Wounds and Sores No Regulations Federal or States

Mom suffered many wounds and sores in her facility from abrasions to openings large enough to require stitches. 

They were overlooked, mismanaged and caused many additional medical costs, pain and suffering.  

Mom had inadequate monitoring of medications -- A MAJOR PROBLEM IN LONG TERM CARE FACILITIES WHERE DOCTORS ARE "ON STAFF".

Computer programs are often old versions that do not  provide anything more than basic "accounting" of medications administered.

These "recordings" are often done by staff who move from one to another and then "enter" the distribution after administering to several patients -- often questionable as to time administered, dosage, etc. 

Recordings of services provided are often not entered until the "provider" can find the time between being called to one and then another and another and only being the single staff person available or perhaps one of two to serve as many as 20 individuals needing assistance and all in varying stages of capability and need for personal assistance.

Doctors are admitted to practicing at the facility and as such are "employed" by the facility and subject to release by the facility. 

While many will tell you is difficult to find Doctors willing to go into a facility, I believe if an accurate invesitigation was done of the number of "patients" seen by a Doctor during one visit to a facility of one hour was recorded we would find less than 5 minutes was spent with each one

I've observed Doctors moving from person to person, in an open environment of a general gathering place like the hall, or an area where food was served or patients were "parked" for hours on end. No gloves, no change of gloves, no washing or sanitizing of hands.

Not only does this violate a person's right to HIPPA privacy it also violates their right to dignity, self determination and privacy as I've witnessed Dr's using stethascopes under garments they lift or lower and other examination procedures in full view of residents, staff and visitors.

AND WE WONDER WHY DISEASES SPREAD SO RAPIDLY WITHIN LONG TERM CARE FACILITIES?

QUESTION:  If this is done in sight of a "visitor"? What might be done when one is not present?

Today, reading more Rules and Regulations for the State of Missouri and reviewing sites giving advice on preparing for the “annual” visit by the Department of Health and Senior Services reviewing Long Term Care Facilities,I was shocked to read the following:

“Neither state nor federal regulations require a facility to keep/provide a report” on pressure sores/wounds.

Here’s our personal list of a few wounds and sores that we believe warrant specific reports generated with or without attention by a Doctor or by an outside Medical Facility:

Mom fell, she suffered a “wound”, a cut; facility looked at it and determined no problem; we took her to the ER and the Dr on duty assessed a need for 5 staples. There was no entry in her record about this “wound” from the fall.

Mom was subjected to having a rough towel used to remove hardened fecal material on her anal area with a rough, scrubbing procedure. This caused bleeding of the Hemhorroids and sores on the exterior part of her anal area. Her screams could be heard all across the floor; I know, I was there.

We noticed small sores on her legs caused by flaking of skin and rubbing of her legs against something. We were told there were no “sores”. Taking Mom to a wound specialist who’d seen her before she was given specific medication for infection and specific instructions for wound care – which was not followed by the facility.

Mom had pressure sores from sitting in a wheelchair for long periods of time; she had pressure sores from not being moved and staying in one position for long periods of time.

Time has passed. Mom passed in 2014. Procedures have not changed. When are we going to speak up about this abuse of our least capable population of human beings? 

Our mothers and fathers, sisters and brothers, relatives, friends and even people we've never met are being treated as though they were less than human and even lower than some animals we keep in captivity or in shelters.

Look Before You Leap: Visit, Shop Around Long Term Care

Even if you have no intention of "going into" a Long Term Care Facility.....SHOP AROUND AS THOUGH YOU NEEDED IT NOW.... or someone you care about is already in imminent need.

Why?  Simple.  We shop for everything else in life but almost all of us don't think we "need" to shop for something we "don't need at the moment". 

How many college visits did you make with your kids? How many people did you date before deciding this was "the one"? Belong to an organization, a club or even making a choice where to eat or meet -- most of us put more into those choices than we do "a place to live" when living means more extensive medical care and supervision.

You need to visit more than once and walk the facility, all areas, check out the on line information from the DHSS including Annual Reports. 

Know where you/your loved one wants to go if it's the choice that needs to be made. IF YOU DON'T, you'll settle for someone telling you where to go and what's available and won't have any ability to choose, you'll just have to "go" where you're told "has space".

Google/Search the web for comments from people who have loved ones there and you won't always find it where you think it will be.  Look for Blogs about families with loved ones in LTC, Assisted Living or Independent Living. 

Visit every facility within a twenty five mile radius of where you want to reside or place a loved one.

Why that distance? Easier to get to for you in times of need and just to visit more frequently because it's closer.

