Mary's Tender Mercy

Invariably, the question is, "Where is Mary M.?

"What time do you have?," comes the reply.

"Five o'clock."

"Oh, she is likely in Dorothy's room." Mary M. is "family."

I don't honestly remember when we first came to know Mary; I believe she began working at GVM roughly the same time Mom became a full-time resident. As with much of the staff who attended to Mother in those early days, I imagine Mary probably didn't know quite know what to make of our intense group of omnipresent family members.

I can hear Mary wondering aloud, "are they crazy?"

Mary was never supposed to work in a nursing home in the first place; her educational background is in accounting. But her father knew better -- she was meant to spend her days caring for others.

I haven't really put together all the pieces of the puzzle. How is it that she forfeited her love of accountancy in exchange for a career tending to the needs of sick, dying elderly residents at GVM?

Her father's prediction was correct. But could he possibly have known the career path he imagined for Mary would begin with his final days?

Mary has walked in our shoes. She was faced with the myriad tough decisions surrounding the impending death of her father. Nursing home or home care? The choices may seem cut and dry but there are innumerable intangibles that get in the way of an easy decision; it is a struggle between blind love for a loved one and the passions people cling to such as guilt and remorse.

In the end, Mary's family opted to care for him at home. It was a monumental undertaking but one she has never regretted; it was a gift. Her father died as he wished -- in the company of family.

Mary wears many "hats" at GVM. She not only dispenses medication to and cares for residents but also is charged with staffing and general ordinances. It is clearly not an amalgam of assignments best tasked to one person; she does the work of many. There are reasons for this: she is intelligent, dependable, responsible, and devoted. It cannot be easy balancing the varied duties -- and there are times when she must surely doubt her resolve -- but, in the end, she perseveres.

With her collective responsibilities, how is it that she came to be such a fixture in Mother's life? Simply put: She made time for Mom -- with a little nudging.

One of my brothers has come to refer to the private residence wing of GVM as, "Dorothy Scott Manor." He jokingly introduces himself to all unsuspecting incoming staff by first informing them they will have to become certified in order to work with Mom. (There is often an understandable look of bewilderment.) I don't know when or how it happened but Mary seems to have been one of the first staffers to make his cut; I think she was "grandfathered" into certification.

As the clock approaches five, Mary can almost certainly depend on hearing a few gentle (maybe, not so gentle) raps at her locked office door -- and window. (My personal belief is that she often wants nothing more than to escape our reach.) But, we are nothing if not dogged. Surely, she understands -- it isn't for us; rather, Mom has come to depend on her visits.

At the stroke of five, Mary can generally be counted on to arrive -- aided by another member of the staff -- to prepare Mom for the night ahead. It is not always easy. But it can often be entertaining.

The process begins by getting Mom up out of bed, wheeling her a few yards to a private bathroom then changing her into nightclothes. I should hasten to add that Mom has lost the governor over her thoughts with time; she pretty much says whatever comes to her mind. A family member is generally within hearing distance of these bathroom conversations; it almost never fails to make me laugh or smile. On more than one occasion, as Mary worked to get her into a nightgown, Mom has loudly declared, "Hey, I am NOT that kind of girl!" One never knows how she may react.

On these "bad" days Mom remains tight lipped after returning to bed; she can get agitated. Early on, as Mary tried to assuage these concerns, Mom finally responded with a demonstration so as to make her point. She outlined an imaginary box in the air then asked if Mary knew what it was. Mary was baffled. Mom went on to inform her, "this is my private space .... DO NOT ENTER THIS SPACE."

Generally speaking, Mary has a way with Mom. It may very well be they have shared experiences as women; Mom is most certainly outnumbered by the men in her life. It cannot be that simple.

Mary can feed Mother when everyone else has come close to giving up. And Mary can hold conversations with Mother I couldn't begin to initiate. They have an easy connection.

After it seems Mom has fallen to sleep, Mary will often take a seat and talk with whomever remains in the room; we have learned to never confuse the appearance of sleep in Mom with a lack of comprehension on her part. A week or so following a particular conversation between Mary and I regarding a family matter of hers, Mom called Mary over to her bed and proceeded to relay pointed, cogent advice regarding her daughter. Mary took the advice to heart.

I believe -- bad days aside -- Mary has become an important part of Mom's daily routine because they both have come to appreciate the simple joy of these visits; they both gain from the experiences they share. Mary does this on her time -- time she could be spending at home with her own family. Mary would be the first to point out, however, these residents are not simply names and room numbers to her. They have become members of her family as well. 

