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Reflections

Maintaining the Watch

Morris, Kristine PhD, RN, CNE

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AJN, American Journal of Nursing: May 2022 - Volume 122 - Issue 5 - p 64
doi: 10.1097/01.NAJ.0000830776.31596.cd
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Figure:
Illustration by Janet Hamlin.

I am sitting in chairs, waiting. I casually observe the handful of others who are there as well. An elderly couple, both in wheelchairs, masks sagging under their noses. A young mom walking around behind a preschooler who needs space to run. A bedraggled man, obviously a frequent visitor, bouncing between his seat and the reception desk.

My mind goes over the current situation. Will she be able to walk again? Can she return to her same facility? Is this the beginning of the end?

I am finally called back. There are no rooms, so I am parked behind a curtain in the hallway. The attending physician stops by. “I haven't seen the scans yet, but the hip looks broken.” I already know this. I saw the telltale hip rotation when the paramedics loaded her for transport. I begin notifying the rest of the family.

The ED nurse is a calming presence, a pro. He quietly chatters with me while assessing Mom and placing her IV. I don't always admit to being a nurse, but I am confident that this guy won't find me intimidating. We reminisce about how things used to be when we were young nurses, swapping war stories. I am grateful for this piece of normalcy. Shrugging into my nurse self steadies me.

A continuous stream of providers rolls by. I adopt a recurring refrain. “She has dementia. Word finding is difficult for her. Do you notice she is just repeating what you say? You can't rely on her answers being accurate. I am her agent; you need to ask me.” Most continue with barely an acknowledgment of my statements and disappear. I don't see any of them again.

She is admitted to a room. Surgery is delayed because the surgeon I think she must have isn't available.

Mom can't remember why she is here, but she seems to know who I am today. In a rare moment of lucidity, she offers, “This must be boring for you.”

Alzheimer's disease has been with us for a while. We missed the early signs. Mom lived by herself, so no one was there to see her pace the floor at night, diligently hiding her costume jewelry. Two years ago, I asked if she would see a provider about her increasing difficulty with word recall. “No. If I'm losing my mind, I don't need to know about it.”

Then the pandemic. We supported her in her home as well as we could from a distance. Groceries. Daily calls. Paying her bills. Disabling her car. It wasn't enough: the decline was too fast. By the time we got a formal diagnosis, there was significant atrophy noted in every part of her brain. “She shouldn't be living alone. You know that.” She was in memory care within the month.

The initial cooperation we had seen on move-in day quickly gave way to agitation. Anger. Confusion. Refusing to leave her room. She would call me, frantic that she couldn't reach her daughter, only to end the call seconds later because I wasn't “helping her.” She eventually forgot how to call my sister or me at all. After three months, she was finally stabilizing, smiling more, participating in activities. Then I got the call. “We found your mom on the floor. She's in a lot of pain. We are going to call an ambulance.”

The surgery in the morning is quick and she is back in her room. The combination of anesthesia, narcotics, and stormy weather means that sundowning starts early today. There is no logic, only reaction. By evening, she cannot be redirected any more. She slaps me and digs her nails into my arm when I try to straighten the sheets. I feel myself slipping. I tearfully tell the nurse that I need to leave for the night. “Go. We've got this.” Nurses always recognize a person who has reached their limit.

“Where have you been?” my mother demands. I recognize evidence all over the room of last night's war with dementia. Incontinence care supplies. Fidget objects. Her IV, urinary catheter, and pain pump I convinced the surgeon to place are all discarded, victims of her agitated plucking. The guilt threatens to drown me. I can't ask the staff to do my job. I steel myself and silently vow not to leave again.

And then I see the open blinds between her room and the computer station, clear evidence that her nurse maintained the watch when I could not. The tears I haven't yet cried finally come. Maybe, just maybe, I don't have to do this by myself after all.

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