Mom & Me Two Archive

    MPS did, indeed, enjoy the pleasure of my mother's company, this afternoon for a couple of hours and has this to report:

1. Mom was in excellent spirits and the two of them walkered with the therapist and a back up wheel chair (literally, a back up, it is wheeled behind her as she walkers) to the day room (quite a ways from her room) for their visit. Mom walkered without oxygen (that's it, no more cigarettes, I've decided; she's been without them for about a week and a half and the difference in her energy level is amazing), did well, didn't lose her strength, continues to need to be reminded to walk closer to the walker, yes, she is hunched over, critically to the right, but this doesn't seem to bother her and her energy doesn't flag. I'm especially pleased to hear this. It looks as though my plans to take her on an exploration of the SNF tomorrow are viable.
2. MPS brought her some crackers and cheese and she ate heartily. Once I heard this I realized this is why Mom sounded so groggy when I reached her by phone this evening (and, now I know why she didn't answer the couple of times I called this afternoon). I reached her at 1830 and she sounded like she'd been drugged. This worried me so much I called the nursing station immediately after talking to Mom to see if she'd been ordered a sleeping pill or a sedative. No she hadn't, the nurse confirmed (before I had a chance to talk to MPS), she'd had a very busy, full day, had "eaten well" and was probably half into sleep when I talked to her. Good, good, good. I'm so very pleased with her progress.
3. MPS mentioned to me that as she was leaving Mom finally put on her glasses and said, "You know, in this light, you almost look like MPS." We both roared over that one. MPS recently got her hair cut so short that when she arrived at the hospital last week, for a moment I didn't recognize her. There is a running, insider, sister joke that travels between the four of us regarding Mom's ability to phase in and out of recognizing people. That joke gained some mileage today.

    I'm satisfied and happy with the report. I know that therapy continues daily regardless of the day of the week. I also know that extra movement is encouraged (as long as the amount doesn't become detrimental, I imagine). When I talked with Mom this evening I asked her if her muscles were sore and stiff and she replied that they were not. Excellent.
    I'm especially pleased about her moving around without oxygen. Although I imagine that at this altitude she'll need some on occasion, perhaps she won't need as much as previously in as high quantity. For instance, maybe she won't need it at night or when she is doing on-her-butt stuff, like reading, crossword puzzling, etc. I don't think, though, that it's going to be as much of a problem to mobilize her as it was before all this happened. I'm definitely going to activate the prescription for out-patient physical therapy up here, as I think she could use the extra therapy to help her get used to moving in this altitude. However, MCS and I were discussing this and stumbled upon the point that, however thin the air is up here, it is quite a bit cleaner than Mesa's. It's entirely possible that the dirtiness of the air in the Valley balances out the thinness of the air up here. There are other aerobic considerations to living at an altitude of 6,000'-. We live higher than the town, thus everywhere we go we descend a good couple hundred feet or more. I believe Mom can adjust to all these considerations.
    I am, as I write, relaxing myself with some hot chocolate and guzzling a good 16 oz of bubble water in order to initiate an early sleep. I'm planning on rising at 0400 and getting out of here between 0500 and 0530. My body no longer aches. I'm feeling in tip top shape, having eaten 3 meals for the first time in weeks, today, and am looking forward to tomorrow's day with Mom, wishing that 0400 would come earlier.
    MPS and her family are planning on visiting again tomorrow so the day will be like Old Home Week, which is good. MPS and I ran through our planned visiting schedules and there will be, this week, some days when Mom will have no visitors. I consider this good. She will be able to experience her independence of spirit and continue to charm the staff with no competition from family.
    This health episode may be one of the best things that has happened to Mom lately. I'm glad I was so assertive about her treatment and so insistent that her problem not be considered or addressed like "just another one of those old age things" as the ER up here would have had me do. We won't be going back to that facility any time soon, even if an emergency arises, if I can help it. They not only were no help, they were downright dangerous. Thank the gods I gave up trying to find her a local physician. I'm sure there must be one or two good ones up here, but having to go through the hassle of finding them and trying to lure them into taking on yet another patient in this "seller's market" is something I'm no longer interested in doing. Until the medical community up here begins to change its attitude it is no friend of ours. As well, I looked up the ratings of the few SNFs/nursing homes up here today. They all fall far below the rating of the that is now treating her. Small mountain communities have their advantages but one of them is not medical care, which is just as well. I feel safer being a distance from medical care, considering what I have to go through to make sure non-alternative medicine doesn't harm her. The physical distance allows me the intellectual and observational distance to evaluate what is prescribed for her and whether it is necessary and/or harmful.
    Time to stop and sleep.
    Later, probably not until tomorrow evening or Tuesday morning.