Mary's father knew his daughter; she is exactly where she needs to be.

The night always ends for the two of them with a private word from Mary whispered into Mom's ear.

At the door, Mary quietly adds, "Goodnight, Mom."

Learning Curve

July, 2008

I have no interest in making a sweeping indictment of or to impugn the hard work of many members of the staff at GVM; there are numerous people who work diligently and faithfully attending to the needs of every resident including Mother. With that being stated, however, I am compelled to write about the learning process we undertook when Mom became a full-time resident.

Some examples:

Medical questions/concerns that arise are eventually reported to a charge nurse who then faxes pertinent information to a resident's attending physician. It often takes a day or more for problems to be specifically addressed.

When these medical concerns are finally submitted to the physician, an on-site visit between the resident and his physician is generally not forthcoming. The physicians tend to rely on the vigilance and reports from the nursing staff of the facility -- the majority of nurses being, LPN's. The acuity of nurses to patients is reportedly 1:4. This is a blatant misrepresentation; on any given day, Mom's nurse is often the sole individual charged with overall responsibility for residents in two to three halls.

Once an attending physician has "addressed" a particular concern -- it may very well take 24 hours for any new medication or treatment to be initiated. While I do know of the existence of "emergency kits" of medication available on each hall, the supplies are not exhaustive.

There exists no in-house pharmacy. When medication requests are submitted to the contracted outside-pharmacy, orders are very often not dispensed correctly. Cipro 250 mg. dispensed vs. 500 mg. -- as ordered. Phenergan 50 mg. dispensed vs. 25 mg. -- as ordered. Worse, as in the case of an antibiotic (Ciprofloxacin) for Mother, the med techs proceeded to give the wrong medication for three days even as their own records clearly indicated an ordered dose at odds with the dispensed dose. It was only after we inquired as to the discrepancy that corrective action was taken.

To trivialize the use of "commonly prescribed" drugs like antibiotics or anti-nausea medication is dangerous. The choice of a drug and dosing generally takes into account an individual's size and age but must also include consideration for his/her general physical or mental state. Deviation from prescribed dosing can lead to serious untoward complications.

There is also considerable grace granted for the dispensing of medications in these facilities. A drug that is scheduled to be given at 8 AM may, technically, be given, "anytime from 7 AM to 9 AM." Drugs prescribed for Parkinson's disease are time-sensitive; there isn't much wiggle room for deviation from strict dosing schedules -- at least in Mother's case. While this particular issue was quickly and satisfactorily resolved -- I was hard-pressed to believe when told, "very few residents have rigid dosing requirements."

"All available staff report to the dining room," is a general announcement prior to meal services. Regardless of promises made to the contrary -- not to mention state guidelines -- there is often no staff available during these three hours of the day to assist residents who -- by way of choice or physical limitations -- do not take meals with the rest of the community.

I learned this the hard way one Sunday in July.

Mother had made the decision to take lunch in her room; she and I were happy for an opportunity to enjoy a meal together without the added distraction of the collective noise in the dining room. That was our plan.

Shortly after beginning her meal, however, the Heimlich maneuver became more than a mere abstraction for me.

I don't have it within me to describe -- adequately -- the terrifying seconds sitting immobile, staring at my mother -- as she stopped moving air, as her lips turned a ghostly blue, as her pupils dilated, and as she began to struggle violently to regain control. I was in total disbelief during those initial seconds; "Is this really happening?"

Throughout many years of training and practice I have been directly involved with resuscitating countless trauma patients in untold, varied life-threatening conditions. Working in such an environment leaves a mark on everyone.

For me, those experiences pale when judged alongside these frantic minutes at the nursing home when Mom was fighting for her life. Every aspect of the experience -- when responsibility for her survival landed squarely in my hands -- is seared into my psyche. The few minutes or so of unbridled terror are worthy of a lifetime of nightmares.

The Heimlich maneuver worked -- but I had never before been called upon to personally test its effectiveness. I distinctly remember seeing the offending small of piece of chicken that conspired to kill Mother -- looking at the innocuous, dislodged bit of protein realizing the power it had temporarily wielded.

It wasn't until later when Mom was safely back in bed recovering that the totality of the situation began to set in. I remembered I had been thinking to myself during the ordeal that, "Mom is dying and her death will be forever on my head;" her physician son, who had never before performed this maneuver, couldn't save her.

