Progress and mischief

 7 September

It’s been ten days now since I reported on Sela’s progress.  I think another one is due.

So, let’s start with her thigh.  Slowly but surely, the spot is healing.  It does not give her much pain, unless she touches it getting dressed or so.  The foot where the implant was placed looks a lot better.  The ‘new’ skin is pink and settled nicely on the spot.  The edges are a bit angry still and she has a ‘6’ pain on the arc of the foot.  The nurse ‘Crystal’ continues to monitor this and ‘Pam’ comes twice a week to give her a bed bath.  Sela enjoys the baths and how Pam sings to her and gives her a nice back massage.  I hear them over the intercom exchanging jokes and laughing the pain and dirt away.   Last time Pam was here, and had turned Sela back and forth for her bath.  She did not seem to like it much and told her, pointing her index finger at her:  Do you know where you’re going when you die?  You’re going to HELL!  It’s a good thing Pam thought it was hilarious.  I was just beside myself with worry when Pam told me.  I begged her to consider Sela’s age and state of mind, but Pam refused to be offended and just laughed.  Today, Pam is back smiling again, thank God.  Over the intercom I heard the laughter, the lovely deep voice singing little tunes.  When Pam was finished with her and she was snug and squeaky clean, Sela said to her:  Now I’m ready to die!  Good, no hell this time!

Social Services start next week, three hours, twice a week.  Hope the worker likes dogs.  So far, all ‘visitors’ have not minded Otto even though he barks as he escorts them in and out.  We shall see.

So, there was an event last week that nearly sent me the edge.  This is her account of the incident: It was around 2, 3 or 4 in the morning, and after using the toilet she scooted over to the sink to wash her hands. Apparently, she did not sit well on it, and lost her balance and started to fall.  She says that she was caught between the bathroom cabinet and the scooter, so she did not fall flat, but gradually.  So, she decided not to call me. (You see, all she needs to do is holler, for I have a baby monitor in her room and mine.)  She took it upon herself to crawl to her bedroom, take the seat of an easy chair by her window, and lean against it for support.  She tried to get up, she says, but to no avail.  She pulled off a blanket from the bed and decided to spend the rest of the night there.  She says she slept on and off until I found her next morning at 8:30 am.  She pleaded with me not to call the paramedics.  It was obvious she was all right, so I grabbed the phone for help.

Florence, who lives so close and was fortunately still at home, came to the rescue and we carefully lifted her onto the chair, then to her Scooter and then to bed.  The nurse checked her over later that morning to confirm that there was nothing hurting her and that her vitals were all right.  I let her sleep all day, well into the evening.   When she woke up, thinking it was morning, she demanded breakfast.  Out came the waffles, the orange juice and some coffee.  Later on she accepted the night and we watched some television until bed time. 

Now, I’m happy to say that she’s dropped the Scooter, which sits neglected in a corner of her room.  I’ve noticed how her left foot angles inward and how her right foot trips on it.  I pointed this out to her in front of the bathroom mirror and she now makes an effort to step out with that foot and walk slowly.  Her knees are so inflamed that they’ve got her legs all out of whack.   So here’s September and we’re on the way to fall.  On Monday the 17th we return to Wake Forest.  Roberto says he will drive us then.  We shall see how many times we get lost, for he was born without a compass… His north is south, his east is west…  Until the next one, good bye and again thank you for caring for my mom and being concerned about her.  (Continues on blog: Last visit to Wake Forest)

Perfect implant.

28 August 

Yesterday morning we left for Wake Forest with much anticipation.  Again, Florence drove us in her car.  Before we arrived we had time to lunch, and we got to the Burn Clinic just in time.  In came three of them, the surgeon, Dr Craig, and two of his students.  He took off the bandages from the foot first, and we could see a 'splendid' graft all snug on her foot, where before there was a very angry burn.  Her foot was not swollen and, apparently, the graft was well 'rooted'.  He explained to us, as well as his students, step by step, how with an orange oil extract spray he was able to remove, without pain, each little piece of bandage.  She still has to cover it with the special bandage until we see him again Sept 17th.  Dr Craig said the two burns on her thighs were 100% cured and the place where the skin was taken was about 50%, for the skin still needs to grow there.  She can't get it wet still, so we will continue with bed baths.

