Paradox of Hospice

So our  plan is one of no pain and a lot of comfort and time spent together. 

I'm a pragmatic person. When Doris [another Hospice nurse] visited this past week she had some incredible advice and pointers. She has been a Hospice nurse for 30+ years. She is full of cheer which seems odd in her profession. 

Her advice. 
Visitors should be one at a time and only those who actually matter to you. If someone you don't really care for wants to visit...don't be polite, just say no.
If you have things you wish to do, do it if you are able. 

Watch the birds, enjoy your mules. Sit on the porch and drink coffee.

We are going to attempt--- with some help, a last fishing trip for hubby. One of Rich's lifelong friends is going to help us. He will provide the equipment, the car ride and the poles. He will even bait the hook for hubby.

We are getting a hospital bed for hubby on Tuesday. He will be able to elevate his legs to reduce the edema he is suffering from. Since he is unable to walk much fluids do build up in his legs. 
I've become and expert at putting his compression socks on.

One of the most important things we did this week was go to the cemetery where his folks and other family members are buried. It was quite the production just to get him in the Subaru for the ride, but we did it...one slow step at a time.

He wasn't able to get out at the cemetery to visit his parents' grave, but I was able to pull up close to the fence so he could watch me take care of the flowers.

He got confused as he said "No one has a flag for me out there."

I pointed out that he was still alive and he shrugged and said, "Oh yeah, I guess I am."

I put out the flowers and as is tradition, put a pouch of Grizzly Wintergreen Tobacco in the ground in his father's spot. 

Me: Do you miss your dad?
Him: Yes. A lot, every day. He was my best friend. OH no! I forgot to bring him chew!"
Me: I brought some and took care of it.
Him [he teared up]: Thanks sweetie. I just miss him so much.

We sat for a while and I pulled the car up where he could see his Great grandparents and Grandparents stones. He was pretty quiet. 
The cemetery is located on a road called Old Buzzard Lane. To get to the cemetery one has to drive through a dairy farm with cattle and round bales on both sides of the road. We waved to the farmer.

Rich had me drive the backroads to the cemetery and then gave me directions [I pretend I don't know the way so he can guide me] to drive another way home. He pointed out the different farms members of his family had on the way. 

So what is the Paradox? Before Rich entered Hospice we rarely had any visitors. Once the 'word' got around we started getting calls for visits. 

We pick and choose and set the rules. Only those who are very important visit. The looky-loos are turned away. 

Good neighbors text and drop by for a wee bit. The visits are nice. We set most visits at about an hour. But Rich enjoys them so much.

His Home Aide brings so much joy when she comes. His face lights up when she arrives. 

This week his regular nurse drove his classic muscle car on his rounds. It was a 1970's Chevy Nova SS which sparkled and growled.  Rich was beside himself. He offered to trade off our car for the Nova. 

So does this Paradox work? Rich is happier now that he is in Hospice than he has been in 10 years. He smiles more, chats more [still has aphasia which makes conversations more fun] and seems to have more light in his eyes when people come.

Hospice is often mistaken for a horrible time of life for many and eventually it is as the patient is expected to expire. 

However, being pain-free and comfortable and ... the extra care from the Social worker, Chaplain, Nurses, and Home Aides has improved his quality of life for the time he is still here.

No, it isn't a cake walk with love bubbles floating about in the air, but we are making our time together count as we have throughout our marriage and time together.

Oddly enough, his daughter has visited once in April. She called once this month to talk to him. I don't quite know how to take it. Rich just says that she is "Too Busy". I guess I'll take that as an answer. 

The Prolia thing

 

My near to last post about using Prolia.

I was called by the Endocrinologist's office regarding setting up another injection. 

Here it goes.

Me: No, I am not interested in continuing with Prolia as it caused me so much fatigue along with aches and random pains. Right now I cannot deal with the fatigue and pains as my husband is in Home Hospice with me as his CareGiver.

Scheduler: Okay, I will notify your provider. I am so sorry to hear about your husband.

Me: Thank you for being kind.

End of call.

Three days later.

Nurse: I'm calling from Emilee Peterson's office in Endochronology. I'd like to have you reconsider your Prolia shot.

From what I understand you said it caused you fatigue. Dr. Yadda Yadda [I don't recall the head doc's name so Yadda Yadda will suffice]...says that Prolia doesn't cause those types of side effects.

