IN MEMORIAM

SUMMER OF MY DISCONTENT

Since I began writing this blog I have been fairly diligent about posting stories and recipes.  I have striven to keep sharing stories and events of my caregiving experiences until a few months ago.  Usually writing is a good, constructive outlet for my frustrations and I am always hopeful that sharing can be of some help to others.

My hiatus began when an unexpected tragedy struck my family.  In the past I would have taken a little time to get things back in perspective and use an event as a teaching or entertaining moment.  This summer has brought an onslaught of events, illnesses, accidents and mishaps which has kept me from my virtual "pen".  My favorite way to refer to a series of events like these is as a "Cluster Fuck".

[credit: Gary Larson, the far side]

Easter Week of this year my family was anxiously awaiting the birth of my [only] niece Kate's second daughter.  I was preparing for the usual family Easter dinner which would, as always, be at my home.  Decorations and holiday china were unpacked, menu was prepared and guests were invited.  I got the long awaited email that Kate had successfully delivered another beautiful, healthy girl. Mother and daughter  were both doing fine.

Two days passed and I was slightly concerned because I had no further updates on the new arrival and my phone calls and emails were going unanswered.  That evening I finally got a phone call from my brother to explain the lack of contact and to deliver the shocking news that his seemingly perfectly healthy 32 year old daughter had gotten out of her hospital bed the morning after delivering and collapsed to the floor with a massive heart attack precipitated by blood clot.  They had performed emergency surgery and now Kate was in a chemically induced coma to recover.  

It was one of those rare times when I was mute.  All I could manage was to offer my love and support and services in any way I could be of use.  I could hear the forced bravado in my brother's voice and I suspected there might be even more to his daughter's condition than he was able to share in that phone call.  I called our sister to catch her up on the situation.  

More time elapsed without further contact or new updates and my sister and I feared the worst.  We struggled with our overwhelming instinct to run to our brother and sister-in-law's side but we also respected that they were inundated with worrying about their only child while helping to care for the 2 year old and now the newborn grandchildren.  Finally, on that Saturday, I got the call we feared letting me know that Kate had passed away.

That evening we went to Kate's home to be with the family and to offer any possible love and support that we could.  In this twenty-first century women are not supposed to die from childbirth.  As I sat holding one child on my knee and the other in my arms all I could think was that parents aren't supposed to outlive their children.  Men aren't supposed to become widowers at 32.  A two year old and a newborn are not supposed to be motherless.  Nothing was right.  The world was off its axis. 

After some time had passed and I was settled back into the normal routine of caregiving for my mom I was feeling the urge to resume my blog.  Summer was just beginning, I was planning a short vacation and also planning my annual summer shindig that my friends and I all look forward to.  I had a birthday party to go in Central New Jersey and I needed some "down time" with dear friends.

It was a beautiful day for the birthday party and everything was shaping up great.  I didn't even have to drive myself to NJ as I was being "chauffeured" by a friend and her husband. We arrived at the party and I was having a great time seeing old friends, laughing and relaxing.  That lasted for about 2 hours before I got a phone call from my mother's aide telling me that my mother was having difficulty breathing and I needed to come home.  I told her to call 911 and get her to the hospital that that I would be home as soon as possible but that was 2 hours away.

I informed my "chauffeur", we said hurried "goodbyes" and headed to the hospital.  All the while I was in contact with the aide for updates which were not good.  My mother was turning blue.  My mother was struggling to breathe.  "Where was the 'DNR'?"  [Oh my God]  I was in a panic.  After all these years of caring for my mother on a daily basis I didn't want her to die without me by her side.  I understand her advanced age and declined health but one is never ready to lose a loved-one.  Now this is a caregiver's big fear.

Meanwhile I called my sister who was also out of town on vacation and about the same distance from my mother as I.  I make an executive decision not to call my brother until we know what's going on because he had enough time in the hospital with his daughter and this was too soon.

I arrived at the hospital and when I saw my mother in the ER she was in bad shape.  I knew she was close to the end.  The doctors said it was pneumonia and we all know how serious that is for anyone let alone a 90 pound 90 year old.  She was struggling to breathe and looks so frightened.  I tried to comfort her to the best of my ability.  They had her on antibiotics, fluids and oxygen but her numbers were very bad.

The doctor caught me up on her condition and suggested we give morphine to try and relax her breathing.  That concerned be but I agreed.  He also informed me that she wouldn't make it through the night.  I know this is a prophecy we have been given all too many times in the past but this time I believed the doctor.  