Do not eliminate any facility because it appears to be high priced or very inexpensive. 

You'll get ideas and see the possibilities to look for at those that are in your budget or category of care range.

Just as you'd shop for a home or apartment -- make a list of what inclusions and features you want to have.

Is there an outside area that residents can use BY THEMSELVES and without having to be "admitted". 

Even if they have mental challenges or wander, an enclosed patio with sturdy chairs, of adequate height and with arms for pushing the body up and easing down, are important.

Put yourself in "their" place. 

Have them use their cane or walker and walk with you from point to point to see their abilities and challenges.

Remember! Their movement will usually become less and less and they will probably advance to other forms of self movement that are more limiting as time passes.

Get into a wheelchair and see from their perspective how far it actually is to get to the dining room, the main area where family and friends visit and even from one room to another on a floor to visit a new "friend". 

Attend a meeting of the Resident Council and the Family Council. They are two separate organizations.

These should be open to the general public although membership is generally exclusive to residents in the one and to family members/friends of residents, in the other.

Talk with residents about what they did today, yesterday and even a few days ago.  

What does the facility do to transport residents to outside activities and for excursions (shopping, etc)?  
Who goes? How are they selected? What's the cost?

Walk with your nose leading the way. 
If there's a smell of urine or other waste products, human or food or whatever, it's not "natural" and "to be expected. 

It's a housekeeping necessity and if this isn't taken care of, what else that might cause infections and other medical problems could there be?

What do you need to ensure you're given immediate access to records (if you have Power of Attorney; and if you don't, someone definitely needs this and Medical Power of Attorney).

Most people spend as little time as possible seeing these as the last place they ever want to live. I understand. Mom always told me that. If  you've read our story, you know Mom was manipulated and controlled by someone using Undue Influence at a time when her Lewy Body Dementia was starting to become more and more extensive and she was "mallable". 

Your life is busy. You don't need one more thing to do. I get it. 

It's your life. It's your choice.....or it should be.

Learning From My Cat's Dementia

Caregivers can learn a lot from their aging pets as they move towards their end of days. 

This entry was started in late 2013, Mom and our cat were both approaching their "end of days". We saw obvious signs in our cat's behaviours and her obvious changes; with Mom, we saw changes and felt her time with us was growing less and less.

OBSERVATIONS:  Cat has lost a great deal of weight and has gone from being "choosy" regarding what she eats to also including where she eats what she chooses to eat.

For humans, one of the "signs" of "end of life" in the elderly is their "choosing" to eat less and less and then refusing food.

Various studies have concluded that medications can change the way we humans smell and taste; medications that affect the body and the brain. 

Perhaps we're not seeing the correlation between the brain that's being affected by disease and the medications elderly people are often given for a myriad of reasons -- including "mood" improvement, especially in Long Term Care Facilities.

Cat is not on any meds but notice she tries to smell more what she eats and may turn away even when given various choices: canned food, fresh food, it doesn't matter.

Our senses are important from birth onward. The newborn "roots" and uses the sense of smell to locate food and to recognize caregivers.

Watching our cat and Mom, I see these "basic instincts" becoming more important as the brain seems not to process everyday common activities as it once did.

Cat's ability to chew also seems to be affected and she's been surviving on the "gravy" we've found in some canned food and the "liquids" we produce from cooking fish or chicken along with a very small amount of the actual solid materials.

Taste for one type of food may produce eating and then again it might cause her to turn away. Is it the sense of smell or taste or both?

In Long Term Care facilities, Dental Hygiene is often non existent or at such a low level as to cause complications never experienced before by the individual while living with family members or on their own.

THRUSH -- take a look at this report by government resources

WONDERING.  Why facilities don't have more food choices they offer and keep track of what items seem to be more "accepted" by residents on an individual basis? 

Why aren't LTC's trying like I am for my cat and did for my children and my Mom when she lived with us, to watch closely their Nutrition and ensure they received the necessary amount of nourishment to promote health and well being?

Reality Check:  Staff that's hired from a service, constant turnover, two few staff for number of residents -- problems are rampant but it takes highly observant family members to eliminate this chronic problem.

INTERESTING COMMENT:  I was once told Mom lived as long as she did because she was a "determined person". Guess what we provided for almost forty years for her mental and physical well being including healthcare that intervened when necessary and didn't wait until the complications (like so many of her Urinary Track Infections at the facilities causing severe challenges) didn't have any positive effect?

And, it was our constant vigilance and action while she lived in the Long Term Care Facilities that added to her life despite the lack of facility oversight and care.

