Retro-Blog 2009.12.22 - Dad has a temporary improvement

Dad continues to improve
Michael Kepler
December 22, 2009   · 6 min read  · Shared with Public

We went to see my Dad last night (Monday) in the non-hospital facility where he is now housed.  Patricia and I brought along Jennifer, our daughter recently arrived home for Christmas, and Patricia's guide dog Reuben (who we had not brought to the hospital in previous visits).

Although I am afraid of "over-selling" it, I really feel that Dad was remarkably better than he has been since this ordeal began.   He was sitting upright in a manual wheelchair when we arrived, and had little difficulty maneuvering it around.  He was regarded by the facility as someone who needs a two person assist to use the bathroom, but he completed the transfer from the chair mostly by himself, while the first attendant was still waiting for the second to arrive.  This is a huge improvement in his strength.

His conversation was much more coherent, and his voice stronger and easier to understand.  He continues to have difficulty hearing voices that are quieter or in a higher register, but had very little difficulty understanding me.   I think this very much has more to do with his long-standing hearing problems that it does with any cognitive function.  My younger sister, in later conversation with me, expressed doubts about his comprehension, but I suspect that she was mis-identifying a hearing problem as a cognitive problem.

He repeatedly mis-identified the dog as "Liesel", Patricia's first guide who passed away a few years ago, and would confuse Jennifer and Patricia for each-other at moments.  I hasten to point out, however, that these specific mis-identifications have been common for him, and other family members and friends, for years now.

His situational awareness was very good.  He made statements which, to me, clearly indicated that he knew that he was previously in a hospital and was now somewhere else.  He also made some very clear statements about the quality of the care he has been receiving.  To quote, or rather paraphrase, as my own rote memory is poor:

"Medical Care certainly has changed from what it once was."

"Common courtesy seems to have gone completely out the window."

He also made statements indicating that there had been some manner of unpleasant behavior from both the staff and other residents, although he expressed that he understood that many of the residents are in a lot of pain, and not at their best.

He repeatedly made statements that indicated that he understood that his cognitive and physical functionality had been much worse, and is improving, yet is still not quite what he feels it should be.  He repeatedly expressed a hope that he would continue to improve and be allowed to be returned home at some point.

He said that he and his wife had met together with someone in the administration of the facility, and that there had been a minimum period of time established for his stay.  He could not, however, recall what that period of time is.

We exchanged a number of statements which jokingly compared the facility to a prison, such as speculating on the possibility of "time off for good behavior".  He has again demonstrated a clear understanding of the difference between reality and more abstract statements such as jokes.

His memory is still not quite what it was.  I am fairly sure that he has little or no specific memory of his time spent in the hospital, and seems to have difficulty sorting out what visitors he has had on specific recent days.  I hasten to point out, however, that his memory of the specific events of recent days is not much worse than my own, and the very unstimulating environment of the facility, and the general sameness of the daily routine, would make sorting such things out difficult for just about anyone.  I would not be surprised or concerned if he never recovers much memory of his experience in the hospital.

The facility itself is clean, but very old and with some broken equipment.  The rooms have the appearance of a Motel that has not been remodeled in at least 30 years.  The staff was outwardly nice enough towards both Dad and the rest of us, but we found it objectionable that they were openly complaining about another resident within earshot of all of us, while they were assisting Dad with the bathroom.

As long as he doesn't have any kind of incident that triggers a reversal of his current rate of recovery, this facility should provide adequate care for him in his present, and improving, condition.

This is not an exact science, and I am not exactly a scientist, but I would estimate that my Dad is currently operating at about %60 of his previous baseline general competency, as compared to his observed behavior as recently as two weeks prior to his hospitalization.  I would further estimate that his baseline competency has been fluctuating in recent years to as little as %80 of optimal.  This is not bad for a survivor of both lung and brain cancer, and with a life-long history of alcohol abuse.  He has had no access to alcohol for over a week now, and seems to be handling it well, so hopefully he will remain "dry" when he is allowed to return home, just for the sake of his obviously fragile general health.

No "Dad" post would be complete without an update on family politics.  In the past couple of days we have learned that in 2004, my Dad wrote up a document that gives, in the event of his incompetency, power of attorney first to his wife, and secondly to her daughter.  Additionally, his wife has declined to exercise this power and has chosen to defer it to her daughter.  Initially, this was very upsetting to my younger sister, who felt strongly that the secondary power of attorney should have been assigned to a blood relative such as herself, or me.  Over the years, she has been much closer to Dad than I have, and spent a lot more time with him, and certainly has been the most consistent advocate for his interests, and attendant to his immediate recent needs, of any family member.  She was even angry at Dad over this, although I believe she was kind and prudent enough to not express this to him or in his presence.  Her anger was somewhat mitigated upon learning that his wife's daughter had not asked for this responsibility, and did not really want it, considering that she had already borne the burden of that role with other members of her own family before.   However, the power of attorney still cannot be transferred unless it is done so at Dad's request, and at a time when he is judged to be competent to make such decisions.  Barring that, the only other option would be to make him a ward of the State, which nobody wants.  My hope is that my sister and other family members will be allowed to work closely with his step-daughter in managing his care and other affairs, both to lessen her burden and to make sure that his interests are being represented, to the best of our ability to know or guess at them.

That's more than enough on the family politics for now.  If everyone agrees to work together for the good of both my Dad and his Wife, the legalities and politics should be relative non-issues.

This has been a very boring post, for a change, and I am very thankful for that.
What I thought had started as a chronicle of my Father's imminent decline and death, seems to be evolving into a story about an episode that will pass.  Perhaps his new baseline condition will be a little lower than it was before the episode, but I see a good chance of an extended post-episode period of maintaining a relatively stable condition, hopefully back in his own home, after some minor upgrades to his home and other accommodations.
2 Comments

Elaine Romero
Not boring at all, Michael. I am glad to hear of the improvement and wish you all strength for whatever comes up for your father in the future.

    12y

Marilen Wood
I'm with Elaine. Please keep going with the updates on your father. I, too, wish you guys all the strength for whatever comes down the road for your father and family.

        12y