Love and All that Shit
    Today my mother had A Mother of All Bowel Movements. I have an idea how she and I managed to work up to it. She hasn't had popcorn for the last several days and apparently not enough fiber to make up for that lack. The other problem is that for the last 3 days at least she's been persnickety about fluids, we've had more than a few pitched battles about this and I gave up during a little over half those battles.
    When she headed into the bathroom to move her bowels neither of us had a clue that a little over an hour later she'd still be in there, would have eliminated very little, would have strained quite a bit despite my advice not to strain, would have read through an entire spice catalog, drunk a cup of hot herb tea and still be very uncomfortably clogged. She didn't want to remove herself from the toilet and walk around a little, which I thought might help. She was afraid she'd have an accident. I was hoping this, which I would not have minded cleaning. Anything to end her misery.
    A couple of times throughout the ordeal I offered to clean her. When she's a little constipated cleaning her mid-movement helps. She refused. After a bit over an hour I told her I was going to clean her anyway. She was so uncomfortable she decided to allow me this. I discovered that she was trying to expel rock shit. Jesus Christ Almighty, it was bad. I was able to trim the shit extending just beyond her anus. She returned to the toilet. I left her alone for about 10 minutes. She wasn't able to expel any more. I told her I was going to clean her again in case a bit more had managed to bulge out. Again she refused and I ordered her up. She complied. I knelt beneath her ass, separated her cheeks, looked up and, well, what a sight it was. Her sphincter was locked open almost two inches by a block of rock shit that appeared as though it had no interest in going anywhere.
    I told her it was enema time. She roared her disapproval but I told her the situation was beyond choice. She was so uncomfortable that she didn't think she'd be able to arrange herself into a reclining position to take the enema. I agreed. I decided I'd better give it to her standing up at the toilet, which is not recommended and carries some danger but, well, what are you going to do when comfortable reclining is impossible? I removed all rugs and plastic from the linoleum floor, brought in a huge towel expecting that the enema might work on her before she'd be able to reseat herself since it was obvious she wasn't going to be able to hold the liquid in. I very carefully inserted the tip of the enema bottle between the shit block and the wall of her colon. Before I'd gotten the tip in a half inch, before I was able to discharge the liquid, apparently the agitation of inserting the tip caused her colon to spasm just enough to catalyze a downward expelling contraction, she turned toward the toilet, which movement dislodged the tip of the enema bottle, sat down, strained mightily and immediately released two very thick, very hard blocks of shit, one of which was about 6 inches long. The ordeal was over.
    I ordered her not to flush and immediately taped the flush handle to the side of the toilet. She remained sitting until her colon relaxed a bit then stood while I cleaned her. Cleaning was easy. The olive oil she receives every day keeps her iron laden shit from soiling her entire uro-genital-eliminatory tract.
    Once I'd cleaned and redressed Mom, instead of letting that shit sit in the toilet and soften (which I wasn't sure was going to happen) I decided to glove myself and go after it. It's a good thing I did. She'd expelled quite a bit and all of it was either like slabs of granite or river rocks. I dug down into the pipe and extracted as much as I could before I finally had the confidence to flush the toilet. It probably sounds like this operation was disgustingly messy but it was the opposite. I only had a toilet to clean, not an entire half of a bathroom. Fishing her shit out of the toilet worked so well that it occurred to me perhaps this is the way I should handle all her bowel movements. That would certainly take care of the toilet clogging problem and after today I have no problem handling her shit.
    What does all this have to do with love? My maternal grandmother was in a nursing home during the last months of her life suffering from what was labeled as advanced Alzheimer's. When she became colonically impacted the staff cleaned her out with a spoon. I recalled this throughout my mother's ordeal today and realized that if she'd been in a nursing home spooning is one of two very uncomfortable, potentially dangerous ways this situation would have been handled. The other was the way the skilled nursing facility perpetuated on my mother last August: Load her up with laxatives and let her rip. If you read about it you'll know that from the nurses' point of view I was amused because I warned that if they used a typical laxative dose on her they'd have a mess on their hands. They ignored me and they had a 36 hour continual mess on their hands, and the bed, and the floor, and the bathroom. This situation was not at all healthy for my mother since her urethra had just begun to work off the challenge of the hospital's 6 day catheterization. Luckily, she was still on antibiotics for a UTI but continued having UTI problems after this, no doubt from the contamination of having diarrhea for 36 hours. As you'll recall as well, after this incident I instructed the staff to make sure she drank at least one 11.5 ounce can of V-8 juice a day (which I provided) and ate a bag of popcorn (which I provided). As you also know, I visited every other day and noticed that the staff never did this. Thus, when she left the facility she was shit impacted, although only slightly. Today was the first time her impaction has been this bad since the laxative incident at the nursing home.