Me [ummmmmmmmmmm jeeze Dr. Yadda Yadda READ the fricking FDA side effects complaints!!!!]:

Oh? Really?

Nurse: Yes, Emilee would like to go over other options with you and we'd like to schedule an appointment. 
You know that skipping a dose can make you lose any bone growth you may have had and make you more prone to fractures. Any benefit you have had will be lost.

Me: Yes, so I will more than likely be in the same boat I was in as of December of last year.

Nurse: We strongly suggest with your severity of Osteoporosis that you consider another treatment.

Me: And that might be what? You know I have tried each medication on the market and so far have not reacted well to any one of them.

Nurse: Well the side effects of fatigue are more likely not from Prolia but from the stress of being a Caregiver to your husband.

Me: [Not going to argue, they have all of the answers] Hmmm. Well, I'm not interested in pursuing this at this time. My plate is full right now. I'm caring for myself with CrossFit and leaning on the Hospice and Respite folks.

Nurse: [I could hear her frustration] Perhaps we can set up an appointment in November to discuss a plan. ... You are doing CrossFit? 

Me: Yes

Nurse: Recommendations for Osteoporosis are to limit certain movements and weights. You shouldn't be lifting more than 25lbs.

Me: [insert chuckle -- snort] This morning I just finished a series of deadlifts of 85lbs along with pushups. My total weight lifted for the workout was 4,675 lbs in a series of lifts. That was my workout today. My warm up included a personal record of 150 lb for the deadlift. 

Nurse: ---very quiet---then... Can I send you over to scheduling for an appointment?

Me: Not at this time. 

Nurse: You will contact your PCP regarding your Caregiver Stress and Fatigue correct?

Me: I'll contact her and see her so she can know how well I am doing. Thank you for your time.

I hung up the phone.

Hubby: Who was that?

Me: The bone people, the want me to take the next shot of Prolia and I said no. Now they are telling me that I'll start breaking apart in June. What the F--k. I tried it, I didn't get along with it.

I went to the FDA site to read once more the side effects most complained about with Prolia:

Fatigue is reported by 45% of Prolia recipients. THAT is the first line of side effects. 
Dr. Yadda Yadda is full of Sh-t.

And after I calmed down and pulled some weeds in the flower garden. I thought about it. Fatigue.

Losing sleep as a caregiver doing home hospice is one thing. Since the meds are basically out of my system now, I have not needed daily naps. In fact I am like a mini dozer who eats Energizer Bunny Batteries. Fencing, mowing, weed whacking, hiking, and NOT having fatigue, headaches, and strange pains that come and go.

I went through a whole bottle of Tylenol in 6 weeks after getting my Prolia shot. I haven't had a headache or bone pain since mid March. 

I rest my case and am going out for a walk with the dog.

The part that really pissed me off was the fact that it felt like she was disregarding MY vision of what is going on with my body. My Osteoporosis is bad. However I am not in pain. I have been building muscles to protect my bones for years. I work hard on balance, strength, and endurance. 

She was just doing her script of what to say to get me in. I may consider it in the future again but not in this timeline.

Anticipatory Grief part II

 I wrote a blog about Anticipatory Grief on March 2, last year. I'd never really heard about it until there was a remote class via the VA Caregiver Social Workers last year.

It wasn't exactly a 'happy' post, more of a reflection of what I thought I knew and understood about the term Anticipatory Grief. I'm glad I did the class. I also thought I'd had it all figured out. 

Insert a big laugh right here. I like to think I can handle all things tossed at me. 

Well, things have changed radically. I actually have adapted I think fairly well. I knew I could possibly enter a phase where I had to do most everything for my husband. The damage to his memory and thinking skills are now more evident from his resp. failure. 

Shay, who is a young single mom and our respite gal said she and Rich had good conversations and that he seems to be okay with what is happening to him. He seems settled and at peace with it.

She then asked me how did I feel?

I said I was good with it. After all, Rich and I set up our Estate plans and Living Wills in 2012 and we had these discussions about aging and illnesses before he had cancer in 2015. The doctors will argue that his cancer treatment gave him at least 10 more years of life.

What didn't happen is good of quality of life. Doctors would point out that he was still 'here' and that he was able to visit with family. The cascade of issues that followed in the next two years took everything he lived for away from him.

Living day to day became a struggle combined with Major Depressive Disorder. His PCP told him not to feel sorry for himself as there were others worse off than he was.