In the facility Mom was in for the last two years, the access to recording information concerning residents appeared to be limited to wall mounted units in the hallways and those appeared to be used by Aides to record what they did. 

The Aide, who moved from one to another to another, had to make/take the time to record after performing a service and she/he could often be seen making notes on more than one resident at a time. THAT'S DANGEROUS.

The Nurses (LPN's) used laptop computers at the "main desk" or at "medication stands located near the main desk" where they pulled up information on individual residents OR they wrote on pieces of paper that then had to be filed and, of course, couldn't really be accessed and referred to easily AND each person's hand writing or printing might be very difficult to interpret. 

ANOTHER OBSERVATION:  Cat eats in different areas and what she refuses in one, she may accept in another. Facilities, at least Mom's did, often move residents from a "main dining area" where they've eaten for a long time to a "special dining area" but there is often one person to feed three people at one time or two will sit waiting for as long as it takes to feed the one before "getting their turn". BY THAT TIME, MANY REFUSE, HAVE FALLEN ASLEEP OR ARE DISINTERESTED.  

Cat likes to be near me and will accept some foods when they're placed near my chair as I work on the computer or even "in bed" in a box she's chosen to lay in near the back door where the Sun warms her very lightweight body. In Mom's facility, residents "share" tables but there's no "moderator", no "promoter" sharing time and place with them who has been trained to lead conversation, share current affairs or involve residents in "the real world" and keep their minds active and involved.

Cat has always been small; she was the littlest in the litter we were told; but she was active and quick and very agile before her Dementia really took effect -- a lot like Mom's abilities to move, be active and accomplish tasks.

Cat reminds me, as Mom did, of a regression physically backwards in time to being a small kitten/child. Animals, however, are born being more capable of moving and fending for themselves while humans go through many stages of being totally dependable to developing skillsets and abilities.

Overheard a woman visiting her husband saying to the receptionist how THEY'RE going to have to give him something because he's just so unpredictable and she can't stand to visit him when he's one way one minute and another the next.

HOW SELF CENTERED WE BECOME, THOSE OF US WHO CAN WALK AWAY AND WHO CAN MEASURE "OUR" TIME AND OUR LIVES as needing not to be "disturbed" by another's needs and wants expressed in a way we do not feel is "acceptable" to us. 

I can only wonder what kind of relationship, what type of marriage these two had. Maybe she's "making up for" the poor ways she was treated; maybe she was always the one who did't listen, wouldn't listen.

LONG TERM CARE needs to focus on all three words, ephasising the CARE. Too few provide real compassion and concern. Too many walk away or simply find other things to do rather than watch, listen and provide caregiving.

Choice Is A Privilege

Some words and phrases have lives of their own.

"It's a choice. You make (have ) the choice." 

Two sentences. Very few words. 

A single word, "choice", that changes dramatically when the words "you make" or "you have" precede it.

Simple word "choice" and no real negativity implied .... until you're placed in a life situation where the "circumstances" surrounding and possibly implementing this word can hurt, harm or even destroy life as you know it.

Unbelievably powerful statement especially when "choice" is not between "which choice to make" but "if", "what" and "when" a "choice" is made.

There can be deep and life affecting interpretation based on who you are, where you live, how you live and what you interpret these statements to mean.  

In this case, the words keep resounding in my mind as I move through life and am faced with decisions, many of them until very recently, considered to be not capable of considering let alone having to decide between or among.

Life has changed. The resounding and ringing in my ears applies to today and often interupts my forward movement as it conjers up the harsh and destructive spoken and written words by some for the "choices" we were making and made.

A heavy burden I try to lay down, try to set aside and sometimes succeed. It remains, however, and is taken on sometimes unknowingly and sometimes undesired through words and actions about "choices" then and now.

The person making the statement has known a life of privilege from birth through adulthood.They deserve what they have and work hard to get and keep it.

The person, me, this was said to, also was privileged for several years, but tried to teach the lesson of walking in another's shoes before determining how they should walk. 

I knew personal sacrifice; making decisions when the "choices" were not what was wanted. I had good training. I know I passed that along to my youngest as we walked the path together and made the sacrifices together through the choices we made.

We grow accustomed to privilege. 

We grow accustomed to any move beyond where we've been. 

It's the coming down, let alone the crashing, that few understand.

It's the not seeing that for some, life doesn't  provide opportunities, possibilities and the doors opening without challenges and consequences.

Or, that life interupts, interferes or just simply doesn't move past where we think we want to be, want to go or want to do.

Does this person have major life challenges? Quite a few.