We left happily, with the blessed boot in a bag, as she does not have to wear it any more.  And... now she can walk!  We're going to try to get some balance and not attempt any marathons.  The nurse is arriving shortly, and I shall have her order some neat burn net to cover her wounds.  Thanks for your concern and prayers.  

Implant

Left leg

Right leg

Misbehaving

Well… what can I say?  We’ve been here just three days and Sela has started to misbehave.  She is quite an intrepid woman.  She needs no more narcotics and only takes Voltaren for her arthritis.  The graft we can’t see, but it hardly hurts.  The place where the tissue was removed, is very sore and it bothers her when she dresses or goes to the bathroom and the bandage moves.  Everyday there’s some improvement thanks to God and His Archangels and the Blessed Mother, that you all having praying to.

As far as her behavior is concerned, that’s another matter.  Since the first day, when Roberto slept with her, I moved my pillows right onto the bed next to her and became night sentry.  Roberto has stayed with us for three nights and we are happy to have him here with us.  Yesterday, on her way to her bathroom on her scooter, Sela slammed the Scooter and took off one of the doors!  Two of three hinges came away from the wall too, and she just turned around and said What was that?  It took us some time to screw the hinges back in place, and now the doors don't close properly.

I got Crystal the nurse to and care for Sela’s wounds and for Pam, the aid to come and bathe her as she cannot take a shower just yet.  One day at about 11am I asked Sela to keep still in bed while I took a shower for I had an appointment with Social Services.  Not ten minutes later, I found her WITHOUT HER BOOT in the middle of her room, trying to walk towards the bathroom.

So I say to her, Don’t you understand that you CANNOT bend the foot, that the implant may not work, and then WHAT?  Let’s see if she pays attention.  The Social Services coordinator, a lively Betty White kind of woman, came and told me what the aid could do to help me care for Sela.  So soon I’ll have someone to look after her for a couple of hours while I’m teaching.  I start the afternoon after Labor Day.

Roberto resigned from his job at Greenville and will be back in Charlotte soon.  We’re happy but worried about his situation.  Thank you for all your messages and prayers and for encouraging me in this journey that life has offered me.  It is fortunate that this has happened when I have only a couple of students and don’t need to be away from Sela for a long period of time.

Back at home

20 August.  At 8:30 am I hear some noises through the intercom and go down to see what was up.  Sela just said "I'm wet all over" or as we say "Estoy empapada"!  To make this shorter, she had gotten up and gone to the bathroom WITHOUT the boot (she can't bend the foot where the graft is) and could not find any more pampers (right next to the toilet where they always are)... went back to bed and the rest you can imagine.  And I just looked at Roberto and he said... I was watching her and she seemed OK...  Men!!!!!  So after three loads of washing, all sheets, blankets, bed covers, mattress covers, etc... undressing, bathing, dressing, dressing the bandage of the thigh, all wet too...  Off to breakfast, this is about 10 am now, and then to the living room to watch Sunday mass.  She watched until after the sermon, the rest, the angels that surrounded her and Otto watched it -I heard it from far away as I re-made beds and picked up her room.

She had almost NO pain at lunch (2pm) so no narcotics this afternoon.  After lunch, she went to the bathroom, and then to bed for a nap with Otto.

If I have not answered your calls, emails/texts, etc... is because my hands are full today.  Roberto, after breakfast went to the grocery store to buy some chicken he's cooking tonight.  Then he called back to say he was tired and was going to take a nap at his house and will bring the food later this evening. 

