Approaching the not-so golden years

Well, I see that five people have viewed my blog today already, perhaps thinking I might post something on my birthday, and I thank those five loyal people, whoever you are, first, for giving me the benefit of the doubt, and secondly, for inspiring me to actually post something.

It is my birthday, and I am spending it in Colorado in the company of my son and his family, which includes a new grandchild, Timothy, only two-and-a-half weeks old and his big brother, two-year-old Willie. They are handsome, healthy, active little sleep-bandits, and I am delighted to be spending my birthday with them and their parents, sleep deprivation or no. Nothing beats the unrestrained hugs and kisses of a two-year-old, the foot races down the sidewalk, or nosing a newborn’s soft head and watching him surrender to sleep in your arms. These are the experiences whose remembrance I hope will sweeten my “golden” years, a subject that is often on my mind these days, especially after I have visited my parents. Because, frankly, based on my observations of them, the golden years appear to suck big-time.

Dad has yet to come to terms emotionally with the fact that Mom can’t live at home with him, let alone cook his meals, do his laundry and be the foil for his acerbic wit. This has made him even more morose and negative than usual. And, as he has always said about his own mother, “you can tell her [him] from a mile away, but you can’t tell her [him] much.” Every time I see my dad he tells me how much it breaks his heart when he visits Mom at the assisted-living home and sees that she can’t carry on a conversation or understand much of what he tells her. (“Poor Mom, she’s just kind of out in space. I told her about her brother dying, but that just bounced off of her.  It just tears me up. But, what are you going to do? At least she’s comfortable.”) She has been there for 15 months now, and she has dementia (a word Dad can hardly bring himself to pronounce). What does he expect? I gently suggest that accepting her reality and trying to meet her there could make it less painful for him. Yet, he continues to try to interact with her the way he always has and ask her to respond to questions that involve remembering (how she slept, what she ate, etc.) He also tells me how depressing the place is (it is quite cheery, actually) and how much he admires the ladies that work there (“that’s tough duty; I couldn’t do it–it would drive me nuts”). I point out that Mom is doing well there, she’s well taken care of, she’s content–that’s all we can hope for at this point. He agrees, and then tells me again how awful it makes him feel. He’s a broken record, and the needle has worn a groove so deep it can’t be jolted out. I’m afraid the only fix will come when the record player winds down completely, and he seems to be readying himself for that moment, if not courting it.

“There are worse things than dying,” Dad told my mom’s doctor the other day, after she suggested we might want to start getting Hospice involved with my mom’s care. Not sure if he was referring to his own agony, Mom’s impaired state, both, or the recent sad demise of friends and family members. Living long enough to witness the decline of and bury the people you love is certainly one of the least appealing aspects of aging.

On the other hand, my dad does take delight in his great-grandchildren and relishes receiving news and photos of them, although visits are few and far between, and he’s never even met the Colorado kids. My mom responds almost lucidly and coherently to photos of “those very cute little kids,” but has no idea who they are or who they belong to. Seeing their photos and hearing me talk about them (as if she understood) seems to relax her and release natural and appropriate verbal responses in her. I’m not at all sure she even knows who I am anymore (another notion that sends my dad into the depths of sadness and denial whenever I honestly answer his post-visit inquiry, “But, she knew who you were, didn’t she?”). But, she likes me, and happily rode in my car to her doctor’s appointment, chatting nonsensically the whole way. When I told her my name is Lynn, she perked up as if that name actually rang a bell somewhere in the recesses of her fractured memory. I take solace in that glimmer of recognition, while for Dad it’s just another reason to despair.

So, on my birthday, I’m thankful to turn 61 instead of 84 or 85 (Dad and Mom’s next respective birthdays) and still be able to cope with life’s vicissitudes fairly well and thoroughly enjoy its gifts in the form of dear friends, healthy grandchildren, loving and successful children, siblings that are also my best friends, a spouse that is still the love of my life and my rock, and (knock on wood) my own good health. The so-called golden years can take their sweet time, thank you very much.

