Aging by the Hour
My 89 year old mother is pretty much confined to bed because she's too weak to walk very far. So far she can make it the five steps to the toilet in the bathroom, with the aid of her walking cane. Mom's had congestive heart failure for years. I've watched the symptoms accumulate and worsen, and I have an idea of how death happens. At some point her heart isn't strong enough to pump her blood through her system adequately. As a consequence, there are times that her blood is not distributed well throughout the body. We hope that doesn't happen in the brain, because you lose the flow of blood through the brain and are likely to have a stroke. Nobody wants that.
For many months Mom has had problems with her ankles swelling up. She was prescribed medication to reduce some of the water in her body, and it semmed that this problem was under control. In her home Mom often walks without a cane, or walking roller, though she has both and uses them when she is having a week spell, and she's still able to walk around the house. Mom came up with the most ingenious contraption: She has a rolling secretarial chair that fits inside her walk and roller. The moving piece of furniture is a bit heavier than just the walker. She's able to lean on the walker-chair, and it's quite stable as a means of keeping her on her feet. She can roll herself from her bedroom, through the den, and into the kitchen where she can get herself a snack or something to drink. She lives alone. Mostly, I've lived alone. It works out fine for some people until they are not able to take care of themselves.
I've been putting off cataracts surgery and the possibility of back surgery because I need someone to take care of me awhile--you are too weak or sick to take care of yourself. It doesn't happen very often. One time I had the flu so bad that I was hospitalized, and quaranteened for a few days. It's a very negative, emotionally debilitating situation. Everybody wants to be able to take care of themselves, but as the senior generation gets older, statistically more and more people of the Great Generation, and now also the huge Baby Boom Generation are going to find they need someone to help take care of themselves. Many people will deal with this situation a time or two, at least, in their lifetimes.
My specific issue with my mother won't apply to everybody, but it will apply to some people. This is a thinking question I never considered, until it came up, or actually I was informed last week.
So my Mother is insinuating that she thinks her life on earth is drawing to a close, and there were changes made to her legal papers that I was intentionally not informed about. Untill last week, I, an only child, was aware of my responsibilities as medical power of attorney. Mom and I spoke about her feelings and what she wanted. I understood what to expect when the time came.
Now, her medical power of attorney is the legal responsibility of her caregiver, and faith healer. Vivian says that she has laid hands, held hands with certain people, and she calls on the Lord with a prayer, and often both participants feel a rush of grace, and the problem recedes. I had no problem with alternative treatments as an additional option. I've prayered with her before.
I am a writer, tutor, and former teacher who has bipolar disorder. I was hospitalized for about a week in November of 2009. My mother holds my bipolar disorder against me. My former husband said of my mother that I was her most favorite hobby. We have been codependent, but I do really try to establish boundaries so we don't try to take control of each other's business. I try. Mother doesn't understand.
Vivian has been a good caretaker for a number of years, but at age 79 is beginning to develop her own set of geriatric issues: loss of memory, not understanding something being explained to her, losing things like keys, forgetting she was going to take Mom to a doctor's appointment, etc. I don't know her educational background, but she reads and writes and prays to the Lord. In addition to my BA in English and History, my certification to teach ESL, and the two years I attended Cedar Valley College in Lancaster, Texas. I took anatomy, physiology, medication dispensing, and in total about 30 hours toward becoming a veterinary technologist, needing only to take the Texas State Exam to acquire the title of Registered Veterinary Technologist. I studied the biology and psysiology of dogs, cats, horses, cows, birds, and snakes. We used many of the same textbooks that the local community college uses for their nursing students. My point is that I know medicine and I need to be the one with direct access to the doctor. Vivian doesn't have my understanding, and she's not the woman's only child (I mention again, and that I take daily meds for bipolar disorder, and see my psychiatrist regularly.
