Mom & Me Three Archive

...the urge struck me to do a little posting over at Caring. About Food.. I just published the recipe for My Version of Hidden Valley Ranch Dressing over there a minute ago. I might wander back there and publish the recipe (also an original) of the Raspberry Maple Sauce that goes so well over cheesecake, among other desserts I can imagine.
    It continues to snow with occasional thunder. The snow is wetter as the day continues so as it snows we lose snow cover. Fortunately it is still Christmas card breathtaking
    I haven't mentioned Dad yet. I've simply forgotten.
    Later.

    The Christmas card in the middle of which we live is being painted, as I write, by a Jackson Pollack sky god. It began before I awoke.
    Snow all day today. I'm not sure whether that means my mother will sleep in or awaken early. I know, either way, she'll be thrilled with the results of our mini snow storm.
    The snow is falling straight down in small clumps. It's a wet snow; I can tell because as the tree branches fill with snow they are dropping snow.
    Prescott hosts a peculiar native bird, tiny, gray-brown like a sparrow with a top hat like a cardinal and a plentiful down undercoat that makes the bird appear like a butterball when it's cold. This bird goes apeshit in the snow. Groups of them burrow beneath branches of low branched bushes, squawk their plans then head out to harvest the berries that the other bigger birds eat only when it's not snowing. They are active only on the coldest side of the house, the southeast, which also has the most branch cover. I can hear them twirping now. I believe it was they who awoke me before dawn.
    My coffee tastes especially good this morning. I'm neither anticipating my mother's late awakening nor poised precariously against the possibility of an early awakening. Whatever she does is fine with me.
    Today is day two of my mother's UTI (which may be the same one as before) and administering Levaquin 250 mg x 1/day.
    I think I'll take her blood sugar this morning, since we polished off that ice cream last night. That's the last of the formal sweets. If she gets desperate I could do what she did for one of my nephews once when he was in the throes of a sweet fit and Grandma didn't have anything prepared. Nah...if we do sugar today, we do sugar. If not, we don't.
    Later.

...has occasional thoughts, especially on days like today, if her awareness is courted toward the day's significance, such as, "You know, damn him! He should have made more of an effort to stay healthy and stay around. You hear that?!?"
    I don't share those thoughts but I've continued my relationship with him through sunsets, the weather, curious natural phenomena, my hands, which I've noticed, over the years, are his...
    But, I know my mother is still capable of anger and feeling that he squandered all their plans in a damn bottle. He did squander their plans. In a bottle of alcohol. No buts about it. She traveled after he died, she traveled a lot before he died; but not nearly as much as she would have if "they" had followed their original plan.
    She used to say that she loved the farm and was sorry they sold it. Lately we were remembering residences. When the farm came up she decided she was glad "that fiasco ended". I was surprised but didn't question her...it didn't fit into the conversation.

    If he'd lived, he would be 88 today, which means it's been almost 20 years since he died.
    I will probably, as I can, turn today toward a Remembering Dad Day. I know we'll both enjoy this. The weather, I think, will cooperate. He loved storms. Remembering him today while it storms away will allow my mother to enjoy the storm. If we're lucky, if his spirit is moving over the fronts and currents, we'll get more snow than rain.
    I'll try to remember to do some baking while she's up. No errands to run, everything's done, so we can stay home and snug, today.

...lab test results for the draw taken on 1/21/05 are up. The results exhibit a hint of 'better' than her last results in September of 2004.
    There was an extended end to the playlet I published on 1/26/05 about getting copies of test results from our local lab. So, today's Friday, the lab is within our main zip code, forchrissakes, how long does it take for 1 page mailed on a Wednesday to travel 3 miles to our house? I call the lab.
    "Oh, yes m'am. We mailed that out on January 24th."
    "Hmmm...well, considering that I didn't call until January 26th, I certainly should have had 'it' by now. What, exactly, was sent out on Monday, and to whom?"
    "We don't have a record of that, m'am. It just shows 'Hudson' and 'send'."
    "Could it have been a fax?"
    "Yes."
    "Okay." I go through a repetition of Wednesday's story, replete with names and times of day. "I haven't received a copy of the lab test results. Has anything been sent out under 'Hudson' since about three o'clock Wednesday?"
    "No m'am."
    "Okay. What time does the lab close, today?"
    "5:30."
    "What if I just show up with my mother's card, my ID, and pick up a copy?"
    "Sure!"
    When I arrived, my mother's copy was taped up on the wall, I asked for it, offered ID and POA's, all of which were refused, and was on my way in about a minute and a half.
    I truly believe that the more stringent HIPPA regulations are not in place just to protect our medical information from intruders, but I think the bureaucracy is also designed to make timely access to medical records harder for patients so they don't develop enough of an interest to seek out information and make decisions in cooperation with but independent of doctors.

