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Caregiver Community Karma July 21, 2010

Posted by swapnawrites in caregiving joys and travails, life, attitudes, choices.
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I guess it has been a long time again since I posted here. After the last post, I thought I had nothing much left to say, well, nothing important, and nothing I hadn’t said before. Okay, so maybe I did have some thoughts, but nothing significant enough to write a blog post about. I was wrong; bulk and originality are not the only criteria to venture out into the cyber world…

The last few months, I used my spare energy to redesign my site. I added a whole bunch of pages on dementia and caregiving, with special focus on caregiving for dementia in India. In these pages, I consolidated and structured a lot of my own thoughts and also some information gathered over the last couple of years, as part of my interaction with other caregivers and with volunteers and professionals. I added resource pages (and was dismayed at how few caregiver resources were in India) and links to books and DVDs. Pages include stuff on how caregiving is different in India, and tips focused on that. I uploaded an awareness presentation I sometimes use. I also jotted down ideas for more updates later. I would, of course, welcome any ideas/ comments you have.

My intention as I worked on this was very simple: make my thoughts and data accessible for anyone who may happen to reach my page, either because they know me or someone directed them there, or a search engine threw up the site’s url. I have not yet thought of how to publicize the stuff; I have no idea how to go about such stuff. If even a few people benefited from my effort, it was effort well-spent.

And people have been contacting me every couple of weeks or so, people I don’t know, seekers who reached my site while they desperately surfed for resources for dementia and caregiving in India. Some were helped by what I had put forth, and some wanted more help (and I tried my best to find out the additional data they wanted).

Today’s post is stirred by one such contact.

A few days ago, a visitor arrived at my site courtesy a search engine. She wrote to me. I wrote back. I learned that she, along with some friends, is proposing to put up a community that links caregivers in India and also provides them support; the name is Caregivers Link. To begin work on this project, the Caregivers Link Team  was gathering data and wanted to reach out to as many people as they could–caregivers, their family/ friends, volunteers, professionals, even employers who have employees who are caregivers. Sure enough, I was interested. I sent out the mailer the team sent, and I even put up a page on my website with their message.

Have a look here.

I hope people will respond and give the Caregivers Link team the data they need. But I am not sure people will. You see, I used to be one of those people who would get a mail, find it good, but somehow not get around to actually participating. I would intend to, but well, it would slip.I would tell myself, so many others must be writing, what difference would one additional data point make? Then the date would be over, and I had a legitimate reason not to put in the effort.

This is what may happen:  Caregivers may be too busy to even write a few lines back. They may think this community may not be available to them in time–they need help now, urgently. They are overwhelmed. Their friends and family, well, they’d like to..but it is amazing how time flows, no? Ditto professionals and employers. Most surveys of this sort suffer because of this reluctance to inconvenience oneself for a good cause if there is no one nagging you to participate. Participating in these things just keep getting postponed.

The last few years have changed my way of thinking.

I am a caregiver. I have been one for years now. And even when this phase of my life is over, it is possible I will be thrust in this role again for someone else. Or that someone else will become my caregiver. And one think I can tell you from experience–caregivers need help. I need help as a caregiver, and I would like my caregiver to have help so that he/ she can look after me and himself/ herself better when I am the one who needs to be looked after.

Having been on the other side for a while, having tried to get information and gather people, I have a different view now. I know now that each participant matters. Each opinion counts, each suggestion helps.

Fact: caregiving is far more common as a role than people admit. Somehow, in India, we behave as if there are no caregivers. We take it for granted that when someone is seriously ill, the family will rally around and do whatever is needed, regardless of the stress, regardless of the tremendous amounts of adjustment and compromises. Outsiders don’t even acknowledge how difficult it is; some may sermonize that the caregiver is only doing his or her duty. Sure, right. But don’t the people around also have a “duty” to make caring easier and more pleasant?

The chances are, dear reader, that you are a caregiver or have been one. Or that you know someone (someone you like, who is close to you) who is or was one. Or that you know a patient who is being cared for, and the patient is someone close to you. And even if caregiving has not touched your life yet, it will some day, as caregiver or patient or as someone close to one. Caregiving is just one illness, one accident away. After all, we all grow old, we fall ill, we need to go gently into the night, and the journey is not always pleasant.