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The language falters…

There’s a lot of linguistic stuff happening in my family lately. Some of it is good, fantastic even, like the other day when my three and a half year old grandson’s eyes opened wide upon spying my cleaning lady swiping at cobwebs with a telescoping duster, and he said, “Wow. She doesn’t even need to use an arterial handler to reach up high.” Arterial handler, material handler–whatever. I love listening to him create and use language. New words stick to him as lint to Velcro. He rolls them around in his mouth, chews them up, savors them and digests them to nourish his rapidly expanding vocabulary. At times, words tumble out of him faster than his tongue can handle, and he stutters as he struggles to order his thoughts and put them into words. And, the marvelous part is that he is able to do just that with every-increasing proficiency and complexity. His one-year-old brother is developing his oral language skills mostly by shrieking so far, but also yelling his big brother Ben’s name (“Ba!”) as he crawls around after him or whenever he hears Ben in another room. Likewise, his 15-month-old cousin gleefully points out and declares, “Da!” at every sighting of a dog, large or small. I’m sure they will soon be wowing their grandma with their linguistic prowess as well.

 

Then, there’s my mom. An Alzheimer’s type dementia has been slowly but surely robbing her of her linguistic proficiency for the last eight years or so, and the decline has been particularly striking and heart-wrenching in the last six months. The first thing I noticed about eight years ago was that the sentence structure in her annual Christmas letter was much simpler than it used to be; there were virtually no complex or compound sentences. And, Mom was no slouch in the language department either. She prided herself on her precise enunciation and command of English grammar and corrected her children’s grammar at every opportunity. I clearly remember learning several fancy words from her as a kid:  inclement (written in an excuse to a teacher as to why we had been delayed returning from a trip to my grandparents’ house), obstreperous (used to describe my brother) and loquacious (said about my sister Mary). As time went by, Mom started to have trouble retrieving common words and telling an organized story, much to her own frustration. Eventually, she forgot the names of many everyday items and had trouble expressing her thoughts, needs and wants. Nonetheless, she would amaze (and fool) us with her ability to utter appropriate cliches in response to certain conversation prompts or social situations. For example, up until recently, when asked how she was, she would invariably reply, “Well, I’m able to be up and about.” Or, whenever she would see me again after an absence, she would say, “Well, you’re sure looking good.” She should have been a politician! By last year at this time, Mom had pretty much lost her ability to carry on a conversation, but she still seemed to enjoy listening to the talk around her and could respond more or less appropriately to a direct question. But, over the course of last summer, she seemed more and more lost in her own world, largely unable to communicate any but the most basic thoughts and sometimes speaking incoherently. She was resorting more and more to gesturing, making faces, and laughing. Thank God for the laughter. She could still enjoy a joke and some silly fun. Just about the time when I thought her speech was no longer was making much sense at all, this past autumn Dad asked her at breakfast one morning, “Well, Ma, what are you going to do to piss me off today?”  Without hesitating, she replied, “I don’t know, but I’m sure I’ll think of something.” Cracked all three of us up. Then Dad told me they had the same “conversation” every morning.

That was last fall. Mom fell at Thanksgiving time, and after a short hospital stay and a six-week stint in a nursing home, we moved her into an assisted living home in January. Physically, she has recovered from the fall, but being institutionalized did not do her cognition any good. With every transition she seemed to lose more linguistic ability to the point where now she carries on conversations mostly with herself. What she is able to articulate in words often doesn’t make any sense to those of us that adhere to more accepted linguistic norms, but she carries on as if she is making sense  or reverts to laughter to smooth over the gaps in understanding. I guess that’s an old conversational trick we all use at times and another one that dies hard.