I think all in all, my mother is now on the way to recovery.  God and the Archangels willing, the implant will take and her foot will be healed.  I have to be careful the back of her ankles don't get sores -we're already dealing with one on her back.  The nurse may come tomorrow, the assistant may come to bathe her, and Social Services are interviewing me for additional help.  For soon enough Medicare will quit paying for the nurse and assistant, and SS gives me 80 hours in a period of 3 months for free of assistance.  Let's see what that assistance is all about.

Sela's blood pressure went down now at 120/60 and she looks nice and rosy.  Her appetite is back and even though she's a bit incoherent with the narcotics and comes out with the weirdest comments, she's doing all right.  Thank you for your concern for her, your prayers and messages.  

The graft and recovery

19 August So, it's around 3pm and I finally can sit to write to all of you who have been so kind calling, messaging or being there with us.  I'm writing in English so that I don't have to do this twice.  I'm really tired and overwhelmed.  I had not anticipated my mother being so incapacitated and it's just a lot to take.  

The anesthesiologists were wonderful, and he doctor in charge was amazing with Sela.  As he was also teaching, he would let us be present when he would explain the anesthesia procedure to the students hovering around.  They did a nerve block on two sides of her upper thigh to cover the left side of the foot and the place where the tissue was removed on the right side.  They did not give her an epidural, but she was heavily sedated before they took her in.  When she came to, about an hour and a half later she was hungry, so we ordered her some food.  The food at the hospital, by the way, is very good.  One can order at only $5 a service and they include a drink and dessert and plenty of food.  She started having very bad pain in the afternoon and her blood pressure was quite elevated so the doctors decided to let her spend the night.  She was given morphine when the heavy pain killers did not help her and, she slept for a couple of hours.  Florence insisted on taking her back to Charlotte, but I put my foot down, how could I put her in a car like that.  So Florence left back to Charlotte and I stayed with Sela in her room.  It was a terrible night.  She was in such terrible pain that more morphine was given to her and more painkillers.  We hardly slept a wink. 

In the morning, she seemed a bit more settled and we removed the boot to give her a rest.  It might have been that the boot was on too tight, for she felt some relief and the pain was more manageable with just the pain killers.  We rode back with Roberto who arrived from Greenville, after nurses gave Sela another Oxycodone.  She was settled comfortably in R's car with pillows and blankets etc...  The trip was uneventful except for a few wrong turns which took us circumnavigating the Charlotte area, and Melissa was waiting for us.  Up she went with effort, for she cannot put weight on that foot -even if wearing one of those boots that look like they belong to Herman Monster.  She's just terrified and grabbing everything and everyone like an octopus.  And, to move one leg, and then the other is amazingly slow.  Sela the sloth I called her.  Anyway... we got her up and I changed and washed her ( as there was some flooding on the way up) and when Anna and Michael came in to bring Otto back, Sela insisted on sitting in the living room in her scooter.

After dinner and some Oxycodone, and a lot of arguing back and forth, Roberto won and decided to sleep with her.  It took us a good 45 minutes or an hour to settle her in bed.  I had to re-dress the thigh were they took the skin off, and well... it was tough.  The foot we cannot touch, the surgeon put a sign on her bandage DO NOT REMOVE... so there it is.  I have to remove the boot when she's in bed or on the sofa.  At that point I was falling asleep on my feet, so I told Roberto NOT to let her go to the bathroom by herself of without the bloody boot.  And off to bed I went.

A graft for Sela's foot.

14 August.  We returned to Wake Forest University Hospital with news that Sela’s foot will need a graft.  The tissue has not grown back as expected and some new tissue will have to come from her thigh to cover her foot.  It is not difficult, done outpatient, the pain will be bad, said the surgeon, but he’ll give her lots of pain killers.  The pain on the foot will come down from 10 to a 3 (it is now 7/8).  The thigh burns have healed well and there’s no more need for heavy bandages.  If this procedure is not done on her foot she may end up getting an infection, and may even need amputation in the worst case scenario.  It will be done early Friday 17, day after tomorrow, as Dr Craig does not want to wait any longer with that open wound.  We will leave early Thursday morning for admission at 11 am.  Brian got Florence and I a room at the Hampton Inn so that we don’t have to travel back and forth, and we can be there before they take her in early Friday morning.  Again Florence will come to the rescue, she has some vacation due to her.

