Going Solo

 February 21, 2021

I've been "going solo" - single, divorced, no longer married - for almost a year.  10 months.  Though sometimes missing the companionship that comes with a marriage, I've never questioned my decision to end my 17 year marriage.  

What are we going to do about Mom and Dad? Part 5

Mom returned home this week after two weeks at a nursing/rehabilitation hospital.  While receiving in-home physical therapy for her injured left knee, her right knee collapsed.  With two injured (non-supportive) knees and noone at home but Daddy to care for her, we requested Dr. R. refer her to Quality Care.  Mom, of course, was resistant to this.  Having volunteered at this same facility in the past, it was an option she hoped to never exercise.  We countered all her concerns with the reality that Daddy could not care for her and her children were (uncharacteriscally) unavailable to move in for an indeterminate amount of time.  There was the expected back and forth - Mom worried about Daddy being alone (my brother stayed with him at night) and, of course, the expense.  Because  Mom's injury was soft tissue, Dr. R. had no diagnosis for hospitalization - a Medicare necessity.  This stay would be out-of-pocket.  That was a difficult pill to swallow.  Once Mom accepted the reality of their situation (and the fact her children weren't backing down) she wrote the check for two weeks stay (required before admission.) One detail that necessitated Mom's stay at Quality Care is the fact their home was built early 1900's - doorways and hallways too narrow for wheelcare access. Her "graduation" home would be based on her ability to get around on her own (with a walker.) When she was told she would not be receiving physical therapy on the week-end, she insisted otherwise! My Mom's determination, while often counter productive when it comes to her health, would serve her well under these circumstances.  Now that she's back home, physical therapy will resume at home.  With PT and Mom's determination hopefully she will be able to avoid surgery to correct the damage done.

What are we going to do about Mom and Dad? Part 4

So far our plan is working.  My sisters and I visit regularly, update Mom and Dad's medical calendar and medications list, stock the fridge.  My brothers take care of any minor repairs in their home; drive to out of town doctor's appointments.  During my latest visit, I took Mom to Jacksonville to have her pacemaker battery replaced - a one day event.  She recovered nicely from this minor surgery.  A fall in the backyard the week before had injured her knee.  My father was able to get her up and in the car for a ride to a nearby drop-in medical facility.  Xrays indicated no fracture - which in itself is pretty amazing.  Falls and fractures are common for those of us over 80.  The only recommendation given was moist heat applied to the knee.  No physical therapy ordered.  Two weeks post event, Mom is still unable to walk without pain in her knee.  Time for a recheck with her primary physician.  We pick up the xrays already taken to avoid any further radiation.  Chris, the Physicians Assistant, examines Mom's knee; Dr. R. takes a look at the xrays and examines Mom's knee.  They agree:  physical therapy needed.  Mom was quick to request in-home treatments remembering the difficulty of transportation into town 3x a week for therapy for a previous injury.  (This is something I highly recommend as an option.  Medicare will pay for in-home treatments when prescribed by a physician.)  The next day a nurse came to their home, evaluated Mom's situation (and took a look at her pacemaker incision sight to assure Mom it was healing properly) and scheduled a Physical Therapist to come the next day for further evaluation.  The PT arrived on schedule, examined Mom's knee and took a tour of their home to recommend any changes to be made to accomodate Mom's walker which she now must use at all times until it's determined she is stable to go back to her 4-pronged walking stick.  Because their bathroom only has a shower stall, I'm told to purchase a shower stool (we had already installed a handle bar.)  The PT also recommends a toilet chair (which Dr. R. will prescribe and Medicare will pay for) that will fit over their existing toilet to not only sit higher but also provide "arms" for Mom to use for support.  As for treatment of her knee, ICE (not moist heat) applied 20 minutes every hour.  Since Mom takes Coumudin she can't take an anti-inflammatory.  She will continue the Acetominophen she takes for arthritis.  I was able to find a version that she takes every 8 hours (instead of every 4) which eliminates one more thing to remember!  A PT will come three times a week for her therapy; Mom will do her exercises in between those visits.  If all goes well, she'll be back on her feet pain free within 3 or 4 weeks. 