We stayed with my mom until she calmed down and was more comfortable and at least her oxygen level approached normal.  She was resting and had had the morphine so there was really no more we could do.  I asked her aide to stay with her and to stay in contact with me through the night, which she did.  She's great with my mother and my mother loves her so I knew my mother was in good hands. As is my tradition in these situations, I kissed my mother goodbye, told her I loved her and also told her that I was making sure she had whatever help she needed to survive but the choice was hers'.  I told her I would understand if she was tired of fighting but it was between her and God.

Once again my amazing Adelaide defied all the odds!  That woman has the most amazing strength, grace and will to live.  It was a struggle, to be sure, but my mother was back home with me in plenty of time to celebrate her turning 91!  You may recall that it was a year ago that we went through a similar trauma and she celebrated her 90th in the hospital.  

We survived another "incident" and Adelaide is doing fine!  Aside from getting even more gray hair, I also managed to get a nasty upper respiratory and inner ear infection while spending so much time in the hospital.  That lasted nearly two weeks with heavy, nausea-inducing antibiotics.  I also had to postpone my planned [very much needed] vacation.

THE CLUSTER FUCK CONTINUES

Mom and I were both back to health and I booked a second attempt at a little vacation.  I was desperate for some swimming, sun and fun.  New Jersey Shore: here I come!  I had a week before the second attempt at vacation so I decided to begin work on my afore-mentioned annual summer party.  I tend to go just a little overboard and build some simple theatrical sets so there is a backdrop for whatever theme I have conjured.  Yes, my neighbors think I'm nuts but they know my history as a man of the theatre and arts.  Last year one of my neighbors wanted to know if I was "getting ready to put on dinner theater" in my backyard!

The set-building was going great.  This party was to have a simple Italian-American backyard BBQ theme to invoke my childhood.  Think of it as "Jersey Shore" meets "The Godfather" with a lovely trellised, grape covered bar, chianti, red and white check table cloths and make-your-own panini buffet.  The trellis / arbor bar structure was done and looked great.  After 4 or 5 hours in the blazing sun I decided it was time to hang the grapes and vines.  I stepped back to admire/assess my wonderful creation.  Unfortunately when I stepped forward again I was still admiring and not looking at the ground.

I managed to stumble over the combination saw that was on the ground and I fell smack down onto my face. I remember thinking "I think my teeth went through my upper lip" before I passed out for a couple of seconds.  When I came to I put my hands to my face and was ecstatic to find my teeth and lips intact.  It wasn't until I managed to get to my feet that I noticed that in the stumble over tools I managed to tear a chunk of fat and muscle out of my right leg.  

After some screaming and swearing, my friend helped me to the front porch.  I told him where to find my emergency kit along with some wound-care supplies [always on hand] and I cleaned the wound and got a nice tight bandage around the leg.  I then had him fetch my wallet, iPhone and some clean clothes for our trip to the ER. He yelled at me for wanting to change my clothes before heading to the ER.  I guess he doesn't know me as well as I had assumed. After so many years of caregiving I should have my own parking space out front although I am rarely there for myself.

While we were waiting for me to get stitched up my friend said " well, I guess you're not going to the shore on Tuesday".  "Like hell" I protested.  Frankly, it hadn't crossed my mind with all the commotion.  "If I have to go in an ambulance, I'm not missing this trip again!"

Did I mention that although I'm a terrific and brave caregiver, I'm a horrible and cowardly patient?  I'm fine with blood.  ....other people's blood.  My blood, not so good.  I hate needles.  I've only had stitches one other time.  I'm thinking it might be a good time to pass out until it's over.  I didn't pass out even though the lovely doctor kept telling me how "ugly" the wound was and that "it wasn't going to be one of those nice scars" and then added "I'm going to have to stitch it open because I can't pull it together".  I still didn't faint, but I wanted to.  Instead, I explained that I'm a coward and asked the kind doctor to get me an nice little anti-anxiety pill.  She obliged and while I was being x-rayed and examined, the pill had time to take me to a better place.  

I got stitched up [without fainting], asked the doctor about swimming in the ocean on my vacation [told "NO"] and even managed to have my mom's aide drive us out for dinner that evening.  Perhaps the dinner wasn't such a good idea.  In the middle of dinner Niki the aide looked at my leg and noticed that I was hemorrhaging through the bandage.  On the way home we made a side trip back to the ER.  Yes, twice in one day...and now it was mid-evening and the place was mobbed.  Anyway, I got patched up and sent home to spend lots of time with my leg elevated and not much else.

