Friday, September 30, 2005

A Visit to Beverly Hills

Today is our visit to the cardiologist who did the surgery for Mom's pacemaker sixteen days ago. For twenty days she hasn't been anywhere except her residence, the hospital, a few trips in the wheelchair around the block, and one visit to my house.
Jona has Mom at the front door, sitting in the wheelchair and ready to go when I arrive at 9 am.
The doctor's office turns out to be on North Robertson in Beverly Hills; there's a lot of traffic, but we make good time.
"Oh, is that where John works?" asks Mom, pointing to the skyscrapers of Century City and Beverly Hills.
"No," I say, once again explaining that those tall buildings are not downtown Los Angeles, though they look like it.
We arrive and park in a glamorous medical complex. The elevator has glass walls so we can see the large fountain and pool surrounded with greenery in the lobby as we sail up from the parking levels.
On the second floor, we find Suite 150, but there is no door; we wheel right into the waiting room where the receptionist sits overlooking the fountain. We sit down and watch the people in the elevators as the glass boxes slide up and down.
The other people in the waiting room are in matching groups, older and younger, as we are: an Asian man my age with his frail father in a wheelchair; an elegant older Caucasian woman with an equally elegant blonde daughter my age; three women in lovely flowered sunhats, speaking Farsi, one older, two about my age.
Forty-five minutes later, we're admitted to a small examination room; Mom is told to change into a gown from the waist up. Fifteen minutes later Dr. Noel B. enters. I have spent the hour making a whole page of notes about events since the surgery and questions that I have.
"How have you been doing?" he asks Mom.
"Fine," she says.
"Except for one episode a week ago where she was nonresponsive for ten minutes," I add and start to describe it.
"That has nothing to do with her heart," he concludes, as Bill did a week ago.
"Okay," I say and look over my list of other questions and concerns.
"Her incision is healing well. Excellent!" he says, about to leave.
"I just want to know about the pacemaker, when it was reset a couple days after her surgery, what level of demand it is set to now," I begin.
"I can get you that information, but that's not what this appointment is for today. I'm just checking on the incision. You need to call the Pacemaker Clinic and make an appointment for November or December, to have the pacemaker checked after the leads have matured."
He disappears to get a written report on the surgery, and Mom says to me, "Don't overdo him or he won't come back." She knows exactly what's happening.
When he comes back, I ask again: "Well, I just wondered about whether the pacemaker is monitoring both the atrium and the ventricles--the specialist in the hospital said it was not set to read 'A-fibs and fluts.'"
"It paces in the atrium, but her ventricle does itself, unless it needs help. The demand is set at 60. In the atrium it's set so it doesn't track rapid beats."
"Okay, thanks," I say, accepting the papers he hands me.
We're back out in the elegant lobby, never having paid a penny, thanks to Medicare.
We wheel out onto the sidewalk to look around, but this part of Beverly Hills doesn't seem to have any shops or anything interesting, so we enter a liquor store next door and buy two lime popsicles and a small glass bottle of Coca Cola with "USC Trojans--2004 National Champions" on the back.
We retreat to the parking levels, pay $9, and drive back to Santa Irena, where we meet Jona.
"How did it go?" she asks.
"Okay," I say. "All he wanted to do was look at the incision. It was fine."
Jona looks at me with wonderment.
"Yeah, we knew it was fine," I say.
We look at each other, shaking our heads, thinking about all the effort it took to get Mom up and out by 9 am for the big expedition to the doctor.
"Oh well, at least we saw Beverly Hills, didn't we, Mom?" I smile.