What they've not had is everything or almost everything removed, taken away or needed to provide for those they love and not able to replace or even substitute. 

Major life interruptions; major life changes remove the "choice" from the "change".

Moving up and down the scale of "privilege" isn't always a choice. Sometimes the ascent or descent is more of a spinning than a climb and sometimes the inability to fully control movement isn't within your scope of ability or action.

Sometimes it's life's way of providing situations to learn and then to teach; to experience and to remember and reflect clearer than we could have without that first hand personal involvement.

For the two of us, we move forward ever learning from the past and the present..

The medical challenges, the harm done by others who found fault and the losses daily and cumulative, continue to be turning points in lives we live daily and have turned adversity into positive focuses.

Your life is and will be beyond the boundaries of the daily challenges and inability to see an end or even remember fully where the beginning actually was.

From your unique experiences you will find ways to beneift yourself and others.

You retain what others can not understand -- personal life changing experiences from a vantage point that cannot be bought or sold, cannot be moved into and out of just by getting up, moving away and on with your life. 

All I ask now is what I asked then....do not see my life or other's from your point of view. You have choices with few limitations or at least you have choices. 

I and others who have walked this path know life isn't about choices, it's about how you look at, how you handle life and what you do, as always, for others and for yourself that are the true Privileges and Choices in life.

Older. Wiser? Weaker? Stronger!

When the year began it was as though I'd turned a corner and found myself walking along a different street, on a different path.

I knew this year would come, was coming. I felt I would see it, feel it, touch it and even smell all the fragrances of life -- sweet, sour, mellow, bright. 

Like light and shadow; movement and stillness. Life and the living. Death and the dying.

Each month that passes the time grows closer. What will it really be like? Hitting that mark. Being at that exact point in time? Will I weep? Will I laugh? How will I meet this inevitable part of my journey?

Before January 2011 I would have sang a song of happiness and anticipation. Thinking back and looking forward. Dreaming dreams and making plans. 

Life had been good, for the most part. 
     Tomorrow would be better.

Decay and germination. Related opposites.

One feeds the other, one rises from another.

It's May. Almost through the month. Mother's Day wasn't as challenging as it has been although Mom was in my thoughts. 

We went to her old facility, visited a woman we've befriended and so many others who sit, wait and are in line for their final journey. 

Each had gone their own way and now come together. 
         One by one they come; one by one they go.

Sometimes I wonder where the time HAS gone. January 2011. Seven years. SEVEN YEARS. How can that be?

Looking forward we couldn't see seven days and now it's been seven years -- moving towards eight.

Four years. 

        Years within years. 

                  Tears not forthcoming then flowing nonstop.

Weight carried in our hearts, in our minds and occupying every fiber of our being.

Admittedly the load has shifted.     It's compressed a little. 

The distribution is a little easier to carry  and we make the load lighter for one another as we carry it together moving forward, day by day.

In May so many years ago there was such great anticipation. I was graduating from College. We were engaged since March. We were going to be married in October.

I would leave the only "home" I knew, the one with my mother, my amazing and always, always there for me, mother.

Plans for "the wedding" helped to set aside my angst. After all, that's WHAT WE DID.  We "left our parent(s)" and made our way in the world with someone else beside us.

And so we did. For three years. Then we became reunited.                                       We added our first child. 
            We added my mother to our family.

Raised in love you give with an open heart. There are no questions about "what if", there is understanding you will go through and beyond whatever. 

And so we did. Almost four decades together.

Today we ridicule and taunt many who chose multigenerational living. 

Sitcoms thrive on these  "dysfunctional relationships"

Sadly they do not see the truth because to see would be to miss, to be without, to not have and to have given up.

We grow older. 
      We hope to grow wiser.

We sometimes become weaker.
      We learn how to grow stronger.

Paper Trails A Must In Long Term Care Facilities

Paper trails are a must as your loved one progresses to need more care, more time and "costs" the facility more money. 

Without your tracking the challenges you've seen first hand or become aware of through a visit, your concerns and complaints become a lost cause to try to remedy when the State comes calling, as they do, for either a regular visit or for a special investigation.

Aides are the lifeline and the heartbeat of Long Term Care Facilities. 

They are the 24 hour people responding to the call, the buzzer, the needs and wants of the residents. And, they see, hear and touch residents having the most frequent contact and the most active physical, emotional and psychological contact.

Yet they are the most under-trained and seldom given first hand, from the best source (especially any from outside a facility), direct experience training.

Aides usually get "retrained" after an "incident" that has involved a resident and caused some form of need to acknowledge a problem. 

