keep her well but not overly hydrated. After dinner she spent almost a half hour emptying her bowels and fairly danced to the car.
Before we left MPBIL provided me with the name of a long time medical activist with whom he is very familiar in Prescott who he said would be able to answer all my questions about the veracity of the information the ER doctor up here offered me during his July 30th extemporaneous lecture on Medicare in rural communities.
Our trip up the mountain this afternoon was quiet. Both of us surveyed the scenery as if in a dream, a very good dream that promised an excellent awakening. When we arrived home and emerged from the car we were both stiff from sitting so long so I showed Mom a trick my body taught me a long time ago: Shaking stiffness out from the hips and continuing through the legs and lower back. I don't know why I'd never shown her this. When I described and demonstrated it she didn't really believe it would work for her. "I'm too old for that," she protested. Then, holding onto my arms, she wiggled and rotated her hips, looked up at me in surprise and said, "My goodness, that works! I wonder what the neighbors think we're doing out here!"
"I'm sure it looks plenty suspicious," I said.
She laughed. "Good! It'll give them something to talk about tonight."
"Yeah," I agreed. "That old woman and her strange daughter doing the hootchy kootchy together in their driveway! That'll provide everyone fodder for at least a week!"
MFS had sent a roll of Hickory Farms honey cured, sliced ham steaks to Mom for her birthday which, through a variety of company-side order errors, all of which could be considered good luck, didn't arrive until yesterday. On the way up we planned a dinner of hard-over eggs Benedict with my luscious, lemony Hollandaise sauce. During the evening she moved about the house under her own steam and went to the bathroom a couple of times with only slight suggestion from me. I noticed that she was managing to control her bladder so well that her paper underwear did not need changing until bedtime and then only as a matter of course; I refuse to send her to bed in anything but clean underwear. I'm now thinking that allowing her, under good circumstances, to determine and administer her hydration needs herself probably is the secret to bladder control for her and that I may have accidentally been not only over hydrating her but short-circuiting her bladder's ability to control itself during my months of anxious water torture.
We settled in to watch the movie Hidalgo. It reminded my mother of the "Indiana Jones" series which she followed with great enthusiasm. She refused to believe it was based on reality until noticing the printed epilogues at the end of the film.
Although I found the film engaging, I was transported into a curious reverie by the bits of Middle Eastern singing and chanting throughout the film. As I was captivated by the foreign beauty of the vocalizations I found myself considering that tending to my mother in her Ancient years has been and continues to be like listening to music created on a scale to which I am unaccustomed, sung in a language of which I have no understanding, engaged by it's mystery and beauty and learning both the music and the poetry, first phonetically, notationally and rhythmically, then technically, then emotionally and finally spiritually. I'm not sure where I am at this point in the learning process. I do know I've always had a fondness for languages not native to my tongue and brain and have sought them out. Doing what I am doing with my mother, I realized, puts me in my element.
I've decided to publish the contents of my mother's official release papers from the SNF:
INTERDISCIPLINARY DISCHARGE
RECAPITULATION OF RESIDENT'S STAY:
ADMISSION DATE: 8/5/04
REASON FOR ADMISSION: TIA, hyponatremia, NIDDM, COPD, VTI, anemia
TREATMENT PROVIDED: Physical & occupational therapy, insulin coverage for DM, fluid restriction monitoring, pain management, antibiotic therapy
PROGRESS (include any complications experienced): Improvement in strength & endurance
DISCHARGE DATE: 8/21/04
FINAL SUMMARY OF RESIDENT'S STATUS:
SOCIAL SERVICES:
SENSORY IMPAIRMENT: Ambulatory via walker
MENTAL AND PSYCHOSOCIAL STATUS: stable
ABLE TO MAKE NEEDS KNOWN: Yes
ATTITUDE ABOUT DISCHARGE (describe): Looking forward to going home
COGNITIVE STATUS: Patient is alert and oriented, daughter Gail is very supportive
DISCHARGE POTENTIAL: Good home with daughter in Prescott
NURSING SERVICES:
VITAL SIGNS AT TIME OF DISCHARGE: TEMP: 98.7 Pulse: 68 Pulse: 68 Resp: 18 BP: 110/64
PHYSICAL FUNCTIONING STATUS: Ambulatory Assistive Devices Needed: W/C & FWW
DISCHARGE TREATMENTS OR PROCEDURES: None
DENTAL CONDITION: Own teeth
DRUG THERAPY REQUIRED: See below
DIETARY SERVICES:
PHYSICAL STATS: WEIGHT: 128 HEIGHT: 5'3" WEIGHT TRENDS: None CHEWING PROBLEMS: No SWALLOWING PROBLEMS: No NEEDS ASSIST (Specify): Independent
EATING HABITS/PREFERENCES: Adhere to therapeutic diet related to diabetes. Recommend extra fluids with seasonal heat.
