The Same Day, A Year Apart

It was June thirtieth, the first anniversary of the death of my brother. Normally, I visit my parents every day to spend time with my father and help take care of him, but I had another stupid early work meeting to attend. There wasn't time to visit, so I called my mom and said that I would come over the next day instead.

At the stupid work meeting, we started off with a potluck to celebrate the birthdays of those born in April, May and June. That included me. I didn't feel like eating, so I just sat silently, while everyone ate and talked. It was a day of mourning for me.

Four hours into the shift, the house supervisor gave me a note and told me to call my brother. It was urgent. This wasn't good. As soon as my brother answered the phone, I asked if dad died. He answered, "yes."

We discussed what to do about our mother. I said that I would ask to leave work, go get mom and take her home with me. As I walked towards the supervisor, the tears started flowing. From the look on her face, I knew she already knew what had happened. She put her arms around me and I began sobbing uncontrollably.

Word got around fast and soon I was surrounded by my coworkers. They took turns hugging me. My memory is hazy, but I remember being told that I could leave, but not until I stopped shaking and sobbing. It wasn't safe for me to drive like that. I was led into the locker room and my coworkers took turns sitting with me.

Once I regained my composure, they let me leave. I drove to my parent's house and the hospice nurse was with my mother. I expected my mother to be hysterical with grief, but she was calm. The nurse had taken over and was busy calling who needed to be called. The mortuary was on its way to pick up my father.

The nurse asked if I would like to see my father. Immediately, I began shaking my head no and said that I wanted to remember him the way he was. She said it wasn't that bad. I kept shaking my head. My mother then said that she wanted me to see him. Defeated, I started walking down the hallway towards my father's bedroom.

My father died with a smile on his face. It was a Mona Lisa-type smile. As a nurse, I've seen plenty of dead people, but I've never seen any of them smiling. I can only speculate as to what my father experienced that left a smile on his face.

The next day, my mother and I prepared to visit the mortuary. We found my father's Air Force uniform and laid it across a table to look at it. The last time he wore it was to my brother's funeral. Now, he will wear it for all of eternity. We agreed it was a shame to bury such a nice uniform, but we knew what his wishes were. I did, however, remove one of my father's medals. His wings are now my most prized possession. I feel a little guilty and hope that my father wouldn't have minded. When I told Lindsay about what I did, he laughed and said that not only does my father know I took the medal, he wanted me to have it. Isn't Lindsay great in a moral crisis?

In getting the outfit together, my mother and I did argue a little. My mother didn't want to bury him in a shirt. She felt that the uniform was enough. Even though the military only does closed casket funerals and no one would see him, I wanted him to wear a shirt and tie. My mother gave in. Next, we argued about the shoes. Mom wanted to bury him barefoot. Eventually, she agreed to hand over a pair of dress shoes. The next fight was over socks. Mom said that dad had very few pairs of black socks and she didn't see the need to give him socks to wear. I settled that argument by going through the sock drawer and pulling out a pair of socks and taking them. Geeez.

The next thing I got ready was Christofur. That was my father's favorite dog, a much loved Dalmatian. Cris died a few years ago and was cremated. There are rules about dogs being buried in people cemeteries, so I gift wrapped Cris's box and asked the mortician to place the box in the casket. The mortician took the box, shook it, smiled and asked if it was a puppy. I didn't answer. The mortician said it was okay. He was a dog person and understood. He has hidden lots of dog's ashes in caskets for burial in people cemeteries.

Tomorrow, my father and his dog will be buried at Riverside National Cemetery with full military honors.

The Caretaker's Girlfriend

My father isn't doing well. He is on hospice, so our goal is just to keep him comfortable. My father survived being a fighter pilot and three wars only to slowly die from smoking. Emphysema is not pretty. It takes all of his energy just to breathe. He just lies in bed and needs to be turned, bathed, fed and have his diapers changed. Occasionally, he chokes, wheezes and coughs.

My father can't swallow because of his stroke, so we feed him through a tube in his stomach. The hospice nurse wants us to stop the feedings, including water. I am not comfortable with allowing my father to die of dehydration. The nurse said that his body would produce endorphins and he wouldn't suffer. I wonder how she knows that dying by dehydration is a good death. I've been thirsty and know how miserable it feels. I don't want to die from thirst and I won't allow that for my father.

