How many times have you been at church or social
functions and witnessed that “little old lady” that is running the show? From
party planning to organizing the Christmas plays to cooking dinners for 30+
people, my grandmother has always been that person. I often compared her to geriatric patients in
my medicine clinic and thought, “how does she do it?” No one in my very large family was prepared
for the day when she suddenly was no longer able to juggle it all.
My grandmother had a very difficult 2013 that all started
with her having back surgery. She had
undergone multiple back and other joint surgeries in the past and always seemed
to be back on her feet within days (so everyone thought this time would be no
different). Unfortunately, following a
very lengthy procedure, my grandmother woke up and really didn’t know
anyone. Her husband of 50 years, her 4
children, the multiple grandchildren, and even great grandchildren that she
often babysat, were only intermittently recognized. At first, I assumed (from 100s of miles away)
that she just had hospital delirium. I
received calls almost daily from my very distraught mother asking “what is
wrong with her?” and “is she going to get better?” The longer my grandmother was hospitalized and
as the confusion persisted, the less clear those answers became. The decision was made to take her home after
about 2 weeks as we all hoped that she would improve after being back home in
her normal environment. This unfortunately
was not the case, she actually declined – screaming all night in pain, became
incontinent of stool and urine, and completely exhausted my poor grandfather
that was trying to take care of her.
There was no medical background in the family and this situation with my
grandmother was not being handled well.
Some blamed my grandmother – they felt that she was “faking”. Others blamed her pain medications (to the
point that they essentially took all of them from her). Everyone started to fight, cry, and many
stopped visiting or communicating. My
grandfather on multiple nights took my grandmother to our local hospital
because he did not know what to do with her.
The last night that he took her she was septic and transferred back to
the original surgeon who did her surgery.
She was found to an abscess at the level of her new spinal hardware so
AGAIN had to go back to surgery. On one
hand, everyone was relieved that maybe the infection was the problem all along
and she would now to cured!! On the other hand, here she was going through
ANOTHER surgery. Following the surgery
my grandmother’s memory did improve some, but she is certainly nowhere close to
the person she was before this all started.
The more I talked with my mother about this case; there were subtle
things that had been missed – like the fact that my grandmother had been
forgetting places and names long before her initial surgery. She likely did have some mild cognitive
impairment that certainly did not help her in the recovery phase – especially
with delirium (and superimposed infection).
My grandmother knows our family members now and is functioning quite
well at home, but constantly has to be monitored and requires quite a bit of
assistance.
This story is just one example of the impact that
cognitive impairment can have on someone and their family. It is important to accept the process of
aging and understand cognitive decline. My
family has learned a lot this year thanks to my grandmother, and finally has
taken the initiative to start learning about cognitive impairment and dementia
and how to prepare as things continue to change throughout both of my
grandparent’s lives. Educating family
members and patients about what to expect is clearly important in the case
above, and something that I have noticed to be emphasized often during my month
on geriatrics.
-- Lindsey Prochaska
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