Vacation day finally arrived.  I decided I was OK to drive and I was going to go even if it meant bringing medical supplies and of course, eliminating the "swimming" portion of the trip.  Yay!  The shore at last!  I walked a lot.  I played tons of mini golf.  Everything was swell.  No, really, swell.  Or perhaps I should say "swollen".  My leg swelled from my toes to my knee.  I called a doctor friend and was assured I'd be OK if I kept it elevated as much as possible and that did work.

My trip was short but great.  I didn't / couldn't swim but that was OK.  There was a lot of summer left and I'd get more chances to swim when the stitches came out after 10 days. To ease back into being at home a friend invited me to a workshop of a new play.  Perfect!  It was a beautiful sunny Sunday.  

We sat in the theatre thoroughly enjoying the show.  A short time into the show I was thinking to myself "I know it's hot out but I wonder who it is that stinks".  This was odd because we were surrounded by some pretty well know celebrities and theater people.  It wasn't until intermission that my dear friend said to me: "look, I know you hate doctors but you have to promise me you'll go to the doctor tomorrow.  I think your wound is infected because it smells".  She was, of course right.  I had been smelling my own leg wound!  I hope no one from the CLOSER reads this!

OK, trip number three in 10 days to the ER.  Hell yes, infected.  So much for having the stitches out and resuming my summer activities.  Antibiotics and 5 weekly visits from my mother's wound care doctor the last stitch came out 2 weeks ago.  I'm as good as new but the original doc was right about not being "pretty".  No leg modeling in my future.

So far it's been a great summer.  Anyone else who shares my seasonal depression will understand just how important my summers are to me.  I forged ahead with my summer party plans.  I streamlined a little but I was determined the "show would go on".

DOG DAYS OF SUMMER

About 10 days before my big party my wonderful old pal Mickey, who had a rather large tumor, began to bleed where the tumor had ruptured.  I tried to tend to him but I couldn't get things under control.  This guy is over 13 years old which is very old for a golden retriever.  I felt so sorry for him but knew I had to muster the strength to do the right thing. I kissed him goodbye and I sent him off to the animal hospital to be put to sleep. I sobbed like a child along with a dear friend who was helping me through this.  This is the same friend who told me my leg was rotting.

The day you get a puppy is the same day you begin to dread the eventual day that you are going to have to say goodbye to him.  We picked up his bowls and gathered his toys from around the house because I didn't want to stare at them.  My friend left.  I moped.  The phone rang.  It was the Vet calling to tell me that Mickey was in good enough shape, even for his age, that they could remove the tumor safely and that we didn't need to euthanize him.  Oh, it was, of course, going to be expensive.

When you're grief stricken and get a reprieve how can you think about cost?  I think they know that, the doctors.  Now if I say "go ahead with the original plan" I feel like a murderer.  It's one thing to put your friend to "sleep" when it's the right thing to do but quite different if he can be helped.  Of course I gave the "OK" for the surgery.  Money be damned.

Mickey did very well with the surgery even though it took twice as long, he had to stay in the hospital twice as long and the cost was three times as much as the estimate!  After some recuperation, my dear old pooch is doing just great.  I keep telling him I want to change his name from Mickey to Jaguar because I could have had a new car with what he cost me!    Still, that is the most happy news of the summer.  Instead I tend to call him Lazarus because he came back from the dead.

My summer soiree came off without a hitch.  The weather was wonderful.  My friends and I had a really great time.  Some of my high school mates that were at the party hadn't seen one another in 30+ years!  

Since the party I have seen the babies a few times, my mom has been doing well, my leg is healed and I'm OK'd to swim, dog is amazingly well and summer party was a huge success!  We have also had a 5.8 earthquake, a direct hit by a hurricane, some locusts, plague and a meteor hit but we survived.

This summer is not one that will ever be forgotten.  Our lives were forever altered.  We will always see Kate in her two beautiful and precious gifts to us.  

I am looking forward to a wonderful autumn!

OK blog readers, I'm back! 

I hope you get back in the habit of visiting here.

FOODIE FRIDAY RECIPE - BAKED RICE PUDDING

Oven-baked rice pudding is one of my favorite desserts.  I like it with a lot of custard, cold and with a dollop of whipped cream.  You can have it either way but I prefer mine without raisins.  Sometimes I like diced dried apricot and/or slivered almonds but usually I'm a "purist".

This is a simple, flexible recipe sure to satisfy.

Whenever I make rice in my handy electronic rice cooker I make extra.  I like to have it on hand to throw in soup or make into Spanish Rice or use it for rice pudding.  

