What was I saying?...

One of my readers sent me an article from The Star Tribune. When I read it I thought -- OH!! Yeah!! That's why I forget the end of my sentences. I always get so frustrated and irritated that my memory is so bad. After all, I'm not an alcoholic -- just a caretaker.

Stress eats holes in your brain

LESLIE BARKER GARCIA, Star Tribune, March 12, 2012.

After her husband passed away, Sandi Bond Chapman said she "could feel it immediately."
"For a year, I couldn't think," said Chapman, founder and chief director of the Center for BrainHealth at the University of Texas at Dallas. "I couldn't write a coherent word. I couldn't do anything. ... Stress is one of the best brain robbers we have."

This isn't merely figurative. According to a recently released Yale University study, stress causes the brain to shrink. So next time you're stressed to the gills and cannot focus, think or remember the ingredients for the meatloaf you make every week, you can legitimately blame stress.

"It's a short, easy story, actually," said neuroscientist and author David Eagleman. "Stress is underpinned by particular hormones that circulate through the body and the brain. Those stress hormones are very bad for brain tissue. They eat away at brain tissue.

"What's new to be stressed about is that stress is literally chewing miniature holes in your brain."
Not all stress poses a problem; our bodies are designed to combat stress by releasing the hormone cortisol. That response grew out of stresses such as, say, being chased by a tiger.

"The general story is that we evolved to have stress systems that are useful when you need a fast response," said Eagleman, director of the Laboratory for Perception and Action at the Baylor College of Medicine in Houston. "What we did not evolve for is chronic stress, that 21st-century stress that man and woman lives with."

Instead of a burst of a stress hormone, most people have chronically elevated levels, he said.
"The body is simply not built to have high levels of stress for long periods," he said. "That's where the stuff eats away at your brain tissue."

The frontal lobe has been identified as "the most critical to everyday functionality," Chapman said. "When you have the impact of stress, things that allow you to be successful will be impaired. You can't figure out how to juggle things, to set priorities."

That's one of four areas of the brain affected by stress. Robert Sapolsky of Stanford University calls the hippocampus "ground zero for stress doing damaging stuff."

"One definitely wants to have a functioning hippocampus," Sapolsky said. "It's all about learning and memory, the part blown out of the water by Alzheimer's disease. It's also the part that is most vulnerable to the effects of stress."

When that happens, "you get neurons dying, shriveling up and losing connections," he said. "It's all really bad news."

The Yale study asked 103 subjects about such everyday stressors as personal relationships and job loss. It found that stress affects areas of the brain that have to do with emotion and self-control, as well as physiological functions such as blood pressure.

"We already know this stuff isn't good for you," Sapolsky said. "If it takes a picture of your brain, seeing pictures of something smaller than it should be, to realize maybe you should make changes, that's great."

He added, "You don't need a picture to realize you're stressed and frazzled."

The definition and effects of stress differ. One person can shrug off what might totally undo another. Generally, stress is considered to come from a feeling of having no control.

"Most people are pretty insightful about whether they're stressed out," Eagleman said. "It's not an all-or-nothing thing. There are varying degrees. For some, their breath is shallow. With others, their muscles ache or their jaw hurts. ... It's important to read your body's signals, to figure out when you're having high levels of stress and structure ways to manage the stress."

When people do, they change, said Dr. Joel Holliner, a psychiatrist.

"When patients come in, we commonly see concentration problems, the inability to make decisions," said Holliner, chief of psychiatry at Medical City Dallas Hospital. "Over time as they get treatment, we see them significantly improve, to going from having memory deficits -- so many think they have dementia or Alzheimer's -- to having their memory totally back to normal. It's fantastic, absolutely."

To view the complete article go here: http://www.startribune.com/lifestyle/wellness/142338285.html

Crying wolf...

One of my favorite fables when I was a young girl was about the little boy who cried wolf. The premises is that a boy stood at the edge of his village and yelled to the townspeople that a wolf was about to do a lot of damage. The townspeople reacted quickly and ran to the aid of the boy to help him fend off the villainous four-legged creature. Each time, the people discovered that there was no wolf anywhere in sight. The child had lied to get everyone’s attention. The boy did this many times until the townspeople just starting ignoring his cries for help. Eventually, a wolf did show up, with its grey hairy face, and consumed the boy because no one came to help him as he cried out for help. The moral of the story for me was that I shouldn’t ask for help unless I really truly need it. Oh, yeah, there’s that don’t lie thing as well.

When an alcoholic asks for help and receives it and then goes out and starts the cycle anew – it’s a lot like the little boy who cried wolf. After a number of attempts, no one will believe that he truly wants help at all. Family, friends, rehab centers, insurance companies, and counselors begin to believe that the alcoholic is not being honest in his desire for help. It’s why an alcoholic will not be admitted to rehab after many failed attempts at helping the alcoholic achieve a sober lifestyle.

There are other ways that the boy who cried wolf analogy works. For end-stage caretakers we become accustomed to hearing medical professionals tell us that the alcoholic’s time on earth is coming to a close. We gather the family around and break the heart-wrenching news to our children. We take on a vigil of prayers for a miracle that will stop the dying process and give the alcoholic a profound desired for sobriety. We wait. We cry. We try to make deals with God. And finally, we believe that God has heard and granted us our wishes because the alcoholic miraculously revives and comes back to us. It appears that the doctors have cried wolf when there was none in sight.

After a few weeks, or months, we discover that only a part of the prayer was granted because the alcoholic goes back to drinking and we find ourselves back in the hospital waiting room.  Once again we gather around and things play out much the same as the previous hospital visit. And once again the alcoholic survives and remembers nothing of the ordeal. How could he/she? They were not “in the present” when the crying, hand-wringing, praying and pleading took place. The wolf never appeared.

