Wednesday, April 18, 2007

Torture Again

I woke with the doctor's words yesterday echoing in my mind: mild kidney failure.
I had promised to take Mom in this morning for a catheterization and more blood tests, and she also had an appointment for dental cleaning at 2 pm.
Not a fun day. I procrastinated as long as possible, leaving the house about 11:15 am. From the car I called to ask if I needed an appointment for the catheterization.
"Your appointment was for 11 am," the receptionist reported.
Whoops. Dr. Rosen must have made that appointment. She had also said. "If her creatinin level is still elevated, we may have to hospitalize her."
If that happened, I would need the POA papers and maybe the detailed answer to the question, "Is she DNR?"
A month ago when my brother was in town, he and I had revised an earlier statement, and I had still not typed up the results.
I turned the car around, went back to the house, and typed up the specific instructions:
Yes to chemical measures and IV.
No to cardioversion and intubation.
No to chest compressions and feeding by tube.
Yes to converting Atrial Fibrillation to Normal Sinus Rhythm (NSR) for two weeks if needed.
Then I set out again, humming my usual tune for a day of medical adventures with Mom:
We're off to see the wizard, the wonderful wizard of Oz.
Because, because, because, because, because
Because of the wonderful things he does!
La la la la, la la!
When I arrived at 11:45 am, Mom was in her wheelchair in the dining room about to have lunch. As I snatched her away, a caregiver reported, "She went on the scenic drive this morning! We just got back."
"Oh, good," I smiled.
So all my procrastination had not mattered: I could not have taken her to the doctor at 11 am anyway because she had been packed off on a tour around town before 10 am. I should have called at 8 am and warned them not to take her anywhere because I needed to take her in for tests.
"How are you today, Mom?" I asked her automatically. I ask this question each time I arrive.
"I'm sick!" she answered.
An unusual answer, I thought to myself. If she recognizes that she doesn't feel well, perhaps this day will end with a hospitalization.
After a non-productive trip to the toilet, I wheeled her out wondering if she would ever be back--because my plan after her next hospitalization is to move her to a skilled nursing facility.
"We're not going to Japan," she announced as we drove to the UCLA Medical Center.
"Okay," I said. "It's probably not a good idea if you feel sick."
"We'll stay in Colorado. That's what we'll do," she said.
I avoided answering that one.
We arrived at the medical center at 12:30 pm, during the nurses' lunch hour, and had to wait until 1 pm to have the catheterization done and the blood samples taken to check her creatinin levels.
When the time came, I hoisted her onto the examining table and peeled off her slacks, nylons, and Depend. She voficerously protested each movement and screamed when the catheter was put in and taken out. For her, in her dementia, a catheterization is a rape. No amount of explaining makes it okay.
Her abdomen seemed too large while she was lying down. I wondered if, as Dr. Rosen suspected, she might have crystals blocking her kidneys from emptying.
Finally it was over and her Depend, nylongs, slacks, and shoes were replaced.
"You took off my black shoes!" she vented. "Why did you take off my shoes?"
"To take off your nylons," I replied, hopelessly drawn into explanation that wasn't going to help.
Then we went to the lab for her blood to be drawn.
"When we're done, we'll go get some French fries," I promised her.
She unleashed vitriol on the phlebotomist but finally that too was done.
Finally it was 2 pm and we were wheeling toward the elevators in the parking garage, but I had to call the dentist and report that we would be late for her tooth cleaning.
Any sane person would have cancelled the tooth cleaning, given her agitation and exhaustion. She can only put up with so much in any one day, but I pressed on, hoping to get it all done and not to have to interrupt my work another day for a trip to the dentist.
"You're a traitor, you are," she hissed at me as we drove down Wilshire Avenue.
I hadn't even told her we still had a dentist appointment to go to.
We arrived about 2:23 pm and the kind dental assistant got to work as soon as I got her moved from her wheelchair to the dental chair.
(I never said "And now, Mom, we will go to the dentist." It was easier to just bring her in without ever making the visit a topic of argument.)
"I'm sorry I didn't have time to brush her teeth before coming," I admitted. "And I guess they didn't brush her teeth after breakfast."
"You need to keep after them about that," she advised.
Her first step was to suction bits of food out of Mom's mouth, from breakfast I guess. Also there was food in her gums and between her teeth.
Meanwhile, Mom was coughing deeply and filling her mouth with clear phlegm, which the hygienist suctioned out.
If an audio recording had been made of the 15 minutes she spent in the chair, anyone listening to it would be convinced that the Geneva Conventions against torture had been violated.
When her cries formed words, they were something like "Stop! Get out! Leave me alone."
"I'm sorry it's hurting you," the hygienist answered.
"Baloney, you don't give a damn," Mom managed to say through the implements in her mouth.
"We want you to have nice clean teeth so you can SMILE!" said the hygienist.
I reflected that Mom is on the brink of either moving to skilled nursing or being put on hospice; she doesn't have a lot to smile about and knows it. But of course, dentists want people to smile.
"What's the use of trying?" Mom said as the appointment ended. "She won't ever do a thing I say. She's a mess, a baby. 'Pee and pee and pee again,' she says. Get me out of here."
"Oh, my mother is speaking about her caregiver," I explained. "We've been trying to get a urine sample for a couple of days, and she is tired of trying. Mom, we have to wait for the dentist to take a look at you."
"Damn fools! They don't know anything anyway," she said. "Nurses know a lot more than they do."
She was talking about doctors, of course. I know because I've been hearing this point since I was ten years old.
Somehow the dentist managed to put his hands in and out of her mouth without being bitten or scratched. I held her hands just in case for the few minutes he needed.
He commented about the Telluride license plate I keep on the back of her wheelchair, and Mom yelled, "To-hell-U-ride! That's what we called it."
Usually it's a humorous comment, but this time it came out like a curse.
"No services wanted, just remember!" she repeated loudly as we left the dental office.
Yeah, I got the message: no catheterizations, no blood draws, no tooth cleaning.
She's sick and tired of all this medical care, and so am I.

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