Epilogue...
Six days after the fall, my mom was well enough to have her hip repaired. Apparently the device they put in doesn't require the bone to grow back to work. With the hip repaired, the hospital is trying to figure out how to get her discharged. My sister, who is an RN by trade, works at a hospital about 90 miles away, and would like to have her sent to their rehabilitation center. This hospital is not that familiar with it, and would like to send her to a local rehab center. Mom's not recovering from the surgery very quickly, which slows down the need to figure out where she is to go. Finally, my sister and the case worker settle on sending her to the one near my sister's employer.
Mom's recovery is not going well. She can't really eat, can't get out of bed, and physical therapy can barely get her to do anything. This is a problem, because the rehab center she is scheduled to go to has a very aggressive physical therapy program, and only accepts patients who can benefit from this, so we're back to square one, 10 days after the fall. It's Mother's Day weekend, and I go down for a visit. On Saturday, I stop by to see her, she's weak but lucid. The breathing tube that was inserted during surgery has damaged her voice, and she's very hard to hear. On Sunday, her voice is better, and we have a very nice Mother's Day. Her voice is better, she's a little less fatigued, and we have conversations on all sorts of topics. My sister has located a rehab center not too far from her house, and we're planning on getting Mom out of the hospital on Monday.
Monday comes along, and I'm at the hospital at 6:30 AM. I want to speak to the doctor and I can't predict when he'll be there, so I start early and make sure the staff knows I want to talk to him. I stay out in the waiting area until around 7:30, as my mother is not an early riser. I do see her nurse and she tells me that my mother is quite confused this morning, so I go in to visit her. She doesn't know who I am, doesn't know where she is or why she's there. I tell her she's in the hospital, she's broken her hip, and that we were going to get her out and move her to a rehab center. At various times, she asks me if she's in Hell, if she's being punished, or if she had died. She also starts asking if she can get rid of the IV. Not too much longer after that, she starts telling everyone to "go away". That includes me, the nurses, the people from food services, and ultimately, the doctor. I stay out of her room.
The doctor rolls in about 11:30, tells me he thinks she can recover from this, that she needs to go to a rehab center because she will need 24 hour care, and that she could be discharged with either physical therapy or hospice orders. He's not her regular physician, and isn't that aware of her other infirmities, which included diagnoses for aortic stenosis, congestive heart failure, COPD, and most insidious, gastroesophageal reflux disease (GERD), which most people think of as heartburn. In her case, it greatly restricts what and how much she can eat and drink. I'm still skeptical that she can recover from this, but she certainly deserves a chance, so we get her packaged up to send to the rehab center near my sister's house. Since it's out of the county she's currently in, I get to pay the $1200 it costs to move her 70 miles, but it's well worth it to get her close to one of us. It's getting towards evening, so I go in to see her one last time before she's transported. I ask her if she knows who I am, and she calls me by my name. I explain where she's going and why, and that my sister will be by tomorrow to see her, I tell her I love her, and she tells me, "I love you, go away".
It's been two weeks since she fell. I still have a job and family, so I head home. My sister goes to visit her the next day. Mom recognizes her and is quite cordial. The staff at the rehab center had gotten her out of bed and taking a few assisted steps. For the first few days there, she goes back and forth between thinking she can recover from this and go back to assisted living, and wanting to be admitted to hospice care. During that time my sister and I came to the conclusion that if she were going to go back to assisted living, we'd insist that she move to one that was near to one of us, so I plan on coming down on a Sunday to visit her, then on Monday morning move all her possessions out of her ALF apartment into a storage unit near my sister's. It's been slightly less than three weeks since the fall, and she looks a little thinner and a little weaker than when she left the hospital. I think the attempts to get her back on her feet have depleted what energy reserves she had, and she seems to have given up, as she describes her living situation as "the pits". After visiting, I check into a motel, get up the next morning, load a truck with her possessions, move them to a storage unit, return the truck, and on the way home get into the car accident described here:
https://www.pilotsofamerica.com/com...-highway-crash-takes-so-long-to-clear.103561/.
The weekend after that is Memorial Day, and we have a vacation scheduled in the Florida Keys. Since she lives on the way, we'd always planned to stop and visit, this time the entire family. I have to warn my daughters that their grandmother is most likely dying, much as they saw both of my wife's parents die a few years previous. She looks smaller, thinner, and weaker than the week before, and we only stay a half hour as we are wearing her out. At this point it's obvious to both me and my sister that she's not going back to assisted living, so we try to figure out which one of our homes she can move into. My house is bigger and there are more people there to help care for her, but it's 400 miles away, and I don't know that she can make that trip in any method of travel. My sister is able to arrange a leave of absence from her RN job, so she starts the wheels in motion to get Mom into her home. On the Friday after that, Mom moves into my sister's house. The next day we arrive home from our vacation.
At six weeks after the fall, my mother was accepted into hospice, just three days after my sister got her home. I'd planned on going down for a visit that weekend, but on the Thursday before that at about 4PM, I got a call from my sister saying I should come down now. I tell her I will leave early Friday morning, and I start making mental plans for a 5 AM departure the next day. I get a call back from my sister, telling me that I should leave tonight. A social worker from hospice told her that she didn't think Mom had long to live. She was already unresponsive and her breathing was labored. I head home, make yet another motel reservation, pack some clothes and head out. I check into my motel at 12:30 AM and get to my sister's around 1. Mom is still alive, but is still unresponsive and her breathing is what medical folks describe as agonal. A long time friend of my mother's is there as well, and they've been watching over her, and administering pain medication as it appears to be needed. I stay until 3, then head back to the motel for a few hours sleep. The following afternoon at 4 PM my mother stops breathing, with myself, my sister, and my mother's friend in attendance.
For anyone who is facing or will be facing this situation, the best advice I can give is you is to deal with each occurrence as it happens and don't try to make longer term plans. You're going to be reacting to what happens as it happens, there's no point in researching what to do three steps later. I was thinking the best thing to do would be to move Mom to my house, but there's no realistic way to make that happen short of an air ambulance. The other thing that comes to mind is that any medical professionals that have not had a long term relationship with the patient tend to be relentlessly optimistic even when they shouldn't be. My mother had been eating and drinking very little in the previous few months, and after 10 days in the hospital where she may have consumed 1000 calories in total, she just didn't have the metabolism to come back from something like this. Not that you shouldn't try to see what the patient can do, but at some point you have to step back and recognize that there's not that much you can do for someone who is that old (86) and has that many ailments. Also, distance counts, your loved one will require too much attention to be far away from everyone who can care for him/her. With my inlaws, my brother in law was five minutes from them and my wife and I were 25 minutes. When Mom was an hour and a half from my sister's, it was too draining on her to spend three plus hours a day in the car.
