Chapter 31
When I turned on my phone after the Moxie meeting, I found six missed calls, all from Mary Ellen at Glenwood Gardens. Panic seized me like an icy claw. Something must be wrong with Gramma! I had three voicemails, which I knew I had to hear ASAP—even though I dreaded listening to them.
The first one had come in at 2:00 p.m. Mary Ellen said Gramma was listless, coughing, had a fever, wasn’t eating or drinking. They were watching her and had talked with her physician. The next message came at 3:15. It said they think Gramma has pneumonia. They are sending her to the hospital by ambulance. The final message came at 4:05. Gramma is in the hospital ICU. Come as soon as you can.
Tears poured down my face. I could barely see to drive. Roads, still icy in places, slowed me down. Red lights seemed to last forever. How could this be happening? My dear sweet Gramma. She’s everything to me. Even now that so much of her is gone, even though she’s confused and disoriented most of the time, she’s my rock. I need her. I can’t lose her. I sobbed so hard I almost hit a car turning in front of me.
I screeched into hospital parking lot, parked crooked, and ran inside. “Where’s the ICU?” I demanded from the first person I saw.
“To the right, down the hall.”
I sped to the ICU where I found Gramma, looking tiny in the hospital bed. She lay unmoving amidst a web of intravenous lines and wires hooking her up to an assortment of machines whose dials showed wavy lines and rapidly changing blinking numbers. A tight-fitting clear plastic mask covered her nose. It was attached with bands around her head and connected to a machine by a plastic tube. Her skin was deathly white, her eyes were closed and the only sound in her little cubicle was the beeping of monitors and the whispery blowing of her facemask.
Chills shook my whole body. It was like I was caught in a blizzard with horrible freezing particles slamming into me from every direction. Nowhere to turn. I could hardly breathe. I struggled to remain upright. I wanted to run away to some place where none of this was happening, but I knew I had to get past my fear and be there for Gramma.
I closed my eyes and focused on my breathing until the shakiness stopped. Then I looked at Gramma’s sweet face. I wanted to embrace her in a hug, to hold her close and keep her safe, but of course I couldn’t. I leaned down and kissed her. “Gramma, it’s Cleo. “I love you.”
She didn’t respond at all.
After quietly stroking her face for a few minutes, I stepped away from her bed and called Pablo. “Hang tight, Cleo,” he said. “I’ll leave Longmont right now and be there as fast as I can.”
I knew it would be at least half an hour before he could get there. I went back to Gramma’s bed, pulled up a chair and sat next to her, holding her limp hand and watching her every breath.
A nurse came in. I looked up and to my surprise saw that it was Lark Dove. “Cleo,” she said. “I saw your name on the chart as next of kin. Martha is your grandmother?”
“Yes,” I said, trying to hold in my tears.
Lark put her hand on my shoulder. “I’m sorry she’s so sick,” she said.
In the face of her sympathy, my emotions bubbled over. “She looks terrible,” I sobbed. “Is she dying?”
“She’s stable right now,” Lark said. “We can talk more over at the main desk if you’d like.”
I followed her out to the nurses’ station at the center of the room. “We don’t know what she can hear, so we don’t want to talk about problems right next to her,” Lark said.
“Does your grandmother have an advance directive—a living will?” she asked.
“No,” I said. “She doesn’t have a living will. By the time Grampa and I realized how confused she was, it was too late for her to consider what she might want.”
“We should talk more about that,” Lark said.
I didn’t want to talk more about that, so I asked a different question. “What’s that mask over her nose?”
“It’s called a bipap machine. It helps push air in and out of her lungs. It improves her oxygen level and it’s less invasive than putting a tube down her throat and having a ventilator breathe for her. Her doctor can tell you more when he comes,” Lark said.
“Oh, here’s Dr. Bremer, now,” she said, turning toward a tall, skinny man who had just walked up.
I had only met Dr. Bremer a few times. Gramma’s long-time physician had recently retired and Mary Ellen at Glenwood Gardens had recruited Dr. Bremer to take her on. He seemed capable and compassionate and I was grateful to have him, as it’s not easy to find physicians to take new Medicare patients. But I didn’t really know him.
