Neither Livia nor Elena had started out thinking they would be caregivers when they grew up. Livia had worked for the government in Romania, in an administrative capacity. Elena had taught first grade. When they came to the U.S., they both took entry-level jobs as caregivers in assisted living/dementia establishments because that was the only work that was available to them. Both said that in spite of their early trepidation, they came to love the work.
They were typical of a vast number of immigrants, from the Philippines, Ukraine, Latin America, Mexico, the Caribbean, and, as with Sang, Southeast Asia. They started out grossly underpaid, doing the dirtiest of the dirty work and some, like Sang, Livia and Elena, became successful entrepreneurs while offering a much-needed service.
The person Elena had planned to hire couldn’t get her schedule worked out, so they continued the search for another live-in caregiver.
Sunny and Mike didn’t pay much attention to each other anymore. A brief look from him, a quick sniff from her, and they each went their separate ways, but I liked to take her with me sometimes, and Sang never objected.
At first Elena was hesitant to have Sunny visit there, but after the first month gave her okay. The first time I took Sunny to Green Hill, one of the usually silent women, Kate, brightened when she saw her.
“What’s your doggie’s name?” she asked, leaning forward to better see the dog.
“Sunny,” I said.
“Cute doggie,” she said.
Although Kate was usually awake and sitting in the living room whenever I visited, that was the first time I’d seen her smile, or heard her speak.
I led Sunny over close to where she was sitting. Mike stopped by my side.
“Cute doggie, Sunny,” she said, again with a broad smile.
I always carried treats in my pocket for Sunny, in case I had to lure her into the car, or get her to stand still while I attached her leash. I handed Kate a few treats, assuring her that Sunny wouldn’t bite.
“Here, Sunny,” she said holding a treat out in front of her.
Mike lunged, grabbed the treat, popped it into his mouth, chewed vigorously, and swallowed it almost as quickly as Sunny would have. Although dog treats may not have been part of the good nutrition plan, I was pretty sure it wouldn’t hurt him.
After weeks on Paxil, I didn’t see any changes with Mike one way or the other. He still lashed out when either Elena or the newly hired caregiver tried to get him cleaned up.
Elena reassured me that they were fine. “Don’t worry,” she said, whenever I expressed my concern.
“Don’t worry” might have been more reassuring had I not recently experienced Sang’s repeated orders—don’t worry, don’t worry, don’t worry—followed by a 30-day eviction notice.
Seeing Kate’s response to Sunny, I’d vowed to bring her with me whenever I visited. However, my next visit included one of those self-imposed errand circuits, and I hadn’t backtracked to pick her up before I went to Green Hill. Once there, I greeted Mike. He walked on but after a few minutes he came back inside and sat in a recliner facing the TV. I sat next to him. He was on my right, and Sunny’s admirer was on my left.
“How’s that Sunny doggie?” Kate asked.
I was surprised that she’d remembered Sunny’s name. I told her that Sunny was home napping, but I’d be sure to bring her on my next visit.
“I want to see her,” she told me. “I had a dog back when I lived as a human.”
As strange as that phrase, “back when I lived as a human” was, when I considered Kate’s present life, the phrase seemed apt.
Mike was back to his loop, and as he went out the door Kate said, “I worry about him sleeping outside all night, but they say he likes it.”
“I think he’s in and out during the night,” I said.
“Sometimes we used to take our sleeping bags outside and sleep under the stars, back when I lived as a human,” Kate said.
Mike had become more and more adamantly opposed to having his fingernails cut. Just after Thanksgiving, Sharon and I had tried to trim his nails, but he yanked his hand away before the first clip could be made. It was as if he were afraid of being cut. No matter how hard we tried to reassure him, he would have none of it. His nails had grown extremely long, and he had places on his arms where he’d scratched and drawn blood.
The Paxil, which we’d hoped would calm him, had no effect. If anything, Mike had been slightly more agitated since he’d started on it. We were gradually weaning him off that medication, with the possibility of trying something else. The only things I’d ever seen calm him were so strong they’d nearly knocked him unconscious.
