November 24, 2009

Caregiver’s Self-Care and Excuses

Mary Ann’s day seemed to go reasonably well. There was no napping, although a few times during the day her head hung pretty low, resting on the arm of her transfer chair. Each time I asked her if she wanted to go in the bedroom and nap or stay out in the living room, she opted for the living room.

Zandra, her bath aide, came this morning, but she was pretty sleepy through the shower and getting dressed. By lunch time, she was open to going out to get something to eat. She did pretty well with a hamburger cut into quarters. She let me cut it into quarters for her, but she would not have tolerated my putting it to her mouth to help her since we were out in public.

After lunch, we headed to the grocery store. As tired as she seemed, she loves going to the store and reminded me that I had mentioned that possibility. It is still a marvel to me how it is possible for us to go through so much food, as little as Mary Ann eats. A few items on the list always seem to grow to a basket full.

After supper (Mary’s pork, dressing and gravy), Mary Ann watched television for a while, went to bed, got up again to watch some more televison in the living room, then returned to bed, where at the moment she seems settled.

In between lunch and the grocery, we drove up to Cedar Crest, and while Mary Ann sat in the car, I took about a mile long walk. That is the first time I have walked for exercise since before the trip to Hot Springs.

My excuses for not keeping up with the exercise walking that began a few weeks ago are legion:

First, there was a break in the pattern that had developed. The trip to Hot Springs was the first break — about a week. Then came the hospital stay. The walking was beginning to take on the character of a habit before the break.

Then, the hospital stay wore us both out. I was pretty tired when we got home. Mary Ann was dealing with such confusion and a lower level of functionality pretty much precluding my leaving her to walk.

Those first days back from the hospital, she slept pretty much all day long every day. I couldn’t leave the house for a moment while she was sleeping.

After a while, she was and still is often getting up pretty early in the morning. Before the trip she was doing so well that I felt comfortable walking for about a half hour before she got up for the day. I always made sure she had gone to the bathroom, and I put the Lifeline button around her neck. When she gets up early, walking is not an option.

When Volunteers have come recently, once I did take a walk. The other times, the weather has been bad, or I just decided I was too tired to do it.

The last few weeks after the hospital stay have seemed especially stressful. That is my excuse for returning to eating endless snacks to provide a treat, or just give me something to do to self-medicate.

It is true that working out times to walk has been more difficult in these past weeks. The trouble with that truth is that it is not the only truth in this situation. I am a resourceful person. With enough commitment and will power, I should be able to figure out how to get regular exercise.

And, of course, no one is shoving the food into my mouth. If there will be food in the house or food on the table, I am the one who will put it there. It is not as if I have no choice about what ends up on that table.

My excuse relative to food, is that I am trying to give Mary Ann things she likes and she needs lots of calories. Of course, I do not have to eat the same thing she is eating. It is my choice.

I have cancelled, at least for the moment, the exercise and weight control program at the exercise therapy clinic that I was going to begin after the trip. After the hospital stay, Mary Ann was doing so badly for a while that I didn’t think it would work to try to have her with me, sitting in on an exercise class.

Mary Ann is enough better that I should be reconsidering starting that program. Now with the holidays looming, that excuse has kept me from making the call to set the appointment.

Under the best of circumstances it is hard to develop and maintain a good set of self-care disciplines. We are not in the best of circumstances. All sorts of excuses to avoid good eating and exercise habits are readily available. The irony, of course, is that good eating habits and good exercise habits translate directly into feeling better and being better able to do the task of Caregiving. Sometimes we are our own worst enemies.

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November 22, 2009

Update and Local Art Museum

Posted by PeterT under Daily Challenges, Meaningful Caregiving, Practical Tools for Coping, Therapeutic Activities, Uncategorized | Tags: Art Therapy, Art Therapy for Caregiver, Burdens of Caregiving, Caregiver's Health, Caregiver's Source of Strength, Caregiver's Therapy, Caregiver/Spouse's need to get out, Caregivers can feel trapped, Caregiving Spouses, Chronic Disease, Coping with Challenges, Feelings of Care Receivers, Feelings of Caregivers, Freedom for Caregivers, Meaningful Caregiving, Parkinson's Disease, Parkinson's Disease Dementia, Practical Caregiving Ideas, Quality of Life, Television and the Homebound |
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Mary Ann got up early this morning since she had no supper last evening, other than a couple of snacks during the night. She ate a good breakfast with help, took her pills and ended up back in bed for almost four hours.

She ate a pretty good sized lunch, and we spent a while just sitting with the television on. Actually, I tend to be up and about doing anything I can think of to keep from just watching television. I was back and forth to the computer, outside to check on the birds, got the mail, paid some bills.

Finally I asked Mary Ann if she would be willing to head out for a bit, even if she just sat in the car while I did a couple of things. I had mentioned that I wanted to visit a small but nice art gallery on a local college campus. Our deal was that I would just go in for a short visit, assuming she wanted to stay in the car. That seemed to be her intention.

I had reached the point in the day that I just could no longer tolerate sitting around the house on a warm day, cloudy, but warm enough to be out. Gratefully, she decided she would go into the art museum with me. It took a while to find the handicapped entrance, on the opposite end of the building from the handicapped parking places.

Once inside, there were two major exhibitions that were very interesting. One is called “Stickworks.” It is pretty much indescribable. There are huge sort of huts on the lawn of the museum. People can walk into and through them. They are made from intertwining saplings into surprising shapes and structures.

Inside the museum are photographs of one after another sculptures made with willow branches and saplings, each stretching the imagination more than the last. Even though they are two dimensional photographs, the sculptures seem almost living. That room in the museum left me wondering how someone could even imagine creating such unusual pieces. The link for the artist is http://www.stickwork.net/news.php

The next exhibit made the one I just described seem quite ordinary. It was called “Hybrid Visions” by Ken Butler. An article online from the university described what he does in this way: “He is internationally recognized as an innovator of experimental musical instruments created from diverse materials including tools, sports equipment and household objects.”

This exhibit has to be seen to be believed. Ken Butler takes everything from the backs of old wooden chairs to a laptop computer and creates musical instruments that, apparently, can be played. This is impossible to describe because no one who has not seen it would have existing in their minds reference points to which to relate the descriptors.

While this has nothing to do with Caregiving other than our getting out of the house, doing something stimulating to keep this Caregiver from going crazy, there is an odd sort of metaphorical implication for framing our existence in terms of the exhibit. If it is possible to piece together found items that appear to have been gathered from dumpsters and front parkings on garbage day, add some guitar/violin/cello strings and make music, maybe we can piece together a life of good quality and make our own sort of music.

