Sparring with adversity

Apparently my dad did a little boxing in college. He never talked much about the actual boxing, although I remember a period of time during my childhood when the entire house would reverberate in the evening as Dad worked out in the basement with a punching bag. I thought he seemed pretty good as the bag swung rhythmically and faster than I could see. Some boxing terminology crept into his vernacular as a result of that experience. My sister Jenny has always received high marks for being a person that “always answers the bell.” “We’ll just have to counterpunch that” is Dad’s standard line when he’s not sure how things are going to work out or what course of action he will take. Dad is an aggressive person, not one to pick a fight, but always ready to defend himself and his family if he perceives a wrong. He never backs away from a fight. He drives aggressively, his debating style is aggressive, and he always fights to win. When we were kids, Dad loved to provoke us into debating with him, sometimes playing the devil’s advocate just so we would argue with him. Dad once coached my brother to “punch the kid right in the nose” after said kid had stolen my brother’s shirt in school and refused to give it back when asked. My brother gave the kid a deadline for returning the shirt and warned him that if he didn’t, he was going to punch him in the nose. The kid did not comply, so my brother punched him in the nose as directed, perhaps breaking the fellow’s nose. Naturally, my brother got in trouble with the school authorities for fighting in school. When the outraged principal called my dad and told him that my brother had punched the kid “right in the nose and may have broken his nose,” Dad replied, “Good! That just what I told him to do!” This pugnacious, some would say belligerent, approach to life has enabled Dad to gain his way in most instances. So, he’s used to getting his way and not used to having to submit to anyone else’s will.

Since that last time I wrote, things haven’t gone quite as well as we were hoping. Mom’s surgery was successful in that her foot was revascularized, but her recovery over the past two and a half months has been fraught with complications, some foreseen and others not. The foreseen complication was that eight hours of general anesthesia on a woman with dementia made the dementia much worse. This fact, of course, makes everything else harder to deal with. My dad, oddly enough, is something of an optimist, or maybe just a reality denier, because he keeps expressing hope that as Mom overcomes each setback, maybe she will “perk up” mentally. Not likely. The unforeseen complications were manifold, and Dad has been “counterpunching” each one with the plucky determination of the old boxer that he is. There was a slightly longer than usual hospital stay followed by a short stint in a rehab center post-op that the inexperienced surgeon predicted would only last five days. What the surgeon didn’t know, and neither did we, was that the red tape involved in getting someone discharged from a nursing home/rehab center is so onerous that it can take precedence over the medical necessity or lack thereof of the person’s being there in the first place. Never mind that she was well enough from a medical standpoint to go home after five days. There was a billing issue, and a paperwork issue, and a “customary practice” issue, and a personnel scheduling issue, and a day-of-the-week issue, a “who the hell discharges the patient anyway?” issue–none of which had anything to do with Mom’s care or well-being and therefore was irrelevant as far as we were concerned. Dad just wanted her home ASAP and figured as soon as the surgeon gave the go-ahead, he would just waltz in and take her out. Well, technically, I guess he could have, and he probably would have if I hadn’t stepped in to try to accomplish the discharge “by the book.” I figure, since this is the only nursing home in town, we may need them again some day, and we had better not burn our bridges with the management there by causing any more of a row than Dad had already caused by “laying the clinical manager and the ‘socialist’ worker out in velvet” and telling them he would let everyone he could know “what a piss poor operation they were running.” Anyway, Mom left the rehab facility after five days and went home to continue her recuperation. At that point her recovery consisted mainly of walking and letting her incisions heal, so Dad figured they were “farting through silk” at that point. Three weeks post-op the staples were removed (there were over 100 that stretched from her hip bone to her mid-calf on one side and from groin to knee on the other). The incisions were still open in a few places, so Steri-strips were placed at the surgeon’s office. Despite the huge incisions, the only pain that Mom complained of was in her back, and it would get really bad at times. Dad was slipping her the “pocket rockets” (oxycodone) again from time to time, but that didn’t always relieve the pain. I get her an appointment with the Physician’s Assistant for the back pain. Dad drives her to the appointment, the PA takes one look at the ghastly incisions, forgets all about back pain, and calls in the real doctor. They make her an appointment with the surgeon for the next day. Dad takes her, the surgeon takes a look at the wounds, re-dresses them, sends her home. The next day she goes for a routine blood draw.  A couple of hours after they get home from the hospital where the blood was drawn, Mom is in so much pain she’s “shaking like a dog shitting tacks.” Dad calls the ambulance, she goes first to the little local hospital, then is transferred to the bigger regional hospital (where she had the surgery). Turns out she has an infection, spends another week in the hospital on IV antibiotics, has another small surgery to drain an abscess and debride the wounds.

Throughout all of this, Mom is a trooper and cooperates with all of the medical personnel, but she has no idea what is going on, why she had the first surgery, where she is, why Dad doesn’t take her home, why she can’t get out of bed, etc. At one point, she got really mad at Dad for leaving her in that place (whatever it was) while he got to go home. Mom left the hospital after a week with five wound vacs attached. Wound vacuum is a therapy the involves packing the wounds with sterile sponge, applying airtight tape over the top and attaching a vacuum pump which keeps constant negative pressure on the wounds. The dressings have to be changed three times a week, there’s a lot of plastic tubing involved, and the patient is constantly hooked up to a small portable vacuum pump. That went on for about six weeks at home. Now, all the plumbing is off, and her wounds are almost completely healed, but her memory is pretty much a soup of disjointed bits that float around and spill over the edge at inappropriate times. So, Dad has been dealing with a lot of bad stuff, trying to keep his chin up (is that a boxing expression?), counterpunching his ass off. I’ve been encouraging him to get more help at home, since his goal is to keep Mom at home as long as possible. He keeps “counterpunching,” waiting to see how long he can avoid making that next capitulation. For a while I was getting frustrated with his foot-dragging, thinking he just wasn’t dealing with reality and couldn’t even organize himself to make some damned phone calls to home health aides. Now I realize the old boxer is still just counterpunching as best he can, bloodied but not broken, hoping for a miracle in the 15th round. Can’t really blame him.

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