I do not know the shape Caregivers Link will take once it is operational. The idea is good, and one whose time has definitely come. The team is committed and sincere. I definitely wish this team the very best. I want such communities to flourish; I have a stake in their success, and so I will help. I think we all should, to the extent we can. The way I see it is, if some people are concerned and committed enough to work in this area, our helping them creates an environment that overall improves the quality of care around us. It creates an awareness. Every effort helps, every person working in this field helps.

Some day, you and I may benefit because we took the time to put down our thoughts and pass them to people who were able to do something with them.

So, do read their message and consider helping.  If you do not have time to fill in the questionnaire, just e-mail to them to touch base with them, share your thoughts. Every input counts. Every thought matters. And spread the word about it. And if there are other such efforts, such initiatives, don’t just smile and nod approvingly and ignore them. Open out with your hearts, your thoughts, that small sliver of your time that will help them. Earn some community-creating karma. Some day it may improve your life or the life of someone close to you.

Ramblings on love, hate, and a life worth living March 1, 2010

Posted by swapnawrites in caregiving joys and travails, life, attitudes, choices.
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February has been a mixed month for my mother, the most painful part being when she went down with fever but could not tell us where the pain was. Much investigation and deduction was attempted, without success, medication given to control the fever. Two days into the problem, she broke and swallowed a tooth–ouch! She broke another tooth again, the next day. Ergo, a tooth infection. Fever’s under control, and a dentist was requested to make a home visit to assess her dental status :-) A major project is now to be planned–a trip to the dentist to remove another tooth that is tethering on a breakdown, and to clean up the stuff left behind by the two not-so-neatly broken teeth. Ah, well.

But what’s prompted me to write this blog is something quite unrelated, actually, a few unrelated things, that happened these last two weeks.

Firs, I’d like to share a memory dating around seven years ago. Seven years ago, I was still naive about dementia and how it affects people, still thinking increased memory loss was like losing ten keys a day instead of one. My mother was in her own denial mode, unwilling to admit to any memory loss. The world around her (as I can see in retrospect) bewildered her, and she was not going to tell anyone that. She was a fighter, she was. Often I saw her writing with a fierce concentration in a diary, and snap it close when I entered her room. ONe day, she left it open near her breakfast tray, and there it was, written with a red pen, written so angrily that the pen had torn through the paper. There were many broken sentences on the page, and I stopped short when I saw my name. She had written that she hated me, written it again and again and again, and written about others she hated, and at the end, there was: I hate hate hate the world.

Frankly, I was very upset.  I don’t think anyone likes being hated, and having to look after someone who spent her time scribbling that she hated me, and everything and everyone around her, was not just disconcerting, it was disgusting. I don’t remember what I did that day, I think I hit a couple of pillows, I wept, I despaired. Then I moved on with what needed to be done, but that thorn was there inside me for days. The hurt reduced slowly, as I began grasping how hostile the world appeared  to her. Then I forgot about it.

I remembered it a few days ago, when I was standing with her, holding her hand.  She was smiling at me, and it suddenly struck me that her smile wasn’t just a simple one, it was a full smile that reached her eye and gave her face a character I had not seen for years. Though bedridden and helpless, and unable to speak, she seemed so much at peace. I bent over her, kissed her forehead, and said, as I do every day, I  hope you are happy. I want you to be happy. I love you. And my mother, who finds speech an ordeal and rarely utters more than 4-5 words a day, spoke up for once. She said, very clearly: I love you, too.

I think few gifts can be more precious than my mother spending all her speaking energy of the day to say such a thing.

The reason I am writing about this is also because of something that happened around the same time, a conversation with some acquaintances.

I do not socialize much. Firstly, there is a problem of time, but even more, there is the problem of my life being on such a different track that I can rarely find enough to talk about to others. Most of my “circle” is therefore confined to those in similar dementia/ caregiving areas, or fellow writers who know nothing about this part of my life. Still, I do have neighbors and acquaintances and occasionally get chatting with them, sharing updates.

