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On June 4 my mom was in a traffic accident. She was traveling home from day care when the driver had to slam down hard on his breaks to avoid a collision in traffic. He did NOT call the police instead he continued on his rounds dropping off people.
we were informed he would bring her home first to make the decision. I am deeply indebted to my mom's home care attendant and her husband for screaming at the driver for waiting so long This was an an act of share stupidity and it lacked compassion. Mom looked as if someone beat her up. She had a swelling on her head the size of a golf ball.
Unfortunately I made the decision to take her to the local hospital which was a city owned. It also has to serve the drug addicts the undeserving. I saw one of them lunge at the EMT people who had brought him in, he was bleeding. This is what we had to wait in the hospital's ER to be taken care of. I keep thinking of how the ambulette driver wasted 30 min of my mother's life.
I wish we had made the extra mileage and went to the hospital where her geriatrician has admitting priviledges, but I was afraid of the time element. I was prabably right to go with my first instincts.
At first it was a short stay and I was happy with the resident, he had excellent communications skills. and kept me informed of her condition.
Unfortunately the nursing and nursing aides were in short supply so mom would go hours without a change in those protective underwear things she wore. She hated being restricted to bed. She did not always get such caring nurses.
I had a conversation with one of the young ones and she said she did not really like working with the dementia patients. I asked her how she would feel if the situation was reversed and she showed NO change in attitude. She hated school, so when she was sick she was glad that she was in the hospital because she didn't have to study.
Fortunately the nurses and aides rotated as some cared.
My biggest blunder for which I can never forgive myself is that I sent her to a rehab, subacute facility instead of home care for physical therapy. I had spoken with a PT who thought that was best, but he didnt' know couldn't possibly care. It was not his mother's life.
My mother had been begging to come home. At first she couldn't because they were concerned by the benign tumor they found in her brain. I am so sorry I did not listen to her.
When she was in the subacute facility she seemed to be sleepy and the PT there had hopes for her recovery to be able to at least use a walker. However it was hard to teach her as she was always sleepy.
Mom continued to want to come home but I was determined that she get the best care and I thought they were providing it.
Two weeks later I answered a phone call from a psychiatrist at the city hospital. She had been moved there because of an overdose of the corticosteroid. They were using it because they were afraid the meningeoma would cause seizures so they were prescribing it. Someone made an error. I am only glad it was not fatal. I guess I should be glad for their honesty. However having her back in the city hospital was a bad idea this time around
I did not have faith in the housestaff and once again it was not always possible to have caring nurses and aides for her. She was in a brand new wing of the hospital but for all the glitz of high tech nothing beats having caring professionals and I was not happy with these doctors. It was always hard to get them to respond to pages and the attendings were not always easy to catch either. Not being geriatricians was not helpful either. I didn't feel that they cared about my mother or whether she ate. AT this point she was on pureed food. She had failed the swallow test.
The last straw was when a nurse decided mom was in pain and she asked me to leave, in fact insisted. It didn't matter that I was the caregiver and a blood relative. She had her hospital protocols to follow and family caregivers were not included.
One of my other friends who was a caregiver bumped into me in the corridor when she arrived to follow her mother to her room. She would also come to agree with me that the communication was poor. However her mother was too weak to move to a better hospital.
Since my mother was stable I was successfully able to convince my mother's primary care physician a geriatricin to let her be admitted to her hospital. It had to be done. The house staff would not even listen to me when I would made suggestions. I know my mother, I should have been listened to.So of course it had to be an AMA because they were not going to admit their housestaff could not do the job.
Moving her to the new hospital gave me more confidence that my mother could recover. I was very excited that she would be watched over by geriatricians and a nurse practitioner. I liked them instantly. Her doctor is also board certified in palliative care so she was not able to go on rounds to see mom every day but she kept in touch and would relay email questions that came to me after hours. Like late at night.
They had mom in a chair every day. Not like the city hospital which always had excuses for not doing it. Also a nurse at this new hospital said if mom didn't eat she would try to help her eat. The head of the geriatric fellowship program and one of the fellows would sit with mom in the AM rounds and try to feed her. Mom seemed to do better when someone was with her.
Finally it was time for that family conference. I was there on time. I had to face certain facts. I couldn't at that time. It was the first time I heard hospice mentioned. I know I did embarass myself at one point telling the fellow I could not bare to lose her. The anniversary of my father's death was right around the corner and at that hospital.
This time I would bring her home. I wanted her with me to be comfortable. She was not begging to go home any more which did worry me but I figured the geriatricians were right, who can sleep well, or eat right when they are poked at all the time and awakened at all hours for vitals.
They did tell me that she had more TIAs also known as transient ischemic attacks.These were in the back of her brain. She also had gall stones. I could not agree or consent to an operation for any of these things. She would not survive or if she did she might be in a coma. I could be the one to do that to her. Let her live out the rest of her life in comfort.
This is where I tell you how wonderful her home care attendant of nine years was a wonderful woman. She gave up all her vacation time so she could come back to us. She did visit mom a few times a week and once her family visited mom.
I also appreciate the work of the hospital social worker who did request that she be returned to us and it worked. I even offered to clean her office windows, I hugged her.
I plan on writing letters of commendation.
After mom was home, her aide returned as promised and within a few days did get mom to eat all her meals, even though they had to be pureed. I did also get an email or maybe it was while talking to her physician that she talked me into the hospice program. It is the one thing mom must fail at. Her soul must fight this disese to live.
First I learned how to give mom her insulin and then I quickly realised that I would something more than VNS.
Cabrini Hospital's Hospice service came highly recommended so I signed up with them. The hardest thing I did though was sign the DNR.
I am glad however that I did sign with them, when she had to be in the inpatient unit the nurses couldn't have been kinder.
Mom died as quietly and peacefully as she had lived. She was surrounded by those who loved her. I was even holding her hand. Secular date Sept 16, 2006, Hebrew date 24 Elul 5766.
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