This can go on and on for years. The doctors cry wolf and then the wolf turns out to be nothing more than a little bunny rabbit hopping along his trail with no intent to harm. Finally, the family stops coming when the wolf appears to be near. They stop praying and crying and pleading. They stop going to the hospital. They begin to believe that the alcoholic is immortal. Even if the wolf showed up, he would not gobble the alcoholic up and cause any mayhem at all.

We, the family, get to a point where we stop believing what the doctors say. How can we believe what has turned out to be untrue so many times? We are the townspeople and the doctors are the little boy. The wolf represents death and it just doesn’t seem to really arrive.

That’s where my family is with Riley. We keep hearing that Riley’s has used up the last of his nine lives, but then it doesn’t seem to be turning out that way. In fact, my daughter comes out and says that she doesn’t believe anything the doctors tell us about Riley’s life expectancy. She observes how he looks from the outside and in her eyes; he’s not even as bad as he was when he had the stroke. So she believes she’ll be able to tell how close he is to the cremation urn using her own measurements.

I have received lots of comments about what a difficult time this is for me and I’m in everyone’s prayers. I am so appreciative that I have so many people who wish I weren’t going through this.

It is unfortunate, that my pain is not so much for the loss of Riley as a companion, but the fear of losing myself as I try to juggle all the details. I make the mistake of trying to make decisions based on a sensible outcome. But there is no logic to any of this. I will probably get to the place where all the paperwork is done, all the arrangements are made and there is nothing left to do but wait. I’ll probably end up waiting for years and the wolf will never appear. By the time he does show his face, what if, because of the stress, the wolf is at my door long before he shows up at Riley’s?

I know that I’m falling into a depression. I am very lucky that I recognize it and can take some positive action to fight it. I also know that the townspeople are on their way to help me. They aren’t really coming to help Riley, instead they will be there for me whether Riley is there or not. I’m grateful that I learned the lesson of the little boy who cried wolf by not crying out for help so many times that I have become unbelievable.

My depression is countered by putting as much focus on my many projects as I can. Oh – but wait – one of the reasons I’m depressed is because I’m not spending as much time on my projects as I would like. My time is being taken up by preparing for a wolf that may never show up. Sometimes the frustration is more than I want to handle. It’s not that I can’t handle it – it’s that I don’t want to.

My mother had a little book that had been given to her from a beloved family member. I don’t know who – but someone. She gave me the little leather bound book one day when I was complaining about not having anything to read. It was her book of fables. I have read that book from cover to cover many times. It is well worn. It is well loved. It is something I will pass down to my great-grandchildren when the wolf is, in fact, stalking me. My hope is that they will learn and live by the lessons in that little book.

In the meantime, I’m going to read through that book again and see if there’s a fable that will help me with doing things I need to do even if I don’t want to do them. There must be something in there…

Don't talk to me until...

Morning coffee is one of my favorite things. I love everything about it – listening to it brew, smelling it and that very first taste which signals my brain to wake up. I’m not mean without my coffee, I just am not really awake until I have my first few sips.

I can drink it black, but I prefer real cream and sugar. Although, I’m not opposed to Splenda, or brown sugar, but the cream… well… that’s a different story. It must be cream. Not milk. Not Cremora. I want real live cream. It can be heavy or regular cream, as long as it is cream. OK. So, mostly I use half-n-half, but that’s only because it’s cheaper.

My family says I’m a coffee snob. I like dark roast and my very favorite is Dunkin’ Donuts Dark Roast. My next fav would be Starbucks Caffe Verona. In the interest of my budget, my daily grind is Folgers’ Black Silk in order to keep the budget happy.

Riley used to join me for that first cup-a-day, but no longer does. He sets up the coffee every evening and puts out two cups even though only one cup will be used. I’m surprised that he doesn’t fill the cup with vodka and then top it off with coffee as his mixer. That’s what he used to do, but now the coffee never reaches his lips. By noon his lonely coffee cup is put back into the cupboard just to be brought back out the when setting up for the next morning.

Morning coffee is only one of the things that has changed in Riley’s repertoire of culinary delights. I asked him to help me make a list of his favorite dishes. It was quite a long list and he has added to it since it was first created. He’ll be watching television and shout out “your most delicious pot pies!” and I’ll put it on the list. The list keeps on getting fatter and I don’t mean just in numbers, but in calorie count – Banana Cream Pie and Fudgy Deviled Food Cake. I’m not worried about the calories, why should I deny a dying man his last piece of pie?

I have been concerned about Riley’s eating habits because, like most end-stage alcoholics, he has a habit of not eating much, if anything at all. My thought was that I would try to make some of his favorite things as an enticement for him to actually consume the food. I have started making him breakfast every morning because I know he will usually eat about half of what I make for him. If he doesn’t get any other nourishment down all day, at least I know he has had something.

Cooking is something I enjoy. It’s a stress-reliever for me. When I’m cooking I’m concentrating on what’s going on in the kitchen and anything outside that gets dulled by my internal dimmer switch. Some days are harder to dim than others. But when that switch works I feel as though I’m cooking my way out of the chaos. And the good part is that Riley really doesn’t bother me too much when I’m tapping into my culinary creative side. Maybe he knows that the end result will be something he will enjoy. Maybe there is still some sanity left in that part of his brain. Whatever it is, I’m grateful for it.

At first things were working well. I made Cream of Sun Dried Tomato Soup, Barbecued Beef Brisket, Chili, and Banana Cream Pie as dinner (and dessert) a couple of weeks ago. He ate a serving of each. Then he started tapering off. He only ate about three-quarters of a serving of Broccoli Cheddar Quiche, Chicken Curry Casserole. Yesterday he asked for Pork Chops and Sauerkraut, but he never touched any of it. It was transferred to a storage container which he took out of the refrigerator several times, but never made it to the microwave. Tonight I’m making Moroccan Lamb with Cucumber Salad. Maybe some of it will reach his stomach along with the Tapioca Pudding I’m making for dessert.