A minute about Medicare.  I'm not a scholar on the topic but it doesn't take a genius to recognize the amount of Federal dollars it takes to sustain this program.  While my parents have money in the bank to pay for the services mentioned above, manageing their resources wisely not only ensures their continued ability to remain independent, it also enables them to feel secure financially and not dependent on their children (or others.)  This is truly a conundrum.  Are they not dependent on the govenment to provide?  While they have resources set aside, they are finite.  My Mom is continually watching the bottom line and juggling to feel they "have enough".  Social Security supplements.  They (and their children) are fortunate to have been able  to "put aside" money through the years for this formula to even exist.  But, without monies and services they receive from Uncle Sam (taxpayers), those savings would have been exhausted long ago.   Only time will tell how all this plays out in the future.  For now, Medicare supplements enable my parents to afford medical interventions that sustain them.  How long Uncle Sam can afford to sustain Medicare is the larger question.

Addiction

Marian Webster dictionary defines addiction as  "persistant, compulsive use of a substance known by the user to be harmful; a compulsive need for and use of a habit forming substance, characterized by tolerance and by well-defined psychological symptoms of withdrawal."  Alcohol, illegal drugs, prescription medication, over-the-counter medication, gambling, sex, cyber-sex, pornography, video gaming, food, shopping, exericise - the list of potentially addictive substances and behaviors has grown as our ease of access and exposure has increased.  Few (if any) of us can say we haven't been touched in some way by addiction  (professionals in the field of addiction cite 10% as the rate of incidence in a population.)  Yet, lack of understanding of addiction, limited access to services for the treatment of addiction, and social stigma continue  to be roadblocks to an individual's successful recovery.  For those of us fortunate enough to not fit the criteria of an addict, it is often difficult to understand the phenomenon.  A common refrain is, "why don't they just stop?"  The short answer is, "they can't."  The simple interpretation of a complex medical model is that chemical substances either ingested by an individual or triggered behaviorally in the brain have the potential in 10% of our population to result in a compulsive need for the chemical.  What often begins as an innocent, pleasurable exposure to a substance (or activity) can result in a lifelong compulsive need by the brain in order for the individual to avoid the painful and potentially life threatening symptoms of withdrawal from the chemical.  (A chemically addicted individual will tell you that their continued use of the chemical no longer produces a pleasureable result.  They will tell you that continued use of the chemical helps them feel "normal".)  Scientist don't have a clear understanding why one individual's brain can experience the results of a chemical and not develop the compulsive need and another individual's brain will.  There is data suggesting a genetic link.  Yet why are some family members addicts and others not?  We do know addiction is a chronic disease of the brain.  As with any chronic disease, with appropriate treatment there is opportunity for long-term recovery.  As with any chronic disease, there is potential for relapse.  Until science solves the mystery that is addiction our options are limited.  Education, affordable treatment options, long-term recovery support and empathy are our tools for now.   

Change

A framed poster on the office wall of a former colleague was of the comic figure Dilbert with the words "Change is difficult...YOU go first!"  Sage expression.  Fear of the unknown, of change, can keep an individual in a situation far from satisfactory - sticking with the familiar rather than risking something new.  Counseling an individual in an abusive relationship would be the most glaring example of this phenomenon.  Though a glimmer of light may shine at the end of a long tunnel to freedom, choosing to stay can seem the only option.  Those of us on the outside may easily see the benefits of leaving, from the inside of the relationship leaving seems impossible.  Only through the often difficult work of counseling, a workable escape plan, and the state of mind to drive the process, can the individual hope to embrace change.  This same model applies to anyone facing the possibility of change.  Though the scenario may seem far less dire than the one highlighted above, finding the courage to change any unsatisfactory life situation can feel overwhelming.  Exploring options, building a change plan, and finding the courage to get started could be the beginning of something new.  The poster could then be "Change is difficult....I'LL go first!"

