Wednesday, August 24, 2016

Anna's Mind Time Travels At The Speed Of Sound

Anna's been home for 12 days, when he spikes a fever (101° F) and his congested chest breathing and coughing starts up again. The symptoms are similar to the symptoms that landed him in hospital last time. So I call the doctor who listens to me patiently and prescribes medication for the weekend. I am told to bring Anna to the hospital on Monday. It takes two hours at the hospital to find out that Anna's chest is clear but he has an infection.

Anna has little recollection of his stay in hospital and seems more disoriented and forgetful than normal. This is common with Dementia patients - physical illness negatively impacts mental acuity. I have dealt with this before and think I am ready for any disorientation, delusion, or hallucination to follow.

I am wrong.

I drop Anna at home at 1:30pm. I have lunch and just about sit down to relax when the phone rings. The attendant tells me that Anna is agitated and refusing to eat lunch. I ask him to put Anna on the phone and spend 40 mins with him on the topic of money.  From "all my money is lost" to "I have no money here" to "what happened to my money" to "I am a pauper". I patiently explain to him that his money is in the bank, that no money is lost, that I manage his money, to ask me if he needs money, to trust me.

He still refuses to eat unless I show him where the money is! I tell him that I will show him his passbooks when I see him later. So I gather my laptop and hoof it over to his flat after a nap (I so needed a nap!)

Anna: Bandiya-Amma? (So you've come)

Me: Yes Anna.

Anna's staff tell me that he had custard 'n banana for lunch. Milk, sugar, fruit - good calories as far as I am concerned. Not really lunch as far as Anna is concerned.

Photo: The Times Of India
Anna (very upset): Sangeeta, I have lost all my money!

Me: What money, Anna?

Anna: Money that was in the house.

Me: Anna, household spending money is with Tairas.

Anna: I need money for my expenses too.

Me: Yes Anna. I have that money. I manage it for you.

Anna: Where is the money?

Me: Anna, the money is in the bank. I take it out from the ATM when you need it.

Anna: Where?

I soon realise that Anna does not understand the concept of banking. So I explain basic banking and how we can withdraw deposited money from an ATM machine. He is somewhere in his childhood where there are no banks and definitely no ATMs.

Anna: Now I understand why Padu says he carries no money. He uses that machine (referring to an ATM). Anna's younger brother, K V Padmanabhan, passed away in April 2009. Anna thinks Padukaka is still alive.

Me: Yes, Anna. He uses an ATM.

Anna: So have we done the division.

Me: Division of what, Anna?

Anna: Amma's things. Are Krishna and Padu here?

My grandmother, Ananthalakshmi
For a couple of seconds, I think he is talking about my mother. He isn't. He is talking about his mother and the time just after her death in 1984.

Me: Yes Anna. What do you want with Krishna and Padu?

Anna: Has Amma's jewellery been divided? Are they happy?

Me: Yes, Anna. My grandmother probably had only one chain and nose ring, & one pair of earrings and bangles when she died.

Anna: Do I have money in the bank?

Me: Yes Anna.

Anna: Will it be at least Rs. 3,000/-?   He says this in a tone that implies that Rs. 3,000/- is a very healthy bank balance.

Me: Yes Anna. I don't want to confuse him with real numbers that are healthier.

Anna: Oh OK! That is good!

Me: Anna, are you feeling calmer now?

Anna: I need some money to spend.

Me (showing him the money in his wallet): Anna, you have Rs 570/- in your wallet for spending.

Anna: That is not too much money.

Me: Anna, the rest of the money is in the bank.

Anna (after a long period of silence): I wanted to ask you all this before now, but you had told us not to discuss money when other people are around. There are always people around.

My Mother, Sarala
Yes, I had. My parents would discuss money matters in rented taxis all the time. I had to sit them down and explain to them why this was dangerous. I literally forbade them from talking about money unless they were alone at home!

Me: Anna, you remember that!?

Anna: Yes, you just told us. "Us" is my mother and him. I had probably told them this the early 2000s. My mother passed away in 2011.