Sometimes I think I’m foolish for going to all the trouble to make these time-consuming recipes. However, I benefit twice for my trouble – I am in my cooking sanctuary AND I get to eat the food! That’s a win-win for me and could be for Riley, if he would only actually eat what I cook.

I understand that at this stage of alcoholism, Riley’s first priority is not what is on his dinner plate. He just wants to make sure his drink never goes empty. When he does eat, often what he gets down comes back up. I’m not sure I’d want to eat either if I was faced with that prospect.

It doesn’t matter to me that when the meal is complete and I have prepared him a plate, the plate sits on the TV tray next to his rocking chair until he wakes up and decides to take a few bites. I always cover the plate with a lid that keeps Jade from sampling what’s there. When Riley stumbles his way into the den and proceeds to have his dinner, he only takes a few bites. The plate gets up on the counter and he will sometimes pick at it throughout the night. I suppose that’s OK, but often Jade will manage to get to the plate and -- wah-la --  the food is gone! Then Riley will insist he was the one who cleaned his plate. One day, I walked in to find Riley feeding himself a bite as Jade was helping herself to her own bites! Oh well… it’s impossible for me to expect him to comply with my request that Jade NOT have human food.

When our daughter was about four years old, she was a very finicky eater. Her brother, on the other hand, would eat anything and everything on his plate. But, Alea was sneaky. We had a little dog whose head was just at the height of the dining room chair. Alea would put bites of her food just on the edge of the chair and the dog would come up and eat what she had placed there. For a long time, I thought she was eating her dinner. I don’t know how long she had been giving her food to the dog by the time I found out. Riley giving Jade his food always reminds me of that situation with Alea and although I’m frustrated – I have to admit that I do smile.

Riley is not four years old and just avoiding eating his green peas. He’s an adult who has the mind of a child. It’s part of the dementia resulting from having a brain that is bombarded with ammonia over and over again. Yesterday that child caused me to start my day in an unpleasant manner. After a very small cup of coffee, I went to the kitchen to refill my cup. It was only 4:30 a.m. but the pot was empty. It was not just empty, the pot was neatly put back into its place on the countertop. WHAT!! Where was my coffee!!

“I thought you were done with it,” said Riley with a quizzical look on his face. He looked like an innocent child who was just trying to help. It was the same look he had when he threw away the whole half of a Prime Rib Roast because he couldn’t find a storage container big enough to hold it in one piece. The roast was a planned left over that would get me another meal. It’s the only way I can justify the cost of such and expensive meat.

“I only got one cup,” I replied as I began to make a fresh pot. Oh well… since I had to make another pot, I took out the good stuff. As I listened to that pot and smelled the strong coffee aroma, my frustration melted away. Ummmm… I pretended it was my very first cup of the day. Riley’s child-like behavior allowed me a do-over morning. It’s another little thing for which I can be grateful.

No more nurse...

I hate it when I misunderstand a purpose or intention. I learned something yesterday and I should be happy, but…

Riley is doing very well. Seems I’ve been an over-achiever at making sure he eats SOMETHING, takes all his medication, and rearrange the furniture to prevent so many falls, Riley’s over all condition has improved.  In fact, he’s improved so much, he’s no longer going to be considered as a “hospice” patient. Instead, he will have a visiting nurse and a bath aide for only two more weeks. Then I’m on my own again.

The fact is it’s not so much that he has improved, but rather he will have reached his limit for provided care under his current insurance. We have great coverage, but his wounds are healing (from his constant picking and scratching – a condition created by the lack of bathing), and he is falling less often. There are still a lot of issues, but I guess there is some kind of scale and he doesn’t reach the right number on that scale. In short, he is better than he was even though in reality he is just the same. He is still dying, but there is really nothing that can be done and it can no longer be determined that it will be within a certain time.

Off the record, the nurse confided that she was really only there to evaluate the need. Riley doesn’t really need anything a nurse can provide. She is simply the visiting nurse who provides the information to the insurance company so they can determine what he is eligible for in terms of professional care. Evidently the primary care doctor didn’t push for anything more at this time since Riley has an excellent caretaker within the home. They could not monitor him as closely as I am already doing.

I confided in her that I needed to keep Riley alive for another six months, or at least until his VA application was approved. She said, in her opinion, his heart would not hold out that long. His blood pressure is all over the place – high, low, very high, normal within days of each other. His heart beat is very erratic and is stopping for a few seconds every minute.

When I asked what was most dangerous, the ammonia level in his brain, or his erratic heart? She said it was a toss up. The ammonia will put him into a coma and then his heart will give out along with the rest of his organs. OR, he will have a heart attack and just be gone. Either way, the end is near.

In her opinion, what I needed was a personal assistant to come in maybe 4 or 5 days a week. The assistant could tend to Riley’s personal needs, stay awake while I’m sleeping and provide him some companionship. The assistant could also help to transport him to the doctor’s or just get him out of the house. There is no insurance coverage for that and it is certainly not in my budget.

She also told me, off the record, as Riley gets worse, I can always call the doctor’s office and ask for another evaluation. It seems our doctor is good about that. I should wait about a month (if he lives that long) and then call.

It’s a little frustrating that I won’t have the nurse or the bath person anymore. But, on the other hand, Riley dislikes having his day disturbed and becomes irritable when they are here -- especially the bath person. He hates the bath person. He’s like a cat when it comes to bathing – he just knows that water is going to make him melt away to nothing.

Today, I don’t have any fight left in me. I’m too exhausted from trying to jump to his every need. I know I'll be better tomorrow. I DO have nearly all his medical records together and ready to be sent off to the VA. I have my fingers crossed that all my record gathering will pay off in shortening the processing time for his application. The only thing left for me to do is find a way to get him to a VA Hospital for his medical evaluation. Once the application is approved, I will be able to afford a full time personal assistant. What a relief that will be!

