A Jewish Perspective on Illness and "End of Life""

I am calling this "A Jewish Perspective" because it is mine.  I can't speak for anyone else except I do know a lot of fellow Jews who agree with me.

I have blogged about being my mother's care giver, so you've probably read the background information that my mom is 89 (Thank G-d!) and in failing health.  I've documented struggles communicating with her many nurses.  I've grown so weary of explaining the same thing over & over & over again. I tell them I want a happy, optimistic atmosphere around us, whether in our home or hospital room.  I retell the story of how my mom tore up her "advance directives" more than 10 years ago in her attorney's office.  My father, of blessed memory, had just died.  She said she didn't want her advance directives in place anymore.  She said they took all hope away from the family & that if she was ever in that shape she wouldn't know the difference anyway.  She wanted her healthcare power of attorney ( at that time my brother, now it is me) to do what s/he wanted or thought was best. I will add that at that time she was perfectly competent to make this decision.

A few weeks ago, a nurse insisted upon  pursuing this subject over my objections because she was convinced my mom was having "mini strokes" which might lead to a "major stroke" from which she would not return. I explained my belief system as well as telling that advance directive story yet again.  I emphasized that no matter what happens, this is her home for the rest of her life.  I am committed to being her caregiver for as long as is needed.  I told the nurse firmly that I thought we had already covered this subject and that my goals & ways of doing things reflect my religious belief. I told her I understood what damage a major stroke could cause. (by the way, my mom has not been having mini strokes. Further testing has revealed that she has been having trouble with her heart.  Medication changes have been made.  Some drugs contributing to the problem have been discontinued.  So much for nurses diagnosing strokes.)  The nurse said "I just wanted to make sure you didn't have your head in the sand".  Who cares? Facing "reality" is over rated in my book.  Why do nurses think that if they just hit you in the face with the facts, that you will change your mind & start agreeing with them?  For the record, I know the reality of this situation, I choose not to talk about it.

Every person has their own definition of "extraordinary measures", at least they should.  I have an idea of how I will act in the future as regards my mom's care, but there are no hard & fast rules.  I will respond to each situation as it comes up.  At hospitals, I hear the tone that is used when talking about my mom's "full code" status (in other words I want everything done).  The tone is one of disdain & disbelief that I would want that for my 89 year old mother. I have worked in hospitals & nursing homes.  I know that as soon as some one is designated a DNR (do not resuscitate) most staff just don't try as hard.  I don't trust them not to get casual about routine care, treatment of infections, medication adjustments, etc if she is a DNR.  I would probably put a stop to resuscitation pretty fast if I were there, but I refuse to let that get in her medical records because of my lack of trust that people will continue to give my mom the best care she deserves.

I don't believe in hospice.  I realize that is not the popular view.  I don't care, I don't want it.  People are in disbelief when I tell them this.  They try to talk me into agreeing with them.  They extol its virtues.  Some people bring it up with me over & over again.  I have to say twice is my limit.  If there is a third or fourth time, I do not respond well.  I hate confrontation & drama but I will not be bullied.  Don't misunderstand, my mom is a looooong way from needing hospice, even if I believed in it.  In the same vein, someone else trying to ascertain my goals for the future (she was well trained & the most compassionate & accepting person who has talked to me about these subjects) brought up the "fact" based on "research" that it does not hurt to starve to death.  I am not buying this, I never have & I doubt I ever will.  As I said, I have worked in nursing homes & I've seen this first hand.  Thank G-d my mom still has a good (though picky) appetite & has no problem chewing or swallowing.

I think it is funny that the people who are telling me that I have my head in the sand are the same people telling me my mom should be eating low salt, low fat, multi grain & low sugar foods.  We do encourage all of those things, but when my mom wants ice cream, she gets ice cream.  If she doesn't like the multi grain bread, I get her white bread. On one hand I feel they are all pushing her into her grave (G-d forbid), but they want her to be eating a healthy diet when she gets there. (grim humor, but that's me)

 One other anecdote, my mom has expressed to me over & over that she does not want to die & that the thought of it makes her afraid.  I told a nurse & she was astounded because as she said "your mom seems so religious".  I thought "Huh?" I asked someone about this later.  How can being religious mean you are not afraid of death? I think is must be a belief of other faiths.  I am not sure.

 I welcome comments, but please focus on your life experience or beliefs & don't try to talk me into or out of anything.  I am tired of the battle & as I said I won't be bullied.

My mom is the third family member I have given care to.  First there was my dad.  I didn't do much more for him than keep track of his medicines, drive him to appointments, hire professional caregivers ( & fired 2), test blood sugar/ blood  pressure, etc.  Then I took care of my sister of blessed memory.  I did almost everything my sister needed.  I learned how to set the pumps & give her TPN & pain medication IV's.  I gave her those shots in her belly to avoid blood clots, I drove back & forth to Phoenix before she moved down here to our home. Her illness was a special journey with a sister I loved more than you could imagine.  We had always been close, but that experience brought us even closer.  My sister remained optimistic of recovery till the end.  We never talked about death.  I didn't want to but would have if my sister gave me signals that she wanted to, but she did not.  The day before she died she asked me if we could go to Phoenix the next day to visit her pets.  I said yes. While she was sick I spent a lot of time on the computer next to her bed reading Chabad.org looking for solace & support.  I found an article that had a profound effect upon me.  It prompted me to write the following:

Life Plan

The Jewish point of view is that life & death are events controlled by G-d.  Every soul that is brought into this world serves a very special purpose; as such each individual is indispensable.  The soul’s mission may take a full lifetime in a body to complete, or perhaps just a few days.  Life is precious and our wishes for Rebecca reflect this philosophy.  We pray that the mission for her soul will take a full lifetime to complete.

We FIRMLY believe that a positive outlook can lead to positive outcomes.  Therefore, we ask that everyone who is caring for Rebecca look inside themselves to create a happy & positive environment.  With G-d’s help, you will become a partner in a very special outcome.  It is unacceptable to us to just watch Rebecca die, as some doctors in Scottsdale suggested at the first of May.  We feel strongly that G-d does not give doctors permission to state that there is NO hope.  There is always hope & one must always try to help to the utmost of their ability.  As a family, we have been fighting for Rebecca’s health.  We feel strongly that the possibility exists that the diagnosis might not be so bad, or perhaps, G-d might make a miracle happen.  (These past several months have been precious & valued.  Rebecca & the rest of the family are convinced that miracles have happened to allow us this time).  We do not accept her prognosis not out of denial, but out of conviction.  Although we worry (a lot), we feel it is necessary to create our own reality with our thoughts, attitudes, words & actions.
There is a Yiddish saying “Tracht gut vet zein gut (think good & it will be good).  We are doing as much as we can to effect a change spiritually in hope that it can change things physically.  Thank you for respecting our wishes that only positive things be said in Rebecca’s presence.

