Zeus Strikes Again

Religious parables, stories, and myths are full of poor, hapless souls who are tested by higher powers via an improbable string of horrific trials. Gilgamesh, Job, Prometheus, Odysseus, Hercules, and Obama all had to prove they were worthy before finding peace. Maybe Natica is some kind of a fable hero, too. Less than 48 hours in board and care, and Natica fell. It was a very bad fall.

She fell while taking a step backwards with her walker. She heard a snap as she hit the ground and knew she was in trouble. The folks at the board and care called an ambulance and then called Andi. But, Andi couldn't come right away because she was with her father at the wound-care center for a tear on his arm caused by—you guessed it—a fall!

There's never a dull moment in Ackerland.

Andi called me at work with the news. So, I went home, got Natica's insurance information and went to the ER in Andi's place.

Natica was relatively lucid, considering her condition. She was in fine spirits—even a little giddy—because she was the center of attention.

"Stu," she said with a big smile. "Why did you come all the way out here? Go back to work. I'm fine."

But the x-ray results told a different story. Her left femur had snapped clean in half near the joint with her artificial hip. Her bones are paper-thin due to osteoporosis and metastasis. The lower part of the femur, with a jagged edge, had drifted several inches away from the upper part.

Andi arrived just in time to talk to the doctor and see the x-ray. Surgery would be recommended in most cases such as this, but because Natica is in hospice care, the doctor felt she could get along without it if she didn't want it, but would be bedridden, and in nightmarish pain. (Is "bedridden" a word we can still use? Seems like it should be offensive for some vague reason.)

The doctor asked who makes the decisions. Natica said, "I do," as I pointed to Andi. Andi and the doctor stepped outside while I explained to Natica that even though she was lucid now, she had been in and out of altered states since her strokes and had been irrational more than not in recent weeks. So, I said, she shouldn't be making life-altering decisions.

"That's fascinating!" she practically gasped. "I have no recollection of that! Are you saying there's something wrong with my brain?"

It took a while to make her understand the gravity of the situation; both physical and mental. But her period of semi-clear thinking was short-lived because the pain finally arrived—late, but in strong form—and opiates were necessary.

Meanwhile, Andi had told the doctor that before her strokes, Natica never feared surgery. If there were a chance she could be ambulatory again, she would embrace surgery. She had agreed to surgery to put everything back together until the pain killers kicked in. The drugs made her extremely loopy and she began to waffle about the surgery.

By this time, I had left to go back to work. Andi was there, and her brother would be coming in from New Mexico shortly to help us out with the situation. Everything seemed as fine as it could be under the circumstances. So, I felt OK about leaving.

That was all before 11:00am this morning. Since then:

• Natica has been admitted to the hospital
• Andi and her brother were with Natica most of the day (Andi got a small break in the middle of the day to clean the house—I know; she has all the fun.)
• Natica's hospice provider has kicked her out of the program because her leg is now the primary focus. She can reapply for hospice when her leg situation is stabilized. 
• Natica has had a few hallucinations that the nurse is an angel of death, come to take her away. She was happy about that idea.
• The surgeon came. He said that Natica would be in excruciating pain for the rest of her life without surgery to repair the break. She is now irrationally fighting the idea of this surgery with every arrow in her quiver. But, because Natica is in an altered state, Andi can invoke Natica's advanced directive. So, the surgery is a go. This is, in the surgeon's words, a humanitarian effort to reduce Natica's pain.
• Natica is a bit more confused now that the Dilaudid is flowing through her veins. She has slurred speech, but we don't feel that this is the cause of her resistance to the surgery. She has, of late, been digging her heels in for no discernible reason.
• Andi, her brother, and I all agree with the surgeon that surgery would be the best of poor options. Yes, there are risks, but it would be better than spending the rest of her life in bed with various tubes, the likelihood that the broken bones would pierce her flesh, and off-the-scale, agonizing pain

Yes Virginia, there is a surgeon clause (in the advanced directive). There will be surgery. We also still need to go to Costa Mesa to clean out Natica's apartment and bring her car back. Part of the roof is torn off our current house for termite repairs; hammering, sawing, etc. make it impossible for Andi to do voiceover work in her studio. And we've barely started packing to move to our new house. Is it bad that all this upheaval is starting to feel normal? Did Prometheus ever get used to having his liver eaten out by an eagle every day?