Mom said she made the change of agents because of the several week delusional state which she eventually turned into her catching me in her locked backyard, and calling an ambulance to take me away. Before that, she never spoke a word to me. She was angry because my psychiatrist at the time wouldn't talk to er. He can't legally, but she demanded the right because she was paying the bill. That doctor and I were dealing with the issue, and had I been left to making MY OWN DECISIONS about my life--thye Mom uninformed takes pysical and "legal action" to have me comitted. Had she left things as they were, the situation would have resolved itself without anybody interfering with me and my doctor.
She meant well. She admitted later that she had made a mistake in what she did and how she did it. What kind of "I'm sorry dear, I didn't mean to insult your intelligence and mental capacity But, I have a power of attorney, and I'm not changing it. You just trust me."
"Mom you don't understand what you;re doing. I have no access to the doctor; I have no power to see that your wishes are fulfilled.
Mom changed the legal papers about two weeks after I told her that the time was drawing near that she would have to move to a nursing home, and as things were, I had the final decision. I mad her mad and she's acting like a child. I couldn't actually swear to the amount of changes that her mental capacity has slipped.
That's at least part of the reason I was removed as her medical power of attorney. Mother knows Vivian will do exactly what she says she wants, no matter what. Mother and I had a disagreement this morning over her care. She wanted to call the paramedics because she was having trouble breathing. She just started some very strong antibiotics last night, and I told her to take the next one when I was at her house at 5:00am. As antibiotics start to work, sometimes you feel worse before you feel better. She wanted to go to the hospital before the last thing the doctor told her to do had time to work.
She called me just about 4:00 am, said she was having trouble breathing, her caretaker Liz was with her, and she wanted to call the paramedics to take her to the hospital. Anyone with experience knows, when you go to the emergency room, you go throught triage, so that the most injured patients receive the first care. It's a great idea, but the way things have always worked out when we've gone to the emergency room at Baylor, is that you can plan to spend six to eight hours for the emergency room to go through its process. If the ER is overloaded, patients are put on gurneys and they wait in the hall.
Is this what a person should be wanting to go through if they've developed spells, where they can't get their breath, as well as other issues that Mom needs to describe, because her descriptions so far have become generic and vague, and she has become a slower thinker.
Mom had called her internal medicine doctor, Dr Armstrong in the early morning hours and had recieved a call back from the doctor on call for Dr Armstrong. She called when Liz was with her, before I got there.
I asked her what the doctor said, and she fumbled with her bed surroundings and said, with pain in her voice, "I don't know."
I wasn't upset because it was 4:00 am and she called for me to wake up, get dressed, and get to her house ASAP. I was mad because she had slipped into her role as a difficult patient.
Some of the general human psychology that goes along with issues like this is a natural instinct to rebel when you don't have control of your life, and somebody is telling you what to do. It's the way I react, I was more than rebellious when my Mother trapped me in her locked backyard with the dog that quite cool November morn.
My mission is not payback or retribution. My mission is to get the paperwork straight. I went online and paid $20 for a Medical Power of Attorney form for the State of Texas, and my Mother needs to get two witnesses and sign it.
When I left about 5:30 am, my Mother was caught up in a businessw whirl. "I've got to pay Liz for staying the night with me." So wherever she keeps her purse, which I couldn't find with directions only yesterday, she found it, brought it to the bedroom, and wrote out a check to Liz who was saying that wasn't the most urgent thing to be doing at the moment. Mom's proud about keeping her bills paid.
On the regular bed, Mom had started a packing pile: her lage bag of medications, a couple of house coats, maybe her comb and brush had made the pile.
I understand Mom wanting to live at her home as long as possible. That's what I'm trying to help her do. In talking to me she was trying to anticipate if this would be her last trip to the hospital, and she was asking for help from both of us on what to pack.
I had wandered around the house, and been in Mom's bedroom when needed, and I stopped in front of her bed, looked at her and came to my own evaluation of the situation. Okay, she says she needs the paramedics to take her to the hospital because she's having a "spell" and breathing problems. For 15 or 20 minutes by that time, I'd been watching her rush around the house, here and there and back again. A good part of the time, she was walking AND carrying on a conversion with Liz or myself. Mom had parked herself in bed. I saw no visible signs of ANY shortness of breath issues.
