When I got the call back in June from
the speech therapist at ManorCare, I must have been in denial.
“She’s not eating well. She seems
to be having trouble swallowing,” the soft-spoken, kind woman said to me over
the phone. I didn’t believe her. I didn’t WANT to anyway.
“I don’t think she has a problem
swallowing. You just have to understand that she’s like a child during
mealtimes. She doesn’t focus and she’s easily distracted. You have to keep her
focused on eating.”
“Perhaps putting her on a
mechanical soft diet would help,” she went on.
“We’ve tried before and she hated
the food. ‘That looks like shit,’ she’d
say. But I guess we can try again, though.”
I agreed to it, but then the next
day called the speech therapist back and changed my mind. I just knew she
wasn’t going to eat her food that way and I didn’t want to put her through that
again.
I decided instead, I would try to
spend more meal times with Gram and bring her food that I thought she might like.
Historically, I hadn’t visited much at mealtimes unless we were having a family
gathering. When it was just the two of us, I was a distraction. Gram would
constantly try to give me her food instead of eating it. “Here, it’s yours,”
she’d say as she tried to hand things to me from her tray. “No, that’s for you.
Go ahead, eat it,“ I’d urge.
In August, I got another call. This
time it was a nurse. She said Gram lost 5 pounds in the last month. She wasn’t
necessarily asking for action or making suggestions, she was just expressing
concern. I had to step up my efforts. Gram was always trying to “fatten up” other
people. Now it was my turn to fatten her up.
Around that time, I had read an
article regarding Alzheimer’s patients and their eating issues. The author suggested
minimizing the number of things on the patient’s food tray. The author went on
to suggest that too many items can be overwhelming for the patient. They don’t
know where to begin. Minimizing the number of items helps them focus. The
article was timely and made sense to me. It was certainly true for Gram. When
she would get her tray, she was immediately interested in all of the things on
it – the carton of chocolate milk, the soup, the pudding, and the coffee, etc.
“What’s this?” She’d say as she picked up each item and held it in front of her
or tried to hand it to me.
I tried this approach during the recent
visits at mealtime. First, I removed everything from her tray but the main
course. I helped her focus on that. Once she was finished with the main course,
I would remove it and bring forth the next item. It seemed to work, but I only
had a few tries at it before she just didn’t want to eat at all anymore.
I started bringing milkshakes and
burgers or fish sandwiches and french fries from McDonald’s, too. At first,
she’d eat most of the burger or sandwich and some of the fries, but soon, it
was only a few bites, then eventually, none. She’d still drink the milkshake
though and I was happy to get at least those 670 calories into her.
I began to add things to the
milkshakes as she drank them down. I added chocolate milk at first, and then I
began using nutrition drinks. Each of these had 325 calories. Sometimes I could
get her to drink all of it - the milkshake and
the nutrition drink. It was close to 1000 calories. That made me happy. And
when she seemed disinterested in drinking any more, I’d wheel her around the floor.
Having the drink in her hands and being distracted while I wheeled her, she
would inadvertently drink it down.
Over the weeks since the calls from
the speech therapist and the nurse, Gram’s appetite waned as did her strength. On
some level I knew what was happening, but I was denying it. She had gone
through periods before of not eating and she always regained her appetite.
After all, she was on hospice twice and discharged!
I was hoping my attempt at the
extra calories was helping, but Gram continued to lose weight. On October 5,
during my visit, I asked the nurse, Rachel, to check to see when she was last
weighed. It was the day before. She was 105 pounds. I asked about her weight history. She was 117
on July 23 and just as early as a week ago, she was 107. She had lost 2 pounds
in the last week. It seemed my efforts were not working.
“Maybe I should engage hospice,” I
said to Rachel.
“Do you want me to call them?” She
asked?
“How about having the doctor see
her first?” I replied.
She submitted the request.
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