Cirrhosis Diaries. Post 5.
It’s 6:00 AM Monday morning, Martin Luther King Jr. Day, and I scan the sides of the road from our 1994 diesel Suburban. Fern, our rescue Black and Tan coonhound mix, peeks up now and again from the back seat. In the trailers, doublewides, and small houses along these back roads, lights flip on with people getting ready for work despite it being a federal holiday.
The morning before, Fern and I had trampled the woods behind a church where Keme, our missing livestock guardian dog, had last been spotted. Our guide was out searching for the Blue Merle Great Dane she and her husband had rescued some four weeks prior, only to have him escape the very day they brought him home. The whole little village of Olin, NC was involved in Operation Find Smokey, with neighbors and strangers texting and walking and driving and chasing and cajoling this dog disappearing into the ether, living up to his name.
On our maneuver, Smokey’s owner and I were officially the anti-stealth, crashing our way through brush, getting ourselves wrapped up in wild grapevines, while my bright orange knit hat attached itself to every thorn of multiflora rose, or some other hateful briar. While we simians flopped and knocked around, our accompanying canine Fern, meanwhile, kept her nose to the ground, her nostrils pumping so hard they caused a flapping sound. Smokey’s owner and I were convinced she had picked up on Keme.
This morning I was going to walk Fern around the neighborhood Keme had been spotted in four days prior. Though, in 12 days, he had travelled, by foot or by vehicle, some ten miles from home, maybe “rescued” by someone only to escape.
I have no good plan for how to look or if Fern and I are heading toward a now vacated spot. How can I think like dog on the run? Is he even looking for us anymore? He had been spotted at sites as far away as 7 miles from each other. Or so someone thinks that she IDed him.
Along with expanding my brain to include canine preferences, I am also trying to learn to think like a human cirrhosis patient. Five weeks ago now my mom got a surprise diagnosis of non alcoholic cirrhosis of the liver, after her symptoms were ignored for years by doctors.
Online I am on lost dog forums and cirrhosis patient forums.
I get advice. Insights. Put things that smell like you out for the dog to find. Food aversion is typical of cirrhosis patients. Often, once dogs find reliable shelter and water, they hang around that same spot. Cirrhosis patients often have good days and bad days with lucidity and full cognitive function.
Seems like Keme has yet to settle down. I try a new tactic with my mom — I ask her what she wants to eat. Salmon cakes and a baked potato. All right. I will try to oblige.
I drive through the dark.
I fling trials at the wall but am I fighting against the inevitable?
I park in the dark church lot. If I were Keme, I would be curled up asleep in some warmth. Lots of open barns around. Lots of abandoned buildings, crawl spaces, dryer vents blowing hot air.
Yet, here I go. I get Fern out of the truck, and she and I search the cold and blowing void together.
Recently on social media an acquaintance posted that we, meaning humans, don’t deserve dogs.
We wander, or I wander us. Semi-trucks start in the driveways of owner operators getting a start before traffic is thick. As an occasional car passes.
My other dogs, adults, think clearly enough several times a day to journey over the 40.45 acres of our farm, through the backlot woods, up to the neighbor’s trailer next to the defunct chicken breeding houses, and back home. Two weeks prior, Keme had not made it back from one of these runs.
It is my fault my mom progressed to cirrhosis, it is my fault Keme is gone. Yes, someone tells me, I am only human.
That. Is. Simply. Not. Good. Enough.
I didn’t question the doctors when I took my mother in with her symptoms. I was too busy last spring and summer. What would it have taken me to sit down and look up their combination: low platelets and terrible itching, and swollen legs…and then combined it with her newish low appetite?
Yes, what would it have taken the doctors to do this? But that is not what they do. An old woman is shoved on down the line, as don’t they complain needlessly?
Maybe we would have caught it earlier. I should have advocated harder.
In the training forum for dogs that I follow, you are not supposed to just turn your livestock guardian dog out with the animals it will guard. You take time to bond, to get to know each other; you teach your dog manners, then you teach your dog what is expected of it.
I did not teach Keme what was expected of him. I had not yet gotten him out to do his job of guarding our goats.
I had let him run with the adult dogs. He seemed old enough; he certainly was bigger already than they were. Yet, at nine months, he was still a pup.
If I had felt last fall that I could not do one more thing due to managing our farm, our family, our household, some time in mid-December, life bought a skywriter, and flew above my house, announcing “hold my beer.”
Since Dec. 17, my mom has been in the hospital and now a nursing home, where I must stay vigilant or important things for her health slip through the cracks. Then there was the aggravation of Christmas.
Someone somewhere along the way massively screwed up my mother’s meds and she spiraled downhill. She has only climbed about 1/2 way back and it is unclear she will ever make that needed turn.
The whole farm and our family turns on my existence and capacity.
I sprained my ankle, then a week later, my whole leg.
Then I am running out to see my mom in town at the nursing home. I don’t gather the dogs back before I do. Keme blows me off and heads up the hill to the neighbor’s. I assume he will be waiting on our hill when I return, as he does, looking over his small kingdom.