Think you're protected? A Federal program. The Ombudsmen (actually men and women).

In our area this Federally Mandated service is now called "VOYCE" so check closely to find your "version" of "Ombudsmen".

Then look closely. You'll probably find variations on a theme. The theme? Must be invited in. Aren't there to really meet with, work with. Usually only able to spend a few hours in the whole facility. Let's see -- a few hundred people -- how many do you think they really "get in  contact with"?

In many, they're not the advocates they're supposed to be. They're "mediators" only activated and coming into the facility when a phone call or email activates a "need to respond" and even then, it may be only a phone call to "check it out" and not a "real personal visit".

CNA's have the ability to see actions on the part of the resident that could lead to more serious challenges, that is if they are encouraged to spend time with the resident and observed and their input is valued and not dismissed or told "that's the LPN or RN's job".

EVERY PERSON IN THE LIFE  OF AN OLDER AMERICAN WHO LIVES WITH, PROVIDES FOR OR COMES IN CONTACT WITH is an important link in the chain of ensuring Seniors have quality of life.

Most facilities are understaffed with CNA's, sometimes as in Mom's old facility with one CNA for a whole half floor, numbering between 15 and twenty people, and one LPN per wing/half floor -- or in some cases for the entire floor.

State Regulations should be based on the needs of the patients and also on the concept one person (Aide) cannot be in two places at the same time; it's like two kids who want something at the same time or who NEED something at the same time and a parent can't be in two places at once.

Taking this concept a step further: think of it this way -- one parent, one child versus one parent five children. Now, have them all be "sick" at the same time although the levels of "need" from providing medication to changing bedclothing or clothes varies. Could you predict when the one parent will begin to "lose it" and or not give the right service at the right time?

That's exactly how our LTC's shouldn't operate but they do. Faced with mounting bills and reduced compensation, they struggle to keep staff and usually face cuts all around -- staffing, services, food, etc.

Ever notice when you visit how early the residents "go to bed"?  

Do you really think it's their choice? 

Ever notice how "sound asleep" they are?  

Did you know they're probably "knocked out" for the night? 

Doctors associated with Long Term Care Facilities are "selected" by the facility, are "allowed in" by the facility. So who do you think they work for? The patient? 

Did you know, at least in the State of Missouri, as I discovered yesterday in my readings of State Rules and Regs that the Facility Doctor in charge can actually "override" and "add" to the PNR's given to patients and among these, of course, can be meds to allow "rest" for the patients who seem to be causing "disturbance's" with their ability to roam, call out or in other ways "disturb" other residents and staff. 

IS THIS WHAT YOU WANT FOR YOUR LOVED ONES?  

HOW ABOUT FOR YOURSELF IF YOU BECOME ONE OF THE MANY FACING BEING "INSTITUTIONALIZED"?

Keep a "Visitation Diary" noting the date, the time arrived and specific notes.

OBSERVE  and check out drawers, closet, medicine cabinet, bathroom, bed.

Where is the call button when you arrive? Within reach? Or pulled out of the connection?

Take off your shoes and walk across the floor. Is it dusty, dirty or slick? 

Any visible black and blue marks? Ask to see the record and when it/they were noticed and what was cited as "the cause".

Check out medical records if you have the Medical Power of Attorney. What meds are give regularly and MORE IMPORTANTLY, ask for a list of all "as needed" drugs still on the record.

WANT TO REALLY ENSURE YOUR LOVED ONE'S SAFETY AND WELL BEING?  

Ensure someone has a Medical Power of Attorney and hopefully you have a family unit that works together so that all members observe, notate and share with other "care givers" what they've observed and heard.

Ask yourself.....as a parent did you use a "nanny cam"? Did you question the children about their "sitter"? Did you interview others who used the caregiving services?

Why do we "turn over" complete care to people who are paid based on the amount of services rendered?

Why do we "assume" our loved one is well taken care of and the facility only has their "best interests" in mind?

Many do. Many don't.

Life Melodies Change Only In Tempo

My sons are moving along a similar path of life even though they'd probably dispute their lives were so much like ours.

They compare, compete and go out to ensure the family unit not only survives but thrives.

Their wives handle the homefront and participate in the business world while working hard and each of them have to work to find a small slice of life to set aside for themselves. 

Where are they all running so hard to reach? What's their destination and when do they plan to "arrive"? 

The women no longer have the choices they had in their early twenties when their worlds were so open, so many possibilities and so many decisions. 

They conform to the mold of being part of a family; wife and mother head their list of responsibilities just as they did for me.

