pills 2

This morning is the 6th day of a 7-day course of anti-biotics that Mum has been taking.*

As I've previously described, before leaving Mum on Wednesday I wrote the appropriate day on each blister in the pack, wrote an instruction on the box for Mum to wait until I call before taking a pill, and I've called twice a day since. It has been, nevertheless, hell every single day, with Mum totally unable to confirm what's been taken or remains to be taken. By Day 6, I would hope some routine to have been established but this morning Mum gave me to understand firstly that she'd already taken both pills for today already (though she couldn't say when) and then that she still had yesterday's AND today's pills to take.

I instructed Mum to take the pack to the Warden and get him to ring me. He told me that today's pills are still there, but that Mum missed both pills on Thursday and one yesterday. I wonder what it was that she audibly glugged down over the phone last night?

What hope do I have to help Mum when she can't follow simple instructions? Do I need to tell the Surgery to hospitalise her the next time there's a course of medication to be taken?


(*or not taking)

envelope

A tax form arrived over the weekend, which I asked Mum to post up to me. She told me that she would have to ask the Warden for an envelope. I questioned this, since I'd left a pack of 50 envelopes in her desk drawer, but she was adamant that this form wouldn't fit in them and she insisted that the form wouldn't fold. I could tell from her reaction that she had not tried these envelopes, indeed she had forgotten that she had them. I'm curious to see this form, which is evidently printed on a large piece of steel.

This morning, Mum called me to ask for my address. Now we had this problem about 2 years ago where Mum misaddressed a couple of items of mail, only one of which arrived. Back then it would take us about 6 extremely tearful and draining attempts to dictate my address successfully, so I sent her a large laminated card with my address on it, which she has used since. It looks now that she has forgotten all about this. We struggled through my address again, falling on all the familiar fences ('Avenue' versus 'Road', 'S' versus 'F' in the postal code). She read her effort out to me in a variety of versions, only to complain that it was all written on the top corner of the one envelope that she'd taken from the Warden and it was spoiled now...

pills

It's evening, and I ring Mum to tell her to take her second anti-biotic of the day.
"It's okay, I've taken them already."
"Them? What do you mean 'Them'?"
"All of them. I've taken all of my pills already."
I calculate quickly - that would mean that Mum's taken at least 8 strong anti-biotic tablets in one day. I don't know how your heart can sink while it's leaping into your mouth, but my heart has been showing off lately. I'm wondering who I should call about this, because I imagine it could have serious medical consequences, when it occurs to me what might have happened.
"Mum.... can you look at the strip of pills that you've taken, please?"
"It's gone. I've taken them all."
"Do you mean that the box is empty?"
"Yes."
"Is it possible that the strip is somewhere else in the flat?"
I get her to look. She finds the strip. The pills are not all taken. We take some 10 minutes to establish which ones are gone, despite my care to label each and every one by the day it should be taken. After I've listened to Mum swallow her 'Sat PM' pill, I say my goodnight.
"Are you ringing tomorrow morning, then?" Mum asks.
"Yes." I answer, thinking how we are on the fourth day of a week's pill-taking, and how each day's pills are a fresh new challenge.

complications

I call the Warden of the flats to let him know my progress with one of the issues I’m dealing with for Mum. He has news for me regarding Mum. Apparently, she headed off down to the Vet this morning after all, then came back 2 minutes later in some confusion without her front door key, and asked him to ring for an appointment. He rang the surgery and made an appointment for her, found the front door key in the front door of the development and took her back to her flat. 5 minutes later she was back, with her shopping trolley and saying that she was going shopping. When she returned she had no shopping with her, and no key. She explained that she had gone to the Vet and made an appointment in person. The key turned up inside her flat, which was unlocked. The Warden says her mental state is markedly declined since yesterday.

medications

The phone rings. Early. I’m exhausted from my 9-hour road trip home yesterday, so I’m a little groggy at first. It’s Mum, naturally.
“Well you can guess where I was”
“Hello Mum. Where were you?”
“On the toilet”
“….Okay.. why have you rung me up to tell me that?”
“….Oh…er…”
I can picture her looking around for clues to why she has called. She hits on one that makes sense to her – I can hear it in her voice.
“Because these tablets say ‘G will ring you when it’s time to take one’ “
“Yes Mum, but I haven’t rung you yet, have I?”
At this point, I anticipate Mum will change the subject to avoid embarrassment.
“Well, I’d better get off. I’m taking the dog down to the Vets about her ears.”
“Mum, I thought she went to the Vet yesterday?”
“No.”
“Mum, I was there when the Dog Groom lady took her for you. She came back with some drops for the dog’s ears.”
“Yes, I’ve got some drops for her ears here.”
“Well then she’s already been to the Vet. Now, since you’ve called me I’ll get you to have your first pill of the day.”
I can hear the unwillingness on Mum’s end. This is just too much for her right now.
“Mum, the box of pills is right by the phone. Can you see it?” (I’d hope so since she’s just read the label I put on the side of the box)
“Yes”
“Get the pills out of the box…. Do you see that 2 have been taken already? … Do you see that the next 2 have “Thu” written on them? …. Take one of those 2”
I end the call quickly before she can be distracted.