So this woman asked after my mother, and I said, ” “She is bedridden, unable to turn herself, barely able to speak, but still seemed happy and at peace most of the time. She smiles a lot, and holds my hand, and I think she is happy most of the time.”

And this woman said, “It must be awful being dependent like this. What sort of a life is this!” Shudder, shudder. “Wouldn’t she be better off dead?”

I repeated my statements on my mother generally seeming content, even described it a bit, but this woman only repeated her statement about my mother being better off if she were dead, shudder, shudder, and a roll of eyes.

I didn’t know what to say, and I excused myself and walked off, scared I would end up being outright rude to someone who was only expressing what she considered “sympathy” .

I am sure most of us have days we would rather not have. Days when we wish some strange and wonderful force would pull us out of the time and place, and plunge us into a better past, or a better future (and we are sure nothing can be worse). When the woman said that thing about dying, I tried placing myself back into such a day and having a friend walk over to me and look soulfully into my eyes and say, “Swapna, you would be better off dead.” And I shuddered.

So what is it that lets people tell me (and this woman was not the first) that my mother should die? And persist in saying that even after I confirm by examples and descriptions that my mother seems happy enough? Not as if people should die if they are not happy; the world would be empty in a jiffy if that algorithm was applied. What really feels odd to me is that always, always, this statement is delivered in a tone dripping with sympathy.

Okay, so maybe she wasn’t wishing my mother dead, only using a twisted way to express sympathy with me because I was taking care for such a dependent person. She chose to do this in this extreme way though I had not expressed any overwhelm to her. But does this woman really think I’d be better off if I continued to look after my mother while a part of me wanted her dead? How could caring be easier if the carer resents the patient for living?

I am fairly sure this woman had not registered my description of my mother’s general state of content. She could not hear a word beyond “bed-ridden”. I am also sure that if this woman had seen my mother when my mother was active enough and frustrated enough to hate the world, this woman would not have dreamed of saying she would be better off dead.

I have been rambling awhile, and I’m not really sure what the point of this blog post is, if  a post must have a point, that is.  Maybe I am wondering why people use the concept of death so easily when applied to people in a state they do not identify with. Why many of us don’t understand that someone may be happy even if he/ she does not possess something we consider essential for happiness. Or perhaps,  why people do not think through what they say.

Or maybe all this verbiage is my way of saying that a life that appears troubled and empty from outside may be very worthwhile to the person living it and to the persons around him or her. That sometimes, the gift of a person’s presence comes in sparkling moments. That, as HH Karmapa said at TED India a few months ago, “there are symbols of happiness in every breath we take.”  And may we all see them, and understand that others may be seeing them in their lives, even if we cannot understand how.

Blogging, introspection, action January 31, 2010

Posted by swapnawrites in life, attitudes, choices.
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Today concludes a month-long blog-a-day exercise, and I must admit I am rather glad it is over :-)

So yes, I managed daily entries, most of them non-trivial. And yes, the introspection helped, even though there were days I would rather not have done it. And yes, I am clearer about my caregiving direction and attitude, so I am ready (so I hope) for the months to come. Most important, I now understand why caregiving has affected me so much, and the answer is, it has shaken me in things that are fundamental to life itself, well beyond caregiving. Sigh!

But enough of introspection. Now I must use my understanding to evolve an integrated approach, and then align my actions to it, whether I am caregiving, or blogging, or writing (trying to?) fiction. Or just taking a stroll and feeling the evening breeze.

Today, I will treat myself to one large chocolate ice-cream to celebrate the end of this blog-month. Then I will rejoice about the fact that I don’t plan to set targets this year, and now have eleven months where I don’t have to do anything :-)

And then, perhaps, in the days that follow, I will peep into all that confusing stuff stirred up in my mind by the last few blogs of this month, and get down to action.

Caregiving, identity, impermanence January 30, 2010

Posted by swapnawrites in caregiving joys and travails, life, attitudes, choices.
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As caregiving has occupied a larger and larger chunk of my timeshare, mind-share, emotion-share, my sense of identity has become tightly-bound with this role. I find it affecting all my other roles, and it remains in my mind like a persistent buzz, even when I am not handling any related work.

For a while now, this has puzzled me.

