Tag Archive | geriatrics

Learning to trust

All the astrologers who warned that the “eclipse season” this month was really going to shake things up were apparently not kidding around.  Just a couple days before the lunar eclipse on August 7, I learned that the position I’ve held with my company for almost 7 years is being eliminated and I’m getting laid off at the end of the month.  There’s a decent severance package, so I’m in the fortunate position of being able to take a little time to rework my resume and consider this unexpected change in career direction without needing to panic about how to pay rent… but I was still reeling a bit from the shock when…

Two days before the solar eclipse, I got a call from the owner of my mom’s care home. I was up in Portland visiting friends and we were in the car driving to meet some other friends for a fun event when my phone rang. When the owner of the board and care told me she had to call 911 for my mother, my stomach dropped to somewhere around my feet. I thought she was going to tell me my mom was dead or dying, I truly did. After learning that it wasn’t (necessarily) something immediately life threatening, I explained that I was out of town for a few days and asked her to call my niece. When my niece texted me that she was also out of town, I texted two other friends who have helped with Mom in the past. They were also out of town. As luck or fate would have it, ALL of my usual “go to” people were out of town that weekend;  even the pastor’s wife, the only  person from Mom’s church for whom I have contact info, is on sabbatical. That’s when I started melting down. Thankfully I was with two of my oldest and dearest friends, who let me have my freak-out and then calmly helped me start problem solving.

I take the responsibility I have for my mom’s care very seriously. I know she trusts me, that she now  looks to me for the kind of comfort and security she gave me when I was a child. It was absolutely unacceptable to me that she was alone in a hospital ER for hours, to say nothing of the fact that she wouldn’t be able to answer any of their questions about her medical history. But the hospital had been given my name as emergency contact and they reached out to me when they needed answers.  And at my friend’s suggestion, I reached out to the hospital chaplain, who kindly agreed to check on my mom in the ER and reported back to me that she was calm and lucid. The pastor’s wife forwarded my email to someone else from the church, who started a prayer chain and organized two volunteers to visit Mom at the hospital.  And none of it was ideal, but it was OK. Mom is OK, or she will be.

She was admitted to the hospital after nearly 7 hours in the ER, with a diagnosis of pneumonia and pulmonary edema. She had fluid in both lungs and was having difficulty breathing, but quickly started improving once they started her on oxygen and antibiotics and increased her Lasix dose. I spent a lot of my time in Oregon on the phone, managing her care as best I could long distance and keeping the family updated.

After three nights in the hospital, they were ready to discharge her to skilled nursing rehab. I was supposed to be home in time to manage that in person, to get her discharge instructions and be with her for the transition, but my flight was three hours late and the hospital had already made the transfer arrangement. I was pretty unhappy about that, and am still pretty pissed off that they let a dementia patient sign off on her discharge instructions and didn’t go over any of it with me via phone, but… again… while it wasn’t ideal, it was OK. She survived. I survived. We’re both feeling a whole lot better today.

I know that there’s a lesson in the confluence of these two events, losing my job and my mom having a medical emergency when I was out of pocket. I wish I could sum up that lesson neatly in a sentence or two, but right now all I know is that it’s about letting go of control and learning to trust.

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What’s new on the medical front

After 24 hours in the hospital for observation and follow-up visits with a geriatrician, her cardiologist and (finally today) her neurologist, here’s the latest. The hospital cardiologist ruled out the need for a pacemaker. After reviewing the results of the heart monitor overnight, he concluded that her heart rhythm is not slow, just irregular. Both he and her regular cardiologist wanted to blame a medication called Sinemet that she takes to help with her gait and balance, because one of the side effects of Sinemet is a drop in blood pressure. That’s what they think caused her to faint in church that day – either a sudden drop in blood pressure or something called a vasovagal syncope, caused by straining on the toilet. Apparently that’s a common cause of fainting in the elderly. (File that under: Things I never wanted to know about getting old.)

She was discharged with no changes to her medication. At the cardiology follow-up, he suggested asking the neurologist about reducing the Sinemet dosage. But he didn’t seem particularly concerned about a single fainting episode and said it was fine for us to wait until the September appointment with the neurologist to review that.

The neurology appointment got postponed by two weeks because the Medicare Advantage HMO failed to authorize it in time (don’t even get me started on that), but we finally saw Dr. O today. She was impressed by Mom’s energy level, how well she’s walking (no shuffling, easily navigating corners with her walker) and the lack of tremors. Her one concern was that Mom’s blood pressure was high (170/60), in spite of all those blood pressure medications she’s on.

Dr. O didn’t give her one of the standard memory tests this time; instead, she just made conversation, asking her what she does all day. Mom replied that she lives in an elderly care home with some very nice people. Dr. O asked if there are activities, do they watch a lot of movies? Mom: “I entertain myself by doing puzzles and reading, mostly. There aren’t a lot of activities, but sometimes we all sit around the table and play… something.” She looked at me hopefully, expecting me to fill in the missing detail, but I’ve never been there when they were playing a game at the table. I asked if they still do exercises in the morning, and Mom said yes and demonstrated the type of seated exercises they do. Dr. O seemed satisfied with that, though I know she’d be happier if Mom didn’t spend 98% of her day sitting.

When asked how she’s been feeling, Mom replied that she’s doing great. I told Dr. O about the fainting episode and resulting hospital visit. When I raised the question about the Sinemet, Dr. O shook her head and told me that with Mom’s BP as high as it is, she doesn’t think it’s having a significant BP-reducing effect — certainly not enough to warrant removing a medication that has made such a positive difference in her mobility and energy level.

Dr. O is ordering a carotid artery ultrasound to check for narrowing or partial obstruction of the carotid arteries. This was not a comfortable thing for me to hear, since a blockage of the carotid often leads to heart attack or stroke, but I’m glad she’s getting tested for it. According to WebMD, one of the first indications is often a TIA, which I am pretty damn sure is what happened to her when she ended up in the hospital three years ago and we started down this road together. You’d think they’d have done this carotid artery ultrasound back then, but nothing about the slipshod medical care she got back in that small mountain town surprises me anymore. It’s getting checked out now and that’s what matters. For all my frustrations with the administrative aspects of her medical group, I am truly grateful for the great team of doctors she has now.

Next week, it’s the kidney specialist.