Thursday, September 29, 2005

Airway Emergencies

No phone calls in the middle of the night! Hurrah!
I don't show up for my daily visit until 4:30 pm. Mom is already sitting in the dining room, eating grapes while waiting for dinner to start. Several other residents are also early for dinner.
"How was her day?" I ask Jona.
"Fine. She was fine today--not a sleepy day, not agitated."
"Great," I say. "Thanks--you can go now. Thanks for everything." I like to let Jona leave at 4 pm or so because she works a 12-hour day, 6 am to 6 pm. Instead of visiting my mother at 2 pm as I used to, I try to come by 4 pm and let Jona get away before traffic gets bad. But it's now after 4:30 so traffic will be terrible.
"Okay," says Jona, always cheerful and smiling.
I scoop up the pile of red grape skins from the placemat and throw it out.
A staff member of Ocean View brings Mom a bowl of soup, a thin dark broth. She picks up the spoon with her left hand, but I make her use the right hand to eat.
"It needs exercise," I say. "It's still swollen." She takes a few spoonfuls, laboriously. The fingers of her right hand are swollen and clumsy.
I begin showing her photos of Colorado, which I have just picked up from the photo shop. She's looking at each one with interest. She tires of trying to steer the small spoonfuls into her mouth and picks up the bowl to drink the soup.
But on the second swallow she chokes and tries to cough. Some soup must have gone down her airway instead of the throat. She makes choking noises. I thump her back, which doesn't help. Bethlhem comes and raises Mom's arms above her head, which helps. The four other residents sitting around the table watch the scene with varying levels of alarm and alertness.
Soon Mom is coughing well and able to talk. Crisis resolved. I throw out the soup, and she moves on to the main course, pasta with chicken. I make a mental note: "No drinking of soup. Too hard. Her swallowing skills aren't up to it."
Then Elva at another table chokes. She is older than Mom, maybe 92, less glamorous: a small gaunt figure with large black glasses and a few strands of thin grey shoulder-length hair that start a few inches back from her forehead.
Bethlhem and Marnie are able to resolve this crisis too. I admire their skill and fortitude.
"Just another exciting meal in the Reminiscence Neighborhood," I reflect later, leaving Connie to deal with my mother, Bethlhem and Marnie to cope with other crises until 10 pm.