Anna: What is my net worth?

Me (not sure what time period he is in and what an appropriate number is): How much do you think it should be, Anna?

Anna quotes a figure that is a few lakhs. I agree.

Anna: What about the safety deposit box?

Me (after I tell him where it is): Why do you want your safety deposit box?

Anna: Amma's jewellery is there. But, it should be empty now.

Me: Yes Anna. Remember after Amma died (in 2011), I cleaned out the box and divided all her jewellery between the children? There is nothing there now.

Anna smiles at this: Good.

This goes on for hours. The theme is money but the time frame moves years, forwards and backwards. Seamlessly. Constantly.

I wonder who he thinks I am. Not Sangeeta, as I do not exist in all the time periods in his mind.

I am really exhausted at the end of my visit and so happy he decides to nap before dinner.

Friday, August 12, 2016

The Body Has Been Battered But .......

Anna is released from hospital on a
wheelchair that walks down the stairs
We brought Anna home on 7th August, after 20 days in hospital with aspiration pneumonia and a critical respiratory distress incident. The first 10-12 days were touch-and-go. The last 8-10 days were spent trying everything we could to wean him off oxygen and IV fluids.

Both were difficult tasks given the fact that there were no tubes and no drastic medical interventions to keep him alive as per his instructions and wishes. No ventilator, no lung drainage tube, no feeding tube. The only "tube" was the IV.

His medical staff were great, looking at "other" means to get him back on track i.e. well enough to be sent home.

The key was to first get him to breath on his own and maintain his O2 level above 90% - something we managed with medication and physiotherapy.

Then there was the eating! Anna did not want to eat anything, could not eat anything.

I decided to do two things simultaneously - one was to cook foods that would dredge up fond memories of his childhood and the other was to grind everything into a baby-food-like consistency. So there was pureed upma, sooji-ka-halwa, vada sambar, idli sambar, curd rice - you get the idea.

Every time he woke up, we'd find a way to shovel a few teaspoons of favoured-foods-of-his-childhood into his mouth. We'd add his powdered medication to a couple of spoons to ensure that he was orally ingesting his medication.

In a desperate attempt to add some nutritional value to his food after I ran out of Nutralite Protien Powder, I tried Pediasure, a supplement for young growing children. Rich Kesar Badam. He loved it. We are now on our 3rd carton of that thing! And I am not moving to a more age-appropriate supplement till he is bored of this one.

We've had him home for 4 days. His disorientation and hallucinations have increased. And thru his bouts of "not being rooted in reality" we are trying to get him to eat. Eat anything at all. Focusing on calories with nutrition. At least 1200 power packed calories per day. Quinoa, eggs, paneer , vegetables, rajma, brown rice, oats, banana, mango, milk, curd, nuts, figs, dates, raisins.

On Thursday, as I drive him to meet his doctor for a review, I lecture him about eating more, re-starting regular physiotherapy sessions, and walking. 

Me (deciding to use a threat): "Anna, I will have no choice but to re-admit you into hospital and put you on IV fluids, if you don't eat properly. "

The father does not react to this threat at all!

Me (in jest): "Anna, will you drink beer? It has lots of calories. If you say yes, then I will ask the doctor." 

Anna (giving me sideways glance): "Beer has lots of calories. The doctor will say it has no nutrition. I need nutrition."  Pause. Then a little grin. "I am happy to have beer, if you think it helps!"

The logic and playful parts of his brain are working well, I see!

As we wait for the doctor, I continue to remind him to eat properly. This time I decide not to threaten him with a hospital stay, but use an incentive.

Me:  "Anna, if you eat properly, you will build up enough strength for me to be able to take you to Barista." Pause. "You remember coffee at Barista, right?"

Anna (with a small smile) : "Yes, Barista."

Me: "Anna, you can have coffee and a muffin. You like muffins, right?"

Anna (the grin widens, and in a teasing tone): "I know you want to go. I will join you just to give you company."

