Saturday, October 28, 2006

Beard trimming 101: THe big event

Brian popped in this morning to visit Dad. We both thought he needed a beard trim. Dad didn’t like anyone touching him anymore. Brian had a wicked cordless electric beard trimmer with an attachment that gathered up the clippings. He took it in to work on Dad, but the batteries died. I needed to give it a go. I was not used to this trimmer, but I did have a hair trimmer I had used on my children’s hair. How hard could this be?
I popped in early to do our evening dinner ritual and routine, trimmer in hand. Dad spoke as if there were marbles in his mouth. I was looking at his beard. “I think we need to trim it! “
“I don’t know. Pieces, suspended on the--”
“Yeah. Brian did his beard this morning. “
“I had three oh packages of it.” He sounded drugged, which was okay. I still suspected that he was in pain, hence his vocalizations. I was not sure.
I could hear Marjorie across the hall, yelling “Help!” as she did continually, in her state of dementia. “Help me! Help me!” Sometimes she would sing the words.
Dad was lying in his bed. Dad seemed calm as I cleaned him up and prepared to trim his beard.
“Do you have any bacon?”
“Yup,” I say, knowing he means scissors. His inability to retrieve nouns did not faze me anymore. I did not correct him. “I’ll get a towel.”
“You want to know. Not what you left. A get back to get up.”
I sat him up, cranking the head of the bed. He gave a big yawn.
“I did not have any relax.”
“Oh, no?”
I started trimming. It was quite long, with his mustache growing into his mouth. I was tickling him, and he moved away. “It’s okay. Sorry, I’m tickling. I’m doing my best, but not giving up my day job, though.” (Oops. Actually, I had.)
I kept working at the beard project and I was relatively successful. It was a bit crooked, but better than it had been. He tended to get so much food into his beard and mustache that it helped if we kept it short. He had always been so meticulous with his appearance. He and Mom had made regular visits to the hairdresser. Dad always got dressed every day in a shirt and pants.
As I worked at his beard, the PSWs came in and asked if I wanted them to get him up. I told them that he would be ready shortly. Off we went to dinner again.

Sunday, October 22, 2006

Choking & Swallowing

Dad greets me with a kiss today. Three times he tipped over in his chair. I think his equilibrium is gone. He juggled right-of-way with another resident, Tom, in the doorway as he tried to leave the sitting room. They are crashing about with wheel chairs, running into one another. He became angry, “I can never do anything well, dammit.” How do I recall for him the home repairs he had done, the work he did over the years, the care and love and the attention he lavished on his family?

He chokes on his milk and he cannot swallow properly. He recites “555”, the first three digits of his home phone number. I leave to get his third cup of milk and when I return he is surprised that I am here. He says, “Oh. Look who’s here!” As if I hadn’t just fed him two cups of milk. He insists on spearing his own meat that day. He manages to get three pieces into himself. He had much trouble doing it. “Shit. Nothing’s worth a shit.” as he misses the small piece I had cut for him. He drank four glasses of milk that day. He is quite thirsty but I fear that he will choke to death and the newspaper will say, “Daughter stands by while father chokes to death on milk”.

Swallowing difficulties are called dysphagia and they are a common result of neurological or neuromuscular damage. At the time I had no idea that it is something to be expected. Large percentages of people with strokes, Parkinson’s disease, MS have this symptom. Those with structural damage include people like my Dad who have tumours. Swallowing is a complex process that involves 26 muscles. It is uncomfortable and frightening, as well as life-threatening because dysphagia interferes with the oral intake of food and medications. Long-Term Care Best Practices says that up to 70% of residents on LTC have signs of swallowing problems. This can result in aspirations, choking, suffocation, dehydration, malnutrition and decreased quality of life.

Dysphagia – choking and swallowing issues

The Regional Geriatric Program publishes an e-zine called BP Blogger. One issue deals with swallowing. The web site has a lot of information.

Signs of Swallowing Difficulties
• Coughing when eating or drinking
• Food or liquid spilling from the lips when eating or drinking
• Trouble moving food or liquid around in the mouth
• Prolonged chewing
• Trouble starting to swallow once food of liquid is in the mouth
• Clearing throat shortly after a meal
• Has a wet or gurgly sounding voice
• Complains feeling that something is “stuck” after swallowing
• Shortness of breath during or right after mealtime
• Has frequent heartburn or bitter taste in the mouth
• Unexplained weight loss
• Recurrent chest infections
• Refusal to eat or reluctance to have food in the mouth
• Pocketing food or liquid in the cheeks or holding food in mouth
(Reprinted with permission)

Sunday, October 15, 2006

Case Conference for Dad

The law states that there must be annual case conferences for residents in Long-Term Care (LTC). Today is the day. Aside from the intake meeting, we keep careful tabs on my father. There is little we do not know. We find that popping in at different times of the day has keeps us apprised of different issues and situations. We have met various staff members who work on the different shifts. Aside from coming in every day to feed Dad dinner, we pop in if we are in town for an appointment or an errand. I have come to know the reception staff. They are very kind. We share stories of parental issues. One woman has dealt with these very issues with which we now deal. Her mother would refuse food in her presence and eat later. Her mother agitated when she is there visiting - perhaps blaming the daughter for the frailties of old age and the insult of leaving familiar surroundings.