First off, there is nothing unique about handling multiple roles. All of us juggle roles, and cope with it. Even a school-going boy balances between roles: student in class, boy playing cricket, participant in a painting competition, fond (or not so fond) son, polite son of colleague at his father’s office party, and so on. When older, the balance moves to balancing job roles (boss, subordinate, colleague), family (parent, child, sibling, spouse), participating in community activities, and so on.

People manage multiple roles in various ways, some more effectively than others, using approaches tuned to their personality. Advice abounds. Compartmentalize, say time management gurus. Live in the present moment, say new age gurus. Debates abound, too, like whether to multi-task or not.

Another factor is that everyone reacts to a role differently. What a person takes away from a role depends heavily on the person’s personality, upbringing, environment, and so on. One parent may end up developing a sense of deep love from the role, another may learn to sacrifice for the child. Some parents may feel helpless or angry because they are unable to do all they want for the child, while some are  frustrated because the child disappoints them, or is rude or obnoxious. Love, again, could be the expansive sort, the possessive sort, or the controlling sort, and may express itself in making the child feel secure and eager to explore and achieve, or spoiling the child, or even suffocating the child and dictating the child’s choices.

Caregiving, too, affects people differently. When I meet other caregivers, I find a range of reactions to this role. To many, it is one additional, overwhelming responsibility, a set of tasks to be scheduled in along with all those other roles. To some, it is a depressing helplessness because their own lives are on hold, and they are tired. Others are depressed because they see a loved one deteriorate, and do not know how to handle that sense of loss.  Some feel sympathy, then empathy, and find themselves as more loving and caring persons; others are put off by all that illness and the smells and nitty-gritty of caring.

For the last few days, I have pondered over  my current emotional state as a caregiver. Not how I handle the role, or what I feel about the responsibility, or about my mother, but how caregiving, if at all, has changed me as a person.

And I think I finally understand why caregiving affects me so much, and touches every part of my life. It is because caregiving has made me acutely aware of impermanence. While many caregivers see caring as being for someone who needs care, and is unwell and in an unfortunate circumstance, I have started seeing the deterioration as something that can happen to anyone, including me. :-(

No one, in other words, is “safe” from deterioration and dying. Not even I, though I am competent right now. My memory is good, I am articulate enough, I can learn new stuff, I can walk, eat, laugh, enjoy life. But none of this is permanent.

This is neat and quite understandable as theory, and not unique. What caregiving has done is move this for me from theory to an experiential realization, one I cannot fold away after reading a book or writing a blog. It is not an intellectual aha! It is a fact that frightens me with its all-pervadingness.

How can I go about a normal day, doing normal things, when my foundation of life is such a quivering mass? How can I be ambitious when something so basic is bothering me? How can I reconcile the buzz of an active life with the fact that I cannot ensure permanence and stability, whatever I do?

A few years ago, I was reasonably clear of what I was. I was a caregiver, a caring daughter, and a (trying to remain) informed and active member of the caregiver community. I was also a professional who wrote technical books and even a business novel. I was learning how to write speculative fiction. I was part of a family – a spouse, a mother. I wanted to read every book I could get my hands on, and then some. I liked chatting with like-minded friends (though the available circle was reducing). I cared for my health, I enjoyed dark chocolate (yes, that was a significant part of my identity :-) I enjoyed learning new things. There was a list of things I wanted to try  – Alexander Technique, playing a musical instrument, learning Kannada, learning Urdu, learning sketching, resuming painting,…oh, it was a long list.

I still want many of these things (including chocolates), and some new ones. But now, in my emotional substrata is this nagging feeling that I am missing something big that matters much more. Because, while all these activities are enjoyable and fulfilling, none come anywhere close to filling the emptiness inside me when I remember the caregiving lesson of impermanence.

A decade ago, I would have nodded wisely at, but dismissed this ‘impermanence’ talk as – it’s all very nice, but I have to live in this world and be practical, so, yes, but later. But the stage I have crossed in these last few years has made such dismissal impossible. I cannot ignore or reverse that insight.

My challenge now is to integrate this new perspective into ‘normal life,’ so that it ends up invigorating me instead of draining me.