    I just spoke to my mother on the phone, which she answered after just a few rings. I don't know whether the nurse from yesterday reclued her in to the phone's existence or Mom figured it out herself. She sounds very good. I mentioned to her that I called her more than a few times yesterday unsuccessfully and she said, "I think you were calling my roommate," which indicates she heard the ringing.
    "Well, Mom, your roommate didn't answer."
    "Well, of course not," she scolded me, "you were calling for me!"
    Gotta love this woman!
    She is missing me at least as much as I am missing her. She understood, though, in her stoic way, why I didn't make it yesterday morning. She is looking forward to "a long visit" with me tomorrow, and I will see to it that I am there for awhile, perhaps even through a therapy session or two so she can show off for me.
    The best news is that she doesn't remember that for a few days last week she couldn't walk. When I congratulated her on using the walker and getting around and not getting tired or sore she was surprised that I was excited about this. Her sardonic reply was: "I've been walking for several years, you know."
    Gotta love this woman a little more!
    One thing I've discovered about mild dementia is that it has its advantages, especially in recovery from an illness or sudden disability. If my mother doesn't remember that she's sick or handicapped, when her body is ready for action, she cooperates without looking over her shoulder (although she has never been known as a woman with fears from her past, neither recent or distant). Of course it can also have the opposite effect, causing her to attempt something she has no business attempting, which is how her back injury occurred. But overall, mild dementia is an optimistic, enabling state of mind for her. She rarely worries about the holes in her memory as she did a few years ago, which is good.
    While we talked I checked her out again on the mysteries of her TV remote. Before I left on Thursday I set it up so that it is permanently tuned to Animal Planet, the volume is audible for her and all she has to do is push the red power button. I also reminded her of the free popcorn machine and the change I'd left for her for vending machines. I don't think she's yet able to wander around on her own, though, so I promised her, if the therapists okayed such, that tomorrow we'd "go exploring". She probably won't remember exactly where the free popcorn is but she'll remember it's there once she has some and will probably keep staff busy fetching it for her if she isn't as mobile as she'd like.
    She reported that breakfast was "delicious" but "not as much as [she]'d've liked," also an optimistic sign. Her appetite has returned to its previously hearty state. Hopefully she'll put on a pound or two while she's there. She could use some padding. She's lost quite a bit since October 25th of last year.
    While I was talking to her one of her therapists arrived so I let her go. I'll be checking back with her frequently today, for my sake as well as hers. Tomorrow we should have an interesting day.
    A storm is gathering on the horizon...great napping weather. I'll report more...
    ...later.

    Following is the directive I wrote and delivered to the hospital while my mother was waiting for pre-admittance ER evaluation. I handed it to the ER nurse assigned to her at 2310, 1 August 2004, previous to her being seen by the ER doctor, ten minutes after I finished writing it (I noted that time with my signature). It solicited amazing results. It should be noted that I came up with the idea of doing this while we were mired in a back-up on I-17 due to an accident 20 miles ahead of us and I was despairing that I was probably, this time, too exhausted, physically, intellectually and emotionally, to perform "magnificently" on my mother's behalf. I wrote the directive, by hand on notebook paper several hours later when we were finally informed that she would most likely be admitted to the hospital. All underlining mimics the original directive and was done to emphasize the underlined words and phrases.

