Caregiver Burnout

Caregiver burnout (noun) WebMD states that caregiver burnout is a state of physical, emotional and mental exhaustion that may be accompanied by a change in attitude -- from positive and caring to negative and unconcerned.  Burnout can occur when caregivers don't get the help they need or if they try to do more than they are able -- either financially or physically.  Caregivers who are "burned out" may experience fatigue, stress, anxiety and depression.  Many caregivers also feel guilty if they spend time on themselves rather than on their ill or elderly loved ones. Or, in my case, guilty for feeling burned out.

     My Granny was the greatest woman who ever lived...at least in my eyes.  She took care of her younger siblings, then children of her own, then me and a few of my generation, then my own kids.  She never complained about the care she gave anyone.  She never fatigued.  Those in her care always felt loved and cared for.  She was a natural nurturer. 

     She was the kind of woman who, when you woke up, had breakfast cooked and coffee made and had already started her lunch/supper.  By the time I would awaken, this woman had already cleaned her house, cooked, watched the news, fed the birds and was ready to serve your plate to you when you got up. 

     She was very independent and rarely asked for help.  I think she was in her very late 70's before she started asking me to help her with the harder tasks in her apartment.  On Saturdays when I was off, Id scrub her tub and toilet and clean her light fixtures...she still had the rest sewn up, well into her eighties.  It really wasn't until we moved to Texas (myself and my kids had to make an emergency move here when I had gotten sick and needed to be near my mom and sister and Granny came a couple weeks later) that Granny did not run a household of her own.  I remember being in my early 20s, full of energy and bringing up a baby and a toddler and this woman ran circles around me. 

     This is why it was so hard to accept when Granny became dependent on us.  It wasn't that I couldn't or didn't want to help her, it was just foreign to me.  Don't get me wrong, on one hand it was the most natural thing to do...on the other, I resented her for getting old and helpless.  I guess I knew (even though I never really accepted it) she was on her way out....and I HATED it.  This also changed our relationship some.  I regret that, but I didn't know how to deal with it.  Sure its easy to sit here and say that if I could do it all over again, knowing what I know now, I would.  It would be the easiest thing in the world to do, especially knowing which day would be her last.  Savoring every moment of our time, asking her every question I wish I'd asked...but I cant do that...so I have to live with the way things ended. 

     A little over a month prior to her death, Granny had a rough weekend.  She could hardly walk.  She slept in the garage on the Friday night.  (No, really, she did.) Her couch, from her apartment was in my garage and she would sit on it to smoke.  Earlier that night she got mad at me because I asked her to stop smoking in the house so she decided that she would sleep on the couch -- in the garage-- "Where I can feel like a human bean (being)!"  She hated relying on anyone...I think, especially me, since I was her grandbaby. 

     I kept standing at the doorway of the garage (that is connected to and part of the house...relax, lol) pleading for her to come inside and she would just say "No, Puh, I'm comfortable on this couch, my bed makes my back hurt, just bring Granny a blanket."  So, finally, I just brought her a heavy quilt, left the garage light on and the door that connected it to the house open, left my bedroom door open and finally just went to bed.  (I've been in the garage ONCE since she died....only because I had to show the gas man the water heater)

    The next morning (Saturday) she seemed okay, but something was off.  I'm a nurse, but its hard to see things when its your own family member, especially one so close to you.  She was walking even more unsteadily (she refused a walker, but had a cane) and complained of her left leg hurting more than usual.  I kept giving her meds for pain and rubbing Biofreeze on it, but a few hours later it was hurting again.  She fell that night. She never admitted it, saying " Aw, guh, I laid down on the floor to rest!" but I got up in the middle of the night and found her on her bedroom floor.  Trying to be calm about it, I just assessed that she could move all of her extremeties, did not have a head injury and resolved to take her to the doctor's office on Monday. 