What are we going to do about Mom and Dad, Part 3

My Mom returned home yesterday from a five day stay in the hospital.   The scar tissue in her lungs, the result of chronic bronchitis as a child, coupled with breathing the smoke from a nearby forest fire, resulted in congestion in her lungs which became pneumonia.   This is a situation revisted often over the last 10 years.  Vigilence and prophylactic measures were not enough to ward off infection.  This latest episode gave me and my siblings the opportunity to continue our email conversation about whether or not it was time for our parents to move from their home to an extended care facility (the term my oldest sister uses rather than "nursing home" which carries too many negative connotations.)  After much back and forth, my brothers, who live closest to our parents, feel moving them while they are still able to manage on their own would be traumatic and premature.  I agree.  The question I brought up is how do we define "manage on their own"?  Since my brothers are, due to proximity, providing supplemental care, we will have to depend on them to be clear about what they can and cannot (or will or will not) do to help our parents "manage".  It's clear we will have to monitor the situation over time, adjusting the situation as needed.  Meanwhile, we will continue to explore options for their care both in their home and, should the time come, somewhere else.

It's been a month since I wrote the above.  A trip home and a meeting with my two brothers and my oldest sister was not the smooth operation I anticipated.  The feelings expressed in previous emails set me up (I believe) to be slammed by their true feelings about the burden they feel caring for our parents has become.  My sister and I walked away a bit shaken and knowing we would have to come up with a new plan of action.  We spent several days coordinating our parents doctor appointments, getting releases of information signed so that we can speak directly with their doctors, getting a clear understanding of the medications they currently take, and making sure we had all appointment dates on not only their kitchen calendar, but also on our own individual calendars so that we can monitor and manage their doctor appointments from a distance.  It was decided that Daddy is still okay to drive to appointments, etc. in their hometown.  Any distance driving would be handled by one of the visiting daughters or, if necessary, by one of our brothers.  It's clear that aspect of care has become too burdensome for them.  Weekly housekeeping was arranged (until now they have been managing on their own with occasional help.)  Daddy has agreed to having someone help him with the yardwork - something he has fought long and hard.  The one area yet to be addressed - we're still investigating options - is preparing meals.  Mom, for the first time, has voiced the difficulty this detail entails.  Most social services that provide meals require - understandably so - financial need to be established.  Not an option for them.  For now, the "girls" will stock the kitchen when we're in town.   We'll explore the possibility of the housekeeper assisting with meals.

My sister and I drove Mom and Dad, taking days in between for rest, first to Georgia (my home), then to Tennessee where my Father has siblings living, then to Virginia and my sisters house. Here they visited an assisted living facility my sister is familiar with.  My mother was ready to move in - her usual response.  Daddy, while pleasant and appreciative, was adamant it's not for him.  Atleast they've seen the option and, if push should come to shove, they would have an idea of their destination. 

So, Plan C is Mom and Dad back home at the river with regular housekeeping help and occasional yardwork help, the "girls" coming for extended visits every month, with our help managing doctor appointments, etc.  Everyone seems happy with this arrangement.  Everyone also realizes it is a stop-gap arrangement sure to be ammended over time.

This process has left me with a greater appreciation of just what it takes to "live forever".   It brings to question all the magazine articles and television programs about aging and how to extend our "stay".  There's a great line from a song by Loudon Wainwright III, "...if you're not a millionaire, you better be."  Understanding just what it takes to "live forever", not only the dollar amount, but also the physical and mental cost of not only the individual, but also those attached by blood or the legal system, it begs to question whether "living forever" is all it's cracked up to be.

Loss

Feelings of loss can accompany any number of life experiences:  death of a family member or pet, loss of a job, chronic illness, aging, divorce, financial reversals to name a few.  Each carries its own weight; each carries its own degree of loss.  When my beloved black lab, Mia, was hit by a car and killed, I was devastated.  For days, all I could do was lay on the couch and cry.  Whenever I thought of all the ways Mia filled my life, I was struck down by another wave of grief.  It took months before I could walk through the woods we walked together.  During this same time, I was going through a difficult divorce, my children were growing up and leaving home.  I didn't know what I know now:  Mia's death, while heartbreaking, was symbolic of all the other loss I was feeling at the time and had felt throughout my lifetime.  One loss became all the other losses combined.  I survived Mia's death.  I survived my divorce.  I survived my children leaving home.  It was a long, painful process of acknowleding and then letting go of all the unfulfilled hopes and dreams that were attached to each of these parts of my life.  There is no right way to grieve.  There is no right time frame for grieving.  Each individual will experience their loss in a way and to a degree that is directly related to the level of attachment to the thing that is lost.  The important thing to remember is that grief is a natural and predictable part of life.  Painful as it may be, grief is a testament to all that matters in our life.  To have lost was to have loved.