Saturday, March 24, 2012

"I Need You"

I Need You

Do not ask me to remember,
Don't try to make me understand,
Let me rest and know you're with me,
Kiss my cheek and hold my hand.

I'm confused beyond your concept,
I am sad and sick and lost.
All I know is that I need you
To be with me at all cost.

Do not lose your patience with me,
Do not scold or curse or cry.
I can't help the way I'm acting,
Can't be different though I try.

Just remember that I need you,
That the best of me is gone,
Please don't fail to stand beside me,
Love me 'til my life is done.

-Author Unknown

Sunday, October 2, 2011

I am a Caregiver

I am a caregiver. I care for my husband, Jim, who will be 67 years old on October 6.

Last Spring, Jim had three strokes and a heart attack. The same week that I broke my hip and had a full hip replacement. By mid-June, we were both at home and life was looking up. Jim had mild word-finding problems and wasn't able to effectively use his right hand, but we could still have conversations, still enjoy each other's company, still argue, tease, laugh together.

After a few days, maybe as much as two weeks, I began noticing that Jim wasn't getting better; in fact things were getting worse. His language skills were improving, but his awareness of his safety, his location in both time and place was fuzzy (and often completely absent), and his level of cooperation with his medications was declining. He was becoming more and more resentful of me and of the fact that I was always the bearer of bad news. He couldn't drive. He couldn't drink. I wouldn't take him to buy bourbon. He couldn't take aspirin for pain. Finally, he began refusing his pain medication altogether and would sit on the sofa writhing and moaning, but stubbornly refusing any aid.

In mid-July, I proposed a trip to the Coast for our first anniversary. It would be the first time since our first trip to the Coast - way back in early 2001 - that we would stay at a hotel, but there was no way I could drive the truck and pull the 5th wheel. Although we both tried to make it a celebration, it was clear that Jim was struggling. Our anniversary dinner was hamburgers and fries eaten in our room, which I had bought from the bar across the street. While there, Jim's blood glucose fluctuated wildly, at one point reaching almost 500. He had thought his glucose levels were low and bought candy bars; in fact it was high, and I came very close to calling 911. Fortunately, he responded quickly to the insulin.

Upon our return, I put in a call to Jim's doctor, explaining what had happened, and asking for a clear diagnosis. When I heard the words "vascular dementia," I was stunned. At last I had an answer for why we were having the problems I'd been trying to handle, but "dementia" is such a horrible thing to face. I was able to find a support group online, where I've gotten the most incredible amount of information and validation of all that we've faced, as well as what we can expect. It's not pretty.

For the remainder of July and all of August, I continued to struggle. Jim became more and more unsteady on his feet, yet he would insist on walking downstairs with his shoes untied. We bought shoes with Velcro closures, but he wouldn't wear them. I found him in the garage attempting to open a bottle of wine with his vise. He talked about getting his ladder out to climb up on the roof to clean the chimney. He threatened to walk to the liquor store - 2-1/2 miles away and down a steep incline - when I refused to buy alcohol for him. The day I came home from a therapist appointment and found him outside, shoes untied, carrying pruning shears, I knew I could no longer leave him alone. When he refused to have someone in to help, and then refused to ride in the car with me, because he wasn't going to go anywhere until he could drive again, I became a prisoner in our home.

Again, I called the doctor and was told that if there were any way to get him to the hospital for psychological testing, it desperately needed to be done. Failing that, if he posed a danger to me or to himself - for example, if he actually did try to walk to the store - to call 911 and have him put on a "transfer hold" to be admitted through the ER to the mental ward. When I found him drinking mouthwash, I thought perhaps that was the key. It was not. I was told to get all mouthwash, all ethanol of any kind, out of the house, along with any guns and/or ammunition. With the help of his son, I was able to accomplish this.

On September 3rd, at a party at his son's house, Jim's behavior became even more erratic and verbally abusive. When he cut his hand and we couldn't stop the bleeding, I made the decision to take him to the ER. When we were approaching the VA Hospital, driving up a steep, curvy hill, Jim realized where we were going and became even angrier and resumed the verbal abuse. Then he put my car in neutral. Twice. When I put it back in drive and kept going, he reached over and turned it off. After I started it, he did it again. It was getting dark, we were in a dangerous place to be stopped, but I started it again and drove as quickly as I could to the ER.

