Finally had a few spare minutes and stopped at Woodbine after dropping Dan off at the Metro station. Unfortunately they were giving Estelle a shower when I arrived and I ended up spending almost an hour with the head nurse while waiting (in vain) for Estelle to be finished with her daily abulations.
Unfortunately I had to be back home by 10:30 for a conference call so I was unable to stay until they were done and was forced to leave without actually seeing her at all.
It was good to be able to spend that much time with Teena, however. She's a very smart woman and very dedicated....she also knows Estelle quite well and has shown an active interest in her care since Mom arrived here. She went over Estelle's chart with me and we discussed her recent refusal/inability to communicate with anyone. The nurses have all noticed it, too, and are trying their best to arouse her and to get her to participate in conversation with them. It is virtually impossible to tell if she is unable to or simply unwilling. Teena seems to feel that she is choosing to retreat - that she is depressed and unhappy with her situation and this is her way of dealing with it. She says it is not uncommon at all and they have several patients who react in the same manner. We discussed changing her anti-depressant medication but, truthfully, there is not much left to try. She has already been on most of them over the course of the past year and none of them have shown much ability to rouse her out of her disinterest. She is currently taking two different anti-depressants. Teena will talk to the doctor about it but she does not expect that he will want to change them again. One of them also doubles as a nerve pain blocker so that one will have to remain the same in any case.
They did run another series of "routine" blood work to rule out any infectious process which might be going on which was causing the sustained lethargy but it all came back negative...in fact, Teena says her blood work is just about "perfect."
Her only suggestion was to continue doing as we are doing - visiting, talking and sitting with her. Teena is making sure that her aides and her nurses do not "switch" patients on a weekly or bi-weekly basis. She says that she has assembled her "best" people, nurses and aides, and has assigned them less patients than normal but they are the most in need of care and attention. Mom is one of them. Teena believes (and I agree with her) that continuity of care is vitally important to people who are unable to communicate and so she does not have the staff assigned to them rotate as the staff usually does unless they specifically ask to be transferred. Mom's aide, Phyllis, and her nurse, Angelicia, are very dedicated and careful people - they are doing everything they can to assure that she gets as much stimulation and care as she needs and deserves.
That's about all I have today. Not good news, I'm sure, but medically, at least, Estelle is stable and doing well. It's hard to tell if it is damage from the stroke which is solely responsible for her lethargy or if it's a combination of depression and damage which is at work here. Either way, everyone seems to be doing the best they can to help improve the situation.
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