Sela is a bit frightened, but she knows that it needs to be done.  Dr Craig told her that this can be cured by itself, over a long painful process, but that it can also get infected.  They will give her an epidural and some sedation.  He also said that the place where tissue will come off will be painful, but again she will be helped with pain killers.  I will be on my cell phone, but sometimes it fails.  Otto will spend the night with Michael and Anna.  This time the trip was uneventful and Sela was a bit subdued and quiet.  I sat in the back of the car while Florence drove and read and slept.  I’m exhausted with all of this ordeal.

Trip to Wake Forest Baptist Hospital

August 2^nd.  We’re going to Wake Forest University Medical Center: Sela, Carla and I.  We're taking Adriana's car, since my car is not up to par, and Melissa's car needs a front tire, and she woke up with scratchy throat and stomach pain.  I talked to the Wake Forest Burnt Center and tomorrow they're going to assess Sela at the hospital’s ER and then call in the Burn Team.  I doubt they will keep her but, we shall see.  Otto will be home by himself, I think we'll be back before dark, but he'd have been fed before we leave around noon.  

 3 August Off we went at noon, after Brian and Florence helped us 'lift' Sela onto the car, since it’s a bit high for her.  She rode in the back, dizzy and sleepy and a bit nauseated from the pain killer.  We drove for 1 hour and a half and arrived at the ER entrance where two people lifted Sela out of the car again, this time squashing her breasts and making her wince and complain loudly.  At the ER a doctor examined her and said he would call in the Burn Specialist doctor.  She was settled in bed in a cubicle sleeping off and on.  

The young and very tall doctor came in and examined her.  He said that the tissue on her foot had not healed properly -sometimes this happens with the elderly and young children whose skin is very thin.  He said he was very conservative about operating a 90 year old woman and that he would treat her with a super special cream (and very expensive too, he added) that would eat away that dead tissue, while the new tissue would start to form.  He also told us that the swelling and redness was not due to infection, but her body trying to get fluids and blood trying to 'fix' the wound. If in 3 weeks the new treatment works, then he would not operate.  If not, then she would have surgery to remove it, and get some new tissue from her upper thigh.  

The other two burnt spots on her thighs seem to be healing properly and he showed us where the new tissue was developing, even though it looked awfully raw and angry.  So, he dressed those spots with the Sulpha cream, putting it on thickly as you would ice a cake, and covering them with soft gauze.  The foot he dressed with the special ointment and also wrapped in gauze.  He was very sweet with ‘Sela who flirted with him and told him he looked like William, the British Prince.  We are to see him again in 3 weeks.  Sela got some prescriptions for pain, not as strong as Vicodin, and was told that the stabbing pain she feels on her foot is a good sign that her nerves there are intact and complaining.  

At that time, 6pm, we were starving, so after discharge we went to the cafeteria and ate a bland but very filling meal.  ‘Sela was in good spirits but awfully tired and sleepy.  Departure with another lifting of ‘Sela onto the car, this time she yelled: "Esperate, esperate" at the young intern who was trying to help her.  We almost peed in our pants at her complaints and the intern’s face.  Everything seems to hurt her, and it’s hard to know how to help her.  She's been so brave and patient throughout this whole awful thing.  We arrived home at around 9pm, and again Carla and I attempted to ease her out of the car.  This time, because of heavy bandages on her wounds, she could slide down to the garage floor where we got her into a walker with a seat, on to the lift chair, off on the landing three steps to the waiting scooter, and hurriedly to the bathroom!!!!