I think that interpretation is a little contrived and heavy-handed for something so whimsical as “Hybrid Visions.” Oh well, remember, I spent forty years looking for sermon material wherever I could find it, so that the message of the Scripture readings could become more accessible in contemporary terms. It is an occupational hazard.

Mary Ann has gone to bed and seems to be settled for the moment. We will again hope for a quiet night.

November 21, 2009

Anosognosia — Say What??

Posted by PeterT under Daily Challenges, Help from Others, Information on Parkinson's, Meaningful Caregiving, Practical Tools for Coping, Therapeutic Activities, Uncategorized | Tags: Anosognosia, Art Therapy for Caregiver, Burdens of Caregiving, Care Receivers in Denial, Caregiver's Health, Caregiver's Source of Strength, Caregiver's Therapy, Caregiving Spouses, Chronic Disease, Cooking and Dressing Challenges, Coping with Challenges, Feelings of Care Receivers, Feelings of Caregivers, Giving up Cooking Privileges, Lewy Body Dementia, Losing Ability to Dress Self, Meaningful Caregiving, Parkinson's Disease, Parkinson's Disease Dementia, Practical Caregiving Ideas, Quality of Life |
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Who knew there was a word for it? The online caregiving spouses of those with Lewy Body Dementia (or some form of it) recently contained a line of posts titled Anosognosia. Wikipedia defines it this way: Anosognosia is a condition in which a person who suffers disability seems unaware of or denies the existence of his or her disability.

Actually, those who have been reading this blog for very long, have heard me describe a variety of behaviors that could be described with the word Anosgnosia.

When anyone asks Mary Ann about cooking, her response is always: “They won’t let me in the kitchen any more.” What she seems to be saying is that she could cook and chop and handle hot pans and sharp knives and prepare meals, if only we (I) would let her.

Mary Ann will often start to undress while standing up, even though for a number of years now, her balance and coordination have not allowed her to do so without falling.

She has headed into the bedroom to get sewing paraphernalia to do repair work, most often on something that ends up being a hallucination.

While I sometimes do it, I dislike reminding her that what she is attempting is something she can no longer do on account of the Parkinson’s. I think the better choice when confronting some attempt at doing something no longer within her capability, is to redirect her attention to something else.

As troublesome as are the times she acts as if she has no limitations on account of the Parkinson’s, I can’t help wondering if they are not part of the reason she is doing so well. As much as she has been through, it is hard to understand how she is able to do maintain such a high level of functionality in so many areas.

Today went pretty well. She slept in late, essentially tacking her morning nap on to the end of her night’s sleep. She had a good breakfast, a fairly substantial lunch. We went out for a ride to Ensley Gardens (I walked through them while she chose to stay in the car) and a treat at the Baskin and Robbin’s on the other side of town.

Mary came over, brought the promised pork, dressing and gravy, and spent about an hour talking with Mary Ann while I worked at the computer. Since I tend to be quick to respond in conversation, my presence makes it hard for Mary Ann to be engaged in conversation. My leaving the room for a time allows her to interact more freely with friends.

Again, she has gone to bed early, without supper. I guess by now I should know that a mid to late afternoon ice cream treat is going to interfere with her eating supper. I suspect she will be up to have snacks during the night. I will, of course, need to assist in that activity.

The last couple of afternoons (before today), I have left the house for a time while a friend spent time with Mary Ann. I have spent the time in a different way from usual. Rather than sitting in the car in some natural setting to read or listen to music, or going for a walk, I have visited a number of small art galleries here. I am pretty much devoid of any knowledge in the area of the visual arts, but I am intrigued by them.

At most of the stops at galleries, there has been a docent or artist or owner there who was willing to spend some time in conversation. I have learned a bit about the art scene here, and how some of the artists have approached their subjects, what processes they have used. It has been very interesting, opening a new window on reality for these well-worn eyes.

The conversations have nourished a discovery I made decades ago. There is more than what first meets the eye in most of what we see. Whether it is a landscape, a city street, buildings, trash, telephone poles, growing plants in any stage, people, there are many ways to see them. What artists often do is provide new ways to see the ordinary. While I have no natural ability or inclinations in producing visual art pieces, my interest has been piqued.

One of the artists described her fascination with shadows on the water in a pond or stream or lake. The shaded area of the water’s surface reveals what lies beneath the surface. Lighted areas show a reflection of what is above. It is a phenomenon I have noticed when out walking with my binoculars around my neck. Often I will look for those shaded areas to see if I can locate fish or turtles or frogs.

In a couple of the visits yesterday and the day before, the descriptions of a particular art piece triggered the impulse to write and preach a sermon using the piece as a visual aid. I had enough sense to spare the poor person describing the work from my launching into three part homily on the implications of that piece for their spiritual growth.

Maybe I can convince Mary Ann to consent to a trip into KC to the Nelson again. There are rooms filled with art pieces, some incomprehensible, some boring (in the eyes of the beholder — me), some exciting, some very thought provoking. They also serve a great lunch in the Roselle Court. We will see.

After such a tough time post hospital stay, this one has been a pretty good week.

November 16, 2009

Imagined Possibilities – A Moment of Sadness

Posted by PeterT under Daily Challenges, Meaningful Caregiving, Practical Tools for Coping, Therapeutic Activities, Uncategorized | Tags: Burdens of Caregiving, Caregiver Seeks New Normal, Caregiver Thinks of Himself, Caregiver's Health, Caregiver's Identity, Caregiver's Longings, Caregiver's Sense Of Loss, Caregiver's Source of Strength, Caregiver's Therapy, Caregiver's Whining, Caregiving Spouses, Coping with Challenges, Feelings of Care Receivers, Feelings of Caregivers, Freedom for Caregivers, Grumpy Caregivers, Help Needed for Caregivers, Meaningful Caregiving, Music Therapy for Caregivers, Parkinson's Disease, Parkinson's Disease Dementia, Practical Caregiving Ideas, Quality of Life |
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Today was a good day in most respects. Mary Ann got up, ate, took pills and got dressed in anticipation of Volunteer Jan’s arrival. Jan did her hair and nails, a real treat. Mary Ann had eaten a good breakfast with some help. Around noon she ate a half sandwich, chips, Pepsi, and large and tasty chocolate chip cookie that Jan had brought.

