Thoughts on “Slippery Slope”
August 4, 2014 at 8:57 pm
SLIDING DOWN THE SLIPPERY SLOPE
Mom began to have more episodes of bladder or bowel incontinence and falls, sometimes one in conjunction with the other. She once fell in the bathroom at 3 a.m. because she was trying to clean herself up without waking us. Falls resulted in terrible skin tears because her skin was so fragile. Wound care was becoming one of the most difficult aspects of caregiving.
Another time, I had just gotten my mother-in-law cleaned up in the shower after an “accident” and was in a hurry because I had a doctor’s appointment myself. The appointment was important because I was experiencing shooting pains up the left side of my head. My mother-in-law had to sit down on the commode again, so I had to leave her sitting there waiting for my daughter to arrive to help her grandmother get dressed and have lunch. At the appointment I was diagnosed with shingles, an ailment common to caregivers.
After the next incident of incontinence a relatively short time later, my mother-in-law said, “I appreciate all the things you do for me. I appreciate your patience.” That was the first (and last) time she ever expressed her appreciation to me; it was good to hear.
My mother-in-law’s decline was especially difficult for my brother-in-law; his wife made a point to express this to me very specifically. He had no confidence in his ability to be alone with her. With tears in his eyes, he told me that he saw himself as the “last bastion of propriety” in his relationship with his mother. I did understand how difficult it is to watch a loved one’s decline; his brother, after all, faced it every day. I felt, however, that was not an acceptable excuse for not assuming responsibility. During that same conversation, his wife also made this comment: “My priority is my children. I am only a daughter-in-law.” I was amazed.
After Mom returned from the graduation trip the previous May, I had a discussion with her regarding my role as caregiver. I told her that I realized that she did not like me to speak up at the doctor’s office or for me to make comments about her nutritional needs. I told her that I would take a less aggressive approach with her healthcare, but that I would expect her to vocalize her wishes to me so I could proceed according to those wishes. Over the next several months I noted a gradual increase of edema in Mom’s legs; she was gaining weight, approximately two pounds per month. She was going to the doctor regularly; her weight was always documented; the doctor frequently looked at her legs. Mom never specifically brought up concerns about the edema with the doctor during that time—and neither did I.
Sometimes, no matter how hard you try, you just cannot stop nature from taking its course. One year after her initial pneumonia Mom became sick again, but this time it was worse. She was hospitalized with pneumonia and congestive heart failure (CHF), and the doctor made a referral for a pulmonary specialist to review her case. Her diagnosis was bullous emphysema; the small bubbles in her lungs had become large, limiting oxygen absorption. The doctor described her condition as “very bad.”
Two days later, David and I met with her doctor. Her oxygen needs had increased to 8-12 liters and were too great for her to be admitted to a nursing home. A hospice referral was recommended to facilitate our ability to take her home. David talked to his mother privately about the situation. When I entered the room, she had a forlorn look on her face. Later that afternoon David called me. Hospital personnel discovered that Mom’s hospital equipment was not functioning properly and that her oxygen needs were actually 2-3 liters. Hospital staff proceeded with getting Mom accepted into a nursing home for rehabilitation once again.
Mom was in the nursing home from mid-December until the beginning of February 2010, despite the fact that she had fallen in the facility a week before her discharge. I did not feel she was strong enough to be discharged, and indeed, she had two falls the first weekend home. Once again, we began in-home services: physical therapist, occupational therapist, and RN. I made sure to give the RN a heads-up before she came; Mom looked like she’d been beaten up due to multiple skin tears from her falls. On February 8 my knee locked up while squatting to dress Mom’s six wounds. The knee became difficult to unlock, and during subsequent episodes, remained locked for up to 12 hours at a time causing me to limp and walk on tiptoe. Two times Mom and I almost went to the ground together!