Friends of Carlotta

To paraphrase Steve Martin in Dead Men Don't Wear Plaid, we feel like we were hit in the face with a wet frying pan. What a roller coaster of a day, full of things we don't quite understand! But it looks as if we've improved Natica's lot a bit.

Last night was one of the worst nights I've had since Marshall was an infant. At least when he woke us up on those amber-lit nights near LAX 16 years ago, we knew we could feed him, show him some love, change a diaper, and he'd (usually) get back to sleep. Unfortunately, my mother-in-law, Natica, was not as easily soothed in the night. The vascular dementia from her series of strokes continues to change daily. For example, she had a pretty good day, yesterday. Apart from some paranoia (what's happening to her is completely unprecedented, apparently, and there's a conspiracy to cover up the other people who are suffering the same fate as a result of poisonings), she was conscious enough to eat, remember us, and watch a little TV. By contrast, today she can't remember how to sit or where the bathroom is.

Anyhow, I was talking about last night. The bigger problem was the dog. Poor Cami was whimpering and waking us up repeatedly. Well, that's not true, exactly. I slept through a lot of it (I'm an impressively deep sleeper and Andi chose not to wake me, for unfathomable reasons). We couldn't figure out what Cami wanted. She didn't want to go out. She didn't want water or food. She didn't want to be on the bed with us (very strange behavior). She just kept whimpering and hiding under the sofa bed in the guest room where Natica has been sleeping. Andi was concerned that Cami was sick. Having to take the dog to the pet ER at 3:00am and leave me with Natica, or vice versa, was more than she could stomach after 5 sleepless nights in service of her mother's needs. Andi was so exhausted, she wasn't sure she was objective about the dog. So, she woke me up to appraise Cami's condition.

She got a flashlight and tried to coax Cami out from under Natica's bed. Of course, this woke up Natica who went into a confused narrative about not being able to go to bed because she was already in bed. Andi was able to calm Natica and lure the dog out with a treat. But after Cami ate the treat, she went back under the bed. Very strange behavior for Cami. So, I tried to bribe her out from under the bed with a treat, but in a different way.  I absentmindedly put the dog treats on the kitchen table, took one from the bag, and called from the living room, "Cami! Would you like some jerky?" She came running. We got her on the couch with Andi, gave her the jerky, and let her relax so we could examine her.

This is when I discovered that Andi had been up multiple times with Cami, but most recently with Natica.  Andi had awakened to find the light on in our bedroom, the door closed, Natica's walker on our side of the door, and Natica on the other side. When she opened the door, she found all the lights in the hall, office, bedrooms, and bathroom were on.

She asked Natica, "Can I help you with something?"

Natica's response:  "I don't think so."

Andi was doubtful of this answer, so she rephrased the question. "What are you trying to do?"

Natica responded, "Well, I need to pee," in a manner indicating she thought this was obvious.

So, Andi helped her find the bathroom (which was literally 5 feet from her bedroom, 2 feet from where she was standing, and a place she had been able to find on her own hundreds of times in the last 7.5 years). Andi helped Natica remember how to sit down, etc. Helped her wash her hands and got her back to bed. This had all taken a painstaking 35 minutes. In the middle of the night. After 4 nights of no sleep. And 3 prior episodes with the dog. Also, we're a lot older and less resilient than we were when Marshall was an infant. Of course, Andi was very emotional. Not only was her mother very ill, but Andi was exhausted. So was I.