Absent the presence of a family member that afternoon, she would have surely died. Every member of the hall staff was gone. They had been summoned to the dining room to attend to the meal service.

I am a physician who practices in a very traditional hospital setting. If I didn't understand it before, the lesson had been learned: nursing homes are most definitely not hospitals. In the weeks and months ahead there was a great deal more learning to do. We could not afford to engage in a slow, steady process; our learning curve was accelerated.

Mom has most certainly never been alone since.

Miss Ruby

There is something intoxicating about the smell of yeast bread as it is baking; it instantly makes my mouth water.

Mrs. Hanlin was responsible for this. She came to us when Mother was ill and hospitalized for a long period of time; she cooked and cleaned for our family. She was apparently very good at both but her cleaning is NOT what I embraced. I distinctly remember the smell of her yeast bread dinner and cinnamon rolls as they were baking. Long after she had gone that sweet smell was forever etched in my memory.

In the days when I started first grade there seemed to be little concern for children walking to school -- everyone walked. Over time, I came to use those walks as a barometer to gauge how my day would go; an ideal day for me would have begun by walking into the bright light of a Spring morning -- a crisp chill hanging in the air. But, perfection was realized only when the sweet smell of yeast bread goodness permeated the breeze as I approached school. Everyone always knew when it was cinnamon roll day. For this reason, and more, the cafeteria ladies held a special place in my heart.

Miss Ruby worked her entire adult life as a cafeteria cook; she was one of the vaunted ladies entrusted with the secrets to making my only vice come to life. I generally carried my lunch to school but it didn't stop me from coveting the "fruits of her hard labors." I might have sold my soul to the devil for one of those rolls; as it is, I had to settle for potato chips as my only bargaining tool.

I don't know what brought Miss Ruby to GVM. I only know that one of my brothers immediately fell under her spell. It wasn't until I found out what she had done for a living that my interest was truly piqued; I decided I would do almost anything to gain access to her secrets.

I can write that she is almost 100 years of age, nearly blind, and has a wicked sweet tooth. My brother began to spoil Miss Ruby and a gaggle of her lady friends early on by bringing Tootsie Roll Pops almost everyday. It got so bad after a while that one of them would invariably lose her manners by blurting out, "What have you got for us today."

I honestly am not sure if Miss Ruby actually eats Tootsie Roll Pops -- or sells them on the black market. I am justified in writing that because the basket of her walker always has the look of a porcupine for all the Tootsie Roll Pops that stick out of it. I always ask if she has any left, to which she softly replies, "No, I don't think so." When I point out evidence to the contrary she expresses surprised innocence; I choose to believe she is a very cunning actress. She is also irresistible.

She is extremely proud of her days as a cafeteria cook and also speaks quite fondly of her myriad students; she is one of the lucky people who truly loved her work. Yes, she does have the secret recipe for those cinnamon rolls but always insists she doesn't know exactly where she stashed it. She is wickedly cunning. I make a mental note to push harder the next time or to corner one of her unsuspecting relatives.

An amazing woman; soft spoken, kind, reflective, funny, and adorable. She loves to talk.

Sadly, just shy of her 100th Birthday, Ruby died in the comfort of her own bed on July 5, 2009.

That afternoon was unsettling for me; I was pensive. I later looked around the nursing home and noticed nothing seemed to have changed; clocks were ticking, residents were eating their meals, and medications were being passed.

I have been around medicine long enough to know better but still the question surfaces. Why doesn't the world quake or stop when a life is taken? Why aren't we forced to stop and immediately take stock of a life lived and lost?

And then -- in the same moment -- my revery ended as I remembered that I had been asked to find someone to address a problem for Mom. This is what happens -- life happens.

That evening I walked down Ruby's hall and noticed her personal effects were still in the room -- as if she wasn't gone. In a corner stood her walker. And there they were -- jutting out of the basket were two sticks from those Tootsie Roll Pops. I couldn't help but smile.

I keep imagining her as the cafeteria lady from my childhood. The thousands of greetings she must have received over the years!

Hello, Miss Ruby!

Even though I never did get that recipe, I know I am a better person simply for having known her.

The sweet smell of yeast breads baking will forever return me to memories of Mrs. Hanlin and the halcyon days of my youth. It will now also bring me back to these days at GVM, when I came to know one of the cafeteria ladies who once held a secret key to my heart.