Theory-wise, impermanence is a very liberating concept. Because, if we accept that everything is going to change, there is no need to cling or grasp, or to get upset when things don’t go the right away. It is easier to enjoy things without getting tense that they will fizzle away with time, because we accept that they will fizzle away.

Like enjoying a freshly opened flower, fully aware that a few hours from now, it will droop.

But  while the thought of impermanence is still big inside me, the fact that this could be a plus point is only theory for me. Nice to write about, but something I don’t emotionally subscribe to.

I guess that will take its own time, and till then I will remain active and energetic in my search for ways to integrate my emotions.

Pacing for effective caregiving January 29, 2010

Posted by swapnawrites in caregiving joys and travails, life, attitudes, choices.
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One of the dilemmas I face is how to care without feeling burnout.

What my mother wants is that I sit near her all day, holding her hand. I cannot do it. I could do it for a day or two, maybe a week or two tops. But not month after month.  Not an year, two years, three. And burning out or getting resentful won’t help, because I’ll end up giving up just when her need for me goes up.

So I need to balance between caregiving activities, spending time with my mother, doing other things I need to do,  and doing things I want to do. I need a balance so that I stay happy and sane and in a state where looking after my mother remains fulfilling and even fun. It is a matter of pacing.

It is an unfortunate fact that even when caring integrates love and compassion, it can exhaust and cause burnout.  The term, compassion fatigue, is sometimes mentioned. People providing care-related services are often warned about burnout and advised to take time off every day, and also every week or month, to ‘recharge’ themselves. Many agencies that provide carers also insist that carers circulate between patients every few months, so that they don’t start getting upset/ irritated with a patient. Rotating between patients gives them a chance to get back that balance in life.

As a family caregiver, my situation is different. I am an only child; I have no siblings or relatives who can take over the work for a few days. The responsibility for my mother is handled by my husband and I, along with (when she is not off for her own family’s illnesses), a trained attendant. On the days when the attendant is there, hubby and I are not required 24 * 7, but we try to talk to my mother several times a day, catching her when she is not sleeping (this usually ends up being 3 to 4 times a day) .  We also monitor her diet and medicine. While we can go out shopping and attend meetings for a few hours, we always remain within a can-be-back-in-half-an-hour distance. We cannot go out for an overnight holiday. Socializing is now at zero, as old social circles do not fit these criteria, and it is not easy creating new friends with common interests.

It is now ten years since I and hubby went for a vacation together. On some days, we really miss it. Imagine getting up in the morning without thinking, I’ve got to rush and give her the morning medicine and check her cough/ cold. Imagine going out for a week-end trip. Imagine just driving down the highway past that back-in-half-an-hour radius. Imagine being able to put off the mobile or not rush back if I forgot to take it along.

No, better not imagine it.

Some people have advised me to use respite care. And maybe some day I will, if I think I will break down without a break. But a respite care can be a very costly thing, in terms of the price my mother will pay.  She had always been very scared of being abandoned, and is very fixed in what she can eat or not. With her ability to communicate almost lost, there is no way she can tell a stranger what she likes or does not. There is no way a stranger can understand what she wants, unless I leave a very detailed note (and probably cooked-and-frozen food for the period). I think of my mother looking around a strange room, at strange faces, unable to ask for me, unable to understand the people around her, and I am not sure any break I want could be more important than saving her that trauma. And while I know of a few caregivers who successfully took such breaks, I also know one case where the dementia patient left for a few days in a respite care stopped communicating to her family when they picked her back. It makes me shudder.

The only way, then, is to make sure I and hubby take enough breaks to remain sane within the bounds set by her state. In other words, squeeze enough of a break in those few hours we can get. A complete change of scene is not possible, but at least take up activities that allow us to switch off this responsibility for a few hours at a stretch. Sort of learn ways to switch off that worry buzz in the mind’s background music.

As I educate myself for this new phase of caregiving, identifying activities I can still do in the gaps available to me will be an important part of finding my new balance.

Palliative care in dementia January 28, 2010

Posted by swapnawrites in caregiving joys and travails, life, attitudes, choices.
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In a support group meeting I attended in December 2009, I was introduced to the concept of Palliative Care and how it may be applied to a patient with dementia.

