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Archive for June, 2009

So, Gov. Sanford wasn’t hiking the trail after all.  And it’s unlikely that he spent the past days driving along the coast of Argentina.  He may well have been trying to clear his head, but it doesn’t appear that the “bruising legislative session” was the only thing troubling him.

I’m not going to criticize his affair.  That is a private matter.  And it’s up to him and his family to determine the ultimate outcome.  It’s likely to scuttle any hopes of running for President in 2012.  But it’s the ongoing hypocrisy of the Republican Party touting themselves as the party that upholds family values that I object to most.  Earlier this month, another family values champion, Nevada’s Senator John Ensign, admitted to an affair.  They are simply the latest among their ilk to have to admit that they have failed to live up to the standards they attempt to impose on the rest of us.  It makes their hypocrisy and cynicism all the more odious when they have the gall to make such a huge stink when Democrats have feet of clay. Let us not forget that Mark Sanford was among the most vocal critics of President Clinton when his affair became public, as was the thrice-married Newt Gingrich, who was himself carrying on an affair as he called for the resignation and impeachment of the president.

The interesting thing about the whole family values deal is that those who preach the loudest seem to have the hardest time living up to their own standards.  It’s curious that those who preach the importance of family values have, as a group, the highest divorce rates, the highest teen pregnancy rates. And that’s only the sexual escapades.  Let us not forget the outright graft of Randy “Duke” Cunningham, Jack Abramof, Bob Ney and others.

The Republican Party has become a laughing stock, an embarrassment to the entire country as well as to its history.  Minorities are leaving it in droves — thanks largely to the racist comments of Gingrich and others in response to the nomination of Sonia Sotamajor as a Supreme Court justice.  The racism of the Republican base was on full display during the campaign.  How it can possibly recover enough to be a viable political party again is a mystery.  We need to have at least two vibrant political parties in this country.  But today’s GOP is neither vibrant nor viable.  One can only hope that saner, more pragmatic conservatives will come together to form a new party, leaving what’s left of the GOP to complete its death spiral and vanish from the American political scene.  Finally, true to form, Fox News incorrectly (but intentionally?) identifies Sanford as a Democrat.  If this were the first time Fox did that, it might be explained away as an error, but it has happened repeatedly when one of their own strays.  Unfortunately, those who depend solely upon Fox for their “news” probably won’t catch the error.  Their viewers don’t seem to have an over-abundance of smarts.  They’ve totally bought into the “fair and balanced” meme as well as the “liberal media” one.  Sigh.  Someone just needs to stick a fork in the Republican Party.  They’re done.

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The morning of June 7 as we were preparing to go to a wedding, we got a panicked phone call from my elderly and frail mother-in-law’s neighbor.  She had fallen while reaching down for a hose to fill a bird bath, gotten a nasty gash on the head and spent the previous night outside, unable to get herself into the house.  The “panic button” she always wore to summon help in an emergency?  She forgot she had it on!  Don’t even ask what the heck she was doing outside trying to fill a bird bath…  She simply didn’t believe that she should no longer be doing that sort of thing.

So, we packed quickly — knowing that bad falls by frail, elderly people often end badly — and hit the road for a seven hour drive.  We knew that our trip might well end with planning  a memorial service.  The cell phone was in use most of the trip as we notified family members and got updates from the neighbor as the emergency docs tried to work their magic.  A possible broken pelvis, 11 stitches and 11 staples to close the head gash, great confusion — but almost miraculously no apparent additional head injury.  We knew she had suffered a compression fracture several weeks earlier and that there had been indications of an additional fracture.  Her bones are little more than shells due to advanced osteoporosis.  The spinal fractures don’t show up even on CT scans because there is so little bone mass.

Fast forward two weeks… a procedure to shore up the (now) two vertebral fractures has relieved pain.   The head wound is healing.  The pelvic crack is stable, and also seems to have occurred prior to the fall.  No stroke, no brain bleed, no skull fracture.   Clear medical proof that she is, indeed, very hard-headed, even if the rest of her bones are extremely fragile.  She’s currently in a rehab hospital for some “sub-acute” physical therapy.  And she will be moving into an assisted living group home when her rehab phase is completed.

While we marvel that she survived and that there is hope that she will graduate from a wheelchair to a walker once her pelvis heals, she is mourning loss on almost every front.  She is clearly no longer able to live alone.  We’d suspected so for some time, but she wouldn’t hear of it — until now.  And when the crisis occurs, options quickly become limited by the need for a rapid solution. Probably the source of greatest worry for her has been her little dog.  She cannot take him to the group home, but we’ve been able to find a new home for him as well.