Wednesday, September 28, 2005

The Morning After

I thought I had solved everything. I had gone to Mom's residence, calmed her down, and tucked her back into bed. Feeling somewhat saintly, I had returned home at 2:30 am and gone to bed, sleeping in to get a total of six hours.
I had promised her, "I'll be back at 2 pm."
But at 2 pm, I thought 3 pm would be good enough. At 3 pm, the phone rang.
"Anne, should I take the doll to your house? You want to keep her there, don't you?"
"Hi, Mom. You mean Anne of Green Gables? She can stay at your place. I thought I'd take her back to Colorado next summer."
"Oh, okay--"
"How are you doing today?"
"Fine, I'm fine, but when are you coming?"
"I'll come in about half an hour. I'll be there soon," I promised. I didn't ask to talk with her caregiver, Jona. Everything sounded normal.
But then I didn't arrive until 4 pm.
Jona began by explaining, "She's agitated today."
I heard the whole story, starting with Connie's report to Jona about the rest of the night.
Mom had only slept for twenty minutes before waking at 2:40 am and again insisting on getting out of bed: "I'm going to the meeting. I have to get dressed."
Somehow Connie had kept Mom in bed and gotten her back to sleep. Mom had slept off and on for 2-3 hrs., waking and asking for orange juice, getting a change of her Depend.
Jona had arrived at 6 am, and Connie had gone home to sleep.
"She was awake and agitated," Jona reported. "She was trying to get out of bed, so I sat on the end of the bed. She was saying, 'I'm going to the meeting! Get me dressed,' and she was trying to push the bedrail out with her knee. 'I'll kick you,' she kept saying and she was crying. "Go ahead, kick me,' I said, and she did."
"Oh dear! I'm so sorry. This is the first time you've seen her this way, isn't it?"
"Yes," admitted Jona.
"It's usually at night when she gets agitated," I noted.
"She wanted to call you. She kept saying, 'Call Anne! Call Anne! I have to go to the meeting. she knows this.
"Thanks for not calling," I said. "And I thought everything was okay when I went home and went to sleep. Oh well."
"Yes. She kept saying, 'You don't help me--you're not doing anything. Give me my earrings! Take my gown off--I don't want this on for a meeting.' And when she was hitting the rail with her knee, I said, 'You're on coumadin! Don't hurt yourself."
"Oh no--you're right. She's on coumadin again. We have to watch out for that now."
"Actually it was a loud noise that woke her up at 6. While I had the door open to come in, a door slammed and Julie started yelling, 'Help me! Somebody help me! I'm dying and nobody cares!"
"Oh, yes, Julie does that," I reflected.
Julie lives down the hall, sarcastic and demanding, another one of the interesting characters in the Reminiscence Neighborhood. The sane residents are on the first two floors; those with various kinds of dementia are on the secure floor, known as Rem.
"She yells every day early in the morning."
"Early in the morning? I didn't know that."
"But your mom finally went back to sleep and slept until 8 am. And then she was okay. I dressed her and took her to breakfast. She ate a good breakfast; at 9 am she was back in the room, sitting in her recliner, but she still wanted to get out, 'to go with Anne to a meeting.' So I asked her, 'What is this meeting?' and she said, 'With Anne. Anne is going to take me to a meeting.' I took her out for a walk, but then she didn't want to go to lunch. She said she was going to have lunch at your house."
"Oh dear--I told her I would be back at 2 pm and I would take her to my house. I guess that's the meeting she was talking about. So she stayed agitated most of the day?"
"Yes, she kept wanting to call you. I wouldn't let her. Then she went to sleep, and Jim called."
"Oh, good. Did she wake up enough to talk to him? Were her words slurred?"
"No, she talked fine. She went back to sleep but then she wanted to call you. She said, 'Let me have my doll. Anne wants to take it back to her place.' I finally called you for her."
"I should have come at 2," I realized. "Sorry, Jona, that you had to cope with this for so long." And I turned to my mother: "Mom, we're leaving now. Do you still want to come to my house for cinnamon raisin toast?"
"Yes! I haven't been to your house for a year," she charged, not opening her eyes. She had been sitting in her recliner half-asleep during this conversation.
"It's been a long time. You came to my house after WomenChurch, at the end of August, remember? We went to Claremont and then we went to my house. Okay, Jona, thank you so much. You can go home now. I'll take her to my house."
But Jona insisted on helping me get Mom to the toilet before she left. After that event I wheeled Mom down the hall to one elevator, then to the other elevator for the parking garage, and managed to get her into the front seat of my minivan, folding the wheelchair and lifting it into the back.
I stopped at Bob's Market to buy cinnamon raisin bread, milk, bananas, and a few of her other favorite foods. At my house I helped her into the wheelchair and easily pushed her up the new ramp built in July, into the house.
We feasted on toast and milk. I made her two pieces and cut off the crust for myself because she's not allowed to eat dry, scratchy foods. Her swallowing isn't that good, probably because of the Lewy Body disease, which affects her muscles with some Parkinson's-type symptoms.
But she wanted more toast. I gave her two more pieces, then half a grapefruit cut up.
"Can I have another piece?" she asked.
"No!" I said. "You've had four pieces, and it's dinner time. This is just a snack. You need to go back to Ocean View and have that tuna salad they are serving. You need the protein."
"You won't let me have it because you're selfish."
"Give me a break! You really want one more piece, don't you? Alright, one more piece."
Back in the car, she had another demand: "What about that other food I saw? Those long slender things. I want one of them."
"What long slender things?" I asked, thinking, "Carrots. She saw the carrots on the counter and wants one."
"You know--those long slender things."
"Well, maybe Sunday. We'll go to church on Sunday, and then we'll come here for lunch." I didn't explain that uncooked carrots are forbidden--she's allowed soft and chewy foods, nothing hard or chokable.

After driving back to Ocean View, I take her to her room, get the tuna salad, and take it back to her room. Dinner in the dining room has ended--it's now 6:15 pm. Mom begins to eat the tuna fish with gusto. Connie has arrived to do another 12 hours of care.
"How are you, Connie? Did you get some sleep? Jona told me Mom was awake again at 2:40 am."
"Yes," Connie says, laughing, showing me her sheet of notes from the night. She laughs about everything, somehow. Each caregiver keeps a detailed list of notes about my mother's food, meds, bms, activities--even things like "8 pm Watched Insomnia. By Robin Williams."
"Okay, well, I hope you have a quiet night tonight. I hope she sleeps well."
"Yes," says Connie, bustling around to get things ready for Mom's evening shower.
"If you have any problems--" I add, pausing.
I almost say, "--don't call me." Somehow I'm really tired; I feel like going home, lying down, and waking up whenever.
But then I manage to say, "Just call me." Cheerfully. Smiling.
"Yes, right," Connie says, wrinkling her brow to show her determination, concern. Probably about as fake as my smile.
I slip out of the room, closing the door behind me, walking past the crowd of residents watching the evening movie, trying not to make eye contact with anyone. Another conversation with a resident is beyond my energy level. I know each familiar face, each flavor of dementia.
I have to escape, but first I have to pass through another crowd gathered to play a word memory game.
"Heavens to ________" the caregiver begins.
"Betsy!" answers Verma.
"Congratulations! You knew it," I say, smiling at her while heading for the elevator.
I punch in the door code and escape, praying that Connie will not call, that I will get a good night's sleep.