    Mom has spent most of the day sleeping, but, then, I did little better. Despite awakening very early this morning, I sacked out with my nausea from 0900 or so until 1420. I was surprised that Mom "took a nap" between 1630 and 1800 or so but I didn't stop her. I had a day piled on me that I had to negotiate. When I don't spread my chores out throughout the day it surprises me how much time they take at a clip.
    No, I don't think my nausea was related to Mom's nausea on the evening of the 24th.
    Later.

    About 0900 this morning I felt suddenly nauseated. The whole bit, including a violent regurgitation of my much 0630 breakfast of two pieces of toasted multi-grain bread with butter and Cinnamon and an unusually small and light cup of coffee (for me...but, my stomach had already been sending signals and at about 0815 I took a Zantac, just to settle it).
    Mom wasn't up and I wasn't into getting her up so I dragged a futon, pillow and blanket in Mom's room and dozed on her floor, continuing to feel pretty nauseated, from about 0930 until she awoke me, much to my surprise, at 1420. I guess I zonked out.
    I was feeling better, able, at least, to stay on my feet while bathing her, prepare breakfast, do all the stuff I normally do some hours earlier than today. She, though, was bleeding from the urinary tract, obviously another UTI.
    She was eating by 1530. I was on my way to the pharmacy to have the Rx for Levaquin filled and stop by the lab to pick up a copy of the lab results that they still hadn't sent. Interesting, it seems that the FNP wrote the Rx directions for 250 mg/1/day x 10 but the quantity was written for 14. The pharmacist speculated that the extra four are to get her started again, should the pharmacy be closed for some reason or unable to fill the Rx the same day its ordered. Apparently this is a fairly common practice. Bless, I say, bless that FNP once again, please.
    "She'll have more UTI's now."
    I guess so. And, frankly, I think Levaquin is the only antibiotic that does the trick for her. So, I'm hoping that we won't have to renew this prescription for awhile.
    Mom has been thrilled with the extra sleep and is, in fact, back in for a "nap" as I write. I am becoming less uneasy about her naps, which is not the same as saying I am becoming easier with her naps. It's just that, well, now I know. Now I know.
    Today was clear and warm, what I saw of it. The morning was crisp. That I remember. We're supposed to get two days of rain/snow mix, maybe some sleet (I finally identified sleet this year, we had some a couple of weeks ago). I hope we do. That'll make for a nice weekend. I might bake. I've got chicken and lots of vegetables...maybe a stock of chicken pot pies.
    I have no idea what caused me to be so ill this morning. It was weird for Mom. She even mentioned that she "couldn't remember the last time" I was sick. I did. It was in the fall of 1998 when I contracted the flu while our house was being painted. I ended up in the ER. At that time my mother drove. Three quarters of a year later I got blood poisoning from a cat bite (not one of ours). My mother was no longer driving. I was not out of commission, though, with the blood poisoning. I'd had it once before, recognized it immediately, spent a couple hours being given intravenous antibiotics in the hospital and was released. I remember, while I was sleeping whatever I had off, having fitful dreams about what would happen if I was out of commission.
    There wasn't any damage today that couldn't be repaired. Mom did marinate in her apparently infected urine for an unusual length of time (the Detrol hasn't yet kicked in at night). But, I was truly unable to be upright for a couple of hours, there.
    I was pleased that I instinctively decided to lay down in Mom's bedroom. That way, when she awoke, she'd have an inkling that things were a little different...and, as well, I'd awaken to her first rustlings. She was a little surprised to see me, but I was no less surprised that we both awoke at 1420.
    I noticed, last night, that her urine was cloudy so I wasn't really surprised to see the evidence of UTI today. I remembered something the FNP said about the Cipro and Augmentin not working before...that the Levaquin probably came along and swept "everything else" up, that it was the right antibiotic for Mom. I can remember many times thinking, and, I believe, vocalizing in this journal, that I do not, I repeat do not want her on multiple doses of antibiotics for the rest of her life. But, it seems, she might be on them more frequently than I'd like. The FNP gave me a thorough explanation of the physiology of the Ancient Urinary Tract: Including such factors as narrower bladder neck, so stuff gets caught up there; much less elastic urethra, which allows easier access to the environment; she did not disavow that the catheterizations are partially to blame. She did not tell me to stop cleaning her, but indicated that this will not stop urinary tract infections.
    Now, I know. Shaking head. Closing eyes. It is a relief to know.

...received the lab results from the local lab. Today is Friday. I hope they're in today's mail.