Ingredients:

1.25 cups cooked white rice [not instant variety]

2.5 cups milk

.5 cup sugar

4 large eggs, lightly beaten

1 vanilla bean + .25 tsp. pure vanilla extract

.5 tsp. ground cinnamon

.25 tsp. fresh grated nutmeg

pinch of ground cardamom [optional]

.75 cup raisins [optional]

butter for coating baking dish

Method:

Begin by soaking vanilla bean in the milk for 20 minutes.  Preheat oven to 325* and grease an 8" X 8" baking pan with soft butter, place the pan inside a 9" X 13" baking pan and put aside.  

Combine eggs, sugar and spices and slightly beat.

Remove the vanilla bean from the milk and reserve.  Add milk to eggs and lightly beat with a whisk.

With a sharp knife, split the vanilla bean and remove the seeds by scraping with the dull side of the knife.  Add the seeds to the liquid mixture.

Add the cooked rice and stir.  Add the raisins [if you're one of those people] and pour the mixture into the prepared smaller pan.

Move the double pan set-up to the oven and fill the outer pan with about 4 cups very hot water to make the water bath.

Bake for 30 minutes, stir and then bake for an additional 20 minutes.  Carefully remove from oven and allow to cool before serving.  I like to refrigerate mine before eating.

Enjoy!

SHAMELESS SELF-PROMOTION

Online Radio Interview

On Tuesday April 5th at 8:30 PM Eastern time I will be intereviewed on the HealthyPlace Mental Health Radio Show, an online radio show that airs over the HealthyPlace.com website.  The show is focusing on Adult Children of Parents with Alzheimers.  

They will also place a small blurb about me on their website.

I hope you will listen to the show.  

CLICK HERE TO GO TO THE RADIO SHOW AND SITE

PRUDENTIALISM

"Prudentialism is a moral principle based on precautionary principles that are acting to avoid a particular negative effect."

wikipedia

Recently I noticed a woman walking aimlessly near my home.  As I watched her amble in the cold and fading daylight I realized that it was an elderly neighbor from a couple of blocks away.  I knew her.  She was a college friend of my mother's and like my mother has Alzheimer's disease.  This is not someone who should be wandering alone so I gingerly approached her, introduced myself to her and asked if I could help her. She graciously refused my assistance explaining that she was out for a walk. "I'm fine" she proclaimed in a thin voice, "I'm not ready to go home".

I didn't want to scare or upset the wandering neighbor.  This is not the first time I have seen her out and about.  I know her husband is also up in years but I also know that they have a caregiver.  I called their home and explained to the husband that I had seen and talked with his wife but she refused my help.  He thanked me and said that they were looking for her and would take care of bringing her home.

Shortly thereafter I got a call from a police officer asking me where I had seen the neighbor as he was helping to locate her.  Later I got a call from the husband to let me know the wanderer was home and to thank me once again.  

This time there was a happy ending.  I'm still worried about their situation because what will happen the next time if they don't make any changes to their environment.  

"Roaming" is a particularly frightening problem with dementia patients but it is only one of many serious yet preventable dangers not only for dementia patients but for the elderly at large.  There are many tricks, aids and gadgets to solve the common threats.  The time to become familiar with them is before you need them.  The time to implement them is also before they are needed.  

Roaming:

The issue of roaming can be easily addressed both for prevention and recovery.  For prevention, there are inexpensive  electronic alarms that can be placed on exit doors.  You can even place them on internal doors for nighttime monitoring within the home.  These simple, battery powered alarms sound if a door is opened to alert you.  They can be purchased over the internet, from your local Radio Shack and even from "As Seen on TV" at your local mall.

Recovery devices are more expensive but there are GPS services available.  The patient wears a bracelet with a GPS device that you can track from home.  

Safety in the home:

The average home is filled with hazards. Danger lurks around every corner.  The first danger to address is the one place we should all feel safest: the bed.  I have heard so many stories from fellow caregivers about parents falling out of bed.  Some have found a parent on the floor hours or even days after the fall.  If your love-one isn't ready for a full hospital bed you can easily and inexpensively outfit a normal bed with side-rails.  They can be found at stores that sell infant and children's furnishings, major chain toy stores, on the internet and through surgical supply stores. They are simple to install and to use and worth any cost to prevent injuries.

If the patient is still self-ambulatory it is imperative that you install rails at key locations around the home.  Showers, toilets, stair landings and near entry doors.  These may require pro installation but they are a must.

Stairs pose a particularly worrisome challenge.  There is a remedy.  It is costly but effective and safe.  It will extend the time your loved-one can safely move about the house, prolonging "normalcy".  It is the stairlift.  They can be either purchased or rented and there are many styles to suit your needs and your home.  We have had ours for over 10 years and it was well worth the investment.  These are available from specialty sources which can be found on the internet or in your phone directory yellow pages.