Mary Ann was up all day, watching football — her choice. The Chief’s won!!! She was awake and mobile enough for us to go to the Evening Service at 6pm. She ate a little supper before church and headed to bed shortly after church.

This was pretty much a normal day even by pre-hospital standards. So far it appears that our new normal will include a little less mobility. Eating by herself was a challenge before the hospital stay. She now needs help much more often than before. Walking unaided seems to be less of an option now. It seems as if in most other areas, we are back to pre-hospital stay levels. That is pretty encouraging. I won’t deny that the last couple of weeks have been scary and stressful, with lots of fears about the possibility of not regaining any of what had been lost.

Maybe it was the barometer change today, but my time away this morning was not so refreshing as usual. The rain did not allow the long walk that releases the mood-lifting endorphins. I sat in the car enjoying the peacefulness of the rain at the lake, listening to a CD. The Taizé Music seemed to open a certain vulnerability to thoughts and feelings that usually don’t have the time or space for attention with the moment by moment demands of the caregiving.

I am embarrassed at the self-centeredness of the thinking, but I have never pretended to be perfect — far from it. I began thinking of who I am as an individual, separate from my role. I thought of all sorts of things I have not yet experienced in life, things that most likely will never come to be. I am not absolutely sure that I would really do some of them even if I had the chance. That is why I titled this post “imagined Possibilities.”

Imagined Possibilities:

Singing with an Early Music vocal ensemble.
Spending a week of study and reflection at Holden Village.
Hiking a section of the Appalachian Trail.
Birding in New Zealand, hiking to see some of the waterfalls.
Seeing the Snowy Mountain region of Australia, visiting each part of that huge country.
Visiting Cornwall England and searching out my Father’s ancestral home there.
Visiting County Cork Ireland, from which my Paternal Grandmother came.
Heading off to Poland and Germany to see where my Mother was born (a German settlement in what is now Poland).
Spending time at the Taizé Community in France and singing the music, having a chance to serve as a Cantor.
Seeing some of the National Parks with my own eyes.
Going on Spiritual Formation retreats at various places in the US.
Probing with great minds the intersection of theology and Quantum Physics (at least listening and questioning).
Attending organ recitals and hearing great choirs and orchestras.

What is so selfish about all this, is that Mary Ann has lost the freedom to do so much more than have I. This morning just opened a bit of sadness about what I might have imagined for myself. I don’t know all the things that Mary Ann would like to have done. Once I was asked where I would like to go if I could, and when I mentioned Australia, Mary Ann said she would like to do that too. We have both talked about never having seen even the Grand Canyon. We talked about going across Canada on a train, traveling to see the fall colors in New England. We got to visit England and Northern Europe forty three years ago, and had talked about wanting to go back, especially to England.

I know intellectually, and most often viscerally, that life is lived wherever each of us is. There is no need to be in some special, exotic place to live life to the full. The grass certainly is not greener on the other side of the fence, as they say. It was just a moment of imagined possibilities and some sadness at what will not be. No matter what any of our circumstances are, all of us have things that are beyond our reach, things we cannot have or experience. We can either face the loss of those imagined possibilities, grieve their loss and get on with life, or spend our precious moments stuck in self-pity.

I have the privilege of caring for someone I love. There are so very many who would give anything to have that privilege. I guess part of living this life to the full is allowing a moment of sadness into it.

November 12, 2009

Sleep! Sweet Sleep! Plus Physical Demands

Posted by PeterT under Daily Challenges, Family, Meaningful Caregiving, Practical Tools for Coping, Sources of Strength, Uncategorized | Tags: Burdens of Caregiving, Caregiver's Health, Caregiver's Source of Strength, Caregiver's Therapy, Caregiver's Whining, Caregivers Bathroom Duties, Caregivers Physical Demands, Caregiving Spouses, Children of sick parents, Coping with Challenges, Feelings of Caregivers, Help Needed for Caregivers, Incontinence, Keeping Care-receivers safe, Meaningful Caregiving, NIght time Commode Trips, Parkinson's Disease, Parkinson's Disease Dementia, Physical Risks to Caregivers, Picking up Handicapped from Floor, Practical Caregiving Ideas, Quality of Life, Sleepless Nights, The Effect of Chronic Illness on Children, Transfers of Handicapped, Turning Handicapped in Bed, Wheel Chair Transfers |
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Whatever happens today, last night we both got a good quality, long night’s sleep. Mary Ann is still sleeping. It is a little after 9:30am. Because of Veteran’s Day yesterday, Bath Aide Zandra did not come. She has arranged to come later this morning, so Mary Ann will need to be up soon.

Later: Mary Ann made it up in time to get her meds taken before Zandra arrived. She has had another loose stool (sorry!) which has been happening for many days now. It raises the question as to whether or not there might be some sort of bug causing some of her problems. We will wait it out. So far it is manageable. i just want to be sure Mary Ann doesn’t get dehydrated. Checking urine color (sorry again!) should provide evidence one way or the other on that. We will not involve doctors and hospitals unless there is something clearly demanding that involvement. If the weight loss continues, I will probably phone the GP’s office for a recommendation of a supplement. Actually, I will also check with the LBD Spouse Caregivers online group. They have far more experience with what works than any medical professional. It seems clear that Mary Ann is just not getting enough calories in to maintain her weight. Oh how I wish I could painlessly transfer about twenty pounds from me to her. I tried to get her to eat a some spectacularly sweet and tasty and moist cherry (homegrown and canned) and nut coffee cake that Maureen brought yesterday. She just wouldn’t eat anything. I, of course, had a huge piece.

After the intestinal activity, Mary Ann decided to lie down again. She has seemed very tired since getting up this morning.

Gratefully, whatever strain lifting Mary Ann from the floor the other night seems to have been healing on its own. The physical demands on Caregivers are often substantial and constant. When I read the online posts of other caregiving spouses, I wonder how on earth they can do it. Most of them are women, many of them my age or older. Some of them have husbands who weigh two or three hundred pounds (one is a former heavy weight boxer). I have no idea how they deal with the demands. Many have a Hoyer lift to use when necessary. We have one also, but have needed to use it only a couple of time in the years we have had it.

The physical demands of course include helping Mary Ann up from the floor when she falls. Our system is not necessarily recommended by physical therapists, but has worked for us for many years. When she has fallen, I work at sliding her (by pulling on her legs) into an open space where she can lie on her back with her feet toward me and her head away from me. I put my feet together in front of hers so that they won’t slide, she reaches up and I take hold of her hands. I rock back, using my weight as a counter balance so that my back is not involved in the process of lifting.

