A Daughter's Journal

After The Fall

by Ann D. Gross

"Uncertain hope is better than hopeless uncertainty."--Sidney J. Winawer, MD, Healing Lessons

Did I say last month it was unbelievable that Mom was back home?

Strike that.

What is truly unbelievable is that I'm sitting on her bed at the skilled nursing facility on the fourth floor--just one room away from where she was last year at this time. It's like déjà vu all over again, as the saying goes.

Now I have a visceral sense of why physicians don't treat their own family members. As a trained gerontologist, I could have looked at Mom's situation when she went home (with revolving caregivers untrained in caring for older adults), looked at her emotional and physical functioning, and looked at the way she interacted with the caregivers. My 10-minute assessment of that situation would have given Mom a rating of "unlikely" as to the "probability of remaining in the home for more than six months."

Instead, as her daughter, I rejoiced with her over her triumph of winning last year's Triple Crown: Completing physical therapy, regaining her physical strength, and regaining enough of her cognitive function to return home. I even heard "Pomp and Circumstance" playing in my mind for her graduation from physical therapy amid the tearful goodbyes from her SNF therapists.

"We will miss you," they said. They didn't have to miss her for too long--just for an all-too-brief eight months.

"I just wet my pants," Mom announces to me as I sit across from her with my computer on my lap.

Reality smacks me in the face again. She really is back here, in the SNF, unable to walk, and so frustrated that she has given up on getting to the toilet on time. (But her nails are still beautifully manicured.)

"Why honey?" I ask her. "Too much trouble to get up and go?"

"Don't I wish I could get up and go," she says mournfully.

The Events Leading to The Fall

I think about the cascade of events that carried her to this point: her difficult interactions with her caregivers that led Suzy, her "anchor caregiver" (aka "The Gift") to quit. That was a tough night.

I had called Mom, and Suzy answered the phone.

"Schoneman residence, this is Suzy."

"Hi toots," I said to her in my usual way. Silence. "How's it going?"

"Not good," she said with a flat voice. "I gave notice today."

She may as well have said, "Not good. I shot your Mom today." The sequelae would no doubt have been the same: pain, misery, tears, anger, blaming, and a life-altering change in Mom's life, in mine, and in my brother's.

Maybe Suzy's resignation subconsciously made Mom give up. Maybe she slid off the bedspread at the end of her bed so that Suzy would take pity on her and not leave her. Mom hates when anyone leaves her--doesn't matter if she likes them or not. She just hates for anyone to leave, ever, in any form.

About a week after Suzy gave notice came The Fall.

I called Mom at 9 Thursday night. She sounded more unhappy than usual.

"Mom, is everything OK?"

"Well, yes, but I fell, it was nothing; it was a stupid thing. Really, it's nothing," she repeated for emphasis. "I just slipped off the bed and landed on my behind. You should see how black and blue I am. And I'm a little sore."

A little sore? God bless my Mom and her Yankee understatement of any physical problem. Her own mother--my adored grandmother--died saying, "Oh, I'm just fine, fine."

So the cascade had begun: First Suzy had given notice, then Suzy's good friend (who worked mornings and who Mom was fond of) quit. Then, The Fall followed by a visit to the emergency room right afterward. Suzy drove her. (She had promised not to leave until we could find someone to take her place.) Mom was sent for more x-rays, which were negative. They sent her home with instructions to rest and take Tylenol.

Over the weekend, Mom tried to rehabilitate herself quickly from The Fall. Suzy took her swimming. Mom worked hard at willing herself better. But by Monday, the pain had worsened, precipitating another ER visit.

And that's where it all fell down, as it were. By then, Mom couldn't even walk. They took another x-ray in the ER, and it was still negative. But because Mom couldn't walk, Suzy and friends felt they couldn't take care of her at home. So my brother was summoned to drive her to the SNF.

That was four weeks ago, and Mom hasn't been home since she left for the ER with only her purse and the clothes on her back. My brother has since taken away her money and jewelry, as he was afraid they might be stolen in the SNF.

The Big Surprise

Mom figured she'd be in the SNF for a couple of days, until my brother could get a couple of caregivers to fill the shifts that Suzy and her friend were leaving open. Perhaps the heavens would send another Gift, and she could go back home and forget the whole thing.

