A TIME FOR EVERY PURPOSE UNDER HEAVEN

I have been at this computer on several  occassions to write about the events of the past months. So much goes through my mind that it is difficult really put it down in writing. But I realize the further I get from January, the more fuzzy the details become.  Donna spent the Thanksgiving holiday with Teresa in Wyoming and her time included taking Dad some yummies. When I asked how he appeared, Donna responded that he had deteriorated since she saw him in June. She stated that he didn't really eat much, but mostly pushed his food around on his plate.

She took their cute little doggy to visit and indicated the dog's response to Dad was very curious and sweet. The dog could not enter the center's dining room so they stood outside the glass enclosure and the dog kept watching Dad as though there was a keen understanding that something was needed for this person. Dad has always loved the dogs in his life. Donna reported that she planned to return to Cody in February.

Walter Frank Beardsley and Bill Eckman

photo by Donna - Thanksgiving 2012

In early December, the nursing home called to inform me that Dad had experienced chest pains but they seemed to go away after giving him nitroglycerin. The situation brought up questions regarding his pacemaker and whether it may have caused his pain. The nurses and I sought out the information on what type of pacemaker he had in order to determine if it was actually a defibrillator. The pacemaker would provide a constant pacing of the heart's pumping, while the defibrillator would actually shock him when his heartbeat becomes irregular. Since I already had a "Do Not Resuscitate" order, I needed to know if a defibrillator would keep kicking his heart back into rythm or if a pacemaker would simply stop functioning as his body failed. Which type did he have? This precipitated a chat between me and my sisters. 

We agreed that we did not want him to go through any type of medical procedure to "fix" it, but to just make him comfortable. Treat the pain and try to reduce his anxiety. It was clarified by a doctor that what Dad actually had was a "dual chamber" pacemaker, meaning that both sides of his heart were electronically prompted to beat. That concept is interesting to me and I will likely study it more for my own information. Phone conversations with Dad were shorter and he often could not follow a conversation. His ability to understand what was being said diminished and he seemed to be speaking with a swollen tongue. Although I would let the phone ring for long periods of time, often there was no answer and I would go a week without speaking to him, which filled me with guilt every weekend.

Dad had a "care conference" scheduled during the month of January and I received a phone call from the social worker the day before. She wanted to discuss Dad's increasing depression and felt she would not have enough time to thoroughly discuss it with me during the 15 minutes that are scheduled for these meetings. Diane informed me that Dad's assessment scores had increased significantly. Assessments were done on a quarterly basis and Dad usually scored between 6 and 8. Diane stated that her most recent score was double his normal range and indicated he was now experiencing severe depression.

She informed me that Dad felt many regrets about his life and felt he had let his family down. When asked if he thought about suicide, Dad asnwered yes. He stated that his current way of life was not worth living, but he had no plans to carry out his own death. Diane wanted to know how I felt about increasing his antidepressant. My recommendation was to either increase his current med or introduce a mild antidepressant to be used in addition to his current medication. He was prescribed Ativan. I was familiar with this medication and recognized that it is often used as an anti-anxiety medicine. This medication began with an as needed prescription but was quickly raised to a nightly routine. Dad is not eating well but has not lost any weight. He states he has his days and nights mixed up and sleeps most of the day. I informed Teresa and Donna about his thoughts and the additional medication. Donna would be able to be included in the care conference by phone but Teresa and I would be unavailable at the scheduled time.

In early January, Donna decided to go see Dad over the President's Day holiday. Since I also had an extended weekend for the holiday, I decided to go with her.

Dad was feeling very poorly, moaning and groaning with each breathe. Sometimes he was lucid and aware of us but mostly he was just struggling to make it. As we walked into his room, he called out for "Mama." I let him know I was there and asked him to do some simple things because I suspected that he had suffered a stroke. I took both of his hands in mine and they seemed to be of equal strength. I asked if he could smile for me, but he didn't. I really wanted to see his tongue because our phone conversations had been so difficult lately but he did not follow my instructions. I went to the Nursing Desk and asked for his record. As I sat to review it, the nursing administrator approached Donna and I and stated that we should meet momentarily to get our thoughts together and then we could meet with the Dr. later in the afternoon.

We went into the conference room and although I know Anne had specific items to discuss, the main agenda seemed to be her desire to have me sign a release of information. Her explanation to us was that a facility in Basin had men only as patients and/or workers and they may not have the difficulties working with Dad that some of her nurses have. She indicated "men could just be men there" and I verified my understanding of what she meant. What I understood her to mean is that he could sit around in his underwear and a t-shirt and no one would care. "Exactly!" she said.

Donna clarified that what she was suggesting was to move Dad, but Anne quickly responded that we were just authorizing information to be shared. Donna sternly stated "No. We are not moving my Father!" Anne kept saying, "well, you don't have to sign it now, just think about it." Donna expressed extreme frustration that anyone was even thinking about moving Dad and stated it wasn't even mentioned in the care conference that had recently occurred. I asked Anne who was actually making this recommendation and she stalled momentarily before identifying a woman in the business office, an administrator over the nurses, and the social worker Diane. I did not believe her. There was nothing to think about really and I stated again that I was not going to sign the form. Anne was distracted and kept moving between discusion with us, and trying to complete an admission for another patient. The form remained attached to Grandpa's record without my signature.

We also discussed the need for possible pain medications and Anne asked for one by name. The final item I wanted to discuss with the doctor was Dad's physical condition. If he gave up emotionally, would his physical body respond likewise.

