Mom is on respite and taking care of business in CA, so for the past few days I have been covering for her by feeding Dad most of his meals and getting him ready for bed. Each meal follows the same basic routine: A glass of OJ first, because he has been sleeping for some time beforehand and is very thirsty. Then, for breakfast, it's a whole banana, that he eats steadily one bite at a time, followed by a pureed meal. Dad had had a lot of trouble with textures for some months, so by the time he came to R Center he was on a pureed diet. This means that foods you and I normally bite and chew are blended until they are completely smooth and the consistency of pudding or mashed potatoes (we don't know why banana is an exception!). It may seem off putting to eat meat and veggies that looks like a scoop of paste, but it enables Dad to get a full days worth of calories, as long as he eats it all. Many residents at R Center are self-feeding, but some require assistance, that ranges from having their food cut up into finger food sizes, to being spoon fed. Dad is in the latter category, so he is dependent on someone feeding him one bite at a time. Mom did not have complete confidence in the staff to do this for Dad at every meal, which is understandable if your personal priority is to make sure a person gets a full meal. There are not enough staff at any facility on this planet for each person to have their own personal feeding attendant. So Mom has gone in every weekday to feed him breakfast and dinner. On weekends she goes in for all 3 meals. During the week we are blessed to have an LNA to come in and feed him lunch. This is a hospice benefit and frees up Mom just enough to she can attend to herself and have a break.
When you spoonfeed a person all of their meals day after day, you start to notice every gesture of their mouth, every chewing pattern, whether they have truly swallowed their food, if they have food caught between their lips, or when they are about to burp. It is not unlike feeding a baby or young toddler. The difference with feeding a person with late stage Alzheimer's is that it takes well over an hour to feed a single meal, with each bite taking up to a minute or more from start to finish. Between bites you watch to see whether they have fully swallowed their food, because if they haven't they may refuse another. There is NO HURRYING a person along when you are feeding someone in this condition. This morning in the middle of breakfast Dad suddenly stopped eating. One moment he was eating happily, and the next he was pouching his food somewhere, not swallowing. For several minutes I tried to see if offering him juice would encourage him to swallow and continue. This tactic works about 30% of the time (no precise studies have been done but this is my guess :) ). But this time it had no effect, and he was starting to snore. No amount of calling and rubbing his face and chest could get him to open his eyes for more than a second. Normally at this point if the resident is being fed by a staff member, they will either assume he was done and clear away the tray, or they will move on to someone else who IS eating and maybe come back to him later. If they are able. What I decided to do was take a much needed trip to the bathroom, so I asked the nurse to not let anyone take his tray because I was coming back. When I got back I rubbed his chest and called his name and he woke right up and was like, "Oh yeah!" And he started eating again, finishing just about everything on his tray. It was as if he just needed a break and re-set.
It seems incredible I can sit here 2 to 3 times a day, for well over an hour, feeding one spoon of food after another into my dad. Certainly I can understand why staff cannot do this. But there is an element of mindfulness to this time. I stop only to change the music when one playlist ends. Otherwise my attention is entirely focused on watching Dad chew, Dad swallow, Dad breathe between bites or open his lips for more. If he starts to pouch his food, I think about what I can try to get him to swallow. I notice when he has detected a bit of texture, like a stray raspberry seed in his yogurt, or fiber in his roast beef. When this happens he will work it over between his lips for what seems like forever, until it either dissolves, or he can spit it out. I can recognize that turn of his lips when it's coming and get the napkin ready so it doesn't land in his lap. When I hold the straw to his lips I watch him swallow and know when he doesn't want any more juice by the way his lips start to relax.
In this way I've entered a zone where my mind is both in a state of laser-like focus on all of Dad's movements and habit, and simultaneous completely relaxed with the way one meal can proceed and end differently from another. There is no, "This the way it goes," expectation with someone who has Alzheimer's. One day might move along a little faster, and another might crawl along at snail's pace, and my brain has learned to slow down and accept these differences as they come.
When I sit with Dad like this I am treated to his momentary occasions of interactive energy and lucidity. Yesterday when I went in at lunchtime and greeted him, he opened his eyes, looked at me and smiled, saying, "Are you inviting me to lunch?" And when I said, "Yes, I am!" he looked so happy I thought he was going cry. This morning after breakfast he suddenly opened his eyes, and asked me,"The children, where are the children?" I said, "They're at church," and he said, "Church?" "Yes, they went to church," And he nodded and said, "OK," and closed his eyes again. These moments would not happen without my actually being there. When Mom goes in I hear about her interactions, and they are great. But when I go in, I have my own, and it's an incredible gift.
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