Wednesday, 25 May 2016

Care Partner Wednesday--The Care Partner at the Hospital

I haven't spent a lot of my life in hospitals. I was born there, and sometimes around my third year of life, I had my tonsils out in a hospital. Each of my children arrived in one, and a few years ago, I got rid of a troublesome gall bladder there. Of course, that's just me.

The year Bill was sick, I spent more time in hospitals than I can count. It seemed every few weeks, another crisis led us back to the emergency room of a hospital, and inevitably, admission. Every night after work and full days on the weekends, I was there. I learned things and saw things and did things I hope never to repeat.

The day after Hunter and I were married, we travelled to a different hospital, where he had quadruple bypass surgery, and for the next several days, that hospital was home for me.

Being care partner to someone in hospital is a stretching, exhausting experience, and this is never more true than when the loved one is frail and elderly.

I would love to give you a list of tips to make this particular journey easier, but there are too many variables. The staff in some hospitals are wonderful and responsive. You ask for help and you get it. You want to contact the doctor and he calls you back or meets with you, and actually answers your questions. The food isn't even too bad. In other hospitals, staffed are rushed and overworked, or perhaps don't seem to care that much. Contacting the doctor is like playing an ongoing game of Where's Waldo. He can't be found. No one seems to know anything, or if they do, they're not telling.

Seared in my memory is one Saturday visit. Bill was admitted over a week ago to have a defibrillator inserted. He had been bumped a few times, and no one seemed to know when the surgery would happen. His appetite was increasingly poor, and he was weak. When I walked in, he was sitting in bed with a cup of coffee in his hand. In his weakened state, he had drifted off to sleep, and the coffee was everywhere--on his gown, on him and all over the bed. There was no staff to be found, so I got him up in a chair, washed him, found a new gown and sheets, made the bed and got him back into it. I kept a cheerful "this is no big deal" expression on my face, while I was crying inside to see my proud, intelligent husband neglected like this.

Paul Taylor recently wrote in the Globe and Mail about the problem of delirium in the elderly during hospital admission. "According to various studies, up to 25 percent of elderly patients develop delirium after being admitted to hospital... Symptoms vary and include having trouble paying attention, not making sense, restlessness and even hallucinations. Some patients may not recognise their own family members and become suspicious and hostile to those around them. Others are docile, withdrawn and can't seem to stay awake. Symptoms can also come and go over the course of a day."1

There are many reasons for this.

  • An unfamiliar environment with strangers everywhere asking questions and poking and prodding. 
  • If they are able to move, they aren't encouraged to do so.
  • "Don't eat or drink because you surgery is immanent." Except when you get bumped, but it might be tomorrow, so still don't eat or drink.
  • Many seniors are on a veritable stew of drugs, and often a few more are added in hospital. Sometimes the prescribing doctor doesn't have training in geriatrics and the unique way many drugs act in a frail elderly body.
When your elderly loved on is in hospital, you are their advocate. This is your primary role. Don't antagonise hospital staff unnecessarily, but there will be times you need to be firm. You need to know the plan of treatment. You need to talk to the doctor. You need to approve any new medication prescriptions. You need to ask your questions until you are satisfied.

The hospital, the doctors and nurses, the whole experience is not the enemy.  They are a tool to bring healing to your loved one.

Your job is to ensure the tool is working correctly.

1. How a disorienting hospital visit can lead to delirium, Paul Taylor, The Globe and Mail, May 3, 2016

Wednesday, 18 May 2016

Care Partner Wednesday--The Dilemma of the Hospital

The care partner's life is full of gut-wrenching decisions.

When and how do I tell my mother she can no longer drive?

How do I broach the subject of getting help for her?

The doctor said she isn't safe living alone--how do we have that conversation?

How do I even begin looking for a place for her where she's treated well and given the kind of care I want for my mother?

All of these are difficult topics. They require many conversations, as well as the wisdom and patience of several old testament characters. In the end, the care partner makes the best decision possible. It's never easy.

There is one decision, however, that has to be made with lightening speed, which is why it's helpful to think it though before the situation arises. It's when you hear the doctor say, "Your mother has to go to the hospital."

For many years, the words would no sooner be out of the doctor's mouth and you would hear the whine of the ambulance siren rounding the corner. There was no question. The doctor said go, so you went.