DIET ORDER: Diabetic - Liberal
TEXTURE: Regular
ALLERGIES: None Known
ACTIVITIES:
ACTIVITY PURSUIT: Please continue to do activities at home that you enjoy. You have the potential to pursue as tolerated.
REHAB SERVICES:
REHABILITATION POTENTIAL: Continue to walk frequently - stay close to your walker and turn with it, not without it. Continue your arm and leg exercises.
ASSISTIVE DEVICES: FWW
DRUG THERAPY:
GENERAL INSTRUCTIONS: Accuchecks before meals and at bedtime
Sliding scale regular insulin coverage:
0 - 60 = orange juice
61 - 150 = 0 units
151 - 200 = 2 units
201 - 250 = 4 units
251 - 300 = 6 units
301 - 350 = 8 units
351 - 400 = 10 units
>400 = 12 units and call MD
HOME DISCHARGE INSTRUCTIONS:
DISCHARGING FACILITY: Skilled Nursing Facility
DISCHARGED TO: Home with daughter
ALLERGIES: Sulfa, Prednisone
SKIN CONDITION: Intact
NURSING SPECIAL INSTRUCTIONS:
1) Home Health PT for safety evaluation and treatment
2) Follow-up with PCP in 1-2 weeks
MEDICATIONS (In layman's terms - no abbreviations):
1) Aspirin 162 mg daily/a.m.
2) Glipizide 10 mg twice daily/a.m & p.m.
3) Protonix 40 mg daily/a.m.
4) Lisinopril 2.5 mg twice daily/a.m. & p.m.
5) Niferex 150 mg daily/a.m.
6) Vitamin D/Calcium 200/600 twice daily/a.m. & p.m.
7) IronSorb Dosage as needed twice daily/noon & p.m.
I did not include identification information of the facility and staff, nor did I include, under "MEDICATIONS" the time of the last dose given. As a note to readers who may be unfamiliar with PT jargon, "FWW" is an abbreviation for free weights.
I didn't finish copying the chart over until this morning. It is a little after 0900. She's still sleeping. I'm giving her until 0930, in part to make sure she gets a good rest and in part to allow the hot water to complete its heating cycle so there will be plenty of hot water for her bath. She lifted her head once around 0800, groaned and asked for "a little more time", which I had no problem granting her considering the late hour at which she retired and the fact that she ran through yesterday at top speed without a nap.
Everyone is much more relaxed here. The Big Girl even reacted to Mom's return by rolling around on the floor in a kind of joy I've rarely seen her express. The Little Girl talked and talked and talked to Mom all evening. I joked with Mom that she was probably telling her that she had been afraid that I'd somehow disposed of Mom and she was afraid they'd be next. As is usual when we're all at home and fine, The Big Girl snugged in with me last night when I retired and The Little Girl snugged in with Mom when she retired, joining The Big Girl and me later when Mom began soaking the bed.
I've noticed this morning,that she hasn't shed nearly as much as usual, which is good, although the amount is significant enough to where I'll need to wash all her bed clothes this morning. I'm expecting progress in this area since her daily liquid level, following her own preferences, will be much reduced.
Although I'm not going to push a lot of activity today, we are going to practice her exercises and do some sort of outing, although I haven't yet decided where we'll go.
I slept very well last night, awoke before I expected, forgot to take ibuprofen last night and realized when I arose I hadn't needed it. I'm satisfied that my tension is quickly draining away.
I'll be calling Home Health this week to set up an evaluation for out-patient physical therapy. I'm going to wait until a week before our scheduled appointment with her PCP on September 8th to have blood drawn for her monthly CBC and the battery of tests requested by her hematologist.
Life is normal again and good. I'm looking forward to more activity in our very near future.
Later.
...the twist being my mother's much improved physical, emotional and intellectual health. It's possible that her spiritual health and her will are improved, too, but I never noticed a drop in either of those.
It was a very good day for the wine of spirit. My trip down the mountain was uncluttered and fast. I felt very good, despite getting only about 4 hours sleep. I still feel top notch. As I drove the decline, winding through what were, centuries ago, the weave of continental drifts down to the abyss that is now The Valley of the Sun, I felt very proud about what Mom and I have accomplished over the last three weeks and realized that "the secret" to life and to a feeling of personal success in this world is to claim both life and the world as one's own then bury one's arms in it as far as one can reach, then reach further and go to it.
