WHO I AM | Kimberly Mitchell
My daughter found my bank card finally - on a dining room chair. It’s no wonder I couldn’t find it. Keeping track of those dang things is ridiculous.
The nurse called last year yesterday. Apparently, I missed my allergy shot on Monday. It obviously slipped my mind. It was so hard to get another appointment. I had to wait a full week to get in again.
Roger
I wonder what Alice is up to this afternoon. She’s been different lately. Quiet. She has always loved to entertain, but lately she just never seems up to having company over.
Someone left the stove on this morning. I better talk to Roger about that. It’s not like him to leave things all over the counter when he leaves in the morning.
Had trouble finding my way home today. That’s not like me. I was always the one with a good sense of direction. I remember the time John and I went up to the lake. He got lost between the car and the cabin! We laughed about that for hours. Those were the days. I miss him. We were so young and free. Like nothing could stop us.
Roger
Alice has been accusing everyone of leaving things all over the house. It’s like she doesn’t realize these are things she’s done. I’m not sure what she has been doing with her days. Her friends seem to have lost touch with her. I used to hear dozens of stories about Alice and Sheilah, Joan, or Cindy golfing or lunching. Those seem to have gone.
It’s been a quiet summer. It’s for the best. I don’t know what the girls would think if they saw me now.
I lost the car keys today. Roger was so mad. I’ve been making him angry a lot lately.
Roger
What a week?! Work has been busy. I’m trying to get all my projects finished before my retirement party next week. Lately it’s like Alice is trying to upset me. She insists she’s fine.
I forgot to put my shirt on before sitting for dinner tonight. Janice and Steve were mortified. I didn’t even notice until Roger said something. What is happening to me?
Jenny
Usually I am on top of things before anything bad happens. Lemons in the oven. Milk in the cupboard. Getting lost going to the mall. Missing half of the groceries. I feel awful for getting accepted at Juilliard and leaving this all to dad. But…. Juilliard!!!!
Grocery shopping was a nightmare today. No one seemed to know what I was talking about. I was looking for cheese. The young twit manning the counter was an idiot. How stupid are these kids now?! You ask a simple question and they stare at you like a deer in the headlights.
Clerk
I made it to the store on time. My uniform looked great. Some lady and her kid ran into me. Her kid spilled his slushy all down my pants. Who gives their kid a slushy at 10 o’clock in the morning? Then some old lady came up to me asking me for clocks. I told her we don’t carry them but she kept yelling about clocks and deer. People are crazy.
Jenny and Janice sat with me for tea today. It was nice to see them before they went to school this morning. They usually bound out of bed at the last minute.
Janice
Mom is getting bad. I used to be able to explain things. She’s always been busy and absent minded. Last evening after dinner, I dropped over to see how she and dad were doing. Mom wanted to sit for tea and toast – like we used to on Saturday mornings. Then she switched the conversation to my grade 3 teacher, Mrs. Brown. It’s been years since I’ve even thought about public school.
I’m so looking forward to going out to lunch with the girls today… Oh. Right. I don’t do that anymore.
Jenny
Knowing that mom is not driving makes starting at Juilliard a little easier. At least dad and Janice don’t have to worry about what mom might drive into next.
I hate the world. I’m stuck here because I’m awful. Worthless. Ugh! I’m never getting out of bed again.
Janice
Mom looked better today. She was up for lunch when I dropped by. The new PSW, Nathan, that started this week is a good cook. Mom seems to like him – even if she keeps calling him John.
John made sandwiches for high tea today. We haven’t done that in years!
Nathan
Alice is a lovely lady who enjoys watching soap operas in the afternoon. She loved the tuna salad at lunch today. She is needing more help with dressing and bathing than is covered by her current assessment. She gets frustrated and angry when she can’t find the right words for what she wants.
I tripped over that stupid rug today. I don’t know how many times I have to say it’s old and needs replacing before someone listens. I don’t give a damn what they say.
Janice
Mom had a fall yesterday. I just got a call from Home Care. They are sending over another therapist to look at house modifications we could make to help her get around better. It could help with her soiling her pants. She says she can’t get to the bathroom fast enough but I’m not so sure.
