Or: “How I've spent the last couple weeks”
Also: “Occupational therapy for a writer who's never had to be a grownup before”
(Maybe normal parents don't write letters like this, but my daughter's always thrived on learning the facts about scary problems so that she can work through all the alternatives. She worries less when she knows what could happen and what to do about it. She's a NROTC midshipman studying to be a fourth-generation engineer, and she might follow me into the submarine force.)
Honey,
Let me tell you what's going on with Grandpa. He's fine so far and he has a long-term plan.
The surgeon says that Grandpa made an amazingly quick recovery from the hole in his duodenum. For the last month at least, maybe longer, Grandpa's failing memory has mired him in his usual habits without him realizing their potential harm. He's preferred to live alone for nearly 25 years since Grandma died, and until now he was fine. For the last 18 months, though, he's been waging a fierce battle to live independently. He's struggled to keep track of whether he's done something, and he's told me that he spent a lot of effort making sure that he shut off the coffeepot or paid his bills. He managed to cope with these memory problems through 2010 but it all went downhill rapidly in February. He says he used to do his chores in the morning and then go hiking. Well, he hasn't been hiking since January and he says that during last month his chores were taking him all day. He didn't even celebrate his 77th birthday.
What his memory problems also meant was that he was eating breakfast every day (usually bacon & eggs with cantaloupe) and lunch (ham & cheese sandwich) but not dinner. When I visited him in December 2009 he had a fridge/freezer full of food and he was cooking all his meals with no problems, although he couldn't remember where he stored the plates. But last month, even though he did his grocery shopping a couple days before he went into the hospital, he only had breakfast & lunch food in the fridge. The freezer was empty. No dinner ingredients or even your favorite frozen burritos.
The nutrition problem was exacerbated by his lifelong habit of having a drink before dinner. He's always been good about that and I've never seen him drunk. In December 2009 I noticed that he'd nurse a glass of scotch & water for most of the afternoon. However starting a couple weeks ago I think he just couldn't remember how much he'd had, didn't feel hungry for dinner (with those alcohol calories) and then kept drinking in front of the TV until he eventually fell asleep through next morning.
The combination of malnutrition and alcohol can dissolve the mucous lining of the stomach and the duodenum, and digestion uses hydrochloric acid with a strong pH. Grandpa's neighbor told me the next part of the story. One night two weeks ago, the alcohol and digestive acids ate through Grandpa's duodenum and started leaking air/alcohol into his abdominal cavity. He awoke at 11 PM in severe pain and was leaving the apartment (in his pajamas) to drive his SUV to the ER. His neighbor (who lived next door for two years but had never actually met him until that night) was coming home
and saw him. Grandpa said he thought he was having a heart attack and the neighbor drove him to the ER. The neighbor saved Grandpa's life and maybe the lives of a bunch of other people on the road that night.
The ER doctor said he spent an hour trying to figure out the heart attack (there wasn't one), and then looked for a pulmonary embolism or a tumor. Grandpa was progressively more incoherent (and in a lot of pain) and wasn't exactly laying still as they tried to do a whole-body CAT scan. When they finally found the image of the air & fluids leaking out of his duodenum, he was almost out of time and the surgeon had to move fast.
The surgery was pretty cool, unless of course you're the patient. The surgeon sliced a six-inch hole from Grandpa's ribcage to his navel. He separated a strip of his omentum and wrapped it around the duodenum to seal the hole (like duct tape), then stitched it down. The omentum has its own blood supply and will nourish the duodenum wall to help the hole heal on its own. Then the surgeon “irrigated” Grandpa's abdominal cavity with a gallon of saline solution to clean & sterilize it. He used subcutaneous dissolving stitches to close the incision he'd made through Grandpa's abdominal muscles and his skin (the stitches will be absorbed in a month or so), and then stapled the incision shut. Grandpa was on Dilaudid for a couple days, and on antibiotics for a week to prevent any lurking infection. 10 days later his incision has healed, the staples are out, and he has no pain. He's eating solid food (although he's not eating a lot) and his digestion is normal. He was walking well when we left the hospital. Unfortunately his muscles have atrophied and he has little endurance, but he'll be working on that for several weeks. If there's anything tougher than your NROTC Marine gunny sergeant, it's a rehab facility's physical therapist. I'll choose the Gunny any day.