When I arrived at the nursing home Mom was reluctant to arise so several of the staff and her roommate joined me in joking and cajoling her out of bed. Her roommate reported to me that yesterday Mom spent very little time in a prone position after her therapy sessions, preferring to sit on the edge of the bed, gaze out the window and discuss life through the symbology of noticing and commenting on what lay beyond the window frame.
We left exactly on time. I checked my watch as we exited the breeze way of the SNF: 1100 on the dot. She had walkered herself to the car. Even though one of her favorite CNAs offered to help her into the car she refused, insisting on negotiating the low sedan seat on her own. I, however, needed help figuring out how to stow the walker in a back seat loaded with her possessions.
We had a wonderful visit at MPS's home. We ordered Filipino food, something we all love and hadn't had for ages. Mom ate heartily, including a can of V-8 juice and a dessert of German Chocolate Brownies. Left to her own sense of thirst, which seems to have returned she drank exactly enough throughout the day to keep her well but not overly hydrated. After dinner she spent almost a half hour emptying her bowels and fairly danced to the car.
Before we left MPBIL provided me with the name of a long time medical activist with whom he is very familiar in Prescott who he said would be able to answer all my questions about the veracity of the information the ER doctor up here offered me during his July 30th extemporaneous lecture on Medicare in rural communities.
Our trip up the mountain this afternoon was quiet. Both of us surveyed the scenery as if in a dream, a very good dream that promised an excellent awakening. When we arrived home and emerged from the car we were both stiff from sitting so long so I showed Mom a trick my body taught me a long time ago: Shaking stiffness out from the hips and continuing through the legs and lower back. I don't know why I'd never shown her this. When I described and demonstrated it she didn't really believe it would work for her. "I'm too old for that," she protested. Then, holding onto my arms, she wiggled and rotated her hips, looked up at me in surprise and said, "My goodness, that works! I wonder what the neighbors think we're doing out here!"
"I'm sure it looks plenty suspicious," I said.
She laughed. "Good! It'll give them something to talk about tonight."
"Yeah," I agreed. "That old woman and her strange daughter doing the hootchy kootchy together in their driveway! That'll provide everyone fodder for at least a week!"
MFS had sent a roll of Hickory Farms honey cured, sliced ham steaks to Mom for her birthday which, through a variety of company-side order errors, all of which could be considered good luck, didn't arrive until yesterday. On the way up we planned a dinner of hard-over eggs Benedict with my luscious, lemony Hollandaise sauce. During the evening she moved about the house under her own steam and went to the bathroom a couple of times with only slight suggestion from me. I noticed that she was managing to control her bladder so well that her paper underwear did not need changing until bedtime and then only as a matter of course; I refuse to send her to bed in anything but clean underwear. I'm now thinking that allowing her, under good circumstances, to determine and administer her hydration needs herself probably is the secret to bladder control for her and that I may have accidentally been not only over hydrating her but short-circuiting her bladder's ability to control itself during my months of anxious water torture.
We settled in to watch the movie Hidalgo. It reminded my mother of the "Indiana Jones" series which she followed with great enthusiasm. She refused to believe it was based on reality until noticing the printed epilogues at the end of the film.
Although I found the film engaging, I was transported into a curious reverie by the bits of Middle Eastern singing and chanting throughout the film. As I was captivated by the foreign beauty of the vocalizations I found myself considering that tending to my mother in her Ancient years has been and continues to be like listening to music created on a scale to which I am unaccustomed, sung in a language of which I have no understanding, engaged by it's mystery and beauty and learning both the music and the poetry, first phonetically, notationally and rhythmically, then technically, then emotionally and finally spiritually. I'm not sure where I am at this point in the learning process. I do know I've always had a fondness for languages not native to my tongue and brain and have sought them out. Doing what I am doing with my mother, I realized, puts me in my element.
I've decided to publish the contents of my mother's official release papers from the SNF:
INTERDISCIPLINARY DISCHARGE
RECAPITULATION OF RESIDENT'S STAY:
ADMISSION DATE: 8/5/04
REASON FOR ADMISSION: TIA, hyponatremia, NIDDM, COPD, VTI, anemia
TREATMENT PROVIDED: Physical & occupational therapy, insulin coverage for DM, fluid restriction monitoring, pain management, antibiotic therapy
PROGRESS (include any complications experienced): Improvement in strength & endurance
DISCHARGE DATE: 8/21/04
FINAL SUMMARY OF RESIDENT'S STATUS:
SOCIAL SERVICES:
SENSORY IMPAIRMENT: Ambulatory via walker
MENTAL AND PSYCHOSOCIAL STATUS: stable
ABLE TO MAKE NEEDS KNOWN: Yes
ATTITUDE ABOUT DISCHARGE (describe): Looking forward to going home
COGNITIVE STATUS: Patient is alert and oriented, daughter Gail is very supportive
DISCHARGE POTENTIAL: Good home with daughter in Prescott
NURSING SERVICES:
VITAL SIGNS AT TIME OF DISCHARGE: TEMP: 98.7 Pulse: 68 Pulse: 68 Resp: 18 BP: 110/64
PHYSICAL FUNCTIONING STATUS: Ambulatory Assistive Devices Needed: W/C & FWW
DISCHARGE TREATMENTS OR PROCEDURES: None
DENTAL CONDITION: Own teeth
DRUG THERAPY REQUIRED: See below
DIETARY SERVICES:
PHYSICAL STATS: WEIGHT: 128 HEIGHT: 5'3" WEIGHT TRENDS: None CHEWING PROBLEMS: No SWALLOWING PROBLEMS: No NEEDS ASSIST (Specify): Independent
EATING HABITS/PREFERENCES: Adhere to therapeutic diet related to diabetes. Recommend extra fluids with seasonal heat.