He greeted me and I followed him over to Gramma’s bedside. He listened to her heart and lungs, checked her chart and the numbers on the machines, then turned to me. “She has fluid in both lungs,” he said. “We have her on some strong antibiotics. I’m hoping she’ll respond well. We’ll know more in a day or so.”
“The nurse asked me about a living will,” I said. “But Gramma never made one. When she got to where she couldn’t make decisions, Grampa made them for her. But Grampa died eight years ago. Now it’s all up to me. I’m her power of attorney.” I dreaded the next question, but I had to ask it. “Are there decisions I need to make for her today?”
“Not right now,” he said. “But that time may come. It will help if you tell us what you want us to do if she needs a breathing tube or if her heart stops, things like that. The nurses can go over the choices with you.”
I didn’t want to go over those choices. I didn’t even want to think about those choices. I so wished Grampa were alive to help me. I didn’t want Gramma to suffer, but I didn’t want to be the one determining when she would die. I felt like I’d be signing her death warrant if I chose not to have everything possible done to save her. I sank back into my chair in alarm.
Finally Pablo came. I rushed into his arms, sobbing. He held me and stroked my back softly. Finally I pulled back, got a tissue to blow my nose and wipe my eyes. “She’s so sick,” I said.
“What does her doctor say?” Pablo asked.
Before I could answer, Lark came in to check Gramma’s breathing and the numbers on the machines. “Cleo, can you come back out to the nurses’ station for a few minutes? There are a few more questions I need to ask you.”
I wanted to jump back into Pablo’s arms and hide my face, but I got up like a grownup and followed her out.
I knew what was coming. I remembered Lark telling me that most nurses don’t believe that someone in late-stage dementia who has no quality of life should be treated with antibiotics.
“Dr. Bremer suggested I go over your grandmother’s healthcare decisions with you,” Lark said. “You said she never made a living will or told you what she would want done in this situation?”
“What situation?”
Lark looked at me with kindness in her eyes. But her voice was firm. “A situation where she has advanced Alzheimer’s Disease and pneumonia and can’t understand why she’s hooked up to all these machines. A situation where she might not be able to breathe without a tube down her throat attached to a ventilator. A situation where her heart might stop.”
“No,” I said. “We never talked about any of that before she got Alzheimer’s. And after that, she was too confused.”
Lark sighed. “That’s the thing about Alzheimer’s,” she said. “By the time the patient might want to say she doesn’t want aggressive treatment for pneumonia, given that she has Alzheimer’s, it’s too late. Now you have to make her decisions.”
“I have to think about it,” I said. “Right now I want everything done. Maybe I’ll change my mind after I have some time to think.”
“Look, Cleo, I’m saying this as a friend,” Lark said. “Your grandmother is eighty-seven and frail and she has Alzheimer’s. Her quality of life is very limited. Would she want to live more years with dementia? Sometimes the most unselfish thing we can do is to release those we love rather than make them stay to suffer longer.”
/> Pablo was back in Gramma’s cubicle, but he was looking over at me. He must have noticed that I looked distressed. He came over and put his arm around my shoulders. “Hey, babe, how about a short break to grab some food? I haven’t eaten since this morning and I expect you can use a snack. We can come right back.”
In the cafeteria, I got a grilled cheese sandwich—one of my go-to comfort foods. Pablo gobbled up a hamburger and fries.
“I feel like Lark has an agenda, and she’s trying to pressure me,” I said.
“Lark’s the blonde nurse you were talking to?” he asked. “You looked devastated. What was that about?”
“About end-of-life decisions,” I said. “She thinks people with Alzheimer’s have no quality of life, so they shouldn’t get treatment for pneumonia, that we should just let them go.”
“Does Martha still have quality of life?” Pablo asked, gently, his eyes filled with love.
“I think some,” I said. “She still recognizes me some of the time, she still enjoys music and art.”
“So you want the treatment?” I heard sincere sympathy in his voice
Tears ran down my face. “Yes. She’s still my sweet Gramma and I love her dearly. And I’m not ready for her to go.”