After much difficulty, Jim was admitted against his will and spent the next twelve days in the mental ward. At various times, he believed he was in Mexico, he persistently believed that I had spent all of "his" money to build the hospital as a home and that the VA had taken it from me. He believed that I had no place to live. He believed that the year was 2076, and he couldn't recall how many children he has. He also believed he still lived in his childhood neighborhood, and would ask when his mother was coming home. She died in 1964.

On September 15,  on the advice of medical staff and with the help of an attorney to gain guardianship, I was able to have Jim transferred to a memory care home, where he lives for now. It's not a good setting for him, although the staff is wonderful and they all love him. He is the most highly-functioning person there (most residents have Alzheimer's Disease, cannot speak, many are incontinent), but because of his continuing threats to "walk away," he requires a locked unit. We are looking for a better placement for him, but all he wants is to come home.

In addition to "brittle" (uncontrolled) diabetes, and the dementia, Jim has congestive heart failure, atrial fibrillation, high blood pressure, and peripheral neuropathy. But Jim insists that his health has never been better, that I am at fault for his uncontrolled diabetes, and that as soon as the nurses teach him how to used the "new" insulin - the one he's used for as long as I've known him - he will be fine and able to come home. Of course, even if this were true, dementia means that Jim cannot learn new things. His short-term memory is largely gone, although he can - as is common with dementia - pull himself together long enough to participate in a conversation, leaving many to believe he's just fine. Unless, of course, you know that we haven't been to Mexico in three years, have never been to China, and the trip we took to the doctor last week wasn't close by, but was across the river, and many miles away.

Well-meaning friends want to "Jim-proof" our house so Jim can come home. They don't realize that if they take away the ladders, he will climb on chairs. If they take away the chairs, he will climb on tables. If they take away the tables, it will be four walls and no longer "home." If they replace the dishes and glasses with plastic ware, he will still be in danger from photograph glass, window glass - whatever he can drop and break or attempt to use as a tool.

They don't realize the stress of managing brittle diabetes - of having to call 911 in the middle of the night because his glucose levels have dropped so low that he's almost comatose and in danger of dying. They don't realize how hard it is for me to exist on four hours of sleep each and every night because I lie awake, touching him to be sure he's breathing. They don't realize that answering the same question 10 times in five minutes - Do I have a doctor's appointment today? What am I seeing the doctor for today? Do you know when my mom will be home? Do you know where my wife is? - is exhausting. They don't realize that Jim can't reason; that there is no cause and effect for him, only what he wants to do in the moment. They don't realize that caring for Jim is NOT like caring for a small child; that child will learn and progress. Jim cannot learn and is regressing.

But mostly they don't realize that after they have done their good deed, Jim-proofing the house, bringing Jim home, leaving us with their good wishes and love, that they will return to normalcy, leaving us here to once again reach a point of crisis.

Do you know a caregiver? I'll bet you do. Give them the gift of your time. Give him or her an afternoon off while you visit with your friend or family member. Provide a meal. Mow the lawn. Rake the leaves. Or, if their loved one has been placed in a home, accept that it was done lovingly and with much guilt and regret and do not criticize or try to fix it. It can't be fixed. Dementia is forever, changing only in a downward spiral. Acknowledge that the one living with it is the one who knows how it really is. Accept that your family member or friend isn't going to get better, and that the caregiver's stress may be slowly impairing his or her own health. Understand that you only add to that stress when you criticize or argue that your solution is better than the one s/he chose.

Understand that nothing is harder than loving someone who has begun a journey known as "The Long Goodbye." Every day is grief. Every day is loss. Every day is pain.

Tuesday, June 21, 2011

Then and Now

One day
We were making plans to go to the Coast
To go clamming with friends.

One day
We were making plans to go to Yosemite,
So you could see El Capitan.

One day
We were making plans for another trip
To far away places.

