Chapter 7: Changing Direction

Changing Direction

Dad was transported to the Clark County Health Center several days after the psychiatric consult. The move caused me concern because this was yet another new environment for him to adjust to. After the disastrous outcome at the other nursing home, I was afraid to get my hopes up. The evening of his arrival, I phoned to check on him. The nurse assured me that his first day had been fairly quiet. Mainly he spent a lot of time walking around to check his new surroundings out. The ward he was on housed only 15 people and was locked, making it impossible for any of the residents to wander away from the unit. While I didn't like the idea of him being locked in, it did give me peace of mind to know he wouldn't be getting lost.

We made our first trip to Clark about a week after Dad moved there. I think it took a moment for him to recognize me, but once we began talking that fuzziness disappeared and we had a good visit. It was obvious to me that he was no longer being heavily drugged and was functioning so much better because of this. We took him off the unit for a more private visit. Just off the lobby was a large room with a pool table, snack machines and a huge glass enclosed bird house filled with a large variety of active little birds. As they flitted back and forth, talking to each other, Dad was mesmerized. He laughed as they would chirp, scold or fly after each other in a seeming game of tag.

After visiting for several hours, we finally had to take Dad back to the unit. Leaving was always hard for me, but our visit had been a good one. I was thankful he was more alert, and happy that he had settled into the new routine with little difficulty. As we prepared to leave, I told him we needed to go home but assured him we would visit again soon. With the sincerest voice I'd ever heard from him, he said, "Thank you for coming to see me." It moved me to tears to think our visit had meant so much to him. My heart ached for him because I didn't want to just visit my father. I wanted to be a part of his life where he could receive our love every day of the week.

The next day I spoke to the social worker at Clark, Janis Misling. I found her to be very understanding. Sharing our crumpled dreams of getting a house for Mom and Dad, she listened patiently and quickly became one of the few people I felt I could trust. She seemed to really care about my father and she, too, wanted him to have as full a life as possible. Getting the guardianship on Dad reversed was no longer even a remote possibility, but as we discussed his needs, I knew it might be workable to have extended visits with him in our home. I was pleased Janis saw this as a positive goal to aim for.

Mom Gets a Roommate

Within a month of Dad's move from the nursing home where Mom was, the bed he'd occupied was filled. I knew it was only a matter of time until that happened because empty beds generate no revenue.

The woman who became her roommate was about the same age as Mom, but more mobile and alert. She had a lot of family in the area who visited often. This lady was always friendly and chatted with us when we came to visit my mother. I hoped that Mom would enjoy her company and find common interests to talk about.

Mom didn't say much about the change, but she no longer wanted us to visit her in the room. Instead, she preferred we spend time alone together in the little kitchenette where we were accustomed to having our "picnic" dinners. Being the private person she was, Mom didn't talk much about her new roommate. She had never shared a house, let alone a room, with anyone but family and I think it troubled her to have a virtual stranger occupying the space which so recently had belonged to my father.

Because this woman had such a large family, her side of the room quickly filled with cards, pictures of her children and grandchildren, and wall decorations. While I was happy for her, I must admit I felt a bit upstaged at how many "things" adorned her side of the room. Mom's area presented quite a contrast with just a few plants, stuffed animals and few pictures on her bulletin board. I had not wanted to clutter her small living space and I think Mom was happy with the way I'd tried to brighten her room. Nonetheless, nagging doubts filled my head. Should I have done more?

Looking back, I am confident that she never felt I had let her down. On nearly every visit she expressed her appreciation for all we were doing for her. Yes, she knew I loved her and would always be there for her. I needn't have worried.

The only thing which hurt deeply was the knowledge that Mom would probably never be able to live with us. When Dad snapped and was so abruptly moved, it clearly sealed my mother's fate. Mom and I never talked about, but I think she knew she would likely be spending the rest of her life in that nursing home.

Ripples of Unrest

By the time the leaves began wearing their brilliant Fall colors, Mom began complaining about her roommate. In a quiet, but determined voice, she stated, "That woman is getting on my nerves." Apparently the woman had developed physical problems which confined her to bed, and the increased lack of privacy was getting to my mother.

Frequently I would now find her in the reading area, or navigating the halls in her wheelchair, just for a change of pace. While she couldn't grasp how to use her arms to move the wheelchair, she had quickly learned how to make use of her left foot. Much like a child pushes himself on a scooter, Mom used that foot to propel herself up and down the hallways.

Mom had been able to walk with assistance when she moved to the nursing home just six months earlier. I had spoken to the nurses and social workers several times about having someone walk with her. She wanted to walk and I felt she had the right to that small pleasure. Unfortunately, those in charge complained that they didn't have enough staff to spend time helping her walk. Since she wasn't very steady on her feet and could move about in the wheelchair unaided, they felt she was getting plenty of exercise all by herself.

In the past, when I had worked with the elderly, it was part of my job to walk residents to help them keep their circulation moving as well as possible. For those who could not walk at all, we did finger, hand, arm, foot and leg exercises to accomplish this. Something was clearly lacking at this nursing home and I was not at all happy about it.

