For almost 50 years, Elizabeth Dunham kept the books for her family’s business in Potomac, Maryland. She raised five children with husband Alvin, and cared for him through illness until his death in 1998. Molly Dunham Glassman had long admired her mother’s "very capable" handling of her personal, financial and medical affairs, including the medications and check-ups needed to manage blood pressure and heart conditions. Entering her 80s, Elizabeth, "was on the ball about everything," says Molly — until a procedure designed to improve her health instead wound up undermining it.
In fall 2007, a cardiologist "looked at Mom’s echocardiogram and told her she might have six months to live if she didn’t have heart valve replacement surgery," Molly recalls. "The surgery went well, the surgeons were happy with how the valve was working. But my mom experienced severe anesthesia-induced delirium — totally out of her mind, didn’t know where or who she was. She ended up in the hospital for a month, including two weeks in intensive care."
"That threw us back on our heels," Molly says now. She and her four brothers "weren’t sure we were going to get Mom out of that, and it really woke us all up to the seriousness of her condition and what might lie ahead." With home health care workers, and visiting nurses coming in for a few weeks, Elizabeth was able to return to her own home. "It was about six months before she was able to handle most things on her own," says Molly. The episode left Elizabeth clinically depressed, so an anxiety-depression medication was prescribed. From then on, Molly would be involved in all her mother’s medical care.
"In summer 2009 when I took her in for a routine exam, we’re sitting there in the doctor’s office and she asks me, 'Do you think I should say something to the doctor about this little thing in my breast?'" A biopsy confirmed that the small tumor was malignant; Elizabeth decided on a lumpectomy, which doctors believed they could do under "twilight anesthesia" instead of general anesthesia.
The day before the operation, Elizabeth slipped getting into her recliner chair, fell on her right hip and shattered it. The lumpectomy was put on hold, and a hip replacement scheduled in its place. "Before the surgery, I talked to the anesthesiologist and explained to him the experience she had before," Molly recalls. "He assured me it wouldn’t be a problem. Again, the surgery went well but the anesthesia was a nightmare: She was in the hospital for a month, incoherent almost all that time."
After this hospitalization, Elizabeth went to a nursing home. "They did a great job working with her," Molly says, "but it took her so long to get her wits about her so she could start physical therapy and make progress toward getting out of there." In the middle of nursing home stay, Elizabeth developed a severe bladder infection, and had to be hospitalized again. Seeing no way for Elizabeth to return to her own home, her children moved her into an assisted living facility which Molly says "is a blessing for as long as the money holds out."
Had Molly not downshifted her career in 2001, from unpredictable hours as a newspaper editor to a more forgiving schedule as a teacher, "I could never have done this much" caregiving for Elizabeth, Molly says now. None of her brothers has a job that provides paid time off for family illness, so year after year, most of Molly’s family, personal and sick leave days are spent helping Elizabeth through health crises.
The lumpectomy never has been rescheduled, because her breast tumor is being held in check by medication. Still, as Elizabeth has endured repeat hospital stays that Molly calls "a study in crossed signals and miscommunication." A bout of flu in October 2010 landed Elizabeth in the hospital for three weeks. Flu in February 2011, with 101-degree fever, left her dehydrated and hospitalized again. When she began to rally, her doctors offered an option: As long as she was in the hospital, why not do an endoscopy, to look at an ulcer in her esophagus that they’d been trying to treat?
While Molly and her brothers considered whether to put their frail mother through the procedure, the hospitalization stretched on and Elizabeth became anxious — in part, Molly later learned, because she was not being given her prescribed anxiety/depression medication. One night when Elizabeth’s panic spiked, a nurse gave her a different anti-anxiety drug, to which Elizabeth reacted with disorientation and incoherence. Molly called the doctor, who assured her the right drugs would be given from then on.
The next day when Molly asked a nurse to show her Elizabeth’s chart on the computer, it still contained an order for the wrong anti-anxiety drug, and no order to give the right one. "I knew the right medication was on the records I had brought from the assisted living home," Molly said. "When the nurse pulled out the paper record, there it was. She said something like, 'Sometimes everything in the medication list doesn’t get put into the computer the way it should.' I said, 'Doesn’t anybody go over this?' It was Saturday, and Mom hadn’t been getting the right medications since Sunday."
Elizabeth is back in her assisted living home, and thanks to physical therapy is able to go to the dining room using a walker. "I know this is just part of life and I know so many other people who are going through all of this," Molly says. "But every time Mom goes through these episodes, she loses a little bit of her will to live. She’s diminished, and she knows it. That’s the hardest part."