So, the lessons learned?  While it’s important for aging parents to retain as much autonomy as possible, they may be unaware that their physical decline has progressed to the point where safety is the paramount concern.  The older they become, the more likely that the physical decline is accompanied by cognitive impairment, whether due to Alzheimer’s Disease or something as simple as chronic dehydration.  Cognitive impairment often occurs slowly, and the signs can be subtle and easily missed.  In our case, we became aware in retrospect that the long recitation of the week’s activities and meals had stopped, but because we’d not been interested in that level of detail, we didn’t recognize that the change indicated that she simply didn’t remember.  Additionally, her cheery “Hanging in there” response to the question of how she was had masked the reality — that she didn’t want to worry us.  Many of us live at some distance from our parents, and our own busy lives combine with the distance to limit contact to regular phone calls and infrequent visits.  It’s imperative to establish relationships with people who live close to the loved one — people who can be our eyes and ears and who will honestly report changes without feeling disloyal to the senior.  We need to know these things.  And our loved ones need for us to know.  It’s not disloyal.  It’s not “ratting” on the senior.  It’s an act of loving concern to let children know that there are concerns of which they may be unaware.  If, once the children are notified, there is no increased vigilance from them, then there may be additional issues within the family that put the senior at increased risk.

We are glad that our loved one had interested neighbors and extended family and that we became aware that there were concerns before Mom fell.  In fact, we were trying to get some help for her.  But getting help takes time unless social workers who know the ropes are involved.  Hospitals can be a great source of information on local resources.  And speaking of hospitals, we cannot thank the professionals enough.  Not only did they provide excellent and compassionate care — well, with the exception of one 1:30 a.m. bath… — but they were able to put us in touch with outside resources who explained options to us, worked with us to identify an appropriate solution, answered a myriad of questions, and supported all of us as we dealt with the changes we were all facing.

UPDATE:  After a visit from the psychiatrist, who assured us that she is not clinically depressed but rather mourning the losses — freedom, driving, her dog, her home — we instituted Plan B.  Instead of the group home, she will be moving into an assisted living facility on Tuesday.  There she will get the care and assistance she needs with daily activities and will have the advantage of numerous activities to keep her mentally and socially involved — far more activities than she would have had access to in the group home.  She has made a remarkable recovery.  She’s now using a walker at least some of the time.  The emotional adjustment will be up to her.  She has been consistently kind and considerate of the care-givers, both in the hospital and in the rehab hospital, thanking them for each interaction.  We hope that portends well for the next phase.  We understand that this is not the way she hoped to complete her life.  It’s not what we had hoped for her, either.  But it is what it is, and we’re all having to adjust to the new reality.

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We’re back home after a physically and emotionally difficult week.  My mother-in-law is our only remaining parent, and at 88 she is getting increasingly frail.  Yet she insists on staying in her home, with her little dog, as long as possible.  So we’ve been trying to assess what she needs to make that a reality — made more difficult due to the fact that we live nearly 400 miles apart.

There are, of course, chronic physical ailments, plus dementia that is making living alone a real challenge.  Fortunately, she lives in a retirement community that has a wealth of support services.  Yet, it’s difficult for everyone.  She knows that she is having problems remembering things and that she gets confused easily, but she’s having a hard time accepting her limitations.  So, we’re trying to help her make small changes — giving up driving “for now, while your back hurts.” We’re hoping that as we get some of the support services in place, it may be easier for her to accept the progressive losses of independence.

We’ll all get old at some point. For some of us, that comes sooner than later.  Once we get to a certain point, we begin to accept that we will probably die of old age rather than from an accident or a catastrophic illness.  We all hope that our aging will be relatively easy — that our decline will be quick and that once we reach a certain point, we’ll just slip away one night, failing to see the next dawn.  We all fear losing the ability to do the things we love.  Some of us fear losing  sight or hearing, or that arthritis will make movement difficult.  Modern medicine can work wonders, allowing us to live longer lives than previous generations.  Sadly, the longer we live, the more likely it is that we will begin to lose our mental capacity.   Dementia robs us of our memories, of those qualities that make us fully human.

Dementia is “the long goodbye.”  Slowly, the person we were slips away. Initially, the symptoms are mild and fleeting — easy to miss or to discount.  And when it becomes obvious, you look back and realize how many of them you missed and over at least months.  My mother-in-law, like many who suffer increasing cognitive impairment, found ways both to cope and to keep the rest of her family from worrying.  We didn’t realize that her “Oh, hanging in there” response to our asking how she was doing was how she covered her failing memory. At some level we realized that the recitation of the previous week’s activities and meals had stopped, but we didn’t pay much attention because we hadn’t been all that interested in that level of detail.  Should we have noticed earlier?  Could we have done something?  If we’d realized and started medications, could we have slowed the decline?  Would that have allowed her body to fail before her mind went?  All of those questions are essentially meaningless at this point.  We are where we are.  So we will do what we can to make whatever time she has left as comfortable as we can — both physically and mentally.  And we will enjoy the time we have with her, even at a distance.  Four hundred miles is too far to go for a quick visit.  We will talk to her regularly, reassuring her of our love and encouraging her, and we will depend on others for details.

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