[Yes, she said that and I immediately asked to be transferred out of her care.]

That is when we transferred to Palliative Care. His issues were dealt with and no shaming for being depressed or feeling hopeless. No intrusive exams. Pain management and mental health support were vital to him.

We stayed with the Palliative Care Team for 6 years.  

So back to the question. How was I dealing with the fact that we were now in Hospice Care. My mantra was 'I'm good with it.'

I understand the implications. I understand that my soul mate is dying. I also wonder what happens after. 

Wait.
I lose half of me in a way. We've been partners for 30 years. We've been part of each others lives for that long. For the past 10 I've been his 'Care Giver'. For the past 30 my life has been helping him negotiate his daily life which included many times in and out Mental Health Admissions. 

I was once asked why I'd hang around someone like him. My reply was pretty simple. He is an honest man, he loves intensely, he has a true heart, and he doesn't play games with people's emotions. And. He is my partner.

So.

While driving to town to get some groceries two days ago, a song came on the radio.  I don't recall what the song was. But I did have to find a spot to pull over. I parked on a side road that overlooked a trout stream.

It hit me.
Yes, I am prepared. Maybe. I am prepared for what happens and the process of his dying. 

Maybe I am not prepared for the 'afterwards'. 

Respite success and failures

We have been approved for 8 hrs a week Respite Care. This was a hard decision to make. I mean how can I leave his care for 4 hours to a complete stranger. Of course we had resisted, but after talking to a social worker I relented.

The care team used an agency to hire someone to come out twice a week. I chose my days that I go to the gym to work out. I can actually work out and then if I need to, get groceries, meds, run errands, or simply do on a picnic by myself [or coffee with friends].

The first week was a disaster. The Home Health Aide didn't show, didn't call, and made excuses to the agency. The second date was no call no show. I was pretty upset and called my Social Worker at the VA from the car as I headed to town to pick up meds and go to class.

Apparently that got things moving. By Friday afternoon I had a promise from the agency that another person had been found and she would be here on Tuesday. I was quite skeptical.

She showed up! 
She is a young single mom who has a cheerful and bright outlook. I gave her the quick rundown on things and off I went to class. 

I finished class and it felt very strange not to have to rush home and deal with the next set of medications or all the other things I generally do. In truth, I sat in my car for a few minutes trying to figure out what I could do and how to work out the timing of ... not doing my regular duties.

I did something I haven't done before. I went and purchased a lunch from a local co-op and then drove to a place where I go to see wildflowers in the spring.

I parked and opened the back of the Subaru and had a picnic. I listened to Tainter Creek making soft noises and then headed out on a little walk. I found plenty of wildflowers, Anemones, Virginia Bluebells, and some Blood Root that had dropped the blossoms. None of the trout lilies had blossoms either.

I didn't feel obligated to photo anything, I just felt like looking and admiring them.

I ended up walking to the old Cottonwood tree along a faint trail. I leaned up against the tree and listened to the creek and the birds in this steep valley. The valley is so steep in this spot that it often floods with rains and washes out our gravel roads. 

Truthfully, I was having a hard time not returning home right away. I had yet to figure out what to do with myself.

When I did get home I found that "Shay" had cleaned the floor [Charlie is a shedder galore!], made cookies, made Rich lunch, and had washed dishes and was looking for more light housework to do.

She and Rich got along just fine and she said she'd love to make homemade goodies while doing Respite. I said that was just wonderful as baking goodies was not my thing. Hubby enjoyed her company and she was very sweet and helpful. 

Today is Friday and she will come again. I'm trying to consider what to fill my 'free' time with. It almost seems obscene that I can have 'time off' for good behavior.

This is all new to me. Having someone come into my home while I am not there was a bit concerning to me at first. Then after my experience with Jason helping and now Shay, I am still a bit hesitant, but but I'm willing to give it a go. It is for hubby's safety after all and a bit of relief for me.

I think I'll take Charlie and go hunting for Trilliums and other spring flowers. It feels extravagant to have time like this.

Time immersed in Nature is always healing and soothing.

Let's just not sleep...ever...

For real.

😵‍💫

Let's just face it. I get really quite cranky and ugly when my sleep is interrupted multiple times a night. Especially when the sleep wasn't good for the past few days.

I know why some people choose a Nursing Home over caring at their own home. The demands are sometimes super human. 