The thrust of palliative care is ensuring the patient’s quality of life, and keeping that in focus while taking decisions such as how aggressive medical treatment should be.

A few years ago, I had assumed that medical intervention is a must. If one has an infection, an antibiotic course is inevitable. Last year, in September, my mother’s lab results showed a urinary infection, and the doctor started her on an antibiotic, based on the culture report. It did not work. Again, based on the fresh culture, a new antibiotic was given. Again, no effect.  Medication for the infection was discontinued finally, on advice of the specialist, after confirming that my mother was not exhibiting any symptoms of the infection (asymptomatic infections are often not treated).

While we were lucky that the infection was asymptomatic and treatment was not necessary, the incident still left me shocked. I had not envisaged a situation when, despite the sensitivity report showing the antibiotic was suitable, the medicine would not work. It had not occurred to me that medicines worked only because the body processed them in a way that allowed them to work…that the body can reach a point where it cannot use the medicines fed to it. Suppose, I thought, the infection had not been asymptomatic? Would the treatment have become increasingly aggressive? What is the trade-off between suffering symptoms of a disease as against the stress on a tired, aging metabolic and excretory system which is plied with stronger and stronger medication?

As my mother becomes frail, I can see a number of such trade-offs that will need to be made. She already has swallowing problems, and these are going to increase. Aspiration pneumonia is likely to occur. She is bed-ridden, and though we are using an alternating-pressure air mattress, we are apprehensive about bed-sores. Then, there are other infections, like chest infections, that can occur however well we guard her. There may be a stage when she cannot swallow enough food to sustain her. For all these situations, there are aggressive approaches,but these do not always work, and sometimes they worsen the situation by introducing other problems.

As a lay person I know very little of the trade-offs, but I am keen to understand enough so that when a doctor suggests something I can ask the right questions and understand how the treatment helps, and how it may not help. The concepts of palliative care as applied to dementia seem relevant and worth studying, and I am searching for comprehensive documents that discuss these.

Decision making for dementia patients January 27, 2010

Posted by swapnawrites in caregiving joys and travails, life, attitudes, choices.
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As I mentioned earlier, one of the most frightening parts of caregiving for me is taking decisions on behalf of the patient.

In most aging, the elder takes his or her own decisions, but in the case of dementia patients, decision-making is the caregiver’s responsibility. Is the patient in pain or not, and should I call the doctor? What, exactly, is paining, and how much? Did the patient’s pain reduce with the medication? If the doctor offers a choice, should antibiotics be given or not, if the patient may not benefit from them? How aggressive and invasive should treatment be? Should the patient be hospitalized?

My current phase of caregiving may require tough decisions that my mother can no longer participate in, as she just does not understand anything. There is so much confusing information around, so much “there is no right answer” type of advice, so many pros and cons to weigh.

Let me illustrate with an example. Consider the decision: if there is a serious medical condition, should the patient be hospitalized? It seems so simple – if a person is unwell, and treatment is more effective in the hospital, he or she should be admitted to the hospital.

But the decision is not as straightforward for a dementia patient. A hospital stay may be good for medical treatment (some may contest that, too), but a dementia patient is traumatized by a changed surrounding. In almost all hospitals, the nurses and junior doctors are pressed for time, impatient, and not trained to handle a confused dementia patient. They expect quick and correct answers to questions like: are you better now, where is the pain. They often (I speak from experience across a number of hospitals) refuse to listen to the accompanying family member and insist they will only listen to the patient (who cannot answer, or answers wrongly). Then, hospitals have rules about visiting hours, food, and a whole set of stuff, so the atmosphere in the ward cannot be made anywhere like what the patient is used to. Patient attendants are not allowed to enter ICU or emergency wards, so the patient is left alone, bewildered, scared. He or she feels abandoned, insecure, and no one rushing around him seems familiar. They poke around the patient with needles, tie armbands to take BP readings, squish gel tubes on bare flesh for imaging equipment. The patient has no idea why he or she is being “tortured.”

The medical condition may improve (or may not, because the doctors cannot communicate with the patient), but the patient is emotionally traumatized.