    The love part is that my mother is not in a nursing home, is not being regularly subjected to spoons and lethal doses of laxatives in order to clear up impacted fecal problems which she'd probably be suffering on a regular basis if she was in a nursing home. She is on an extremely high fiber, high olive oil diet (which she wouldn't be enjoying in a nursing home) in order to keep incidents such as the one today as infrequent as possible. I also monitor her liquid intake much more closely and successfully (even when I lose pitched battles) than the hospital or nursing home did (and I kept after both places, explaining more than once to each that telling her to drink and leaving the vicinity would not work...she has to be coaxed to drink and monitored while she's drinking).
    After today's shit fest I gave her a modified and expanded lecture on refusing liquids which I think probably made an impact (forgive the pun, I couldn't resist). I expect we'll continue to have occasional problems. Although I'm being careful not to overdose her on liquids (expect today), she still has flashes of remembering a couple of doctors saying, "Have her drink only when she's thirsty." When these memories return she becomes so inordinately obstinate that, well, this time, I gave in. I obviously shouldn't have. Now I have an argument that, I hope, will trump her next "I don't need to drink anything if I'm not thirsty, that's what the doctors said" episode.
    I'd like to say that I can't imagine how a hospital or nursing home would have treated her today. Unfortunately, I know exactly how they would have treated her. This is one of the many reasons she's not in a nursing home. I love her enough to willingly maneuver through days such as today rather than have her in a nursing home. Someday, the gods please forbid, I may have to put her in a nursing home. But not today. Today, once again, I pulled myself up to her needs and discovered I am able to meet those needs in a way that preserved her safety, her dignity and her sense of community. I'm now even more determined to keep her at home as long as I possibly can. If I can plow through her shit I'm willing to bet I can plow through anything on her behalf.

9/15/11
Hmmm. It seems that Blogger has put a limit on the number of characters that can be entered into a comment. I discovered this when I attempted to respond to the comment below, left half a month ago. Since I don't want to shorten my response, here is my response:

Gary,
Sorry it took me awhile to get around to responding to your comment. Thank you for noticing my post and commenting, even though my mother died in December of 2008.
In response to your question: During the last year of my mother's life she was in a skilled nursing facility for short term physical therapy after a difficult bout with pneumonia drained her strength but, other than that, no, I didn't consider looking around for other nursing homes for long term care, for a variety of reasons, not the least of which was the extraordinary relationship my mother and I developed during the years in which we were companions and my ability to rise to ever occasion of care that our companionship demanded. I not only have never regretted that decision, I have been constantly extraordinarily grateful that mutual companionship worked out for my mother and I through the last several years of her life. I wouldn't trade it for anything. I wouldn't even trade the intense-need care circumstances for anything else.
Despite the tone of my post, I completely understand when people find the need for nursing home care for their infirm relatives. There are so many reasons why nursing homes, assisted living facilities and skilled care facilities work well for families. Each care profile for each family, while having similarities with others, also contains striking differences. I do wish that our society was at least as supportive of in home care for the needful elderly and infirm as it is for parents with children. The government is beginning to realize that supporting in-home care is much less expensive than facility care, but there are still many problems with government intervention. Of course, our society has problems in supporting parents, as well, but that's another subject for another day and, at least, it's not nearly as bad as it was in the later 1800s and the early 1900s when children whose in home care support fell through the floor and lots of children were warehoused in orphanages or left to fend for themselves. I have a great grandfather and two great uncles who became orphaned in that time and were orphan-trained from New York to the Midwest. Their lives turned out well, thank the gods, but I know this was not the outcome for many, many children.
I often think of that time when I consider the booming industry in long term care facilities. Children, at least, sometimes have the opportunity and the time to rise above their circumstances. Elders do not. Although I personally know cases that have great outcomes, I also personally know of cases that have been less than optimal; some of these cases include families moving relatives from one facility to another in order to attempt to find better care.
In the case of my mother and her first period of short term facility care (two weeks) of which I spoke in this essay, we were given a short list of facilities that were available for care, had a social worker in the family who used his contacts to narrow the list to the best facility not only on the list (which was compiled by Medicare) but among any other facilities which might have fallen under the auspices of my mother's short and long term care policies, and the care was scheduled, ahead of time, for two weeks and no more, to start on a particular day, so a move would not only not have been a good idea, it would not have been supported by the institutions funding her Skilled Facility Care (we checked into this). We handled monitoring of her time there in family, kept ourselves well informed and operated on a meticulous schedule of oversight.
One of the problems, of course, inherent in selecting a facility under these circumstances is that facility care cannot wait, so if a particular facility doesn't have an opening, one must go to "the next one on the list". This didn't happen to us at this time; the facility we determined to be the best also had an opening.
During a later short term stay (four years later) in a much smaller community, two institutions were recommended above the one that took on my mother's care, but both had no openings, so our hands were tied; she needed therapy immediately.
I'm sure that the situation is different when families are looking for long term care options, when time can be taken to research and choose an appropriate facility. The conundrum of the need for short term skilled nursing care is quite a bit different than seeking long term facility care.
Thank you again, Gary, for your comment and your link. Although my blogs are rarely visited, anymore, I suspect that the link may prove valuable to an occasional visitor.
Gail
- posted by Gail Rae @ 01:19   email...this post