The men have "settled in" to being the "bread winner". The oldest is home, as he says, every night and the younger often finds himself travelling the world.

Both have adapted and adopted and created "the life" they want, they value and they recognize as being "in the best interests" of their family and its members.

Neither lifestyle is right and neither is wrong.

We gave them skillsets they've carried and neither truly recognizes as being "life and living" through our practices and beliefs.

Interestingly neither really fully recognizes the real gifts we gave them. Perhaps like so many others, they'll recognize them when we're both gone and just a memory, fading with each passing day.

Those who see, those who understand and those who verbally recognize often and sincerely, the struggles, the challenges, the focuses and the benefits a family dedicated to one another, all stages and ages of life, all ends of the cord of life stretched to include other family and friends, theirs is a life of true value.

We set the pace of the race and the boys and daughter are taking the hand off and entering the field moving forward, upward and onward as their lives pass through years and decades where they too wonder how quickly time passes.

The song is the same while the meter and the measure often vary.  

We sing the song of life through generations.

Hide! Close Your Eyes & No One Can See

How To Win A Disagreement when you're on the wrong side of the truth:

• Throw distractions in comments and remarks mentioning life occurrences so far in the past it takes time to bring them forward into the "thinking" part of the brain
• Hurl insults that aren't accurate and use language that blames, insults and includes numerous accusations
• Explode your power through cc's and direct sends of email messages altering and leaving out "segments"  & "sections" to anyone you can think of
• Involve everyone even if it causes pain or doesn't affect them directly
• It's your job to ensure confusion and promote negativity 

"Kids say the darndest things' is a quote from a talk show host who had a fun part of his show "interviewing" very young school age children who sat on chairs on the stage of his TV program in the earlier days of television.

Art Linkletter, Host of the show, moved beside each one with a microphone (a necessity back then) and asked each a question. He listened and watched. 

He often knew just the remark that might get a really interesting answer -- one the audience would laugh about but sometimes the parents would cringe and possibly "lecture" their child once home.

My oldest son takes a twist on this "funny" approach to communication. 

He uses "loaded language" to ensure conflict and continuing discord.

Unlike Mr Linkletter, my son isn't "putting on a show" but he is using children to get a response from his audience and in some ways they're both guilty of taking innocence and using it as a tool to get notoriety and recognition. 

Enter my oldest son. The subject of this blog entry. 

Bright. Capable. Not to say the others weren't, he was just "the first" and therefore almost always "led the way" for the others in terms of what was offered, what was given and what was done.

Eduation: Early start. Toddler. As soon as he was "toilet trained" which was 18 months. He walked at 8 months. Yes, walked, not tried, not stood -- walking....and almost running.

Sports: What's your interest? What would you like to try? 

He named it, we provided it. And, of course for the other two as well. 

We were "those" parents of the 70's and onward; there with the hand and the wallet outstretched.  

We were children of the Post War era; parents who'd lived through the Depression; many started the movement to the suburbs; all wanted a better life for their children.

What do you want?  What do you need? When do you need it? How high do you want me to jump and how many times and how far do you want me to bend over backwards?

We'll go out and get all the equipment tonight after my challenging day working, we'll write a check for the membership/dues/donation -- whatever it takes, son, after all, we do it "for you".

Interested in computers? Science? Drama? Whatever! Here for you. 

Two jobs at once I'm trying to work. 

Your brother has similar wants and needs but I'll find the time, why, I'll "make" the time -- for you, for him. 

Enter a little baby sister. MUCH older Mom and Dad. College? Right! Take your pick. We can't afford some but we'll find a way to get you THE BEST. We'll take on debt and years later.....you'll say you paid your entire way through.

REALLY?

We have the bills. When you came home to "reorganize" your way of thinking and applying yourself at college at their request and returned, we took up the slack and the additional cost of your "lost" benefits because of poor grades. But you don't seem to remember that, my son.

We gave you a monthly stipend. You "needed" furnishings for your room. We bought them. Clothing? Got it. Want to "build" a special loft for your room. Consider it done. We're in town, we buy it, rent a truck to cart the materials and, when Summer roles around, we pay for the storage of that and other "college items" until you head back for another year of "fun" and "games" and some studying.

You need a car at school? Well, it would be less expensive than flying you home for breaks. Here, son, take mine. I'll use the old car a family member has; it's not as reliable but I'll make do.

You drove where? What? Why? A little "romantic getaway" and you visited a cousin but no one ever told us about your "travels". How thoughtful of them. How deceitful of you. And that was only one time you "used" your privilege for self gain, no thought for or about others and certainly no respect for the sacrifices of your family.