I suppose I should be happy that he is getting better?? I’m a realist. I know he may look better on paper, but the real person is no better today than he was a couple of weeks ago. He’s on the edge. I doubt he will last until the VA approval.

But still my plan stays the same, if he becomes unconscious, I will still call 911. If he survives, I will place him in a nursing facility – I know his insurance will cover that. It’s really the best way to keep both Riley and me safe. According to the nurse, the stress of detox, with all the ammonia in his brain, will most likely leave him with over whelming dementia. She asked, “What kind of life would that be for him?” I answer her “The life of his own creation.”

Tornado repost...

With all the tornados whirling around our states, I thought it would be a good time to re-post one I wrote last year.

Tornado warning… (5/3/2011)

When the Emergency Broadcast came over the television announcing that we were under a Tornado Warning, I gathered my stuff – blankets, pillows, laptop, water, etc – and put it in a secure place in my bathroom. I was ready.

Riley was in his rocking chair watching his usual NCIS. I told him we needed to get his bathroom ready in case the worst came about. He just said – “Don’t worry, I’ll be fine.” And being the good little caretaker that I am – I stocked his bathroom. Both the bathrooms are small and there is really only room for one person in each.

As the night wore on, I settled in and listened. Wind, rain, hail, more rain, quiet, wind and more wind – but there was no rumble. I was waiting for the rumble sound of an oncoming train. It never happened – and I was thankful.

As I was waiting, I could feel the house swaying with the wind. We have a brick rancher – solid as possibly could be – but the wind was so strong it was moving the house. I thought of the three little pigs who built their last house of bricks. What a smart thing to do.

In spite of the three little pigs’ wise decision to use brick in the construction – some lyrics kept running through my head -- but they weren’t verses about the pigs’ quest for a secure dwelling. Instead, I was hearing in my head the lyrics to a song from The Wizard of Oz.

The wind began to switch – the house to pitch and suddenly the hinges started to unhitch.

Life with an alcoholic is much the same as a house in the middle of a tornado. This first verse could well define what it is like to watch the beginning of an alcoholic downfall. Things are unsettled, the family never feels secure and things start to fall apart.

Just then the Witch – to satisfy an itch went flying on her broomstick, thumbing for a hitch.

The alcoholic (the Witch) needs to satisfy the craving for alcohol and so he/she seeks it out. Sometimes they ask others to help them obtain the alcohol – as in hitching a ride to the liquor store.

And oh, what happened then was rich.

I think if we substitute the word “sad” for the word “rich,” this would be exactly correct. Because what happens after the alcoholic gets the booze is rich with sadness.

The house began to pitch. The kitchen took a slitch.

Things become increasingly upsetting in the alcoholic household as the drinking continues.

It landed on the Wicked Witch in the middle of a ditch, which was not a healthy situation for the Wicked Witch.

The consequences of the alcoholic’s actions cause him/her to land in unpleasant situations. Eventually the health of the alcoholic deteriorates and puts the alcoholic’s life in danger.

Who began to twitch and was reduced to just a stitch of what was once the Wicked Witch.

The person who was once a vital, productive, happy member of the community is reduced to becoming a mere servant of alcohol. At that point, the entire family is not in Kansas anymore, but rather in some uninhabitable place – like Antarctica. No matter how many times you click your heels, those ruby red slippers are not going to help you now.

I’m told by fellow country dwellers that this is unusual weather for this time of year. Funny, in Linda and Riley World – living in a tornado is a way of life.

Balancing the seesaw...

If I make a change in my life and then I stand back and look around, I see that I’m really the only person who has changed. As a result of the change, I may not want the same things as I did before. Maybe I want the same things, but I want to add other things into the mix. Still, I’m the only person who has changed. Is it right for me to expect others to accept my changes thereby forcing them to make changes in their relationship with me? Whether it is right or not really doesn’t matter. What matters is that one change, whether it is an addition or subtraction, doesn’t happen in a vacuum. Others are always affected by changes we make.

Change can be difficult for some people. If someone in our lives makes a change, it can be hard to adjust or accept. Even if that change is for the better, the status quo can often feel more comfortable. This is especially true in families. One family member attains sobriety after a lengthy marriage with alcohol, and the whole family is affected. Even if the family knows it’s for the best, they may still struggle to find a balance.

It is inevitable. Change is going to happen no matter what. An alcoholic may go back to drinking or choose sobriety, either way the person who is not making the decision to do either one is forced to be a party on the seesaw. If you don’t want to be on the opposite end, you can always walk away. Oh, but that, in and of itself, means you are making a change.

My life with Riley has always been a series of changes. He’s drinking. He’s not drinking. He’s living with me. He’s not living with me. Those are just the big ones and I handle those really well. I’m good at making those adjustments. But, it’s the smaller ones that seem to get to me. Today he’s eating, tomorrow he’s not. Today he is peaceful, tomorrow he’s agitated. Today he likes roast beef, tomorrow he will only eat chicken. Finding a daily balance seems impossible.

Just a few weeks ago, I had no help with Riley. It was just me on the seesaw trying to keep it level. It meant that I had to stand exactly in the middle. Today, I have a lot of help with Riley. The bath aid comes once a week and the visiting nurse comes out at least once a week. I have support and that helps me stay balanced. Although, at the time, I didn’t see much sense in taking Riley to the hospital to have his potassium levels stabilized, I am grateful now that I did. If he had not been hospitalized, I would not have gotten the help that both, Riley and I, need at home. The change has been good.

The bad side to this change is that I have had to do some fancy footwork to prepare for all the contingencies. In the past, I was just going along and waiting for Riley to die. But, now, even though he is still dying, I’m feeling the necessity of devising a plan – actually several plans. It has to be more than one plan because Riley is the “immortal” alcoholic. It doesn’t matter if the nurse says he could be gone in a few days – he could still end up with years to go. I’m standing up straight in the middle of the seesaw and waiting to see which end will drop first.