But, at that moment I figured out what was going on with the dog. It's important to understand how much Andi loves Cami and Cami loves Andi. Of course, we all love Cami and she loves all of us as dogs do, but she and Andi have a special bond. Cami was reacting to Andi's upset. My upset, too. She was the bichon version of a canary in a coal mine showing us that things had gotten out of hand when we were too far down the shaft to see for ourselves.

Cami was telling us—only via my own interpretation in a Jungian kind of way—that we were no longer qualified to take care of Natica. We'd have to take turns sleeping so one of us could always keep her from getting into some kind of trouble. But, both of us have to work, so that would be completely untenable. What we were going through wasn't realistic for us and wasn't safe for Natica. She couldn't stay with us anymore.

We had already planned to find her a room, board, and care situation. But we thought there was no money to take care of such a thing. So, we had applied to MediCal for help. The application process takes 90 days. But Natica's hospice social worker told us that most board and care facilities would take a person as long as their application had been submitted. Thankfully, MediCal pays retroactively once the application is approved. Before the strokes, Natica had always made it clear that she did not want to live with us under any circumstances. We hadn't respected her wishes out of good intentions, guilt, and frugality. That was a poor decision. But then we discovered that Natica had too much money in her savings to qualify for MediCal. So, we'd have to spend a good chunk of it on her care before she'd qualify. Luckily, too much money for MediCal isn't that much.

The day before this difficult night, Natica was well enough for Andi to take her on a tour of a nearby board and care facility. It was nice. But afterward, Natica made it clear that she didn't want to stay there because it was part of the conspiracy. So, we planned to wait a few days—as her consciousness, memory, and mood varied from day to day, she often changed her mind on any number of subjects (e.g., she suddenly likes chocolate ice cream). But last night's events made it clear we'd have to move faster. So, as I took Marshall's carpool to school, Andi got to work expediting things.

At about 2:35pm, I was in a meeting at work. It had gone very well and we were about to start documenting what we had decided. I quickly checked my texts, and it was then that we got hit with that wet frying pan I mentioned earlier. Andi had received the results of Natica's MRI from last week. I'll write a little bit about the report here. But, Natica does not want to know. So, if you talk to her, please don't upset her by telling her. Notable discoveries in the report:

1. "The patient" was "combative" and refused to allow the contrast injection. So, they couldn't see as much detail as they would have liked to
2. Evidence of many small strokes and vascular brain issues
3. Bone cancer of the skull, which is likely metastasis of the breast cancer she's been fighting for 17 years.
4. No malignant brain lesions as of yet

Andi's text mentioned numbers 2 and 3 (I read the rest in the report later in the day). I knew how devastating this would be to Andi, but also how imperative it was that we get Natica into better care right away. Andi would need support with both. So, I left work. I called her as I left and discovered that she was at the board and care facility and would soon sign the paperwork to admit Natica. I went over to meet them. Natica was with-it enough to be grateful for Andi getting her into the facility. It's a very nice place, after all. It's in a well-maintained home in a suburban part of Thousand Oaks. We plugged in Natica's cute little red cell phone to charge, made sure she had what she needed, and promised to visit the next day.

As we left, Andi burst into tears. She felt guilty because her mother is gravely ill and she left her with other people. This has been so difficult. Although she knew intellectually that this was the right thing to do, sometimes the heart takes a different path to acceptance.

But, a few revelations later in the day would help Andi's heart down that path. Marshall had a dentist appointment and Natica still needed comfortable pants. So we decided Andi would take Marshall and I'd get the pants. After Andi and Marshall returned from the appointment (no cavities!), but while I was still shopping, Andi got a call from Natica:

NATICA

I need my cell phone. Can you bring it to me?

ANDI

You're talking to me on your cell phone.

NATICA

Can I come there and get my cell phone?

ANDI

You're holding your cell phone in your hand, right now.

(Ten more revolutions in this vein)

NURSE

Dr. Greer, this is your cell phone. You're holding it.

ANDI

Exactly! You already have it! It's your little red phone.