The next item may seem daunting but it for the benefit of both patient and caregiver.  The Hoyer Lift.  This is a pneumatic winch and sling system used to lift and transport a bed-bound patient. The patient can be lifted in either a seated or prone position. One person can easily lift the patient for bed changes or to aid in transport from bed to chair, etc.  This has been a back-saver for me and I think my mother actually enjoys the ride.  Medicare will pay for this rental if it is medically prescribed.

Of course there are also small precautions to be taken such as removing obstacles and scatter rugs.  Another precaution is to check the temperature of your hot water.  Make sure it is not hot enough to scald if the patient dials it up to high.

Please evaluate your home or your loved-ones' home and make any improvements you think are necessary.  This will save you hours in the ER as well as fending off feelings of guilt.  

"An ounce of prevention" really is "worth a pound of cure".

FOODIE FRIDAY RECIPE - IRISH SCALLOP "PIE"

If it's "Irish" you know it has potatoes!  This is a delicious variation on Shepherd's Pie and perfect for the Lenten season.  The recipe calls for baking in the traditional "pie" shape but I also like to bake it in ramekins for individual servings as a decadent first course.

Ingredients:

1.5 pounds fresh large scallops

1 carrot [diced]

1/2 tsp. salt

1/4 tsp. freshly ground black pepper

3 tablespoons butter

1 generous tablespoon all purpose flour

8 sliced white mushrooms

1/4 cup cooking sherry

1 cup light cream 

3 cups mashed potatoes [prepared]*

1 egg

Method:

Preheat oven to 350*

Prepare mashed potatoes as you normally would but beat in 1 egg and set aside. This is also an excellent use for leftover mashed potatoes!

Rinse the scallops and quarter them.  Poach them in the light cream, salt and pepper for 15 minutes.

Parboil the carrot, drain and set aside.

While the scallops are poaching, melt the butter in a small sauté pan and sauté the mushrooms. When the scallops are done, drain but reserve the warm light cream. When the mushrooms are softened, stir in the flour and mix well.  Then add the warmed light cream and the sherry while stirring constantly.  Remove from heat, add the scallops, sherry and carrot.

Transfer the scallop mixture to a casserole dish [ceramic pie or quiche dish works well]. Cover with the mashed potatoes and dot with additional butter if desired.

Bake for 25 minutes until lightly browned.

Serve with soda bread and your favorite ale.

Happy St. Patrick's Day!

*prepare mashed potatoes with milk, butter, salt and pepper.  A tub of prepared mashed potatoes from your grocer's refrigerated section [Country Crock, Bob Evans, etc.] are a great shortcut trick for this. 

CAREGIVER AS MANAGER

The word "caregiver" conjures up images of healthcare, companionship and moral support.  What many people do not consider is that so much time is devoted to being a manager.  The amount of paperwork can be staggering.  Bureaucracy is intimidating.  If caregiving is stressful, managing is exhausting and mostly unrewarding.  When one signs on to be a caregiver for a loved one they never expect that the total realm of the job will take on that of CEO.

When my aunt Theresa began to fail at the age of 93, my sister and I had to step in.  Luckily she had appointed us as Power of Attorney several years earlier.  This legally enabled us to act on her behalf in her best interest.  At first I took over her bill-paying and straightened out her finances.  She had always been meticulous but the early stages of dementia had taken its toll on her book keeping.

When her condition further deteriorated, we had to make the difficult decision to place her in a nursing facility.  Now what were we supposed to do?  After the limited time that insurance would pay for her stay, the facility charges a staggering $355.00 per day.  That is roughly $11,000.00 per month.  I continue to think of how luxuriously I could be living on that kind of money for housing.

Theresa owned her own modest two-family home which we would have to sell.  Trying to sell any home in the current real estate market is difficult and time consuming but a house that hadn't been updated in 50 years was going to be impossible.

After quite a bit of research I decided that a reverse mortgage would be our best hope.  The reverse mortgage process was simple enough and took about 5 weeks from start to finish.  Now the paperwork had begun!  First there was the application process which required copies of documents which I had to hunt down.  Then there was a required phone interview.  Then, finally the closing process.  The closing required my signing in no less that 130 places on the documents.  Not only did I have to sign, but I had to sign in the extended and clumsy legally required "owner's name by my full name 'as attorney in fact'".  That was quite a challenge for a guy with Carpal Tunnel problems!  It was made worse because they changed their mind as to the exact signature format half-way though the process and I had to go back and revise all those signatures.

I chose to go with a reverse mortgage because it would buy time.  I could use some of the funds to pay the nursing home.  I would use some funds to renovate the house in order to make it salable.  I would allocate some of the money to fund everything while waiting for the house to sell.  I figured it gave me about a year to have the house sold.