The risks in that approach are mostly to Mary Ann’s arms and shoulders. Again, since she is not heavy and we have been doing it for so many years, her arms and shoulders seem strong enough to manage. So far there have been no noticeable side effects to that process.

One of the movements that has created problems for me in the past, is that which is required to turn Mary Ann in bed and move her to the center of the bed so that she doesn’t risk falling off the side of the bed (been there!). We have single, adjustable beds. For many years she has been able to climb on all fours on to the bed and flop down one way or another. She has come very close to flopping right off the edge of the bed on to the floor. Now, most of the time she simply cannot negotiate that movement. When she tries, she usually gets stuck on all fours on the bed or with one foot still on the floor, unable to move any farther in the process.

Now, most often she sits on the side of the bed, and if she wants to lie on her left side, facing the television, I cradle her and twist her in a sort of dramatic swinging motion until she is facing the appropriate direction. Then I lean forward, slide my arms under her and pull her toward me to center her on the bed. That is the motion that has caused back pain in the past. Now, I squat down and let my body weight (lot’s more than her body weight) pull her to the center of the bed.

If she wants to lie on her right side, the side of choice for her, again, she sits on the side of the bed. I let her head down to the pillow and reach with my right hand to lift her feet on to the bed. Then I travel to the other side of the bed to pull her to the center. Since the size of the bedroom does not allow much space between the two beds, I often can’t seem to get accomplished the motion using my body weight. Most often, I slide my arms under and just pull her to the center with my arm muscles, a movement not unlike doing a curl. Again, that keeps from involving my back in the process.

Now with that image in mind, imagine the nights she is up every few minutes. One of those two actions of moving her to the center of the bed happens every time she gets up, even just to sit on the side of the bed. When I watch her on the monitor, if she begins to move at all, I head in to see what she needs. Sometimes she just needs to be turned from one side to the other, or the covers have gotten twisted out of place.

When we travel, the large beds pretty much preclude my reaching under her to move her. I can do some manipulating to help position her, but most of the options are simply won’t work. If I try to move her much, it puts my back at risk. It won’t help her if I am debilitated.

At the moment, one of the activities that is the most risky for both of us, is the trip to the commode. I pull her up to a sitting position on the side of the bed and pull the commode close enough so that it only takes a transfer with a few side steps to get her into position, pull down her Pj’s and disposable and get her seated on the commode. That part is pretty straight forward.

The risky part comes when she is finished. I pull her up and hold her so that she can use the TP I have handed her. Most often, she just cannot balance well enough to stand on her own. I hold her with one arm, feeling her weight against it, knowing that if I let go she would fall back down on to the commode and over the back of it into the wall (does that description ring of experience?). While holding her with one arm, I have to reach down first to pull up the disposable (we call it a pad), which of course binds since I can only pull from one side, the other hand attached to the arm holding her up. It is hard for her to remember and then to have the dexterity to move her knees apart enough to get the pad through and pulled up.

Then come the pajama bottoms next. They have always gathered at her ankles. Reaching down all the way to the floor with one hand while holding her with the other high enough to be above her center of gravity so that I can keep her from falling challenges my flexibility and strength. When I think of it, I remove the PJ bottoms so that I can put them on her in a separate action while she is safely sitting on the side of the bed.

The commode trips come very often since one of the problems of a compromised Parasympathetic Autonomic Nervous System is the need to urinate frequently. The last time Daughter Lisa stayed with Mary Ann over a couple of nights, she shared with me that she was pretty concerned about the risks associated with the night time commode trips. Both of our children are very concerned about the precarious nature of our situation. They recognize that it would not take much to mess up our system. If I am not able to handle Mary Ann, either due to her physical condition or mine, a whole new set of challenges would emerge. None of us wants even to think about it, although it is hard not to do so.

One other activity has become more challenging since the hospital. There are more times when she can’t open her eyes, and/or is almost too weak to walk making the short trip from the door to the car pretty difficult. If this continues, I will set up the aluminum ramps and roll her down the two steps to the door of the car in her transfer chair. Oddly, steps are far less problem to handle than walking on a level floor to those with Parkinson’s. Steps usually are her best thing.

While I need cardio-vascular conditioning exercises, I think I am getting plenty of upper body strengthening in this caregiving role.

It is still only mid-day, but this has gotten far too long — as have most of the recent posts. She is still sleeping. I hope to get her in the car and to the grocery store this afternoon. We will see.

November 12, 2009

Visit to Former Life

Posted by PeterT under Daily Challenges, Meaningful Caregiving, Practical Tools for Coping, Sources of Strength, Therapeutic Activities | Tags: Burdens of Caregiving, Caregiver's Health, Caregiver's Source of Strength, Caregiver's Therapy, Caregiver's Whining, Caregiving Spouses, Consequences of sleepless nights, Coping with Challenges, Dramatic change in retirement, Feelings of Caregivers, Freedom for Caregivers, Grumpy Caregivers, Help Needed for Caregivers, Letting go of Career, Meaningful Caregiving, Parkinson's Disease, Parkinson's Disease Dementia, Practical Caregiving Ideas, Purpose of life, Quality of Life, Reflections after Retirement, Retirement Issues, Sleepless Nights |
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No, I do not subscribe to people having former lifetimes in other times in history. Last evening I spent some time back in a part of my life that seems a distant memory even though it ended only sixteen months ago. It is as if my forty years of ministry exists in a former lifetime. There were feeling swirling around throughout the evening.

The fire happened three years ago. I got a distressing phone call from the Rector of the Episcopal church, St. David’s, across the intersection from the church of which at that time I was the Senior Pastor. I called Mary, who was willing and able to come over and stay with Mary Ann freeing me to rush over to check out our church and give Fr. Don some moral support.

It was arson. The damage was extensive. It was painful to see such an important place in the hearts and minds of so many people rendered uninhabitable in a few hours. The vision of an elegant organ console charred and pipes melted, in a heap on the floor beneath the balcony is almost unbearable to those who have sung to that organ, whose spirits have been lifted by it for numbers of years. I did not go in and see it. I am remembering from the comments of some who did.

I had the privilege of being able on behalf of our congregation to offer support, a place to hold the first worship on the Sunday following the fire. I will never forget that worship Service early in the afternoon, after our three morning services were concluded. The church was packed with the members and friends of St. David’s Congregation. There was a bond created that day that has since brought continuing joy to both our faith communities. The pattern of worship and the visual style of the worship rooms of the Lutheran and Episcopal traditions are virtually identical. They felt at home in the worship space and we felt at home with the liturgy they used.

