Staying busy part 1: eldercare

Ever since I was laid off from my job in February, life has been exceptionally hectic. This seems completely counter-intuitive. This is because I obviously have much more free time than I did when I was working full time. Nonetheless, the free time seems to fill up fast with things that I either wish to do or that come up that I must do.

One huge thing that has come up is caring for my mother. This started the very day I was laid off when she fell and broke her wrist. About three weeks later, her left hip, which had been painful for months as the prosthesis from a much earlier hip replacement was rattling around loose in her femur, finally just broke. That is, her femur just started disintegrating. It was time to attempt a total revision of the hip replacement. This was a major undertaking that just a couple months before was seen as not worth the risks by an orthopedist at Kaiser Richmond. But now the risk of a failed surgery, becoming wheelchair bound, was already a reality.

The first orthopedic surgeon to look at her new situation, basically thought he could not do anything for her, but offered to refer us for a second opinion. The referral was to Dr. Bini, director of orthopedics for Kaiser East Bay. Dr. Bini was very confident he could fix her. “I can cut this and replace that; and if that doesn’t work, I have some other toys I can play with.” But he was very upfront about the risks: “For a 91-year-old, the anesthesia is dangerous. Or afterwards, she gets a clot and it goes to her lungs, that’s it. Or she gets pneumonia, which it’s unlikely she’ll recover from.”

We decide to move forward with it, and he schedules her for April 29th, at the end of an already full day of surgery for him. He just adds her in. So, there were three days of appointments for tests, including blood, urine, ekg, and biggest of all, a heart stress test with nuclear imaging.

Finally, she has the surgery. Dr. Bini calls me 5 or 6 hours after I left her with the pre-surgery team to say that the surgery went great, and that she came through it well. By Friday, she was recovering really well and they were planning on discharge to a rehab home the next day.

But the next day, Saturday, she started having terrible trouble breathing, and a chest x-ray showed patchy fluid throughout her lungs. It looked like pneumonia. By Sunday, she was moved to ICU, on an oxygen machine that helped keep her lungs inflated (bipapp?) and the doctors there were mostly talking to me about her health directive and “do not resuscitate” (DNR) status. We were all preparing for the end game. But I know these old Greeks, and her in particular. She’s too stubborn. Monday morning, the doc on watch suggested that she could be on the breathing machine indefinitely and that if she goes a couple days without change it might be time to think about pulling tubes out of her and just keeping her comfortable till the end. I said let’s see what we can pull back in terms of intervention and see how she does. So, over the course of a couple hours, we took her off the back-pressure oxygen, and got her down to just a little oxygen through a nose tube, not even a mask. And there started the big rally. The ICU docs were surprised.

She continued to improve through the week in terms of her infection and ability to breathe. However, she refused to eat, take her meds or otherwise cooperate in any way. Her lack of English, baseline dementia, and combination of lack of sleep and regular morphine all had her totally delusional. I was having to come in everyday to try to get her to eat and take some meds. By Friday, the ICU docs were again concerned that this was going to send her into decline again. And they felt like the hospital environment was a big factor in her disposition. They wanted to discharge her to a skilled nursing facility for rehab and focus on getting her on a normal routine. Saturday they did that, and sent her to Kaiser Post-Acute.  Of course, that didn’t change her attitude much. They called me this morning to talk to her about eating, letting them take her vitals, and starting physical therapy on her hip. I tried. Later in the morning, we (Sarah, Theo, and my friend David) all went there for a mother’s day visit, and to see what the situation is. I actually got her to eat several bites of pureed food (can’t blame her for not liking it), and let them get her vitals. It looks like that is going to be the drill for the coming days, until she gets oriented. Assuming she ever does.