Of course, the past experiences with Riley and “you’re gonna die right now” scenarios have left me in the State of Denial. I can see the state borderlines right there between the States of Peace and Chaos. I hear what the nurse is telling me and I’m nodding my head in agreement and understanding. But, deep down inside I deny that what they tell me is actually going to happen. One end of my seesaw is named “Immortal” and other end is “Gonner”. Right now Gonner is up in the air and Immortal is almost touching the ground.  From the viewpoint of the nurse, it’s the opposite situation.

No matter which end of the seesaw is higher, a change is sure to come. Even if Riley is immortal, things will change because I may no longer be able to take care of him and he may be forced to detox and move to a care facility. If Riley does prove he is mortal after all, that will mean another change. Both possible changes mean a change in my lifestyle.

All these changes are difficult for my family. They are unable to deal with the daily up and down of the seesaw and have absented themselves from the situation. They also live in the State of Denial. Although they see things may change and Gonner may end up firmly on the ground, they really just see everything just as it was. For them, nothing has changed. Riley is a drunk. Riley is miserable to be around. Same-o, same-o. No change here.

I’m wondering what their expectations will be of me when Riley is not around – either in a nursing facility or at the bottom of the sea. Will they expect me to spend every weekend with them? Will they except me to run to them on a moment’s notice? They are already resentful of my not spending time with them because of my Riley Duty. Even though they say everything will be the same, I know better. I know all of us will be forced to make changes – some mostly good and some bad.

There is nothing to do but wait and see. Wait for the changes and adjust myself on the seesaw.

I can take it...

Last night I made a valiant attempt to host the Thursday night OARS meeting. I haven’t been able to do that for a couple of weeks and I miss all my members providing support, encouragement and lots of humor. I really wanted my “fix” last night. But, Riley had other ideas and so the meeting went on without me. I’m happy that everyone is so comfortable that they just keep going in helping each other. I’m very proud of them for being open and caring to everyone in the group. And, by the way, the group is very welcoming to new members. If you’re searching for people who understand and listen without judgment or criticism OARS is the place to be.

 I don’t understand how “waiting for the end” can be so hectic and chaotic. There are things to buy, schedules to coordinate, menus to plan, and meetings to be kept. Yesterday was one such day.  It started with cooking Riley breakfast. After that, I was in my office making phone calls to facilities where Riley had been a patient. I am gathering his records so they can be submitted to VA in a complete package. Then there was an in-home meeting with the VA representative to go over what else was needed. Usually, VA takes care of everything involving gathering of the records. But, in my efforts to hasten the application process, I am doing most of the gathering myself. Anyway, after that I had a meeting with Gill, grocery shopping, prescriptions filled and shopping for a bath bench and oil-filled heater.

When I returned home, Riley was “in a mood” as it were. I knew he had been timing me and I had been gone much too long for his comfort. He knew better than to say that I was late or ask what had taken me so long. But, his attitude said it all. He wanted to put away the packages I brought in.  It is how we usually unpack bags of stuff from the store. That way he gets to see what I buy and many times there are little surprises for him. It’s a game we play, but today the game was not working.  He questioned every purchase and then complained that I was visiting with the teen age girl down the road who wanted to talk about teen-age alcoholism. My focus was not on Riley and that was troublesome to him.

It may not be recognizable to some people but what was really happening was that Riley was abusing me. There were no fists flying or even very much yelling. It was fairly quiet. But there was an undercurrent of anger coming from the kitchen. I knew what was wrong. I had been gone too long and was not giving him immediate undivided attention. Riley was furious with me, although, he would never come out and admit it because to him having anger means he’s not able to control his emotions. Somehow he thinks maintaining control makes him better than other people.

Riley has been abusing for me years. He’s just like most other alcoholics and I’m just like most spouses of alcoholics who, in the beginning, do not recognize the abuse. It comes in small doses – much like the Frog Soup Theory. Maybe he keeps his drinking money out of the salary household bank deposit – and you don’t know. You have to work twice as hard to make up the money – that’s abuse. Maybe he never spends Saturdays helping you clean the house or dealing with the kids – that’s abuse. Maybe he will leave you a long list of things that need to be done and maybe he could just as easily do those things – that’s abuse. He may not say anything to you about any of it, but you just know. There is a feeling in the room – the proverbial elephant that no one ever talks about. It’s abuse.

Somewhere along the way the alcoholic begins showing disapproval of the things you do and then calls you names or belittles you. That’s abuse. You’re now walking on egg shells because you don’t want this discord in the middle of family events or day-to-day activities – that’ abuse. Telling you he will do something and then not doing it – or lying that he has done it – that’s abuse. Name calling, degrading your sense of logic and making your life generally more difficult is abuse.

Of course then there’s the biggee – physical abuse. It will seem that you have so disappointed him that he will lash out with a slap or hit. Maybe he will even tell you it was an accident. Trust me it was not – AND that’s abuse. Each time he gets behind the wheel of a car and you worry about what he’s doing to himself or innocent bystanders – that’s abuse.

Besides all that, abuse comes in all sorts of fashions. There is abuse of power, abuse of inanimate objects, abuse of emotions, abuse of society. When there is an alcoholic involved you can be sure that he’s abusing everything and everyone around him, but especially the spouse/caretaker.

The question is, what do you do about it? No one can make any decision for you and we are all prone to forgive especially when it is someone we’ve vowed to love and accept no matter what. Most of the time, the spouse doesn’t even understand that they are being abused. Riley abused me over the nearly entire 40 years that we’ve known each other. I didn’t really recognize or understand it until recently. Now I see it. Now I understand. It’s too late for me to do anything about the past. But, I can make sure it stays in check in the present.