We were sitting with Dad, not really doing much. Donna was keeping Teresa informed via text messages. Teresa was recently ill with the flu and was still feeling weak so I insisted she not come to the care center. My comment was, "that's all we need is for Dad to get the flu!" While waiting for our appointment with the Dr., Dad continued moaning with an occassional outburst of "Oh!" I kept asking him if he was in pain or where he was feeling pain but he couldn't really tell me. When I returned to the chair I had been sitting in, Donna looked at me. I never know what she is thinking behind those raised eyebrows and dilated pupils but I interpret it to be the "deer in the headlight" look. She was nervous and concerned about what we had gotten into. It was then that I felt strongly Teresa should come to Cody and join us in the conversation with Dad's doctor. Donna sent Teresa photos of what Dad looked like, and told her to come.

We watched as aides helped Dad into the restroom using an electronic lift. The aides would wrap a sling around his back, and beneath his arms. Then he was to hold very tightly to the bars that now extended over his shoulders. When the nurses pushed the button, the bars automatically began to lift the sling upward and the nurses would remind him to use his legs to stand. He could not straighten his legs and it was very exhausting for him. (This photo shows a similar lift, but the one used at the care center seemed much larger than dad and he never looked as secure as the man in the image.)

I went to the motel room about dinner time on Friday while Donna sat with Dad.  Then I went to the care center to observe how he acted during the night. I stayed until about 1:00 AM. He lay in his bed with his knees pulled up, rubbing his hip and thighs. He occasionally moaned but seemed to be more relaxed than during the day. I watched as he maneuvered himself to a more upright position causing the alarms to sound. A nurse came to check on him and helped him use the restroom. She was very good at using the lift and although it looked uncomfortable to me, Dad seemed to understand what was happening. Because I was with him so late, I told Donna that I planned to arrive late morning on Saturday.

When I arrived on Saturday, Donna was agitated and immediately informed me that the nurse had used swear words toward Dad. She stated that she had always liked this nurse, but now she wasn't so sure. I asked if she had addressed it with the nurse, which she hadn't so I took the nurse's name and headed for the nursing desk.
  

I warned the nurse there that I was very angry and wanted to talk to _____. Was she ____? She said no but that she would find her. Soon the nurse returned and _____ followed. I stated that I understood she had a problem with my father that morning, which ____ adamantly denied. She stated she never had a problem with Dad. I asked her if she had difficulties using the lift and she denied having problems with the lift. I asked if she swore at my dad and she acted surprised that anyone would think her capable of this. I reminded her that my sister was in the room the entire time and witnessed her behavior. She said we should go speak with her and I agreed.
  

We asked Donna to join us in the hallway. Donna identified what she saw and heard and _____ continued to deny. I asked if it was possible that her attitude overshadowed her ability to complete her tasks, which she also denied. She stated that she loved our Dad and she would never swear at him. She was a grandmother and never used such words. she claimed she was Dad's biggest advocate at the center and he really needed that. I ended up asking her to please be mindful of her attitude as she worked with the residents and asked her to spread this reminder to the other aids and nurses. I warned her not to mess with Mr. Beardsley, but I cannot recall exactly what I said. Often times there is a blur between the professional me, and the internal me who can be very irreverent and mouthy.
  

 Donna continued to insist that _____ was unprofessional toward Dad and added that she swore when he couldn't lift his legs onto the platform of the lift. When she bent to put his leg on it is when she said "dammit." I suppose it may have just been frustration and not necessarily aimed at Dad personally. Donna also said that when she brought him back out of the restroom, _____ was struggling with operating the lift and Dad was exhausted from the position. Ultimately he slipped/fell out of the harness and onto the bed. It is very fortunate that I was not present to see that. My ugliness would have blatantly been exposed.

When my sisters and I met with the Dr. in the afternoon, we were all on the same page. It was obvious that Dad was detiorating rapidly but whether that deterioration included his physical health was not clear. Because of the fluid retained due to the heart congestion, he appeared as large as normal. He certainly was not wasteing away physically, but how did his emotional and mental health affect him physically. In visiting with the Dr. she agreed to examine him, agreed to provide pain relief, and was going to do an xray to determine if the fluid was within the tissues or whether he had ascites. The Dr. would report back to us later that there was fluid around the bottom of his lungs but it did not appear to be ascites.


My sisters and I went to dinner and when we returned, the aides were helping Dad into bed. They had appeared to help him clean up in the sense that he looked a bit more "fresh". Maybe they had helped him was his face. They also put paste and powder on his bottom to prevent dampness and sores. While he was sitting on his bed, I approached the bed from the opposite side and sat behind him. He asked for someone to scratch his back so I obliged. When the aid left the room Donna moved to face dad and she sat hand held his hand. Her hands and Dad's hands are mirror images. Eventually we helped Dad get into a lying position and he wanted to know were little Pepper was, I placed my hand on his chest and he responded, "oh! there he is!" Then he petted my arm as though it was our old dog. Teresa needed to leave and she approached to let dad know she was there but it was time for her to go. There was momentary silence. I was mouthing toward her to please say I Love You. And she did. Dad immediately responded with "When?" and Teresa said "All the time, Dad. Everyday." As Dad continued to pet my arm as though it were the dog, he sighed and said "oh, ok." Teresa and Donna then left for the evening while teasing me about being Pepper to which I responded by shaking my butt at them as I am sure Pepper would have been very happy to have Dad's attention!!

 My plane returned to Utah on Sunday afternoon but before I left, I went to see how Dad's night had been. He was sitting in his wheelchair with his coat on and seemed more relaxed than the previous days. I talked to him about Tori and that her baby could be born anyday now. I let him know I had to catch my plane so I was letting him know I was leaving now. He wanted the blanket that had been a gift from the care center wrapped around him. It was made of heavy yarn so it provided warmth as well as weight. I wrapped the blanket around him and then he asked for his hat. Ughhh! I kissed him on one cheek and then the other and then kissed his forehead. Placed his hat on his head and let him know I would be back in May. He said "May! Huh."

Yea...I would return the following week...