Juggling Old Ladies, Pt II

For those of you following our mini-saga, a quick update:

Audrey is looking much brighter (see photographic evidence) and is regaining some strength: she has taken her first steps in over ten days. Doctors are still juggling the various antibiotics to best counteract ‘the infection’ whilst closely monitoring her kidney function via ultrasound tests. 

As for Ivy, we finally reached a point where we and the care team felt that it was no longer safe for her to remain at home alone. We had to get social services involved to find her an emergency respite place and after many phone calls we learned that she had got a place at the home she and Audrey spent time in in January this year. Cue sighs of relief all round.

Audrey had obviously been doing a lot of thinking while she’s been in hospital and has decided that perhaps the time has come for her to be ‘cared for’ too. Although privately we had been thinking this we had expected a bit of a battle in persuading mum that this might be the best route for her. Imagine our shock when she put forward the suggestion herself —.

Early days yet but we are trying to stay and think positive.

Juggling Old Ladies

That’s what it feels like at the moment.

Ten days ago MiL was admitted to hospital with suspected severe cellulitis. It turned out to be an infection in the replacement knee joint which she had fitted last October. After the operation to ‘wash out’ the joint (a benign term but by no means straightforward. I wouldn’t want to put you off your dinner so won’t go into details here) she was to go to the HDU : High Dependency Unit ‘as a precaution’. As it turned out she spent the entire weekend on HDU for reasons/s unknown. It scarcely mattered to mum because she was either asleep or confused almost the entire time she was there. When she eventually ‘came round’ after 3 nights on the unit she couldn’t understand why she wasn’t on an ordinary ward and we were not informed enough to tell her.

It was on HDU that we first heard the word ‘sepsis‘. In addition, the staff nurse on her pre-op ward had already expressed concern about mum’s ‘kidney function’. This was mentioned again on HDU as well as the fact that the intravenous antibiotics being used to treat the sepsis would likely cause further kidney damage. All very worrying. Since then, however, none of these things have been mentioned. Doctors on the geriatric ward have been trying to find the right antibiotics to treat ‘the infection’ and believe they are ‘getting on top of it.’

Mum’s confusion has lessened to the extent where she is all-too-aware of what is going on around her. She is concerned about her weakened state (she has after all spent a week completely bed-bound) and about the state of her legs: they have taken the brunt of ‘the infection’. And these were not ‘good’ legs to begin with. Her right leg in particular has taken several hits in the last two years: a leg ulcer on her calf eventually required surgery; once that was healed she was able to have her replacement knee joint revision surgery in October 2014 (hospitalised 6 days); 11 days after leaving hospital she fell and fractured her tibia (hospitalised 17 days); and on 2nd January this year she broke the same tibia after yet another fall (hospitalised 7 days).

After returning home from hospital in January she was at home for a week before her GP recognised that she and Aunty were not coping and arranged respite care in a nearby care home. After two weeks they were judged fit enough to return home. Although they had initially resisted the need to be ‘looked after’ mum was dismayed to be ‘kicked out’ and had even started asking us how much it might cost to stay.

Spring saw Aunty admitted to hospital with ‘an infection’ (pesky little blighters these infections, eh?). She also developed cellulitis and was discharged after 15 days. Now she is home alone the care workers who attend twice a day for half an hour are concerned about her. We are concerned about her. And mum is concerned about her. Aunty is no longer able to work out when to take her medications and what to take. She talks about feeling like her legs might give way beneath her. She is depressed and anxious because MiL is in hospital and none of us know when she will be coming home. But Aunty is resistant to returning to the care home: “I’ll be alright.” Will she? And if she isn’t? If she falls and ends up in hospital will we blame ourselves for not insisting that she goes into respite care?

We are juggling old ladies and it’s bloody tricky.

My Name is Denise and I Am A Control Freak

For almost two years I have been receiving automatically generated emails from Rightmove, the property website. Each one reveals a tantalising property or two in a custom-defined area of the Lake District capable (or potentially capable) of housing three generations of our family. We have cooed and what-iffed and demolished walls, converted garages and extended rooms in our imaginations.

This weekend brought with it the stark realisation that all of this forward thinking and planning and research may have been for nothing.

I had yet another confrontation with my mother-in-law who is in week two of a rehabilitation period. She is recovering slowly from a mid-shaft fracture of the tibia of a leg which had recently undergone replacement knee surgery for the second time. Does that make sense? Basically, at the moment, her right leg is knackered. And she is railing at the world, or more specifically, at me because, in her words, she just wants to be left alone. She is fed up with her lack of mobility, with being confined to the house, with ‘strangers’ coming in twice a day, with the mountain of Tena Lady pads in the garage and with me.

In the past my organisational skills have been praised to high heaven. She tells all the health professionals (and there have been many in the last four years) she comes into contact with that ‘my daughter-in-law deals with X’. And I do. Because she is not confident with finances, because she is unable to make a case for herself because she cannot hold the thread of an argument and because, frankly, sometimes she simply cannot see the bigger picture and makes appalling decisions (solar roof panels at the age of 80?)

Since returning from her most recent stay in hospital she has found my efforts intrusive, overbearing, controlling… She hasn’t said as much but that was the inference I drew following our most recent (and voluble) bust-up.