Last evening was three years later to the day in a journey that began in ashes and ended in celebration of an elegant and functional space for a faith community to live out their call to service.

When I arrived, the Nave was full. There was space in a multipurpose room outfitted to allow us to participate fully in the service, though in a place far from the central worship space. The feellings swirled. There were some feelings at first, ones of which I am not proud, feelings that I was now relegated to a place far on the periphery of what had shared with my family a central place in my life. I am grateful that my feelings moved away from feeling a loss of worth and value, to recognizing what the evening was about. A community of people had taked a powerful hit and come out stronger that ever. I got to touch their lives for a moment three years ago. The night was about them and what had been and would be accomplished through them by the One we both serve.

Later in the evening there were some words of thanks that touched me deeply as Fr. Don acknowledged by name those people and faith communities who had supported them after the fire.

The contrast between the world in which I live now and the world in which I lived sixteen months ago is stark. It was moving to be back in a liturgical setting with a large number of worshipers gathered, listening to and singing with a pipe organ, instrumentalists and choir producing powerful sounds, singing loudly in the midst of the congregation. The moment was a poignant one for me as the forty years of ministry with its hopes and intentions and dreams broke into my awareness. Current circumstances in my life and the needs of the congregation from which I retired have converged to provide a clear separation from my former life in the ministry.

What settled in my mind and heart last night is that my goal has been to impact those I served in a positive way as our lives intersected for a time. Whether or not it is remembered is quite secondary. My hope is that my ministry had a positive effect on most of those I served in the three parishes and the high school these last four decades.

Now my goal is to make a difference for good in the life of someone I love deeply, even though I don’t always show that love as clearly as I should. So that I could attend St. David’s new building dedication last night I arranged for a person from Home Instead an agency that provides people trained to do Companion Care. It will cost between $60 and $70 for that care for Mary Ann, but I felt I needed to be there for my own sake and to provide a formal presence for my former parish. Needless to say, it is not feasible to use agency care very often. I am grateful to have an income at all in this economy, but a fixed income does demand care in how and when that income is used.

Mary Ann has been up for most of the day today. Last night did not start out too well, but after a while, she settled and slept soundly. She has had a reasonably good day. She ate with only occasional help needed. She napped in the morning for a couple of hours, but has been awake and sitting up most of the day. There were two Volunteers here at different times.

She went to bed around 7pm (less than an hour from this writing), and she is awake now watching her beloved NCIS repeat episodes. It would be a wonderful experience to have a sleep-filled night tonight. Time will reveal whether or not that comes to be.

November 11, 2009

Wake up! Go to Sleep! Please!

Posted by PeterT under Daily Challenges, Meaningful Caregiving, Practical Tools for Coping, Relationship Issues, Therapeutic Activities, Uncategorized | Tags: Burdens of Caregiving, Caregiver's Health, Caregiver's Source of Strength, Caregiver's Therapy, Caregiver's Whining, Caregivers Bathroom Duties, Caregivers Household Duties, Caregivers' Sleep Deprivation, Caregiving Spouses, Consequences of sleepless nights, Coping with Challenges, Daytime Napping and Sleep, Daytime Sleeping due to Dementia, Dementia and daytime sleeping, Feelings of Care Receivers, Feelings of Caregivers, Grumpy Caregivers, Hallucinations, Help Needed for Caregivers, How Long to Let Sleep, Incontinence, Mealtimes with Handicapped, Meaningful Caregiving, Parkinson's Disease, Parkinson's Disease Dementia, Practical Caregiving Ideas, Quality of Life, Sleep issues, Sleepless Nights, The Good Life, Writing as Therapy |
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It was a night from Hell. We have plenty of them. I went to be early in hopes that my presence would help her sleep. Not so. She wanted to go home more than once. Often she would get up and when I asked, admit that she didn’t know why she had gotten up. Once she woke up and said she had swallowed a snake. I have no idea from where that thought came.

It went on through the night. Once there were only seven minutes between times of getting up with some need. The next one was twelve minutes. Then came a couple about twenty minutes apart. I am just tired enough that I went back to sleep during each of those short times, only to be wakened again. I am not sure what words to say to communicate the level of frustration with that behavior.

One of the times she got up, she agreed to go to the table and eat some applesauce. We started toward the dining room, and soon it was apparent that she just couldn’t walk well enough to make it there. I asked her not to move, while I ran a few feet to get the transfer chair. Of course she fell. My level of frustration was enough that while I was complaining about her not staying still, instead of patiently working out how to get her off the floor in a way that was safe for me and her, I just picked her up off the floor and seated her in the chair. Yes, she is only a little over 120 pounds. No, a small 66 year old man with a family history of back issues should not try to pick up someone from the floor, someone who is not able to help in the process, essentially dead weight.

While it hurts, at the moment (six or seven hours later), it is not excruciating. I am hoping only minor damage was done and that Advil, ice and a call to Chiropractor Tim will eventually take care of it.

Last night, all I wanted was for her to go to sleep! She got up early again. I just insisted that she stay in bed so that I could get another hour of sleep. Gratefully, she did stay in bed for a while.

When she got up, things were pretty difficult. I, of course, was not in a very pleasant frame of mind having been up and down every few minutes during most of the night. She was able to get some of her food eaten by herself. After breakfast she sat by the television in her PJ’s. She was in popping up mode. While at the moment, she is not fainting, her weakness and balance are making her vulnerable to falls. I got a phone call. Just as I got into the conversation, she hopped up and headed across the room. I was frustrated by the timing of it, but after determining it was a bathroom need that precipitated it, I got off the phone and got her into the bathroom and seated.

I have not mentioned this much in the last three days, but there has been intestinal activity verging on diarrhea. Sunday morning when I was gone, she had some major activity. That activity required a later cleanup that involved removing the toilet seat, taking it to the large basin I had installed in the basement storage area for things like this, soaking the toilet seat in water with lots of Clorox Bleach, scrubbing the hinges with a toothbrush, rinsing, drying, disinfecting the stool itself and replacing the toilet seat. This is all taught in Caregiver school.

The good news is that the activity does not come often. It is just takes some extra effort to keep her and whatever else clean. We have dealt with much worse in this area. This morning’s trip to the bathroom was not an easy one.

When she returned to the living room, the popping up continued. She was almost always getting up to look around at the floor. I don’t know exactly what she was seeing, but it was some sort of mess that needed cleaning up. Just going into the kitchen to get a bowl of cereal had to be done in short segments of time, often less than a minute in length so that I could check on her and get her seated again.