His med change hasn't changed his sleep habits. For two days we thought we had it going pretty good.

Then bam.

A half hour after he went to bed, I got the "Val. I need that pill." I had just turned off my reading light and started to fall into dreamy land.

Lights on. Pill handed out.

That med worked for 2 1/2 hours. "Val. I'm hungry." I looked at the clock. Midnight. "I want oatmeal."
Lights on. Bleary eyed I made instant oatmeal. I went back in the living room to wait. Tap, tap, tap, tap...the endless tapping of stirring his oatmeal into tiny chunks felt like a hammer in my brain. It was a hammer in my brain. My teeth hurt and my eyes squinted.

So this is what a major- burnout -melt -down felt like. I wanted to walk into the other room and grab his cereal away and then tell him to cut it out and JUST GO to BED!

Then the waves of guilt hit me like a brick up side my head.

He couldn't help what was happening to him. He can't. It is not his fault. His brain says feed me. His brain says *I'm awake.* 

I clear the empty bowl away and say something snide under my breath. Where did that come from? Geeze, I'm so bad. I hate myself for a moment as my head starts to feel squeezed.

I ask if he is ready to go back to bed. He says no, he can't sleep. Do I call the nurse line and ask if he should have another pill? Rich says no, it won't help. He is wide awake. 

He wants to sit at the table and just sit.

I go back to my little cot which feels like a torture chamber. My everything aches and my head throbs. And I am surprised by how angry I feel.

Damn.

At 3am--ish he wheels back towards the bedroom. I help him switch over to his CPAP. He decides to leave his clothes on and lays down. I try to lay down again.

He gets back up and sits on the edge of the bed.

"What now?" I ask.

"Nothing," he replies.

I get up and find some Tylenol and try to find slumber. Charlie groans when I return to the cot. Even he is tired out.

I keep an eye on him. By the light of his clock and can see him attempting to peer at his hands as if he'd never seen them before. What is he doing? 

I fall into a fitful sleep and am awakened an hour later as I hear him get up and sit in his wheelchair. The lights go on and as he scoots through the living room he says, "Coffee made?"

My head blows up and I put on my clothes for the day. I grumble under my breath with words I shouldn't use around children or the dog.

Night and day blend together in a nightmare. Rich asks me why I am so mean when I put his coffee cup down harder than I intended to.

I apologize and explain that my head is pounding from lack of sleep. He just looks at me. He hasn't had sleep, his night must have been even more miserable than mine. I take a deep breath and rearrange my attitude.

My mantra.

It is not his fault.

It is not his fault.

It is not his fault.

Be kind. Be kind.

Think kind thoughts.

Stop before you say things.

And then my biggest fear hits me. What happens when he is gone from my life? Maybe that this is why I am here. This is us. I will not look back on these days with anger but with more understanding of what it is like.

Maybe my experiences could help someone else.

More changes... and adjustments.

 Well, things are changing again which is how life goes, right?

The Dexamethasone has helped with the breathing and with the appetite [none at one point] and wakefulness. In some ways the wakefulness is overbearing. Often hubby is experiencing being awake most of the night and not having any day time fatigue. 

He has asked for breakfast at 3:30 am. Uffdah. It gives a whole new meaning to making coffee while bleary eyed. After exactly 2.5 cups, the oatmeal must be made in an exact prescribed manner. Each day I am given the specifics, even though I've memorized it.

At first I get peeved, then I remind myself that the DXM disturbs his sleep cycle and he has dementia. This is how he lives day to day. Our new ab-normal of sorts.

It seems that every other day he actually sleeps the night through and I have trouble waking him. I imagine his poor ol' body is just exhausted after a 20 hour marathon the day before. This effect is from the DXM interrupting the cortisol in his body so his brain isn't on the same clock as mine.

Meals. Every two hours.

"Can I ask you something?" I hear. 

Sure.

"Can I have an apple/popcorn/cereal/toast/chips/cheese and crackers."..name something that is eatable and that is what he wants. Or "I have a taste for...a banana split, liver or onions, chocolate cake...", or something SO specific that I would have to go shopping for it. I usually placate him with the intention of doing exactly that.

My thought process. He wants it and it won't leave his mind. I have a 76 year old toddler. At least he doesn't stomp and throw a tantrum. I do my best to accommodate. Why not? One day I won't be able to.