The garden turned black today. One minute I was sitting with Roger and enjoying the day. Our flowers are opening. We have always spent a lot of time in the garden when the flowers start to bloom. Then the blackness came. Everything black. And broken. Zapped. And dead.
Roger
I am ready to give up. In the garden today, Alice flew into a fit. She started shaking and yelling at me about ‘the blackness’. She’s woken me up every night for the past week. She’s always yelling about the darkness and calling for John. I don’t know if she’s crazy or confused. Maybe I’m crazy. I need a rest. No sleep at night and her constant demands all day. I have been thinking it’s time to look at a home, but how can I abandon my wife there?
Roger tells me we are moving. I hate packing but it sounds like things will be better after the move.
Janice
Clearing the house and packing for the move has been a lot of work. Dad seems exhausted. He’s short with mom a lot now and looks like he’s lost some weight. Mom hasn’t said a lot. Does she know what’s happening? She still eats when Nathan brings her lunch, but I noticed he is helping her quite a lot.
I’ve arrived at the new house. It is glorious. The gardens. I haven’t been able to find Roger since I arrived. Perhaps he is coming with the moving truck. I also can’t find any of my things so I suppose that’s the case.
There’s a few bitches here. Like that one over there. She keeps looking at my baby.
Dietary Aide
We have a new resident today. She was pleasant this morning at breakfast until Joe sat down. She ate pretty well with some help.
The food is lovely at the resort. I felt bad eating without Roger. Hopefully, he arrives with my things soon. I got a new chair today and I can’t wait to show him.
Roger
Alice was pleasant this morning. She seems to like it here. She loves her motorized recliner. I’ve been feeling so much guilt for leaving her here. Seeing her happy makes my heart glad.
John Roger came for breakfast today. I got to show him my new chair. He wouldn’t eat but it was so nice to see him I didn’t think to mention it before he left.
Janice
I saw mom today. She didn’t seem to know who I was. The girls made some cookies and she seemed delighted to get those. They were a little dry and she choked on one a bit.
Nurse
Alice has been increasingly agitated. Usually during the morning when residents are taking breakfast. Verbal altercations have occurred three times this week. Requested the doctor check on her.
That John! He came in here today trying to put a snake down my shirt. Always was a trickster. I batted that snake out of his hand good.
Sat in a garden today. I don’t know whose it was. Beautiful.
Blackness. Everywhere.
Doctor
Patient is a 78-year-old woman, who presents with a history of dementia, coronary artery disease, and diabetes mellitus type 2. For the past 3 weeks, patient has been increasingly agitated and is showing signs of potential for violence toward staff and other residents. The patient has lived at the care home for 8 months. At the time of admission, patient had unidentified atherosclerosis affecting blood flow in the carotid arteries bilaterally. She required assistance with all Activities of Daily Living with limited ability to ambulate independently but otherwise stable.
On exam, the patient appears moderately groomed. Clothing is appropriate. Demeanour initially composed, but changed rapidly with the start of physical exam. Patient would not permit complete cardiovascular exam. Partial findings are noted below.
Respiratory – upper lobes clear on auscultation; no crackles, wheezes, or stridor noted
Cardiovascular – HR 63, strong/regular. Tibial pulse not palpable on left. Right tibial pulse weak. Pedal pulses not palpable. Edema grade 3 bilaterally.
Musculoskeletal – No signs of clonus, rigidity. Minor hand tremor bilaterally. Strength in upper limbs 4. Strength in lower limbs 3+. Sensation diminished in left foot beginning at ankle. Right is normal.
Assessment:
Worsening behavioural symptoms of dementia; CHF; Urinary Tract Infection; low blood sugar
Plan:
Complete bloodwork to assess blood sugar control, lipids, kidney function, liver function, electrolyte status, signs of infection.
Urine dip, followed by urine culture & sensitivity if positive for signs of urinary tract infection.
Prescribe anti-psychotic by mouth every 6 hours as needed.
Follow-up when test results are available.
That bitch! She keeps trying to steal my baby. I’ll get her next time she comes by me.