    Well, I did over at Mom's Daily Tests and Meds. Because I am taking significantly fewer stats, I include a bit more detail about her day over there than here. If you're a regular reader and pickings seem a bit slim over here, try the stats section. I try to remember to alert readers over here if I'm spending more time and detail over there. Consider yourself warned, for the time being.
    So, I'm up very early this morning, well, I don't know why, exactly. I believe I finally decided, "Ah, what the hell," at 0315 and decided to do some concerted research about the elderly and iron supplements, since it was mentioned by the FNP during our 1/24/05 appointment.
    It could be that she didn't know whether I was aware of the dearth of anxious information regarding the possibility of iron overdose and the elderly versus all the other possibilities due to Mom's ACD and CRF. I took this as a cue that there might be more information, but there isn't. Same old stuff. I am, I notice, becoming more comfortable with the acronyms now applied to my mother. My expectation is that using the analogous codes will allow my mother somewhat more leeway, insurance-wise, for evaluative and treatment options. The openended prescription for Levaquin that lasts for a year, for instance.
    In my mother's case, she has a history of bad reactions to iron supplements, too...through pregnancy. Iron supplements used to be standard. But these symptoms have not reappeared throughout her Ancient Iron Supplementation so I have to believe that the nominal rise in her hemoglobin when she is on exactly the type and daily dosage of supplements she is on now is better for her than allowing her to lag for 3 months, get a transfusion, lag for 3 months...especially considering all the health risks to other organs and systems on this yo-yo system.
    It is important to note, as well, because of these iron overdose concerns, I did let her lag in iron supplementation (although never completely stopped it) in the spring of last year. Cut her back to 18 mg Iron Protein Succinylate at lunch and dinner (kept her on the 150 mg Niferex in the morning) and frequently 'forgot' her lunch supplement. Before she quit smoking, in fact. This led to a 5.6 hemoglobin and a blood transfusion. And, her first catheterization.
    I'm noticing, this time around, the special comments about the stroke prone elderly. This information may have been there before when I began looking up information in the fall of 2002. There is some discussion as to whether excess iron (which many of the elderly exhibit) in conjunction with ACD, has anything to do with stroking, especially if the stroke occurred before the anemia, which is true in my mother's case. Anyway, my feeling is that with the increased blood vigilance, any problems will be noticed immediately and problem areas have already been noted.

    I think I may have almost got her out, yesterday, but it was cold, it rained some, always around the time I was discussing the impending and necessary trip to Costco, so she finally won out. I waited to embark on this chore trip until she laid down for a nap. I was gone 1.5 hours. She was up when I arrived home, sitting at the table, reading the new magazines I got her yesterday. She started when I walked in the kitchen. "Oh! I thought you were taking a nap!"
    I chuckled. "I wish I could take half the naps you imagine me taking, Mrs. Hudson!"
    "Oh! You went to the store!"
    "Did you want to go? You said you didn't."
    She looks out the window. It happens to be sleeting at that moment. "Absolutely not!"
    I can see she's thinking about it, though. Good sign. Besides, she brought something to my attention today that forebodes an early, early spring. Our much neglected/abused ornamental plum tree has already got buds on it. I've also noticed The Little Girl shedding profusely. Unusual this early. This does not, I should add, predict an unusually warm summer. Just the opposite happened, last year: Warmer winter, cool summer. Not that wet but I can imagine a wet summer this year. Maybe my mother is stirring early this year, as is the rest of this area. That would be nice. I'm ready to usher her out and about.

    A side observation: I'm not sure if the Detrol is working. I recall mention, at the official web site, that noticeable "changes in urinary frequency" should occur within 12 hours, although it can take up to 7 weeks to work to maximum effect. So far no change at night, although she is awakening herself in the middle of the night to pee. She just doesn't think to change her underwear and, anyway, I'm not sure she remembers where it is. The day changes could be attributed to the clearing of her UTI as well as the initiation of Detrol. She still needs paper underwear. 2 pairs when she's running, 3 pairs when she's down. Yesterday, though, she spent the entire day in the same two pairs and took herself to the bathroom frequently, "just to pee".
    We have a four week trial course. We'll know by then if it's helping. There was also mention of special caution when using with the elderly who exhibit symptoms of ACD and CRF (bingo), but not necessarily avoidance. Just heightened alertness. It can be tricky because, physically, my mother is, in some ways, not 87, not even close, considering her life. In other ways she is well past 87. A strong 87, all in all. I got the impression from the FNP that she may see her mother's age at death, 92, and in somewhat better condition, especially more alert, than her mother. Because my mother felt so healthy throughout her life, her medical history is lacking in information but loaded with possibly unreliable anecdote. The stuff about her past reactions to iron supplementation, for instance. The death of a direct older relative from "pernicious anemia", which my mother doesn't have. The possibility that she may have been swimming around in high blood sugar for a long time before it was discovered. And then, there is her metformin usage, which coincides with the worst of her anemia. But, there isn't much of a history before 2000. Both sides of her family are pretty much 'wing and a prayer' people, when it comes to health and healing. They've pulled some surprises out of their hats. Mom doesn't wear hats but she does have this extraordinary fascination with her hair (what little she has) and can be said to wear a hat, almost constantly, in the form of her pastiche.
    Later.
    Probably.
    Later.