The Siegel family
(Personalized with permission of the author of “Yerachmiel”, a memoir available at Chabad.org)
Written 9-7-2006

A LETTER TO MY FAVORITE NEPHEW ON HIS BAR MITZVAH

Dear Samuel, oh alright I'll try to use your grown up name, Dear Sam,

Ok, you are my only nephew, but you are still my favorite! This morning was your Bar Mitzvah.  I was so happy to be there & I was proud of all of the hard work you put into studying. You did a wonderful job.

Your father's Bar Mitzvah was in Springfield, Illinois. He also did a good job.  He wore a tie I picked out for him.  I remember lots of people & eating salmon. (sound familiar?)  There was a famous person there.  The Governor came! His name was Otto Kerner (look him up, but NOT on Wikipedia!) He was a friend of your Grandfather Siegel.  Thankfully, your grandfather wasn't too friendly with the Governor, cause like a lot of Illinois politicians, he eventually was tried, convicted & sent to prison for something involving bribes.

Another Bar Mitzvah that stands out in my memory was our cousin Steven.  He also did a good job & the party was fun.  There was also a famous person at that simcha.  An author named Herman Wouk attended. You can look him up too.  I was very impressed to meet him, but as I admitted in a previous blog post, I was a little tipsy when I met him.  There is a funny story about an exchange between Aunt Patricia & Uncle Stanley before the party started. Uncle Stanley wanted to move Mr Wouk's books to a more prominent location in the house, but that would mean they would need to be on the same shelves as the Torah books.  Aunt Patricia said he was a great author, but she didn't think he could compete with Hashem. I think the books stayed where they were.  Herman Wouk did NOT go to jail.  Recently, B"H, he celebrated his 100th birthday by publishing another book "Sailor and Fiddler:  Reflections of a 100-Year-Old Author".

I think the famous people at your Bar Mitzvah today were your Great Grandfather Lewis- Eliezer- Siegel(who you are named after), the previous Lubavitcher Rebbe & his successor The Rebbe Menachem Mendel Schneerson.  In the 1940's, Grandpa donated money to Chabad.  He would bring the donations in person when he was in Crown Heights.  We really didn't know this story until Rabbi Shemtov's  father was visiting in Tucson & met your Grandfather Siegel. It turned out the Rabbi's father recognized the Siegel name & asked if our family was from Lancaster, Pennsylvania.  He remembered Grandpa Siegel! I don't believe in coincidences.  This was all meant to be.  Your Great Grandfather contributed to the very organization that educated Rabbi Shemtov, who in turn educated you.  You are a product of the generations that came before.

I remember the day you were born.  Your parents were generous enough to allow your large extended family to wait right outside the operating room and then into the recovery area.  We were taking turns holding & kissing you & your sister when you were less than an hour old.  I leaned down to kiss your mother.  I whispered "Thank you" in her ear.  I think she said "you're welcome".
 
When you & your sister were named, I was awed at the meanings of your names.  Your Grandfather Siegel pointed out that your names mean G-d was asked & G-d answered.  I consider you and your sister to be miracles who bring great happiness to our family.

Samuel, you are your own young man.  You know your mind.  I hope this remains a life long trait.  This makes you strong.  (I do hope you realize this is a super power.  Please use for good, not evil.  Just kidding, wanted you to laugh in case I am being too sentimental.)You are a sweet, kind boy with a loving disposition.  I hope that doesn't spoil your reputation with your friends! I won't reflect on your entire life to this point, I don't want to embarrass you any more than I have already. However, I do remember you helping your sister stay out of trouble with the water fountain we used to have, when you offered her food from your plate, your extreme excitement at getting the little electric car, the fun you had moving dirt & rocks around the yard with a just your size tractor, how you pretended to be your Grandfather & made snoring noises, how you could talk & talk about how to fix things around the house, how during your fireman phase I made you very happy at Chanukkah with a roll of yellow "Do not cross" tape.  I remember more happy times when you and your sister helped me make challah or clean for Passover. You have loved cleaning things since you could walk.  I don't know if you are still interested in cleaning, I'll ask your mother:)   Earlier this year, we had to replace our refrigerator.  I was happy to get a new one, but will miss the old one especially because there were cracks in the bottom of it where you used to stand to reach the top shelf.  One of my most precious memories is Simchas Torah when your Grandfather Siegel was still with us & 3 generations of Siegels were called to the Torah at one time, you, your dad & your grandfather.

I was not prepared to cry like a baby today at shul, but you did such a good job & I was thinking of these good memories & my sadness that some very important people are no longer with us.
I know we'll have lots of fun times in the future.  I can't wait to see what they are.

Love, Tante Pam

Some People are Just Crazy

This is a follow up to a previous blog post We Don't Live In Oregon: Caregiving Part Umpteen and a Half.  Events yesterday were too weird to believe.  I went to see my Internist for a routine checkup.  She works in the same clinic as the provider who "fired" my mom as a patient because they could not meet "family expectations".  This was my second visit to the clinic since my mom was "termed". (I've been told that is a preferred word to "fired") Both times I prepared myself for running into my mom's former provider.  I would keep a blank expression on my face & look past her if the situation arose.  It had occurred to me to switch doctors, but I really like the one I have.  I think she likes me.  We are a good fit.  She's been nothing but supportive through all the cancer saga.  I didn't want to give that up just so I would never have to run into the other provider.  The fly in the ointment is that my mom's former provider is the owner of the practice.  My doctor is her employee.

Yesterday I was called back from the waiting room for my appointment.  My vitals were taken & I was shown into an exam room.  I should have known something was up as that is not the usual routine there.  (Usually I would be shown back to the waiting room & called back to the exam room when the doctor was ready.) I waited a few minutes in the exam room, there was a knock at the door & the Nurse Practitioner who was my mom's former PCP walked into the room & proceeded to literally yell at me for about 60 seconds about how she had heard from 3 separate people that I had been saying "disparaging" things about her.  She never took a breath.  She said "it must stop" & if it didn't that I "would no longer be welcome at the practice".  She then turned around & left the room.  I was completely blindsided.  I thought my privacy had been invaded.  I wanted to flee immediately.  I wish I could say I wanted to follow her down the hall doing my own shouting but I'm not that person.  I started pacing the room, I opened the door, I didn't want any more surprises.  My doctor came in.  She knew what was going to happen before hand, but was not in the position to interfere.  We had a frank discussion.  I was quite agitated.  I said I had been afraid of conflict (tho not to this degree) , but I didn't want to change doctors.  She said she would understand if I did & she could give me some names.  Then we went on to have a normal appointment.  She wants me to see yet another specialist. This will be about my 10th doctor.  I made a follow up appointment for 3 months & got the hell out of there.

