Hot water bottle - 2023 12 08

There is no protocol in place that is activated when a family member says, "We are going to bring our frail elder home because they can't fend for themself anymore and we don't want them to go into an institution." 

A couple of mornings ago I noticed a large swelling and open wound on Mom's left ankle.

There is no preparation for the scope of work the family is undertaking. Often this is the first time the family has taken on the role of primary caregiver and the responsibility of providing geriatric caregiving infrastructure.

What could it be? Was it the cancer we had treated last spring re-emerging in a new place? Was it a bed sore? Was the hot water bottle too hot and burned the skin?

There are no predictions for the timespan for the mission of providing family-based caregiving infrastructure. The mission is to provide for the needs of our frail elder until their life comes to an end. The final milestone in the family caregiving mission is death of their loved one.

Mom couldn't feel anything - there was no pain even though her ankle was swollen. Like a basketball player injury when they land on the outside of their foot. I booked a video call with Mom's doctor so we could figure out what to do. In the meantime I treated the wound in accordance with bed sore protocol - iodine, clean gauze, minimum tape, a sock to keep it all in place.

There are no systems or structures in place to prepare the caregiving family for the financial costs of providing family caregiving infrastructure. There is no accounting for the cost of property, utilities, housekeeping, maintenance, improvements, nursing, meal preparation, transportation, administration, leadership, and management of the caregiving resource. There is no costing or accountability for lost wages as the primary family caregiver finds it impossible to maintain outside commitments to paid work.

Later in the day, when Mom could leave the wound open to the air, I started slicing fresh pieces of aloe vera off my plant and applying that to the open wound. Over the course of the day the wound started to dry out and look a lot better. 

There is no preparation for human resource assignments: providing 24/7 caregiving service, social engagement, physical therapy, occupational therapy, shopping, cooking, cleaning, driving, making appointments, etc.

At 4:30 pm in the afternoon we were able to have our consult with the doctor. He didn't think it was a bedsore because of the way it appeared overnight. He re-assured me that it wasn't cancer re-surfacing. He determined that it was caused by Mom knocking it on the bed frame or some other hard object. He commended my nursing treatment and we discussed what to look for in case of infection.

There is no training for communication management. In particular, there is no preparation for new levels and intensity of inter-family communication. Family members are put in new positions and relationships with their frail elder and the primary family caregivers. These relationships may have a history of disengagement or avoidance. There may be current behavioural or psychological issues that need to be managed through highly-skilled communication management.

All through the day and into the call with the doctor I had compartmentalized the thought that maybe Mom's ankle had been burned because I filled her hot water bottle too hot and her ankle resting on it was enough to cause this much damage. As I was wrapping up the call with the doctor, he paused and said, "I want to re-assure you that this injury was not caused by the hot water bottle. It does not look like a burn injury." In that moment I felt all this tension and anguish drain out of my body. A lightness of spirit flooded in. "Thank you, Doctor, for telling me that. I needed to hear that."

Family caregivers take on an extremely difficult mission and they do it because that is the next right thing to do. We need to do a better job of preparing ourselves, and each other, for the risks and rewards of this undertaking.

Later that evening, as I recounted the day's events with my husband, tears of pain, shame, guilt and grief came to the surface at the thought that I might have burned my Mom. That something as innocent as a hot water bottle to warm her feet as she goes to sleep at night could cause this much damage. And I was the instrument of that damage. I was grateful to the doctor for taking the time and having the presence of mind to remove all that from my consciousness. I didn't realize the toll it was taking until the moment he said, "It was not the hot water bottle."