Notes to the nurses, doctors and all staff:
    The following notes should be helpful to you in caring for my mother. They apply to problems experienced during her stay for a blood transfusion of 6/8 - 6/10 (or 11, not sure):

1. She left the hospital with skin tears from the tape used to hold her saline drip in her arm. The skin tears began to develop the day before she was released and were brought to the staff's attention the night before she was released but were not attended to until I brought them to the attention of the day shift the day she was released.
2. She is a type 2 diabetic. She was put on a normal diet the last time she was here and remained on it for 24 hours until her blood sugar shot up to 368.
3. She left the hospital so dehydrated last time that her calf skin folded about a half inch and stuck. This is severe tenting. The doctor said it was due to blood loss but:
   1. She was on a saline drip.
   2. She has never been this dehydrated, although doctors have been assuming internal bleeding for 2 years. I have no trouble keeping her more hydrated than this without a saline drip.
4. She suffered severe bruising on her fingers from blood glucose testing. This isn't necessary! I test her 3 times a day, sometimes more. She doesn't get bruised. She doesn't need to get bruised!

    I want copies of all labs, tests, etc., before they are used as a basis for recommending other procedures. Full copies of all results.
    After tonight and tomorrow morning I will be commuting back and forth from Prescott daily. You will work with my schedule, not the other way around. I manage our life, including pets, and will be returning home to Prescott every evening, returning here every morning. On August 2nd, after sleeping at [Mesa phone number] and checking in on my mother, I will be returning to Prescott.
    You are not to do any procedures without my consent and without a full discussion with me. When I am not here after midday August 2nd I will either be in Prescott at [Prescott phone number] or in transit. You will need to take this into consideration regarding discussing my mother's care with me, scheduling procedures and planning her discharge. You will work with me - not the other way around.
    I will keep at least one of you informed of my movements. It will be your responsibility to find me.
    I am hoping we will work well together in regards to my mother and her care here. Further, I expect all staff members who need to know the above information to have access to this document, including but not limited to: physicians, nurses, CNAs, techs, dieticians, etc.
    I expect my mother to be treated with the respect and honor she deserves. I expect her not to be abused (as she was here in September of 2002) or neglected (as she was, as explained above, in June of 2004) whether I am here or not.
    Overall, as you can see in the attached document rating this hospital's performance [a standard rating sheet which is sent to patients after a hospital stay to be filled in and returned] last time, I consider this hospital a good hospital, full of good intentions, with some pesky little problems that need some attention.
    I expect every member of this hospital's staff who attends to my mother to receive a copy of this declaration. Might be a good idea if all who see it sign it, too, and keep it on file, as if there are any problems I will first look to determine whether this document or a copy thereof was indeed distributed to all staff attending to my mother.
    I think we can work well together to heal my mother - I hope you feel this way, too.
    --Gail Rae Hudson
    2300  8/01/04

    This document had an almost immediate effect. Soon after my mother was transferred from the ER waiting room to a bed in an examination cubicle and seen by the attending ER physician, the nurse arrived with a pill to administer. I asked what it was and was told it was an unbuffered 325 mg aspirin, standard practice medicine in the case of TIAs, actual or assumed, which I understood. I expressed concern, though, about her receiving this because of her iron deficiency anemia. I informed the nurse that her surprisingly good hemoglobin result that night (10.8) was probably due to the mega-doses of iron I'd been feeding her since soon after her transfusion and I was unsure whether her iron deficiency anemia was due to internal gastro-intestinal bleeding since, after much testing, none had been discovered. I knew the doctors were concerned about this, though, and the neurologist had not yet arrived to determine if, in fact, she had suffered a TIA or a series of mini-strokes, thus I was unsure that giving her an unbuffered normal dose of aspirin was appropriate treatment at this time. I indicated that I wished to discuss this with the attending ER and was told he had left. I mentioned that I would not be averse to intravenously administered aspirin and was told "it doesn't exist". I was, however, able to draw the attending nurse into enough discussion that she decided to hold off on administration of the unbuffered normal dose of aspirin until the arrival of the neurologist and her evaluation of my mother.
    The neurologist agreed with me, saying that considering my mother's history, which she solicited in detail from me (she was, I think, another physician sent by the gods, as were her partners) and the possibility that what appeared to be mini-stroking might also be caused by her extremely low sodium and chloride levels, the aspirin should not be administered until it was determined that my mother's hemoglobin was stable and she was, indeed, suffering classic TIA or mini-stroking, thus indicating that past internal bleeding or not, her anemia would likely not be affected by taking unbuffered aspirin in normal doses.
    The second effect of my directive took place the next day. Early in the morning I was met in my mother's room by the Clinical Manager of my mother's floor and a woman whose cards weren't ready but who I believe was pretty much head of PR at the hospital and whose job it is to be primary negotiator between patients/caregivers and the hospital when "situations" occur.
    The first words out of their mouths were that my letter was "excellent" and the entire directive should apply to "every patient" in the hospital. We met standing, for a good 45 minutes, discussing the directive and my complaints in detail, with frequent reference to the directive. Aside from me being given a chance to correct a few clerical errors I'd discovered when I reread my copy of the document (relating to dates and miswritten words), each of my complaints was addressed specifically as follows:

1. Skin Tears: Unacceptable, yes, they agreed, but not always avoidable, although more care would be taken with my mother's skin, which the RN noted through on-the-spot examination, was extremely delicate. Alternatives such as Coban would be used with my mother when possible. When not possible, tears, if they should occur, would be treated immediately and observed and tended for prompt healing.
       I also related the incident which happened on the morning of my mother's discharge when, after bringing the tearing to a nurse's attention after the same nurse had been alerted to it by my mother's doctor the night previous, the nurse, in an exasperated voice, while looking at the tearing, appeared baffled as to how to treat it and demanded of me how I treat my mother's skin tearing. I replied, "My mother's skin doesn't tear around me." Both of the hospital representatives who were responding to my directive were taken aback at this nurse's response, which, I might add, I'd documented in the survey form.
2. Meal Ordering: Would definitely be correct this time around. In fact, with each meal that was delivered the dietician made a special effort to announce that the meal was a "special diabetic meal ordered by your doctor".
3. Dehydration: I already know this is a tricky issue. As it turns out I had apparently been over-hydrating my mother during the few days prior to her entry into the hospital. My techniques and standards for determining dehydration in my mother had already been solicited and reviewed by two neurologists and corrected, where necessary. The problem was that I have been over-ambitious in identifying and combating skin tenting in my mother
       In my defense, I was using standards explained and shown to me by one of her Mesa PCPs through the clinic that I trust and I've been following them for four years. They have only recently caused a problem. I did not, however, explain my defense to the hospital advocates, as it seemed unnecessary since I was getting new, up-to-date instruction on identifying dehydration in the elderly.
       As well, because of my ambitious over-hydration, which caused a significant and potentially dangerous and possibly immediately affective drop in her sodium and chloride levels, her hydration was ordered to be closely managed in order to raise these levels, which, in fact, were back to normal in less than two days. My mother's quick recovery of the rudiments of her natural strength attest to the probability that her "TIA" was actually a dangerously low sodium/chloride episode. The probable reason for her weakness manifesting primarily on her right side is because this side is already weak due to the years' ago mini-stroke.
4. Finger Bruising: Was explained to be due to the hospital equipment used to take blood glucose readings versus standard home testing equipment, as well as the techniques used to pump adequate blood into fingers withered with age. This discussion lasted a while and came to a compromised end. I continued to argue that perhaps their equipment should be changed and perhaps their pumping efforts should more mirror mine and be done before sticking rather than after sticking (which is the hospital's practice).
       Interesting sidebar: One of the CNAs who regularly took my mother's blood glucose is also a type 2 diabetic and mentioned that she took her own readings three times a day or more. As she worked on my mother I noticed that her fingers showed no evidence of bruising, even as my mother's fingers blossomed under her touch. I'm now thinking that this problem is completely avoidable in hospitals by two means: The first being the use of better equipment; the second being taking a few more seconds to be careful when testing, despite the fact that the CNAs who collect the daily stats are bombarded with several patients whose stats must be taken on a timely basis. Perhaps more CNAs are needed.
5. My Time Is Not At Your Disposal: When we got to this section of my directive I took the time to explain my circumstances in regards to my mother's and my life. I also explained that in June during her stay for her blood transfusion I was literally driven temporarily insane due to the doctors' expectations that I would be at their disposal. This temporary insanity, I explained, caused me to be able to oversee my mother's care with a lowered level of effectiveness. While I believe I did a good job overall, I was reduced, finally, to incoherent babbling in some cases. I was determined, I explained, that this would not happen to me again. I needed to be in as high form as possible to negotiate the medical complex on my mother's behalf. To this end, I expected to have my schedule and my availability respected. Both representatives agreed that this was reasonable and assured me that, whether I was able to be present during examinations or not, if the doctors who conducted the examinations were unavailable to me when I was available they would be paged to speak with me.
       As it turned out, only one doctor was unavailable but I knew how to get ahold of him and his determinations were reviewed for me by the charge nurse that day in such detail that I found it unnecessary to contact him.