I can’t work out which is more stressful and infuriating: trying to help down the phone or in person.

2nd visit overview

I had thought that this second visit would pass more smoothly, since we achieved so much in the last week I was down about a fortnight ago. However, Mum seems to have degenerated further.

I find that she’s been put on anti-biotics for a foot infection (she hasn’t been cleaning properly between her toes), and she isn’t able to remember to take the tablets. She’ll angrily claim that she’s taken 6 that morning when she’s only meant to have taken one and there are the same number of tablets that there were last night.

Mum is constantly telling me “You’ve said that before, of course” when we’re talking. This reminds me of a road-trip we took 5 years ago, where we would have massive arguments whenever she insisted we had been on a particular French street the day before, even though she acknowledged that we had started that day 300 miles away in anther place entirely.

Each morning, when I’m at breakfast, Mum will glance down at my legs and criticize my running shorts, saying “We can’t go to the Doctors/Bank/Shops/Walk with you wearing those! You’d better buy yourself some long trousers.” This is despite the fact that I’ve been wearing long trousers every day this visit and the last.

Mum never never says “Thank you” to me once, even when I spend a whole evening cleaning her kitchen.

We watch television but she doesn’t understand the plots of the simplest dramas. After about 5 minutes of anything, I’ll find that she has fallen asleep hunched forward in her chair.

I test Mum this evening, after a full day which has involved 3 visits to the Doctor’s Surgery and much fussing around her. I ask Mum if she’s taken the dog out for a walk today.
“Yes, of course!” she says.
I ask her to tell me where she took the dog, and she describes the whole route.
Of course, I was with Mum all day and we neither of us took the dog for a walk. This confirms my suspicions about all the times she’s told me over the phone that the dog has had a walk that day.

stomach pain

After giving about 6 big vials of blood at the Surgery this morning, Mum wants to go out for lunch to this particular restaurant. We get there and Mum is 2 bites into a rather expensive roast salmon when she winces and cries out a little. She tells me that she has a sharp stomach pain. She experiences a few more twinges and I notice that she's not eating any more. I ask her if she'd like to leave. She would.

On the way back to the village, I ask if her preferred stomach medication would deal with the pain, but Mum says no. I divert to the Doctor's Surgery, only to find it closed for the afternoon "for training". We ring the emergency number, but the Doctor on the end of the line is reluctant to offer any treatment since Mum is unable to give a consistent history. We make an appointment for Mum's surgery after 5pm, when the training is over. At home, I find that Mum's 'Gaviscon' settles her almost at once.

Shortly before 5, I stir Mum from her slumbers in front of the television to tell her that we need to leave for the surgery.
"Why?" She can't remember the pain now.

We see a different Doctor today. She is warm and funny. I do most of the talking at first, mentioning Mum's previous problems with constipation. Mum is adamant that the pain was from her stomach and not her bowels (she remembers it now!). The Doctor asks for a urine sample and uses a testing strip which instantly tells her that Mum has a bladder infection.

Interestingly enough, it turns out that a bladder infection can cause memory problems, according to the Doctor.
"And there was me thinking your brains were dribbling out of your ears!" I say to Mum on the way out.

a trip to the seaside

Mum has been saying for months that I should take her out for day-trips when I come down, but she has shown little enthusiasm since I’ve been here on this visit. I decide that we should drive to the coast (about 25 minutes away) and have lunch down there. I pick a town I know to be on flat terrain, and which I know is less bustling than others, and we set off. At the seaside, Mum shows no interest in the views, the pleasant surroundings, or in anything at all. There are a good selection of cafés and restaurants and I ask Mum what she’d like to eat. I see her scan the shop fronts in view. She starts reading out notices and store names that she can see. I step in front of her and ask her to think what she would like to eat and say that we’ll find a place that serves it. She can’t think of anything she’d like.
I suggest “Fish and Chips” and she pulls a face.
“Oh no, I don’t like Fish and Chips.”
“That’s odd, Mum, because you told me a couple of days ago that you hadn’t been able to have Fish and Chips for ages and that you loved it. You certainly tucked into your Fish and Chips on that day!”
“Yes, I’d like some Fish and Chips”, she says.

After our meal and an ice cream which turns into an ordeal of keeping the drips off Mum’s clothes, we wander back to the car via some shops, buying Mum a gold watch, some items from the chemist and some clothing. In Marks & Spencer, Mum can’t find her size on a rack of clothing. I ask her what size she’s looking for and she says “12”. I help her to see the many many size 12 items right in front of her. Clutching them to her breast, she looks vacant for a moment and then says, “Perhaps we could ask an assistant?”
“What for, Mum?”
“Size 18, of course!”

