General Update #172

Dusty arrived to farmhouse ~8:18 a.m. (9/27) after purchasing supplies in town for Joyce from Walgreens (bread, disposable gloves, Tylenol, 2 packages of diaper inserts). Joyce found awake in her recliner without her oxygen line in, having just seated herself. She had taken the remaining hardboiled egg from the refrigerator, along with one of Craig's Baby Bell cheese rolls, and set them onto the tray Dusty prepared last night before leaving the farmhouse along with a mug of tea. Joyce had also picked up the bowl that had been used for burning votive candles during the last few days on the stovetop and had set to work on chipping out the old wax with her fork. Dusty took the bowl of wax away from Joyce as she was in danger of stabbing her stomach with the fork as she attempted to chip it loose. Dusty unpacked the supplies he brought and Joyce gave him $100 cash from her purse to replenish his errand envelope after Dusty explained that he had used the cash Joyce had previously given him to buy supplies for her when she offered to pay him back. 

Joyce informed Dusty she had gotten up and used the bathroom by herself earlier in the day while it was still dark outside. She was frustrated that she could not work the television, the remote and the controls on the display were too difficult for her to understand. 

Dusty finished building Joyce's breakfast tray while listening to Joyce's concerns about her life. Dusty realized that Joyce was confused/disoriented as Joyce expressed that she had a lot to do today because the IRS said that she had to get her taxes done. When Dusty asked Joyce what taxes she had to do she said "mine and everyone else's!" Dusty reminded Joyce that she retired from doing taxes. Joyce stated that she had to do her own as she "has to add up all her taxes and figure out where [I] am at for money." Dusty said that the family would help her do those in the spring during tax season. Joyce stated that she did not have to pay taxes because the IRS has a rule that "If you prepare taxes you don't have to pay them." Dusty asked how long Joyce had thought that, as he had never heard her tell him that before in all their years of being at H&R Block together. Joyce stated that it had been that way, and that's why she didn't have to pay taxes. Dusty told Joyce he thought that everyone needed to pay taxes and that Joyce should not worry as Connie and Carol would help take care of mom's finances and make sure her taxes were paid when it was tax season for the farm. Joyce asked why Connie and Carol were doing that instead of Dusty. Dusty explained that Connie and Carol know the farm's finances better than he and Jess and that they were better able to process and plan for her finances. Joyce expressed she did not want people "in her personal business" and got irritated at Dusty because she had made him promise he would handle her finances. Dusty explained that he understood and reminded Joyce that she had previously not wanted Dusty to know anything about her finances. Joyce became visibly angry, balling her fists, raising them above her head and then slamming them both down onto her knees four times. Dusty paused working on building Joyce's breakfast tray, moved to her side, and asked her why she was hitting herself. Joyce yelled at Dusty, stating that "I'm tired of everyone treating me like an imbecile!" Dusty worked at calming down Joyce, assuring her that no one thought she was an imbecile and that the family was only trying to help her. Dusty attempted to steer Joyce's mind onto other subjects and eventually succeeded, Joyce returning to a baseline normal calm but still weaved back to an irritated mental state at times, stating she was "frustrated that she is not getting things done around here." Dusty asked Joyce if he could help her with what she wanted to do around the house and Joyce stated "you might be able to." They made plans to tackle some of Joyce's imagined projects today and Joyce calmed again.

Joyce's vitals taken ~8:38 a.m., blood pressure 178/97, pulse 88. Blood glucose level @ 141. Lidocaine patch applied.

Breakfast given to Joyce ~8:40 a.m. (1 slice of toast with butter, 1/2 banana, 1 chocolate Ensure, 1 hardboiled egg). Morning medication administered (Metformin, Carvedilol, Multivitamin, 2 Tylenol, Potassium, Iron). Breakfast finished ~9:15 a.m.

Dusty visited with Joyce, who was still frustrated. Joyce stated she thought that Dusty was mad at her because he did not eat breakfast with her this morning. Dusty reminded Joyce that he usually doesn't eat breakfast at the farmhouse as he eats at his apartment so his medications have to have something to digest alongside. Joyce expressed frustration that Dusty was not sitting in the rocker chair near her and Dusty explained he was doing his work for the university and other projects for himself over at the work table and that if she needed anything all she has to do is ask. Joyce expressed frustration and lament over being a burden to Dusty, Carol and Connie who "have to come out here to be with me." Dusty talked Joyce through her feelings and what they could do together to help her feel better. Joyce stated she was thankful they are here for her but is frustrated at getting old and being unable to be independent, that she was exasperated at all of the unfinished projects around the farmhouse she had wanted to do over her lifetime that she most likely will not get done now, and that she was not happy that everyone was "in her business" (finances) and that she was generally feeling like a burden to the family. Joyce alluded to concerns over the end of her life approaching. Dusty visited with Joyce for a while about gardening and the patio plants, cooking, and other topics while letting her hold his hand, and was able to get Joyce calmed. 

