Monday, July 13, 2009

It got worse again

"You BITCH!"

With those lovely words my mother greeted me a couple of days ago. "I can't believe that you, of all people, would do this" she continued. Since I hadn't taken her home, had let the hospital keep her in custody and care, I had become the enemy.

As a runner, "downhill" has always been a good thing to me. It means my path is easy, better, smoother. But "downhill" for the rest of life isn't as good. My mom's condition has has continued to go downhill quickly. Mentally, physically, emotionally. Despite our hopes and the actions of the medical staff my mom is almost certainly about to be put in a mental hospital.

A week ago it looked like changing her medications would calm her down, clear up the mental confusion, steady her moods. Even while giving her some of the most toxic drugs available she has only gotten worse. Suspicious, paranoid, still unable to string together any type of coherent conversation. Her only focus was going home, being by herself. She said she was in prison, locked up, out of her own control and being held against her will.

Unfortunately her physical strength continued to build as her mental state continued to deteriorate. She's able to get up and walk, almost run, even though she's still bent over and stumbling and unsteady. Her anger built day by day.

The hospital decided she was stable and healthy enough to be released. We found what seemed like the perfect, peaceful rehabilitation facility (aka rest home aka nursing home). Since she really couldn't be left alone we hired a sitter, someone who would watch her and make sure she didn't hurt herself.

Early this afternoon she was transported to the place I'll just call "Manor." She didn't want to get in the transport, was rude and vile to the ambulance attendants, ignored me when she saw me waiting at the door. She arrived at her room, continued ignoring me. I introduced the sitter and mom was quite clear in telling her to go away. I was just as clear in telling mom that the sitter was staying.

I had brought clothing and some personal possessions so she could feel more comfortable. I don't know if she didn't recognize them, or just didn't care. She was very cold to me, outright rude to the sitter and ignored the nurse who was trying to do intake. My mom kept asking for my sister's phone number so she could call "the daughter I love" and finally I told her that if she allowed the nurse to do a short exam, the nurse would call my sis for her. My mom cursed, told me to get out of there, so I left.

We had told the Administration, the admitting people and the nursing staff we met that she was not compliant and was very angry and could be very loud and horrible and mean with what she said. We also told the sitter and the sitter's boss the exact condition of my mom. We made it clear, and the hospital discharge papers made it clear, that giving her Haldol would calm her down. Either none of them listened, or they just didn't believe us, because it turned out to be more than they wanted to handle.

I got a call from the sitter about an hour after I left (while I was in the middle of Safeway, shopping). She was in tears and told me my mom had pulled her hair and yelled at her and threw her purse at her. I called the doc, he called the Manor and told them to give her the drug, they told him they would, I called the sitter back, she sounded relieved.

Five hours later I got a call from the Manor telling me that they had called the police twice because they couldn't handle my mom. I was shocked. The nurse told me that while a cop was standing there my mom finally agreed to let them give her the Haldol - 5 hours after I thought she had gotten it. Since my mom was a little quieter after that, it seemed everything would be ok.

I then received a call from a wonderful Walnut Creek Police Officer. She was the one who responded to the second call and was sitting outside the Manor waiting to make sure everything was ok. She just wanted to get the full story about what was going on. I explained the whole over-medicating, dementia/psychosis thing, told her the Manor was well aware of what they were getting. She said that they had called 911 wanting to get an ambulance to take away my mom.

The staff had told the cop that they had spoken with the family, but were unable to produce the staff member who had made the call. Probably since that was a big fat lie, nobody had called me (or my brother). They told the cop they weren't staffed to take care of a high maintenance patient, that they couldn't handle her. They said they couldn't give a patient any medication unless the patient agreed, and my mom didn't want to take anything (this despite my having told the nurse and the administration that I held the power of attorney for health care and that they should give my mom all the drugs on the discharge orders). After a long talk with the very nice and sympathetic cop, who told me that she would note that if the police were called again the police should call me, I called back to the Manor.

I asked to speak with the Administrator in charge. I was told there wasn't one since it was evening. I then asked to speak to whoever was in charge for the evening. I was given the phone number of an offsite nursing supervisor. I told the operator I wanted to speak to whoever currently in the facility was in charge and was connected with the LVN who had called me earlier regarding my mom.

She told me that they didn't have anyone in charge, that the staff knew what they were supposed to do and just did it. I was openly incredulous but she wouldn't put me through to anyone else. I asked why she hadn't called the family when the police were first called, or why she hadn't called the family before it got to that point. She said that she was busy following my mom as she walked around outside and she didn't have a phone with her, "we're not a hospital you know and we're not equipped like a hospital." I asked who had called 911 and she said someone inside. She had no answer as to why that person couldn't have called me.

I asked what had happened to the sitter and was told both "she's scared" and that the sitter had been replaced by another sitter. This was the person who I thought would be the front line of care for my mom. Apparently I paid over $1,100 for 3 days of someone whose only job was to stare at my mom, and call someone if my mom moved. Quite helpful.

I told the LVN to call me if anything else happened, preferably before she called 911 again. So about a hour later she called again to tell me that my mom had never settled, that my mom had twisted her arm and pushed her when the LVN tried to give her some more medication. I asked her to hold the line and called my mom's doctor again. He called the nurse, called different facilities, made a couple of other calls.

At that point it was determined that the Manor would call for transport and have my mom transported to a hospital. Preferably it would be to Concord where there is a hospital with psych intake and triage, where they could provide for my mom and figure out where to go. Unfortunately the closest hospital was where they would probably take her and that was back to Muir, the hospital that broke her in the first place.

Then came calls back and forth; to my brother (being yelled at didn't help me too much), brother to doctor, doctor to hospital, doctor to Manor, doctor to brother, brother to me. At this point my mom was sound asleep and transport was deferred to the morning. Hope were high she'd sleep all night, but I'll be sitting by my phone in case that doesn't happen.

That's where it stands. In the morning my mom will probably be sent to a psychiatric facility, either one specializing in geriatric patients if they have a bed or a general one otherwise. All my mom wants is to go home, she's fixated on going home, and she's going to be locked up because she's incapable of caring for herself and doesn't understand that she's currently mentally incapacitated.

I'm told that's the best solution, that they'll be able to care for her, be able to find medications that will clear up her mind, give her physical and mental therapy that will make her more like herself. I will never be able to forgive myself that it's gotten that far since she trusted me to help her and make any decisions if she was incapable. But that's ok. I know my mom and even if she is fixed, even if she begins thinking straighter than she's thought for years, she will never, ever forgive me either.

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