I suggest that since Dad’s grave is nearby we should take that in on the way home. Mum agrees without any sign of interest. At the cemetery we haven’t walked a hundred yards before Mum says, “Shall we go back to the car now?”
“Mum, we haven’t got to where Dad is buried, we haven’t seen the tree that you planted or the memorial stone you paid for.”
Mum says she’s going back to find a toilet, and I wander on feeling a little aggrieved that she’s not interested in being here when I thought I was here for her.

On the journey home, I ask Mum what her wishes are regarding her funeral and burial, assuming she will say she wants to be placed with Dad. She tells me that she has no idea.

doctor's quiz

It’s been 6 months since I wrote to Mum’s Doctor about my concerns, and I’m fairly sure nothing has been followed up. I make an appointment and drive her over. At the Surgery, Mum is well-behaved and doesn’t interject much as I list a few of my more recent observations and concerns. The Doctor pulls out a sheet of paper and starts asking Mum some questions. First off, he asks her to remember 3 words: “candle, ball, shoe.” Then the questions begin:
“What day of the week is it?”
She can’t tell him.
“What month is it now?”
She thinks it might be August.
“And what season is August in?”
“It’s late Spring, at the beginning of Summer.”
The Doctor concedes that this year, particularly, it’s been hard to judge what season we’ve been in.
Next he asks Mum to subtract 7 from 100 and keep going. He offers “93” as the first answer.
“93….er…89….er….87?… er 82?”
The Doctor points to his watch and pen and Mum identifies them correctly. He asks her the name of the village she lives in and whether she knows where she is now. Both are answered correctly, with a touch of indignation. He then asks her to copy a drawing of 2 intersecting irregular polygons. For some reason, Mum feels that she’s completed her copy when she’s only drawn one of the polygons. Finally, Mum is asked if she remembers the 3 words the Doctor gave her at the beginning. She can recall only “candle”.

The Doctor sits back and tots up Mum’s score. I’m feeling a mixture of emotions: anxiety and shame mixed with a surprising relief that the Doctor finally has witnessed a little bit of Mum’s problem. While she’s still normal on some areas, there are others (numbers particularly) where her capacity is gone. I picture her brain like a Swiss cheese.

The Doctor decides to refer Mum to a specialist Elderly Psychiatric team who can analyse her in more detail and possibly prescribe drugs that might help. They will also be able to refer Mum to specific Council services. The Doctor also wants to take some blood tests, and we set an appointment the next day for blood to be taken.

Finally, I ask whether I need the Doctor’s referral to get Mum a “meals-on-wheels” service. He thinks not and gives me a leaflet on the local volunteer service.

2 minute call

I arrive home to a message on the answer machine. It's from Mum. She talks about how she's had a phone call from a relative and how she told her all about me and what's going on (I dread to think what sort of garbled message she passed on). Then how she went to see D (the Warden) this morning and sat outside his office door to talk to him and how he made her a cup of tea and gave her a biscuit and how special it made her feel. She ended the call by saying, "anyway, I'll get off now, so good-bye.........oh....hello?....hello? ooo [piqued]"

It dawns on me that, in the time it took her to leave the message, Mum forgot that she was talking to an answer machine, and was somewhat surprised and indignant not to get a "good-bye" from me at the end. Suddenly the 16 messages left on my machine a couple of weeks back make sense to me. The reason she was increasingly angry and kept calling out "hello" and asking "Why won't you talk to me?" that day was that she had forgotten that she was talking to a machine.

By my calculation, that puts Mum's short-term memory around one or two minutes.

support

I rang Mum a couple of days ago to let her know that I was coming down again this week (on Thursday). Naturally, she rang me yesterday and this morning under the impression that I was about to arrive. This morning's call was a request to bring toilet roll with me. How she thought I would arrive in time when she was talking to me on my home phone is beyond me.

She had been hobbling pretty badly when I was down there just over a week ago. It turns out that her Chiropodist saw her yesterday and announced that she had an infection in her foot which required the Doctor to come out. She was told to stay in her flat until the visit, so that's why she was calling me about the toilet paper.

I called D, the Warden, to ask if he could help, but he told me that Mum has been taking toilet rolls from the guest toilet in the block for months now. As she never remembers to replace them, he was unwilling to facilitate her any further. I'll have to buy a massive quantity when I'm down with her. I'm getting the impression that Mum has been leaning a little too hard on those around her.

We got to talking about Mum's ability to feed herself. We're in agreement that she's not managing. I raised the idea of arranging meals-on-wheels for her, but D informed me that (these days) this is something you need a GP referral for, and even then this is only offered on a temporary basis to those who have been recently discharged from hospital. Apparently the frozen meals service I've already instituted is meant to fill in, but I know that the cooking instructions are beyond Mum.

It looks like Mum needs to go into a Care Home sooner rather than later.