...I have also thought of publishing some of the particularly effective business letters, typically medical, that have worked for me.
    Maybe I'll do that.

...I've provided the BUN/Creatinine Stat Comparison I devised to question one of the skilled nursing facility doctors in August of last year. There is more information with the chart. I added two more dates to it. Overall, she does, through the period represented in the chart, "run high", but, I can also see, viewing the contextual tests, that it's possible she may have always run high. Then again...
    You may also have noticed that I'm in the process of gathering hits and visit stats through Sitemeter. Feel free to browse my numbers. They're public.
    I'll be up for awhile. I may do some more posting elsewhere. May do some research. May just clean out my folders.
    Later.

...on behalf of a loved one for whom you care, or, perhaps, even yourself, will appreciate the following playlet:
A True Story
    It happened today, just about an hour ago.
    The standing monthly prescription we have at the local lab for Mom's CBCs was written 6/14/04 and specifically said that a copy was to be "given" to the patient's daughter, Gail Rae Hudson. We've been getting blood draws off this prescription since then. The draw taken last Friday, 1/21/05, was on this prescription.
    When we left the lab I saw, on the counter, the order, with distribution information, bolded and highlighted in yellow, as follows: Fax copy to PCP [faxing info]; copy to Gail Rae Hudson, pt daughter. The last conversation I had with the receptionist ["I am here to help you" (and she truly is the only one there who helps)] was as follows:
    "Should we mail your copy?"
    "Yes. That'll be fine. I'll see the results Monday, anyway."
    So, today is Wednesday, I've seen the results at the doctor's office and I refused a copy at our Mesa PCP because I knew one would be waiting for me in the mail when we arrived home, as always happens.
    I was wrong. No report.
    I called the lab. First, I was transferred to billing. When the billing clerk finally understood that, as I told her, she probably couldn't help me, she takes a phone number and promised a call back from "the proper department".
    I didn't expect a call back and made a mental note to recall around 1500. But, blessed cynic that I am, I received a call back in less than an hour.
    The call was from a lab employee who patiently (pun not intended but probably appropriate) explained to me that the prescription reads as follows (his interpretive version): "'pt daughter to receive copy of results 6/14/04'. This prescription only authorizes you to copies of the lab results for that date's draw."
    I couldn't believe my ears. I was almost laughing, helplessly. "No, no," I said in what I hoped was a helpful, patient (pun not intended but probably appropriate) tone, "that's the date of the prescription, the date the prescription was written by the doctor!"
    There is a moment of silence. One of us might be praying.
    "M'am, according to this prescription and current Federal HIPPA regulations governing the dispersal of medical information..."
    "No, but, you see, you always send me these lab reports, so I can make decisions regarding whether to take her to see her doctor in Mesa, every month, you always mail them, the last time was in September..."
    "According to this, as written, m'am, you are only allowed copies of the results from the blood draw of 6/14/04."
    I quickly researched my computer. "There was no such draw."
    I heard a familiar, receptionisty voice behind him.
    "...hold on..."
    Two moments of silence.
    "Yes. Yes m'am. I see. Yes, so she's right. So, you're right. Do you want to pick up that copy or have it mailed?"
    I had a sinking sense of deja vu but I answered, "mail it please?"
    I allowed him to determine that my mother and I live at the same address, same phone number, and I shuddered because I was thinking I'll have to go through this again on the fresh prescription.

    I'm thinking I'm going to publish the comparison I did, probably over at the Mom's Tests & Meds site, of her BUN and Creatinine readings since I've been collecting her medical records. There has been a trend, as I recall, toward high BUN and Creatinine levels, although all I could ever get any doctor to say was, "Her kidney functions are good."
    To which I would respond, "So, she just, you know," delivered at a comic slant, "'runs high'?"
    Yes. What the hell does that mean?!? Well, now I know what it means. Although her kidneys are functioning well, they are in chronic failure.
    "A pleasant way to die."
    Later.