A Problem for Dad

At the Clark facility, the staff had gotten to know my father and shared his routine with me. Mornings were always best for him as far as thinking clearly was concerned. He ate well and was generally quite genial...unless there were problems with his hearing aid. When Dad had been admitted to the nursing home where Mom still resided, he had two hearing aids. A new one had been purchased for him the summer before Mom's stroke, and he had an older one reconditioned for use as a spare. Somehow that nursing home managed to lose it which created some real problems. Without his
hearing aid, Dad was basically deaf and could not hear a word anyone said to him, regardless of how loud they spoke.

On one of our visits to see Dad shortly after his move to Clark, I was dismayed to learn his new and now only hearing aid had broken and would not be fixed for several days. Needless to say, this was upsetting. Bill and I had planned to take him out for lunch, but with no ability to communicate, we knew that would be too stressful for all of us. Aside from giving him a lot of attention, it was frustrating to not be able to talk to him. I tried a few times, hoping he could read my lips, but his response was always the same, "I can't hear what you're saying!" As if to say it was alright, I patted him on the back, nodded and gave him a big smile which he readily returned.

Arriving back on the ward, I left Dad with Bill while I spoke to the staff. I was encouraged to learn that he was participating in a lot of the activities and, once a week he went out for a ride in the country to get some sunshine and fresh air. He was also attending the weekly religious services and readily took part in recreational offerings. Dad had always been very active and the staff at Clark recognized his need to be kept busy, which I greatly appreciated.

When adults are affected with dementia, be it from a stroke or a disease like Alzheimer's, they frequently retain a lot of knowledge from when they were younger. This was the case with my father. In his mind, he was still the hard working businessman of his thirties and forties. On many visits, Dad would tell us how he had just been asked to paint the walls, or take charge of some other project. While this was not reality, it was for him and it provided the spark needed to keep my dad happy.

Before we left after one of our visits, the nurse laughingly shared that Dad would get upset with some of the other residents because they just sat around doing nothing. In the afternoon when his thinking would get somewhat foggy, he could often be heard prodding them. "Come on, get up and help me. We've got lots of work to get done around here."

The fact that Dad believed his talents were needed served to give some meaning to his life. He enjoyed being active and the thought still persisted that he could lead a fuller life if we had him living with us. In the meantime, I was just glad he was adjusting and happy to see he was no longer be drugged into compliance.

No More Shoes for Mom

One crisp September day as I walked into Mom's room, I took immediate note of a large, white bandage around her right foot. Even though she had not been walking for quite some time, Mom had never felt completely dressed for the day without her shoes on. This day, however, she wore just a slipper on her left foot and her bandaged foot was elevated.

Mom told me she had a sore but that it didn't hurt. Excusing myself for a minute, I went to ask the nurse what was going on. Apparently Mother had developed a blister on her heel which later became infected when it broke open. That didn't sound too serious so I relaxed and went back to spend some time chatting with her. She was in good spirits and we both enjoyed the visit. Mom was happy to see summer gone because the nursing home had no air-conditioning and on many occasions it had been stifling hot. The cooler air made it easier to breath and put us both in a fun loving mood.

From the time I was little we had often fallen prey to what we called "laugh attacks." Something would get one of us laughing and from there, we'd both laugh at anything and everything until we were exhausted. I well remember one time when our "attack" came at the dinner table. After hearing us howl and screech for ten minutes, Dad could take no more and left the room until we were laughed out.

I enjoyed seeing Mom perk up as I talked about my memories. They were still etched in her mind as well. We had a wonderful visit that day, one that was relaxed and good for both of us. Mom was getting her hair done weekly by the beautician that had a small shop at the nursing home, and aside from her injured foot, she looked and felt great.

It wasn't long, however, before the nurse informed me that Mom's foot simply was not healing. It was being treated and bandaged daily to keep it clean, but now the doctor had been called in to look at it. Even though he prescribed strong antibiotics, the sore would not heal and was now termed an ulcer. The doctor ordered tests to be run at the hospital to check her circulation, fearing no blood flow was getting down to her foot. The afternoon of her appointment, I met her at the hospital, not wanting her to be alone. While doctors generally pass on test results to the patient's physician, the one who examined my mother talked with me right then and there after doing a Doppler study. He was gravely concerned about her prognosis. Tests showed Mom had virtually no circulation in her lower right leg, depriving the ulcer of any oxygen to permit it to heal. He said it should be kept clean and treated, but also said the foot would never heal as the tissues were slowly dying. While he was trying to be as gentle as possible, a part of me died when he ended by saying, "At some point, she will need to have her leg amputated above the knee."

When she was brought back out to the waiting area, I somehow kept a smile plastered on my face and told her I'd be visiting her soon. I was thankful her ride was ready to transport her back to the nursing home so I could make a quick exit and allow the tears to flow. In my work with the elderly, I had cared for many people with amputated limbs who were still alert and happy. But knowing this was something that would happen to my mother made me see it in a whole new light. Mom would be devastated.

I could only pray this would not be needed for awhile yet. I couldn't bear to think of her being in despair over the upcoming Thanksgiving and Christmas holidays. It was bad enough that she and Dad would not be spending them together.