For my dad, of course, this process of watching and trying to deal with Mom’s mental decline has been devastating. It would be for any spouse. But, I can’t help feeling that for him it is especially hard because his way of interacting with people, including her, has always been about the B.S.– the banter, the debate, the verbal give-and-take, the expounding, the pontificating, the lecturing, the ranting, and always with the ear tuned for a smart rejoinder, a witty comeback, a new joke–something to incorporate into his own vernacular. Mom was his foil and (mostly) appreciative audience for over 60 years–laughing at his oft-repeated jokes and stories in spite of herself and sharing in the fun, even when it was at her expense. It was part of  their public and private dialogue, their dialect, their dance. Now the dialogue has become a monologue, the dialect is becoming extinct, and the dance is coming to an end.

There is much research being done into Alzheimer’s dementia and how to relate to patients and understand their needs and the reasons for some of their bizarre behavior. Familiar music, old photos, and coloring all seem to help calm my mom and trigger some memories, but so far I cannot decipher this new language that her diseased brain produces and that she tries mightily to use. I can only cling to the moments when we share a laugh over something silly, she acknowledges that I’m her daughter, or at the end of a largely unintelligible visit, she hugs me and says as plain as day, “You can leave now, but you come back to see me.” And, I will go back, always hoping for a glimpse of the woman I used to know and whose advice and easy company I miss so much. I would give anything to discuss a book with her or to have her know her great-grandchildren, to marvel at their intelligence, teach them fancy words, and even correct their grammar.

On death, the afterlife and new cars

Death and dying are frequently on my mind these days because of recent events with my parents, and I assume they are topics that also preoccupy my Dad. Both he and my mom have experienced some potentially life-threatening health problems over the past couple of years, and my mother’s dementia steadily worsens. Couple those issues with their eighty-plus years of age, the death and decline of friends, various stays in hospitals and nursing homes, and the subject of death is bound to be foremost in his mind. While he’s perfectly capable of being absolutely maudlin at times, my dad’s sense of humor does extend also to the subject of death and the afterlife. He is fond of ruminating out loud to his black Lab and best companion Paco, “Paco, Paco, you have it so good. We haul the food to you and the shit away. When you die, you just die, and that’s it. When I die, I have to go to hell yet, besides.” Dad also refers to death as “going to the fields (of ambrosia).”

Despite any preoccupation with death and its imminence, my dad recently bought himself a new car even though it was probably not essential. But, who doesn’t love a new car? I take it as a very good sign that he’s not ready to “go softly into that good night” yet himself. Unfortunately, cars have changed enough in the past few years to create a rather steep curve around learning how to operate a new vehicle. For example, the lack of a key, having to depress the brake pedal in order to start the engine, figuring out how the cruise control functions, and–the biggest frustration of all–the placement of the fuel intake on the passenger side of the car. That discovery unleashed a flood of “pungent vernacular language,” some might say a diatribe, over the absolute idiocy of fixing something that wasn’t broken. Somewhere Dad believes it was written that the gas intake goes on the driver’s side, by God, and that there is no possible good explanation for putting it on the other side, necessitating walking around the car in order to fill ‘er up. Oh, the aggravation of having to take ten extra steps! A month ago I would have told him it was good for him to take those extra steps, given his very sedentary lifestyle. However, in mid-December he fell at the dump, standing right next to his car–lost his balance on icy terrain just turning around and probably broke his collar bone. I say probably because he has opted to treat himself with gin and hydrocodone rather than go to the doctor to confirm the break or not. Why pay $500 just for an x-ray and a sling? So, now I’m not so sure that any extra walking out in the wintry elements is a good thing for him, and I wish I could turn the clock back to a time when their local gas station offered full service. But, then, if I could turn back the clock to easier times, there would be no need to fret about infirmity, death, hell or cars with push buttons.

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.

Nicknames (2)

The person with the most nicknames might be my mom, which makes sense since Dad has known her longer than almost anyone. As far as I can tell her first nickname was “Snake,” short for “Snake Hips.” She was really slender when she was young, and I can remember him calling her that when I was a little kid.