So, I want to do the OARS meeting and Riley comes in and makes a comment that I’ve been gone all day long and haven’t spoken to him at all for the entire day. I know none of that is true, but I decide to forego the meeting and deal with the issue. I return to the den and ask what it is he wants to talk about. He wants to know why our house is such a mess all the time. I want to say that the house is not a mess and defend the cleanliness level to a person who has feces smeared on his bathroom wall. But, I don’t do that. I simply say that the housekeeper will be here in the morning and what else did he want to say. He asked why I didn’t put hard-boiled egg is his chef’s salad. I told him I forgot about the egg and would remember it next time. And so it continued on… And that, my friend was abuse and I gave into it. Never once was there a real conversation or a slight smidgeon of thankfulness or gratitude for anything I did do that day. It was all about what I was failing to do or had failed to do.

I should have told him I would come talk to him when the meeting was over. Period. I should have closed my office door and gotten the support I needed from my group members. But, I didn’t. My choice was the abuse because it seemed like the easiest thing to do.

When living with an abusive person, the spouse gets presented with these choices over and over again. The spouse must weigh the potential outcome in their mind before acting. If you could slow down time, maybe you would see this image of the spouse talking to themselves about which road is the best to take. If I do this, then this will happen or if I do that, maybe that will happen. There’s a battle going on in there.

So, I often choose the abusive route. I deal with it. My reasoning is that Riley’s days are numbered. I know and understand he is a sick man and could emotionally  snap in a moment’s notice. So I tread lightly to keep the tiger inside him sleeping. I don’t have to placate for very long. He is sleeping more now and that provides me with solace. But the bottom line is no matter what he says or does, I know that I’m a good, intelligent, loving person – no matter what he says or what his passive aggressiveness wants me to think.

I am more fortunate than others. My abuse is at its end. For other’s it is just beginning and all I have to say is decide early on what you are willing to accept. Recognize it for what it is. And know that once you agree to accept the Bull Stuff that’s being handed out, you are agreeing to a way of life that may leave you feeling useless, stupid, unlovable. Get off that cycle now. Put a stop to it. Decide now that you are worth a solidly reciprocal relationship where things are shared and not just managed. Be the person that we all know you are – highly intelligent; very confident; genuinely loving; and over forgiving. It’s OK to take the easy way – as long as you know inside yourself that you’re doing it because it’s easy and not because you accept it as a way of life.

Waging war...

It was one year ago yesterday that Riley went to the store for some milk and came home with a 24 pack of beer. It was the beginning of the end for him. I wish yesterday had come with us being able to celebrate a year of sobriety, but, of course, that was just wishful thinking. And now, here we are, at the end of his life and I wonder – was it really worth it? I’ve clearly stated before that the reasoning for why a person would degrade themselves for the sake of alcohol is beyond my comprehension.

I remember reading somewhere that in our early settler days, the merchants provided whiskey to the Native Americans so that the merchants could cheat them out of land, pottery, and other items. Native Americans became addicted to the whiskey and that ensured a high trade volume for the merchants. The merchants took the Native American artifacts back to the homeland and sold them for a high price. So, the fact is that the merchants took advantage of the Native Americans for the sake of money. The Native Americans sold themselves out just to get some whiskey.

We hear a lot these days about biological and chemical warfare. A lot of money goes into creating ways for one side to do another in by means of a silent killer such as a virus or a non-distinguishable gas. I wonder what would happen if one side started spiking the drinking water supply with small amounts of alcohol and then increasing the amount slowly. I imagine that eventually there would be a whole nation of alcoholics or at least a whole segment of alcohol damaged populace. In time, the alcohol would render the population with the inability to think or reason clearly. Just like the Native Americans, they would be easy pickin’s.

OK. So maybe it would not be as quick acting as the opponent would like. But, it would be far cheaper than hiring a bunch of scientists to re-invent the horse. And it wouldn’t be creating a new malady for the entire world to worry about getting into the wrong hands.  I’m sure someone somewhere sometime along the way, has thought of this scenario. Maybe Hitler was working on a plan like this.

Of course, I hate the plan and the scenario. I hate it that people have been duped by others to believe that just a little couldn’t hurt. I believe that if two factions want to war it out, they should each have a certain number of warriors send to a far off place. They should fight it out in hand-to-hand combat and the last warrior standing wins. Quick, clean and to the point. No injured children. No raped or pillaged villages. No collateral damage.

It’ll never happen. The reality is that war is good for the economy. It creates jobs building war machines and hiring soldiers. It is profitable. Just like alcohol is profitable. Our government recognizes the value of the alcohol industry. In some states the liquor industry is controlled by the state government. Alcohol is only available in state regulated stores manned by government employees.

I know that alcoholics wage a war inside themselves. It’s a war between the desire for the alcohol and reality of common sense. I’m not an alcoholic, so I can only imagine what kind of war that would be. Losing that war and becoming a victim of substance abuse results in the ultimate loss – loss of life. And the effects are far-reaching. The collateral damage is overwhelming. Children, families, homes are all included in the circle of devastation. There are so many people waging this war right here and now, that I wonder if the water has, in fact, been spiked with the awful juice.

Riley has lost that war inside himself. Although for him, he never considered it to be a war. He made a decision. His choice was to die an alcoholic death. Now that our country home is a buzz with hospice workers, bath aides, and others who simply want to make Riley’s last days as comfortable as possible, he is losing his ability to hold onto his life and he just doesn’t care. He enjoys the company, but denies why they are all here.

I’m told over and over that there still may be hope. Riley could still get through all his bodily devastation and return to sobriety. I’m a realist and I follow Dr. Phil’s theory that the best indication of future behavior is past behavior. I know that long-term sobriety will never be something that Riley will ever have or appreciate.

Even if Riley manages to survive detox and achieves sobriety. The alcohol has so damaged his brain function that he will most likely suffer from permanent dementia. If that is so, I most likely would have to place him in a nursing facility. I don’t believe I could physically care for his needs. So, what kind of sobriety is that?? It’s like saying, you can be sober and live, but your life will be contained within this specific space – much like a prisoner. The alcohol still wins.