These days, that's not always the case. Care partners are wondering if the hospital is the best place for their elderly relative. And as in many decisions, there are times when the answer isn't clear. There can be nothing more devastating than knowing your loved one's life and comfort hangs in the balance and the decision is yours.

Let's look at some instances when going to the hospital was definitely the right decision:

Ruth was a frail elderly woman with osteoporosis. She walked with a walker. One day, while in the dining room, she turned to push in her chair and let go of her walker. She lost her balance and fell on her arm. Staff rushed to her aid, but because of the pain, were not able to lift her. Her arm was in extreme pain and her leg was lying at a strange angle.

The ambulance was called, and the paramedics were able to lift her off the floor through the use of a special stretcher. Ruth was sent to hospital and had surgery for a broken hip and elbow. It took months, but now Ruth is walking well and has regained almost full use of her arm.

Betty fell as well, in her bedroom, but got up again and seemed fine. The next day, however, she was experiencing severe pain in her hip and couldn't walk.

Betty had and x-ray at hospital and it was discovered she had bruising, but no fracture. In a few days, she was gingerly walking the halls, and by the next week, she was fine.

Hazel  was diagnosed with pneumonia, and was given an antibiotic. After a few days, she seemed to be getting worse. Drowsy and short of breath, the doctor recommended she be sent to hospital for IV antibiotics and oxygen therapy. Although in her nineties, Hazel was active and generally healthy, and had been lawn bowling the week before she got sick.

Hazel was sent to hospital, where she stayed for a week. The recommended treatments were successful, and after another week of rest at home, she began to lawn bowl again.

There are also times when a trip to the hospital is the wrong decision:

Over the last six months, Margie had increased trouble swallowing. Her diet had been changed to minced and then to pureed. Margie enjoyed her food, but hated the pureed diet. Then one day, she couldn't swallow even that. The doctor recommended sending her to hospital to get a feeding tube.

Margie's family struggled with the decision. She had several complicated medical issues, and it was evident that her organs were beginning to shut down. However, they weren't comfortable with letting that happen, so she had the feeding tube inserted. Over the next few months, she had multiple problems, as her body wasn't absorbing the nutrients it was being given. Finally, the family saw what this was doing to Margie. The feeding tube was removed and she passed away peacefully several days later with her family at her side.

Agnes is 102, but has all her cognitive abilities and is interested in others and life in general. She also has a skin cancer that is spreading in her leg. Her pain is well controlled, and every day the wound nurse dresses her leg. She enjoys going to the dining room and chatting with her friends, and sitting outside with the sun on her face. The wound nurse, however, has been strongly suggesting that she get treatment at the hospital for her leg. Agnes and her family had already decided not to do this, but with the wound nurses' continued insistence, Agnes is wondering if she made the right decision.

After talking again with the doctor, her family and other staff, Agnes was reassured. She concentrated on pain control and quality of life.

It's never an easy decision, and often not a clear one. Here are some questions to ask:

Will going to hospital increase quality of life or just prolong life?

Is it possible to go just for an assessment and return home?

What will be the probably outcome of whatever decision is made?

And here's an important consideration--what would your loved one want? If they aren't well enough to tell you, then consider conversations you've had in the past about this topic. If you've never discussed it, then find a way to do that.

"Sometimes the hardest thing and the right thing are the same thing." unknown

Keep the conversation going--have you ever had to make this kind of decision? What did you decide? Were you happy with your decision and the outcome?

Sunday, 15 May 2016

The Small Miracle of Leadership

I am not a natural leader. You know the type--charismatic, wise, interesting people who draw a crowd of followers wherever they go. That's not me.

I'm the one at the back of the crowd. I'm listening and processing what's being said, and perhaps making notes. I'm following slowly until I am sold on what the leader is saying, and then I will speak passionately about the same topic. But if the leader wants something done, I'm the first one in line. When I believe in something, I will work tirelessly to accomplish it.

For a long time, I didn't think I was a leader at all. Then I looked behind me.

There were people following. Wow.

Here is what I've learned about the style of leadership that fits who I am. I recently had a performance appraisal which asked about leadership and if I am a leader, and I waxed eloquent on the subject. (Good thing those little boxes expand when you are typing!)