So, all in all, the experience was a favorable one.  We all were pleased with the way she was looked after at this hospital and the doctor's instructions.    

Not getting better.

The days go by and my mother's thigh wounds seem to be getting better but the foot burn is angry and red, her foot is swollen and very, very painful.  On July 31st I posted this to family and friends:  

Today, Carla and I took 'Sela back to the doctor because we decided that her wounds are not healing properly.  The pain is horrendous and she cannot move or sleep.  She can take a couple of tiny steps from the bed to the scooter to the toilet and back, and that's all.  She is very uncomfortable and suffers horribly when I apply the ointments.  I don't think I can do this any more, my back is hurting and just having to see up close these horrid wounds and cure them is much too cruel.  It takes great effort not to gag each time I remove the bandages.  It's been a week since 'Sela got burnt, shouldn't it be healing now?  

The doctor said she wants 'Sela to be seen by a skin surgeon, plastic surgeon I guess.  She made an appointment right there and we went to see him in the afternoon.  This young doctor spent some time looking at the foot, and finally said that it was definitely a third degree burn, that it was not yet infected, but the trauma had cause terrible inflammation.  He explained that the tissue that looks dead and discolored will probably have to be removed and grafted.  That the inner thigh burns are second degree burns, and seem to be healing, but that all must be treated by a specialist.  He took pictures of 'Sela's burns and then gave us the names of only two burnt centers in North Carolina: Wake Forest or Chapel Hill.  We chose WF which is closer to Charlotte -one hour and a half in Winston-Salem. It may be that they decide to keep her there, but we shall see.  Meanwhile, I keep the cure of the thighs and foot which seem horribly angry still.  'Sela says it feels as though the water was still burning her. The pain has not ceased and the pain killers do nothing but make her sleepy and confused.  When I cure her twice a day my mother screams so loud that Carla has to go out to the back yard.  She cannot endure the anguish of Sela's cries.  Last night she slept a bit more than usual, I suppose she's exhausted.  I sleep lightly too because I hear her pitiful moaning coming sadly through the baby monitor.  Here are some photos of her burns, not for the weak of stomach:

Right foot, dead tissue appears yellowish

Right leg, only a nickle sized spot to heal.

New skin has appeared!

Accident

Since my mother, whose name is Ana Gisela, had an accident on July 24th, 2012 and I have been overwhelmed with her care, I started writing down bulletins to send to my relatives.  In doing so, I thought it would be a good thing to create a blog with all these notations as a way of introspection and relief.  

I must first point out that I started to call my mother 'Sela because a lot of people in our adopted country cannot pronounce it.  It was either Gay-zeela, Gah-zella or Gee-zeela.  So this is what I started calling her, when moved in together, and it stuck.  

Here is the first bulletin informing my family of 'Sela's unfortunate and very preventable, accident:

July 26^th, 2012.  Tuesday morning Sela got up quietly, and without my help, for I was upstairs in the office, she heated water in the microwave for her coffee, in a small glass teapot.  She was riding her Scooter at the time, and facing the table, she had to use her left hand which has nerve damage.  She took out the teapot and rode with it towards the table, dropping the hot water on her thighs and right foot.  She called loudly for me, and I found her in such state of distress and pain, I just did not know what to do.  My cousin Carla was spending some time with us, and was asleep upstairs.  I called her and asked her to call the paramedics, while I applied egg white on the burns –I had heard it was good for burns- and this seemed to calm her a bit. 

Four firemen and two paramedics arrived soon after with orders to put the pet away.  One of them said that the burns were severe and they soon took her to the ER at Carolina’s Medical.  In the ambulance they gave her some morphine to ease the pain for she was in agony.  At the hospital she was given a tetanus shot, and some ointment was spread on all burns.  After checking her vitals and watching her for a few hours, we were sent back home with instructions to go to our doctor for a follow up soon.  Today we took her to her to her doctor and she gave us a different cream (SSD) for the burn that had lost the skin.  The other burns are covered with big angry blisters.  She was given Vicodin for pain, and we were asked not to cover the wounds.  Here are some photos of the burns.
  

