A few weeks ago, I mentioned to a work colleague that my family had made it through an entire year without any calamities. No one had died. No one had any serious health issues. If I were a superstitious sort, I might have thought I’d jinxed us with that comment. (I also might not have filled my home with three lovely black cats.) As I mentioned in my last post, my mom’s assisted living sent her to the hospital on the evening of Wednesday December 10th. The AL nurse and the paramedics reported weakness on her right side and confusion. The ER doctor did not notice the weakness, but the confusion was evident. She was admitted and the ER doctor requested a neurological consult. Between the internist and the neurologist, they ordered an impressive array of testing: blood work, urine culture, CT scan, carotid Doppler, MRI of head and neck, EEG, EKG, and ultrasound of her legs (due to her history of DVT).
Over the next few days, mom’s cognition improved. When I was visiting on Saturday, I noticed mom listing to her right. Even though we had attempted to adjust her positioning, she continued to lean. She also complained of a stiff neck on the left side. After they brought her back from the MRI, however, she was sitting up straight and no longer kept leaning right. I wondered whether she actually had been sitting crooked, which had been corrected when they helped her back into bed after the MRI. Whatever had caused the leaning, like the weakness, it had mysteriously stopped.
By Monday December 15th, all the tests had come back negative. Yet, mom was still not where she was cognitively before whatever happened on December 10th had happened. (My research has led me to conclude she had a transient ischemic attack. But I’ve kept my armchair diagnosis to myself.) She also was very weak and unable to transfer or walk (using her rolling walker, as she had been). The hospital doctor issued orders for mom to spend some time at acute inpatient rehab before being released back to AL. This wasn’t exactly what she wanted to hear ten days before Christmas. Nor was it what her cat wanted to hear. When Jenny visited to check on him at mom’s AL apartment that day, he had pooped on the floor. This was an anomaly for mom’s cat. Clearly he was upset that his human had been gone for five days and would not be coming back as soon as he would have liked.
At intake, the rehab hospital case worker told me the average length of stay was five to eleven days. Eleven days would have her out the day after Christmas. I decided then and there that mom was not staying in a rehab hospital over Christmas, and that she would be leaving at latest on Christmas Eve. I imagined dressing up like a (black) cat burglar and busting her out in the dead of night. I didn’t mention my plan to the case worker (or to my mom) at the time, deciding instead to wait until I’d received news of the official plan.
Over the course of the week this week, mom improved steadily, both physically and cognitively. Conversations were less halting as she found words a bit more easily. She could distinguish between morning and evening. She became a bit spunkier, expressing irritation that they were making her do exercises for three hours a day. Not to mention the food was not as good as at AL and the other patients were unfriendly. I told her to work hard so she could make enough progress to get back home by Christmas Eve.
“Where’s home?” she asked me.
The question wasn’t born of confusion, but rather was philosophical. For over a year she hadn’t been living in the home she’d shared with my father for nearly thirty-five years. Initially she had considered AL a temporary stay–a transition between skilled nursing and her home. Yet as the dementia progressed, it was becoming evident she wouldn’t be going back to that house; at least not without full-time care. As the months spent in AL have accumulated, my mother seems to have had a shift, being less inclined to return to her house. A house now empty save the memories of my father.
“I don’t know where home is,” she said again.
“I think home now is where your cat is,” I told her. “Since your cat is at AL, that’s where your home is.”
“Okay,” she said, seemingly satisfied with my logic.
Even without my prodding her to work hard with the therapists, mom is motivated. She’s begun transferring on her own and walking with her rolling walker. At first it was only twenty feet, but by Friday, she’d hit one hundred. On Friday afternoon the rehab hospital’s case worker called me.
“We now have your mom’s discharge plan. She’ll be discharged on December 27th back to AL, and she’ll continue with therapy through home health.”
Did I call it, or what?
“I’m fairly certain that spending the holidays with her family will do her more good than a couple more days of inpatient physical therapy. Especially since therapy will be continuing outpatient. How about December 24th?,” I said.
“Okay, we will schedule her discharge for December 24th, with home therapy to begin on December 26th,” she answered.
The case worker did not hesitate in her agreement with a Christmas Eve discharge. Why they recommended December 27th to begin with seems, at best, idiotic. And at worst an attempt to keep their beds full during the holidays. Regardless, mom will be out of the rehab hospital in three days. Out of the hospital and back home with her cat.