    This is excerpted out of an email I sent to MFASF (see Legend of Journal Abbreviations) telling him of our trip. It includes all the high points, more detail, etc. I've edited it and amended other material. I've called him my muse in regards to this journey I'm taking with my mother and he is, as well as a treasured Long Time Friend (as he also appears in the aforementioned Legend). I am ever grateful that he easily takes my plundering of my emails to him. Here is the excerpt:

...this doctor's appointment was extremely productive, medically and spiritually. I was finally told how my mother would die. As the FNP explained what to expect she described my mother's current behavior perfectly and, with perfect wisdom, my own reactions and thoughts as a caregiver at this stage of my mother's life. She even volunteered that all the 'tricks' doctors have applied to me in order to up the ante treatment-wise were 'typical', the doctors' way of avoiding the inevitable and making sure that my mother provided them with as much of a revenue stream as they could squeeze out of her. From what she told me I an confident I've performed well in that arena, even without having the benefit of knowing I was in an arena.
    She also approached what she had to tell me from the perspective of a caregiver. She took care of her mother as she declined and finally died from exactly the conditions that are ushering my mother to her death: Anemia Due to Chronic Disease ["So we'll stop this nonsense of looking for internal bleeding," she said as I sobbed anew and felt the urge to grovel and kiss her feet.] and Chronic Renal Failure (although my mother remains on the high end of this). My mother remains without heart disease although her CRF may cause her to exhibit symptoms of CHF. She is particularly vulnerable at these times, so these conditions should be treated. Mom "will", the FNP explained, "take more naps, because she'll be more tired." We will control her anemia with occasional transfusions, if necessary, and take a no treatment stance on her blood sugar because, her diabetes will, as her ACD and CRF advance, "go on a holiday", which, according to the FNP's interpretation of my mother's stat history, is beginning to happen. In essence, Mom will comfortably fade away. Keeping her up as much as possible and applying "tasks" (the trip to Mesa-in-a-day was, for instance, a "task" for my mother) for interest is fine, but I am to do both with obeisance to my mother's schedule. When she saw the times associated with Mom's awakenings, around noon, and I told her she sleeps anywhere from 12-14 hours, sometimes stays up late, sometimes not, she nodded and said, "Yeah, my Mom did that, too. And taking more naps. Shorter but more." So far, Mom is a one nap a day person but that one nap often easily qualifies her for 14+ hours of sleep in a day. At one point the FNP suggested I "back off" taking stats because for the most part I and my mother's medical providers will be taking a no treatment approach except for things like urinary tract infections, transfusions when necessary and procedures to alleviate temporary, critical but not fatal discomfort. She'll be closely monitored through the lab up here: four tests, I think, if I remember correctly, a month, now.
    We now have a standing (one year at a time) prescription for Levaquin for UTI's. She explained that although the catheterizations didn't help, age shortens the urethra and widens the neck of the bladder, a body's "flora and fauna" are no longer of a reliable mix to boost the immune system and, yes, maybe the magnetic properties of the iron laden shit are problematic but she's simply prone to UTI's now.
    I burst into tears, out of joy, out of grief, but mainly out of relief. Someone finally explained the terrain, not only acknowledged but confirmed my observations, I know where we are again in this journey, which I hadn't known for awhile, and have even taken some steps to move us more comfortably along.
    Our appointment began at 1500. We were having Mom's stats taken in her assigned medical cubicle by 1502 even though the office was busy, but everyone had appointments. We left at about 1720, when the only staff left (closing is 1600) was the FNP and someone at the front desk. She mentioned once, when I gushed my gratitude for the time she was taking with us (and, still, we forgot to get the flu shot) that knowing where "we came from" she wanted to make sure the visit was productive. Can you believe it?!? I wanted to sacrifice a lamb to this woman!
    I'm just now beginning to get my bearings. This feels good. To know. To be able to anticipate. To have some labels that are really definitions that predict certain behaviors at certain times. I can't tell you how relieved I am. For about a year I've been thinking, "Oh my god, it's me, it's me...I'm being too easy on her...I'm responsible for getting her moving, etcetera..." and, I am, up to a point. I have been following her lead, with restrictions and occasional frustrated routings, but, as the FNP noted, my mother's will is strong and will remain strong so I can depend on her to lead me.
    She never said, specifically, "relax". She included multiple cautions to be ever vigilant to detect "falling situations" ahead of time, absolutely go for treatments that promise strength and do no damage and wouldn't be considered "torture", continue to fight off doctors who want to 'poke the living daylights' [one of my mother's contributions to the conversation] out of her "in the name of science" (I can't believe the FNP said this...I've suspected this for some time, that my mother's generation is the guinea pig for our generation, medically).
    So I remain ever vigilant but in a beta state, I think that's the one, isn't it, relaxed alertness, a sort of advanced meditative brain wave pattern, The Zone. It's like I've been going around asking, "So, is this Ancient Age?" and finally, someone said, "Oh, yeah, this is Ancient Age. Let me take you on a tour..."
    One of the amazing internal developments is that my sense of tenderness toward my mother has grown by leaps and bounds. This particular development continues to bring me to my knees, emotionally.

