Tuesday, July 12, 2011

My Third Child

That's what I call my mom nowadays.

Not long ago, I discovered I was part of something called the "sandwich generation."  It refers to adults who are simultaneously raising children and finding themselves having to care for one or more parents. 

I joined the club a little over five years ago, when my father died from complications resulting from a surgical procedure in the hospital.  My mom had frequent bouts of anxiety and depression during the course of her life.  My dad was the type who handled all of the finances, so when my mom found herself a widow, she was woefully unprepared for the job of managing her own money.  Add those two factors together, and you have someone who is not consistently up to the task of managing her own affairs.

My uncle and I helped her out by setting up funds to provide her with an income stream to supplement her Social Security and pension checks, and we both had online access to her checking account so that we could monitor it.   So, from a financial perspective, my mom was in decent shape as long as she lived within her means.

For the first six months or so after my father's death, things were not so bad.  While my mom was understandably still in grief over the death of her husband the better part of half a century, she otherwise was doing okay.  That all took a sudden turn for the worse in December of 2006.  I have already recounted the details here in an older post, but to make a long story short, my mom experienced a double-whammy, catching pneumonia and injuring herself in a fall.

For the next three months, visits to the hospital and then the nursing home where my mom underwent physical therapy were part of my daily routine.  On weekdays, with my wife at work, this often meant having to bring my then 6 year old son and 4 year old daughter with me.   We also hosted my mom's dog Kiki, a Shi tzu-Maltese, until about June, when my mom had recovered from her injury.  She even seemed in good enough shape that I felt comfortable leaving her on her own for two weeks while the wife, the kids and I went to visit my wife's family in the Philippines.

Sadly, Kiki died a few months later.  Shortly afterwards, my mom bought a new dog, a seven month Pomeranian that was not potty trained.  About a month later, my mom ended up being hospitalized again,  which meant that yours truly got saddled with a dog that found my basement an all-too convenient place to take a frequent shit.  Finally, my wife and I got so disgusted, I took the dog to the Town of Oyster Bay animal shelter.  I had hoped that would be the end of my mom's dog days, but alas, some months later, she got herself a little Chihuaha.  Luckily, it took my mom little more than a week to realize she could not handle this new dog and it ended up being given away to someone.  Again, I dared to hope that my mom had finally come to her senses and understood that as much as she desired the companionship a dog offered her, she was not up to the task of handling the responsibility of ownership.

As for my mom herself, I was beginning to notice signs of mental deterioration, most worryingly with regard to her medications.  Every week, I would fill up one of those pill containers where you pop open the lid for each dose.  It also revealed to me the extent to which she was forgetting to take her medications.  When I would come by to fill the container at the end of the week, I would see that she would be missing several doses over the course of the week.   My uncle suggested getting a pill dispensing machine, so in August of 2008, I purchased one for my mom.   Every Saturday night, I would fill up the pill tray and stick it in the machine.  Twice a day, once in the morning and once in the evening, the machine would let out a beeping sound at the programmed time and deposit the medications into a pull out container.  It cost a lot of money, roughly $800 if memory serves, but it was definitely worth the piece of mind.

Around that same time, my mom was having recurring bouts of depression and anxiety, and for weeks at a time she wouldn't be able to fall asleep at night, despite taking anti-anxiety medication and Ambien.   In addition to the loss of her husband that she continued to mourn, she was also saddened that two of her lifelong friends had ended their friendship with her.  When brooding on it in my presence, she would chalk it up to them abandoning her, but I suspected there was more to it than that.  I spoke to one of them in person when I stopped by her house to sound her out on the possibility of visiting my mom to try to cheer her up.  She told me that my mom had been insensitive to her in a phone conversation they had.  As for the other friend, I can only guess that my mom must have said something that inadvertently offended her as well.  Sometimes my mom has a tin ear, and with her memory problems, I wouldn't past her that she said something to each of the two friends to upset them and then didn't remember the substance of the conversations, thus mentally insulating her from recognizing her culpability.

Fast forward to the summer of 2010.  My mom had come out of her depression and was entering another active phase.   She would drive herself to her doctor appointments, beauty parlor appointments and other local errands, though she did get into a couple of minor traffic accidents.

Then one day in September at work, my phone rings and I see on the caller id that it's her number.  I pick up the phone and greet her.  "Guess what, Thomas?" she said to me with a slightly jubilant tone.  I groaned inwardly and replied "Oh, please, no."  She had gotten herself another dog.  It was a Papillon.

