Saturday, June 29, 2013

Today's Gem of Grace in the Gray Areas

"Resentment is like drinking poison 
 and then hoping it will kill your enemies." 

                            (Nelson Mandela)


Monday, June 10, 2013

Stroke of Luck

“Show me the way to go home, I’m tired and I want to go to bed…”  My mom heard someone singing in the hallway and chimed in on the subsequent verses, whereupon a delightful red-headed Irish woman came into her room and the two of them finished the song (one of my mom’s mother’s favorites) together in fine fettle, then chatted happily for a while longer.

That was three weeks ago.  My mother had been in the hospital for a week after suffering a stroke.

We were lucky in so many ways.  My niece in Massachusetts, up unusually early for a Saturday, had called her grandmother to say hello.  With both nursing and EMT training under her belt, when my mother started talking, Alyssa immediately realized something was wrong.  She told her to hang up and called the state police to have them get in touch with 911 down here.  She then called me.  And I, barely beginning to wake up, decided not to answer and to just call her back in a bit.  Seeing her name on my phone’s screen again several minutes later and even my sleepy brain realized I’d better pick up.  As I threw on my clothes and passed a toothbrush haphazardly across my teeth, my mom was already hurtling toward the emergency room in an ambulance.  At this point all I knew was what Alyssa had told me, which was that Mom was having trouble speaking and breathing. 

At the ER, I hurried back to my mom’s curtain.  She was conscious and undergoing tests.  As I arrived the doctor told us both what I had feared: she had had a stroke.  My heart fell, and then I numbed myself sufficiently to go into medical advocate/pillar of strength mode.  My brother—my only sibling--lives in Mass., which felt like a million miles away. 

As the hours rolled on, the doctor asked my mom if she’d ever been told she had a heart condition.  Except for a minor murmur, the answer was no.  But she did—her heart was in atrial fibrillation, meaning her heart was not pumping efficiently and this could allow blood to pool and clot.  It’s likely this is what caused the stroke, which could have happened much earlier even than the phone conversation I’d had with my mother the night before, when nothing unusual caught my attention.

When I’d arrived my mom had been slightly slurring her speech but was understandable, at least by me.  One side of her face was drooping ever so slightly.  As the day progressed, though, she became less easily comprehensible, resorting to writing things down on a pad of paper to communicate, thankfully having not been paralyzed from the neck down at all by the stroke.  But by nightfall even the writing failed her and she had become unable to make herself understood.  We were both terrified.

Amazingly, during a hurried conversation out in the hall later the doctor said her speech might improve.  I couldn’t believe it; I thought once you lost it, you lost it. 

What followed was a largely nightmarish stay for my mom in the hospital, shuttled to four different rooms, with what seems to me to be the systemic problems of hospitals, not enough nurses and techs, so patients left frustrated and fearful, waiting, waiting, waiting. 

Did I mention that my mom had just two weeks before the stroke finally been discharged from all of the physical and occupational therapy and wound care needed after a fall which broke her hip in December, and subsequent complications?  The poor woman has only been out once, aside from ambulance rides and doctors’ appointments, for Mother’s Day, just days before the stroke, since November!

The days were a blur of good news/bad news.  The day she was admitted the medical staff was anxiously trying to figure out how long ago she had had the stroke, so they could administer the magic bullet of tPA (a protein which could break down blood clots), which had to be given within five hours.   As the clock ticked on, that soon became a secondary point as they conferred with her and her regular doctor and learned that the next line of defense against another stroke on the wave of the first, the anticoagulant warfarin (Coumadin), was counter-indicated for my mom.  She had had a severe gastric bleed a number of years back and was at risk for more bleeds, including in her heart or brain. 

The good news was that the second morning as I was walking from the parking lot into the hospital, I got a phone call—astonishingly, from Mom, who I’d left the night before speaking gibberish, now slowly able to make me understand what she was saying.  My wonderful mother had already had a session of speech therapy early that morning and had been practicing constantly ever since.  For not the first time I felt blessed at her strength. Her speech and her brain power improved day by day, a miracle of the human body and human determination. We were lucky, lucky, lucky.  

I kept vigil at her bedside for four days and evenings, trying to help be her advocate (which sometimes meant as little as going down the hall to explain to the staff the urgency of a request for a bed pan, to as much as going to the hospital’s medical library and getting the saintly librarian to help me with research on what was happening to her and what to do next).  I experienced the frustration and fear with her as her environment continued to spin out of control (feeling a lack of control being something none of us is comfortable with but which very much does not agree with my mom).  I made and received a whirlwind of calls, especially to and from my brother and niece (the latter now rightfully anointed as having saved my mother’s life), updating them and concerned friends and family from Mass. to California. 

My brother came down five days in and gave me a much needed break from the stress of staying 12 hours a day at the hospital.  We both felt hopeless at the doctors’ inability to come to come to a decision about whether it was riskier to give my mom the needed anticoagulants (which could expose her to a chance of a bleed, including to her brain or heart, from a minor bump into something or even a heavy sneeze) or not to give them to her (which kept her, particularly with the atrial fibrillation, at a high risk for another stroke). At one point they were trying to push the decision back on us, for which we felt completely unqualified and told them emphatically so. Finally after more than a week they decided to give her the Coumadin. It’s something she’ll have to be on and be monitored for the rest of her life, and she’ll have to carefully monitor her eating for her vitamin K intake, too.

Mom’s in rehab now, just a few minutes from my apartment.  She changed from the place she’d gone for her post-hip-surgery rehab not because she didn’t like it but because she was “desperate for a change of scenery.”  It’s been overall a good experience so far as she continues her speech therapy in particular, loving her homework of crossword puzzles and word games and some exercises that seem hauntingly like taking the SAT day after day. She’s doing very well with them except for the occasional one that reminds her that her brain power still isn’t back to 100%, and she doesn’t let that get her down.  When I come to visit we often play rousing games of Upwords (her favorite board game, a variation on Scrabble).  I’ve beat her the last two games, but only by a few points.  We agree this counts as homework, too. I was there today and she was delighted that her new physical therapist was working her really hard, and Mom asked for more.

I have been under a lot of stress these past few weeks as all this unfolded.  My stomach has been in knots, and I’ve been on what I call the “oh, shit, my mom just had a stroke” diet, realizing it is time to get serious about my own health.  I have developed an obsessive relationship with Purell. I’ve been exhausted being the dutiful daughter, and am humbled knowing that so many more women (and men) out there have been caregivers at a much more intensive level and for much longer.  I don’t know how they do it.

Mom, as usual, I don’t know how you’ve gotten through all this with the strength and good spirits you’ve somehow held onto.  Yes, growing old isn’t for sissies.  But once again you are an inspiration.