Hospice provided us with morphine, so I have been sneaking it to my father. It is necessary to sneak it because my mother doesn't want him to have morphine. She is afraid it will kill him. I don't like seeing my father thrashing about, gasping for air and grimacing in agony. A little bit of morphine relaxes him and allows him to breathe easier. I'm a nurse and am comfortable with giving morphine to ease pain. My father isn't going to suffer because my mother has mistaken notions regarding pain control.

My father's former caregiver, the one who is in jail, did not take good care of my father. The day he landed in jail, we discovered that the tips of two of my father's toes were completely black. My father's toes must have been resting against the foot board. In addition, he has a black pressure ulcer on one of his heels. The caretaker was careless in keeping my father properly turned and positioned with pillows.

The caretaker's girlfriend dropped by to collect his belongings. Unfortunately, I wasn't there. My mother let her in. The girlfriend pulled a dresser away from the wall and a pile of beer bottles rolled out. The caretaker is a so-called recovering alcoholic and goes to AA meetings everyday. He also stole the beer that my father bought for me when I visit.

The girlfriend also went into my father's room and disconnected every cord connected to the computer. My mother watched and said nothing. It wasn't until she started to walk out of the house with the computer keyboard that my mother said anything. The girlfriend put it back and laughed it off as an honest mistake. Next, she started to walk away with my father's briefcase. It was the one he used for every court appearance when he was practicing law. It has priceless emotional value to me. Thank goodness my mother stopped her. Again, it was just an "honest mistake".

Now, there is a tangle of cords all over the floor and I have no idea how to connect them. I want to kill the caretaker's girlfriend. Of course I won't, but I want to. What kind of person walks into a room with a dying man inside and knowing that the wife has dementia, tries to steal a computer and briefcase?

Jail Bird

My father's caretaker is in jail. He got caught driving with a suspended license. Now, I'm back to square one in managing my father's care. It's annoying, but at the same time it is a relief. The caretaker was a fool.

When my mother kept calling and complaining about him, some of her concerns were legitimate. He would leave the house for several hours everyday. A couple of hours would have been fine, but to disappear for most of the day meant that my mother would have to change diapers. Some days, he would sleep until noon. This meant more diapers for mom.

The caretaker once showed up several hours late to take my father to a doctor's appointment. His excuse about slow freeway traffic didn't hold water. He either forgot, couldn't tell time or just blew it off.

Another time, my father had a doctor's appointment, so I came as "back up" in case he forgot again. I started getting my father dressed, but he told me that he would do it. I left the room and came back when it was time to leave. My father wasn't dressed yet. I got him dressed, but by this time we were running late. The caretaker came in and said in a whiny voice that he was going to do it. I mentioned the time and then he realized his mistake. He thought it was an hour earlier than it was. This confirms my theory that he can't tell time.

During the brief time the caretaker worked for my parents, my father became deathly ill twice. The first time, I found my father barely responsive. My mother had called and said that my father's diaper was filled with bright red blood. The caretaker had insisted that it wasn't blood, my father was fine and left the house as usual. He also borrowed my mother's car. Of course, I called in sick and came right away.

I figured that my father either had a urinary tract infection or was bleeding internally from too much coumadin, a high-risk blood thinner. Either way, he needed to go to the hospital, but I couldn't take him because my father's wheelchair was in my mother's car. I'm strong, but not strong enough to carry my father through the house and out to a car. I had to call 911.

The hospital determined that my father had a urinary tract infection and was severely dehydrated. The dehydrated part annoyed me. I had told the caretaker how much water to give my father a day and he hadn't followed my instructions. He had only been giving my father about a cup of water a day. What kind of fool would think that was enough?

My father was treated and released after a few days. This time, I removed my father's catheter, to avoid future infections. He didn't need it to void, it just made caring for him easier. The caretaker called and chastised me for removing the catheter. I'm still angry about that. He didn't care about my father's health. It only mattered what was easier for him.

My father later got dehydrated again on the caretaker's watch. I thought that he had learned his lesson the first time. He had increased the fluid intake, but when my father developed watery diarrhea, he didn't give him extra fluid to compensate. The diarrhea was the result of the caretaker deciding to give my father Milk of Magnesia. He made an honest mistake with the Milk of Magnesia, but to me, it is just common sense that if a person loses excess fluid, it needs to be replaced. I wanted to fire the caretaker, but my mother wouldn't let me, because although she also was unhappy with him, she felt sorry for him.

I have a long list of stupid things he did, but I think you get the idea. I'm glad he's gone. He's nothing more than a great big screw-up. And now, I'm back to going to my parent's house every day to provide care.