Early in December, while shopping for groceries, I reached for a quart of milk and saw an array of eggnog cartons on the adjoining shelf. It was the season. Fat free, light, the original recipe, organic, and with soy milk. I was reminded of how much Mike had loved eggnog, and, though knowing Elena would not approve, I grabbed a carton, the original recipe, and added it to my collection of broccoli, low fat milk, and toilet paper.
When Sunny and I visited the following day, I watched as Elena read the eggnog label carefully. She sighed and shook her head. I suggested that she let Mike have a very small portion and see how it went. She said she would, but I could see she was resistant to the idea. She was being very careful about what he ate and felt that the extreme diarrhea was slightly less frequent.
I liked to offer Mike a bit of pleasure by bringing a favorite food to him when I visit, but I needed to follow Elena’s lead on this, since she was the one on cleanup duty. The soy latte Sharon brought Mike on her previous visit had received Elena’s stamp of approval, so soy latte it was. Decaf, of course. Honestly, I didn’t know if it made any difference to Mike. He downed whatever we handed him, and plenty we didn’t.
When I entered on that eggnog day, Kate, the dog lover, was in her chair, staring off into space. She brightened. “I knew Sunny was coming,” she said.
With my right hand I pulled a handful of Cheerios from my pocket for Mike. With my left I handed Kate a few doggie treats. That worked.
That evening I went to the Chanteuses Christmas concert—very nice music, well done. But as I sat there I couldn’t help remembering Mike’s better days, back when he was their director. I didn’t want to, wouldn’t ever, forget the Mike who was. On the other hand, the Christmas season was so filled with that Mike that I felt I needed to carefully portion my remembrances.
On the wall in my office I had a Cherokee proverb, “Don’t let yesterday use up too much of today,” advice that I needed to be particularly careful to heed during this time of year. It is a poignant time for all of us, so many precious holiday seasons stacked one upon the other in our memory files, so many visitations from past people and long-gone times. Like the eggnog, best to be taken in small doses.
TOOTH AND NAIL
December 2013 through March 2014
Just before Mike left Sang’s, he’d lost two teeth. One when he bit into a cookie. Another that he just spit out onto the ground as I watched him walking his loop. His brushing techniques left much to be desired and, of course, he wouldn’t allow anyone to help him. So it was no surprise when, a couple of weeks before Christmas, Elena had noticed that Mike’s jaw was swollen and his lower right gum was inflamed. She’d given him ibuprofen and the swelling subsided, but it was soon back again. We knew he needed to be seen by a dentist, but we also knew he was unlikely to be cooperative. I wanted to take advantage of Matt’s availability before he left town, since Mike was still more likely to be cooperative with Matt than with anyone else.
In discussing the difficulties of keeping Mike in a waiting room with others, how he needed to be constantly on the move, which generally included trying to get into examination rooms, or out the door to wherever, or out emergency exits, Dr. E , our longtime regular dentist, offered to meet us in his office on the Sunday after Christmas, days before Matt and family were scheduled to leave.
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br /> One of Dr. E’s dental assistants also joined us. It continued to amaze me that so many people, both friends and professionals, were willing to go the extra mile under difficult circumstances.
At our request, and in hopes of keeping Mike calm, the dentist called in a prescription for Valium. Because it would take an hour or so for the pill to take effect, Matt and I got to Green Hill about an hour before Mike’s appointment, gave him the Valium, and waited for it to start working. Marg was waiting for us in the dentist’s parking lot and helped us get a very groggy, unstable Mike on his feet and into the office. He stayed seated in the dental chair, mostly on the verge of sleep, while Dr. E examined his mouth, then, with the help of his assistant, took X-rays. Matt, Marg and I were on the job, anticipating a difficult time, but our fears were, luckily, not fulfilled. Thank the Goddess for Valium.