Today there is an accreditation meeting for the nursing home. Our case conference conflicts with this event. Dad’s doctor, who is responsible for the entire floor of patients, sees us in the hall outside the nursing station and apologizes that he cannot make the meeting. We went upstairs to see Dad before the meeting. He sees us and says, “What are you doing here this early?” It is 10:20, just before our 10:30 meeting. He must have some remaining sense of time and that we visit at dinner time on most days. He cannot really understand what I am saying – that we have a meeting, maybe. He is talking gibberish.

The case conference is in our familiar Muskoka Room. I have taken Dad down the hall to where our meeting will occur. As a teacher I always included students in our parent-teacher meetings. I think it an important thing to do. It is a small conference with the charge nurse, and another staff member, a PSW unfamiliar with dad’s case, and us. They tell me Dad has been aggressive with a caregiver. He was agitated and grabbed her arm. They tell me he is refusing a bath. He did this for two weeks at the Manor in the summer. This is not my father. As we talk Dad wheels his chair around the large, heavy pine table. He gets caught up on the table leg. He is talking out loud. “What do we deliver to?” And later, “Where can I go to a radio activity team?” I sit and write these things down as we talk. It gives me a focus and a purpose. I find it surreal, these interactions. I bought a spiral bound book to record all the information.
The PSW suggests that we get Dad involved in some activities. He cannot hear. He refuses to interact when he is embarrassed. They suggest music therapy. Dad loves music so very much. If he can only hear that might be a good bet. I ask if they can arrange to have the resident hairdresser cut his beard weekly. It grows so quickly. His hair, on the other hand, what is left of it, is straggly from the radiation treatments in the spring. It is very fine and wispy. They tell me about the massage therapist, as well. I knew she existed. I had previously contacted her and ask that she try a visit once a week. It might help his circulation and improve his well-being. I have questions about dad’s medications, but since the doctor cannot attend the meeting I will have to try and talk to him later. This proved the most difficult challenge of all: trying to talk with the busy doctor, especially at the most crucial times. He is only in the residence once a week.

Eventually, I learn that the best person to talk to is the Charge Nurse when I visit at mealtimes. She knows more of his behaviour and can speak to the doctor on our behalf. We have full power of attorney, both medical and personal, as is the case with about 90 % of the residents in this wing. I began to suspect that Dad is in pain, but cannot be sure. I had to figure out what to do with this information. They can give him Tylenol 3, but, since he has had arthritis pain in his knees for years, I think it will not have much of an effect on him.

Monday, October 9, 2006

Thanksgiving Dinner

Today I went in to visit dad. As always, the building is beautifully decorated. There are many Thanksgiving symbols and decorations. As I approach the front walkway I see huge bales of straw, with stuffed Wizard of Oz people made of hay, pumpkins, and bright orange ribbons. The activity staff put up cute little turkeys, too. Indoors, the floral arrangements are in tune with the theme and fall colours. It is cheery and a recognition of the changing of the seasons. I must dig out some decorations for Dad’s room.

The kitchen staff prepared a wonderful dinner. Brian doesn’t like turkey and so I am quite envious of dad’s full dinner; turkey, stuffing, hot vegetable and pumpkin pie. We will not eat so well, as there are only the two of us. We are drained with the demands of regularly feeding dad. I have found it much easier to visit Dad and feed him at dinnertime, rather trying to drum up conversation. I have the need to cry when I visit, but I can fight it if I concentrate on meeting Dad’s dietary needs. It means that Brian and I often go out to dinner after this, since I do not get home until dark and too late, with little energy to cook.
I sit there thinking of the numerous turkeys Dad had prepared. His job is to put the turkey in before church. He will quietly go about the kitchen making the stuffing; cooking and saving the giblets for whichever animals he had at the time. The cats loved them.
One of the photos I displayed for Mom’s Memorial Service visitation is one that shows them two years ago, aprons tied, Mom at the sink, Dad at the stove. He wore a bright pink vest over his dress shirt. Mom wore a white, embroidered sweater. Both dressed in black dress pants. They always take pride in their appearance. They hated it when people popped in, especially when they become so ill. Mom spent all day in her pajamas, as the tumours are painful and her colitis horrible, with emergency visits to the bathroom on an irregular and unpredictable basis.

Dad is calmer today, Monday, than he was on Sunday. He can’t figure out the hearing aid. He keeps turning up the volume, making it squeak. He reads lips a lot. He loves the ladies: cheering up every time a young caregiver pops in. He smiles and turns on the charm. He seemed to accept being fed as a gesture. It is only fitting that the person that nurtured and fed me should be, in turn, be receiving such care. I cry on the drive home, for moments lost to memory, never to be repeated. A childhood remembered with great joy. The photo shows them making the last Thanksgiving dinner they ever made. I will become an orphan. I am now the matriarch. How different it all feels.

Monday, October 2, 2006

Incontinence

Brian arrives before 8:00 a.m., in time for breakfast. Dad ate a double ration of breakfast. All seems much better. Perhaps, as the Charge Nurse says, he needs to become acclimatized to his new surroundings. When I arrive at 3:30 in the afternoon he is sleeping. I walk into the room and he is quiet and peaceful. He is now incontinent. Depending upon others to clean him up and change his adult diapers, bedclothes and clothing. When he awoke we tried to communicate. He tells me, “You don’t have to do laundry.” As always, I just nod and smile. There is a time, before Mom and Dad deigned to purchase hearing aids, that Mom will nod and smile to everything I would say. She really did not hear what I said, but does not want to admit that she could not hear us. What a weird turn of events.