I went home & almost asked the caregiver who was with my mom for one of her cigarettes. (I haven't smoked in about 2 and 1/2 years.) Instead I ate two bowls of ice cream.  Yeah getting fat is really going to show her!

I've thought about this since last evening & have come to some decisions.  I guess I do have to change doctors.  My psyche simply can take no more stress.  I could not picture myself ever walking into that place again.  I'll wait on the referral to the nephrologist, then call my doctor & ask for recommendations for a new provider.  I will miss her, but I see no other option.  I did some googling to find how to lodge a formal complaint with the State.  I had considered this before, but thought things would just calm down.  I want peace & happiness & feelings of positivity in our lives & our home.  However, after yesterday I concluded that people need to be protected from such unprofessional behavior.

 I have no idea who these 3 people are who the nurse practitioner says I have been saying disparaging things about her to.  One of them may be my former employee who I "termed"(after late night inebriated phone calls, missing pills & lies including continuing to present herself as a CNA more than a year after her certification had expired.)   The two of them are friends.I said very little about the matter to that person.  I am too busy to be obsessed with spreading gossip. This brings me to my final thought on the subject.  How would she thinks she knows that I have been saying disparaging things about her if she wasn't talking about confidential patient information at inappropriate times & places?



 

  

Letter to my cousin

Following with a few minor modifications is an email I wrote to one of my cousins this morning.
   
    Hi, want to keep you updated even when some of the news is disheartening.  My mom is literally getting worse by the day.  I was not prepared for that rapidity.  I've never heard of it before.  Every doctor or nurse I tell this to has no explanation, except sometimes this is the way it is.  Just at her birthday 8 months ago she was at the table, wearing her crown,enjoying the meal,company & presents.  Yesterday she started spitting out her pills all of a sudden, seemingly out of nowhere, although she did begin to have trouble getting some of them down last week.  I guess starting this morning I crush them & disguise their taste in food.  Last night I called the pharmacist & found I can crush all but one of her pills.  I will need to call the doctor for a substitute.  Her food has been getting softer & softer.  My brother brought her a root beer float yesterday.  I'm making her shakes & smoothies although she can eat small bites of chicken that the caregiver made in my toaster oven.  We are feeding her most of the time, tho we left a bowl of ice cream in front of her, went to do something else & found her feeding herself! She keeps her eyes closed most of the time.  She is not walking or standing anymore,but only because her fear outweighs her strength/abilities.  Last night she said good night to me as her "sweet darling girl", but had been mad at me most of the day because I would not leave her alone to just vegetate.  I made cookies yesterday in effort to get her to move her arms and hands to feed herself.   It did not work although she enjoyed the cookie when I put pieces in her mouth. The tests in the hospital indicated no strokes.  I realize she has dementia,but some of these symptoms happening so fast make me wonder if some of it is psychiatric.  I'm pretty sure my Great Grandmother deteriorated not only from "senility" as it was called in those days but from a broken heart after my Great Grandfather died.  My mom has at times in her life been "high strung", but she has not been the same since her sister, then my father and then my sister died.  Some of her eccentric behavior in the past decade or so I now see as the beginnings of the current problems.

Sorry to burden you with this, but thought you would like to know.

Love & Hugs, Pam

Boss In Training

Care giving for my mom has been a continuous learning experience.  I cherish every moment we have & everything I'm able to help her with.  She says " I don't want to be a burden to you." I tell her she is not a burden.  It is my honor to be able to help her now.

One thing I did not bargain on was being someone's boss.  I did everything here by myself until I couldn't do it anymore then I hired some caregivers to help me. I have made mistakes.  I mentioned at least one of them in a previous post "I have to leave at three o'clock".  I have made friends with some of the caregivers.  Not recommended.  There needs to be some respect for each other's roles & mutual recognition of the employer/employee relationship which is negated if you become "friends".  I waited too long to replace two caregivers who were not working out.  I kept thinking I would awaken one day & the two of them would suddenly discover all on their own that their performance was lacking. I had too much faith in being "lucky" rather than in directing their work.  On the other hand, I did post a short list of things to do each day on my mom's bathroom mirror.  I appear to have been the only one who read it.  There was one employee who thought she was directing my work.  I let that drag on way too long.  She thought it was appropriate work place behavior to roll her eyes, leave the room in a huff & then give me the silent treatment. Her explanation for this adolescent behavior was that I must not trust her if I kept "interfering".  What can I say to that? Thank you very much for your help & good luck in the future.

One employee pushed me to cut out a list of 10 questions to ask a home care agency about how they select their caregivers. The irony is that she is the one who caused the most problems.  Someday when I write my book, I will go into details, but the problems included fraud, alcoholism & possible theft of some of my mom's anti anxiety medications.

I resolve: I will stop making friends with the caregivers, I will keep our medications under lock & key,  I will not make them take a breathalyzer test before coming in the front door, but on the other hand maybe I should.

Annoying People

I should be able to get some peace & quiet in my own home, don't you think? No!!! Lately, the most peace & quiet I get is sitting in waiting rooms of various doctors.  The annoying people are at home.

I have prima donna caregivers (not all of them, but enough to matter).  They come here & take over & offer opinions on everything.  I have long since given up the notion that there is any chance of consistency when it comes to working with my mother.  I don't sit quietly & let this happen.  I try to tell them, but get responses like "Oh, I know how to get people out of bed" before I get more than a few words out.  Anything more direct from me is met with either stony silence or an argument.

There is a never ending parade of not quite, but close to  really judgemental people marching though our home.  They are irritating is various degrees.  I confess that there are actually a couple that I look forward to seeing.  However, twice this morning I was asked "What is the matter with you?".  The answer is swirling in my head "Maybe you are gnawing at my last nerve".  I was also told "You look tired".  Thanks a lot for pointing out how bad I look.  I could have gotten up earlier than 5:00 AM & taken time to put some makeup on so I wouldn't look tired.  I was also told "You seem agitated today".  Yes I am, because you annoy me & I have to pretend that you don't.

I also deal with annoying phone calls.  Those "Microsoft Windows" scammers keep calling.  I think up ridiculous things to tell them such as "I don't have a computer".  Would you believe that the guy at the other end of the line actually shouted at me "You are a liar, you are a liar, you are a liar..." until I hung up.  He was more annoyed with me than I was with him. Maybe there is some justice.