One day
We were making plans to paint the house,
And tile the floors
And maybe find a new home to love as we do this one.

One day
You had a stroke.

Today
I'm learning how to test your blood glucose
And give insulin shots.

Today
I'm learning how to cook the foods you like
In a way that is healthier.

Today
I cut up tiny pills and put them in tiny boxes
And smile when I bring them to you four times a day
And call them "appetizers."

Today
I'm learning, still learning, still learning
Not to respond in anger when you take out your frustrations
On me.

Tonight
Each night
I wake three or four or five or six times
To touch you, to test your blood,
To watch you breathe
To give thanks
That you are beside me.

Tomorrow?

Sunday, June 19, 2011

Memory

When they ask you where you worked
You can tell them
And give them details.

When they ask if you have children
You can name them
And give them details

And so they say,
"Your long-term memory is good!"
And they smile and you smile and I smile.

When we go to bed
You can't remember which side you have slept on
For twenty years.

When you sit in my chair
In the family room
You don't understand when I ask,
"Do you want to sit there - or here?"
Where you have sat
For eleven years.

When you make coffee
You remember to use four scoops of coffee
But not how much water.
You can't find the teabags
Where they have been
For twenty years.

You marvel at how well I navigate
The route home from the doctor,
Through curves and roads with oddly-shaped turns.
A route you taught me,
On roads you have traveled
A thousand times,
But claim you have never seen.

What are long-term memories made of?

Wednesday, June 8, 2011

Milestones

Tomorrow, my Sweetheart comes home for good! I am so excited to have him here with me that I can hardly stand it. We will begin reordering our lives to match our "new normal." Some things we both hope we can resume: reading the paper together in the mornings while we drink our coffee; discussing events of the day; watching our favorite t.v. shows; enjoying our deck in the afternoons - the warm weather is arriving just in time!

Some things will be different for us. There will be new regimens of medications, learning to navigate safely around each other and the house, piecing together the events of the past several weeks so they begin to make some sense for Jim, more doctor's appointments (for both of us), physical therapy, learning to shop with wheelchair and cane - the list goes on!

One of our biggest challenges will be Jim's level of awareness regarding his - and my -limitations. I'm trusting that coming home will provide the comfort and security he needs to not only settle his mind (he still has occasional hallucinations), but also to help him regain his mobility and use of his right hand. I told him that I don't care how long he plays Solitaire on his computer, since I firmly believe using the mouse will be positive in healing it. Fortunately, his therapist agrees with me!

It will be seven weeks on Friday since our lives changed so drastically. We've had the love and support of so many people, that it humbles me and makes me even more aware of how blessed we are. We've both come a long way, but Jim's journey has been longer and more arduous. Given the fears that I had in the early days following his strokes, I'm just so very thankful to know that he'll be home in fewer than 12 hours! I do ask that you, my family, friends, and casual readers, keep us both in your good thoughts and prayers as we begin this new chapter.

My Sweetheart is coming home!

Wednesday, May 18, 2011

One woman show

Okay, I confess that I'm feeling a little sorry for myself tonight, and I'm doing a bit of grieving as well. All normal, I suppose, given the events of the past three weeks, but a bit unusual and uncomfortable for me. I'm also a little uncertain about putting this out in a public forum like this, but I really feel that if I don't get it out I'll explode. That could get messy and someone could get hurt by flying titanium!

Part of the problem, of course, is that my rock, the man who would ordinarily be providing the emotional support for me, is in no condition to do so. He's struggling with his own issues and doesn't understand that, in addition to being worried about him I'm worried about myself. This afternoon when I went to visit him, he stood up from his wheelchair (which he is absolutely NOT supposed to do without someone on staff there with him), so he could sit on his bed and change his clothes. I won't kid you; I freaked out. He's not real stable on his feet, and I was terrified that he would fall and knock me down. The absolute last thing I want to do is fall, believe me. He got upset with me, because he's quite certain, of course, that he won't fall. And he didn't, but I was still very frightened and found myself backing away from him instead of going toward him to help him. That felt very odd to me, but the instinct for self-preservation is strong, and if I fall and dislocate this new hip I'll be of no help to anyone for a long time.