I had not yet gotten my morning shower. I could not trust her to stay seated for the ten to fifteen minutes it takes for me to get ready. She often agrees that she will stay seated, but pretty much does not do so. I finally realized that the only way I was going to get ready myself, would be for her to be napping.

There is such an conflict of wants and needs that converge on this simple process. I want her to stay awake during the day and sleep at night. I want her to be sleeping even during the day so that I am not dealing with the popping up, the constant needs, the hallucinations, not knowing what will come next. I should keep her up in the daytime, but when she moves into her need-for-sleep mode, she ends up hanging her head and sleeping in her chair, if not in her bed. There is a sense of relief when she is sleeping during the daytime hours, but a dread for the horribly frustrating nights that come when she can’t sleep then.

I suppose I could sleep during the day while she is sleeping. I don’t want to shift days and nights for both of us. I want to be tired enough at bed time that I can go to bed and sleep, if she will allow it. When she is asleep, I have the freedom to do things that nurture my own well-being both for my own sake and so that I don’t lose the capacity to care for her. These posts have been long and detailed lately because she is sleeping enough during the day that I am free to write. These posts have been long and detailed these last days since we are almost entirely homebound now and the task is frustrating enough that I need the outlet of writing these posts as therapy.

Then there is the question, how is Mary Ann dealing with this new place in our experience. She is stuck with the frustration of not having the mobility and mental acuity she has had, and she is stuck with Grumpy Caregiver who gets frustrated with things she cannot control. She vacillates between days when she is exhausted and just wants to sleep, and nights when she can’t sleep, wants to be up while the person on whom she depends is scolding her and insisting she stay in bed. She needs food but often not what is in front of her. She hates the feeling of needing to be fed but often needs to be fed. She wants to do things for herself but is constantly being asked to sit down, being reminded that she can’t do them.

I wish I were better at this caregiving task. On the positive side, I think that most of the time I act in ways that are caring and helpful and affirming of who she is. I try to treat her with respect, recognizing that my words are not always respectful when I am frustrated with some difficult behavior that seems still to be under her control (probably most often a result of the disease more than her willfulness). I work hard at keeping her neat, hair washed, dressed appropriately, the house in order, beds made, kitchen in order. I work very hard at determining what she needs or wants and if it is possible, trying to provide whatever it is. With that said, in fairness, my assessment is based on who I want to be, not necessarily who I am in her eyes. In the area of this sort of self-awareness, my propensity to feel guilty when I have been unkind provides some internal metrics. My self-centeredness drives me to do things that allow me to feel good about myself. My batting average in that task is probably just that, painfully average.

Back to our day: When med time came after she had been sleeping for a couple of hours, I decided not to make yesterday’s mistake. After I took her to the bathroom, she stayed up for us to head to Glory Day’s Pizza to bring a couple of slices home for her (lunch and supper). Her mobility was very poor, and she still would not open her eyes, so the trip out to the car and back afterward was pretty difficult.

She insisted on eating the slice of pizza without help. She only managed to eat the topping (cheese only) from a little more than half of the one piece. Then she was done. After refusing once, she finally agreed to a dish of ice cream. She is about five pounds lighter on our scale than she was the last time she weighed herself before the trip and the hospital. She has been eating so little it is no wonder. When I took her to the bathroom after the pizza, as I was getting her clothes down so that she could sit on the stool, she stopped me, asking what I was doing. She thought we were still in the dining room.

At about 4:45pm, she wanted to get her bed clothes on and get into bed. She got up again when a paid worker from Home Instead to stay for a few hours while I honored a commitment that was important to me. She was still up when I returned and went to bed at about 9:30pm. Let’s hope for some sleep tonight.

November 8, 2009

Fourth Day Home From The Hospital

Posted by PeterT under Daily Challenges, Help from Others, Meaningful Caregiving, Practical Tools for Coping, Relationship Issues, Sources of Strength, Therapeutic Activities, Uncategorized | Tags: Adapting to changes in plans, Adjusting Medications, Administering Medications, Burdens of Caregiving, Caregiver's Health, Caregiver's Source of Strength, Caregiver's Therapy, Caregivers Bathroom Duties, Caregivers Medical Responsibility, Caregivers Need Flexibility, Caregivers spirituality, Caregiving Spouses, Consequences of sleepless nights, Coping with Challenges, Feelings of Caregivers, Finding what is normal, Help Needed for Caregivers, Impact of Changes, Importance of Bowel Movements, Managing Medications, Mealtimes with Handicapped, Meaningful Caregiving, Parkinson's Disease, Parkinson's Disease Dementia, Practical Caregiving Ideas, Quality of Life, Spiritual Formation Group, Spiritual Renewal, Support for Caregivers, Support System for Caregivers, Value of Friends' Support |
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It is about 11:30am and Mary Ann is still sleeping. She got up last evening long enough to eat some ice cream and apple crisp. Then she took her pills, went back to bed and slept the entire night. This morning, there was a commode trip at about 7am, then at about 8:30am she got up long enough to have juice (with Miralax) and yogurt. Then she decided she wanted to go back to bed.

The good news about this is that when she has been up, she has been able to interact verbally and has not been picking up threads that are not there, nor has she acted as if she was hallucinating. Her head is no longer hanging down on her chest. Needless to say, those are encouraging signs. She is still unable able to eat without assistance. I fed her last night and this morning, even putting her pills in her mouth. She did manage to lift the cup and drink most of the juice by herself.

Yesterday, I chose not to awaken her for medications. Most of her meds are intended to help her when she is up and about. Most of them have a short half life. They help when they are in her system, but are not necessarily maintaining a constant level of medicine 24/7. Missing one dose of the meds seemed to me to be acceptable. I concluded that the rest was more important. She did take her night time meds, so there has been no interruption in them. She took the morning pills today, and while she was lying in bed, I changed the Exelon patch she had worn for two days. That is a med that needs not to be stopped for long. It is pretty powerful and when initiating the patch, it takes a month on a lower dose to keep from creating the unpleasant side effect of pretty bad nausea — been there, done that. I am also going to wake her up for the meds that come every two hours during the day. My goal is to return to and maintain a normal schedule in hopes that will help us return to the pre-hospital norm.