But more nasty surprises were on the way. Mom was finally given an MRI. Her doctor at the SNF talked with her about it.

"Well, Mrs. S, we found out why you're in so much pain," he said. "It seems they've found a tiny, hairline fracture."

"Well, they've been working in therapy with me and I think I'm getting better, but it's slow," she said. "And it hurts, but I guess that's what it takes."

"Actually, ma'am, that's not what it takes. I'm sorry we didn't find this earlier, but it looks like we're going to have to send you to get it repaired."

"I know. That's what I'm doing," she shot back at him, annoyed he was wasting time with the obvious.

"Right. But we're actually going to have to do a little bit of surgery on that hip," he explained. "If we don't, it will tear more, and, in a few months, you won't be able to walk at all. That will be it; you'll never walk after that."

I was in New York when my brother called. "Turns out they have to do surgery on Mom," he said, "and they're going to take her in tonight."

I felt sick. Surgery. What a frightening word when it applies to your own mother--especially when she's thousands of miles away.

I rushed to call her. When she answered the phone, I don't think I'd ever been so happy to hear that voice.

"Hi Mom," I said, trying not to let my voice quiver. "How're you doing?"

"I'm fine, honey," she said. "I guess I have to have some surgery."

"Yes, I heard; Ed told me," I said, waiting for the onslaught, for the tears, for her to tell me how frightened she was.

I was certainly frightened. I thought about how I would obsess about the dangerous details if I were having the surgery. I held my breath for a moment.

"So," I said, "um, I guess they're taking you over tonight."

"Yes, I think I can't talk very long," she said. "They're coming to get me pretty soon."

I felt a sob swimming around in my throat, but managed to drown it with a wave of denial and forced optimism.

"OK, honey, well how about if I call you in your room at the hospital?"

"OK, Annie. Don't worry, I'll be fine. It's really nothing."

Good, I thought. She should keep thinking that. I would try to grab onto that belief as well and hang on tight.

"You're so brave," I said, keeping my voice even.

"Oh, really it's nothing. I won't even know about it."

"OK, honey, " I said. "I'll talk to you later. I love you."

"I love you too, Annie. Don't worry," she said. "Goodnight."

I hung up the phone and decided I wasn't going to start crying now. The woman is amazing, I thought. Here she is, back in the SNF, waiting to be taken to surgery any minute. She's felt so terrible all day that she's barely eaten. And now she has to be prepped for surgery, which will mean she can't have anything by mouth until it's over. She talks about it as if she has to get over the flu: It's unpleasant, but one has to get through it. Where was this trait in Mom's DNA when my brain was forming? It missed both my brother and me.

As for the surgery, Mom's Yankee toughness served her well. "Surgically," she did great," her doctor told me. So I waited until after she was transferred back to Room #404 at the SNF before I flew down to be by her side.

For now, I am back on my parents' bed in Mom's condo on the Gulf, listening to the waves crashing outside my window 10 yards away. Mom's condo is clean, uncluttered, sophisticated, and elegant--unlike my cluttered, dusty, chaotic apartment up North. Funny, because I worry all the time about something like this happening to me--being in an accident and unable to return home. I keep thinking how inconsiderate it would be to have someone stepping over the piles of clothes, shoes, and dog toys to get to the important things.

Meanwhile, Mom had been complaining since she returned home after the first stay, of having trouble "getting words out." So having sat in on Mom's speech therapy with her and her therapist, Amanda today, I watched as Amanda, all of 24 years old, tried to teach my mother to relax (not Mom's best event).

"Go to your calm place," said the young woman to my Mom, who sits in a wheelchair doing exercises to make even her mouth work right.

My Mom looks beautiful, with her elegant gray wig with the black hairband. Not a hair out of place.

"What's your calm place?" asks Amanda. "Oh yes, it's your balcony." Hearing this, I feel a lump in my throat.

Now, having spent five days visiting Mom (it seemed like a ridiculously long time when I made the plans and now feels a ridiculously short time because I'm leaving tomorrow), I look out over her balcony, her calm place. I hear the waves breaking on the shoreline; they are so close that I can see the designs the white foam makes.

This is a dream come true, this place Mom has made her home for eight years. Her nightmare is to have been pulled away from it as the moon inevitably pulls the tides. And my heart breaks along with the waves, over and over again.

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