He does not come back. I have a sleeping five year old in our house. My husband is on the road. I cannot go driving around for Keme, so Keme goes missing.
Plus, you got all the family drama and revelations of the holidays when everyone is at their worst behavior.
Then this Saturday, after our son and I follow a lead on Keme, my husband texts me he is being prepped for surgery, his appendix being taken out. Now, he is off work for two weeks and he is a private contractor.
Yesterday at the nursing home where my mother is, I cornered the nurse I like. He is South American and very thorough.
Look, I say, I have this problem. Friday the Assisted Living facility we prefer called and told me that at this time, they cannot take my mother because the wounds on her leg are not healed enough and she is not eating enough protein. Then, you know, over the weekend I thought, well, she eats food I bring, and that is not getting listed on her chart. I know you won’t add things to her chart beyond what she has eaten from what you provide.
He gives me several standard lines about the food they provide at the nursing home. He won’t look at me when I ask whether he would expect his mother to eat the food there. He is not going to risk his job with regular hours for some white girl trying to stir things up.
I switch tactics; I ask about how they chart the food. I explain my mother eats more than they chart she has been eating. He says they do it by percent — 20% eaten, 40% eaten. Like that.
Grey clouds streak in the red above yet another patch of woods. I gather Fern up and we drive 7 miles away to the spot someone thought they had seen Keme playing with another dog the evening before.
Fern and I get out, wander around. She and I both know there is nothing to be found here.
My mom and my dog are moving targets.
Later that day I manage to whip up some salmon cakes to take to Mom. No time to wait for a baked potato. I pack up a little yogurt drink.
After I visit there, I drive around in the dark. I pull over, search on my phone for dog tracking tips. Smells! One afternoon this week, could I walk the ten miles from the church home and he would follow the trail? A website explains how to train your dog to track humans. Soak a sweaty T-shirt in water, then use a spray bottle to spread it.
Efficient! More efficient, I could get my recuperating husband to be in the passenger seat as every 50 feet or so for ten miles, I pull our van over and he pours out a human-stinking concoction to make a trail for Keme to follow home.
Would that satisfy me, that if he is found dead, at least I had tried everything?
At the nursing home, much to my relief, my mother perks up a little. When I came in, her speech was a bit slurred, and though she was in bed (where I have found her more and more the last week), she was in better spirits than the day before.
As she is eating her salmon cake and drinking the protein drinks I brought her, the nurse’s assistant brings in her dinner.
It is some weird-looking open faced biscuit thing with gravy and mixed vegetables in it.
I offer it to my mom and she waves it away.
I sit on the stool part of her walker and chat with her. I make conversation about her day: what did she do at physical therapy? Did she have a bowel movement? Okay, no. I will mix up some Metamucil for the orange-pineapple juice I brought.
Then, it hits me. Yes. If the system will not count what she is eating that I brought in, then it is time to game the system.
I throw the cookie and crap high fructose corn cranberry syrup drink from her tray into the bag I brought.
I close my mother’s door, then I pick up the biscuit plate and walk into the bathroom and dump one into the toilet. Of course, after I flush, one biscuit is stuck, so I have to reach my hand into the toilet water, mash it up, and flush again.
I wash my hands and return the plate to the tray.
I look at the remaining contents, satisfied.
Her chart for that evening should reliably read, meal completed, 50%.
Update: If I wait long enough to post the article, the circumstances will change.
The Blue Merle Great Dane has been caught! He walked into someone’s yard for food, and she simply shut the gate behind him.
Medicare will stop paying for my mother this Saturday, which means she is now supposed to be released.
No assisted living facility in town will take her as she is too much work for them.
Today, when I walk into her room mid-morning, the wound care nurse is there. She explains to me what I have been mixing up.
See, your mother’s body no longer processes protein. You can shove as much protein down her as you want, but her body no longer processes it, thus she heals very slowly.
Also, these wounds on her legs are veinous, that means, that although they heal, they will open up again. This will be the cycle with them from now on.
My charting victory is meaningless.
My god, I think, what have I done? When her legs swelled up like balloons from the medication screw-up, I massaged them and fluid burst through, causing these wounds.
Now, no assisted living will take her. They don’t want to deal with this.
I have to call Medicare and appeal to keep her where she is for now.
On the phone to Medicard I am giving reasons. Wounds. Self-care.
Today my mother no longer wanted foods she ate fine just a few days ago; cirrhosis has again shook up any routine.
I call my mother’s social worker at the facility where she currently resides for “rehabilitation” enough to go home or to another downgraded, less care intensive place.
So, now what? I ask. If assisted living won’t take her, and she stays in the nursing facility for a while longer, what then?
What is next?
She calls me back.
The nursing home social worker tells me not to cry. Your mama will be able to keep staying at the nursing home in a good warm bed.
Tonight it is 19 degrees Fahrenheit and Puppy Keme is still at large.