Before any real work could get started, my sister and I had to spend several weeks sorting through my aunt's possessions.  Not only is this tedious and back-breaking, it's emotionally draining.  It's thought provoking when you see what a life boils down to.  As a side note, I went home every evening and began to sort though my own possessions and make donations.

We did months of renovations to the house.  I hired a contractor, electrician and plumber.  We used four large dumpsters for building debris and a large part of fifty years of accumulation.  We donated huge amounts of clothing and household items to charitable organizations.

Anyone who has ever experienced home renovation or has seen "The Money Pit" understands what a management job this is.  Planning, design, decisions, budget, permits and delays rule your life.

Finally the house is finished, the tenants have vacated, the house is "staged to sell" and the realtor is chosen.  More paperwork for the realtor agreement.  The house is officially "on the market".

All that work, time and money paid off.  We had a buyer in less than a week!  In any market economy that would be impressive and in this "burst bubble" it was amazing.  Now more bureaucracy:  sign the contracts,  wait for home inspectors,  haggle over required upgrades, and  spend more money for asbestos removal.

Now the waiting game.  We found the buyer in 6 days.  The buyer had to wait months for financing.  We had to continue to carry the house.  Now winter was here which meant I had to heat the house.  Not only did I have to heat the empty house but I had to worry about heating the empty house through blizzards, sub-zero temperatures and storms. I had to keep checking to be sure the heat was working.  I had to keep the snow shoveled.  I had to worry about vandals.

Finally after several postponements it was closing day for the sale of the house.  Oh, good.  More paperwork, more [full, legal, expanded] signatures.  Done!  No more worry about the empty house.  The "albatross" had been removed from around my neck.  I'm ecstatic!  Free sailing from here on out, at least as far as the property was concerned.

That feeling of liberation and satisfaction was brief.  Now it is time to apply for Medicaid so that when all of my aunt's hard-earned money has been used to pay for her nursing home stay, the government insurance will begin to pick up the tab.  "Government" is the operative word here.  Not only do you have to spend your life's savings but then there is a 50 page application to be filled out.  Along with that application you have to submit endless amounts of supporting documentation.  You have to provide five years of bank statements,  receipts  for expenditures over $3000.00 each and every other form of legal document you can think of.  You have to dig up everything from birth certificate to tax returns, marriage certificate, spouse's death certificate...and the list goes on.

I'm half-way though collecting the required documentation.  So far the stack of copies on my desk has reached 20 inches.  It is a nearly impossible task to document someone else's life this way.  My aunt was very fastidious about keeping records and document and I am still having a dreadful time filling in the blanks.

I can't wait to get back to only having to worry about my normal duties as caregiver for my mother.  Sitting quietly doing my own personal work will be a pleasure.

FOODIE FRIDAY RECIPE - ITALIAN RICOTTA CAKE

Italian Ricotta Cake

This is a wonderfully simple recipe which is actually an embellishment to a boxed cake mix. A guaranteed pleaser,  when I serve this for company everyone begs for the recipe. My family loves it.  My friends love it.  I love it.  Don't let the rustic appearance fool you.  This cake is moist and creamy, light and satisfying.  There is a cake layer on the bottom with the scrumptious ricotta cheese layer on the top.  You can bake it in one large rectangle cake pan but I prefer to bake it in two 9 inch round pans.  I usually put one of the baked cakes in the freezer for a future treat!

Ingredients:

1 package white cake mix* and ingredients listed on box

in addition:

4 eggs

1 cup sugar

2 pounds ricotta

1 teaspoon vanilla**

Method:

Preheat oven to 350*

grease and flour 1(9 x 13) or 2 (9" round) pans

Prepare cake mix as directed on box and pout into prepared pan(s).

In the same mixing bowl that you used for the cake mix, combine eggs, sugar, ricotta and vanilla and mix well. Pour cheese mixture over the cake batter in the pan(s).

Bake in preheated oven 1 hour 10 minutes for the rectangle or 50 minutes for the round cakes.  Cakes are done when golden and firm.

Cool in pans.

Turn out onto plates or tray and dust with confectioner's sugar just before serving.

I like to serve this with fresh raspberry puree drizzled on the plate.

*yellow or flavored cakes can be substituted

**orange juice or Amaretto can be substituted

FOODIE FRIDAY RECIPE - PASTA e CARCIOFI

Pasta with Artichokes

This is a very simple, delicious and flexible recipe.  Light and satisfying, you can add, remove or substitute vegetables and even shrimp or clams.  I Like to keep mine to about 4 main ingredients served over angel hair pasta.