I need to leave at three o'clock

I will not even try to re tell the events of the last 3 days in chronological order.  Suffice it to say that on Monday afternoon I could not help my mom out of bed.She did not have the strength or focus of attention that she had earlier in the day.  I don't know what,if anything happened.  It could be something physical or something to do with dementia.  I can often talk her out of these "spells".  It didn't work Monday.  I called an agency & they were able to send someone who had been to our house before.  She couldn't come for about two hours, so I sat in my mom's room talking to & trying to reassure my mom.  She was, as she would put it, in a "tizzy".  She wanted to go to the bathroom.  She was thirsty.  I tried getting her to drink a little from a straw, but since she was laying down, it only led to choking. By the time, we got her out of bed when the home health aide arrived, she had been in bed 5 hours.  Her back simply can't take that.  We got her to the bathroom, cleaned up & in her "sleeping" chair. (recliner).  Then I gave her dinner.  It was 9 pm.

So I've hired a bunch of extra help.  I keep hoping things will get back to "normal".  This is going to cost a fortune.  I was hoping that any major expense could be put off until August, but I'll just have to be frugal in other ways.

Yesterday a coordinator of one of the programs that is helping us called to see how things were going.  I gave her the update.  In the course of the conversation something came up that prompted her to warn me not to make friends with the home health aides.  I laughed & said she was the hundredth person to tell me that.  However,....... three hours later I was exchanging intimate details of our lives with the newest aide.  I like her, I really like her.  I will never learn.

Then there is the "respite" aide.  She is supposed to be here Tuesday & Thursday from 1:00 to 5:00.  It took over 2 months to find someone who would come to my side of town.  She began with us on May 26.  Today was the fourth time she has asked to leave early.  What part of "respite" does she not understand? She's not just coming here so I can take a nap.  I have appointments.  I have places to go & hopefully people to see. (Then I wouldn't need to make friends with the aides, I could see some actual friends.) If I do choose to use the time she is here to take a nap, that's ok too.  Trouble is my mom is needing assist of two people for all transfers since Monday.  Right now I'm praying she doesn't say she needs to get up for anything for another 25 minutes when the respite aide arrives.

Oh don't let me forget the nurse from hell who rode in here on Tuesday.  She was an RN from the doctor's office.  I didn't understand why she was coming.  We have home health.  I was talking to the home health nurse when this other nurse range the doorbell.  Since the home health nurse didn't understand why the other nurse was there I handed the new nurse the phone & let the two of them talk.  It sounded like dueling nurses having a turf war.  After she hung up the phone she began giving orders & asking no questions.  She seemed totally confused about my mom's case.  She thought the person she talked to on the phone was the physical therapist.  She gave a bunch of orders on how to care for my mom's skin that contradicted every other piece of advice I'd ever been given.  Nurses often have their favorite product or technique, but it all boils down to keep it moist & keep the pressure off.  This woman said to use soap & water which anybody knows is drying.  She was wrong about what Medicare would pay for.  She said my mom's wounds were not bad enough for home health.  Bulls**t! They have been paying for it on and off for 5 years. This woman had painted on eye brows arched half way to her hair line.  She was leathery from the sun & she was sweating.  It would be putting it mildly to say I took instant dislike to her.  I called a contact I have at the doctors office & voiced my displeasure.  It wasn't just me who was upset, it was my mom.  She said not to ever let her in the house again.  Today the administrator from the medical practice called me to apologize.  She was very eloquent & sounded sincere.  She said the nurse in question was being "called into the office" on Monday.  I didn't want this to turn into a big ruckus because I don't want my reputation to be one of "unreasonable expectations".  I don't want my mom termed by another doctor because of me, but the woman had my mom on the bed half naked to look at a few wounds on her derriere.  My mom is modest.  I covered her with the blanket & said we could uncover what we needed to.   I think of myself as pretty meek & mild.  I only speak up some times.  I don't see myself as difficult to work with.  Maybe I am though, maybe I am....

The cherry on the sundae? Early this morning my mom said she didn't know who she was or where she was.  She asked what my name was. My heart sank further than I thought it was capable of sinking.  Fortunately, after breakfast she knew who she was & who I was.

Reborn from an MRI tube.

This morning I had to have yet another MRI. This one was to get a better look at a lump on my back which most likely has nothing to do with my cancer. I consider the cancer eradicated from my body. This lump was diagnosed with one of the most painful procedures I've ever had. The Pathologist sticks a needle right into it to withdraw fluid. This is a lump that is on,in, around or some where  near a NERVE. He told me that it is most likely benign and he could tell me more after  it is removed. He said he could tell me more then & there but he would have to stick the needle in 6 more times & neither of us was for that option. I had already nearly broken the fingers of the nurse who volunteered  to hold my hand. It was hard to withstand that pain AND not move. He looked at the fluid right away & came back to give me the diagnosis  of Shwarnomma. Isn't that a middle eastern food eaten in a pita pocket? He had to write it down for me. BTW, the reason they couldn't anesthetize the area is that  administering the anesthesia would hurt as much as withdrawing  the fluid.
The MRI today was the next step. Thursday I see a doctor to go over the MRI,  & then I'm guessing I go see a surgeon. If this thing only hurt when someone touches it, I'd say leave it alone, but it's begun to hurt all on its own, so sometimes  it burns, other times it feels like I'm being stabbed. They've given me  special medicine for nerve pain, but it leaves me unimpressed.
This is all a preface to this mornngs MRI. I'm not going to retell the waiting around beforehand  part. I'm going to quote from my journal that I was furiously writing in to try to stave off my anxiety, because I hate MRI's.

"I swear this is the first time I have taken  oxycodone  for anything other than pain. (I also took xanax.) I just need all the help I can get to get through this. Heart still racing. When will I calm down? Thinking & writing about it probably wrong thing to do- making it worse. Need to meditate- if I knew how- ready to jump out of my skin -not just claustrophobia-scared  that  this  is cancer or that I need another operation or that I'll be a paraplegic - nearly a quadraplegic. Nuts, now I'm  crying. It wouldn't be a medical appointment without crying. At least I don't get hysterical or sob anymore.
Stop
Take a breath
Options/choose
Proceed to  act


Options-can try hard to calm down, can just grin & bear it, can flee,can hope that med start working soon, can sit here & just worry  myself sick...

