One of the many fun aspects of dealing with a very sick elderly parent with dementia is determining when to seek medical attention. It seems pretty straight forward...if a person is sick...you seek medical attention. Problem is in practice the whole business isnt so black and white. First you have to determine if the person is sick. In my mothers case this is no simple task. First you have to account for an assortment of disease processes...dementia...cardiovascular disease...breathing difficulties...cirrhosis...diabetes. And the try to figure out if something else besides is going on...and if it is as simple as a cold or bug...or if it is something more serious. The logical thing would be to ask the person. Even at her best my mother was a raging hypochondriac...she always said she was sick and that her illnesses were worse than anyone had ever had. She never seemed to notice that those who were really sick ended up dying, but whatever. Well, my mother is hardly at her best now. Dementia is not just a disease of the memory, but also destroys rationality...logic...even language. My mother is in no position to answer the question usefully, even if it were in her nature to be helpful. So...one does the next best thing...one observes. Walking...breathing...color of skin, lips, nail beds, mental coherence...that sort of thing. And you attempt to make the best judgement based on what you are seeing. Yesterday was one of those should I seek medical treatment days. I saw my mother in the morning and her breathing was labored. Her lips were blue. I was concerned. As she was walking as best she does these days and babbling incoherently...which is her norm...I decided to wait a bit...see how it plays out. Though I had formed a conclusion that medical intervention was necessary. The reason I waited...to get her to seek medical attention somewhat voluntarily would have required a huge argument...the results of which were by no means assured. The alternative would have been to call an ambulance and have her taken against her will. Neither is a pleasant prospect, and I wanted to be reasonable certain that the circumstances actually warranted such a step. I also have to keep in mind medical intervention would do nothing for the underlying conditions listed above. They all have their own degenerative trajectories. In the course of a few hours my mothers breathing improved a bit...and her lips were less blue. Granted a relative judgement because because her breathing is never great and her lips are always a bit blue. Not to mention she is always a bit yellow from the cirrhosis, the degree of yellowness varies, and that can complicate figuring out how blue her lips are. One also has to factor in one is never sure if one is seeing a new symptom, or if one is merely noticing a symptom now that has existed for some time but one hasnt noticed. Hard to tell after a while. So I decided against seeking medical intervention yesterday afternoon. I guessed...and it was nothing more than a guess based on experience...that the circumstances didnt immediately warrant it. Im not clairvoyant or omniscient...I made my best judgment. And I hoped for the best. Seeking medical treatment comes with its own risks. New medications will put even more strain on a liver that no longer functions as it should. Illness already exasperates dementia...putting such a person in a hospital inevitable causes decline in mental status which may or may no be recoverable if or when they emerge. In a hospital elderly people lay flat on their backs. Makes them more susceptible to pneumonia because they are not walking around. Makes them have to go to rehab to regain their ability to walk. Exposes someone like my mother to all sorts of illnesses she doesnt encounter because she very rarely leaves the house and has few visitors. Medical treatment has the potential to cause harm as well as good. None of this is occurring in a vacuum. All sorts of other things are going on at the same time. My health issues...my depression...my wifes health issues...our attempts to have some sort of life for ourselves. Other issues pertaining to my mother not directly related to her health. David and a range of issues to do with him. The person making such determinations is tired...he doesnt sleep a lot. Hes frustrated and honestly...I never had a particularly good relationship with my mother to begin with. So my experience...and I have a fair amount...is somewhat counterbalanced by the fact that I am not at my best these days. There are two things I try to keep in my mind as I make determinations as to seek medical treatment. First...the person I once knew...that others once knew...for all intensive purposes no longer exist. That person is gone. Very rarely I will see a faint shadow of the former self, but less and less as time goes on. Second...my mother has a number of degenerative processes going on. They arent fixable. Sooner or later she will die either directly or indirectly because of one or more of them. Neither I or any other human being can change either of those things. So I make determinations as best I can keeping those points in mind and in the knowledge that notions of right and wrong have long since evaporated. Victims of a long, difficult, often confusing situation where one can only do the best one can.
Posted on: Wed, 30 Oct 2013 17:23:04 +0000
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