Ingredients:

1/4 cup olive oil

1 stick salted butter

1 clove elephant or 4 cloves regular garlic [chopped]

One 10 ounce bag frozen artichoke hearts

2 carrots [peeled and rough chopped]

2 tablespoons chopped onion

2 tablespoons sliced sun dried tomatoes [in oil]

6 leaves fresh basil

1/2 teaspoon red pepper flakes

1 teaspoon salt

1/4 teaspoon fresh ground black pepper

1 cup canned garbanzo beans [optional]
Freshly grated Romano or Parmesan cheese

Prepared pasta of choice

Method:

In a large skillet, combine oil and butter and let the butter melt over medium heat.  Boil the carrots until just fork-tender.  Cook the artichoke hearts in microwave as directed on package. Sweat the garlic and onion in the oil until translucent but do not let brown.  When the garlic/onion are cooked, add the drained carrots and the artichoke hearts.  Continue to simmer on low and add the 

sun dried tomatoes, oregano, salt, black and red pepper [to taste].

 Drain pasta, reserving 3/4 cup of the cooking water.  Toss in a large bowl with the artichoke mixture.  Add reserved cooking water as needed for a shiny, moist dish. Toss in the basil.

 

Serve with grated cheese at the table.

 

 

UP TO THE PRECIPICE

Gloria Eleanor Clemente

Gloria was a strong woman.  Except for one serious hospitalization I never remember her ever being sick.  If she was ever sick she certainly never let it stop her.  Hardy stock those Clemente women.  Enviable for their strength, determination and longevity.  Gloria was my mother's next younger sister and would be 89 years old now.  

Sometimes strength can also be translated as stubborn.  Stubborn can masquerade fear.  Fear can hide embarrassment.  Nine years ago Gloria began to have some "female" problems.  After doing her best to hide her discomfort she finally confided in my sister who urged her to see a gynecologist.  After much persuading from the family, Gloria went to the doctor.  

The doctor immediately referred her to a specialist for what turned out to be cancer of the vulva.  The specialist performed quite radical surgery during which Gloria encountered some surgery-related problems.  After a very difficult recovery period she was doing remarkably well.  At her six month check-up the doctor was very pleased.

By the time the one year check-up rolled around Gloria had once again been hiding additional symptoms.  The doctor made the pronouncement that the cancer had returned.  If an original diagnosis of cancer is bad, reoccurrence is much worse.  

By this time early signs of dementia had been surfacing.  Signs easily recognizable to a nephew who had been taking care of his mother with Alzheimer's disease for a dozen or so years at that point.  The dementia combined with the problematic previous surgery ruled out another surgery.  My sister and I were in agreement with the surgeon.  We agreed to a consult regarding radiation therapy.  We also agreed that we would not tell Gloria the extent of her condition because of the dementia. These are very difficult but pragmatic decisions caregivers are faced with.  I decided it was more humane not to keep her completely informed.

The visit to the radio oncologist was devastating.  The doctor examined Gloria and then made an excuse to speak with my sister and me alone.  She said the treatment would be excruciating.  It would require weeks of  burning treatment with frequent hospital stays.  I asked the prognosis and the doctor said she thought Gloria would have four to six months with the treatment.  "With the treatment"!  My sister and I were stunned.  I looked at Patricia who was now in tears and then asked the doctor to please give us the information for Hospice.  There was no way we would put my aunt through torture for such little gain.

The doctor was lovely.  She said she was hoping we would choose Hospice and promptly contacted them for us.  We agreed that we would tell Gloria that her discomfort was part of the healing process, knowing that she would never be able to get thought the months ahead of her if she didn't have hope.  We knew what we were in for.

Within the week the Hospice representative was in my kitchen getting things started.  That was the first night I slept in a while because I knew I wouldn't have to face this tragedy alone in my home.  Now I had Gloria on Hospice and my mother with her advanced dementia.  I had been thrust into running a de facto nursing facility.

Hospice was miraculous.  There were people to take care of Gloria.  Supplies would magically appear at my front door.  There were numbers to call if [when] I was feeling overwhelmed.  Hospice looks after the whole family.

Overwhelmed happened.  Even the strongest of caregivers is mortal.  Between the stress of both patients, the parade of strangers through my home and seeing Gloria in ever-failing health, I ended up with pneumonia.  It wasn't horrible but it was a warning for me to take care of myself.  That is a caution to all caregivers:  TAKE CARE OF YOURSELF!    It's akin to the instructions on an airplane that "in case of loss of cabin pressure ...put the mask on yourself first and then help others".