At this point, I thought pointing out to her that she wasn't having breathing problems, and therefore, logically, didn't need to take her to the hospital. When her second husband died, he also expired from congesative heart failure. Mom said he went to the hospital and the doctors were able to draw some of the fluid from his body. She's expecting that to happen as she's preparing to head for the ER.
Then came up the DNR--do not ressucitate. Mom said they didn't need it at the hsopital. I know for a fact they ask for it at the nurses station, because they asked one before and she didn't have a copy with her. Vagueries in my brain where shouting , "a DNR means don't help me. Let me live or die at God's speed." If one has a DNR, and is in the final stages of congestive heart failure. . . why would a person go to the hospital when they don't want help. She wants to die at home.
A wheelchair is being delivered to Mom's house today. I suggested that we went one to get her to the doctor's fifth floor office. Mom made a few inquiry calls, and she found out she was elligible for medicare to bring her a (non-motorized) wheelchair for use at home, rather than relying on her walking roller with the rolling chair. Another reason that rolling chair was a great idea is because she can use the seat of her chair to carry the things she needs with her:telephone, water, snack, etc. But it's even better with a wheelchair, I would think, because you only have to worry about falling out of the chair. If she went to the hospital this early Friday morning, she would undoubtedly miss the delivery of one piece of useful and needed medical equipment.
I don't have a good grasp of what Mom's spells consist of. It would be useful to everybody, like the doctor, is she could think about it hard and write down all the symptoms she was having, and the next time she had a spell she could add anything else she noticed.
I'm not the doctor, just the only child daughter who does not have medical power of attorney. Maybe the doctors would all be nice, not refer to the LEGAL paperwork and directives, and we would experience no hang ups or problems.
Almost as an afterthought: isn't this just another version of what gay couples want to be married for. It's American legal rights, and my Mom got the paperwork wrong.
It's difficultnot to be emotional with her at this point. Whatever I said this morning got her yelling at me at one point in time. I observed that yelling caused no change in her breathing pattern. These spells just come and go in the night, and I'm not sure she's even timed one to see how long it lasts.
She is definately retaining fluid in her body tissues, because her face is swolen up, on both side now, quite noticeably. Her shortness of breath indicates that she has fluid building up around her heart.
If the doctor can draw off fluid, Mom needs to wait until she can go through regular admission to the hospital, rather than going through a crowded and streesful (for everybody) ER admission. She could go through the ER process, and if she's not having "a spell" at the time, they can't diagnose or treat anything. We would probably both be very tired, with a good deal of environmental stress added in.
If I could talk to her doctor, I'd ask if he could prescribe or reccommend that she have oxygen available for when she has trouble breathing. She could use it just when she needs it. I hear ads on televison about portable nebulizers. I looked at some on the Internet this morning. I don't know how she gets one, or even if this is a good idea. Maybe Vivian has a good idea.
I am very frustrated. My mother uses my bipolar disorder so she can always get her way and have last word. I feel very strongly that her last word isn't right. I'm concerned about her care. I'll have a new Medical Power of Attorney ready for her to sign this afternoon, whihc is 100% guaranteed legal, and cost my debit card $20.00.
This matter is not over. I won't conceal what this has done to me emotionally, because I count as a living breathing human being, deserving respect too. I pray that my Mom still has the mental ability to realize what she has set up for herself. If she doesn't respect my place at her side at this time, she needs to change the paperwork. Legal documents are binding. I won't fight with Vivian because I'm not sure I have the patience. I don't mean to hurt anybody's feelsings, but I'm frustrated over something in which I have no voice or authority now, I'll cry instead.
She knows that I will do what's best for her in whatever situation she ends up in, and there's a possibilty she won't like it. She keeps forgetting that her time on earth is premeasured by God.