NATICA

Everyone seems to believe that but me.

Andi and Marshall told me about this exchange over dinner. Andi also told me about one other thing. In the morning, she had parked Natica in her wheelchair at the kitchen table for breakfast. Andi served her toast and quickly went to the bathroom. She returned to find Natica eating something other than toast. She was chewing on the dog treats I'd left on the table the night before. 

These two incidents were enough to convince Andi that A) Natica was no longer capable of making decisions in her best interests, and B) caring for Natica at home would keep us too exhausted to keep her safe. So, although it was an emotionally taxing day, we now know and feel that we did the right thing. We're looking forward to our first full night of sleep in nearly two weeks. Andi's brother comes on Thursday to help us clean out Natica's apartment in Costa Mesa. Wish us luck!  

When I arrived, I thought of the words
Marlowe had said to me years ago:
"Dead men don't wear plaid. "
Huh!
Dead men don't wear plaid.
I still don't know what it means.

May You Live in Interesting Times

I know where my bread is buttered. It's not about career, although that's important. It's all about family and love, maudlin as some may find that sentiment. We're just trying to do the right thing from moment to moment. That is its own reward. As they say.

My mother-in-law moved in with us a week ago, today. There was really no other option. She'd had a number of small strokes (TIAs) and was no longer able to work and take care of herself. It's amazing that she was able to live independently as long as she did; driving to work and earning her own living at the age of 85.

But all good things... 

Natica and Marshall around 2001

In the last week, her decline has been shockingly precipitous. A week ago, she was arguing with us about which hospice provider she wanted. She grilled the hospice nurse sharply, to the point of being rude, and needing a rebuke from Andi and me. By contrast, she couldn't remember how to swallow or hold a glass, this morning. She couldn't track basic commands (like "Put the pill in your mouth."). One week from sharp to absent. 

She's recovered—a little bit—since this morning. But, Natica is no longer completely with us. The nurse visited earlier this afternoon and told us that she'd had another TIA and will definitely continue to have them. In fact, it's likely that she'll have a massive stroke. We were offered the choice of putting her on a large regimen of aspirin to thin her blood and prevent further strokes. But, this will make her a bleeding risk. Plus, one kidney has failed and the other has stage 3 kidney disease. So, that's an indication that aspirin shouldn't be taken. And either way, she'll still be a stroke risk. So, we've decided against the aspirin; first do no harm, right?

Natica's health has declined so quickly that we were caught off guard and have been struggling a little to care for her. So, we're working on getting her into a hospice facility. Before she became an unreliable narrator, she told us that she would prefer to live in a place like that as opposed to with us—if things went in this direction. But now, there's no choice. She needs round-the-clock care. Andi and I can't provide that while still working. This will require her getting MediCal. The application is in. As soon as it's been acknowledged as being submitted, we can get her into a hospice facility (if a bed is available). So, that will be sometime this week, if the fates allow.  

When my mother passed away in January, her decline was equally as sharp. Of course, we don't know what the future will bring. But Andi, Marshall and I are still reeling from that loss, as well as the loss of my cousin, Margo, who passed away the same week as my mother. This isn't a complaint, or self pity. It's just grief. It takes time.

But we won't be letting 2014 get us on the ropes. We're thinking as positively as we can. We're moving into our dream house in the next few months and going on vacation in July (assuming we can find a place for Natica during that time, if she's still with us).

So, list of things to be grateful for:

• Great family

• Dream marriage

• Son without fault

• Incredible friends who are also really great people

• Wonderful pets

• A career and workplace that makes me feel like I won the lottery

• Coworkers that are seemingly too good to be true

• Good health (I lost 20 pounds, got control of my blood pressure, dramatically reduced my cholesterol and blood sugar, got my asthma completely under control, and dealt with some other things I won't talk about here so I don't embarrass you all)

It's all about context. I'm reminded of the old curse,"May you dance in the sun... with butter on your head." We're working to move the butter to our bread.