So now you have a few more graphic stories to tell your dorm's partyers why you choose not to drink. As for me, even a couple of beers these days can disrupt my sleep-- and now I'm thinking real hard about whether I ever want to drink alcohol again. Too many new negative associations.
After a week Grandpa was as eager to leave the hospital as the surgeon was eager for him to start rehab, so they didn't do much testing on his cognition. However the surgeon noted that both Grandpa's short-term and long-term memory are failing. This is considered to be more of a symptom of Alzheimer's than of vascular dementia. In the next few weeks the psychiatrists and neurologists will try to make a better diagnosis and prescribe medications to help combat the symptoms. There's no cure for either condition but there are ways to delay its progress.
The doctor told Grandpa that he wasn't ready to go back to independent living and recommended a skilled nursing facility in the city (to be near my brother) while completing a few weeks of physical therapy. (The doctor and I planned this discussion with the help an elder-care lawyer and a geriatric care manager. Then we all spoke our lines for the dialogue with Grandpa.) We decided that I'd drive Grandpa the 250 miles in his SUV and check him into the rehab facility for your uncle to take charge.
I got to the hospital yesterday at 7 AM to find Grandpa eager, packed, & ready for a road trip. What with all the discharge paperwork and the nurses hugging him goodbye, we didn't get going until nearly 9 AM. I'd packed his warm coat and extra clothes plus some of the apartment-- photos of Grandma and you, his daily-reminder calendars, a file folder of old letters and his 50th high-school reunion, a memo pad & pen, his calculator, and the afghan that his mother had knitted him in the 1930s. They all turned out to be a hit. I'd also packed a couple sandwiches & fruit with bottled water. He left the hospital without eating breakfast and didn't seem to be very hungry but by 11:30 he was willing to eat a sandwich. He was more interested in the water and didn't want to stop for a bathroom, let alone a Big Mac, so we made the drive in just over 3.5 hours.
The driving weather was mostly sunny and in the 30s. The mountain pass (elevation 10,600 feet) was 20 degrees and piled high with snowdrifts from plowing Monday's storm. It was sloppy & wet around there, no ice, but I used half the windshield-washer tank in 20 miles. (The rear window was covered with road mud.) The highway actually goes close enough to the resorts to see the skiers... Grandpa and I kept joking about "You go ahead, I'll wait in the car." The car drove pretty well and we just kept barreling ahead. We really enjoyed talking about the scenery and about his future. It's the best time I've spent with him since he visited us over a decade ago.
The skilled nursing facility is a good place with a tough job. It's a 1950s brick single-story building that's seen a lot of hard use (and some remodels) but it's keeping up appearances. It's tucked away in an older residential section of the city. Lots of nurses and physical therapists and a good admin staff were waiting to greet us at the door. (That was a big relief. I'd been worrying about “You know what, Mr. Nords, we're not quite ready...”) Grandpa's in a semi-private room with more space than his private hospital room (more space than your dorm room, too), and there are plenty of staff around. Instead of hospital quiet it's more bustling and a bit chaotic. There were three friendly “therapeutic care” dogs wandering the halls and making their rounds of their favorite patients. The admin staff went through the charade of explaining the 93-page "Welcome Aboard" package and getting his signature. (It's really just a good conversational technique to make sure he understood "the rules" and the schedule, and to learn more of his life/family/medical history.) While we were talking I brought in his luggage, hung some pictures on the wall, taped his “reminder” calendars on the wall, and put a few thing away. He can tackle the rest.
After they finished check-in, the senior nurse introduced herself and then the head doctor came in to learn more. Uncle had toured the place the day before and told me that the street sign was in hangul as well as in English, so I wore our dojang's taekwondo t-shirt. When the doctor (also Korean) saw my t-shirt he immediately hit it off with me. Literally-- a single chest-high punch, but he pulled it before making contact. When I said you and I had been training for seven years and had our black belts, Grandpa was IN with the man. So I did my situational-awareness good deed of the day. The facility even let us leave the SUV in their parking lot until Grandpa agrees that your uncle will take better care of it in his own driveway.