Lacking originality with dog names, my mom called her Lola, the same name she had given to the Pomeranian.  And like the first Lola, this one had the same problem with peeing and defecating indoors.  And like the first Lola, soon after purchasing her, my mom ended up in the hospital for a few days, this time because she had problems swallowing something she ate and ended up becoming dehydrated after a couple of days of not being able to take her medication or hold down any food or drink.  Once again, yours truly had to pay host to another Lola, Lola 2.0.   No matter how often she would be taken outside, she would crap somewhere in the house moments after coming back inside, even if she was observed doing her business outside.  A couple of times, she even ran up the stairs to my son's room on the second floor and took a shit on his carpet. 

It was such a relief when my mom was released from the hospital and was well enough to take her again.  Don't get me wrong, Lola is a cute, friendly dog.  But in addition to the lack of potty training, she can be very noisy when she wants attention.  Not just barking.  She makes this whiny sound that can be very irritating when you are trying to sleep.

In what was another sign of the change in my mom was her toleration of Lola going to the bathroom frequently on her living room carpet.  It got to the point where the smell was almost unbearable sometimes when I entered her apartment.  When I was a child, my mom had always been a clean freak and as recently as a few years ago such a state of affairs was unthinkable for her.

A further development was a tendency for my mom to lose her balance and fall from time to time, though luckily none of the injuries were that serious.  At the beginning of this past June, she had told me about an incident at a department store where she felt pain in her legs and that she was going to fall, but held herslf up by holding onto a clothing rack.  Some store employees aided her and called an ambulance, but she refused to go to the hospital and instead had herself wheeled to her car.   She had dropped off Lola at the dog groomer earlier and had to pick her up.

About a week later on a Saturday, it was my birthday.  I had tried running in a 5K that morning at Muttontown Preserve, but the trail was muddly from the rain and after about a mile I had decided to just turn it into a nature walk.  I had gotten home around 11:30 and was looking forward to spending the rest of the day with my wife and children.  Then around noon the phone rang.  It was my mom's neighbor at the senior housing development.  My mom had fallen while walking her dog and had to be taken to the hospital.  Shortly after I got there, they had diagnosed her with a dislocated left elbow.  They did a procedure to pop it back in and discharged her.  But her left arm was wrapped in bandages and in a sling.

I ended up missing the next four days of work.  On Monday I tried to get an appointment to see her primary care physician but there were no openings.  As for Lola, who had caused the accident by running away after the leash slipped from my mom's hand, I decided it was best at least for the short term to put her somewhere so I wouldn't have to deal with her, so I brought her to a dog hotel out in Deer Park.  The next day I was on the way to work and called the doctor's office and was able to secure an appointment with her PCP later that afternoon, so I went into work for a couple of hours and left early.  Earlier that morning I had stopped by my mom's to check on her, and she was babbling about hearing people speaking in her apartment.  When I was helping her off the couch to go to the bathroom on the commode, she even told me to shut the door so that that wouldn't see her.  I told her that there was no one else in the apartment.

The PCP gave us a referral for an orthopedist in the area and an appointment was made for the next day.  When I brought my mom there, they took x-rays of the elbow and the doctor took one look at it and said "She needs surgery."  Then informed us that his office doesn't do elbow surgeries and referred us to another orthopedist in Great Neck, which is on the North Short of Nassau County near the Queens border.  I understand that orthopedics is a very specialized field, and it wouldn't surprise me if some orthopedists specialized only in the upper knuckle of the pinky finger.

So, day 4 (don't worry, we're getting close to the end!), and I have to bring my mom all the way to Great Neck.  And when we get there, I find out that the PCP's office had not sent the authorization, so the orthopedist could not see my mom until it went through.  After calling them on the phone twice, it finally came through nearly an hour after the time her appointment was scheduled.  The ladies behind the desk told me they frequently had this issue with my mom's medical group.  Anyway, after nearly an hour and a half wait, my mom finally gets seen.  They take some x-rays and the orthopedist tells us my mom might not need surgery, particularly since she is right hand dominant.  He tells us though that he would like her to have a CT scan.

Things finally seem to be returning to a state of normalcy.   Saturday night, the wife and I stayed up almost to 3 a.m. watching tv together.  I turned into bed a few minutes after her, chiding myself for staying up so late, but figuring I would just have to sleep late Sunday morning.  Then I drifted off to dreamland.   Alas, my stay there was cut short when I awoke to the phone ringing.  I looked at the clock to see what time it was and it was only 5:30 a.m.   I grumbled, because I knew it was my mom calling about something.