Proceed to act-breathing, I may have to stop writing. I think it's making it worse. Remember, with only 1 exception that I can remember these people are NICE. That 1 person ...wasn't bad,just said I had cancer before I was sure I had it, remember crying then. Plus I hate to get Iv's"

At this point they came to get me, changing into gowns,getting IV (she got it on the first try!) & finally going in to MRI room. I was situated on table & given instructions. I told them I wanted Diana Krall or Norah  Jones to listen to, then they slid the table back  & started the concrete mixer.  ( that's  what  the  MRI sounds like to me if you  throw in a jackhammer & a foghorn). I kept my eyes closed cause I didn't want to be reminded I was in a confined space. I think this is when the meds started working. The tech kept telling me what would happen next & telling me I was doing a good job. At what I had no idea. Then they stopped, rolled me out of the tube & injected the dye for the next part of the test. I asked them to change the musc to reggae. They rolled me back in the tube &this is when the meds really started working or I had a spiritual experience. I don't know. I started thinking about my maternal grandparents &  how nurturing they were to me. I felt them both hugging me. I kept still, but started to cry again. Then the test was over & they rolled me out of  the tube. Tech gave me kleenex to blow my nose. I asked her why she kept telling me I was doing  a  good  job.  She said it was because I held still. I didn't know that was such a great accomplishment.

I ended up being "under the  influence" for several hours. Next time I'll  stick to xanax. I told this story to someone who said it sounded like I was being reborn coming out of that tube. Hmm...

Reflections

I'm really happy about all of the positive feedback I've received from my family  about the "Outlaws" post.  There are other stories I'd like to share, including from my maternal side of the family but I need a little time to  decompress  from the emotions I put into that post. One of my cousins  wonders if several of us could somehow put our memories together. That would be  a fun project, but how to do it? I read my post & the many facebook comments about the post aloud to my mom this afternoon. She enjoyed remembering & the nice compliments about how cool, thoughtful & funny my cousins think she is. She will absolutely never forget the Waldorf episode when the cousins locked themselves  in a room with open windows. Do any hotel rooms actually have windows that open these days? I think the windows were open at the Waldorf  that day cause we were  feeding pigeons on the little  ledge outside the window. I'm surprised  they weren't flying around inside the room. Next time I write family memories I have to include  the week my family stayed at the Beverly Hills Hotel. We were there for David's medical school graduation.  My dad would never have paid for that expensive a hotel but we were compted for some reason. I wish some of my cousins had been there to enjoy a fairy tale stay at the Hotel California. My other most fun memory of being in a famous establishment was when we went to the Russian Tea Room  when we were in NYC for Laura's wedding.

On a completely  different  subject yesterday I went to a  gym.
 I've actually never been to a real gym before. I've done aerobics classes ( the reason  I can't stand Hall & Oates to this day). I've tried yoga a few different times. I went for a while to a "rehab" gym in the '90's after a lot of Physical Therapy on a previous back issue. Just before I found out I should not be climbing hills cause of some spinal problems ( compression fractures, a healing fracure in my sacrum & a pinched nerve) I was attempting to try getting in shape by walking my street which is a steep hill. I was making it twice around our looping street in about 30 min but with every step uphill I could feel my back.The PT's I'm seeing now said it would be OK to do the treadmill if it was flat & the recumbent bike. I was really sweating. Sometimes I get somewhat compulsive & I may have gotten carried away.  I also got down on a mat & tried some of my PT exercises.  While I'm still in PT, I'll probably only be able to get there once a week, but I'm so glad I got started. Besides the sweat my biggest challenge was  figuring out the dashboards on both pieces of equipment. My writing idol, Nora Ephron said that every time she got into shape, something broke. Having had the following in the  last 2  1/2 years I can relate: broken arm, rectal cancer, radiation therapy, 2  kinds of chemotherapy, 3surgeries, a kidney stone, a heart problem. Oh, I forgot the broken ankle.

I just realized something strange. I have a full plate of stress inducing realities right now but I may be happier than any day except when I gave birth. WHY? I am making my way through it. I survived 2 years of hellish cancer treatment all the while taking care of my mother. I wasn't always graceful. I cried in doctors  offices all over Tucson. I had to deal with a one incompetent  doctor who was trying to dictate what my surgeon should do with me & my first therapist lasted one session. She thought I was feeling sorry for myself. She needs to go work in a drug treatment program. I was not a candidate for tough love in the middle of my cancer treatment.

The Outlaws

When I was a very small girl,I became acquainted with the term "outlaws".  My Uncle Artie coined the term to refer to the men & women who married into the Siegel family. He told my mom that they weren't  inlaws, but outlaws. The Siegel family was large so there were lots of outlaws &cousins. My Siegel grandfather &his brother married my Siegel grandmother &her sister( a lot like twins marrying twins) so all of us were proficient at figuring out who was a first,second,once  removed etc cousin. Unfortunately I never had the pleasure of knowing my Siegel grandmother as she died suddenly at a tragically young age. My grandfather remarried. Her name was Fan.  She was an outlaw I guess but I knew very little about her. I assume she is the one who oversaw the huge spreads of food when the family gathered in their house at 205 Church Street. There were tables laden with everyone's favorite foods.  Along with the various varieties of fish,bagels &  salads there was always some Rice Krispies for my sister.

We used to have family reunions while my grandfather was still alive. They were held in a park in Lancaster,Pennsylvania around the time of my grandfather's birthday in June. They were large gatherings with many active children running  around. I remember barbecues but I don't remember  anyone in the family who  could do that. It must have been catered. Some of the cousins  have talked in recent years about resurrecting the reunion, that would be much fun. Some of my cousins I have not seen in 10 years. This is my fault I know for living in Arizona and  not Massachusettes,NewYok,New Jersey, Maryland Pennsylvania or Virginia.

Unclet Artie as I  said coined the term outlaw, so he will be  the first I talk about. He was so funny,loving and he genuinely liked other people especially children. He always had something funny to say.  He never lost his Brooklyn accent so the jokes always sounded funnier because of his delivery. He danced with all of the little girls at weddings& Bar Mitzvahs. He let us put our feet  on top of his shoes while we danced. He had a nickname for me. I was "Pammy from Miami". ( I wasn't but it rhymed & it was funny  so I loved it). Uncle Artie worked at the Pentagon.  We always wanted him to tell us what he did there. Some of us were convinced  he was a secret agent of some kind.  When he explained what he did it never made any  sense. I was sure he was under orders not to tell anyone about his top  secret job. I still don't know  what  he did  Maybe someday his kids will tell me.