The Ordeal

I have procrastinated for so long, that I no longer know where to start. The situation with my parents absolutely overwhelms me, so I have avoided blogging about it.

It turns out that in addition to my father's emphysema and congestive heart failure, he also had a major stroke. That is why he is now fed through a tube in his stomach. He has enough strength in his arms and legs that he should be able to walk, but he doesn't remember how. He also doesn't remember how to turn over in bed. He wears a diaper and needs to be changed regularly.

I have no idea how much he understands. He can speak in complete sentences, but rarely says a word. When asked a question, there is a long, long pause. He may give a one word response or no answer at all. He doesn't know how old he is, but he does seem to recall the past, I think. I'm not really sure. At least he remembers that I'm his girl and tells me he loves me and that I'm the greatest.

My mother isn't doing all that great either. Recently, she called me and with slurred speech, said that she was having a stroke. She refused to call 911. She didn't want the embarrassment of big red trucks with sirens and flashing lights coming to get her. My mother hates being the center of attention. I had no choice but to go get her and take her to the hospital. By that time, the window period for giving a clot-busting drug had expired.

The stroke mostly resolved itself. Her speech is fine, but she leans to one side when she stands. When I remind her to stand up straight, she can, but soon she forgets and goes back to that Hunchback of Notre Dame stance again.

An MRI was done and showed that my mother has had many tiny strokes in the past. Her brain is like Swiss cheese. That explains a lot. Since my mother's mother also had dementia, I had assumed it was genetic and I might be next in line. It is a tremendous relief to know that I only have to continue to take good care of myself (and maybe take a baby aspirin everyday) and I should be fine.

The problem is what to do with my parents. Medicare doesn't cover nursing home care and it runs about 5 or 6 thousand dollars a month. Even though my parents are fairly well off, it would eventually eat through their savings and then their house. When everything is gone, then Medi-Cal would kick in.

I tried having my mother take care of my father and it was disastrous. She couldn't remember sometimes how to feed my father. When she couldn't remember, I would have to drive over and take care of it. It is 50 miles round trip and she forgot at least once, sometimes twice a day. I was exhausted from having to do this before and sometimes after my shift in the hospital.

My father is on ten different medications given at different times of the day. Even though I organized the pills in little pill boxes labeled for each day and time, it was impossible for her to handle. She also kept forgetting to give my father water. I would call several times a day to remind her of the things that needed to be done, but it didn't help and she resented being told what to do.

I soon hired a nurse's aide to come for two hours a day to take care of my father. He did a great job, but it wasn't enough.

Twice, my father ended up in the hospital with dehydration. The last time, he also had a pressure ulcer on his bottom because he hadn't been cleaned and turned frequently enough. This got us in trouble with social services. The hospital let us bring my father home only if we had a care plan that didn't involve my mother.

Next, I hired an out of work construction worker. A nurse's aide would have been a better choice, but they are too expensive. The construction worker lives at my parent's house and seems to take good care of my father. It costs two thousand dollars a month, which has my mother very unhappy. She calls me several times a week and complains about him and the money. I can't do anything about the money, but I have offered repeatedly to find someone else. She doesn't want the construction worker fired because she feels sorry for him. I get stressed listening to my mother complain.

In a one year period, my brother and both of my parents had strokes. My brother died, my father was left bedridden and my mother has dementia. In the last two and a half years, I lost three dogs (who were really children, not dogs) to cancer. I feel like my family is disappearing.

So, now that I got this over with, I will return to more upbeat posts. I just wanted to let you all know why I have been so quiet lately.

Georgie

Not that they were ever enemies, but my dogs had become especially nice to Georgie lately. They has always been a little jealous of him. But now, MacKenzie often sat next to him on the couch. She would kiss his face. Tommy, who had always been aloof, would sniff his face. I was happy that we were finally a happily family. But, it turns out the dogs knew something that I didn't.

My sweet, blonde cocker had become a finicky eater over the last week or so. I was begging him to eat roast chicken, roast beef, cheese, bacon, and anything else I could think of. Yesterday, he would only drink water.

He was also panting. The weather was fairly cool, but he has such a thick coat of fur, I thought perhaps a shearing my help cool him off. I sheared the fur around his neck and chest, but it didn't help.

I took his temperature and it was 103.5. His nose was chapped and a little bit of milky discharge was coming from his nostrils, so I made an appointment to see the vet that afternoon. In the meantime, Georgie would not sit or lie down. He just stood and panted. I figured that he had pneumonia and just needed some antibiotics.