 9:36 a.m. - Epsom salt foot soak setup for Joyce. 

11:40 a.m. - Joyce traveled to bathroom without incident, passing urine and Type 5 bowel movement. Dusty cleaned Joyce's wounds and applied fresh barrier cream. Weight @ 166 lbs. PT walk to living room and out to kitchen window followed before returning to recliner.

Noon - Lunch (1/2 peanut butter sandwich with honey, 1/2 banana, 1 cup diced peaches, remaining Ensure drink from breakfast). 2 Tylenol administered for pain relief.

12:20 p.m. - Joyce spilled her remaining 1/2 Ensure drink (leftover from breakfast) onto her pillow and books beside her recliner. Dusty assisted with cleanup.

~12:30 p.m. Dusty brought Joyce a box of old recipe books and magazines to work on sorting out.

~1:15 p.m. - Craig stopped by to visit Joyce, going through recipe books and discussing baking recipes before he departed ~1:38 p.m.

4:40 p.m. - Derik arrived to use the farmhouse bathroom but Dusty was cleaning it so he sat and watched Harry Potter and the Chamber of Secrets while waiting with Joyce. Derik provided update on his ongoing health conditions. 

4:58 p.m. - Joyce asked Dusty who had just been in the house after Derik left. Dusty reminded Joyce it was Derik, that she knew who he was, and that she knew about his living situation. Joyce asked how long that Derik had been living on-site and Dusty provided what he knew. Joyce asked who approved this and Dusty said that Craig and Derik had arranged it. Joyce asked "why she was always the last one to know." Dusty reminded Joyce that she knew Derik was living up in the garden in the camper. Joyce said she knew Derik was working for Craig but thought he was still living with Craig and Carol at their place and not in her garden. Dusty reminded her it has been this way for a while and she had been aware of it before her fall down the stairs. Joyce changed subject to a dinner request.

5 p.m. - Bathroom trip. Accidental bladder release occurred while Joyce moved to sit down on toilet riser requiring change of diaper, diaper pad insert, and slippers. Dusty will wash slippers again with next load of laundry, switching Joyce to her purple slippers for the remainder of the evening. Remainder of urine passed without incident, wounds on buttocks were cleaned and fresh barrier cream applied. Dusty re-sanitized the bathroom floor and toilet riser. Joyce returned to recliner ~5:25 p.m. 

Blood glucose level 148 @ 5:28 p.m. 

Jay (Kindred PT) called Dusty's cell phone while Joyce was toileting and bathroom cleanup work was underway so Dusty missed is call. Jay left a voicemail message that he would be arriving tomorrow between 11:30 a.m. and 11:45 a.m. to work with Joyce. 

Dusty departed farmhouse ~5:48 p.m. to pickup dinner from Panda Express for Joyce at her request. Prior to departing farmhouse to make run into town Joyce kept attempting to give cash to Dusty. Dusty reminded Joyce she had already replenished his errand envelope earlier in the morning and so did not need more funds to make purchases for her. Four more attempts were made by Joyce to give Dusty additional cash for the errand envelope. Dusty managed to get Joyce to put money back where she had pulled it from.

Dinner ~6:20 p.m. (honey sesame chicken, teriyaki chicken, and super greens from Panda Express, 1 vanilla Ensure drink). Evening medication (Metformin, Carvedilol, 2 Tylenol).

7:15 p.m. - Bathroom trip. Changed out diaper pad due to urinary incontinence. Joyce passed urine and Dusty cleaned her wounds on her buttocks and applied fresh barrier cream. Joyce had difficulty in rising up from toilet, citing her left knee was not working. Time elapsed as Joyce made several attempts to stand under her own power before her knee finally permitted her to stand up from the toilet riser. Joyce was able to make it back out to her recliner by ~7:39 p.m. under her own power.

7:41 p.m. - Dusty prepared Joyce's serving tray and morning medication for tomorrow, set her dentures to soak in their container, removed Joyce's lidocaine patch that was applied earlier in the day, and sanitized toilet riser and bathroom sink.  

9:45 p.m. - Bathroom trip, no issues. Urine passed.

~9:55 p.m. - Joyce was settled into her recliner for the night. 

Dusty departing farmhouse ~10:10 p.m. and will return tomorrow ~8 a.m.