At least one of the outlaws came with a partner & that would  be Aunt Maureen.  Aunt Maureen was beautiful (inside and out) & vivacious.  To make her entrance into our family even more exciting, she brought her parents with her. I apologize that my memories of her dad are fuzzy, but I think he was the pet wrangler in that family. Àunt Maureen's mother was a force of nature. She too was beautiful.  Her name was Aunt Reggie. She was exotic (at least to me). She had a British accent.  She taught us how to get the best suntans (while it was still OK to get suntans). The secret was to mix  iodine & baby  oil, slather yourself up & then sit  with a reflector aimed at your face. Both Aunt Maureen & Aunt Reggie were born to be married.  They were also never say die matchmakers. They were always dressed impeccably( they also offered fashion advice). I remember Aunt Maureen &Uncle Charles stopping by our house in Illinois on their way back from their honeymoon. They were a lesson in newlywed  romance. You could see the love in the air. If any of my cousins have a picture of their wedding party, I was a flower girl. I had to stand still for the longest time during the ceremony & I was gently reprimanded by my mother  afterwards because I had been sliding  my foot back & forth. I have a bracelet  that was a gift to me for being in the wedding  that I still treasure & wear. I'm pretty sure it was before Uncle Charles & Aunt Maureen's wedding that the infamous "locked door freak out"of my mom occurred at-- I think it was the Waldorf in NYC. We had connecting rooms. One of us cousins locked the connecting door leaving  a bunch of us kids alone  in an upper story room with wide open windows. I dont know how we got out, but no one fell out the window. I was honored to be present when Aunt Maureen  remarried after being widowed,  it was a beautiful wedding in her Japanese garden. I'm so glad Morris Tischler made her happy.

Unfortunately, Uncle Peter is a far away memory, but certain things are imprinted in my brain. He was kind, warm & soft-spoken. I remember loving him so much it hurt. He & my Aunt Anne brought me a native American doll from Oklahoma. Uncle Peter was a physician with, I'm not sure what it was called  then, but something along the lines of "Indian health Services". Maybe one of the Ball children can let me know what it was called. He left us much too soon.

If Aunt Maureen came with a partner, then Patricia came with a whole posse.  Patricia married my youngest Uncle, so she is only about 10 years older than me.  She felt too young to be an Aunt& really wanted to just be called Patricia, but I could never do that. These days skipping the "Aunt" has been easier.  She was (and is) beautiful & sophisticated. I looked up to her. She brought along her parents, sister, a few cousins& the most glamorous aunts ever.  They were all gorgeous & very well put together. The Siegel family definitely needed their infusion of (I hate the word, but...) CLASS. Patricia & Uncle Stanley took me along to an outstanding cultural experience(Mikhaiĺ Baryshnikov). Sorry to report that no matter how impressed and excited I was, I could barely stay awake  due to some late night  teen shenanigans the previous night.  I don't even remember what the shenanigans had been. By the way Patricia heard of Ravi Shankar before I did.

Aunt Selma was mysterious to me. First of all she never seemed to age. I had a couple of firsts at her house. One of those things was caviar. Oh my goodness, I've been addicted ever since. Aunt Selma also offered fashion advice. I was slow to find my style. I think I needed all the advice I could get. I remember show tunes always being on the stereo. I've been  addicted  to  those  ever since also.

I have one last Siegel outlaw & that was my Uncle Myer Nathan. He was a quiet sweet man. Maybe he wasn't always quiet. Maybe it  was just when he was surrounded by Siegels. He had a lot of extra family responsibilities due to my Aunt's poor health. From my vantage point he did a fantastic job. I know his children loved him very much.

I had one outlaw on my mother's side of the  family. Uncle Bob was a character, not a laugh out loud character, but just very unique. He was an entomologist & taught at St Lawrence University. He had no patience with us kids who were afraid of "bugs". He had a very distinctive  voice. I can still hear it. I wish I could see his reaction to a local business here in Tucson   "Uncle  Bob's Popcorn".

I know some of these memories may be &probably are romanticized a little. Unless I made an outright  mistake I ask my cousins to let me keep my fantasies. I also know that everything wasn't always "hunky dory". I know not everyone always got along, but I also know everyone loved one another. I left out someone's 2nd marriage cause it didn't work out & I figure that's not my busines to write about .

Thanks got to Uncle Artie for the outlaws joke. It stuck in my mind all of these years &gave me the idea for this post.

Addendum: My cousin Ellen messaged me on Facebook this morning. She said she liked this post &ŕeminded me that Aunt Reggie's husband's  name was David Hayman. She also said it was OK to talk about her stepfather Ralph Klein. Yes, for a while at least my aunt's name was Anne Klein. Ellen told me that Pat(Patricia) used to refer to "Ralph Klein time" as opposed to Siegel time. Ralph liked to stick to the schedule like my dad did.  They were prompt/ready to leave at the time they said they were leaving. The Siegels had famously long goodbyes which always put us behind scedule. Thank you Ellen.

WE DON'T LIVE IN OREGON (caregiving part umpteen and a half)

Interesting to read my last post again. The interim has been almost chaotic. My mother has had an infection that required her to be admitted to the hospital for IV  antibiotics . She then went to rehab for 2 weeks to try to regain her strength. She is now home and healthy though not yet back to her strength and  abilities she had before this infection started.  Looking back I  realize this had probably  been going on for at least 6-8 weeks. She is now receiving home  heath.  There are  therapists, nurses  &  aides  coming  &  going. I  am  grateful  for  the  help. It won't  last  forever, but  I  will  try  to  make  the  most  of  it  now.

The day  my  mom  went  to  the  hospital  was  Friday  April  3. Her condition  deteriorated  throughout  the  day. I  was  in  touch  with  her  Primary  Care  Provider  who  was  less  than  helpful. I've  blogged  before  how  dismissively  they  have  responded  to  my  concerns, suggestions &questions. I had  had  it  with  the  symbolic  condescending  pats  on  the  head they  gave  me. However  I  thought we had  finally  come  to  an  agreement  to  respect  one  another's  voice. WRONG . I  was  trying  to  prepare  for  the  first  Passover  Seder  that  night  while  monitoring  &  helping  my  mom. Thank  goodness  for  the  wonderful  Charlotte  who was here  to  help  for  part  of  the  day. I  won't  detail  the  phone  calls  back  &  forth  with  the  PCP  at  this  time ,  but  the  gist  of  the  message  I  got  was  that  I  was  overreacting. She  almost ,  but  not  quite  told  me  to  give  her  2  aspirin  &  call  her  in  the  morning. Just  before  the  third  cup  of  wine at the Seder I  called  the  home  health  nurse  for  advice. She told me  to  take  her  to  the  emergency  room. The  rest  of  the  family  agreed  &  I  called  an  ambulance.  The  severity  of  what  was  wrong  assured  me  we  had  done  the  right  thing. The  PCP  called  me  the  next  day  to  see  how  my  mom  was. I  told  her  she  was  in  the  hospital. She  seemed  genuinely  shocked, but  of  course  offered  no  apologies. (I think  lawyers  must  teach  a  class  to  them  titled  "  Never  Aologize").