    I will most likely have one more major post to make regarding The Trip over in the Essaying section...
    ...later.

    At one point in the evening, after she'd helped herself to stray cigarettes at the dining room table, at which she insisted on perching all evening, I discovered her and silently assented to her smoking with restrictions. After maybe her third cigarette, she threw her head back and exulted, "This cigarette tastes good."
    I shuddered.
    Later, she "remembered" that she'd brought a pack of cigarettes with her and continued to insist, throughout the entire trip back up the mountain, that she'd "left" her cigarettes, "back there."
    I shuddered again.
    She also quickly reinstated an old habit that I wouldn't even let her practice when she smoked regularly: Lighting a cigarette during dinner, holding it in one hand whilst eating with the other and occasionally taking a 'digestive' puff. This is one of the many smoking habits I recall from both my parents smoking when I was a kid. MCF pointed it out to me and gave me a shocked look. I guess they'd never been exposed to this. I immediately put a stop to this behavior and removed cigarettes from her immediate vicinity.
    She has not, however, today appeared to miss cigarettes, look for them or insist that she not only smokes cigarettes, she "had one this morning"...which is always untrue.
    No reacquired habit agitation. Thank the gods.

...this and this post for yesterday (technically) over at Mom's Daily Tests & Meds. They contain yet more information about what the FNP said about Mom, information which I may not repeat here.

...I am still processing. Yes, I do have stats of a sort for the rest of yesterday. I'm going to continue posting daily meals, meds and bowel movements.
    I feel that we have turned a corner. I know exactly when it happened,and Mom's aware of it, too: When the FNP said, "It's a pleasant way to die..." and went on to describe exactly what is happening to Mom. I know Mom heard it. She didn't react in the office. There is something, though, about the way we're now interracting in small ways with one another...we're more sturdy with each other. We're both more relaxed, as though we looked around, took note of our environment and are now at home in it.
    I remember the FNP making a distinction between treatments for comfort and reasonable life extension, which are to be favored, and treatments that will prolong her life at a cost with the addition of suffering, which MCF, dialysis tech that she is, interpreted for me as meaning, "No dialysis, unless it is temporary and allows her to leave the hospital in comfort."
    While talking with the FNP I mentioned that my plan of attack, until we find out if the freeze is off the veteran's hospital, is to bring her to Banner myself if I feel that emergency treatment is needed and keep her PCP office and medical providers in Mesa as her Primary Care Providers. I said that I would not trust her to Yavapai Regional Medical Center again because they "did nothing" both times.
    "There may come a time," the FNP said, "when you will appreciate and want that low key response. Don't write them off, yet."
    I understood immediately what she meant. I think I will call the hospital and see we if we can come to some reasonable arrangement regarding my mother and her primary care medical providers in Mesa. If necessary, I would also like to have her transfused up here.
    For the time being the goals are:

• To manage her for comfort and maximum alertness, as much as this is possible without creating irritation and frustration;
• No more torture in the name of diagnosis and treatment;
• Keep an eye on her to make sure she doesn't fall and evaluate treatments from the standpoint of keeping her reasonably balanced on her feet, and;
• Foremost, allow my mother to determine her own timetable.

    I know there will be more...
    ...later.

...and I expect this post to be a short beginning regarding our trip of yesterday to consult with her Mesa PCP (who, this visit, was, happily and luckily, an FNP). Expect further posts on a variety of issues raised, settled, and settled with as the hours increase.
    First, some details about which some of you will be wondering:

• Hemoglobin On Friday 1/21/05: 10.2 - diagnosis, low, but high low, an improvement, good
• Labels are sometimes useful and revealed themselves to be invaluable yesterday: Two new, effective labels have been added to Mom's diagnoses. These labels actually explain a great deal in their definitions, which I will cover later. Mom suffers from:
  1. Anemia as a Result of Chronic Disease [this one explains a lot]; and
  2. Chronic Renal Failure [not as bad as it sounds].
  Thus, certain patterns are to be expected. When the FNP apprised me of these patterns, based both on her knowledge and her background of taking care of her mother (whose patterns are very similar to my mother's), I was astounded to realize I was looking at a portrait of Mom and her life as though it had been painted by Rembrandt.
• I am, once again, enjoined to back off on my statting: Measure only when a need appears and then only the appropriate measure; i.e., don't take a temperature unless a blood pressure or some other symptom indicates it might be necessary, since I've established a (admittedly dynamic) baseline.
• This is probably the most important detail of all: I now feel immensely relieved and relaxed. I know how Mom is most likely going to die. And, yes, she may very well have a good 5 more years, maybe a few more than that depending on how diet and lack of smoking bolster her natural (failing) immune system. More, much more, about this.
• I should keep her diet relatively low carb, especially refined carbs, but relax my standards regarding frequency and type, and, in some cases, amount. It is good to use sugar free candies and desserts, as well as sugared ones, more frequently than I've been doing. Keep up with the cranberry juice, supplements, etc.
• Maintain a somewhat flexible "no treatment" attitude.
• No more looking for internal bleeding.
• Possibly occasional transfusions, although the FNP was impressed that Mom hasn't had one since June of last year.
• Expect an increasing frequency of naps. Take a posture of relaxed alertness to this development.
• Encourage movement but don't harass. Take my cues from her (which I've been doing) while trying to extend her strength as long as possible.