    When The Addressing of Problems was over I was invited to participate in their "Partners in Caring" program which involves:

• Wearing an identification badge, in which I secretly took pleasure in since this would alert staff to the need to handle my mother and me with care and respect;
• Participating in as many or as few personal care procedures for the patient in question. I chose, I imagine, a medium number since I knew I would not be constantly available and frankly expressed that there were certain duties, like overseeing bowel evacuation, from which I wanted a rest;
• Receiving discounts at the hospital cafeteria and gift shop.

    Although I'm sure I was offered this option in a mollification attempt, I accepted readily knowing that this way I would be highly identifiable and no one would be likely to forget my ability to assert myself when problems arose.
    When I retrieved the paperwork necessary to establish my legal right to oversee my mother's care I discovered, to my surprise, that while I have Durable Power of Attorney I did not have Medical Power of Attorney, which I'd thought I had. No problem. The hospital keeps notaries and forms for this contingency. I was immediately attended by an extremely capable notary who took care to determine whether my mother was mentally capable of granting me Medical Power of Attorney over her. She was, but I consider it important that this woman would have questioned the granting if my mother seemed somehow unable to understand what was going on. I was also able to establish Mental Health Care Power of Attorney (which I didn't know existed) and my mother was able to establish Advance Directives to be used in the event of paramedic involvement in which a choice had to be made, pre-hospital, as to whether to revive her from terminal heart or breath stoppage. Both of us were also informed of and invited to participate in a program which allows for the donation of one's body to science at death, a program which we will, indeed activate and I will discuss in a later post with web links. I might add, all of these services were provided as a part of normal hospital procedure. No out of pocket fees were involved.
    I was surprised throughout my mother's stay how much of a difference asserting oneself made in my mother's care and my ability to negotiate on her behalf. I was careful to try not to make a pest of myself but I know I kept the staff on their toes. I feel no need to apologize for this. This, I believe, was as it should be. If everyone, patient or caregiver, who comes into contact with hospital staff demanded the level of care and respect I demanded hospitals would have to respond with a higher quantity of better prepared, more responsive staff and the reverberation would have to be translated throughout all areas of the non-alternative medical-industrial complex including insurance, drug and research companies and medical administrative organizations.
    Before 24 hours had elapsed I was readily identified by all the people involved directly and peripherally in my mother's care. Apparently my reputation spread, as people who were not involved knew who I was, probably because of the description of my unusual arrangement of earrings, attached to a cautionary verbal note to "watch out for [me]".
    I was my usual ebullient, off-the-cuff self, perpetually interested in the others around me, friendly and available, stern when necessary (which wasn't often), willing to help and, as well, made some very interesting acquaintances who I will not forget and who I believe will serve my mother well the next time we are there.
    I was very, very pleased with the level of care provided this time. As I told the PR representative on my way out of the hospital to meet my mother at the SNF, the only complaint I had this time was about the furniture and it was not on behalf of my mother but myself. We both laughed, knowing that this isn't a complaint which is likely to be addressed, except, perhaps, in the storied manner of the movie Calendar Girls.

As of 2055, 8/20/06, I removed a long amendation to this post, the contents of long comment I left addressed to "ER Nurse". At this time, it is the last comment attached to this post. I had added this amendation because on 8/18/06, when I published the comment, I was having trouble posting comments, as, apparently, were others. However, my comment published quickly and well. Since it is a long one, its repetition here seems ridiculous. Thus, I've deleted it. You can find the comment to which I'm referring below in the comments section.