The  reason  I  am  blogging  on  this  subject  is  that  this  is  instead  of  an  angry  letter  to  the  PCP.  I  don't  have  to  worry  about  saying  it  just  right, I  can  just  express  myself  without  endless  drafts  of  a  letter  I  would  probably  never  send. I was  ready  to  fire  the  PCP, I just hadn't  made  a  final  decision. On  the  15th  I  received  a  letter  from  the  PCP  firing  my  MOTHER  as  a  patient. I was angry but  not  entirely  surprised. Frankly  what  made  me  the  angriest  was  that  she  had  kicked  us  to  the  curb  before  I  had  a  chance  to  do  it  to  her. What  can  I  say?  One  of  my  least  attractive  traits  is  that  I  don't  forgive  or  forget.

Her  letter  to  me  looked  like  it  had  been  written  by  an  attorney. (I really  have  nothing  against  attorneys, but  realize  this  is  my  second  snarky  remark  about  them). It  said  they  were  giving  us  thirty  days  notice  because  they  could  not  meet  the  family's  expectations. Damn  straight! This was the most honest thing she ever said.  My  expectations  include  listening  to  me  as  much  as  I  listened  to  them. I  expect  that  they  respect  my  religious  /  spiritual  beliefs. I  expect  that my mother  be  treated  no  matter her age. I  expect  infections  to  be  carefully  treated. I  expect  not to  be  subjected  to  hockum  about  weird  diet  fads & their  proselytizing  about  Oregon's  assisted  suicide  law. My  mother  has  been  seeing  this  PCP  &  her  nurse  for  about  six  years. The  first  time  the  nurse  came  to  our  house  she  said  my  mom  was  on her"way out". I expect  them  to  respect  my  requests  that  we  not  talk  about  death  in  our house. My  mom  wants  to  live. She  has  said  it  over  &  over & may  she  live  for  a  long  time  to  come. I  expect  them  to  know  that  a  medication  should  be  discontinued  because  of  certain  lab  results. I expect  an honest  recounting  of  recent  health problems  my mother has had. (A hospitalization  3  years  ago  was a result  of  my mom's sodium  getting  to  a  dangerously  low  level  while  under  the  PCP's  watch. The  PCP  continually  refers  to  that  hospitalization  as  being  because  my  mom  was  constipated-She was  but  that's  not  why  she  was  admitted  to  the  hospital). Why did  I  put  up  with  this  nonsense ?  My  mom  liked  her  &  I  thought  by  being  vigilant  I  could  keep  the  PCP & her  nurse  on  top  of  things. All  I  did  was  irritate  them.

I'm  not  considering  it  now  but  if  I  ever  do  decide  to  sue  them, it may be for  religious  discrimination  as  much  as  malpractice. Jews just don't talk  about  death  especially  in  front  of  the  patient. They  questioned  me  frequently  about  my  Healthcare  power  of  attorney  &  advance  directives.  I  told  them  repeatedly  that  the I WAS my mom's POA,presented  proof  &  more  than  once  explained to  them  my mom tore up her advance directives  over  10  years  ago  after  she  saw  the  effect  they  had  on  us  as  a  family  during  my  dad's  final  illness. They  didn't  seem  to  understand  the  difference  between  a  power  of  attorney  &  advance  directives. We didn't  fit  the  cookie  cutter  mold  of  their  expectations.

I would be less than honest if  I  did  not  mention  that  I  made  a  huge  mistake  with  these  providers  by  letting  professional/personal  boundaries  disappear  because  for  a  while  I  thought  they  were our friends. When  you  are  greeted  with  a  hug, sometimes  your good sense  goes  out  the  window. I won't  cross  that  line  again.

By  the  way, I  had  a  new  excellent  doctor  for  my  mom  within  48  hours. When  I  talked  to  their intake person, I was open what had happened with the  previous  provider. I  expressed  my  philosophy & was  assured  that  it  was  their  philosophy  too.

One last jab at  this (I almost said crackpot but  that  would be wrong wouldn't  it?) woman  is that I  think  the  attorneys  didn't  tell  her  to  never  leave  an  angry, incoherent  voicemail. I'm  never  erasing  it.

Who's the Boss? Caregiving Part Umpteen

Someone I trust (even tho I haven't seen her in a couple of years) told me "They work for you, not the other way around" (referring to doctors, nurses, home health aides, etc, etc....).  People have been telling me this for the last eleven years when I first helped my mom coordinate care for my father (of blessed memory).  First we cared for my him, then for my sister (of blessed memory) & now I am caring for my mom.  I am sometimes a slow learner, but this particular lesson (that I am in charge, not all of the holders of the jobs mentioned above) has been imprinted on my brain finally, I hope.  I am stronger & more capable of standing up for what I believe my mom needs.  I realize I'm not an expert in their fields & will of course listen to them, but I am the boss, I am my mom's advocate.  I will fight for her right to be as independent as she can for as long as she can be.  I am tired of being "patted on the head" & mocked as some kind of obsessive- refusing to face reality- daughter.  They need to recognize OUR reality, OUR goals & OUR beliefs.  I think I might write it up & make it required reading for anyone coming into our home to help us.

Last night, I called the old friend mentioned in this post's first sentence & asked for free professional advice.  She offered some suggestions within her practice guidelines(friend or not, a professional cannot offer advice without actually seeing the problem).  I called her because my mom was going to have to wait 2 weeks for this kind of official appointment. The PCP wanted to wait until some other test results came in.  I understand the theory of this.  It's good medicine, although my suspicious nature told me it was being denied because they thought I was not facing "reality" &/or expecting too much. There is also need to suss out problems of cognition vs problems of strength.  I don't want my mom getting weaker because I expect too little of her, on the other hand I don't want to endanger her because I am expecting too much of her. I won't go into detail in this post about the problem, but it involves the bathroom.  I said that if we could not get help for 2 weeks, then the bathroom was going to be completely unsafe & dysfunctional in the interim.  The nurse said, in that case, she would come look at the problem today.  I appreciated that but it wasn't good enough.  I cannot describe how dangerous & upsetting the situation is/was.  I called my friend & told her the problem.  We talked a long time.  She said she agreed with the PCP about waiting for the test results but understood my frustration.  She offered a suggestion.  I immediately put it into effect & guess what?  It works!!!!! No more crying or arguing from either my mom or me.  Also, a lot less stress.  I wish I had insisted on this type of consult several weeks ago.  Instead I was left on my own & the PCP/Nurse suggestions.  This lead to a wasted $110 fix that didn't work.  You of course cannot return used bathroom items.
I am so happy right now that every trip to the bathroom does not need to be feared by either my mom or me! 
 