I didn't like leaving when he was so angry, but it was better for me to leave. He was going to bed, the nurse came in when he got up (it sets off alarms), and it only upsets him (and me) when I can't communicate to him the fear that I have. I wouldn't trade his strong will for anything, but he's not currently able to really understand that he's impaired and that I am, too.

I'm also still digesting the information that I got from the Physician's Assistant on Monday. My healing is going extremely well, so that's not the problem. The problem is that I have an artificial hip. It will always be in greater danger of dislocation than the OEM version. The only cure for a dislocation is - you guessed it - another hip replacement surgery!

It may mean that I can't crawl around on the floor with the grandkids or play trains and cars on the floor with Addison. That has always brought such great joy to me that it's upsetting to think I may have to give it up. Perhaps my physical therapist will be able to allay some of these concerns - s/he'll be here tomorrow - but for tonight they're tumbling around in my poor brain.

I have flowers that I bought just a week before this all happened, and they're sitting on my deck, waiting to be planted. I had gathered some of the stuff together that I needed and was only waiting for some sunny weather to put them in their pots. Well, the sunny weather is here, but I'm not able. My fuschias need to be fertilized, but the mechanics of doing that are frustrating me. I think I can do it, but gathering together the things that I need presents a challenge.

It's mostly just dumb stuff like that driving me to this melancholy. I really don't have any insurmountable problems. Thankfully, we both have good insurance and the money to cover what insurance doesn't, so it really does feel like a one-woman pity party. I've managed to make it this far with only one real crying session - though I've teared up a few times - so I'm really not doing so bad. But the tears are always right there, waiting, and I guess I just needed to get it in writing. Somehow that seems to make it more manageable. I've always been someone who feels that nothing is insurmountable if I can see it in words.

I should be back and ready to conquer the world tomorrow. As long as no one bumps into me.

Saturday, May 14, 2011

Updating

Well, I've survived my first 24+ hours home by myself, although I confess to being a bit lonely in this big house without the daily presence of my Jim. It's funny how much I always have looked forward to the times when he's away hunting or fishing or pursuing some other such pleasure. It's always been a time for me to embrace my alone time and not have to think about anyone else. This time, though, all I think about is Jim.

My youngest son, Ben, ran all over Portland yesterday, gathering up all of the medical accouterments I thought I'd need for my convalescence - bath chair, cane, "grabbers," a new shower head, prescriptions - then picked me up from The Old Folks' Home and brought me back to my much-loved, but now quite lonely, home. He spent a couple of hours getting everything set up, and then kissed me goodbye to return to his wife and children. My sister stopped by last night and brought me some wine (yay!). I drank half a glass and then off to bed for me.

Although I'm technically not cleared to drive, the rehab center where Jim is currently staying is less than two miles away, and I was able to visit him twice today. It takes me almost as long to get into and out of the car as it does to drive there! And since I'm so close, wild horses couldn't keep me away. And it's become abundantly clear over these past two weeks that my presence is vital to Jim's recovery. He's surrounded and loved by our children, grandchildren, other family members, and many, many friends, but our connection to each other is strong. There is nothing that gives me quite the thrill as the joy I see in his face and hear in his voice when he sees me.

He's doing very well, though he has a way to go in rehab. For an impatient man, he's actually coping quite well. He wants very much to come home and would walk out tonight if I were to give him any indication that it would be okay. But we both know that he needs the physical therapy to regain control of his hand and his balance, and that we still have time to be together and to resume the life that we love and enjoy. Every day I realize anew just how blessed I am to have found this deep and abiding love at this stage of my life. Each day brings us closer to once again enjoying our morning ritual of coffee, newspaper, and local news; our afternoon ritual of wine on the deck, admiring our yard and the company of our neighbors; and just the simple pleasure of being together, taking care of things around the house, sharing mealtimes, and arguing politics.

Last July, when we were married, my middle son, Jason, read from I Corinthians. The final words of that reading keep coming to my mind:

But now faith, hope, love, abide these three; but the greatest of these is love.