...although not the dread. I'm looking forward to recording the stream of consciousness detail surrounding my mother's and my latest adventure. Over the next several days I'll be entering a variety of documentation including results of blood and diagnostic tests done on my mother in the hospital, sections of e's to a friend, the hand written directive I presented to the emergency room staff at the Mesa ER at the time she was initially evaluated and admitted to the hospital, which letter was the first of my Acts of Magnificence involved in this health care episode (and which elicited a surprisingly positive response from the hospital staff), information about selecting a skilled nursing facility for her short term, intensively rehabilitative stay and, well, whatever hits me as I go. I'll also be updating the stats on Mom's Daily Tests and Meds as I recorded and remember them up to Sunday afternoon when we headed down the mountain for professional health care. I'll also be entering information about mistakes and successes I've scored in her home health care up to the hospital stay, all of which I discovered as she was cared for and evaluated in the hospital.
    I'll be documenting while keeping up with Mom every other day, keeping our life business going and reviving myself as I continue, so expect up-to-date reports mixed with recent history.
    First up-to-date report: Although I had planned on checking in on Mom yesterday morning before heading back up the mountain after settling her into the skilled nursing facility on Thursday, the lack of sleep, food and hydration coupled with the intense demands on me to negotiate the quick succession of mini-events over the last few days caught up with me Thursday night. I thought, with a good meal, I'd be able to crash long and easily. I made sure I arrived at our Mesa home early enough to begin personal revival. I was ready to lay down at 2030 but was unable to sleep despite (or, most likely, because of) my exhaustion. Finally, long before Friday's dawn, aching in every joint and muscle, having jerked awake numerous times, I decided, if I waited any longer to head back to Prescott I'd risk an accident due to severe driver fatigue. So I struggled back into my day old, sweat soaked clothes, packed the car and took on the maze of freeways, culminating with I-17 along side the summer construction workers and delivery semis.
    After a few hours sleep in comfortable surroundings with cats snuggling close to me I called the S(killed) N(ursing) F(acility) to let them know of the change in my plans and began the series of calls to my mother's room, all of which went unanswered. This doesn't concern me. I'm not sure my mother understands how to work the phone in her room (although I explained it to her the night before and we practiced), nor that she realizes that the phone is hers to be answered when it rings. As well, from the report I solicited from the day nurse, she is being kept busy and was walking yesterday, "hunched over", as she said, but walking. Although I suppose, with some effort, I could show up today, she will be receiving a visit from the Chandler branch of our family and I need today to recuperate before I begin the round of every-other-day-or-so visits that I'll be performing during my mother's stay at the facility.
    My mother's initial therapeutic evaluation on Thursday by the charge nurse at the facility was surprisingly thorough. I'm extremely impressed with this facility and its staff. This is a "head 'em up, move 'em out" facility, which is exactly what I was hoping. As the evaluation came to a close I asked the charge nurse if she could make an initial prognosis based on her experience with people in my mother's state. Without hesitation, she replied that considering how good her resting strength was (including the balance of strength between her right and left sides) and how far she'd recovered with the intermittent, low key therapy applied to her in the hospital (her penmanship and ability to use eating utensils was much improved, and her ability to stand with aid was good as was her alertness and general physical condition), the nurse's guess was "a week and a few days to two weeks." I also noticed that, while I was there on Thursday, the halls were filled with therapists directing their charges on a variety of walks, strengthenings and motivational exercises. As well, aside from the quickly and deftly researched recommendation solicited by MPBIL, after I'd decided on this facility I was treated to a few unsolicited stories, not the least of which was from the independently contracted driver who delivered my mother there and had, at one time, entered his daughter into the facility for short term, intensive back therapy after an accident, regarding the quality and intensity of the therapeutic care given at this spot. They were all positive.
    Yes!
    "Thank you for taking me seriously," I told the Thursday charge nurse after she'd consulted with me regarding the detail of this mini-stroking episode and my preferences for my mother's medication administration, including a meticulous discussion of what the doctors had ordered versus (although, this time, I had no complaints) what I thought would be appropriate. "I have a devil of a time getting health care providers to take me seriously in regards to my mother's care."
    In response, with a "don't thank me" air, she explained that I'm the one who is with my mother all the time, I'm the one who manages and manipulates her care and medication to best advantage, of course I should be taken seriously and listened to.
    Yes!
    So today I revive, I take care of minor life business here, rest up, contact people I know would be interested in what's going on and prepare for a day on the road tomorrow. I'll be shutting down the Mesa house tomorrow, as I see no reason to traipse back there. I have no intention of spending nights there. I can take bathroom and food breaks either on the road or at the facility during my visits.
    After a full night's sleep, begun early and aided with ibuprofen for my incredibly aching body, I'm feeling good this morning. I expect to feel even better tomorrow. I'm confident that my mother is doing well. I will check in with the nurses' station at the SNF and continue to try calling my mother in her room, although I rather expect this will be a wasted effort.
    I have a very good feeling about this SNF episode. My mother has an independent spirit. She probably not remember my oft repeated visiting schedule and my reasons behind it:

• That I want her to perform and she tends not to perform for me;
• I want her to take full advantage of any social opportunities available at the facility;
• I need to keep from driving myself crazy going up and down the mountain on a daily basis, as I found myself doing while she was in the hospital;
• I want her to rediscover her ability to rely on her wonderful independence of spirit and regain some confidence in her ability to maneuver through life and I believe she is capable of doing this;
• I want her to consider this boot camp for our continued life together.

    I saw to it that the staff was also well informed of my objectives. Mom probably won't remember any of this no matter how often I repeat it but I'm going to stick with my original plan.
    I discovered why I was unable to sleep throughout the week: Aside from the general worry that attends such episodes in my mother's life, I am so used to listening to the drone of her oxygen concentrator at night and the quality of her breathing that I find it difficult to sleep without subconsciously monitoring the night rhythm of her life. The absence of her day rhythm is strange, as well, but I'm adjusting.
    Once she is out of the facility I will be activating the prescription we still have for ongoing "ambulation and strength" physical therapy. I am keeping my expectations high and flexible. My most constant expectation is that my mother will continue to surprise and delight me through this episode in our shared lives and beyond.
*Stephen Stills: So Begins the Task

...when it was determined that she would be prescribed short term skilled nursing facility care to rehabilitate her body, I've been making sure that she understands that she is not being "relegated" to a nursing home. I have assured her that this is rather like training camp...a place for her to put some intense, directed, supported effort into strengthening herself. She hasn't thought otherwise, thank the gods. She knows that her stay will be short term. The exact length with be guessed tomorrow when she arrives there and is evaluated by the physical therapy cadre.
    I made sure while talking to the doctor who signed the recommendation that, unlike the nurse said, she is not going there for "diabetic control", her diabetes is already under control. She is not going there for "dementia therapy"; although she is definitely mentally creative at this time in her life, she is not in need of therapy for this. She is not going in for anemia control; her anemia, as it turns out, is pretty much under control, much to my surprise, and was so on the day we arrived at the ER. I felt as though I needed to verify this with the professionals recommending this type of care. I did not want her care to be misdirected, nor did I want recommendation to follow recommendation ad infinitum until it would be almost impossible to bring her home. The nurse, who graciously stood corrected, also was careful to mention to me that her therapy is voluntary and can be ended at any time. Good. If it begins to look as though too many people are profiting from her therapy and she is not, she comes home, regardless of what has or has not been accomplished. I will not allow her to languish in the hands of well meaning therapists who are bound to see her first in terms of her age and second in terms of her spirit.
    I will be keeping a close eye on her, as will MPS & MPBIL. I'm going to try not to visit every day. I want to encourage the intensity of her therapy and I do not want to accidentally stand in the way of her ability to perform to high standards for others, as she tends not to do for me. I want to allow myself, as well, to express delighted surprise at what I expect will be her development and success. Daily visits tend to make surprise less possible. As well, I want her to take full advantage, according to her desire, of the social opportunities the facility has to offer. I think this will be good for her. Although she's never been a terribly social person, she does have a certain magnetism that draws people to her. Over the last few years it has been very, very difficult to get her out and talking to people. My sense, from talking to the facility administrator, is that people contact is not only encouraged but, well, forgive the repetition, "facilitated". I believe this would be reviving for her spirit and would help jump start her interest in life outside of our home. This would be good for both of us. As well as family, MCFs, who my mother and I consider important informal family, live close by. I know they will be interested in dropping in on her. I'm hoping this SNF episode will be the best thing that has happened to her in a long time.
    I've told her that I am counting on her developing her strength so that we can mix, easily, with our community again.
    And, I am dead on my ass and need some sleep. Tomorrow is coming very early. So, just the facts, m'am.
    The fact is, I've become so used to us sleeping in the same home, listening to her breathing through her life, that I have had trouble sleeping over these last few nights without her here. I told her this today. She smiled and said, "I never have trouble sleeping." I'm smiling, a huge smile, as I remember her saying this. That's my mom. I love you, my dear. Sleep well tonight, as usual. We have an important job to do that begins tomorrow.