I believe I predicted somewhere that it would take about a year for Riley to get to this place – the end of his life. Sometimes I hate it when I’m right.

It won't kill you...

First of all, I want to thank all my readers for their patience while I have been away from the blog. I appreciate the many letters I have received expressing concern for my lack of posting. I want to assure you that I’m OK. It’s just been a little more difficult lately and my usual time for writing has been overtaken by other responsibilities.

After Riley returned home from the hospital, he never quite returned to where he was before he went in for stabilizing. He is weaker now than ever. He has absolutely no bowel or bladder control and cannot walk without assistance. On Thursday he fell eleven times. One of those falls was only about an inch from the fireplace.

I met with Gill and we talked about having Riley committed to the state mental hospital. My fear was that he would detox and come home so we could start up this routine all over again. It pains me to say that I really don’t want to go through all this insanity ever again. I’ve done it so many times and each time my physical health deteriorates and he just goes on. If the hospital would keep him, I’d be all ready to have him committed.

The reality is detox is dangerous. I know that and I know that Riley may not survive detox this time. But, too many times I’ve been told he that he would not survive and then he becomes immortal. When Riley is alcohol-free after detox, he actually presents himself as a sane and rational individual. I don’t believe it’s sane for anyone to return to drinking after detox, but my opinion means nothing.

Because I thought it might be possible that they would keep him, I did some checking to lay the ground work for Riley’s being committed. I spoke to the Magistrate. I learned that going before the Magistrate only initiates an order to have a Sherriff’s squad car to come to my home, handcuff Riley, put him in the back of the car and transports him the almost 3 hour drive to the hospital. Well -- that doesn't sound like something I would want to have happen to him. It just seemed like overkill to me.

Once there, he would be evaluated by a hospital doctor. That doctor would make a recommendation as to treatment. It may be that he will simply be detoxed and let go. If he presents himself after detox to be a danger to himself and others, then and only then, they would admit him in a residential program. Well – for me – that sounds like a crap shoot! I’m not much of a gambler and I think maybe I should just pick up my cards and go home.

I took my information and met with Gill once again. We agreed that for Riley to state he intended to drink again was an act of insanity. He is a danger to others by virtue of admitting he would drive drunk. He is a danger to me because of his inability to clean up his biological waste from the floor and walls. He is a danger to himself because he knows the drinking will kill him. But, generally speaking, they don’t commit people for that – or at least – I don’t think they do.

When Riley was discharged from the ICU, I was told to take him back to the doctor’s office on Monday to get his lab work re-done. There is no way that can happen because I can’t get him into the van and once in, I don’t know if I could get him out. I called the doctor’s office to let them know that I wouldn’t be bring him in. I was told not to worry about it, that the doctor would be calling me.

I rarely have much sympathy for the medical community. I find their lack of knowledge and understanding to be a constant irritation. When the doctor called me back I knew I would get the lecture about getting him detoxed and into rehab. I was surprised when the doc simply said that there was really nothing more he could do for Riley. He understood that Riley was not going to stop drinking even if they got him to agree to rehab. There was nothing medically that could be done for him. He couldn’t even give him anything for the pain from his arm or any past or future injury because there was just too much alcohol in his system. When I told him that I didn’t know how much longer I could take care of him, he said he would be ordering hospice. I told him I was reading between the lines. He acknowledged that I understood what that meant since he knew of all the work I have done in writing this blog. Because he knew that I was informed, he didn’t try to give me anything but the facts. I was so appreciative of that.

The events over the past week had made me a bit unsure of a few things and I asked him some questions.

Q:        Riley’s ammonia level is increasing at the rate of about 250-300 micrograms per month. What can I expect as the ammonia level increases?

A:        There will be increased confusion and agitation. He will lose all control of his bodily functions. He will be falling more because he’ll become unable to balance himself. He will sleep almost continuously and will fall asleep any place and at any time. Eventually, he will most likely fall into a coma from which he will not recover. However, it will NOT kill him.

Q:        If the ammonia (hepatic encephalopathy) doesn’t kill him, what will?

A:        The elevated ammonia level is caused by his liver failing to function properly and that WILL kill him. But, that is if nothing else is going wrong inside his body, which clearly there are lots of things going wrong.

He has a history of esophageal bleeding, so he may have esophageal varices which are almost instant death.

His potassium level is extremely low makes him susceptible for a heart attack and since his system is so weak, he would most likely not survive.

He has a lesion in his brain which was the cause of his last stroke. His blood is thinner from the alcohol and any bump to his head could cause that lesion to bleed. That can either cause another stroke or kill him. Because of Riley’s history of falling, he believes this is the most likely thing to happen.

I found it refreshing to get straight forward answers from a medical pro. I know I knew all of this, but to have validation that I am correct is great to hear. But it wasn’t really great because, until now, my knowledge was all about my research and experience. Now I have to look at reality and make some decisions or changes. I’m just not sure how to do it or what changes to make.

Today the hospice worker will come out and evaluate Riley’s condition and what they can do to help me take care of him. I’m also having the POA’s updated, so a Notary Public will be here. It’s Friday, so the housekeeper will be also here. It’s going to be a busy day – again.

At the moment, Riley is asleep sitting up on the love seat in the den. It has been peaceful in my office and I’m grateful for having the quiet so that I could write this post.

No detox zone...

When I took Riley to the doc for his arm they did blood work. I got the results on Wednesday morning when I was called and told that I MUST get him to the hospital immediately. His ammonia level was over 700 when it should be in the 100s. Also his LFT (liver function) was extremely bad as well as his potassium level. Erica is our PA and I told her that it was not my decision to make. I let her talk to Riley and he refused to go. She told him that I had agreed to take him, if he consented to go but that if he didn’t go, she would have to call the rescue squad and get him to the hospital. He agreed to go, but made it clear he did not want to detox.