At some point, probably when I was in middle school, he started calling her “Opal.” Mom did not like this nickname, as its origin is a funny, but sexist joke that goes something like this: An old Kentuck and his buddy were sitting around a campfire drinking moonshine and telling lies while watching the comings and goings of Opal, the Kentuck’s wife. Opal was frying fish over the campfire and otherwise waiting on the men hand and foot, whenever her husband would call her over. “Opal, bring us some more whiskey!” “Opal, come pull off my boots!” “Opal, come throw some wood on this fire!” After a while, the frying fish smelled a little too hot to the Kentuck, and he called, “Opal, come turn these here fish!” Opal complied by hurrying over with the spatula and flipping the fish over. They were black underneath. “Well,” remarked the Kentuck to his friend, “reckon I should have called her sooner.” Even though she didn’t like it at first, the name “Opal” stuck, and my mom learned to live with it. She is nothing if not a good sport.

“The Dowager” is another moniker that Dad has hung on my mom, probably in the last twenty years. I think he just likes the word and likes teasing my mom about getting older and the likelihood that she will outlive him and inherit the “estate.” My efforts to convince him that this nickname is illogical since he is still alive have been in vain.

In one of my early posts I asserted that my dad isn’t acquiring new material for his vernacular, but that is not entirely true. He keeps his ear to the ground and adopts new lexicon when it suits him. An example is the most recent nickname that he has bestowed on my mom: “Lady Gaga.” Where he learned about Lady Gaga, I can only guess. The Today Show? Anyway, it’s not because of her singing voice or her outlandish costumes. It’s just that my mom has dementia and is kind of ga-ga, and she’s the first to recognize that her brain doesn’t work as well as it used to. But her grand sense of humor is still intact, and she can laugh at herself, and she still thinks my dad is funny (sometimes) after more than 57 years of marriage.

Whatever you do, don’t call ’em “health care providers”

Talking to Dad today, he tells me that next week he needs to go see the “clap doctor,” and has to take Mom back to the “farrier.” Translations:  urologist and podiatrist. Dad was treated for bladder cancer quite a few years ago, but goes for regular check-ups that involve having his “hobby” violated with “a garden hose,” after which he’ll “piss hot lead” for a few days. Mom has poor circulation and neuropathy in her lower extremities, so goes regularly to have her “hooves” trimmed. Dad has to drive her because Mom has dementia, but he’s thinking about breaking it off with the podiatrist, because “those bastards are getting as bad as the chiropractors. Once they get you coming, you gotta keep going back. They never actually cure you of anything. Just like the damned pimple doctors.”  Last week, Dad saw the “pump doctor,” i.e. cardiologist, another one of the “quacks” that he sees regularly since his heart attack last spring. Dad actually likes the cardiologist, even though it really pisses him off how much medication he is prescribed and the strong admonishment to cut down on his alcohol intake. It turns out that heavy  alcohol consumption over the course of many years will damage your heart and is a common cause of atrial fibrillation. As Dad put it, “Here all along, I thought I was being responsible by not drinking before 5 o’clock, and it turns out I’m nothing but an old drunk.” The cardiologist barely cracked a smile, but Dad keeps trying out his schtick on him, and it appears they’ve come to some kind of an understanding. Dad takes about half the medication the pump guy prescribes for him, and drinks about half as much gin as he’d really like to each evening. As for internists, Dad has gone through quite a series of them over the last few years. “They’re getting to be just like migrant workers. You start getting ’em trained up, and they leave. Can’t blame ’em, really, they don’t pay these guys enough anymore to make it financially feasible for ’em. Kids getting out of medical school and residency programs into debt up to their asses. Come the Revolution…”  Regardless, he will then launch into a diatribe about how the internists are “just there like tits on a boar,” anyway. That is, they don’t really do anything except refer one to specialists, order tests and push pills. “Healthcare providers, my ass! What an offensive use of the English language!”