Sunday, February 19, 2017

Attention to Details

The decision to put Maggie back on calming medication, as needed, raised the concern about her recovery from a very large dose, from what she had been taking, of Xanax for the past two weeks. The following Sunday afternoon I took her to the classroom we use at South Hampton Place after saying good-bye to my brother and his wife at the front door.

She did not want to go into the room. Then her favorite resident, Dr. ____, facing the glass door, stood up at the far side of the room. Her face lit up. Her hand no longer was trying to force mine from the door but was trying to turn the door handle.

They met in the center of the room with big grins on their faces. Each had a right hand pointing straight ahead in an “ET phone home” pose. There was a brief exchange that no one understands followed by both turning and going their separate ways.

I came back later, to find the refugee group playing with a beach ball. This went on for almost 1½ hour. Maggie was having a good time. Dr. ____ got tired and called for an end of the play part way through. After a nap, he rejoined the play. Maggie has shown no adverse sign of recovery from a larger dose of calming medication.

Our PCP pointed out to us that the fears of decreasing medication, promoted by doctors who use Xanax, did not apply to the low dosage that was effective for Maggie. The details are that 0.25 milligram, as needed, is far from 2-3 milligrams per day for over three years used for panic and anxiety control in psychiatric patients.  

So what did happen? The falls every other day stopped. Then three days ago I woke up, at midnight, to go to the bathroom. As I left the bathroom, Maggie was sitting on the floor. Her back was resting against the bed. Her legs were straight out in front of her. Her shoes were on.

I failed to get her into a nightgown before I fell asleep. The caregivers had had no better luck. By not forcing her to do things but waiting for her to respond to a request, medication has been used only once in the past week.

I pulled both call buttons. One call button during the day means Maggie has pulled it in her endless inspection and rearranging routine. Help arrives and she is lifted to her feet. We all gasped. She looked like both ankles were broken. As she was lifted, I saw her feet swing out to the point that the shoes were on their side.

Our best guess is that she had taken off or loosened her shoes to the point her heals were exposed. When she tried to stand up, her black crew socks, slipped on the floor. She did not fall. She slid. She was not wearing her yellow gripper socks.

We goofed in managing the details. Now we put the gripper socks on whenever she is in bed. We do not wait for the “normal”, orderly, way to do things.

Both beds are now positioned with one side against a wall. The bed that Maggie slid out of has been fixed to the floor. Again the details: Maggie changes beds any time we are both up in the night.

JUST NOW. Yesterday a bruise was showing on her right knee. Today it is a BRUISE as I help her get her stockings on. Did she fall rather than slide? My guess now is a fall. She then pulled herself up to the bed where I found her. How this could have happened in 3-5 minutes without me hearing anything is a mystery. At Provision Living at Columbia the door to the bathroom is directly into the bed area, not in the short hallway into the room that provides privacy in a two bed skilled-nursing room. Also the floors are a hard weave rather than tile.

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