Lewy Body at 2 am

"Your mom is agitated... she wants to get up and get dressed. Can you talk to her?"
The call from the caregiver came at 1: 30 am. I was in town and hadn't gone to bed yet.
"Hi, Mom. How are you?"
"Well, I'm fine but this lady is trying to control me. I have to drive to Denver, and she's trying to stop me."
"Oh, she is?"
"Yes, and I am sick and tired of these people who think they can tell me what to do."
"Yeah, it's frustrating, isn't it. But it is 1:30 in the morning, you know."
"Yes, I know, but I have to get dressed--"
"Okay, I'm going to come over. I'll see you in a few minutes."
I pulled on sweatpants and a sweatshirt over my pajamas and drove over to Ocean View Assisted Living, thinking, "Why not? It's the easiest way to calm her down. And it's probably because I just drove in from Colorado and told her about the trip, got her all excited."
I used my garage pass to enter the building's basement parking, took the elevator using the building code, and walked through the silent corridors to the third floor.
Connie in pajamas, her futon rolled up, opened the door to Mom's room.
Mom was sitting on the edge of her bed in her Lanz flannel flowered nightgown, next to the short bed safety bar that was intended to keep her in bed for the night. We aren't allowed to have a full-length bar--the facility is only licensed for assisted living, not skilled nursing.
"Hi, Mom. How are you?" I asked, squeezing in to sit at the foot of the bed.
"I'm fine now that you are here. But I have to get dressed and she won't let me. I've got to get to Denver."
"How are you planning to get there? Are you going to take a plane or are you driving?" I sat with one arm around her, hugging her from the side, rubbing her back.
"I'm just driving but she won't let me--"
"Well, there's no need to leave at 2 am. Do you know it is 2 am?"
"Yes, I know but this lady is not helping me. She took away my watch and my opal ring." Mom studied her right hand, minus the ring.
"Where's her watch, Connie? She needs her watch. It's good to know what time it is." We found it and the ring, which would not go on her finger. The right hand was still swollen from her struggles and agitation in the middle of the night three weeks earlier.
"Now, Mom, if you're going by car, that means I'm driving. And I just drove for 11 hours yesterday, from Kayenta to LA, so I don't want to drive to Denver right now. That wouldn't be a good idea."
"No..." she smiled, realizing that plan would be a little ridiculous.
"Actually I don't plan to go back until next summer. The next time we drive in a car to Denver will be then. Here are those Navajo beaded earrings I brought you. You should wear them tomorrow with some outfit."
We continued talking and sitting there.
"Are you doing your hand exercises? We have to get this swelling down."
"Yes, I do them all the time. Just leave me alone. You think you're the boss of me, but I'm the boss of my own body."
"Now you're mad at me. You want to get rid of me. Okay, let's all go back to bed. You go to bed and I'll go home and go to bed."
"Okay," she said, looking back toward the pillow. She lay down, and Connie and I lifted and slid her three feet backwards so her head was on the pillow.
"Okay, good night," I said, kissing her and arranging the pillows and covers. "I'll see you tomorrow at 2 pm. You can pick out a good outfit to wear with those basket earrings. Yellow or black to match it."
"Yes, I'll wear that yellow suit."
"And be sure to check the sky next time. See, if I turn this little light out--"
"No, don't turn it out! I leave it on."
"But if I turn it out and open the curtains, you can see the sky. Can you see the sky? It's black now, isn't it?"
"Turn that light on!"
"If you want to get up, check the sky. If the sky's blue, it's time to get up. If it's still black-- Okay, I'll turn the light on again. Connie, if she tries to get up, open the curtains--"
"I already did that--I showed her it was dark."
"Okay... I hope you can get some sleep."
I walked back through the third floor, chatting with Rose (who had made the critical decision to call 911 in the June 14 crisis at 1 am) and a new staff person and Lorenza, now working only a three-night shift while taking classes to earn her LVN and also caring for her four children.
I drove home under the dark, starry sky and got to bed by 2:30 am, thinking yeah, it was worth it, an hour well spent.