It was 11.45am and neither mum, nor her 94 year old aunt had eaten breakfast. She knows from the Intermediate Care Team – who are currently in charge of her reablement and rehabilitation – how important it is not to skip meals. Typical reasons given are “It’s been mayhem here” (translation: the carer has been) or “We’ve been busy.” Too ‘busy’ to eat? I am more concerned that Aunty is forced into this regime because she is unwilling to ‘rock the boat’. She goes along with everything my mother-in-law dictates because she just wants a quiet life. But she is 94 and everything has slowed down, including her bowels. Eating little and often would be good for her, but it is not to be. As a result she suffers from constipation in the upper bowel which leads to ‘leaks’ which she is unaware of until it is too late. She is a proud and very private lady and this loss of control is extremely upsetting for her.

Ironically the Tena Lady pads delivery was the next point of conflict. I checked the delivery against the delivery note and noticed that only 1 packet of pants had been delivered, rather than 20. When I pointed this out to mum she said it didn’t matter because she washed them anyway. These are disposable products for ease of use why would she want to hand-wash? Everyday tasks are difficult enough when you’re walking and standing with the aid of a Zimmer frame. “Well, that’s what the District Nurse told me to do!” Did she really?

We moved on to a discussion about the kitchen chair raisers added to lift the seat to make it easier for mum to get in and out of. We all agreed they were not the most attractive addition to the furniture. She then directed her aunt to sit in the adapted chair. When I said that this was the chair she herself should be using mum averred and said it didn’t matter because the Occupational Therapist would soon be bringing some more. “But you just said they were hideous!” “Well they’re quite useful actually.” I laughed. And she turned on me, wagging her finger in my face, “Don’t laugh.” I could tell as soon as I arrived that mum was not in a good mood and I should have turned around and walked straight back out.

And that was it. A couple of trivial incidents and one major bone of contention and I’m left seriously doubting our grand plans for multigenerational living. And with them, our future.

I can hold my hands up and admit that I am a control freak. I like lists, schedules, punctuality and routine. When faced with an unknown situation or new problem I will immediately turn to the internet and research so that I am informed and able to advocate accordingly. It has stood me in good stead until now. I spent the best part of 2012 lobbying for a place at residential college for our learning disabled son. And was successful. Now I fear failure.

I walk in to my mother-in-law’s home and see disorganisation and my stomach goes into knots. I dread what new scheme she may have agreed to during the course of a cold call or seeing yet another shoe box from the expensive mail order company. Shoes she will never wear because her feet are swollen and misshapen. And I think about Atul Gawande‘s book Being Mortal and realise that I need to let go. I need to let her rail and make mistakes and go about things in her own sweet way. Because she is 83 years old and she is not going to change. I have to take a step back (several steps?) and become less involved (interfering?) and only then will the tension subside.

My husband is an only child. His father died over the course of a week in August 2007. I was there, with my mother-in-law, throughout. When I was left alone with him I held my father-in-law’s hand and told him not to worry, that we would look after mum. And I stand by that promise. We must look after her (as much as she will allow us to). But perhaps, despite all our plans, it cannot be in the same house after all?

I Am Sandwich Woman

1964: Child, Mother, Grandmothers and Great-Grandmother

And by that I mean, I’m not just fond of a bacon butty (which I most certainly am), I am becoming part of the so-called ‘sandwich generation’: “those who are simultaneously providing care, including financial support, to younger and older generations at the same time.” It is also a nod to Allison Pearson’s column about the fictional character Kate Reddy who finds herself torn between the needs of children and parents.

Women like my mother aimed to be married by the age of 21. Any older and you were in danger of being ‘left on the shelf’. Invariably babies soon followed. So it was with both of our mothers. By the time they were forty their offspring were leaving home for first jobs or university. When I was forty my children were aged 10 and 7. When my husband was forty our eldest child wasn’t even a twinkle in his father’s eye.

Like many couples we now have children who, although they are of college age, are still dependent on us to varying degrees. In DD’s case she still needs us to ferry her about to social engagements, while H may never be wholly independent  (he is learning disabled). At the same time our parents are becoming ever-more-reliant on our help and advice.

These, then, are our sandwich years: sandwiched between children and parents. Not for us the responsibility-free years enjoyed by our parents, who, from the age of 45 onwards only had themselves to please. These were (literally) their carefree (care-free) years.

Once or twice DD has said that she intends to have her children while she is “still young.” My initial reaction was to throw up my hands in horror. But she probably has the right idea. By the time she is my age (50) we, her parents, will be 83 and 94 if we are (un)lucky enough to live so long. In addition, she may also have the added responsibility of caring for her brother. So it would seem we are bringing up the next generation of sandwich carers.

Since 2010 we have been ‘keeping an eye on’ my husband’s mum and her aunt who live together in a nearby market town. They are both fiercely independent, capable, house-proud, northern women. Auntie has been widowed for thirty years and as such has learned to fend for herself. MiL (mother-in-law) was widowed in 2007 and has found it difficult adjusting to being the sole decision-maker.

For the time being our caring is a juggled, from-a-distance affair. This coming Thursday we will take MiL into hospital for a(nother) knee replacement operation. Then OH will pick H up from college for the half-term break. And finally I will take DD to stay with Auntie so that she doesn’t have to go into respite care whilst MiL is in hospital. Like I said, juggling.

Keep your fingers crossed that all goes to plan x