Goodbye, Miss Ruby!

Making Friends

Bertha W

It's hard enough dealing with the reality of seeing your own Mother living in a place such as this – a “long term care facility;” there is, afterall, only so much worry a person can assume.

Most of us set out to shower all our love and attention on Mom, but soon discovered there was also another insidious process at work – one that seemed to have a will of its own. Suddenly, we found ourselves taking on much more than we could have imagined.

It started with polite hellos in passing, later moving on to surface level banter. Depending upon personalities, it might very well have ended there. We were, after all, made up differently and there were so many factors at play. To my way of thinking, there was no right or wrong ~ people just needed to allow their personalities to carry them.

A few members of our family are prone to reaching out. It might simply have been that we are “people persons,” but I believe there was much more going on than this. There is a real need in this environment ~ beyond simple niceties ~ to share with others who are walking the same path. Even as members of our family moved in and out of this environment, spending as much time as possible with Mom, some of us came to be on a first-name basis with many residents and family members alike. This wasn't a conscious process – it simply happened.

I long ago came to the conclusion this may very well have constituted a coping mechanism. If we were to constantly dwell solely on Mother’s concerns it could have ~ and did at times ~ become overwhelming. Simplistically, I think there is often a process at work that “moves” some people to reach out; when people express an interest in someone or something else ~ putting aside our own selfish concerns for a moment ~ their own problems are somehow rendered less significant.

Whatever the silent motivation, some family members took to it with a passion. All of us ~ no matter how much time we spend at GVM ~ always return to the familiar faces of residents, family members, and staff. For someone who never wanted to step foot in any nursing home, I feel I have truly come a long way; I actually look forward to seeing many of these people ~ I am sincerely curious to know how they are doing or if there is anything new and exciting to share. To this end, we have all become an extended family of sorts. One of my brothers even knows the coffee tastes of some fifteen or more residents ~ whether they take sugar, cream, or thickener. There is comfort in this.

There is also, however, an extremely harsh reality ~ an unspoken but attendant risk ~ that comes with these relationships. Just as you form bonds with these residents and their families you are often dealt a sudden and bitter reminder:

As if ice water is being thrown on your face, you are taught ~ time and time again ~ most of your newfound friends have come to the nursing home to die.

"525,600 minutes"

July 7, 2008

I will never forget that day.

Mom was up early and dressed; she actually seemed to be excited. She didn’t understand.

I couldn’t do the work my brother’s were doing – it was impossible. I was a coward.

Instead, I opted to go with my cousin, Lou Ann, and sister-in-law, Linda, who had crafted plans to take Mom shoe shopping and then out to lunch. She didn’t understand.

We also took along the new cherry-red wheelchair Mother had been so excited to receive; it didn’t matter what it was -- it had been a gift from her “Sweetie.” The wheelchair had not yet become an essential fixture in her life; it was available. She didn’t understand.

We walked out of their home around 10:30 in the morning. She didn’t understand.

We shopped for shoes, and then went on to the Olive Garden sitting down for lunch. That is essentially all I did; I was not interested in food. The mood was somber; it was a wake of sorts. She didn’t understand.

At noon, as choreographed, after a few cell phone calls, we made our way to the van. I was physically ill by the thought of what was to come. I understood. Did I?

We drove past the boulevard leading to their home? Oh, my God! This is for real.

We drove another half-mile or so and then turned onto a property I had visited before in the final years of my Grandmother’s life. I remember thinking, again, “Oh, my God.” But Mom seemed fine; she was making plans and even a grocery list. She didn’t understand. Or did she? She had certainly spent more time here with her Mother than any of the rest of us; could those memories have faded as well?

My twin brother was in the circle drive – as planned; he was hurting – visibly -- but he was determined to do what was necessary for Mom. He was strong – or at least he acted the part. He understood.

We had arrived. Our life, as we knew it, changed in a moment.

I remember the sense of a weight seeming to push me back as we entered the doors; I didn’t want to be there under any circumstance. It was supposed to be for the best, right? I honestly did try to put on a brave face. It wasn’t easy.

Feeling numb and moving along unfamiliar hallways, I felt pulled – as if by some invisible rope – toward an uncertain reality; I was blindly following everyone’s lead.

Suddenly, there it was. Room 610. Worse was the card that hung beside the door which read, “Dorothy Scott.” I felt weak in the knees.