    The visit with friends was spectacular, the highlight of the trip. Mom was very alert, her faculties of recognition were in good order, she enjoyed the surprises offered by a new environment and participated in them with enthusiasm; in some cases, the smoking, for instance, with too much enthusiasm. She has, fortunately, forgotten that she came close to chain smoking yesterday.
    In case the visited family peeks in here, she was particularly taken with whom she considered a newcomer, the late comer. She asked me several times on the way home who she was and in what way she was connected with MCF's family.
    She finally agreed that even though we paid for a day and used the motel room for 3 hours it was a good idea. She was shocked when I explained to her, upon her asking me how much we were paying for the room, that we were paying for a day. "Too bad you can't get rooms by the hour," she innocently observed.
    "Well, Mom, we could down on Van Buren and they come with a girl."
    Mom started, then laughed. "I already have a girl!"
    "Come to think of it, so do I!"
    She used the walker with slow aplomb even though it's been a couple of months since she's used it. She dozed in the doctor's office while we were waiting but came to splendidly when the FNP began the session.
    The FNP conducted a much needed, "Well, since you've come all this way, let's do the full review." Much was learned and much was accomplished. In case I haven't mentioned this, Mom will be having the following fluid draws up here once a month:

• CBC (already in force);
• Chem Panel highlighting electrolytes;
• Urinalysis to catch UTI's early, which, I've been informed, I can expect to recur.

    There's more to tell and I will in at least two more posts, one which will probably show up in Essaying the Situation. I'll post an alert here if that happens.
    To those of you who care, know that I feel as though I am embarking on this new phase of The Adventure of Mom as an Ancient One with both a lighter heart and step. Now that I know.
    Later.

• Many interesting observations regarding our trip, hmmm, it's yesterday, now, isn't it;
• Lot's of intriguing thoughts, words and support exchanged throughout the day;
• Provocative subjects broached such as, "What is it like to die the way my mother is likely to die?"
• A shockingly poignant description of her understandable diagnosis that both rent my heart and caused me to feel autonomically, humbly grateful to be with her now;
• An interesting smoking occurrence involving spending the evening in a smoking household, so I did not disallow Mom's automatic smoking but monitored it, made sure she didn't chain smoke; and the results, both objectively and with a comic slant.

    And, I am beat. And somewhat lighter of heart. I am going to bed.
    Later.

• The current medication chart with mentionable developments since September;
• The blood sugar graph with readings and percentage calculations since 12/11/04 (the meter only holds 120 readings and I do all this by electronic transfer and, anyway, I think 120 readings is all they need to see how she's doing currently);
• The blood pressure chart since 12/01/04;
• I have my list of questions, things to mention and needed prescriptions;
• I've gone over everything in my head to meticulous fault.
• All our supplies except those we'll be using tomorrow morning are gathered and stowed in the car including her wheelchair and walker and some incidentals for our friends;
• The car is gassed;
• I need to clean the windows but will do that in the morning;
• All plans have been confirmed;

    I'm ready.
    Mom is primed and retired about a half hour ago, then arose 15 minutes ago "for a glass of water" (even though she always has fresh water by her bed) like an excited child. She's talked a couple of times tonight about our Chandler friends and their dogs. Just before I called them to confirm she reminded me to ask if they still have the dachsund. They do. That's her favorite breed.
    Every time we go to the doctor (unless it's an emergency) I prepare all the above ahead of time.
    Time for me to hit the sack. It's going to be an early, long, busy day tomorrow.
    Later.

...in which I play the part of her body reacting to whatever is being done to it by whomever is doing it (sometimes I'm the one doing it). Yesterday, in the face of her obvious and unusual day incontinence and the strong medicinal smell of her urine, the playlet unfolded as follows:

    "Well, Mom, it looks like this is what your body is saying:
    'Did you hear? Gail said last night's dose was the last of the antibiotics. Thank god! Now we can get rid of all that shit! Liver alert! Kidney alert! Bladder alert! Start shedding...3 - 2 - 1 - Eject!'"