The vet took some x-rays and said that his lungs appeared to be filled with fluid. There was also some distortion in his chest cavity, like everything was being pushed to the side. He thought that Georgie had heart failure which was causing his lungs to fill with fluid. Or, it could be cancer.

The vet said that Georgie was in critical condition and needed to go to a 24 hour emergency hospital. While I was in the waiting room, the vet came out and told me that Georgie was crashing. He let me come in the back. Georgie had passed out, but now an oxygen mask was on Georgie's face. He was doing better, but every time they tried getting the mask off, his tongue turned blue.

The vet said there was a good possibility that Georgie would die on the way to the hospital, but there was no alternative. The vet had me turn the air conditioner in my car on full blast and once the car was good and cold, Georgie was put in my car. He did fine on the drive. I think that the stress of being at the vets office was what had pushed him over the edge.

The next vet put him in a glass cage with pumped in oxygen. They let me stay with him. He looked so cute, just like a dog for sale in a pet store. I was able to put my arm through a port and pet him.

More x-rays were done and the vet said the Georgie had a hernia in his diaphragm and that his intestines, liver and other organs had migrated into the chest cavity. This was squishing his lungs and explained why he was so short of breath. It was something that could be surgically repaired. It would be expensive, but when it comes to my dogs, there is no such thing as too much money.

The vet found a thoracic surgeon who could operate on Georgie that night, but it was at a hospital in West LA. They had me wait a couple of hours until rush hour traffic eased up. They checked sig alerts and as soon as it looked okay, they let me take Georgie, again with the air conditioner running full blast. His tongue was a little blue on the trip, but he was a trooper.

So far, the day had cost me nine hundred dollars, but that was fine. My dogs are priceless and get the best of everything. At the surgical center, they asked for five thousand dollars and got it. I would have signed over title to my house if they had asked. I just wanted Georgie well again.

The thoracic surgeon was on her way. They suggested that I go home and wait, so I did. The surgeon called before the surgery to explain the risks and said that she wasn't at all sure that she could save Georgie. I told her to operate and just do her best.

About and hour later, the vet called in the middle of surgery. She said that Georgie had had the hernia for years and that it wasn't the cause for Georgie's respiratory distress. There was a massive growth on Georgie's lung and liver. It looked cancerous. If she removed his lung, the remaining lung would not be able to compensate. His prognosis was extremely grim. She recommended not waking him from the surgery. In tears, I agreed to let him go.

My heart is broken and I can't stop crying. Georgie came from the pound and I only had him for less than two years. It's just not fair. Four months ago, I broke my dependence/addiction to Xanax, an anti-anxiety drug. Now I'm back on it, big time. It's not doing anything for the grief, but at least it made the panic attacks stop.

In the meantime, a candle, with his collar in a circle around it, is burning. Lindsay, my boyfriend, said that it will help guide his soul to Heaven. Lindsay is more spiritual than I am, but who am I to say it won't help? Rituals serve a purpose sometimes.

Swinging In The Wind

This is an update to my post, "The Misunderstanding," dated April 4, 2009. This situation involved a patient who was made a DNR (Do Not Resuscitate) by mistake. The patient died because when he went into cardiac arrest, we let him die. The family claims that the patient never would have agreed to be a DNR and didn't speak enough English to understand what the doctor said about a DNR. The patient would smile and nod his head just to be polite. The doctor took the nods of the head to mean that the patient wanted to be a DNR.

I don't know if we have been sued yet, but the investigation is still ongoing. One of the administrators called me into his office the other day to discuss the case. He had read my version of the events and wanted to know what I was talking about. He had the computerized chart open and the patient was clearly a full code. I felt like I was in the Twilight Zone.

When the patient had gone into cardiac arrest down in CAT scan, they called me because I was the charge nurse that day. They wanted to know what to do. I told them not to call a code because the patient was a DNR. They soon returned the dead body back to us. The family unfortunately showed up before we had a chance to notify them and found their dad lying dead in his bed. Things went downhill from there.

So, now I'm looking at a chart that shows the patient was a full code and wondering if I have lost my mind. With more confidence than I felt, I said, "He was too a DNR."

One of the great things (and bad things) about our work computers is that you can't entirely erase what happened. We did a search of the order history and discovered that the doctor had deleted the DNR order the day after the patient died. This is evidence that the doctor knew he screwed up and was trying to cover his tracks. He probably didn't give it much thought, but in his haste to protect himself, he left the nurses (and especially me) swinging in the wind. Changing the patient's chart made it look like the nurses just twiddled their thumbs when the patient went into cardiac arrest. Well, in a sense that is what happened, but we did nothing because we had a written order not to call a code.