Friday, September 23, 2005

Oh, I'm Dead

Mom had been working on her laptop computer, then got tired and took a nap.
At 5 pm, Jona decided to wake her up for dinner. But she wouldn't wake up.
"Evelyn, wake up. It's dinner time," Jona repeated, finally using the electric control to raise the recliner to a sitting-straight-up position.
The motion roused her. She opened her eyes and, looking at Jona, said, "Oh, I'm dead."
She closed her eyes again and was unrousable for ten minutes.
Jona ran to get Marnie and Bethlehem. Soon Beth, director of the Reminiscence Neighborhood, was in the room, along with Anna, the LVN in charge of the residence when the nurse was not present.
Jona kept talking to Evelyn, patting her hands, trying to get her to respond.
Her pulse was excellent, her blood pressure fine. But she did not respond. They debated what to do: Call the paramedics? No, her vitals were okay. Use the Epi-Pen? No, her tongue was not swollen or blocking her throat--her breathing continued.
Here eyeballs were moving left, then right beneath her eyelids. Was she in REM sleep? Or was it a petit mal seizure?
"Open your eyes! It's dinner time," Jona said. No response.
"Can you open your mouth?" She opened it slightly.
Suddenly Evelyn woke up and said, "Oh, you people leave me alone."
She was weak--her hands had no strength, but otherwise she seemed to be fine, as if nothing had happened. They took her to dinner, and she ate well.
"Why did you do that?" asked Jona, but Evelyn had no answer. She usually has an answer for everything, a story, an excuse, but this time she didn't seem to know anything had happened.
Jona called me at 6 pm, which was 7 pm in Colorado. I happened to be in Telluride, where the cell phone gets a signal. She related the whole story.
"Oh Jona, I'm sorry you had to go through another crisis--how scary," I said. It had been less than two weeks since the bingo game, when she had lost consciousness, gone to the ER, and ended up with a pacemaker.
"Yes, it was scary because she said, 'Oh, I'm dead.' But this time her tongue was not hanging out; she was not drooling or pale."
"Okay--well, you don't think she needs to go to the ER?"
"No, she's okay now," Jona concluded.
I said goodby and sat in the car. It was a rainy evening. Should I be doing something? At least I could call Bill or Jim or Emily. Actually, everyone was out of town. Bill was in San Antonio for a conference; Jim was in Houston for a conference, or had been until Hurricane Rita evacuated the town; Emily was driving Meridith back to college.
Emily's theories: 1) a Lewy Body event or 2) a petit mal seizure.
Bill said it was not a heart thing (one of the leading explanations of the bingo game collapse)because the pacemaker would now prevent the heart from slowing to the point of her losing consciousness. He rated Emily's theory #1 as possible and her theory #2 as unlikely. His theories: 1) a TIA (transient ischemic attack) or 2) what she wanted to do.
He called back the next day and said it might have been an "absence seizure," something that is not harmful. He wanted to know if they had stopped her anti-seizure medication. I checked, but she was still on Keppra, started after her anoxic seizures in June.
That evening I didn't try to reach Jim.
I drove back to Trout Lake, wondering how Mom could command my attention even here, a thousand miles away.
At least she hadn't died--or had she? Apparently she had hovered somewhere on the edge of consciousness, remote from the voices around her, and it had seemed like death.

Tuesday, September 20, 2005


Mom sailed out the hospital doors today, chatting happily and wearing the pink hat. No crowd of photographers recorded the event--they vanished on Friday after Britney and baby were discharged.
But jaws dropped, nevertheless. Anyone who saw her vegetative state on Friday or Saturday, or even part of yesterday, couldn't believe she was dressed and out of that hospital bed.
Was the sleepiness and slurred speech we saw then just her slowness to metabolize the anesthesia from the surgery on Wednesday evening? Or was it one of those Lewy Body states where, on some days, the brain just doesn't seem to boot up? Or was it the Remeron? She talked with her eyes closed, barely able to wake up enough for her meals.
Anyway, her blood was thin enough today (INR 2.0) that the doctor okayed her to leave. Yesterday I was praying that she would be awake and alert when the doctor came by to make the decision, and she was.
By 3 pm her caregiver Jona and I were giving her a shampoo in her room at Ocean View Assisted Living. By 5 pm she was in the dining room in her wheelchair, happy to be back at the table with the other residents.
Why didn't she collapse into a stupor from the effort of getting out of bed for the first time in 8 days, getting dressed, and enduring a shampoo and set?
I don't know--but I am going to take a planned, but shortened, drive to Colorado before anything else happens.