What my brother’s accomplished in the hours after we left the house that morning with Mom was miraculous. As if by magic, many of Mom’s favorite things had been transported to that room – it quite honestly already felt like a “home.” On seeing her favorite rocking chair, Mom took a seat with nary a complaint; she was alright. My brother’s had worked a miracle – at least from my point of view. By making this day – this transition -- easier for Mom, they had paved the way for the rest of us as well.

I was the weakest link in the chain that day. I had not prepared myself for this eventuality. Yes, it had been discussed over time but there was a part of me that had continued to push the thought aside for “another” day.

July 7, the day that had dawned just a few hours before, had brought more change than I could have imagined.

Before leaving the house with Mom that morning I had the opportunity to tell Bob what was on my mind. I assured him that while I was personally distraught by the blinding reality of the day, I didn’t want him to feel any guilt. Though my heart was breaking, I assured him that he was doing the right thing. He seemed strong but I suspect he was holding on by a thread.

Has it really been one year? It feels like a minute. It feels like a lifetime.

Mom understands. Mom doesn’t understand. It is all true.

One year.

“525,600 minutes … moments so dear … how do you measure, measure a year?”

“Seasons of Love” from the musical, “Rent.”

"Dr. Scott"

I was not old enough to understand, but I did.

I couldn't yet spell the word “cat” but instinctively knew what “divorce” meant. I was told it was for the best. I do remember the moment I first heard the word from my father; beyond that, I have no memories – good or bad. I was simply too young.

Mother met and later was remarried to a man named, “Dr. Scott.” That is how we were introduced.

He was very different from our own father in many respects. That was a fact; it wasn’t a good thing or a bad thing. They were simply two very different people.

The name stuck – an unfortunate thing for him. I can now imagine the pregnant pauses after friends were introduced to them as, “Mom and Dr. Scott.” Many years later he truly sat us down and asked that we quit the moniker, “Dr. Scott,” for something -- any other name of our choosing. For me, this was simply his name – no less so than Dorothy is Dorothy, Jeff is Jeff, or Max is Max. But for him, it was a title for work -- not to be used by family. Finally speaking to me about this “name problem” fifteen years after they married, I came to understand the embarrassment it may have caused them over time. But, I will have to admit that it wasn’t easy for me to change; I have often wondered what he would have done had I ultimately decided to call him, "Ralph?"

Bob, as most of us call him now, has been very good for Mom – and vice-versa. It had been said of the two of them that they don’t take a breath without first consulting each other. It had been a true partnership.

He has an abiding respect for Mother. They have given each other everything they ever needed or wanted. And, while their extended family has seemed important to them, it may very well be said that if a dire situation was foisted on them, they could easily be completely content alone – together -- in a world of their own.

They recently celebrated their wedding anniversary. It was bittersweet.

They are now both very different people than when they married, and Mother seems to be fading from him with every waking day. Being a private, quiet, and introspective man, I once decided to brave asking him how it must feel for him to watch Mom – his partner for all these years -- suffer as she does. Quietly, he replied that he is slowly losing the one person in the world who means the most to him – the very person with whom he has now spent a veritable lifetime making decisions. He is now, figuratively, on his own.

Tomorrow, July 7, marks the one year anniversary of what was easily the most difficult decision ever made during their life together. A decision that certainly pertained to Mom – but one he had to make on his own.

Dementia

De-men-tia (di-men-shuh) - noun Psychiatry. Severe impairment or loss of intellectual capacity and personality integration, due to the loss of or damage to neurons in the brain.

Believe me when I write that Parkinson’s disease is a great offender. It makes victims of everyone it touches – patients and families, alike.

Studying Parkinson’s disease in medical school was basically a process. I learned what was required to pass my exams as well as gaining a baseline facility at recognizing the rudiments of diagnosis and treatment. It was assumed that I would probably not be required to know much more about the disease.

I could not have been more wrong.

In the years following her diagnosis, as we finally came to accept Parkinson’s as a permanent factor in Mom’s life, we were then asked to grapple with yet another unwelcome complication – the onset of dementia.

Technically, dementia is a condition which results in gradual loss of brain function; it presents with a decline in cognitive and intellectual function. In addition to memory loss, confusion, and problems with speech and understanding, dementia can also bring about changes in personality and behavior resulting in an increased reliance on others for daily activities.

It isn’t a disease so much as a constellation of symptoms which derives from a variety of causes.