That car was supposed to be given to your brother, attending the same college, had two more years to go. But that didn't matter to you, the golden boy, the always being given what was meant to lead to a dream future but ended up building a multi level nightmare for your immediate family.

FAST FORWARD. More than a decade has passed. Ups and downs. A marriage we did not attend because there was no regret, no feeling of shame about striking me down, causing teeth to be broken and others to be cracked (years of putting off dental work and then being told by son, "you should have gotten that done years ago" as we struggled to cope financially, physically and emotionally after using everything we had to care give for two immediate family members. 

Thanks, son, for loading on the guilt when it was already piled high by circumstance.

Something always setting you off. Then came the "taking home your toys so we couldn't play anymore" action.  That was actually your removing any and all contact with the children you began to have. Started with the first. Went on for a while. We came back together, not close, but communicating and meeting in your brother's home when we visited.

This is the third time, if I recall correctly. This time it's been almost three years. Let's see, five children now -- don't know the name of the fifth, we weren't told you were "expecting" or when the baby was born, if it was a boy or girl (a boy), a name or anything. This time the split was over your father and my gravesite. The one you manipulated into controlling completely and solely the erection of a monument and internment.

I wrote you I could't find the grave and how a marker really needed to be put up.

You responded, "If you want it so bad, do it yourself".

What a tribute to your father.

What a lie you tell about what you do.

Your brother says we can't get along because we're alike.

You're not like me, I'm not like you You are, my son, like your grandfather. You are self centered. You are focused on what you need, not helping family, not seeing needs, not caring.

Your brother is right. I never understood my father and his self centered actions and I never will understand yours.

How sad you choose a woman who supports your actions,  perhaps encourages them. She gains, after all, more power over you. That's hard to write. Sad to write. 

I read letters you sent to us before you "hooked up" with her. Between the lines I see you were "ripe" to be picked up by someone who would accompany you on paths away from and towards what she wanted, what she needed.

I've often wondered. Wondered about her brother, who died of an overdose. Who had a mother who was an RN. 

I admit I did not see what you were doing and had done but I cannot understand how a mother with a Nursing degree cannot see someone on drugs. Or, did she try and fail. As I did with you?

Finding letters you wrote. Before she came into your life.

They weren't angry. They weren't hostile. They included some choices I see now as detrimental but saw then as "typical college student" and "typical first born".

Close your eyes. You can't see. You can be seen. You believe you cannot. When will you learn. When will you see.When will you know the future depends on the past

Like your grandmother, you believe you can change someone. You cannot.

I commend you for your devotion to your children. It's sad you do not realize that in turning away from those who have been there for you, cared about you, are being shoved aside to ensure you have no support, no one on "your side".

I wish it hadn't happened. I wish you'd heard our concern, your father's, your grandmother's and mine.

Time will pass. You have choices. When will you see truth and accept it?

Criticism, Critical Care, Critique

Looking back the words still sting.

Emails filled with vicious accusations of incompetence.

False accusations, wild misstatements. 

How could someone who lived in the same house as two other children at the same time believe their life was so completely different especially when that life parallelled a brother's almost completely?

At the time I was barely coping. With two family members, husband and mother, both facing their life challenges, differently but similarly. 

He losing his physical abilities and she losing her mental abilities while going through continuing physical challenges and losses as well.

Where was the "coming alongside"? One visit during the 100 days almost constantly in Critical Intensive Care for his father?

I understand. He was working. He didn't have the advantage his brother had of travelling for business and being able to "swing through" with quite a bit of planning.

Phone calls?  They were to question, to accuse, to find fault and to let me know no matter what I did it was never enough, never the right way and always, always, in some way negatively affected him and his life.

That last phone call he had with his father. I walked in as it had ended. I watched my husband begin to sob and shake. He went from this to uncontrollable shaking and needing a Nurse to find blankets and administer meds.

He cried after ending the conversation when I walked in. I can't remember seeing my husband cry. I'm sure he did when his father passed as they were close and for his mother but not in this way. He seemed to be torn inside out.

My husband knew this son had ripped me apart on the phone and in emails. Even when I didn't share what was said, when he had bad days or when I thought it wasn't good to "update" him on all the verbal attacks the son had made on me and in so doing on him. We were abusers this son said. 

Today I know it could have been different. We'd called this son after talking with the other and finding he could not help but his words were gentle, kind and wishing he could. We were going through every penny we had. Poor planning the oldest son said. We should have and could have done better all the years before, we were told. 

Didn't matter through it all we ensured he, his brother and his sister and for a while a child we took in, husband's brother's son's child, was provided with food, clothing and education and more.