But, while I was getting dressed he called her back and told her he did not want to go. Since she didn't pick up, he got in the van and went with me to the hospital.

At the hospital, as Riley went longer and longer without a drink, he became more and more agitated. I refused to intervene. I gave information when I was asked and corrected him on details that he didn't remember clearly. But, when it came to whether or not he would stay -- I shut up. Eventually, he agreed to being admitted and was placed in ICU.

He was now into more than 6 hours of withdrawal. I started my mental countdown - only about 30 more hours and he would be in full blown DTs. He was told they would only keep him overnight, but that they were prepared for the possibility of seizures since he had all the appropriate padding around his bed.  Their goal for him was to elevate his potassium and get him more stabilized.

The ICU doc came in and told us that the lab results she had used were based on a different and using her method, Riley’s ammonia levels were really not that bad. So she wasn’t that concerned. When she started asking Riley questions, the same inaccurate garbage was spewed as it had been in the ER. I started to give her the facts, but was abruptly stopped and told she wanted to hear it from Riley. Well… OK… I let it go and sat quietly marveling at how much misinformation was being bantered about.

While this whole process was going on, I was continually thinking – So now what??? Will this trip to the ER mean another year of hell with Riley? I have vowed not to pull him back from the brink of death, but when  a medical professional gets involved and makes the decision for me or for Riley – I see no way of being able to stop what could easily turn into a snowball rolling down a mountain in the Alps. I can see in my mind and follow the progression. They just want to give him some potassium; then he has a seizure and they have to keep him because he is too weak to be discharged; next thing ya know he’s in full blown detox and that silly little snowball is now an avalanche. And I feel helpless to stop it.

I was invited to spend the night in Riley’s room. They would bring in a cot and make accommodations for me. Sure, like that was going to happen. I had a Riley-free night and intended to make the most of it. I went home and cooked some of my favorite foods, curled up on the sofa with a soft blanky and watched Survivor. Then I took a long hot bubble bath followed by climbing into bed with fresh sheets. Jax joined me on one side and I allowed Jade to sleep in my room next to my bed.
That’s where we all snored the night away until almost 6 a.m.

The doctor made her rounds between 8 and 9 a.m. I had called Gill and he was going to try to meet me at the hospital to talk to the doctor. I really didn’t know what I would be walking into this morning, but I didn’t really expect to see that much of a change from the night before.

Riley was sitting up eating his breakfast complaining that what he needed and wanted was a drink. His night had been OK because they had given him Librium. He was shaky and weak. When the nurse came in and told him to push himself up high in the bed, he could not do it. His general appearance was one of a weak old man, even more so than when I brought him in.

The ER doc said Riley’s lab work looked much better and he would be released that day. I was impressed that they had actually been able to accomplish their goal without him going into DTs. In my mind, I’m still questioning the point in all of it. Why did we really go through this?

I went to get a cup of coffee and when I returned to the room, Riley was sitting up in the recliner. The nurse told me to get him dressed. Oh. Really. Was it really my job? I pulled out the sweat suit I brought with me and started the task of getting him into it. First there was the issue of the Depends – which he did not want to wear. I informed him it was not his choice to make – Depends or stay in the hospital. Once he conceded, trying to get the Depends actually on his body was still another issue. I told Riley to lift his butt so I could slip them on. He couldn’t lift himself high enough for me to slip them on. When they were half-way on, I moved on to the sweat pants and it was the same thing. I thought if I got them partially on, I’d have him stand up and pull them up the rest of the way. The sweat shirt was no problem as were the socks and slippers. I told him to stand up and I’d finish his pants – but he couldn’t stand up at all. He couldn’t walk. He couldn’t do anything but sit. At least when we came into the hospital, he was able to move under his own steam. He was worse now that he was before!

The problem-solving part of my personality kicked in. I could drive up the ER entrance and the nurses could get Riley into the van. But what was I supposed to do after that?? I couldn’t carry him into the house. He couldn’t walk. I expressed my concerns to the nurse. She told me to call a neighbor for help or a family member. WHAT?? The only neighbor I have is at work. My kids are about two hours away and at work. To me the suggestion was ludicrous. I asked if they thought I should call the rescue squad to help me get him inside. After a lot of mucking about, it was decided he would be transported home via the rescue squad. That sounded like a good plan to me.

While waiting for the rescue squad, the hospital case manager came in and told me she would be having a home health agency contact me so that I would have some assistance in caring for him. They knew Riley’s aversion to bathing and knew I needed help at that area – at least. I was extremely happy to hear it. I was also told that I might be able to get assistance from the Veterans Administration since Riley was considered a Viet Nam vet, there may be programs open to him that we didn’t know about until now. Wow! More useful information – this hospital overnight was turning out to be a pretty good deal.

I got home, fixed Riley a drink and within a few hours he was trying to make his way around the house. The more drinks he had, the more mobile he became. So, the drunker he was, the more stable he was. The irony in that amazes me.

Tomorrow I am to take Riley back to the docs office so they can repeat the blood work and see how much he has improved. OK. I can do that. I will comply.

I checked back in my records and when Riley was admitted to detox in SoCal, his ammonia level was almost 900. So while a level of 700 is alarming, Riley has survived much more startling lab results. I suppose to someone who is new to the Immortal Alcoholic, he seems in dire need of help. I know that’s their only goal – to help. I respect that and understand it. It makes my job more difficult and the medical pros don’t seem to understand my point of view.

I’m not upset over the hospital stay because Riley did NOT go into DT’s. They released them exactly as they said they would. I’m thankful for my 24 hours free of Riley insanity. Gill informs me that I have some other decisions to make and wants to meet with me as soon as things settle down. At this point, I feel I’ve made all the decisions I need to make. But, we’ll see what he has to say.