Monday, March 8, 2010

Down the Rabbit Hole

I smell bad, I'm dehydrated, I've had one hour of sleep in a bed since Sunday morning and maybe a total of one or two more dozing off in hospital chairs.  I can't get the taste of bad hospital coffee out of my mouth and my head is in rebellion.  But, the first thing I did when I hit the door was turn on the TV and look for Law and Order.  Thank God I found some.  This is a really old one - Mike Logan and Lennie investigating a crime to turn over to Claire Kincaid and Jack McCoy.  It's a good one (that's an inside joke).  And I need a juicy murder with a twist because it's been a heck of a day.

I had been in bed almost exactly an hour, a Tylenol PM in my system to try and dampen the rumblings of a headache I felt toward the end of the Oscars, when the phone rang.  It was a little before 1:00 AM.  I should have known what was coming.  Who else called the house phone at that time of night but the nursing home?  I was too deep in the clouds to even get out of bed.  I think somewhere in my head I thought that if I didn't answer it, it wouldn't be real.  But my husband, damn him, picked it up and handed it to me, confirming my fear; it was the home.  And, they weren't calling to say hello.  Mother had not been able to breathe and her vital signs were off the mark, so they were reporting the ambulance had already left with her.  Here we go.  I tried to blink the sleeping pill away and heavily pulled myself out of bed and rummaged through the closet for the requisite emergency room uniform:  sweat pants, comfortable shoes and a fleece top.  I grabbed my book, made sure I had the iPod and cell phone and off I went, taking the short middle of the night trek to the Round Rock Emergency Room that I have taken so many times.  At least, I noticed gratefully, they had her in Room 2 this time.  All the ghosts for me seem to live in Room 3.  I have been there a few too many times.

Mother was already in a room, a full oxygen mask strapped on, along with all the normal accoutrements (IV lines, electrodes dotted all over her chest, leading to lines constantly checking her vital signs).  Once again, like the fateful day of the Steeler-Viking game, the ER had determined she had fluid in her lungs.  However, things were a little more intense than I've seen before.  The doctors were asking pointed questions about advanced directives and whether she would want to be placed on a ventilator if it came to it.  The way they were asking the questions, with a little more urgency and force than usual, I am sure did not escape her notice.  I tend to think it set the stage for things that would take place as the day wore on.  She has a brain disease, but she's not an idiot.  The information she is intelligent to gather gets in there and mixes with the disease and then gets scrambled, but it gets there.  And in a way that makes her highly dangerous, if only to herself.

The layman's version of her condition is that the ulcerations on her leg are infected and that toxicity is poisoning her and causing fluid to form in her lungs.  Already with one faulty heart valve, her 91-year old body can't work that hard to give her oxygen.  One of the two doctors, looking at her legs, pronounced that she was likely close to a state where amputation was once more in the discussion.  Again, she is hearing all this and processing it through the broken filter of her Alzheimer's.  However, legally, she is still responsible for her own medical decisions.  I do not have medical power of attorney, but even if I did, the legalities are complicated.  As long as the patient can be deemed reasonably competent (and she did know all the pertinent facts; what day it was, when her birthdate was, who she was, where she was, etc.), her wishes have to be followed.  That's legally.  But, it's never that cut and dry.  There's always pressure to get her to do what they want her to do, which is to let them treat her.  Being reasonable has never been high on her list of personality traits.

Long story short, seriously ill, she was admitted and taken upstairs, but there wasn't a lot of discussion with her about it.  The assumption, of course, is that she, having made her background as a registered nurse clear, would understand her own predictament.  That was likely a critical error.  She cannot stand the feeling of being out of control of her own destiny, she fears it above all else.  Add to that the sweet young male nurse with a bit of Adam Lambert flair who told her she would only be there for a "couple of hours".  Trust me, she took that literally.  She repeated that she had been promised she'd only be there "two hours" at least a half dozen times before they even got her settled in the room, and she would keep it up like a mantra the entire day.  She dozed a little at first, but the other thing she seemed to be very capable of was clock watching.  The two hours expired and she went nuts.  She tore off her oxygen mask and started becoming abusive.  She was refusing all care.  The target of much of the abuse, I extracted myself.  Groggy from no sleep on top of a pill meant to make you sleep, I knew I was treading dangerously close to reacting incorrectly to her tirades.  So, I excused myself and retired to the main waiting room, having already decided I just wanted her to be released back to her nursing home.  There is no point to trying to care for someone in that state.  The opposite effect was taking place, in my opinion; her agitation was so severe that she was increasing the trauma on her body.

But, the hospital had other ideas.  Not willing to simply let her leave untreated, they tried to coax me to strong arm her, and then they tried to coax her themselves.  The doctor, having failed at trying to reason with her, called in the chaplain, a kind, soft spoken woman who had lived in Pennsylvania for five years.  She was devoted to turning Mother around.  She did not.  All the while, the clock was ticking, I wasn't working, which means I was not getting paid and whatever mounds of paperwork I had left from the week before was likely growing.  I projected that onto a misintrepreted e-mail my boss had sent me, and drama on that front ensued, thanks to some intervention by my husband, who knows us both.  Summary of that sub-drama, my agitation and paranoia was increasing with the exhaustion and stress.  Toxic behavior, it seems is contagious.  Finally, the hospital staff gave up on her.  Probably in large part because by then she was throwing things.  When Greg and I walked back into the room to take her back to the nursing home, she was doing her best Linda Blair imitation.  She was practically vomiting obscenities at the patient group of earnest women gathered around trying to help her.  They took it all in as though she was telling them what a lovely day it was outside.  They truly are angels of mercy.

This is a highly edited version of a long and complicated day, but suffice to say, after depositing her back in her room, I limped home to fall asleep in front of old Law and Order episodes.  Mother, a nurse from the nursing home told me a few hours ago, went to play bingo.  Having committed what is tantamount to a slow version of Hari Kari on herself and caused me to declare this the second worst day of my life, she actually was pleased enough with herself to play bingo!  There just aren't words for how bizarre and off balance life with Alzheimer's is. 

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