Appreciate the great sacrifice and hardship father!
Thanks for the favour. :-)

I am not taking Anna out for coffee and a muffin this weekend.
The long Independence Day weekend crowds and traffic are best avoided.
We've planned our coffee date for 16th August.
Hope he is well enough to go out then.

Thursday, August 4, 2016

Turtle Watching with Anna

Anna is still in hospital, recovering. He was on oxygen for 5 days and on IV fluids for 12 days. If he eats enough to give him adequate calories and nutrition, we should be able to take him home in a few days.

Over these 15 days, there have been ups and downs. Downs were I thought he would not survive, and ups when he grunted responses or slurped liquefied food hungrily. And thru' it all, the thing I remember the most is turtle watching. Turtle watching! I don't know why. When I tell Anna I have been thinking of Turtle Watching, he smiles remembering a fond family outing, but says nothing.

Trinidad and Tobago hosts the 2nd largest population of leatherback turtles, supporting over 80% of sea turtle nesting in the Caribbean region. Grande Riviere Beach is one of the world’s most renowned and intensive nesting sites.

The largest of all living turtles, these ancient marine creatures have been swimming our oceans for over 100 million years. They visit Trinidad and Tobago’s shores from March to August every year to lay their eggs.

I don't remember how old the four-of-us-siblings were when Anna first took us Turtle Watching. I remember that we were told that we needed to stay up late into the night - on a full moon night - to go to the beach! Two beautiful exciting things happening at the same time had us all excited - going to the beach, and being allowed to stay up late. There was nary a protest when we were sent upstairs to have a long nap after lunch. Any hardship was worth a late night beach trip.

After dinner, we dressed in long pants and long-sleeve shirts. To go to the beach nonetheless! We didn't protest - the outing was too precious to be lost by bickering over what clothes we wanted to wear.

Anna drove us in our sky blue Volkswagen Beatle to a beach, somewhere on the east coast of Trinidad. Anna does not remember the name of the beach (and neither do I!) We parked the car far away from the sand and followed the guide in single file. After what seemed to be a long walk, he stopped and asked us to hide behind a long sand dune that ran parallel to the waves. We lay in makarasana, peering over the sand, watching the moonstone sparkling waves, waiting for something exciting to happen.
Photo: Steve Garvie
At first it looked like large dark boulders waddling up the sand. As they came closer we saw small necks, topped by a head, sticking out in front of gigantic shells. When they reached the bottom of the dune, they slowly turned to face the waves.  Little fountain spurts of sand told us that the turtles were using their rear flippers to dig a nest-hole. It was only after the digging stopped that we were allowed to move stealthily  towards them to watch as they laid their eggs in the nest-hole. 

Turtle Nest
As these huge mama turtles laid their wet eggs, they cried. Tears that cleared their eyes and cheeks of sand. Watching them cry made me sad. Being allowed to lightly stroke their backs and pat them seemed to comfort me and I imagined that it comforted them too. And though we were safe, we are asked not to make any loud noises or sudden movements out of respect for these ancient creatures and their nesting ritual.  

When they are done, they shovel sand over their egg-loaded nests, and pat the sand so that an untrained eye can not make out that there is a nest, safely tucked underneath. They then slowly walk back into the sea, without a backward glance at their future babies, who will hatch far away from their mothers' eyes.

Leatherback Turtle Hatchlings make their way to sea
Two to three months later, on another full moon night, Anna takes us back to the beach.  We again hide in makarasana behind the dunes and watch the sand with peeled eyes. At first the sand seems to give a twitch here and there. The twitch changes to a shiver. And from little fault lines in the sand a few tiny heads and flippers appear. Then the sand over the nest looks like its boiling, and lots of little baby turtles come tumbling forward. Unerringly, they turn to face the sea and crawl their way towards the waves.

Leatherback turtles are classified as Vulnerable on the International Union for Conservation of Nature and Natural Resources (IUCN) Red List of Threatened Species.

Trinidad and Tobago’s shores support a large accessible nesting population of these turtles in various locations.