Nurse
Continued agitation with lack of cooperation in the morning. May be hallucinating. She has been pacing with tearfulness each afternoon. She has a doll (her baby). When the occupational therapist suggested she lay it down to have some cake, Alice hit her.
No need to speak on my account. You cunt.
Nurse
Communicated medication change to nursing staff. Anti-psychotic has addressed safety concerns.
John. Roger. Who’s Roger?
Occupational Therapy
Alice’s aggressiveness has decreased since addition of anti-psychotic. Spending much more time in bed without glasses or prosthetic teeth. Was able to get Alice to agree to raising the head of her bed and reposition to face the window after putting on glasses. Smiled when she saw the garden.
Flower.
Janice
I visited mom today. She is not looking good. Very frail and not really talking at all. Brought some of her favourite chocolate, but her nurse says she takes food only as a puree now.
Roger
Alice is not doing well. The end feels like it’s coming. I wish we had lived the last few years differently.
Doctor
Urine dip was positive for infection and urine culture grew E. Coli. Kidney function below normal. Referral entered for nephrology. Patient treated with antibiotics for 5 days. Prescribe anti-psychotic 2 mg by mouth once daily at bedtime. Discontinue ‘as needed’.
I love sitting out here when the sun is shining. The butterflies come to the garden this time of year. Their wings flap slowly while they take a break on the tree. We talk.
Roger
Alice has perked up a bit since her urinary tract infection was treated. We sat together in the garden today and watched the butterflies come the way we used to.
Stupid cow! Shoves that stick in my mouth.
Dietary Aide
Alice is back to being difficult. Well it was a short respite.
John. Roger is here again. Happy.
Nurse
Patient has periods of delirium-like states followed by restlessness. At times, Alice is content but becomes violent on occasion. Requested physician reinstate antipsychotic on an as needed basis.
Physician
Patient presents similarly to previous encounter. Urine dip negative for signs of infection. Prescribe antipsychotic 2 mg via intramuscular injection every 1 to 6 hours as needed; maximum of 10 milligrams per day.
Bitch.
Jenny
Saw mom today. I don’t think she knew I was there. She moves her mouth and makes some sounds but she can’t talk any more. Having pneumonia in the spring took a lot out of her. It’s spring and it is nice to be home. Dad looks good. Less stressed. Janice and Steve are having a baby! I’m going to be an auntie.
Roger
Visited Alice today. She seems happy. Not distressed like some of our previous visits. It was nice to sit quietly in the garden and listed to the birds. Alice always loved finding a little nest in the garden. It’s been hard to spend any time in the garden at home without her. It was truly her world.
Pain. Flash.
Dietary Aide
Alice was out for dinner tonight. They finally got her out of bed and into a wheelchair. Her bed sores don’t seem to bother too much. She is having lots of trouble with taking any food. She won’t open her mouth after a few spoonfuls. Keeping her from choking is a chore. I thought the thickener for her water worked well.
Janice
Took the baby and Steve to my visit with mom today. Mom gets sick so easily now that I’ve been worried to bring our germs with us. She has a nice room now. The physician called last week about moving her to a palliative room. That was a hard day. She doesn’t seem to know us, but the baby made her smile.
Small.
Roger
Visiting with Alice today was peaceful but hard. Since she’s moved, we could bring some of her favourite flowers inside. Jenny brought a painting of a butterfly for the room. She has a music player with her favourite songs on it.
Sweet.
Jenny
The nurse called today while I was at school. Mom doesn’t have long now. They’ve stopped feeding her. She won’t eat apparently.
Nurse
The palliative physician reviewed her case and prescribed some medication for pain. Someone is sitting with Alice now around the clock she has little time when she is awake. Her breathing is apneic.
The palliative physician ordered breathing supports for the next 6 hours so her daughter could come to the bedside.
I am loved.
Kimberly Mitchell was born and raised in Newfoundland, Canada where she developed a love of teaching through storytelling. She is a strong indigenous woman who is a mother, daughter, sister, wife and friend. Now studying medicine at Queen’s University, Ms. Mitchell is grateful to all those who have taught her the wondrous beauty of life and the great privilege it is to be present with someone in their death.