He nodded emphatically. “Then that’s it,” he said. “It’s your choice, not the nurse’s choice. Just try to think it through and be clear about what you want.”
Back at Gramma’s bedside, I tried to clarify my thinking. But my mind kept slipping back to all those summers I had spent with Gramma and Grandpa as a teenager and how she had shared her artist’s studio with me and taught me to paint. Gramma was an award-winning painter—so creative and productive. It’s hard to accept that she’s ended up like this. Was Lark right? Had Gramma lost so much of who she was that her life wasn’t worth living?
It’s agonizing to make life-and-death decisions for another person. How could I know what she would want? Was I just trying to keep her here for myself?
Lark’s shift ended at 7:00 p.m. and thankfully she left without bringing up the subject again. Pablo and I sat quietly with Gramma until about 9:00 p.m. when another nurse insisted we leave and get some sleep. We agreed to go with the nurse’s promise to call us immediately if anything changed even the slightest bit.
When we got to my house, we both fell into bed exhausted and were asleep as soon as our heads hit the pillows. I set the alarm for 6:00 a.m. so Pablo could get to work and I could get back to the hospital.
But I awoke in a cold sweat at 3:00 a.m. thinking about Allie, whose mother had been at Glenwood Gardens with Gramma.. Her story kept running through my mind. When her mother had Alzheimer’s and was in the ICU with pneumonia, the nurses there pushed Allie to consider withdrawing treatment. She didn’t agree. She thought her mother was getting better with the antibiotics, but then her mom suddenly died in the middle of the night.
Omigod! What if that happens to Gramma? Why hadn’t it occurred to me? There must be something to Allie’s suspicions if the hospital offered to settle with her. Allie thought Sabrina might have been the nurse responsible. But Sabrina’s gone so that would mean Gramma is safe.
But what if it wasn’t Sabrina? I sat bolt upright in the bed, my heart racing. I almost screamed, but gulped down some quick breaths to stifle the cry. What if it was Lark? That’s hard to believe when Lark is so kind and helpful. But she is very firm in her beliefs about not treating demented patients with antibiotics. Is Lark euthanizing demented patients in the ICU when their families choose to have treatment continued? What if that’s what Sabrina meant about Lark violating her oath?
An image of Gramma lying there dead in her bed flashed before my eyes. I shook Pablo awake. “I have to get back to the hospital right now,” I said, my voice shrill. “Gramma might not be safe with Lark there.” I threw off the covers to climb out of bed.
Pablo grabbed my arm and shook his head sleepily. “What’s going on, Cleo?”
I was way too jumpy to sit still and talk, so I pushed him away and stood up. “Lark thinks Gramma would be better off dead and I’m afraid she’ll make that happen. I need to get over there to stay with Gramma and keep her safe.” I headed for my closet to grab some clothes.
“Wait, Cleo,” he said. “I’m not sure why you think that, but remember that Lark left at 7:00 p.m. last night. She won’t be back until at least tomorrow morning. So you don’t have to rush over there right now.”
I grabbed my phone and called the ICU to check on Gramma. No change. I asked for Lark. They said she was off duty until Tuesday morning at 6:30.
“You’re right,” I said to Pablo. “She’s actually off until Tuesday morning, so I have more than twenty-four hours. Oh—and they said Gramma’s condition hasn’t changed.”
He held out his arms. “Come on back to bed,” he said. “We can talk about this more in the morning.”
I snuggled up next to him, listening to his even breathing as he went back to sleep. But my mind was active, running through what I could do to find out more about Lark before she could do anything to Gramma.
Chapter 32
Monday
The 6:00 a.m. alarm yanked us both out of a sound sleep. We were groggy from my middle-of-the-night panic, and I was kind of queasy. Pablo grabbed a shower and said he’d pick up breakfast on his way to work so he wouldn’t make my upset stomach worse with the smell of brewing coffee. I would have liked to talk to him more about Lark, but I didn’t feel up to it at the moment and I appreciated his thoughtfulness about the coffee.
He left, assuring me that he’d keep his phone on and be available to come any time I needed him. I called the hospital to check on Gramma and find out when her doctor would be coming. She was about the same. They expected Dr. Bremer to come by around 8:00 a.m.