The senior nurse estimates 3-6 weeks of physical/occupational therapy. Compared to most of the other patients, Grandpa is in good shape. He's mobile and flexible and he's almost healed. They'll also assess his mental condition-- part of that will include psychiatric testing (the "mini-mental exam") and neurological tests before deciding on medication. He has an option to move to a private room when one opens up (in a week or two) and if he wants to he can stay there after completing rehab. But I kept telling him that this is where he'd stay while he and your uncle toured assisted-living places until Grandpa decided where he wanted to live. I managed to break the news that he wasn't going back to the town where he'd lived for over a decade, and he agreed that he'd rather be safe and have help and be near Uncle. Grandpa was really more concerned about breaking the apartment lease than about going back to the town. But tomorrow's another Groundhog Day and I hope he can remember enough to not worry about the future. Uncle's going to help him write reminder notes to himself and tape them on the wall by his bed.
After Grandpa got settled I said my goodbyes and caught a taxi to the airport. I made the next flight to his town and was in bed by 9 PM. I had my first full night of sleep in over a week.
I've taken care of Grandpa's mail and his 2010 tax return and caught up on his bills. Meanwhile your uncle (and the lawyer and the care manager) are going to petition the city courts to be appointed as Grandpa's guardian, and then Uncle's going to delegate Grandpa's finances to me. Uncle and the care manager will also work with Grandpa to find the assisted-living facility where he wants to spend the rest of his life. Somewhere in the next few months your uncle and I will return to town to take care of Grandpa's possessions and shut down his apartment.
No worries about Grandpa's finances. He has his Westinghouse pension and Social Security. Medicare paid for the hospital and will pay another 2-3 months of the rehab. The facility charges about $7000/month (!!) but after the Medicare stops then his long-term care insurance will kick in. It'll be several years before the Medicare and insurance benefits are used up. He also has equity mutual funds with Fidelity earning dividends & interest. So by the time he's using his own funds he'll be able to cover the remaining expense for at least a decade.
I have to admit that this was one of the toughest weeks of my life. I've had tough days, like the Mount Pinatubo eruption or our black belt test, and I've had tough months in college or “on station” with my submarines. But last week I needed to call on every bit of stamina and vigilance and patience that I've learned from those experiences. I got real tired of being the grownup but I had to press on.
You're welcome to visit Grandpa anytime; Mom & I will be happy to pay your airfare and you could probably stay with your uncle. But you shouldn't feel obligated to do so. Although Grandpa will be happy to visit with you, he won't recognize you or remember you. The Grandpa you know is gone. Seeing your first rehab facility will be a pretty intense experience at any age, let alone at your age. I only visited my grandfather twice in all the years he was in his care facility, only because I felt I should, and it was a mistake. You shouldn't feel obligated to visit Grandpa unless you're curious about his current life, and you won't need to visit him to prepare yourself for dealing with Mom or me someday. (We Baby Boomers are going to fix this whole care-facility situation in the next 30 years.) If I were you then I'd choose to keep my old memories of Grandpa without bringing in any new ones. I'll send you the photo I took of him when we hiked the national park in Dec 2009.
If you're like me then you may be viewing the male side of your family genetic inheritance with some concern, perhaps even with alarm. You probably remember my stories of how much Grandpa was bagged with his father's tax returns and the apartment cleanup. The good news is that Grandpa used every bit of his engineering training to live independently for as long as he possibly could. He kept this apartment spotless (far neater than I've ever seen your bedroom!) and it was filled with calendars and memos and other reminders that he used every day. His filing system was flawlessly organized with every bill annotated for the check written and the date the payment was mailed. Grandpa even managed to complete his 2009 tax returns. He said he was going to use a tax service this year so the 2010 dividend reports and other forms were all filed and ready for me to enter into the software. It took me very little time to get a handle on what was going on in his apartment and to pick up the pieces. I suspect that if I get to that point in my life (at least 40 or 50 years, hopefully never!) then your mother and you will have no problems with my turnover.