I just ordered a 'camp' bed to put in the living room so I can be closer to him at night. Our only other bedrooms are up the stairs. I've always wanted one of those for sleeping on the porch on summer nights so I can watch the stars overhead.

Time to redecorate! See, I will find something positive in this. I ordered a nice 'Antique Rose' blanket and matching curtains since the camp bed will be next to the porch windows. I might as well make it my 'special spot' for the duration.

The Hospice nurses knew that Rich was having some trouble with sleep but it has gotten much worse. The up side is that I found some programs he might enjoy watching. 

Here are a couple of funnies to go along with Caregiving.

Some good news is this. The Social Worker for the VA Caregiver program and I talked last week. I inquired about Respite Care. 
Destiny called me [Yes...very cool...THAT is her name] and is now interviewing a couple of candidates for weekly respite.

YES!

and I can arrange to go to the gym and maybe even have lunch with a friend.

I qualify for 8 hrs of Respite Care a week. I feel like somehow I won the lottery. I'm not sure what my share could be yet, but the fact that someone who can be with hubby while I do the things I need to get done?

Priceless.

I'll split it between two days a week.

Fingers crossed for this.

One day at a time.

A lesson I just learned to accept:

Not a good start to a weekend...

This new territory of Hospice and medications is a new experience for me that I'd like to share with other folks so they can understand what to expect if they are to choose this path.

First off. Thursday night was one of 'those' nights. Rich had trouble sleeping and would wake up and sit on the edge of the bed for a hour or so at a time with his CPAP on. Sometimes he'd turn the light on and sometimes he wouldn't. 

I'd hear it and get up to check on him. He said. "I'm fine. Just can't sleep."

Finally at 3:30 he was up once more and called my name. I drug myself out of bed and answered the 'call'.

By 4 we were having coffee and as I was making a cup for myself. He suddenly called for a bucket as he was having the heaves. He had a bit of nausea that eventually passed and I made him his breakfast by 5ish.

By 6 he was ready to go back to bed, which he did for an hour and then was awake again. 

The new medication that replaced Prednisone was dexamethasone which helps him breath much better but has nausea and insomnia as some of the side effects. IF anyone is going to have side effects, it is my husband. 

A good side effect was getting his appetite back. 

That passed and by the time I made CrossFit and picked up a few things in town, I'd already put in an 8 hour day. 

Late Friday night, Charlie woke me up by standing on my chest. I told him to go back to sleep. Then ick. I heard the retching. The poor thing, poor me. By 3am Charlie finally settled down after being ill quite a few times.

This morning he is refusing to eat so I'm going to make some cooked rice for him. -- He has had water.

My other half got up complaining of a tummy ache and feeling off. Now hubby takes some pretty powerful opiods to ease the pain of breathing [I cannot imagine since it is no effort for me]. 

A side effect of these meds is...well. You know. Constipation. We have meds to counteract that side effect but once in a while when prunes and prune juice doesn't work.

Um. Other efforts must be done.

I won't go into detail. 

But let's just say that 'we worked things out'. 

We had a bit of a chuckle when we were all done. 

Now back to nursing Charlie. There are no small animal veterinarians available in our rural area on weekends. So I'll be working on him next and doing some cuddling with the little guy.

We never quite know where life is going to take us and I must say that my experiences with hubby, my MIL, FIL, and my father have proven invaluable. I've learned so much about elder care and caring.

Not a thing that happened to me this day was 'disgusting' or gross. As they say "Shit happens".

My one grand daughter was curious about these things. She said she wanted to learn about this process we call life and elder and end of life care so that it wouldn't be such a shock when she encounters it with her own folks.

She said her mom keeps getting shocked and surprised by the things she has to do for her great grandmother [96] and her mom [mostly blind]. 

Life is a process. I've had so many great years with my soul mate that I don't mind caring for him. It is a reflection of caring and love.

Sure, some days I feel it is a huge burden and I even get a bit tired of being 'on call' all of the time. I am going to call my social worker from the VA [if they still have jobs!] and set up a companionship day each week for hubby. 

It will give me a break one day a week for a few hours to go hiking and doing outdoor photography.

You all have a great weekend!

I see snow in our forecast for tomorrow after an 80 degree day yesterday!

Both patients seemed to be recovering. So now I am going to let my laundry fold itself while I get out a clean blanket and read a book until I fall asleep. Wait...does laundry fold itself???

Hubby and Charlie are snuggled in taking a nap. How sweet is that?