I ate some soda crackers to settle my stomach and took a long hot shower. With all my focus on Gramma, I’d stopped thinking much about the baby, but my pregnancy symptoms were a strong reminder. Although I was on autopilot, I did what I needed to do. I knew my baby needed protein and by then my stomach was calm enough to eat, so I scrambled some eggs with cheese. Then I headed off to the hospital so I’d be there when Dr. Bremer came by.
Gramma opened her eyes briefly when I kissed her. “Hi Gramma,” I said. “Are you feeling better?” She looked at me, but I saw no sign that she recognized me. “It’s Cleo,” I said tearfully. “I love you, Gramma.” Of course she couldn’t talk with the bipap mask on. What was I thinking? She closed her eyes again.
Dr. Bremer came and checked her. “She’s not worse, but she’s not better either,” he said.
“Is she going to be okay?”
“It’s hard to say,” he said. “We’ll know more in a day or so.”
“She seems very sleepy. Is she sedated?” I said. “She does always sleep a lot, but now she can’t seem to stay awake for even a couple of minutes.”
“I have her mildly sedated,” he said, “so she won’t pull out her IVs or pull off her oxygen mask. We don’t want to have to use restraints to keep her still.”
“Can she move out of the ICU to a regular room?” I asked, thinking this would be one way to get her away from Lark. “I think she’d be more comfortable there.”
“No,” he said. “We have to keep monitoring her in here for now.” His pager beeped. He looked at it. “We’ll talk tomorrow,” he said over his shoulder to me as he rushed off.
I leaned over Gramma’s bed and spoke softly to her. “I love you so much, Gramma. “I want you to get well so you’ll be around to meet my baby when it’s born.” I sat next to her quietly gazing at her and smoothing her hair.
Then worry crept in. I flashed back to a few days ago when Lark, sitting at my kitchen table, had said, ” Most nurses don’t believe a person in end-stage dementia who has no quality of life should be treated with antibiotics.” I thought about Sabrina’s thirty-day plan, which said Lark is violating her nursing oath. Would Lark somehow stop Gramma’s antibiotics? Is that what she do
es? Is that what Sabina meant? Did Lark do that to Allie’s mother?
I knew Lark would be back on duty in the ICU the next morning. I had to find out before then whether she was a suspect in the death of Allie’s mother. I had to ask Allie about it right now. I jumped up and hurried outside to my car to call her so my conversation wouldn’t be overheard.
When I told Allie about Gramma and my fears that something would happen to her in the ICU, she screamed. “Oh, no! Not again! Cleo, that’s horrible! We have to keep your grandmother safe.”
“I know,” I said, tearfully. “I’m scared about the pneumonia, but I’m even more scared that some nurse will stop the antibiotics or put something deadly in her IV. The hospital must think it happened if they offered you a settlement. I need to know what they know so I can keep Gramma safe. Do you know any more about what they found out?”
Allie sighed. “No, they never said anything specific,” she said. “They didn’t admit anything, just offered the settlement.”
“Did you end up taking it?”
“I finally did.” Allie sounded resigned. “What I really wanted was justice for Mom, but the settlement offer had a deadline and my lawyer convinced me that it would be way too expensive to go ahead with a suit against the hospital. My chances of winning weren’t good. So I took the settlement. I’m going to take Mary Ellen’s idea and use the money for a memorial to Mom, but I haven’t decided what yet.”
This wasn’t getting me anywhere. Time was slipping away and I needed answers. Lark had made it very clear to me that she didn’t approve of my choices for Gramma’s treatment. “Do you think your lawyer knows anything more about what the hospital found out? Could I talk to him about it?”
“Oh, no, no, no. You can’t do that.” Allie said, her voice shrill. “Remember I told you the whole settlement thing is confidential. I had to sign a non-disclosure agreement that said I’d keep everything about the settlement secret. You can’t tell my lawyer I told you about it.”
“Well, could you ask him if he knows anything else?’
Lynn Osterkamp - Cleo Sims 03 - Too Many Secrets Page 19