Quoting myself: "I prefer the term 'servant leader.' A servant leader is someone who gets to know and is in tune with their team. If someone is having a bad day, they notice it and find out what is going on. The servant leader knows things about their team's lives and is interested them as people. They work together with their team, and is there to help and give support when needed. A servant leader has relationship with the team, and because of this they all (the leader and the team) work together.

However, the servant leader is also able to address issues if they come up, and hold the team members to the highest standard. There is an aspect of both strength and vulnerability. There are times (whether they feel like it or not) when the leader has to be strong and take a tough stance. There are also times when the servant leader needs to be vulnerable and open with the team, and let the team minister to them.

Am I all these things? I think I am growing in this. Strength and toughness doesn't come naturally to me, but I am learning to stand strong for the good of the team, the residents and our neighbourhood."

"You add value to people when you value them." John Maxwell

Over the years, I have many supervisors. Some made me nervous, and I never felt safe around them. Others micro-managed, so that I never felt trusted. A few left me to my own devices, and I didn't feel supported.

It's not easy to be a good leader. What I have found, though, is that the best leader pours into you, so that all the leadership qualities in you, stretch and grow. Under a good leader, you can become your best self--a servant leader. Today, right now, I have the privilege of serving under an excellent leader who is allowing me to grow into the leader God wants me to be.

I am thankful.

What about you? Let's keep the conversation going. What kinds of leader have been the most valuable to you, and which ones stunted your growth? How are you growing as a leader?

Wednesday, 4 May 2016

Care Partner Wednesday--Becoming invisible and how to avoid it.

I was sitting in my spot on the couch watching Midsomer Murders on Netflix. This episode involved a suspicious death at a retirement home. The main character's daughter had come to visit an elderly aunt, but had been charmed by another resident--a gentleman who must have been quite the rapscallion in his youth. As she is leaving, they chat, and he turns pensive. "You know what is the worst part of ageing?" he says to her.

He stares into the distance as he answers his own question. "You become invisible."

I wanted to turn off the program, as my interest in the murder had vanished. This man had just been incredibly profound, and I needed to think about it.


Having worked for so many years in an environment where seniors are valued, the comment jarred me. Yet it contained a lot of truth.

What does the world value? The easiest way to answer that question is to look at advertisements. What is being sold and what are we buying?  Looks, position, power. Smart people who are at the cutting edge of whatever new development is happening. Strength, fitness, fame. We value people who are at the top of their game.

Does that describe many elderly people you know?

The people I work with have wrinkles, sagging skin and marks on their faces that can't be erased by any cream bought at the drug store. They are retired, and although many of them still live vital and interesting lives, their contribution isn't something most of society values. For the most part, they wield little power in the traditional sense of the word. They aren't at the cutting edge or the top of anything. Most are frail, and fitness is measured in how much mobility they can maintain. Many of them made huge contributions to art, literature or business. They changed the world, but it was their world. Our world isn't all that interested.

If we let them, they too will become invisible, fading into the pages of history.


It is my job to find out who these amazing, interesting people are. What was their job? Did they do research in children's diseases, or did they raise incredible children? Did they write books, or travel and see awesome sights? Did they fight in wars, or live through indescribable horrors? Did they teach in a one room schoolhouse or learn in one? It is my privilege to ask these questions and find out who they are--not just who they were and what they did, but who those experiences turned them into. It is my privilege, and my responsibility.

It's yours, too.

In our elderly, we have depths of wisdom that we need. We need to know what they learned from living through a war, a depression, in a world that was difficult and frightening. What did they learn, and what can they teach me? Or you? They experienced all kinds of relationships. They made mistakes and learned from them. They are not perfect, but they are wise. Their wisdom is a commodity we can't let slip away.

What would happen if we did? Imagine if we lived our lives in the moment, chasing after the things that seem important--the fame, the money, the good looks etc. that I've already mentioned. Or maybe we're not that shallow, but we make our way forward with our own lives, and never ask the questions that matter to our elderly. We look after them and we love them, but we let them slip away without ever getting to know them. We don't value what is valuable until it is gone.

What would happen?

We would lose opportunity to be enriched. The depth of experiences, the funny stories, the lives well lived, would be gone. We would have missed the cream and be left with the skim milk of our lives.

We would become invisible.