Monday, December 03, 2007

When you just can't keep a promise...

I hadn't seen my eighty-something year old patient in months. She'd been going downhill with dementia and Parkinson's disease. When she came in last week, the immobility of the two diseases working together had made her so stiff she couldn't even get out of her wheelchair alone nor support her own weight once upright. She also was clearly suffering from that failure to thrive thing that turns the frail elderly into shrunken shadows of their former selves.

Her conversation rambled from completely coherent to totally out to lunch. When her caretaker eased her out of her chair, her backside had several 'hot spots,' red and tender areas where the skin was breaking down under pressure on its way to open bedsores. Her husband, who hovered anxiously by her side, also walked with a Parkinsonian shuffle and was in pain from degenerative disc disease and a torn rotator cuff.

"I promised her," he declared as we held a brief conversation out in the hall, "that I would never ever put her in a nursing home." I could've cried...well actually I did. I had made that promise to my Mom, and I couldn't keep it. How many make that pledge only to find out that even tiny little ladies are near impossible to move from bed to commode when they can no longer move themselves?

This is the conversation I wish I'd had with my Mom, and that I've already had with my daughter. Home is always preferable, but there are circumstances where it's just not feasible. When and if that happens, tell your loved ones now while you've got your wits intact that they have your permission to move you to a skilled care facility.

4 comments:

Laura in L.A. said...

Until you have lived with or cared for someone with dementia, you can't know what it means. It's 24 hours a day, and it never ever stops. My mother and I are going to do the best we can with my daddy for as long as we can, but we must be realistic. The day will come and we will have to do it. No one should feel guilty that they need that kind of help.

You did right by your mother, with a lot of care and love, and I admire that you told your daughter that, too.

Mauigirl said...

Good advice. So many people have such guilt over having to put their aging parents in a nursing home. But at some point caring for them can become impossible.

kenju said...

My husband had to promise that to his mom and when she developed dementia, he had to go back on his promise. He was horrified and she was scared to death, but she ended up really loving the place she had been so afraid of and sadly, she only lived 9 mos. after moving there. We were sorry tht we hadn't done it 2 years before.

Femail doc said...

I appreciate that you three have been there and/or are doing that. Thanks for your supportive comments. Today my Mom had the wherewithal to dial my office number, but dialed it once to tell me she was stranded in a motel and couldn't get out, and the next time not two minutes later to tell me she was stuck in her office and couldn't get out. At least I didn't have to go flying out in the middle of office hours to her home.