Ultimately the excruciating pain exacerbated Gloria's dementia. My wish had been to make it through the holiday season which was about three months after the onset of Hospice.  We made it gingerly though Christmas but on New Year's Eve morning I was awakened at 7 to Gloria hollering.  She had gotten dressed and made it downstairs, which was miraculous, and was in full psychotic break.  She was no longer in pain but had been transported, in her mind, back 40 years.  She was calling for my father to take her to work.  My father had been deceased for 30 years at this point.

I called Hospice and ultimately made the decision for Gloria to go to their cancer wing at a local hospital that they served.  There were more ups and downs but I was able to rest knowing that she was being well taken care of.  I knew that I was no longer able to provide the comfort and care that was required to make her final time comfortable.

Seven years ago this week I got the 5 o'clock in the morning call, in the middle of a blizzard, telling me that Gloria had passed away.  The pain and suffering were over.  None of our lives would ever be quite the same again.  

Pushed to my limits I was forced to learn so much from this experience.  An experience that no one wants to  face but so many of us do.  I found strength and compassion that I never knew I had.  I learned more about caregiving and Hospice and bureaucracy  than any post-graduate degree could ever offer.  An education I never wanted.

Never feel that you have to face these challenges alone.  For end of life, Hospice is there to ease the burden and the trauma.  At other, less serious, times there is Visiting Nurse.  Consult your physicians.  Turn to your clergy.  Utilize the help that is out there for you.  It's never going to be easy but at least it becomes more bearable.  

FOODIE FRIDAY RECIPE - PIZZA

PIZZA!

The word alone makes most people smile.  That perfect combination of home made bread, tomato, cheese opens the door to an endless variety of personalization choices.  For me, the basic combination is all I need but once in a while I splurge with some fresh asparagus or leftover meatballs or shrimp.  

There are few aromas that can compete with that of pizza baking in your oven.  The rich cheeses, the aromatic basil and the slight acidity of the tomato all get your memories flowing and your mouth watering.

I am going to give you the basics, including the dough recipe.  I promise not to frown if you choose to use a fresh pizza dough from your grocer's refrigerator or from your local bakery.  They are fairly readily available and perfectly acceptable.  Please do not used one of those pre-formed packaged pizza / focaccia shells sitting on the shelf next to the white bread.

I do not usually advocate single-use or specialty gadgets but one item that I suggest you add to your collection of  baking sheets and pans is an aluminum pizza screen.  They are reasonably priced and help produce a wonderfully crisp crust.

Ingredients:

[for the dough]

1 package active dry yeast

1.5 cups room temperature water

3.5 cups all purpose or bread flour

1 tablespoon salt

1 tablespoon olive oil

[for the topping]

2 cups shredded cheese [I like the mozzarella/provolone mix]

1/3 cup grated Romano or Parmesan cheese

6-10 fresh basil leaves

2 teaspoons dried oregano

1 teaspoon salt

1/2 teaspoon ground black pepper

1 tablespoon olive oil

1 cup tomato puree

1 small clove garlic, minced

Method:

[for the dough]

Combine the dry ingredients in the bowl of your stand mixer or in a large bowl if you are going to kneed by hand.  Stir to mix well.  Add the oil and all but 2 tablespoons of the water. Mix with the dough hook for 5 minutes. If the dough seems dry then add the rest of the water. Let rest for 5 minutes and kneed for another 10 minutes.  Transfer the dough to an oiled bowl, cover with plastic wrap and let rise for an hour.

[for the sauce]

For pizza it is best to use a raw "sauce".  Please don't use a pre-made sauce!  Blend the tomato puree, garlic, oregano, salt and pepper.  

Assemblage:

When the dough has risen for an hour, turn it out onto a floured surface.  I like to use a silpat mat for this but you can work directly on your counter top.  

Preheat oven to 425*

Rub some flour on your hands and begin to stretch the dough with your hands.  At this point you can cheat and use a floured rolling pin to flatten and continue to stretch the dough until it is quite thin but not torn.  This dough generally makes a 16" crust.  Feel free to leave the dough in a free-form shape if you are unable to get it into the traditional round.  I like the rustic look and then you can be sure your guests will know it is handmade!

Place the dough on the pizza screen or baking sheet and very lightly cover with the sauce.  The sauce should barely cover as illustrated in the photo above.  If you use more sauce than that the pizza will be soggy.

Sprinkle the grated Romano over the sauce. Now arrange the fresh basil leaves over the pie.  Cover with the shredded cheeses and sprinkle with the remaining olive oil.  

Bake on middle rack for 20 minutes or until golden and bubbly.

Serve piping hot from the oven.  You can also cut into bite-sized pieces and serve as an hors d'oeuvre.