A word here about Valium and other anti-anxiety drugs. There were meds that could tamp down Mike’s combativeness, but they also caused him to be unsteady on his feet. Livia and Elena were opposed to those because, with Mike’s constant looping, the likelihood of a fall would be greatly increased. I knew they were concerned with Mike’s well-being, but they were also concerned about their reputation within the licensing bureaucracy. Falls in a facility raise red flags, and they definitely didn’t want red flags.
The immediate dental problem was an abscessed gum, for which Mike would be treated with an antibiotic. But his mouth was a mess, with seven or eight broken-off teeth, and his gums were highly susceptible to infection. We wanted only the most conservative treatment to minimize infection and to keep Mike pain free, but what would “conservative treatment” mean?
As much as I would have liked to continue having Mike be treated by our regular dentist, Dr. E did not take Medi-Cal patients, and private dental work was way beyond my means. Dr. E recommended a consultation with an oral surgeon, so I needed to find a Medi-Cal dentist who could then refer me to a Medi-Cal oral surgeon.
After Internet searches, checking reviews, making numerous phone calls complete with Press 1 for …, Press 2 for …, Press 3 for …,” then being held captive by static, tinny “music,” minutes had accumulated to hours that felt like days. Finally, though, I made an appointment with a dentist who, judging from Internet reviews, was the lesser of several evils.
On the day of our appointment, Dorin drove Mike down to the office in his van equipped with childproof doors. Marg and I met them in the parking lot of the new dentist’s building about 7:50 for the 8 o’clock appointment. Usually Mike would be doing anything possible to get out of the van, and one of us would have to walk some loop with him in the parking lot until the doors opened. That morning, though, he sat quietly in the van until we could get inside. The glories of Valium.
It turned out my fears about a Medi-Cal dentist were unfounded. The office was clean and cheerful. The staff understood our situation and got Mike set up with the dentist as quickly as they could, although “quickly as they could” wasn’t quick enough for Mike. Dorin and Marg took turns walking Mike up and down the outer hallway while I finished the necessary reams of paperwork.
Once seated in the dental chair, Mike needed some prompting to stay there but, unlike Valium-free times, that was easily managed. The dentist was gentle, thorough, and sympathetic to our situation. He agreed that we should do as little as possible and started the paperwork for referral to an oral surgeon, recommending extraction of only the tooth that was most prone to infection.
The front desk woman was knowledgeable about Medi-Cal dental benefits and walked us through what we might expect of coverage for oral surgery.
By the time we left, the Valium was wearing off, and Mike was on his way back to restlessness and anxiety. But it had worked long enough. I dreaded his having to go through the next process. He would undoubtedly have to be anesthetized. As helpful as the Valium was for brief visits, oral surgery would be a whole other affair.
What followed was another round of phones calls, scanning and emailing power of attorney documents to the next office, repeating ID numbers, birthdates, what I’d had for breakfast and Sunny’s maiden name. As tedious as this all sounds, it doesn’t begin to depict the reality of tediousness.
Our appointment with the Medi-Cal oral surgeon was more difficult than had been our experience with the referring Medi-Cal dentist. Despite being assured by phone that staff would get Mike in quickly, we had an hour-and-a-half wait. During that time Mike was up and down, out the door, walking past other offices, trying to get into other offices, coming back into the dentist’s office, leaning over the counter to look around, trying to get back to the treatment area, etc. Marg, Livia and I took turns walking with Mike, but it was an excruciatingly long and busy wait. When Mike finally got taken back to see the dentist, it took him all of five minutes to assess the situation. He felt it would be best to do the job with only a local anesthetic, with help from Valium. They would give Mike a 10:45 appointment, the first of the day, and get him right in so we could avoid the nerve-wracking wait.