Dementia only occurs in about 20% of Parkinson’s patients; in these patients, Parkinson’s disease Dementia (PDD) generally lags at least 10 to 15 years behind the original diagnosis of Parkinson’s.

Sure enough. As if on schedule, dementia gradually reared its ugly head in the tenth year or so following Mom's diagnosis.

Commonly voiced statement, “Oh, your Mother has OLDTIMERS!”

Once and for all: WRONG. Wrong on more than one level.

1. All dementia is NOT Alzheimer’s; conversely, all Alzheimer’s IS (a form of) dementia.

2. It is “ALZHEIMER’S,” not “OLDTIMERS.” (I wish I had a nickel .... )

Please understand that this attempt to describe dementia is not intended to be all encompassing; I am merely presenting an overview.

I have had a great deal of difficulty coming to terms with the fact that the Mother I know and love is slipping away in piecemeal fashion. The diminution of her physical and mental faculties in the last six months is staggering. A “good” day has now become relative; everyday has an element of “bad.”

This is our reality. For myself, I accept the facts, begrudgingly, but don’t ask me to like it.

Currently, Mom generally (and gratefully) seems to know who I am by sight when with her, but I have occasionally also been referred to as Billy, Mark, Jimmy, Ed, George, or, even Max – as in the dog.

I honestly do try very hard to find humor in moments like this -- without laughter I truly don’t know how I would survive.

When the laughter fades, however, there is generally a moment -- a pause followed by a “sigh” -- as I again remember that the laughter comes at an incalculable expense.

I miss the Mother I knew and love.

And, I also love the Mother who no longer fully knows me.

Mom's Favorite Joke

Mom has never been one to tell a lot of jokes but this is certainly the one exception that, in the end, always leaves her laughing and crying at once; it is all in the telling:

FREDDY, THE BIG-MOUTH FROG

There once was a BIG-MOUTH frog named Freddie who lived not far from here.

One day he decided to leave his pond and see the world.

On his journey he met any number of new and strange looking animals. And every time he came upon a new friend he would excitedly SHOUT with his BIG MOUTH WIDE OPEN using his LOUDEST, CROAKIEST voice:

"HELLO, I'M FREDDY THE BIG-MOUTH FROG! WHAT ARE YOU, AND WHAT DO YOU EAT?"

On his first day he met a four-legged, black and white animal with two horns;on asking his question the animal replied,

"I'm a cow, and I eat grass"

To which Freddy would always reply, "OHHH, IS THAT SO!?"

His adventures took him far and wide; after meeting the likes of mice eating eagles, and honey eating bears -- he eventually came upon a watery swamp.

There he happened on a long, green, slimy creature with huge jaws.

Happy to meet yet another new friend, Freddy BELLOWED:

"HELLO, I'M FREDDY, THE BIG-MOUTH FROG! WHAT ARE YOU, AND WHAT DO YOU EAT?"

At this, the watery beast inched closer, snapped his jaws and replied:

"I'm an Alligator, and I LOVE TO EAT BIG-MOUTH FROGS."

Freddy, the not-so-big mouth frog, gulped and in the tiniest of croaks replied:

“ohhh ... shit.”

Parkinson's Disease

A picture of Mom about the time she entered college; the trial of Parkinson's Disease had not yet entered her world.

Mother is little more than five feet tall (plus some change) and has been blessed to never experience problems with her weight; it was probably enough to anger a few of her friends. 

From what I know of her college days, she possessed a wicked sense of humor and had a tremendous zeal for life. She was in her glory days -- enjoying every moment. Life was very good.

It was after marrying our father as they worked to build a family that health issues emerged; she has almost never been free of these problems since. 

Her first major medical concern was precipitated by her small stature combined with the burdens brought on by child bearing; her back ultimately failed, forcing her to undergo numerous agonizing surgical procedures to bring about even a modicum of comfort; in all the years since she has suffered quietly with ongoing back problems. 

She was later diagnosed with what was thought to be Tuberculosis. The extent of her disease was so pronounced that her doctors were forced to perform extensive surgery -- certainly by today's standards -- to remove the diseased right lung. It was a monumental trial for her physically. 

As if this was not enough, she later suffered a head-on collision at the hands of a drunk driver -- driving on the wrong side of a bridge -- which further compounded her extensive back problems with a neck injury. 