...as I write, for what has been diagnosed, initially, as a TIA (transient ischemic attack). I say "initially" because whatever happened to her, she has been recommended for intense, short term rehabilitative therapy in a skilled nursing facility, to which she will be transferred from the hospital, in order to reverse the effects of her "TIA", despite the fact that the buzz word on TIAs is that, and I am quoting from the hospital literature provided to patients who have suffered TIAs, "The effects of a TIA are usually completely gone within 24 hours." Her "effects" are not "completely" and quickly leaving, as the literature says they "usually" do. Her right side has been affected. It seems that her TIA probably occurred in the same lower left quadrant of her brain wherein she mini-stroked some years ago, a mini-stroke that was not discovered until some years later, in September 2002, when she was admitted to the same hospital for a medically induced blood pressure crash (which was also labeled a TIA).
    At any rate, as a result of this "event" she is suffering pronounced weakness on her right side, including the collapsing of her right knee which began some time last week and, since Sunday, August 1, the inability to hold her right side up for more than seconds at a time. Since I took her to the hospital in Mesa where she typically receives care directed by her PCP in Mesa she has recovered some. Her "sitting" strength is good in all limbs but, when on her feet she is unable to mobilize [Don't you just love medical jargon?!?] well, even with the aid of a walker. Her health care providers, including doctors, nurses, physical therapists, etc., are quite optimistic about her ability to recover most if not all of her mobility skills and her strength with the help of short term, live-in, skilled nursing facility therapy.
    Her mind is unaffected. As usual, she is blossoming in the rays of attention she is receiving at the hospital. Her spirit, will, wit and durability are firmly intact, as is her sense of herself and her ability to present herself to others as others expect her to be from their experience of her. As I write this I'm smiling. She's a pistol, which is appropriate, considering her naval career during WWII.
    Her appetite is strong. She not only remembered but advertised her birthday on Monday, she has won the hearts of all members of the staff "waiting" on her at the hospital and I think she is enjoying the independence under which she is operating due to me commuting daily between Mesa and Prescott in order to oversee her care.
    Because of the two previous hospital experiences we've endured (me as her caregiver/care overseer) in the very recent (in Prescott), recent (in Mesa) and distant (in Mesa) pasts and the exhaustion I've experienced since the middle of last week negotiating her suddenly appearing and alarmingly, increasingly accelerating right side weakness, I was completely unsure of my ability to adequately direct her care under the hands of hospital staff again so soon. Somehow, though, I pulled it together on our way down the mountain from Prescott and have been, once again, magnificent.
    I will write much more in what my readers have come to know as my excrutiating detail in the days to come as I am able. Right now, work on her behalf is more intense than usual, especially in regard to negotiating the selection of the proper facility for her. I'm lucky in that MPBIL is a powerful, long standing, well known health care MSW in the area and is helping me negotiate the morass of detail involved in the selection of a facility.
    I'm very optimistic about the present status and prognosis for both my mother and me of this particular episode in my mother's life. We both seem to be exhibiting reserves of strength and resilience of which neither of us knew ourselves or the other was capable. This, in itself, is energizing.
    East Coast business hours, which figure prominently in this particular path of our journey, will begin shortly. I need to shower and begin phone negotiations, then prepare for my daily trip down the mountain to see to my mother and the details of her care there.
    Far from being down and out, my mother and I are up and functioning at full operating capacity with hopeful spirits and constantly, almost miraculously renewing energy. I can't wait to see how this adventure unfolds.
    Amazing grace. Amazing.