On Monday I got the dreaded call from assisted living (AL): mom fell again. She had a big bump on the back of her head. The AL nurse feared her hip was broken. So this time, unlike the last time, I agreed to allow her to be taken to the ER to be checked out.
Jenny, long-time friend and employee of my father’s business, agreed to hold mom’s hand at the ER. Meanwhile, I googled things like:
- elderly dementia candidate for hip surgery
- prognosis elderly dementia hip surgery
- prognosis elderly broken hip forgo surgery
Fortunately, the x-rays and CT scans of her head, back, and hip all came back negative. But, not surprisingly, Mom has another UTI. Which is why she fell. They seem to be coming faster, now. She had the last one in March, just before her 80th birthday. Which means she’s gone just sixty days this time before another took hold. Each time another infection pops up, I wonder if this one is the one: Is this the one that will overcome her failing immune system and resist all antibiotics?
The emergency room doctor prescribed Bactrim and sent mom back to AL. Well, actually he wanted to send her to a rehab hospital, which I vetoed. Instead, I asked that therapy be ordered via home health. I don’t think my sister was happy with that plan. She’s more the treat-the-crap-out-of-her-irrespective-of-the-mental-toll mentality. I’m done with that. A tension is emerging between us.
So mom is back at AL, and the Bactrim isn’t working. Mom is progressively getting worse. She’s weak. Confused. She can’t walk. She can’t feed herself. The AL caregivers are overwhelmed. I hired a helper from a home health company. The culture should have been back yesterday from mom’s trip to the ER. We were anxious to get the results to know what antibiotic to switch her to. The sooner we get the right antibiotic in her, the hope is, she’ll start feeling better and the permanent effects will be less. As it turns out, the ER doctor did not order a urine culture. All of us (the home health nurse, the AL nurse, the physician’s assistant, and me) exclaimed in unison:
What the fuck?
OK, maybe I was the only one who used those exact words, but the sentiment was the same with the others.
When we learned the ER doctor failed to order a culture, home health did so yesterday. And so we wait another seventy-two hours to learn which bacteria has invaded mom’s urinary tract this time, and which antibiotic is indicated. Since the oral Bactrim the ER doctor prescribed clearly isn’t helping, the physician’s assistant ordered injectable Rocephin, which did the trick in March, and one other broad-spectrum antibiotic, while we await the results.
The physician’s assistant called me last night with an update. She sounded down. Discouraged. She told me the infection has hit mom hard. Much harder than past UTIs have. She brought up hospice. I asked her if it was time. She said we should wait for the culture and find out which antibiotic is indicated. But it could be mom now has an antibiotic-resistant UTI that will require a hospital stay, perhaps weeks of antibiotic therapy, and then a several-week stay at a rehab hospital. So the question may become, do we put mom through all that, or call hospice and let nature take its course?
I know what my sister would do. Treat treat treat. But what is best for mom? Do we keep putting mom through hospital stays and follow-up stints at rehab hospitals? Do we keep taking her away from the comfort and familiarity of her AL apartment? Not to mention away from her cat, which is her only consistent pleasure. When do you say, stop? Enough?
We’re in a gray area. Dementia. Diabetes. And chronic infections. All slowly and inexorably pushing mom toward the end of her life. When do you stop treating the infections in an attempt to keep her here a bit longer? When do you stop putting her through the stress of hospitalizations? And even if the treatment is successful, to what end? A few more months of doing OK, until the next infection hits? What is best for mom? Hospitalize her and pump her full of antibiotics? Or call hospice?
I’ll leave for Houston a little later today. I’ll spend time with mom this afternoon, and throughout the weekend. Maybe I’ll find an opportunity, a moment of clarity, to ask mom what she wants. I wish she could tell me. Three years ago, after my dad died, mom said she didn’t want to go on living without him. My sister got angry with her. I wonder if she’d get angry with mom if she told us she’s ready to die now.