However I'm a bit concerned about one of your mother's comments. She's promised me that she'll have an extra-special surprise tucked into my 82nd birthday cake for me when I attempt to blow out the candles, and that she's just going to duck down behind the counter for a second. Maybe you'd rather skip that particular celebration... Love,
– Dad
Also: “Occupational therapy for a writer who's never had to be a grownup before”
(Maybe normal parents don't write letters like this, but my daughter's always thrived on learning the facts about scary problems so that she can work through all the alternatives. She worries less when she knows what could happen and what to do about it. She's a NROTC midshipman studying to be a fourth-generation engineer, and she might follow me into the submarine force.)
Honey,
Let me tell you what's going on with Grandpa. He's fine so far and he has a long-term plan.
The surgeon says that Grandpa made an amazingly quick recovery from the hole in his duodenum. For the last month at least, maybe longer, Grandpa's failing memory has mired him in his usual habits without him realizing their potential harm. He's preferred to live alone for nearly 25 years since Grandma died, and until now he was fine. For the last 18 months, though, he's been waging a fierce battle to live independently. He's struggled to keep track of whether he's done something, and he's told me that he spent a lot of effort making sure that he shut off the coffeepot or paid his bills. He managed to cope with these memory problems through 2010 but it all went downhill rapidly in February. He says he used to do his chores in the morning and then go hiking. Well, he hasn't been hiking since January and he says that during last month his chores were taking him all day. He didn't even celebrate his 77th birthday.
What his memory problems also meant was that he was eating breakfast every day (usually bacon & eggs with cantaloupe) and lunch (ham & cheese sandwich) but not dinner. When I visited him in December 2009 he had a fridge/freezer full of food and he was cooking all his meals with no problems, although he couldn't remember where he stored the plates. But last month, even though he did his grocery shopping a couple days before he went into the hospital, he only had breakfast & lunch food in the fridge. The freezer was empty. No dinner ingredients or even your favorite frozen burritos.
The nutrition problem was exacerbated by his lifelong habit of having a drink before dinner. He's always been good about that and I've never seen him drunk. In December 2009 I noticed that he'd nurse a glass of scotch & water for most of the afternoon. However starting a couple weeks ago I think he just couldn't remember how much he'd had, didn't feel hungry for dinner (with those alcohol calories) and then kept drinking in front of the TV until he eventually fell asleep through next morning.
The combination of malnutrition and alcohol can dissolve the mucous lining of the stomach and the duodenum, and digestion uses hydrochloric acid with a strong pH. Grandpa's neighbor told me the next part of the story. One night two weeks ago, the alcohol and digestive acids ate through Grandpa's duodenum and started leaking air/alcohol into his abdominal cavity. He awoke at 11 PM in severe pain and was leaving the apartment (in his pajamas) to drive his SUV to the ER. His neighbor (who lived next door for two years but had never actually met him until that night) was coming home
and saw him. Grandpa said he thought he was having a heart attack and the neighbor drove him to the ER. The neighbor saved Grandpa's life and maybe the lives of a bunch of other people on the road that night.
The ER doctor said he spent an hour trying to figure out the heart attack (there wasn't one), and then looked for a pulmonary embolism or a tumor. Grandpa was progressively more incoherent (and in a lot of pain) and wasn't exactly laying still as they tried to do a whole-body CAT scan. When they finally found the image of the air & fluids leaking out of his duodenum, he was almost out of time and the surgeon had to move fast.
The surgery was pretty cool, unless of course you're the patient. The surgeon sliced a six-inch hole from Grandpa's ribcage to his navel. He separated a strip of his omentum and wrapped it around the duodenum to seal the hole (like duct tape), then stitched it down. The omentum has its own blood supply and will nourish the duodenum wall to help the hole heal on its own. Then the surgeon “irrigated” Grandpa's abdominal cavity with a gallon of saline solution to clean & sterilize it. He used subcutaneous dissolving stitches to close the incision he'd made through Grandpa's abdominal muscles and his skin (the stitches will be absorbed in a month or so), and then stapled the incision shut. Grandpa was on Dilaudid for a couple days, and on antibiotics for a week to prevent any lurking infection. 10 days later his incision has healed, the staples are out, and he has no pain. He's eating solid food (although he's not eating a lot) and his digestion is normal. He was walking well when we left the hospital. Unfortunately his muscles have atrophied and he has little endurance, but he'll be working on that for several weeks. If there's anything tougher than your NROTC Marine gunny sergeant, it's a rehab facility's physical therapist. I'll choose the Gunny any day.
