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Mom Goes Nuts

My mom has gone a little loopy.

On May 14 2012, the day after Mother's Day, my 69 year old mother had spine surgery. She had previously been diagnosed with lumbar spinal stenosis. Though the surgery was offically elective, she was unable to do much without pain. She couldn't walk without pain, and she generally used a walker to get around. She waited until the pain was too much to take to have the surgery.

The surgery itself went well enough, at least according to the surgeon. He put a bunch of bolts and rods in her, and she was moved into the ICU directly after the completion of the operation. It was an 8-hour long surgery. She had a general anesthetic, as you might imagine.

Unfortunately, she had a heart attack on the 15th or 16th (they don't quite know). As a result, she was in very bad shape for a couple of days. Her "ejection fraction", which basically records the amount of blood that her heart can pump, was at 8 for a while. A normal person's ejection fraction is 55 or 60. She came very close to death on a couple of occasions. Thankfully, her heart function recovered over the days which directly followed. She had a cardiac catheterization, which let us know that she has no artery blockages. They call the condition that caused the heart attack "broken heart syndrome" in which the heart just basically gives up for a while when under stress. It's a temporary condition requiring no follow-up surgery. She has been recovering from both the spine surgery and the heart attack over the last couple of weeks. Her physical recovery has been going well. Her ejection fraction is now 52. She is still unable to walk as a normal result of the surgery, but that's not unexpected. She has been moved to a rehab hospital now, and they're going to try to get her walking and able to do the normal stuff everybody takes for granted like getting to the bathroom herself and in and out of bed, etc.

Unfortunately, in the meantime, something about the surgery or the following complications has severely impaired her cognitive ability and her memory. She is able to converse with people in a way that seems superficially normal, but she cannot remember anything she hears for longer than about 30 seconds. Sometimes she thinks she's in a hotel on vacation or on a cruise ship. When she remembers she is in a hospital, she doesn't know the name of the hospital, the location of the hospital, or why she is there. She often can't remember the current year, what state she lives in, how old I am, what the current president is, and so forth. She doesn't understand that she is not permitted to get out of bed without help. She tends to ask the same set of questions and tends to perform the same self-destructive behavior of trying to get up by herself every 20 minutes or so. She hallucinates frequently. She confabulates, sometimes merging what's happens to be on TV at the moment with reality. For example, she might say to me "did you have a good golf game?" if golf is on TV, and over a short period of time following the question she'll create a narrative around the idea that we're actually in a country club or on a golf course. She often believes she is at Penn State (her alma mater), and says things like "it's 20 years since I've been here, I remember this building" (it's actually more like 45 years, and she can't remember the building, because she hasn't ever been there before). She very rarely answers "I don't know" to a question. Instead, she will always answer any question asked very confidently, usually with false information. As you can imagine, this is very dangerous in a hospital setting. For example, three or four days ago she answered "no" very convincingly to "We'd like to do an MRI on you. Do you have any metal bits in your body?" even though she has more metal in her than the terminator. She also tends to just spontaneously make stuff up. She told me the other day that Wayne, her boyfriend, communicates with Nolan Ryan (the baseball player) every day by talking through the sink. Wayne said to her previously that people say he looks like Nolan Ryan, but why she would turn that into "communicates with Nolan Ryan through the sink" cannot be determined. She can't remember how she met Wayne, or anything about where she currently lives, although they've been living together in the same area for 7 years. Although she can read words perfectly well, she can't understand the concepts they're trying to communicate, so she can't get any pleasure from reading a book. It's a struggle to get her to eat more than a couple ounces of food every meal (when prompted, eventually she will tell you that if you stick a fork in the food they give her, "bugs will fall out"). When family is absent for more than about 20 minutes, she tends to lose emotional control.

This has been going on now for almost three weeks. A CT scan and EEG of her brain reveal nothing. The official diagnosis so far is "encephalopathy", which basically just means "brain problem". Her boyfriend and my sister are helping with the fallout. Her boyfriend and I have been acting as her surrogate for every day for the last week and a half. I've taken 12 hours (8am to 8pm) and he takes the other 12 hours at night. We prevent her from hurting herself, get her to the bathroom, make sure she eats, help her with physical and occupational therapy, and communicate with nurses and doctors on her behalf. My sister is there starting today and will stay there this week so I can try to get some work done.

Since she's been able to, I've been helping mom try to play solitaire every morning (real cards, not the computer) and I have seen significant improvement in her ability to remember the rules of the game. I'm actually pretty upbeat and positive at this point that she will have at a partial recovery pretty speedily although it's clear she may never recover fully. My conservative hope is that she gets well enough to be independent enough to not require 24 hour/day care. My wildest-dreams hope is that she'll have a full recovery quickly.

In any case, this week I am back "at work", at least temporarily, although I haven't done any yet, and I've spent the time writing this blog post. I hope I can get some work velocity going shortly.

Created by chrism
Last modified 2013-11-12 10:44 AM

Here's hoping

... that your wildest dreams turn out to be not so wild. Brains can be pretty resilient.