Potpourri

Several things are going on...
My mother's strength & ability to stay focused in reality are declining rapidly.  I have written about my mother before.  (The D word, Lost in Translation, & A Cup of Tea) I feel like I am betraying her by writing about how she is doing.  It's private, but I need to write.  It is my way of trying to make sense of the incomprehensible.  Let's just say that I remember my great grandmother in her final years.  She "saw" & "heard" things that were not there.  She was not always cooperative.  She didn't communicate much.  She needed help from my grandmother in the bathroom.  She was strong though.  She walked around the house without a problem.  My mom is having trouble even getting around with the walker.  We have the wheelchair easily available now, because some times she needs it.  She is capable of far more than she attempts.  "I can't" is her favorite expression.  If I walk away, she can do more than if I stand there & tell her she can do it. It's hard to decide though.  I don't want her in danger, but sometimes if she says "I'm going to fall" it sounds to me more like a threat than a prediction.  When I think about what I used to worry about with her, I would give anything to go back to those problems rather than the ones we have today.  Will the current problems sometime in the future look "easy" or "mild"? I have been alone with my mom for almost 48 hours, save for an hour when the nurse practitioner came to see her yesterday.  I have some relief coming in the morning for a few hours.  What I look forward to the most is conversing.  When I am away from home or if I'm able to talk on the phone after my mom is in bed, I chat & chat & chat..... I strike up conversations with almost everyone I see.  Now I sound like I am whining. This is happening to my mother, not to me.  I have so much to be grateful for.  I need to count my blessings.

I am finding it hard to interject any humor, even my dark, sarcastic humor into this. I titled this post Potpourri because I intended to discuss other things that are going on.  Thursday night the world lost a lovely inspirational woman at the tender age of about 57.  I only knew her for a year but will never forget her serene demeanor in the face of an awful illness.  Someday I hope to find what it takes to be at peace with a bad situation even while fighting against it.  Tomorrow morning I am going to a group meeting where I met this lovely lady.  The mood will be sad.  Unbelievably, the set topic of the presentation & discussion will be friendship which has been planned for a long time. 
We should all just breathe.......& try to be present for ourselves & one another. 

A Cup of Tea (Trakht Gut Vet Zein Gut)

My mom has a nurse who has been coming to see her here at home for about the past 5 years.  I like her very much, but she has one habit that has bothered me.  Many health care professionals feel the need to force the patient & family to "face reality".  It's gotten to the point with this one nurse that I irritate her by interrupting her little speeches.  She tried again the other day.  She wanted to talk to me alone before we went in my mom's room.  I thought "uh oh".  We sat down, she leaned forward, looked me in the eye & said "Pam, you know your mother is a very old woman...".  I waited for her to take a short pause before I interrupted her again & said "Just because I don't want to talk about it doesn't mean I don't know it".  I went on to use about 3 metaphors such as "I may appear to have my head in the sand but I don't.  I just don't want to talk about it"..I think she finally understood!!!! We shook hands.  My mom hasn't been out of the house for 2 1/2 years.  The only place I want my mom to go is to the emergency room if an emergency happens.  We are not going to go to any specialist's offices. S/he would just want to order a bunch of tests which would mean more trips out which would drive my mom crazy & wear her out.  The nurse practitioner & RN will continue to see my mom here at home & try to manage her care & medications.  We are lucky that there is a lab that comes to the house so that my mom's blood can be tested every few weeks to see if her medications or diet need to be adjusted.  In other words, just because my mom is a "very old woman" does not mean we don't want vigilant care.  Infections will get treated, fluid imbalances will be addressed & things that can be fixed or improved will be.  This nurse wasn't suggesting we ignore my mom, but the message I was getting from her was that she thought I was living in "la la land". (Even if I wasn't facing "reality" I still don't understand this need from medical professionals to beat you over the head with it).  I believe in the old Yiddish expression "Think good & it will be good" "Trakht gut vet zein gut". Our home will remain a place to talk about what is going right, what is good, what is optimistic.  Words & attitudes affect one's surroundings.

The very day after the nurse visited, I went out for one of my doctor's appointments.  My mom was home with our most excellent caregiver Charlotte.  When I left it was cloudy & ready to drizzle.  When I got home, it was 40 degrees F & pouring rain.  Charlotte had a cup of tea waiting for me because my mom had ASKED her to make it as I would be cold when I came home.  My mom had told her to be sure not to make black tea, because I'm not allowed to drink that.  She is correct. I am not allowed to drink black tea.  Pretty good for a "very old woman" !

Texting Etiquette

Not long ago I was invited, via text message, to an important event just 3 days away.  I was offended! Maybe you wouldn't be, but I was.  As readers will know, I need to arrange caregiving for my 88 year old mother whenever I am planning to be out of the house.  I can not leave her alone.   I stewed about this  invitation for a while, trying to figure out if I could make arrangements on such short notice.  I was also annoyed at being invited at the last moment & not even with a phone call, but with a text message.  I thought how to respond to this invitation for a few hours.  Apparently, this was not fast enough, because the person who had invited me telephoned to find out if I had received the text message! Why not call me in the first place? Why not call me a week ago?  Maybe I should save this righteous indignation for more important things, but I am not the person who could do that.  I did manage to make arrangements so that I could attend, but apparently it's still bugging me! Ha!

Again not long ago, I saw a post on Facebook that someone who was a friend of a friend had passed away the previous night. This of course was sad, but the problem was not all of the family had yet been notified!  Subsequent comments indicated that some of his relatives found out about the death on Facebook. Tragic. I think if we hear of a death, we should keep our fingers off the keys & make a phone call, an old fashioned telephone call.  I appreciate the irony that someone who is blogging details of her life would object to people sharing too much on Facebook, but this is my choice & my life. 
I know a few people who don't like congratulations, happy birthdays, invitations, etc issued online.  They want phone calls or greeting cards.  Yes, I know a wonderful woman who has a full collection of greeting cards & sends them out for holidays & birthdays.  They are a treat to receive.  "Snail" mail has its positive side.  It's fun to open the mail box & find something other than a bill or junk mail.  It's touching that someone took the time to personally reach out to you.  I am not that motivated to send out cards like my friend does, but she likes me anyway.