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:
- "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
- Evidence of many small strokes and vascular brain issues
- Bone cancer of the skull, which is likely metastasis of the breast cancer she's been fighting for 17 years.
- 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.
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