Didn't matter we survived at least once each decade odds that put others in far worse circumstances:  his birth and necessity of medical care far beyond the insurance we had; his brother's birth and complications from a milk allergy; his sister's birth and taking in an extra person while helping with two college tuitions and so many additional costs; a fire and loss of seven years of what we'd accumulated; loss of a job and months trying to find another; economic losses from moving to another location in times when company's didn't cover the cost.

A long story. A life story. Always focused on family. Always focused on the son and the others but him first as the oldest. He set the way, we did not want to play favorites. 

It's interesting now. He's shut us out. The two of us who remain of three of his immediate family. It's not the first time. He's played this "joker" of a card at least twice before or is it three times -- going through as much as we have I've lost count.

I can't be around his children. I'm the problem. His sister chooses not to be around him. She's not a child. She's an adult who's endured many of his abuses and wants no more.

I understand. This son once asked me since I'd said long ago how when he was born he "looked like" his Grandfather, my father, "how" he resembled his Grandfather now. 

At birth this first born was bald and blue eyed -- just like my father. And I'd told him that several years ago. It's typical after birth to compare physical attributes to one or another family member and he was my "first" so that physical comparison was expected. Plus, my father passed.

Cancer of the lung, too many years of smoking and too much drinking, when I was in my first year of college. Even with the life we had together and what we went through apart, I still loved him and watching my mother cry after years of being divorced, when she was told of his death, I knew she did, too.

So many times I told him he wasn't like his Grandfather, my father, as my Dad was an abuser. An alcoholic. He couldn't stop. Once in a great while he'd try but he always returned.

"Don't reach in that trash can, little darlin" he'd say to me. "Dad's thrown away a razor blade and I don't want you to get cut."  

Now, I didn't usually reach into trash cans around the house but I knew, even at less than nine years old this meant he'd thrown away another empty bottle of Hill & Hill, his whiskey of choice, cheap but able to give him the "escape" he needed.

No, my son, even when you went through your phase of underage drinking and the other questionable actions you took, I never compared you to him, I never believed you were "like him".

You see, as I've told you, my first born and my oldest son, I did what I did for you because I'd been told my father probably did what he did because he had no advantages in life. 

Dad was intelligent, I was told by members of his family, but he had to work in the Barber Shop, take money home to the family, never able to go regularly to school and never able to feed his love of learning.

I vowed no child of mine would ever have to go through not having the opportunity and the best I could provide. 

I lived my own life loving to learn and making sure, in a time when people my age were just starting to go to college in higher numbers, I was the first female and the second person in my mother and my father's family to go to college and I finished and I continue to learn.

I'm sorry for you, my son, as I've told you .... what is it now, going on five years...since you cut me off, for the third time, from any contact with "your family" and that includes your children.

You've had another child in that time. Believe he turns three this year or it could be four. 

Interesting how life moves forward. You've told me how poor my choices were and how they created problems.

I noticed your wife wrote on the internet how she was surprised by this "late in life" addition. It had been what, six years, since your fourth was born?

I'd heard differently. I'd heard there was a request for a vasectomy and it didn't happen. That's a personal choice. Like so many we all make in life. And, like many choices, it can have unexpected or difficult challenges added.

You know, my son, I'm reminded how your father and I communicated. How we cared about one another and how he had once considered taking that action after your sister was born. I told him I'd be there with him if he did. And I would have. He didn't. We had your sister late in life; a true blessing as were our sons, you included.

Life is choices. Some good. Some may not appear so good. 

What I value the most is the love we had and the support we gave one another and how as I approach, alone, this year of celebrating an amazing anniversary I wish was alongside him maybe taking a trip together somewhere or gathering the family together as we did when we hit that first milestone while you were in college.

But I'd do things differently. I've learned, you see, my son. I opened my heart and arms to the woman who became your wife and who, in my opinion, has split our family apart along with your willingness to let it happen.

I can bear this time. I've been bearing many "times" in life since I was very young. I don't like it; I wish it wasn't so and I'm concerned that what the two of you have done this time will have repercussions you cannot begin to imagine the longer you refuse to reconcile and remedy other actions you've taken to tear asunder what a power higher than you joined together.

I've gone through several years since my husband's passing and Mom's. Years when your coming alongside would have made the journey easier even in the most difficult of times.

You walk your path. I walk mine. As did your father with you.

Why? What cannot be mended and what cannot be fixed if LOVE is truly within us?

Criticism, critical care, critique. States of mind and states of living. For how long is in your hands, my son.