Saturday, September 17, 2005

The Turd

I walked into the hospital room to visit my mother, two days after she had a pacemaker implanted in her chest.
She lay in the bed pale and immobile with her eyes shut and mouth gaping open. I assumed she had not moved since my visit earlier in the day, had not left the bed since a difficult stumble onto the commode the day before the surgery. She had lost much of her mobility in the past month or two, since a previous hospitalization.
"Go ahead and take a break," I told Jona, her caregiver, who was helping her with meals and whatever she needed.
After she left, I saw a small round brown ball on the floor.
Kind of like the fake turd my daughter Roz likes to leave in the bathroom, along with plastic cockroaches, as a joke.
I picked it up with bare hands.
It was not fake.
"But this is a nice hospital," I thought to myself. "How can there be a turd on the floor?"
I threw it in the toilet, cleaned the floor, washed my hands, and forgot about it.
Until three days later, when my mother announced, as I was serving her lunch, "I'm having a BM!"
Not waiting to call an aide, I swung into action and managed to get her almost on the commode before much happened. Afterward an aide came and helped me clean her up and clean the floor.
By the time Jona returned, Mom was lying in bed, dressed and ready to leave the hospital, looking as peaceful as if nothing had happened.
But now I had an idea or two about how that turd got there.

Monday, September 12, 2005

The Pink Hat

Waiting is a big part of what you do in a hospital.
Mom's surgery is probably going to be Tuesday, if the cardiologist has time today to analyze her case and make the decision. If not, it will be Wednesday. (The doctors point out that she's getting Heparin to stabilize the blood clot, so waiting is not a total waste of time.)
Meanwhile, Mom sits in her hospital bed, bored, feeling fine, chatting with Jona or me. She can't figure out why she is in the hospital. All she did was faint for a moment or two.
"Let's go to your house for dinner," she says. "And we'll go to church tomorrow."
"No," I say. "You can't just bust out of here. You're in the hospital. Church was yesterday, but we didn't go because you're here. Tomorrow you're going to have surgery--they're going to put in a pacemaker."
"Oh," she says with disappointment. We talk. She's telling me about the Bingo game and going to the ER.
"John came to visit me," she says, beaming. "He brought me a pink hat."
Which is partly true--he did visit her, a rare event. Usually she sees him at home when I bring her to spend Sunday afternoon, but this time it was in the ER.
It's also true that last summer he pointed out a bright pink sunhat in a hardware store, when we were on vacation and needed to bring back a gift. I gave it to her in July "from John."
"Where is that hat?" she asks. "John picked it out for me."
"It's back at Ocean View," I answer, but soon just for fun, I go to get it and put it on her.
She sits in splendor in the hospital bed, in the dazzling pink hat, surprising the various aides and medical people who pop into her room.

Sunday, September 11, 2005

Analyzing The Event

Everything that happened yesterday is now known as The Event.
While I was talking with the nurse at 10:30 pm last night, the doctor walked in, Joshua G., a cheerful resident who sounded like Sherlock Holmes as he outlined the task of figuring out why Mom had fainted.
"We don't yet know why this event occurred, but after looking at her chest x-ray I ordered a CT scan that showed a mass near her heart: a first-order pulmonary embolism, somewhat significant, but subacute to chronic. It did not happen in the last 24 hours, but it was not on the scan done in June. It could have happened sometime in the last few weeks."
"So that isn't really why she fainted?"
"No--a blood clot can cause syncopy, but this probably was not the cause of The Event. We will observe her heart rate and other things for a few days, and we will give her Heparin followed by Coumadin."
"Okay," I said. "Thank you." I went home and to bed.
When I came back at 10:30 am, Dr. G. was still there. He had been up all night, and he had more to report.
"During the night her heart had a few pauses, about two seconds long, intermittently. Her heart rate dropped into the low 30s. Therefore, it's possible that she had a second-degree heart block yesterday. This could have caused her loss of consciousness. For this we usually recommend a demand pacemaker, which delivers a small jolt when the heart slows."
"Okay, fine" I said. But I was wondering how he could string two sentences together with no sleep. Nice guy, smiley, young--but I know how spacey I get when I'm sleep-deprived.
I called my brother Bill, who is a general surgeon in Washington state, to run this info by him.
"How could she get a blood clot, when she has a venal caval filter?" I asked.
He provided a background lecture on venal caval filters and why doctors don't use them as much now--"They can cause the vena cava to totally occlude."
He told me to ask: "Have they done a Dopplar duplex ultrasound of the great vessels?"
To remember this question, I wrote it down, trying to suppress the image in my mind of ocean-going vessels. Knowing a little bit of Medispeak is like knowing a little French. When you ask a question and sound fluent, you provoke a torrent of response that may be incomprehensible.
"Also ask if they know where the clot came from," he said. "The ultasound may show a bigger clot somewhere else, from which this clot broke off."
When I called my sister Emily, she reminded me of another possible cause of the fainting: an LBD-type of event. Lewy Body Dementia causes a fluctuating mental status--grogginess one day, alertness the next, agitation the next. But apparently these mental changes can include moments of totally checking out--and then returning.
To summarize: we don't know why The Event occurred. But several detectives are on the case.