Two years ago, my mother fell down and suffered a head injury. There was blood all over. We put ice to stop the flow and rushed her to the emergency ward of a well-known hospital . I told the attending doctors that she would not be able to communicate, and that she had dementia. I told them she was unable to bear the air-conditioning cold, and that she must be kept warm (I had swathed her in woolens) I handed over her medical files and reports, which included, right on top, a one page medical history summary and current medication details. I showed it to them.

They shrugged and grabbed the file, very busy with the emergency. They bustled around my mother and shooed me out of the Triage. I kept trying to find out what was happening; they treated me as a disruptive element :-)

Anyway, after a while, I managed to enter the Triage area. My mother was sitting on a metal chair in her nightgown and without slippers, her woolens on her lap, shivering and obviously scared. She thought I had forgotten her or left her. She grabbed my hand. I made her wear her woolens. There was no doctor or nurse anywhere near her. She wanted to go to the bathroom, and had tried telling them that (those days, she was moderately continent) but no one was listening.

Turns out they stitched her head and took her for a scan, which meant removing her clothes. They never bothered to help her wear her clothes after that.  They did not wrap a blanket around her. They didn’t ask her what she wanted. The scan was normal, so the case needed no further action. Show over, interest over. None of all my cautions and pleas were remembered. It took me another hour to complete the formalities and get her out of that room. The release papers misspelled her form of dementia into something unrecognizable; possible, the attending doctors, not being neurophysicians, had not heard of that variant of dementia

I didn’t have a choice about taking my mother to the hospital in this instance- a head injury requires a checkup. But it was emotionally traumatic to her and the impact of that visit stayed with her for days.

More recently, my mother injured her eye, which turned a frighteningly-bright red that did not subside. Again, I had to take her to the hospital. The doctors and nurses were considerate and helpful, but even so, my mother showed a distinct dip in her mood for days after it.

When my mother was young, she lost two sisters and a mother to TB and her father to a heart-attack before she turned 12. The TB deaths were particularly bad – this was the era before TB had a cure; the sisters and mother were sent off to sanitariums so that the remaining members of the family (such as they were)  did not get TB. To my mother, as a child, a hospital was where you dumped people to die, and places where family would not visit.

As she grew up, her revulsion/ fear of hospitals reduced, and she was normal enough, but as her dementia progresses, older memories have become stronger than recent ones, and hospitals have reverted to being a punishment and a token of abandonment and death.

How does this affect me as a caregiver?

There may be times I have to decide whether the advantages of hospital treatment outweigh the disadvantages, given her mental state and my personal knowledge of her past and the dread she has. I may feel a hospital is unavoidable for an accident-type of emergency, but detrimental for other treatments, like infections, which can be given at home.

Decisions like this are tough, and often faced by caregivers of dementia patients. What makes them even tougher when people around you don’t understand (and don’t want to understand) how having dementia can affect such decisions. They are quick to judge and criticize/ blame family members, not acknowledging that the carers are trying to do their best.

It is in this context that I find reports like the Nuffield report very helpful. It recognizes the complexity of issues, and sensitizes people to them. I hope to evolve clear criteria for decision-making after studying such reports and other literature – but whatever I do, there is a rather large element of subjectivity that will remain an emotional challenge.

Moving forward January 26, 2010

Posted by swapnawrites in caregiving joys and travails, life, attitudes, choices.
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I use this blog as a means of introspection, mainly with respect to my caregiving role and its impact on my choices and attitude. As January draws to its end, so does my month-long one-blog-a-day exercise it is time for me to consolidate my thoughts and get ready for the year stretched in front of me.

A number of my blogs so far have described the current status, and examined the past to see what  I did, and what in hindsight), I would do differently if life pressed rewind. And it now makes sense to see what lies ahead to incorporate all I discovered about myself into my future.

One lesson I have learned is that there are no easy answers for what is right or wrong, but being better informed about the various option, and their pros and cons, will allow me to make choices I remain comfortable with, even in hindsight. So yes, I will read up more on topics that are relevant now.

Dementia end-stage, for example. About two years ago, when I began collating material on caregiving, some of the booklets I downloaded were about end-of-life decisions and late-stage care and  put them aside with a sticky saying, “later.” The sticky has been consigned to the dustbin now. I need to understand these issues now, as my mother is in stage 7 of her dementia. (Here, btw, are two of the documents I am studying right now: End-of-life decisions and late-stage care )

I had also bought a number of books and CDs on home nursing; again, there were sections I didn’t read because they pertained to caring fro a totally bed-ridden patient. I have been going through those sections carefully now.

