It’s been quite a week, beginning with one of those bad news phone calls in the middle of the night.
Mom was being transferred to the hospital by ambulance. Her blood oxygen level had dropped, the by-now chronic cough had changed into something worse, and she was running a fever.
At 2:30 am, I met her in the emergency room, where she was in rough shape — disoriented with a horrible wracking cough that shook her whole body and left her gasping for air. I had just seen her at lunchtime, and she’d been fine, making the transformation all the more shocking.
The ER doctors agreed with the nursing home nurses that she’d probably aspirated something into her lungs, causing aspiration pneumonia. It wasn’t showing on the X-ray, but apparently, that happens.
I stayed until late that morning, when they finally settled her into a room, and the next seven days became a blur of worry and waiting.
A modified swallowing test, an x-ray of her esophagus, and an endoscopy showed no blockage. Her esophagul muscles have simply lost their motility, making it difficult to breathe and eat at the same time, and more likely that she will aspirate in the future. This is called dysphagia, and is common in the elderly.
As a result, Mom is now restricted to purees and liquids. She also has to sit up for 30 minutes after eating or drinking to allow gravity to aid in getting her food to where it belongs.
Her response to these restrictions has been mixed — surprisingly sanguine about the pureed food, but almost insulted by the idea she can’t lay down after eating.
“I know how to eat,” she says, “I’ve been doing it for 92 years!”
As if any of us is likely to forget her vast age.
Meanwhile, my brother was diagnosed with pneumonia, which meant he was out of the picture. This was followed by some kind of a stomach upset, which left him frustrated that he couldn’t help, but too ill to chance either his health or Mom’s.
Finally, on the day before Mom left the hospital, he felt well enough to venture out and stopped by before going to work.
While at the hospital, he had a dizzy spell, but said he was fine. I put it down to not eating properly while sick.
Silly me. Given his history of health problems, I should have known better. A few hours later, on arriving home from that day’s visit with Mom, I saw I’d missed a call.
It was from the school where Bro was substitute teaching. He was being taken by ambulance — no, make that life-flighted — to the hospital.
Despite his carotid artery being completely blocked, they sent him home the next day with medication, leaving me to wonder what happened if … when it happened again? What if he had such a spell while driving? It was like throwing a bomb into the community, set to go off at some unknown time.
Also, my sister-in-law, who usually visits Mom when she’s in the hospital, was going out the door with my niece to do just that when she tripped over something, smashing her head on the patio.
She ended up being diagnosed with a concussion in the same ER Mom had been a few days before. The next day, she was back at the hospital, where they discovered she had a broken orbital bone. I wince every time I think about it.
Still, I was very grateful to my cousin, who visited Mom, and my niece who did manage to run up and say hello while her own mother was being treated in the emergency room.
In the end, Mom returned to her nursing home just a few hours short of a week since she’d left.
She was glad to be home, and I was relieved she recognized it as such.
After her last hospital stay, she thought she was there for rehab, and had no memory of the three years she’d lived there. I’m still not sure she remembers her previous life there before her hip break, but at least she’s come to see it as where she lives.
While she was still in the hospital, her doctors asked if we wanted them to insert a feeding tube. Bro and I said no. It would do nothing to improve her comfort and quality of life. And now I’ve read more about them, it seems they don’t even prevent aspiration because quite often what’s aspirated is mucus or saliva.
It was hard to tell the doctors we didn’t want to proceed with this action, difficult to voice a decision that might enable Mom to receive nutrition more directly. I am so sad that things have reached this stage, that her life had become so filled with discomfort.
Nonetheless, this decision echoes the one she made long ago when she signed a Do Not Resuscitate-Comfort Care Only order.
A feeding tube might prolong her life, but it certainly wouldn’t make her days more comfortable or happy.
Sometimes, mostly in the hospital, but occasionally at her nursing home, it seems like there’s only a thin veil between the present and the past for Mom. There’s a look in her eyes, as though she’s seeing something I don’t, as if she’s somewhere else.
It’s different from before my dad died, when he was in the last stages of Alzheimer’s. His eyes became vacant, as if the father I knew no longer existed. With Mom, it’s like she’s just elsewhere.
This doesn’t happen all the time, but enough for me to feel we should prepare ourselves for the end.
Also, she’s tired, as if the struggle to live is almost too much for her.
Obviously, I could be wrong. She could live another ten, or even fifteen, years, and if she can somehow recover from the difficulties of these last months, I’d be happy with that possibility.
But, as things stand, I can’t help wondering why she has to go through all this, why her last days couldn’t just be slower, peaceful, and without such struggles.
I can find no reason, and it’s hard to realize I can’t help make things better.
Certainly, I’m not the first, not even the first of my acquaintances, to have dealt with this situation, and there’s some small comfort in knowing others have gotten through this (although I certainly wouldn’t wish this on anyone).
Meanwhile, my Bro went to the follow-up appointment with his nuero-vascular doctor. (Yes, he has one, which makes it all the more ridiculous that he insisted he was fine to go to work and that I didn’t push him on it.) She was amazed that he’d driven to his appointment and said he should have been transported.
He’s now been admitted to the hospital for an angioplasty on Monday. And although I know he’d prefer to be home, I feel much relieved that this situation is being addressed.
On another note: Once Mom was safely settled back at the nursing home, and the first doctor said Bro was fine to go home, The Engineer and I went for a hike in a local park.
I needed some of nature’s calming influence, and she did not disappoint.
It was a glorious day, over 70F, with the red-winged blackbirds trilling, the cardinals calling, and loads of skunk cabbage along the trail to assure us spring is coming. (Sidenote: This was yesterday, and today we woke up to barely 30F.)
Skunk Cabbage is such an interesting plant, not only because it is a welcome early food for bees, but because it is actually able to generate its own heat.
I must admit we felt a little jealous because we tried planting some in the yard for our bees, and it just disappeared. This is an not infrequent occurence with our gardening efforts, which The Engineer has begun to refer to as “hiding.”
“Didn’t we hide some of those plants in our garden?” he’ll ask.
Thus, we would have been a lot more tempted to break the rules (and possibly the law) and dig some up to plant in our yard if we hadn’t known it would just disappear, never to be seen again.
As it was, we instead revelled in the sight of so many plants just waiting to be discovered by the bees.
We also passed the incredible, many-trunked tree, seen below from both sides.
Even though I know my mom’s and brother’s health troubles are probably not over, I felt my tension seep away as we hiked.
Nature is so healing.