So now you have a few more graphic stories to tell your dorm's partyers why you choose not to drink. As for me, even a couple of beers these days can disrupt my sleep-- and now I'm thinking real hard about whether I ever want to drink alcohol again. Too many new negative associations.
After a week Grandpa was as eager to leave the hospital as the surgeon was eager for him to start rehab, so they didn't do much testing on his cognition. However the surgeon noted that both Grandpa's short-term and long-term memory are failing. This is considered to be more of a symptom of Alzheimer's than of vascular dementia. In the next few weeks the psychiatrists and neurologists will try to make a better diagnosis and prescribe medications to help combat the symptoms. There's no cure for either condition but there are ways to delay its progress.
The doctor told Grandpa that he wasn't ready to go back to independent living and recommended a skilled nursing facility in the city (to be near my brother) while completing a few weeks of physical therapy. (The doctor and I planned this discussion with the help an elder-care lawyer and a geriatric care manager. Then we all spoke our lines for the dialogue with Grandpa.) We decided that I'd drive Grandpa the 250 miles in his SUV and check him into the rehab facility for your uncle to take charge.
I got to the hospital yesterday at 7 AM to find Grandpa eager, packed, & ready for a road trip. What with all the discharge paperwork and the nurses hugging him goodbye, we didn't get going until nearly 9 AM. I'd packed his warm coat and extra clothes plus some of the apartment-- photos of Grandma and you, his daily-reminder calendars, a file folder of old letters and his 50th high-school reunion, a memo pad & pen, his calculator, and the afghan that his mother had knitted him in the 1930s. They all turned out to be a hit. I'd also packed a couple sandwiches & fruit with bottled water. He left the hospital without eating breakfast and didn't seem to be very hungry but by 11:30 he was willing to eat a sandwich. He was more interested in the water and didn't want to stop for a bathroom, let alone a Big Mac, so we made the drive in just over 3.5 hours.
The driving weather was mostly sunny and in the 30s. The mountain pass (elevation 10,600 feet) was 20 degrees and piled high with snowdrifts from plowing Monday's storm. It was sloppy & wet around there, no ice, but I used half the windshield-washer tank in 20 miles. (The rear window was covered with road mud.) The highway actually goes close enough to the resorts to see the skiers... Grandpa and I kept joking about "You go ahead, I'll wait in the car." The car drove pretty well and we just kept barreling ahead. We really enjoyed talking about the scenery and about his future. It's the best time I've spent with him since he visited us over a decade ago.
The skilled nursing facility is a good place with a tough job. It's a 1950s brick single-story building that's seen a lot of hard use (and some remodels) but it's keeping up appearances. It's tucked away in an older residential section of the city. Lots of nurses and physical therapists and a good admin staff were waiting to greet us at the door. (That was a big relief. I'd been worrying about “You know what, Mr. Nords, we're not quite ready...”) Grandpa's in a semi-private room with more space than his private hospital room (more space than your dorm room, too), and there are plenty of staff around. Instead of hospital quiet it's more bustling and a bit chaotic. There were three friendly “therapeutic care” dogs wandering the halls and making their rounds of their favorite patients. The admin staff went through the charade of explaining the 93-page "Welcome Aboard" package and getting his signature. (It's really just a good conversational technique to make sure he understood "the rules" and the schedule, and to learn more of his life/family/medical history.) While we were talking I brought in his luggage, hung some pictures on the wall, taped his “reminder” calendars on the wall, and put a few thing away. He can tackle the rest.
After they finished check-in, the senior nurse introduced herself and then the head doctor came in to learn more. Uncle had toured the place the day before and told me that the street sign was in hangul as well as in English, so I wore our dojang's taekwondo t-shirt. When the doctor (also Korean) saw my t-shirt he immediately hit it off with me. Literally-- a single chest-high punch, but he pulled it before making contact. When I said you and I had been training for seven years and had our black belts, Grandpa was IN with the man. So I did my situational-awareness good deed of the day. The facility even let us leave the SUV in their parking lot until Grandpa agrees that your uncle will take better care of it in his own driveway.