    Although these playlets may, then again may not, be an accurately allegorical description of what's going on, they provide the needed dose of humor that gets us through unexpected and potentially worrisome body displays until I can find enough information to adequately explain them or satisfy myself that these displays have yet to be explained by anyone. Once in awhile the displays reveal themselves to require further attention, either of a medical or practical caretaker sort. Most of the time they do not. The playlets reinforce the confidence my mother has that her body will keep her around as long as she wants, a confidence that is probably the most medically important treatment in which she participates.
    Despite this, yesterday was a good, full day for my mother. We watched "Bible movies", one of her favorite entertainments. My mother was begat of respectable ancestral line of Methodist ministers, including the last couple centuries of Methodism's evolution from circuit riding fire and brimstone preachers through staid deaconesses to ordinary, mild mannered, "Oh my god, there's a Catholic in the community" parish preachers (her grandfather on her mother's side). She has always been fascinated by religion, Protestant Christianity in particular and The Yearning for The Sacred in general. Thus, her enjoyment of these movies doesn't linger on the melodramatics or the off-track interpretive acting contained in so many of them. She searches between the spectacles for clues that might illuminate spiritual inconsistencies or throw some light on what, in the character of a particular spiritual person combined with the spiritual character of the age in which that person lived, might have contributed to their involvement in the encouragement of spiritual evolution and, eventually, the creation of religious doctrine. She often notices, as she did yesterday in the two movies we watched (both rented), Luther and Judas, curious discrepancies: During the first she commented, "He seems too innocent to have come up with all that troublemaking interpretation." During the second: "I see Jesus is a blond again," she always finds this incredibly funny, and "These movies never mention that Judas was directed by God to do what he did. His job was the hardest..." [cont'd after next paragraph]
    It is 1509; this is the third time today I've come in to "finish" this post. I hope I'll be able to finish it off this time.
    At this point her voice trailed...her unspoken meaning is that she believes this is why he killed himself. I love watching "Bible movies" with my mother, whether they're good or bad. They always provoke her to talk about doctrine versus belief versus spirituality. We have involved, enjoyable discussions during and after these movies.
    So, today is "getting ready for the trip tomorrow" day. That's why I've interrupted myself so often while trying to polish off this post. I am in "remember to do such and such" mode. Mom is sleeping a bit more than usual today. She's excited about the trip and is using it as an excuse to "rest up". The highlights from last weekend's dog show are on. When she laid down she asked me to awaken her for it, just before 1500 our time. I did, at 1445, and she said, "It lasts three hours...call me a little later. I'm not completely rested." So, I'll call her at 1600.
    I'm concerned about the blump on her right elbow. It seems to have enlarged a bit. Although she is showing no other signs of low sodium I'm cutting back on her fluids even further and I picked up a chicken pot pie at Costco today to serve for dinner, which is loaded with sodium. With my luck, her problem will be exactly the opposite! Her body seems to be settling down on the flushing...did I mention that? No. I don't know. I expect, since her routine monthly CBC's do not include BUN and Creatinine readings, they'll probably draw blood tomorrow. All I'm hoping is that they don't discover anything bizarre or worrisome that causes them to say, "Mrs. Hudson, you need to be admitted to the hospital. Now." This possibility suddenly occurred to me this morning while we were bathing her and I burst into tears, much to my mother's astonishment.
    When I explained to her why I was crying she said, "Oh, Gail! You worry too much! I feel fine! They won't put me in the hospital!"
    I hope she's right. She always "feel[s] fine", though, even when she's so far under the weather she's close to underground. I'm concentrating on directing the healing energy of the Universe in her direction, just in case. In addition, if anyone of the medical persuasion expresses concern about anything I'm going to vociferously lobby for keeping her at home and monitoring her closely, even if that means a few more back and forth trips to Mesa in a short period of time. I don't care. One way or another, while they are giving her what she needs, they always manage to screw her up. This morning I even told her, "You know, Mom, I'm almost tempted, from this point on, to refuse to ever put you in a hospital again, even if it appears as though you really need it."
    "I'm for that," she said. Of course, I will probably reverse this position if necessary. At least now I know to refuse unnecessary catheterization and keep an even closer eye on procedure than I usually do. Each visit to a hospital reveals more procedural care problems.
    I can't help, at times like these, to consider the present day confusion over the various versions of the Hippocratic Oath and modern day medical oath taking in general. It's scary, when you think about it. I've had experience with most of the gamut of physicians/non-alternative medical providers and there is no clear internal or external agreement anymore upon which a patient or medical advocate can fasten her trust.
    I'm not sure whether I'll be back here before Tuesday morning. It depends on how time is filled over the next 36 hours or so and how exhausted I am when we return home tomorrow night, assuming, hoping, that we do return home tomorrow night.
    Later.