I should be angry, but my reaction is more astonishment than anything else. It amazes me that the doctor thought he would be able to get away with it. He altered a legal document. If we are sued, the opposing attorney will feel like he has won the lottery when he discovers this.

Getting Dad Home

Negotiating my dad's release from the nursing home was harder than expected. After finally convincing my mother to let me bring him home, I showed up at the nursing home, unannounced, and said that I was taking him home. They wanted to know why and I told them. In a calm, professional voice I told them how unhappy I was with their facility. How, while under their care my father had gone from being able to walk to now, just lying in bed, day after day, with no one getting him up. He was so weak, he couldn't even roll over. He had also lost an alarming amount of weight. He looked deathly ill and was barely responsive. They called the doctor for discharge orders..

The doctor suggested that my dad go to the ER . That was fine with me. I knew dad was sick and would die if he stayed in that nursing home much longer. The ER sounded great to me.

The nursing home called an ambulance and we met up at the ER. Dad was admitted to the hospital with severe dehydration, malnutrition, urosepsis and aspirational pneumonia. Dad had lost 15 pounds during his two or three months in the nursing home and he was skinny to begin with. That is criminal.

After a week, my father was discharged back to the same nursing home. My mother is not in her right mind and no one consulted with me in advance. As soon as I heard about the transfer, I called the nursing home and said that I would be over to take him home. The director of nursing called me back and begged for another chance to get my father better. She said they had a team of physical therapists who would get him up twice a day. A speech therapist would work with his swallowing difficulties. The hospital had discovered that he couldn't swallow safely and had inserted a G tube (gastric tube) into his stomach through which he was now being fed. She convinced me they had skills that I lacked and that his best chance of recovery was with them. Sometimes, I'm such a fool. I gave her one week.

After the week was up, dad looked as bad as ever. No one had gotten him up and the speech therapist did not even try to get him to swallow. I was livid, but said nothing about the care. I asked for the discharge instructions. While reading through the list of medications, I felt a growing rage. They had been giving him thorazine. That is a drug which is used to chemically restrain out of control psych patients. No wonder dad was such a zombie.

The explanation was that they were giving it for hiccoughs. That is a possible use for the drug, but they were giving it around the clock, regardless of whether dad had hiccoughs or not. They were sedating an old, bedridden man as though he were a young, violent maniac.

Then, I noticed the absence of a critical medication. Dad has A fib, which is a type of heart arrhythmia that causes blood clots to form, if not treated. It leads to strokes. Coumadin is the treatment for this problem. Dad had been on coumadin, but now he wasn't getting it. I looked up from the paper with my eyes in a death glare. The nurse winced.

In a soft voice, I said that my father had A fib. I asked if he had received any blood thinners. The nurse said no. I didn't know who I wanted to kill first, the doctor or the nursing home people who failed to bring an obvious oversight to the attention of the doctor. I took a deep breathe and left to go get my dad in a wheelchair.

Once we got home, I somehow got dad out of the car and into the wheelchair. It wasn't easy. He is dead weight, but somehow, I did it. While going through the garage, dad suddenly stiffened, his eyes rolled back and he started sliding out of the chair. I grabbed him under the arms and yanked him back up. He was stiff as a board. I couldn't stop the fall, so I helped glide him gently to the floor.

I thought he was dead.This couldn't be happening. I went into nurse-mode and quickly determined that he was okay. He had just fainted. He had been laying flat in bed for so long that sitting upright caused his blood pressure to drop. Lying flat on the cold, concrete floor, he was fine. But, now what? I'm strong, but I can't lift a grown man off the floor and into a wheelchair.

I went in the house, got a throw rug and rolled dad onto it. It was a cold day, the concrete was cold and I figured that he was going to be there for a while. It was time for a beer.

While drinking the beer, I considered the options. Calling 911 was tempting, but the paramedics would just take him back to the hospital. It seemed doubtful that they would pick him up and put him in bed for me. My mother suggested having him live in the garage. We could put a mattress on the floor and make it nice. Mom may be nuts, but at least she still has a sense of humor. We laughed at our predicament.

Once the beer buzz took effect, I went in the garage, picked up my dad and put him in the wheelchair. Soon, he was in bed. Then, the real work was about to begin. I had to teach mom how to take care of him.

To be continued, if I get around to it.