In the mid-1990's, she began to demonstrate symptoms of neurological impairment: a shuffling gate, cramped writing, as well as a paucity of arm movement when walking. This led us to suspect the probable onset of Parkinson's Disease. Unfortunately, her doctor's took a few frustrating years to finally reach the same conclusion. Once appropriate therapy was initiated her symptoms improved. It was proving manageable. 

The problem with Parkinson's Disease is that it is progressive. Certain dopamine producing brain cells die resulting in less available dopamine necessary for proper body function. As the cells continue to die, you are forced to throw more and more of the "dopamine-like" drug(s) at the problem so as to achieve an adequate result. Unfortunately, just as the dopamine producing cells are fading, the receptors that feed on her medication also begin to diminish in number. It is a losing proposition. 

On average, patients with Parkinson's live anywhere from 15 to 25 years; Mom is well into 15 plus years. She is not on the winning side of these averages; Mom's health has declined precipitously in the last year alone. 

Nature has a curious way of balancing everything. Mom has been blessed in so many ways throughout her life; it seems the price for all the good may have been at the expense of her health over time. Yet even as she has endured a great many medical issues over the course of her long life, I have honestly never heard her bemoan these problems -- current or past.

I wish I could write that the litany of her medical concerns ends here. In the last two to three years, a form of Dementia has altered her life with a vengeance.

She may not be one to complain, but I, for one, have been left wanting to shout, "Enough."

Max

I never considered a Sheltie for a pet; we had always had Golden Retrievers, Beagles, German Shepherds, and any number of mutts.

Only once did I amend my own rigid "dog" list after coming to know and love the most fierce, blind Yorkie a person could ever meet.

But a Sheltie? Wasn't on my radar.

Well, my Mother and Stepfather really didn't much care what any of us thought back in the early days of 2005 when they adopted a Sheltie named, Max.

He had a troubled history with owners; Max was fine -- his owners were NOT. At the hands of these people he had apparently suffered from emotional abuse; he had been isolated for long periods of time -- as a result he was not well socialized.

Our parents fell for him at first glance; he apparently cleaned up well.

They took him home for a trial period. I believe the first thing he did on entering the house was "pee" on some furniture. After that, I am told all he did was stare at the front door apparently waiting to "go home." It is sad to think he may have preferred the life he knew with some abusive owners in his past rather than making an effort to bond with people who would give him a very good life.

I met the dog two months into their courtship; by this time Max had made serious inroads adapting to his new life. He had come to believe in and to trust the two of them -- he was, however, not going to tolerate anyone else being added to HIS mix.

When they picked me up at the airport, Mom was seated -- strategically -- in the back seat alone with Max. He was having NONE of this odd looking stranger. I have never endured such an intense silent interrogation; unflinching coal black eyes daring me to make a single move or to utter even a monosyllable.

Most dog people have rarely met a dog they don't like. Well, I had that day -- I honestly wanted no part of him, either.

The picture of the two of them on that couch seems sweet -- if not posed. But is wasn't. This is the position he assumed every time I came anywhere near my Mother. Whenever I dared to move closer, his mouth assumed a menacing snarl.

I had never met a dog like Max. But, I was also equally determined to win him over.

With time his defenses wore thin; he came to gradually accept the strange people called "family" who continued to move into and out of their life -- with no adjustment required of him other than accepting a great deal more attention -- and snacks.

He eventually became more of a people person -- er, dog.

Best is that he became Mother's second shadow; she could go nowhere without him following her every move. And as Mother became increasingly ill, he gladly took on the added role as her "nurse." He had become completely devoted to her.

I remember one night when an agency nurse was not available; another brother and I were in town so we took on the role of caring for Mom overnight while our stepfather attempted to get some much needed rest. I was asleep in the greatroom when I was awakened by the touch of something cold on my face; Max had become concerned for Mom and sought out my help -- he nudged me with his wet, cold nose so as to get me to my feet. Mom had truly needed assistance.

So it is that I came to love Max. He, too, has learned that the boundaries of love are not limited to the three of them -- we all share in a love for him which makes his life even better.

Max and the rest of us have gone through alot together; we are all intent on making Mom's life tolerable as her illness progresses. And now I actually savor every opportunity to look into his warm dark eyes and revel in his happy bucktoothed smile.

Nursing Notes Excerpt

Wednesday, June 17, 2009 10:00 pm

Dorothy asked me to move her up in the bed because her halo was tilted --
funny :)