Tuesday, March 30, 2010


After so many years as a caregiver there is nothing new about a crisis occurring, however each one is a unique event.  The challenge is finding the inner strength to be able to remain logical.  Panic is the natural first response and that is human.  The difficult part is pulling back from the panic in order to assess the situation. That is a tall order.  When you find a loved one in a compromised situation emotions fight hard to win the battle over common sense.

This week has been a difficult one.  My mother is having a medical crisis. I am sleep-deprived.  Even when my mother is resting comfortably it is difficult for me to sleep because I am regularly checking in on her to take her temperature, adjust her position or just to satisfy myself that she is breathing normally.

"It is truly said: It does not take much strength to do things, but it requires great strength to decide what to do." 
chow ching

At any given time there is a whole list of symptoms and manifestations which are part of my mother's health repertoire.  Some are more serious than others but all need to be monitored.  Even on the best of days when my mother is in good health, she is still an 89 year old patient in late stage Alzheimer's so no symptoms are taken lightly.  In the past several days the "perfect storm" developed.  At first I noticed the mildest of symptoms had arrived.  When my mother is not feeling well she holds her contracted leg very tightly to her body.  I did some physical therapy in an attempt to loosen the stiffness for her.

The next symptom to arrive was lethargy.  Normally Adelaide is awake and alert most of the day.  She smiles when she sees people.  She eats and drinks robustly.  She never cries out or whines.  Now she presents as exhausted.  She eats and drinks but struggles to stay awake long enough to finish.  Smiles are scarce.

I know something is "brewing" so I am vigilant.  I keep close track of fluid intake and bodily functions.  

I have a remarkable dog.  He's a loving golden retriever named Mickey.  He's quite old now but completely devoted to Adelaide.  He is very in tune to her health.  In the past he has woken me up to alert me that my mother was having a seizure in time for me to get 911 to the rescue.  An event that I might well have slept through until it was too late.  My friends and I affectionately call the pooch "Nurse Mickey".  

Nurse Mickey was on full duty this week.  He remained at my mother's side 24 hours a day except for the necessary visits to the food bowl and brief trips outside.  Normally Mickey sleeps with me but not when he senses a problem with Adelaide.  I am convinced that he can smell infection in her system.  He's never been wrong and I have full faith in him.

Next symptom to arrive was fever.  My mother woke me up by moaning and when I checked in on her she was HOT.  When my mother has a fever it puts me on edge.  I don't like to see her so red and uncomfortable.  It worries me.  I get the cold compresses and begin giving her Tylenol but these things take time.  

Stiffness, lethargy, fever and Nurse Mickey's concern: I know this is a urinary tract infection.  Luckily we have antibiotics on hand because she is prone to infections.  In the past, when we had a less cooperative doctor, these symptoms would land us in the hospital emergency room for hours of tests followed by a diagnosis of urinary tract infection.  

Visits to the ER will be another entire blog at some point.

I started the drug regimen in hopes that she will respond quickly.  Meanwhile the other sure sign of urinary tract infect has presented itself and my mother is holding her urine for stretches of up to 14 hours.  "Come on drugs, work your magic."  I push fluids on her.  

"When someone tells me there is only one way to do things, it always lights a fire under my butt. My instant reaction is, I'm going to prove you wrong!" 
picabo street

What followed next was no one's fault except bad timing and my temporarily giving in to fear.  Adelaide's wound care doctor came for his weekly visit.  He hasn't experienced my mother in crisis before.  She was throwing a fever and lethargic and he was, of course, concerned.  I'm glad that he shows concern for my mother's well-being.  Over the years there have been health providers who lacked concern.  

I explained that she had been ill for a couple of days and that she was on her antibiotic.  He was worried that her infection might be more serious.  He checked her wound and deemed that to be OK so we didn't think the infection was from that.  He did however say that he thought her overall condition might be in decline and that I should keep a close eye on her because she might need to go to the ER.  We decided to switch her medication to a different antibiotic because he didn't think the current one was working.  This is common for us.  Non-specific infections react differently to different medications.  Antibiotics target different bacteria.  

The wound care doctor left.  Contrary to all of my instincts and magnified by lack of sleep, I worked up a small panic.  I am completely aware of the fact that eventually everyone dies.  I am not in denial but I am also a fighter.  Adelaide is a fighter.  

After a few minutes I regained my composure and re-assessed the situation.  I switched the medication as suggested.  I put in a call to our friend in the doctor's office to alert them of the situation.  I was assured that I was following the right course and that we would try hard to keep my mother out of the ER.  I would keep monitoring the situation and the physician's assistant would come for a visit.

We had a quiet evening followed by a quiet night.  There have been no more fevers so far.  This morning finds my mother alert and far more comfortable.  We're not through with this crisis yet but the signs are cautiously hopeful.  Perhaps we can both rest up before the next crisis.


  1. cheryl delavallierreMarch 30, 2010 at 1:21 PM

    So glad that your mom is doing better! As I was reading your blog, I kept asking myself a question but coming up with an answer. Perhaps you can help. The question that kept coming to mind was, When caring for a patient with Alzheimers, are they even able to tell you the symptoms they are having? It seems to me that they are not able to communicate their concerns to you, I hope I am wrong, because on top of the challenge of caring for them, you now have the challenge of trying to figure out the symptoms that do not present themselves in an outward fashion. With that said, I hope this note finds Adelaide improving and Mickey and you getting some much needed shut eye!

  2. I have always said that dogs are Human. We had a rescued greyhound who was with me from before I was married to Susan. When Meredith came home from the hospital, he moved to sleeping under her crib rather than with us. They know who needs their protection. LPM