Tuesday, December 09, 2008

A Strange Step

Yesterday was my day off, and I spent some of it driving around, enjoying a lovely mild day and gas at $1.45.

I found myself in Georgetown, and decided to go to the Goodwill and see if they had anything I couldn't resist. They didn't, but as I was coming out of the store, I stepped over the spot where Addy fell in October of 2002, starting the downhill spiral that ended with her death the following February.

They have put in a step.

Seeing the spot filled me with a lot of guilt. I wish I could have caught her when I saw that she was starting to step off the sidewalk. I hesitated because the only appendage I could have grabbed was the elbow she had dislocated a few months before. While I way trying to get in front of her so I could get a better place to hold on, she listed the other way, and down she went. I wish I had made her stay down on the ground and called 911, but there were helpful people around, and she insisted on getting up. She was on her feet and in the car before I could lay hands on her phone. I didn't have a cell phone at that time, not having felt the need. She asked to be taken home and so I did, and tucked her into bed. She had a doctor's appointment the next day, anyway, so I figured he would look at it then.

The fact that a person could break a hip, and get up and go on as it were just a bruise never even occurred to me.

She phoned Jim in the middle of the night, saying she was hurting, and could we take her in to the ER.

Of course we did, and, sure enough, the Xray told the tale.

They did a partial hip replacement, consisting of the ball joint and a rod that went down her leg, parallel to her femur. She went into residential rehab, which was an old folks home that had physical therapists on staff. She was there for about a month, until she fell, and that steel rod broke her femur. So she was back in the hospital for more surgery, and on to a different residential rehab.

By Thanksgiving, she had run out of hospital days for that quarter (or whatever) on her medical insurance, so they sent her home to us. Visiting nurses came for a couple of weeks, and then she was left to my uncertain nursing skills. A neglected nick on her big toe festered and became gangrenous, and nobody told me. I didn't know it was an issue. She had a sore on her heel that was raw and oozing, and that I was taught how to treat. Lord knows, I did my best with the information I had.

Meanwhile, we had a baby monitor in her room, and the other end of it tucked under my pillow so that I could get up for her without waking Jim.

The night (a few days after Christmas) she woke up, screaming, and couldn't tell us what was wrong, I realized she was running a fever and we took her back to the hospital. She had pneumonia.

She never came home again. New Years Eve, Jim had to sign papers for the docs to amputate "part of her foot" because of the gangrene in her toe. While in the OR, they decided to take off her entire foot, and a few inches up her leg, to the place where she had already had surgery due to her poor circulation.

A few days after that, she was schlepped off to yet another residential rehab but the stump was not healing at all. In fact, it was getting awful. I looked at it when they were changing her dressings, and wished I hadn't. A bedsore on her tailbone was starting to look like the one she had had on her heel.

On Valentine's day we took her out to Johnny Carino's for dinner. The next day, when I arrived to take her to her doctor's appointment, she was asleep at a table in the commons area of the facility. That was so unlike her that I called ahead to the surgeon with whom we had the appointment, and he got hold of her internist, who said take her to the ER. Sure enough, her many medications had got out of balance, and she was in trouble.

Back in the hospital, Jim had to sign another paper for a further amputation, this time to just below her knee. That refused to heal just like the first one.

They wanted to do a further amputation.

By now, she had few really lucid moments. Between the pain and the morphine, she was pretty crazy most of the time.

I sort of channeled her, and took the war to the doctors, demanding to know exactly what the prognosis was. I wanted to know if (as she thought) she was going to heal enough to be rehabbed into a prosthetic and back on her feet for hours of the antique shopping she loved. The answer, as I had feared, was "No." I told Jim. He advised that they needed to pick a lucid moment and tell her. They did. She nodded and nodded, and when they left, she looked at me with a vestige of her normal spunk and said, "Now, we're going to fight this thing!" I answered, "Addy, with what? You've been fighting since October."

I still feel badly about saying that. I just didn't think that she would want to live, bedridden, in pain, without being able to do any of the things she had always loved.

She had cataracts in one eye and macular degeneration in the other and was legally blind. She had a tremor in her right hand that prevented her from doing almost everything, including steering her new $5K power wheelchair.

I hope she didn't think I said that because I didn't want to look after her. I would have looked after her forever if she was enjoying life.

I've already written somewhere about the hospice experience, such as it was. Suffice it to say that poor communication and an inexperienced volunteer soured me on the hospice organization the hospital brought in.

It was Saturday when Addy decided to let go, and Monday at dawn, in the middle of an ice storm, when she did.

Less than five months from that first fall until she died.

I've got to quit going to that Goodwill.

10 comments:

  1. Compassion. You are a woman with an amazing heart. It's painful to read of this experience but helpful. It's a topic we may all like to stay in denial about or bury. I'm glad you have the capacity to write so eloquently and honestly about such an emotional thing.

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  2. Death sucks. I don't want to do it, witness it, feel the pain of it or acknowlede it. Dammit. Wish we had that choice. Thanks for being there for Addy, everyone deserves that kind of care at the end of thier life.

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  3. Ugh, reminds me of a story of my grandfather. I dont know why they just cant amputate far enough up from the start.

    He got the gangrene too with his diabetes, and they took a little off at a time. All in all before he died he had 6 amputations and no legs. I DO believe if they had cut further up the first times on both legs that it wouldnt have been so bad.

    I dont blame you for your reaction at all. I certainly wouldnt want to have lived like that, and I am sure she is grateful to you about the care that you gave her! Her tripping was not your fault.

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  4. My issue was with the fact that her orthopedic surgeon was willing t keep on cutting, even though he knew it would not heal, as long as her insurance would pay. She had very good insurance, and it would keep paying for a long time.

    Why do only one surgery when you can get paid for three?

    He internist had to know that it would not get better, and yet he went along, rubber stamping everything the surgeon did.

    Jim said that one of the hardest things he ever did was sign the papers for the first amputation, and another was refusing to sign for the last one.

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  5. Our problem was that they didnt cut far enough up. Maybe for the same reason, but I REALLY hope that doctors could not be that evil. They werent going to be getting around anymore anyway. Make sure you get it all.

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  6. I am sure not all of them are. And I don't really think Addy's doctor was "evil." I think it's just that medicine has become a business.

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  7. That is such an emotional story, Ronni. I didn't know so thanks for sharing.

    A very tough generation, never wanting to be a "bother".

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  8. Ronni:

    As a Nurse Practitioner of many years, I am impressed with your compassion and stamina with what is absolutely a terribly complicated joint replacement. You did a great job--against all odds.

    Congrats on sticking it out--it sounds like nothing but a miracle would have changed the outcome.

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  9. It's so sad to see someone go downhill so quickly. You took wonderful care of her, and I'm sure she appreciated it.

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  10. OMG,You brought up so many memories of what we just went through with my Aunt,the place she was in was horrible to her and there was NOTHING I could do, I talked to my cousins till I was blue in the face, I still have nightmares about it. As for gangrene,Eric's Grandmother almost had to have her foot amputated,but somehow they took viens and rerouted stuff so that blood started circulating in her foot again,she is 90 and doing great now! all she is going to lose is one toe that they wont amputate,they said it will just dry up and fall off! EWWWWW! sorry,didn't mean to be gross.
    I'm so sorry for what you had to go through,but you stuck it out,did your best, that's all anyone can do.

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