Saturday, September 10, 2005

A Game of Bingo

In the Reminiscence Neighborhood, Bingo can be exciting.
In addition to what numbers are called and varying levels of ability at covering numbers, you've got many other levels of chance: whether players will leave the table, whether someone not playing will make an escape attempt through the secure door, whether someone's heart or brain will shout "Bingo," ending the game.
Today I called Mom to say, "I'm flying home from New York--I'll see you tomorrow."
"I'm winning!" she reported, using the cell phone of her caregiver, Jona.
Within minutes I boarded the plane and turned off my cell phone, happily, thinking "For the next five or six hours, no one needs me. I can be out of touch with the world."
But half an hour later, Jona noticed that Evelyn was slumped in her chair.
"Evelyn, are you okay? Evelyn!" All the care givers joined in the effort to rouse her, but she sat motionless, her body bent forward and to one side.
"Evelyn, can you talk to me? Evelyn! Can you talk to me?" cried Jona. This had never before happened in the year she had been working six days a week as Evelyn's private caregiver. There had been a crisis three months earlier, an allergic reaction causing Evelyn's tongue to swell and block her airway, but that had happened on Connie's shift, and today seemed different from that. Her tongue was not swollen, though it was hanging out of her mouth, and saliva was drooling from each corner.
"Marnie, call 911!" Jona decided.
Phone calls went out and almost two minutes passed as she continued to be unresponsive. Everyone tried to rouse her.
And then, amazingly, she opened her eyes. "Leave me alone... I want to go back to my room."
Meanwhile the nurse's aide and medications nurse rushed into the room from the second floor to find a big fuss being made over a patient who seemed to be fine.
"Why did you call 911? She doesn't need to go to the ER."
"Anne told us to call 911 if anything happens, even if it turns out that she's fine."
"You didn't need to call 911!"
Then the paramedics arrived, trying to assess the situation.
"Leave me alone--let me go back to my room!" Evelyn yelled.
"She's pale--her skin is cold," Jona told them. "She was unconscious for one or two minutes."
"I was just sleeping," Evelyn insisted.
But the paramedics took her vitals and decided not to take any chances. Over her protests, they put her on a stretcher and carried her out to the ambulance. Jona stayed with her and negotiated the questions and paperwork of the emergency room--all without so much as a Medicare or Blue Cross card.
Meanwhile Lorraine at the reception desk of Ocean View Assisted Living was enjoying a real emergency. She reached Emily at a football game in Maryland: "Your mother's unconscious! The paramedics are arriving!" Somehow word of Evelyn's miraculous recovery never reached her as she witnessed the action at the front door, including the inglorious exit via stretcher.
Lorraine did not reach me. I was peacefully reading The Atlantic at 40,000 feet, then sleeping for the last hour of the flight.
"You may turn on your cell phones," I heard and realized we were taxiing to the gate. When I turned the thing on, it exploded with messages.
Emily in a voice of alarm: "Mom's been admitted to the hospital. She was playing Bingo...."
John in a text message: "I visited your mother in the ER. She seems fine but--"
Groggily, I stumbled off the plane and to the baggage area, where John met me and took me directly to the hospital. By the time I got to bed, it was 3 am New York time.
In the constant game of chance at Ocean View Assisted Living, Mom was the winner of today's prize: an ambulance ride.