DIET ORDER: Diabetic - Liberal
TEXTURE: Regular
ALLERGIES: None Known
ACTIVITIES:
ACTIVITY PURSUIT: Please continue to do activities at home that you enjoy. You have the potential to pursue as tolerated.
REHAB SERVICES:
REHABILITATION POTENTIAL: Continue to walk frequently - stay close to your walker and turn with it, not without it. Continue your arm and leg exercises.
ASSISTIVE DEVICES: FWW
DRUG THERAPY:
GENERAL INSTRUCTIONS: Accuchecks before meals and at bedtime
Sliding scale regular insulin coverage:
0 - 60 = orange juice
61 - 150 = 0 units
151 - 200 = 2 units
201 - 250 = 4 units
251 - 300 = 6 units
301 - 350 = 8 units
351 - 400 = 10 units
>400 = 12 units and call MD
HOME DISCHARGE INSTRUCTIONS:
DISCHARGING FACILITY: Skilled Nursing Facility
DISCHARGED TO: Home with daughter
ALLERGIES: Sulfa, Prednisone
SKIN CONDITION: Intact
NURSING SPECIAL INSTRUCTIONS:
1) Home Health PT for safety evaluation and treatment
2) Follow-up with PCP in 1-2 weeks
MEDICATIONS (In layman's terms - no abbreviations):
1) Aspirin 162 mg daily/a.m.
2) Glipizide 10 mg twice daily/a.m & p.m.
3) Protonix 40 mg daily/a.m.
4) Lisinopril 2.5 mg twice daily/a.m. & p.m.
5) Niferex 150 mg daily/a.m.
6) Vitamin D/Calcium 200/600 twice daily/a.m. & p.m.
7) IronSorb Dosage as needed twice daily/noon & p.m.
I did not include identification information of the facility and staff, nor did I include, under "MEDICATIONS" the time of the last dose given. As a note to readers who may be unfamiliar with PT jargon, "FWW" is an abbreviation for free weights.
I didn't finish copying the chart over until this morning. It is a little after 0900. She's still sleeping. I'm giving her until 0930, in part to make sure she gets a good rest and in part to allow the hot water to complete its heating cycle so there will be plenty of hot water for her bath. She lifted her head once around 0800, groaned and asked for "a little more time", which I had no problem granting her considering the late hour at which she retired and the fact that she ran through yesterday at top speed without a nap.
Everyone is much more relaxed here. The Big Girl even reacted to Mom's return by rolling around on the floor in a kind of joy I've rarely seen her express. The Little Girl talked and talked and talked to Mom all evening. I joked with Mom that she was probably telling her that she had been afraid that I'd somehow disposed of Mom and she was afraid they'd be next. As is usual when we're all at home and fine, The Big Girl snugged in with me last night when I retired and The Little Girl snugged in with Mom when she retired, joining The Big Girl and me later when Mom began soaking the bed.
I've noticed this morning,that she hasn't shed nearly as much as usual, which is good, although the amount is significant enough to where I'll need to wash all her bed clothes this morning. I'm expecting progress in this area since her daily liquid level, following her own preferences, will be much reduced.
Although I'm not going to push a lot of activity today, we are going to practice her exercises and do some sort of outing, although I haven't yet decided where we'll go.
I slept very well last night, awoke before I expected, forgot to take ibuprofen last night and realized when I arose I hadn't needed it. I'm satisfied that my tension is quickly draining away.
I'll be calling Home Health this week to set up an evaluation for out-patient physical therapy. I'm going to wait until a week before our scheduled appointment with her PCP on September 8th to have blood drawn for her monthly CBC and the battery of tests requested by her hematologist.
Life is normal again and good. I'm looking forward to more activity in our very near future.
Later.