The senior nurse estimates 3-6 weeks of physical/occupational therapy. Compared to most of the other patients, Grandpa is in good shape. He's mobile and flexible and he's almost healed. They'll also assess his mental condition-- part of that will include psychiatric testing (the "mini-mental exam") and neurological tests before deciding on medication. He has an option to move to a private room when one opens up (in a week or two) and if he wants to he can stay there after completing rehab. But I kept telling him that this is where he'd stay while he and your uncle toured assisted-living places until Grandpa decided where he wanted to live. I managed to break the news that he wasn't going back to the town where he'd lived for over a decade, and he agreed that he'd rather be safe and have help and be near Uncle. Grandpa was really more concerned about breaking the apartment lease than about going back to the town. But tomorrow's another Groundhog Day and I hope he can remember enough to not worry about the future. Uncle's going to help him write reminder notes to himself and tape them on the wall by his bed.
After Grandpa got settled I said my goodbyes and caught a taxi to the airport. I made the next flight to his town and was in bed by 9 PM. I had my first full night of sleep in over a week.
I've taken care of Grandpa's mail and his 2010 tax return and caught up on his bills. Meanwhile your uncle (and the lawyer and the care manager) are going to petition the city courts to be appointed as Grandpa's guardian, and then Uncle's going to delegate Grandpa's finances to me. Uncle and the care manager will also work with Grandpa to find the assisted-living facility where he wants to spend the rest of his life. Somewhere in the next few months your uncle and I will return to town to take care of Grandpa's possessions and shut down his apartment.
No worries about Grandpa's finances. He has his Westinghouse pension and Social Security. Medicare paid for the hospital and will pay another 2-3 months of the rehab. The facility charges about $7000/month (!!) but after the Medicare stops then his long-term care insurance will kick in. It'll be several years before the Medicare and insurance benefits are used up. He also has equity mutual funds with Fidelity earning dividends & interest. So by the time he's using his own funds he'll be able to cover the remaining expense for at least a decade.
I have to admit that this was one of the toughest weeks of my life. I've had tough days, like the Mount Pinatubo eruption or our black belt test, and I've had tough months in college or “on station” with my submarines. But last week I needed to call on every bit of stamina and vigilance and patience that I've learned from those experiences. I got real tired of being the grownup but I had to press on.
You're welcome to visit Grandpa anytime; Mom & I will be happy to pay your airfare and you could probably stay with your uncle. But you shouldn't feel obligated to do so. Although Grandpa will be happy to visit with you, he won't recognize you or remember you. The Grandpa you know is gone. Seeing your first rehab facility will be a pretty intense experience at any age, let alone at your age. I only visited my grandfather twice in all the years he was in his care facility, only because I felt I should, and it was a mistake. You shouldn't feel obligated to visit Grandpa unless you're curious about his current life, and you won't need to visit him to prepare yourself for dealing with Mom or me someday. (We Baby Boomers are going to fix this whole care-facility situation in the next 30 years.) If I were you then I'd choose to keep my old memories of Grandpa without bringing in any new ones. I'll send you the photo I took of him when we hiked the national park in Dec 2009.
If you're like me then you may be viewing the male side of your family genetic inheritance with some concern, perhaps even with alarm. You probably remember my stories of how much Grandpa was bagged with his father's tax returns and the apartment cleanup. The good news is that Grandpa used every bit of his engineering training to live independently for as long as he possibly could. He kept this apartment spotless (far neater than I've ever seen your bedroom!) and it was filled with calendars and memos and other reminders that he used every day. His filing system was flawlessly organized with every bill annotated for the check written and the date the payment was mailed. Grandpa even managed to complete his 2009 tax returns. He said he was going to use a tax service this year so the 2010 dividend reports and other forms were all filed and ready for me to enter into the software. It took me very little time to get a handle on what was going on in his apartment and to pick up the pieces. I suspect that if I get to that point in my life (at least 40 or 50 years, hopefully never!) then your mother and you will have no problems with my turnover.
However I'm a bit concerned about one of your mother's comments. She's promised me that she'll have an extra-special surprise tucked into my 82nd birthday cake for me when I attempt to blow out the candles, and that she's just going to duck down behind the counter for a second. Maybe you'd rather skip that particular celebration... Love,
– Dad
