On September 1, Jean and I went to a Care Conference for Betty and noticed that there were some significant changes in her. She no longer recognized me, she favored her left side, and then she started having falls.
On October 13, I went to a Care Conference for Grandma at Evergreen. Jean was out of town at a veterinary conference in Reno, Nevada and couldn't attend. While I was at the Care Conference, the staff discussed with me their concern about Betty because she'd been making a rapid decline. Most of this was because of her falls; she'd been having about two a week. As a matter of fact, she just had one Oct. 21. On one of her falls, she broke her bottom dentures. I asked the resident social worker Roger if he thought that there would be any benefit to Betty's way of living if we got new dentures for her. He didn't even hesitate to say no. The staff has moved Betty to a new room where she can be better monitored, but that doesn't stop Betty from trying to get out of bed when she wakes up. The staff recommended that I put her on hospice care.
To me this was not shocking news. Having studied a bit about Alzheimer's Disease, I recognized that once she started falling, she would probably make a rapid decline and then pass away. Alzheimer's patients can be obsessive walkers, which Betty is, and at some point, they forget how to walk. The combination can become fatal. It seemed that this was coming true for Betty. Based on what Evergreen was telling me and how fast someone can decline, I guessed that she only had another month to live.
I tried to get an appointment with Betty's doctor because he wanted to talk to Jean and me about some test results on Betty, but I was unable to that day because it was Wednesday and neither the doctor nor his nurse were in.
Thursday, Oct. 14, I called both Hospice Care and Rocky Mountain Hospice. Wow! There is certainly a difference in the companies! If anyone in the Livingston/Bozeman area wants a recommendation for a hospice company, I can easily recommend Rocky Moutain Hospice. We set up a meeting at Evergreen that day and talked about Betty's care for an hour and a half and then I signed their paperwork. We still needed Betty's doctor's orders to put Betty on hospice though.
I went back to Park Clinic and tried to make an appointment to see Betty's doctor. I had two errands now: Betty's test results and hospice care. His nurse, told me that he was "booked for the rest of the day and can't see you, and he's going out of town tomorrow and won't be back until next Thursday. Is that too late?" That was just about the stupidest question I had heard.
"I don't know," I replied, "Betty's going into hospice. When is too late?" Nothing was accomplished by talking to that nurse.
Rocky Mountain Hospice went to bat for me and found out that Betty's doctor was actually going to be back in town before he was actually supposed to be at work, so they were able to get the ball rolling. Betty was officially on hospice October 20, six days after we tried to get this done. Thank you Rocky Mountain Hospice!
Yesterday, October 21, Jean got a call at 2:30 pm asking us where we were because we were late for an appointment with Betty's doctor. I kid you not: I flew off the handle, especially at the Park Clinic employees, because Jean and I knew nothing about this appointment with her doctor, for which we would have gone to had we known about it. For real! I tried twice last week to make an appointment, in person! (Living in Gardiner means that we need to know at least an hour before an appointment so that we can drive to Livingston.)
I did get to talk to Betty's doctor, and explain all the road blocks I had been having trying to get in touch with him concerning both Betty's test results and hospice care. Her doctor is a good one, and he's always tried to help us out when he could, but I recently kept having obstacles in arranging an appointment to meet with him, and this was really the third strike.
Betty's test results showed that she had scarring in an aortic artery. That may or may not have any affect on her falling.
Also, tests were done on her vocal cords because she doesn't talk anymore. The doctor doesn't believe that the paralysis of her vocal cords is because of Alzheimer's; he believes there may be a tumor or other malady near her throat. All her life she's had thyroid problems, and I consider that this could be a result of that. The doctor doesn't believe that treating it would be in Betty's best interest, and I agree; one of the reasons I wanted to put Betty into hospice is because of problems that we can't fix without life-threatening solutions.
The doctor agreed to sign the orders for hospice because of our wishes, but doesn't necessarily believe that Betty is terminally ill. On the other hand, the nurse who did an exam of Betty for Rocky Mountain did believe that she qualified. Evergreen staff and Betty's social worker at Evergreen recommended hospice. I see Betty's rapid decline myself and know it's a really bad sign.
I hope that Betty gets better with the extra comfort-level attention that hospice can provide. Maybe she'll get out of this scenario. But if she does, I don't think she will live very long anyway because of the possible tumor and because after losing the ability to walk, Alzheimer's patients lose the ability to swallow.
I haven't been too close to Betty myself, so I hope I don't sound heartless in writing so dispassionately about her circumstances. Her decline is sad, but it doesn't affect me very personally.
My biggest goal in her care at the moment is making sure her immediate needs are taken care of. I think it's especially important now because of the possibility that she will soon die. Montanans want to die with dignity; it's even written in our constitution. I won't deny her that.
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