The other parallel recuperation activity needed includes intestinal activity. There has been some activity, this morning during the 7am trip to the commode. Then before going to back to bed after breakfast (the yogurt, juice and pills) there was a little more substantial activity. At the risk of being indelicate (there is nothing delicate about being a Caregiver), it is still at the stage where manual help is needed. With that lovely image in mind, you can appreciate my excitement when things come out on their own and Dr. Oz’s S appears. We are not yet back to that wonderful normal. At this point I am hopeful that in a couple of days we will be there.

Of course I cannot know where this will go, but my intention is to methodically do all the things we have normally done in the past as they are possible. My hope is that by Tuesday, a week from leaving the hospital, normal will have returned. Whatever is so by then will probably need to be established as our new norm.

My need to establish a norm of some sort, any sort, comes from the way I am wired. When I get a set of expectations in mind, it is tough for me to incorporate changes very quickly. Since retirement, the rewiring is in progress. By removing almost all commitments, there is space and time to adapt to whatever changes come without the added stress of failing to meet those commitments. When we went to the hospital, there were a few appointments (dentist, doctor, among them) to be changed, but nothing for which I had to find substitutes or burden others to do for me.

Even though things can change dramatically at any moment (as in Saturday’s entrance into the hospital), the norm is where my pivot foot rests when I turn to meet the unplanned, unexpected. Unlike Michael Jordan in his best days, I cannot hang in the air for very long without a place to stand.

In a moment of devotional time last evening, I read this prayer. I receive a weekly email from the National Catholic Reporter web site with a devotion by Fr. Ed Hayes. (Yes, they allow Lutheran Pastors on their site.) I have appreciated his writings for decades, and I had the privilege of doing a marriage ceremony with him many years ago.

I need prayers for flexibility!

A Psalm of Flexibility

By Ed Hays

Created Nov 06, 2009

O spirit of God’s eternal springtime heart,
grant me the virtue of elasticity.

Make my heart as boundless as my Beloved’s heart,
which at this moment is creating
new galaxies and infant suns.

Make me pliable and playful with your Spirit
as you teach me the alchemist’s recipe
of how to keep my heart’s skin
like baby’s skin, ever-expansive,
able to hold the wildest of wines.

Stir my mind well with your sacred spoon
to awaken the fermentation of ideas
stilled by the ten thousand little compromises
required of me by the stiffness
of the old leathered skins of society and religion.

Gift me with elastic frontiers of heart and mind,
so I can see before my eyes,
both in the heavens and on earth,
how old and ever-new are those partners
passionately dancing together
in the perpetual birthing of your universe.

From Prayers for a Planetary Pilgrim by Ed Hays

The Spiritual support I receive through Ed’s writings, through the Taize Music from their site, from Weavings, a spirituality journal, through Scripture, corporate worship and the Spiritual Formation Group that meets at our house weekly, helps provide the source strength that has allowed survival so far.

There are many wonderful folks who give personal support to our household. Yesterday afternoon, John called and asked to come over for a time to talk. John has been a support for very many years. Mary, our friend who schedules Volunteers, had let him know that things were getting a little hard to handle at our house. Yesterday, Edie, the leader of our Spiritual Formation group emailed about the possibility of bringing dinner over. Don and Edie came over and we feasted on lasagna, salad, gourmet bread, some Shiraz red wine, topped off with apple crisp and vanilla ice cream. Mary Ann slept through supper, but ate a big bowl of apple crisp and ice cream later in the evening.

It is now about 1:30pm and Mary Ann is still sleeping soundly. She has had two rounds of the meds that come at two hour intervals during the day. To administer the meds, I put my hand under the pillow, lift her head, put them in her mouth, hold a straw to her mouth and she drinks until the pill(s) are down. Often, when I give her the pill(s), she gets up from napping. The last few days when I let her head back down, she just goes back to sleep. It has not been unusual in the past for her to continue to sleep, just not so many times in a row.

She finally got up and dressed around 2:30pm. She ate a little more, then provided some unaided intestinal activity worthy celebration. She went back to bed at about 5pm. It is 9:30pm now. She is still sleeping. We will see how the night goes.

November 5, 2009

Second Day After Hospital

Posted by PeterT under Daily Challenges, Meaningful Caregiving, Uncategorized | Tags: Burdens of Caregiving, Caregiver's Health, Caregiver's Whining, Caregivers Medical Responsibility, Caregiving Spouses, Coping with Challenges, Feelings of Care Receivers, Feelings of Caregivers, Help Needed for Caregivers, Lewy Body Dementia, Meaningful Caregiving, Parkinson's Disease, Parkinson's Disease Dementia, Parkinson's Support Group, Quality of Life |
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There is smoke coming out of the china cabinet! You had better wash that bedspread, there is dirt all over it. Is that cat real? The cat question was a bit encouraging since she did not simply assume that it was real.

She accepted my offer to feed her when she just couldn’t seem to negotiate her bowl of “Little Bites” shredded wheat. She had managed most of the yogurt on her own. She again had trouble getting the straw to work as I tried to get her to finish the Miralax in water. That is one of the most important items in her medication regimen. At first she wanted to drink without the straw, but there was no way to get her head erect enough for the water to make it in her mouth. In the hospital, when she was most disconnected at night, she couldn’t manage to suck on the straw, but blew through it instead.

There have been some moments of lucid interactions. As she was lying down for a nap (about an hour after getting up), she mentioned lisiening to the “radio” meaning the book on CD that we were listening to on the trip.

By the way, she did sleep better after the applesauce last night. It is a good thing. I was running out of patience with the constant needs every few minutes. There were more times up throughout the night, but there was enough time between them to get some sleep. She did get up pretty early this morning.

I am starting this post early in the day in hopes that I can get to bed earlier tonight. Of course, my hope is that Mary Ann will be able to get to sleep at a reasonable hour and stay asleep other than a few trips to the commode during the night tonight.

It is now mid-afternoon. It continues to be a very difficult day. After her nap, during which I wrote the paragraphs above, we attempted lunch. There was a piece of Glory Days’ Pizza left from yesterday. That is her favorite. I cut it up for her, and she managed a few bites of it with her fork. Normally, she has no trouble eating small pieces of pizza with a fork. Finally, I needed to help her. As she had yesterday, she tried to take a drink of Pepsi and set the cup down on top of the pizza on her plate, seemingly unaware that she was doing so.

She ate a few bites of her favorite green Jello, Cool Whip and cottage cheese salad that Mary brought yesterday. After a two or three spoonfuls she was done. I offered her a chocolate chip cookie. She could not negotiate holding it and getting it to her mouth. I helped her eat half the cookie.

