Delirium

 When we think about the health issues of old age, the issues that will really reduce independence or limit life span, we probably think of broken hips, frailty or dementia but when we really get into the trenches, we meet a thing we rarely hear about: delirium.

  Delirium is a sudden, temporary state of severe confusion and impaired cognition, often arising from underlying illness, surgery or medication changes in hospitalised or older adults. 

My mum has been hospitalised several times over the last few years and has had delirium each time. According to the definition, delirium is temporary but what the definition doesn't tell us is that, oftentimes, people don't fully recover. Mum has been left with a cognitive loss after every episode. One time she had a long running difficulty with numbers, it seemed to eventually resolve but for many months she would use numbers in ways that were just so far wrong, it was impossible to make sense of. She would announce a heart rate of 300 or a blood pressure of 20, she thought her wedding was in the 90s (1968)

Mum also developed confusion about her phone service. She had once had a working understanding of internet service, mobile phones and landline but after delirium they were all dumped into a cognitive basket for communications and she would say things like she couldn't find an email because the phone at the house had been disconnected. No amount of explaining could help her understand but she also refused to let go of trying make it make sense so we had an ongoing saga of "trying to pay for the phone/ fix the phone/ fix the email" which just couldn't be solved.

A man who came to work looking for care for his dad expressed his frustration about deliriuim and about the silence around it, saying that his dad developed delirium after a surgery and was still impaired months down the track. He thought he might have taken a different approach to his father's medical decisions if he had understood the implications of surgery in old age. He commented that unresolved delirium is the same as dementia and he was right, technically speaking delirium and dementia are different but if they make a person confused and steal independence, the end result is the same.

These past two weeks, mum has been hospitalised again and has developed the worst yet case of delirium. When I visited on Thursday she asked when Dad was coming, tried to rip her oxygen off, wanted to know if she had to pay for a towel (apropos of nothing), undressed herself multiple times, kicked her sheets constantly and told fantastical stories about the great buffet that had been laid out (in a public hospital) and which she wasn't allowed to eat. She wanted her bed up and down about 6 times in a half hour and was angry when I asked how I could help her. After I left she spent the whole night trying to climb out of bed. 

It was bad enough that every nurse I spoke to on Friday mentioned it, including some who had been working down the corridor.

After seeing all that, I went home on Thursday night sure that Mum was dying and trying to figure out how to get her back to her nursing home so she could live her final days in peace. When I visited on Friday she was sitting up in bed writing text messages to her grand daughters, still a bit confused but much more herself. I guess I can leave her in hospital to finish treatment after all.

I'm sure there will be permanent cognitive changes again and I wonder how we will navigate them. The good thing this time is she has an aged care facility to return to and we won't be trying to manage a confused, combative person on our own. 

Tales from Aged Care

A couple of weeks ago, the phones at work were not able to transfer calls from the main reception number to us in admin. It was frustrating and the receptionist started telling people they would be best to email us.

One man, let's call him Joe, became slightly unhinged and word has it he phoned reception twenty times in an effort to speak to us about a room for his mum.

When I arrived the next day, there was an email from him and so I responded. He wanted to come in for a tour so we booked a time for the same day and I showed him around. 

I did my usual spiel, designed to be friendly but also point out that there are many steps to admission and most people will never be offered a place, simply because we get about thirty enquiries for every vacancy.

Joe started asking if he could present his case to the manager, the head of nursing or the board of directors and I laughed him away.

A couple of days later he came in with a floral arrangement "for a resident"

The same day he came back asking if we had a volunteer program.

Next came a request for an introduction to the manager.

I had, of course, talked with the boss about Joe and she was aware of his goings on.

Then we were having a casual lunch for a colleague's farewell and in all of the chatter, Joe was mentioned. The area manager piped up and said that Joe had so many red flags, he could surround the place in flowers and still never get a place.

Joe's behaviour is all very stalker-ish and the flowers are unethical as well. Joe isn't frightening yet but it's only a matter of time.

When another email came from Joe I knew I needed to be firm and chilly. I even  ran my response through chatGPT and asked for it to check the tone. ChatGPT told me my email was cold.

haha, Bingo!!

Hopefully that's the end of that story.

Drat

 When I started in my current job, I was offered two days a week. It's not enough but I hoped it would become more. Within a week, I found out that my counterpart on the other three days would be going on maternity leave. I would have savings to use until she actually took leave and then I thought I might be able to do full time until she returned from leave.

Well, that didn't happen because the facility wants to keep a job share arrangement. When my latest counterpart resigned, I hoped I could at least get three days but so far that hasn't happened.

On the way to work yesterday, a woman driving in front of me slowed to take a left turn. She slowed and I braked, slowed more, I braked more. She almost stopped and still wasn't around the corner. I was braking as hard as I could and the car wasn't stopping on a slippery wet road. It was like a bad dream.

Her first words to me were "YOU HIT ME" 

The damage to my car will never be fixed, I just get to drive around in a more beaten vehicle than I already did.

I am responsible for the damage to the other car and have just made the insurance claim.

After that upset I got to work (late) and was called to the boss's office to be told the succession plan for my counterpart who is about to leave (the second person in 8 months) I had hoped that at this change, I might be able to increase my hours but no, the new hire will, again, take the greater number of hours.

It was a hard day and I am getting real tired of hard.

The aged care home where I work is a stone's throw from where I grew up so I have an association with the area and sometimes run across people I knew or knew of a long time ago. One of these was my piano teacher. I was about 14-15 when she taught me. I used to ride my bike to her house and I had to take my shoes off at the door. Mrs H taught in her loungeroom with plush white carpet and baby grand piano. I played half heartedly and she often took phone calls from friends. Mrs H seemed posh and scary.

Now she has pleasant dementia and when I told her I was a terrible student she said " Oh, you were probably interested in other things, darling"

Here she is at the Valentines Day afternoon tea. She saved a piece of cake for her hubby and when he didn't arrive she fed it to the visiting dog. She seems a lot less posh and scary now.