The following week, a little before 10:45, Marg and I met Elena and Mike in the parking lot. Mike was somewhat subdued, having been given a Valium about 45 minutes before the scheduled extraction. Mike waited with Elena in her car while I checked to see if the dentist was ready for us. The front desk person gave me two forms to fill out, and took my cell phone number so she could call when the dentist was ready. I completed and waited for the phone call from the office. Mike was getting restless and, around 11 o’clock, I went back inside to check with the receptionist. She said the dentist was flying in from LA and should be there any time. She’d let me know.
At 11:30, after one or the other of us had completed many circles of the lot with Mike, 45 minutes after our “we’ll get him right in” appointment, the dentist still wasn’t there, nor had he been heard from. This was obviously not the oral surgeon for us. Mike’s tooth/gum had not been bothering him for the past few weeks. Marg and I had been questioning the necessity of putting Mike through such a procedure anyway. We gave it up.
Though we’d managed to sidestep oral surgery, it was impossible to sidestep nail-clipping issues. Livia and Dorin had managed to clip Mike’s fingernails and toenails days after he entered Green Hill back in October, but they’d had no success in future tries. By early February, the length and sharpness of Mike’s fingernails was a danger to himself and to anyone else around him. He had scratches, some open, on both arms. Elena also had scratches from Mike’s attempts to push her away during the course of daily hygiene necessities. After we endured several unsuccessful nail-clipping endeavors, Mike’s doctor prescribed trazodone to be taken half an hour or so before the next try.
In a bow to the prohibition against caregivers cutting nails, I joined Elena, Livia and Dorin around 8 o’clock one evening, scissors and nail clippers in hand. By that time, the trazodone should have taken effect. Livia and Dorin’s three sons were also there and the older boys entertained their baby brother while the adults got to work.
Mike had been in bed when I arrived, but he got up as soon as he saw me. He gave me a quick smile and started walking. I led him back to bed and suggested he stretch out. He did, for an instant, then tried to get up again. I sat on the bed in a position that made it difficult for Mike to get up.
My presence, with my nail-cutting tools, was mainly for show. I was more than happy that Livia, undoubtedly a more competent nail cutter than I, was on hand, complete with sterile gloves, cotton swabs, and alcohol.
Mike was definitely more relaxed under the influence of trazodone than he would otherwise have been, but “more relaxed” wasn’t exactly relaxed enough. I sat facing him, blocking his view, talking to him, rubbing his neck and shoulders while holding his upper right arm secure. Dorin, the strongest of the gathering, secured Mike’s lower arm, just above the wrist, in an attempt to keep him still enough for Elena to clip his nails. Elena stood beside the bed, reassuring Mike, or at least trying to, that we all
loved him and that no one would hurt him.
At the first attempt to clip a nail, Mike jerked his hand away. We all went on with reassurances. Another attempt. Another jerking away. That was the pattern for what seemed like hours but was probably more like 15 long minutes. Finally, the right hand completed, we shifted positions to secure the left hand, to block Mike’s view, and to continue our attempts at reassurance.
“Take a deep breath,” I said, as Elena retrieved Mike’s jerked away hand. In a doctor’s office, Mike would still take a deep breath at a doctor’s suggestion. However, my attempts to guide him into deep breathing fell short.
The toenails required another, more pronounced shift of positions. At one point Elena somehow ended up on my lap. Eventually the deed was done.
“All done, Mike,” I told him. “Okay?”
He smiled, nodded, got out of bed, and started a loop. He walked around for five or so minutes, then went back to bed.
As I was leaving, Elena, a nondrinker, suggested that vodka might be more effective and less extreme than trazodone. What did I think? I said I thought anything was worth a try—use their own best judgment. What I didn’t say was that I could hardly wait to get home to give myself a vodka treatment.
In my other world, I spoke at an English teacher’s conference about engaging reluctant readers with material of their liking. I never tire of mounting that soapbox, and the talk was well-received.
New Wind Publishing had a table in the exhibit hall where we hawked books and talked with teachers, some of whom I’d known from years past. It was good to reconnect, and to be out in the broader world, especially since the weekend away had been free of emergency phone calls.
'til Death or Dementia Do Us Part Page 30