As I educate myself, I can see that I may soon face  some tough decisions. In a lot of the literature I encounter, this stage of caregiving is handled in old-age homes and specialized facilities, where more specialized knowledge is available. Also, many countries have the concept of advanced directives, and caregivers (relatives or professionals) are usually well-informed about the criteria the patient had specified earlier. My situation (and the situation of peers in India) is different. While I am aware of my mother’s choice in some aspects (such as, she wanted to donate her body for research), in others I have to judge her preference based on what I know of her past.

One of my concerns is understanding what “quality of life” constitutes to my mother, so that I can keep that in mind while making decisions. The definition of quality of life differs from person to person, and also depends on factors like age and state of health, such as the stage of various diseases. What may have been important yesterday for her may no longer matter now, and vice versa.

A month-and-a-half ago, I had a neuropsychiatrist assess my mother. After talking to her for a while, and examining her, he gave me several tips on how to look after her. At one point, he said, “You don’t have to restrict her diet any more. Give her whatever she likes to eat, if she can digest it.” And it occurred to me that he was saying, the benefit from the pleasure she would get out of a food she likes clearly outweighs the long-term harm the food may do…..

I realized then that I should re-examine earlier decisions to check their suitability for my mother’s new reality. I have already made changes to match her current needs, but I plan to go about this review systematically, to make sure I haven’t missed something that would matter to her.

Bioethics and dementia January 25, 2010

Posted by swapnawrites in caregiving joys and travails, life, attitudes, choices.
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Just saw this site, Nuffield  Council on Bioethics, and read about their work on dementia here. Then I followed the link on the page, and downloaded the reports.

I have only one word. Wow!

Sometimes, someone catches every thought you have or could have had.

Every section, every point, every sentence resonated. I wish  could make this compulsory reading for…oh, well, everyone, because dementia and caregiving is something that affects everyone. Anyone can get dementia, anyone can be thrust in the role of a caregiver. And even if not, there are people around you who are patients or caregivers, and they deserve a life, too. What I loved about these reports is that they address a wide range of impacts. They don’t just talk about the patients’ right, they acknowledge the carer, and they acknowledge the role of society in it all, even that of shops and restaurants a patient may visit (or should be able to).

Dignity. Ethics. The right to life fully, despite the condition. The dilemmas and difficulties. The carer’s own life, and the balancing act. How every case is different. How difficult it is. How it hurts. What can help. It’s all there.

I thought I would place a summary here, but I can’t do justice with a summary, so go ahead to the download page and have a look yourself….

we need more of us January 24, 2010

Posted by swapnawrites in caregiving joys and travails.
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In many of my blog entries on dementia and caregiving, I have shared my impression that poor awareness of dementia in India is a major concern area. I often feel that dementia is far less understood in India than in some other countries, and that the role of the caregiver not seen as a significant, contributing role  that needs special patience and skills.

Relevant in this context is the work of 10/66 Dementia Research Group. To quote them:, “10/66 refers to the two-thirds (66%) of people with dementia living in low and middle income countries, and the 10% or less of population-based research that has been carried out in those regions.” This group is a collective of researchers working on population-based research into dementia and related areas in these countries.

Interestingly, the website includes a report on Qualitative Studies which confirms my view of poor awareness of dementia and caregiving in India.

The report reminds me of a support group meeting where a caregiver shared how, when his father was diagnosed with dementia, the family was so ashamed they wanted to institutionalize him and  isolate him (hide him, get rid of him so that they were not associated with him), and when the son took over the caregiving, they isolated him, too.

I think we need more people speaking up about dementia, and about caregiving. We need more people admitting that the elders in their family have dementia (admitting to themselves, admitting to others). I hope more people will write about it (blogs, books, articles, reports, novels, whatever), speak about it, think about it, so that one day people with dementia in our country can life a fuller life to the extent their ability allows them, and carers can care for them and lead fulfilling lives of their own, all done with dignity.