As I posted in “Mom’s Dementia and the Next Crisis”, I had just promised mom I would come to visit her and dad in just 2 months, when she fell and broke her hip. It was just after 6 PM when the phone rang with the news that mom was on her way to the hospital. I called the nurse companion to sit with mom until she was admitted. I called the hospital. I was beside myself with worry and fear. I had spent the past 3 years trying to set up a safety network around mom and dad but in the end, there was no way to keep mom safe.
No one knew how mom fell. She didn’t remember falling and dad didn’t remember seeing her fall. The nurse said dad came to the nurses’ station to tell them she had fallen and couldn’t get up. The nurse came and saw mom couldn’t get herself up. They are not allowed to help the person stand as it might make things worse. She could just call 911 and stay with mom until they came. At the hospital I was told that frequently with osteoporosis (which mom had) the hip bone will just give way and they will fall while standing, and that seemed to be what happened to mom.
Because of her dementia and dad’s Alzheimer’s, neither remembered by the next day that she had even fallen. Dad didn’t understand why mom wasn’t in the room with him. Mom wasn’t sure why she was in the hospital. The x-rays showed she had a fractured hip and would need surgery. On Sunday night I was told the surgery would be in the morning and I should be near the phone to give permission when the surgeon called.
On Monday morning, I spoke to mom on the telephone from my northeast home. I told her they wanted to operate on her broken hip. She said OK. I told her she needed to understand that this was a serious operation and that at age 90 she could die from the surgery. She said: “I’m 90 years old. What do you expect”? Tears started to run down my face as I said: “OK, mom. I will tell the surgeon it is OK to operate.”
I talked to the surgeon shortly after that. I asked him if he thought I needed to be there as I was planning to come 2 months later. He said: “Breaking a hip is usually a life-changing event. You will want to be here.” “OK”, I said. “I will fly down as soon as I can.”
I got online and made my reservations to fly the next day. I started to pack a suitcase, not knowing how much to bring. How long would I be there? I checked the temperatures in that southern city on weather.com. I would need shorts and pants, maybe a light jacket, who knows what else? I started throwing things in the suitcase. What am I forgetting? I usually take a week to slowly gather things to put in the suitcase, but in it all went.
I left early Tuesday and then grabbed a sandwich at the airport when I arrived and took a cab to the Assisted Living Facility where my parents were living. I booked an independent unit for myself on a day-to-day basis. I said I thought I would be there a week or two. I dropped off my suitcase, talked to dad a few minutes, and went straight to the hospital. I spent almost every day at the hospital after that for the next few weeks.
Each morning I would awaken early, have a quick cup of tea, visit dad in his assisted living unit, and then take the ALF’s transportation vehicle to the hospital to visit mom. A few days I brought dad with me, but mostly he waited in his room. Dad never liked hospitals and mom didn’t want him to see her like that.
I was exhausted within days. I was trying to spend early mornings and late afternoons and early evenings with dad, and the rest of the day with mom at the hospital. I had dinner with dad some evenings and other times I sat with him while he ate. I had no time to think or to relax.
Things weren’t going well at the hospital. The only time I could find a doctor was when they wanted me to sign some papers, usually to give permission for a test or procedure. I needed some up-front information so I would have time to determine if that was what we wanted. Mom had already stated her wishes in her health care proxy written ten years before. I knew she wanted “no extraordinary measures to prolong life”, etc. But she never spelled things out such as tube feedings, antibiotics if she was terminal, etc.
When I first arrived, the doctors were very optimistic. They expected to discharge mom to a rehabilitation center by Friday. They said that I needed to hurry and tour at least 2 rehab centers and give them a list of what we would accept for a discharge. One was near the Gardens, the assisted living facility where mom lived. The other was adjacent to the hospital. I was supposed to tell the social worker within 2 days which ones we would accept. How would I squeeze out time to visit the rehab centers? I didn’t even have a car. I didn’t rent one because I had no idea how long I would be there and it would get expensive if I stayed more than a few days.
In the meantime, mom needed me by her side to call nurses or others and ask for help with getting a bedpan, getting her turned to make her more comfortable, etc. We spent a lot of time talking. Mom was suffering from dementia long before she was hospitalized. Yet sometimes she responded with amazing clarity. Other times she saw things that weren’t there – like she thought there was a cup of water sitting in her bed, or a few pills on top of the covers. She heard “music” that must have been from the machines that were hooked up to her bed. They seemed to be playing the songs she had danced to in line dancing. She heard: “Elvira” and other favorite tunes played in her bed.
Within days of her surgery, physical therapists were coming to her room to work with her. They wanted to make sure to keep up her strength in her arms and legs. They had her lifting her arms to reach the bars over her bed and even sitting up and dangling her legs over the side. She was very weak and unable to do much. One day she had a male physical therapist sitting with her on the bedside (both dangling their legs) singing country songs that she knew from her line dancing. Her spirits seemed good at first, yet she didn’t seem to be getting better.
After the first 3 days she started to vomit. She couldn’t keep any food down. They determined that there was a blockage in her colon and stopped all oral feedings. Now she was on IV nutrition only. They were hoping the colon would clear itself without surgery. I was beginning to worry about mom’s recovery. Then someone gave me a form saying mom was supposed to be discharged by Friday (less than a week after she was admitted) and I needed to specify what rehab center I wanted her to go to.
I asked the nurses to help me find the doctor. I needed to talk to someone. They couldn’t discharge her when she was hooked up to all those IVs, could they? Finally the doctor came by. He said not to worry; the paper was “just a formality”. They wouldn’t discharge her “until she was ready”. (Apparently there is a law that the family has to be notified and given 48 hours advance notice in order to object before a patient is discharged. In order to meet the requirements of that law without thinking too much, they simply give the letter to every family within a certain numbers of days after admission, no matter how the patient is are doing!) “When will mom be ready to go to the rehab center?” I asked. They had no way to know, but they would let me know a few days ahead of time.
So on the one hand, I was supposed to be ready with a list of acceptable rehab centers as soon as she was ready for discharge, and on the other hand, they wanted me to be there, by mom, ready to approve and sign for the various tests and procedures they wanted to do. I could feel the stress rising inside me.