We drove over to Doug and Marikay’s so that I could get a much needed haircut. She sat with her head down during that time. When we drove back by the coffee shop, I offered to use a buy one get one free Dairy Queen Blizzard coupon. She just couldn’t answer intelligibly. I concluded that she did not want any. She would not have been able to handle eating it at the DQ, but we could have brought them home.

Moments ago, she wanted to go to the bedroom for some reason of which I was not aware. When we got there, she wanted to get dressed for bed and was irritated that I didn’t realize what she thought was obvious. I explained that it was only 3:30pm, and she recognized that it would be too soon to go to bed.

She is now listening to the book on CD that we started on our trip to Hot Springs. What a dramatically different place we are now, less than a week from the time we were enjoying there. I just asked if she had any pain or anything was hurting. She said clearly that she was not hurting in any way. Her head remains hanging, but she seems to be awake. I don’t know if she is able to follow the book, but at least at the moment she is remaining in the chair.

I continue to hope that at some point she will snap out of it. Right now, we would not be able to manage going out to eat in a restuarant, one of our main treats. This is a whole new place in this trek, a place we would rather not be.

So far this is a pretty distressing day. She is lying down again. It is about 4:45pm. I asked her earlier if it would be okay for us to go to the Parkinson’s Support Group tonight. She connected with the question and said it would be. Then a while later she fell while I was on two phone calls, one a survey from our Financial folks on the land line and another on the cell phone from our Son who is on vacation with his family in Colorado. They had just seen an American Bald Eagle as they were driving along. She decided she did not want to go to the Support Group meeting. She said she needed to lie down. There had apparently been lots of drainage from her mouth the last time she was napping. I hadn’t noticed just how much it was earlier. I changed the bed and have her bedding and pillow in the washing machine at the moment.

I am writing lots today, I suppose on account of the need just to talk about what it going on. This is a new level of need. At moments like this there is a sense of isolation that comes, recognizing that even with all the support we have from so many wonderful people, ultimately we are on our own as we deal with this. No one can do it for us. Others have lives full of needs that they must deal with.

I am, of course, confident of the Lord’s Presence. Even the Lord experienced a sense of isolation. It is helpful to recognize that kinship.

On a lighter note, I forgot to spring the live trap this morning after there was no raccoon to be found in it. A squirrel managed to trip it while foraging for seed that had fallen into the trap. Is he going to have a story to tell! He moved like lightning when I opened the door to the trap.

There may be more to tell as the evening wears on, but I will post this now and write more later or tomorrow.

Addendum: Mary Ann got up from her third nap today just long enough to change into her pajamas. The sheets needed to be changed again on account of the drainage from her mouth. The washer and dryer are getting a workout. Logic says that tonight will be a restless night since there were three naps today. I guess my hope is that she is sleeping off the confusion and will soon return to normal.

November 4, 2009

Home From The Hospital.

Posted by PeterT under Daily Challenges, Help from Others, Meaningful Caregiving, Practical Tools for Coping, Relationship Issues | Tags: Burdens of Caregiving, Caregiver's Health, Caregiver's Role at Hospital, Caregiver's Source of Strength, Caregiver's Therapy, Caregivers Bathroom Duties, Caregivers Household Duties, Caregivers Medical Responsibility, Caregiving Spouses, Consequences of sleepless nights, Coping with Challenges, Dementia in Hospital, Dreaded Hospital Stays, Fainting complicates Parkinsonians' Lives, Feelings of Care Receivers, Feelings of Caregivers, Freedom for Caregivers, Grumpy Caregivers, Hallucinations, Help Needed for Caregivers, Hospital Stays Increase Dementia, Lewy Body Dementia, Meaningful Caregiving, Music Therapy for Caregivers, Parkinson's Disease, Parkinson's Disease Dementia, Practical Caregiving Ideas, Quality of Life |
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Finally! We came home around 3:30pm today. While the staff at the hospital was wonderful, and Mary Ann had excellent care, the dementia has increased dramatically. Physically, she is fine. We are back to normal, riding the margin between heart issues and Autonomic Nnervous System issues (fainting due to sudden drops in blood pressure). It is not, of course, where we would choose to be if we had a choice, it is just what is so.

From the very first sleepless night, the first night we were there, the decline has been steady. Last night was terribly difficult. I put up the rails on the bed so that she would not get up and try to walk by herself on a very slippery, very hard floor. She just could not accept that the catheter allowed her to stay in bed rather than head to the bathroom. She saw people and animals and messes here and there. Today she described in detail a busy cluster of bees on the floor at some time during the night.

I sat beside her on her bed for fifteen minutes to a half hour a number of times during the night. At one point when she was awake, in the middle of the night, I checked my watch to see how much time there was between the need for me to get up and respond to her or help her. The time was usually between ninety seconds and two minutes.

I realized that if we were required to stay another night, I would need to arrange for a paid companion so that I could get some sleep. The constant nighttime needs are more than I can handle and remain rational, patient and helpful, after just two or three nights like last night.

Talking with the doctors helped clarify just how important it was to get back home to a stable routine and familiar setting. They agreed that the additional tests being considered would not serve any real purpose.

While there were differing opinions by the two doctors and the Physician’s Assistant, two out of three felt that there was no compelling reason to expect more vulnerability to Congestive Heart Failure than there has been since the first bout five years ago. We are going to return to our pattern of life to the degree the dementia will allow.

Mary Ann decided to go to bed at 5:30pm this evening. She has been up and down a a few times already. Of course, I won’t know how tonight will go until morning.

I had mentioned in passing to one of the nurses that I appreciated having all the folks at the hospital with the care recognizing that Mary Ann and I would pretty much be on our own to deal with the aftermath when we got home. I suspect she mentioned it to the Social Worker at the hospital who came in to talk with me before we left. It is the norm that a Hospital Social Worker will check to see what if any needs there might be when a patient goes home. This time the questions indicated some extra effort at listening to our situation.

The Social Worker mentioned that the nurses had spoken well of the care being provided Mary Ann. Since I am no longer in a role that provides opportunity for external validation it was especially meaningful to hear those words of affirmation. The Social Worker seemed to feel very good about the support system we have, from family and the congregation. She sees folks who have little or no support as they try to care for a Loved One.

The day tomorrow is a full Wednesday. It will be interesting to see how Mary Ann does with all that will go on. I am going to continue our activities based on the assumption that alertness and the ability to track will return and the hallucinations will diminish. It that improvement does not come, we will adapt. It is what we do.

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