I'm sorry to say I wasn't in the best of moods when I answered the phone.  "What is is mom?" I asked.  She started telling me about how a top she was wearing got tangled on her left arm.  But that wasn't the real problem.   She also told me that her granddaughter Jamie was underneath her bed and wouldn't come out.   I could tell from my mom's voice that she was in a confused state.   Unfortunately, having barely two and a half hours of sleep in me, I was not exactly at my sharpest either.

Because my mom is hard of hearing, I had to practically shout back at her that I would be there in a few minutes.  I hung up the phone and, to my disappointment, let loose a litany of angry and profane words at having my life disrupted again.  I stormed into her apartment and found her sitting on the couch in her tv room naked save for the sleeve of a shirt on her left arm.  After I got it off her, I either helped her to a standing position or she got herself up.  She told me to put the shirt in her washing machine.  As I walked to the washing machine outside the room, I heard her cry out and looked to see her fall backwards onto the carpet, hitting the back of her head on the leg of a plastic chair behind her.  One of her implant teeth also came out, evidently being dislodged by the force of the impact.

I tried to help my mom up to get her back on the couch, but she was too heavy for me to move.  I called 911, not only because I couldn't get her up unassisted (and who exactly was I supposed to call at 5:30 in the morning on a Sunday for help?) but also I wanted her to have medical attention to make sure she did not suffer a serious head injury.  About ten minutes later, a police ambulance showed up, followed by two additional Nassau County police officers.  It took all three of them to lift my mom up and then sit her on a chair that they then used to wheel her out to the living room where they had placed a stretcher.   She was then taken to Plainview Hospital.

Fortunately, it was determined that my mom did not suffer any injury from the fall.  They discharged her around noon.  Before that point, I hit my nadir for the day, and the recent past for that matter.  At that point I just felt the crushing weight of all that had happened for the past eight days pushing down on me.  I sat down on the floor in the emergency room with my back against the wall and my head in my hands.   One of the staff, a nurse I think, saw me and asked me if I was alright.  She gave me the number for a hospital social worker to inquire about getting placement somewhere for my mom, for which I thanked her, though I ended up not calling the number.

Since then, things have gotten more tolerable.  I arranged for a home companion to be with my mom on weekdays from 9 to 5.  I have to take time off from work again for a follow up appointment with the orthopedist in Great Neck.  Her dog is back with her, though I had to take it for a few days because the home companion was complaining that the dog was pooping on the rug and making the apartment stink, which caused a bit of a brouhaha between mom, the home companion, and me.  Just what I needed.

As much as I complain about the burden of having to be a caregiver for my mom, I know that there are other adult children who are in much more difficult situations than I.  Some have parents who are in far worse shape than my mom.  Some caregivers are in poor health themselves.   I'm sure quite a few of them handle their situations with more grace and stoicism than I do.  With my mom, as the story above describes, it has not been a daily strain for the last five years.  Rather, there are periods, often lasting many months, of relative calm that is then disrupted by episodes that last anywhere from a few days to a few months.

In addition to being a member of the "sandwich generation," I also suffer from what I call The Curse of the Responsible Sibling.   Longtime readers of my blog might recall that I am the youngest of three siblings, but when it comes to caring for my mom, I might as well be an only child.   While my oldest brother Bobby calls my mom once in a while, he doesn't really do anything meaningful to help out.  His excuse is that he does not have a drivers license (taken away for drunk driving) and a car.   Lately he has also been hobbled by a foot injury incurred at work, which at present gives him a plausible excuse for not being able to help.  Then there is my brother John, who has barely been heard from in the past year.  He never calls mom or myself to inquire how she is doing and if there is anything he can do to be of assistance.  Therefore, the burden has fallen squarely on my shoulders.  I have coworkers and acquaintances who are in similar situations.  They have siblings as well, but those siblings seem to think nothing about washing their hands free of any responsibility of caring for their elderly parents and leaving it by default to the "Responsible Sibling."

What makes it even harder for me is that I am raising two school age children and I commute to a full time job in Manhattan.  My two brothers are both divorced and each has three children that neither plays any role in raising.  Like I wrote above, I might as well be an only child.  So, all I can do is carry on and do the best I can, knowing that the best I can do might not be the best that could be done.  With an elderly parent like my mom, the situation is not one of a very sick parent who requires lots of care.  Rather, it is more like trying to manage a steady decline over time, hoping that a placement in a nursing home or assisted living facility can be put off for as long as possible.   And I know that one day, the burden will end.

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