Right foot

Left thigh

Right thigh

During the week that followed, it was painful to watch my mother, struggling with the pain, not being able to walk, trying to maintain the wounds clean.  I covered them with a light gauze, for all the oozing was sticking to her clothes and her socks as she's always cold and wears cotton socks and long pajamas.  She began taking Hydrocodone which she could tolerate better than the Vicodin.  I noticed that one part of the foot burn that looked like dead tissue.  When I put the ointment on, with gloves, it was stiff and the color not good.  Carla and I tried to entertain her and watched movies with her to keep her mind of the pain.    It is hard for me to answer so many calls and tell the same story to all so I have decided to give you bulletins from time to time.  Thanks for your prayers and calls, again.

How it started.

It all started thirteen years ago, just as I had decided to go for an English Master so that I could teach English as a Second Language.  On august 23^rd, my father died, leaving my mother in a Retirement Facility called the Carriage Club.  They had lived there for three years, as my father’s health deteriorated.  At this time, I lived with my son, Michael, in a 3 bedroom apartment nearby. My mother and I soon decided that it would be more economical if we lived together and shared expenses.  Sela would take care of the mortgage and I would pay the expenses.  Michael was going to school at the time, but also had a part time job, so he helped as much as he could too.  We found a house in Southwest Charlotte with a master bedroom downstairs and a bonus room where Michael could have his domain.  As big as the garage downstairs, we accommodated my dad’s made to order bookcases, and Michael fitted his 75 gallon tropical fish tank on the living part of the bedroom.  We brought along our miniature Dachshund Otto, who since then has been Sela’s constant companion and escort, except for bedtime, reserved only for me.

Otto and Sela, December, 2000.

Life was simple, but I had too much to do, taking care of everything, paying bills, etc…  My mother was very sad having been with my father for fifty five years.  I wanted to be with her, and finally have a chance to enjoy her company.  She had been totally absorbed in my father ever since I can remember.   I decided to stop working and the ESL dream flew out the window effortlessly, for I was tired of teaching in the crowded schools.  I started tutoring in Spanish, first elementary students, and then a friend recommended I tried the high school students that were not doing well.  Slowly, I let go of the little ones, and concentrated only on the teenagers and twins whose mother was homeschooling them, and who have been with me since they were six years old.

Beginnings are always tedious but necessary.  Now you know how this came to be.  At the start my mother still volunteered at Presbyterian Hospital and went out with her friends.  I did the same, and even took the odd trip to the mountains and the beach.  We enjoyed living together, for my mom and I have always had the same tastes in movies and books, gardening and cooking, and most precious of all, the same way of finding humor even in the most adverse of circumstances.   Eventually, my mother’s arthritis prevented her work as a volunteer and she started having much pain and discomfort.  Even though everyone advised her on getting a knee replacement, which wouldn’t have been a major issue in her seventies and early eighties, she did not find enough courage to have it done.   So, from a cane, she went to a walker and lately to a scooter, when the pain is unbearable.  Michael moved away and has since married, and in his room, I have found a great nook for classes.  

 I’ve always known that taking care of my mother would be no easy task when she became dependent on me.  I’ve never been one to plan ahead and give the future much thought, so I did not prepared for it.I will then use this new thing called a blog not only to vent my frustrations, but also to record what has become an adventure, a trip, not a burden or a duty.   Life with Sela has never been dull, caring for Sela never been routine.  Somehow we find, at the end of the day, something to laugh about.  We both share mutual feelings of compassion, patience, tolerance and love, mixed with frustration, sadness, loneliness and fear.  Getting old together, we have found comfort in each other, I am lucky that she has shown me the way.