     Things just progressively got worse on Sunday. All of that day, her walking got worse.  I think some part of me tried to ignore it.  (she'd die, no pun intended, if she knew that I was telling this part of the story, but....) The stench of urine was very strong. If you're a nurse, you know what I mean.  It wasn't old stale urine, it was fresh urine, but it had that distinct "UTI" odor to it.  WHY DIDN'T I JUST TAKE HER TO THE ER THEN?!?!?!?!?!  Well, its because there was just no way anything serious could be wrong with my Granny!

    Late that afternoon, after several pain med doses and biofreeze rubs, I knew I had to get her to shower.  Granny HATED bathing at this point.  Her whole life, she was very clean, its not that she didn't want to be clean, its that it was just such a hard task. (I will have to blog another time about the day I bought her a shower chair, omg, LOL)  I stripped her bed, put her sheets washing, redressed her bed and freshened up her room.  She hadn't eaten at all that day because she was in so much pain, but thankfully she did drink everything I offered her.  Anyway, I was able to FORCE her to shower.  It was December, and if you're from Louisiana and had a grandmother then you know the whole " Im gonna catch pneumonia if I wash my hair " spill.  I bathed her very well, 3 times over as a matter of fact, and scrubbed her hair, all while the poor woman who loved me and cared for me my entire life suffered. 

     After getting her out of the tub, which was a daunting task in itself because she required the maximum assistance, I powdered her up, put on her deodorant, combed and dried her hair and helped her to the bed.  It was so hard for her to get into the bed (okay, this story is killing me, but I have to get it out!) and settled her in, turned on her TV and gave her the remote.  I asked her if she would PLEASE eat, and finally she said " I could eat some ramen noodle." So I made her some noodles, grabbed a sprite out of the fridge and went back to her room.

     This was the first, and only time, I ever FED my Granny.  The look on her face while I fed her made my eyes well with tears.  I swallowed the lump in my throat and continued. "Granny, I'm going to try to get you into Dr. Messer's office in the morning so you can see Rey." (Rey is the most awesome PA I've ever met in my life and I had wanted, for a while, her to be established there as a patient.) " If we can't get into Dr. Messer's we will go as a walk-in to Dr. Poole's " all she said was "Okay, Puh"  She looked and sounded so defeated, my heart couldn't take much more, yet I remained cold as stone.

     This is when my Granny looked me right in the eye  after swallowing her bite of food and started crying.  "Im so sorry Baby"  so, I said "Don't be sorry, Granny, don't be silly, you're sick, and its going to be okay." This is when she killed me with "No, Puh, Im so sorry that youre only 35 and you've got these two boys and Babe you work so hard" I said "Granny stop!" and she said " Apuh, ever since you became a nurse, you have worked hard, I watch you work hard, like a man works, and you come home so tired, I never knew, in all my years a woman that worked as hard as you do, so Im sorry I got old, Im sorry you have to take care of me, when I should be cleaning your house while you work, or helping those boys, I'm just old now, and not worth a dern, so Im sorry and I want you to know that Im sorry. Apuh, its hell getting old, I tell you!"

     At that point, I broke down, kissed her forehead, put the food on the dresser, crawled into the bed behind her and wrapped my arms around her and just rocked her.  We cried for about 20 minutes, laying there...the roles reversed.  How is it that I can take care of everyone else's grandparents but I was ANGRY at mine for being old?  How is it that its an honor for be to be part of another family's life, as a nurse, yet resent the very woman who is part responsible for who I am?  So Granny said " I love you, April...I do....so much, you'll never know" "Granny I know, and I love you too...so much, YOU will never know"  I went on to thank her for taking such good care of me when my mom had to work and for teaching me how to cook and how to take care of my own kids...and for taking care of my kids while I was in nursing school.  For seeing to it that I never had to worry about those boys, EVER!  If I had to work a double shift, or had the opportunity to work over, especially fresh out of nursing school, id just call her and ask her if it was okay and she'd just say "Make your money, Babe, just bring me a pack of cigarette(s)"

     This woman was the very backbone of this family.  And I guess I could see, right before my eyes, that she was slipping away.  She fell asleep and I got up and went into the kitchen and cleaned up, made sure the boys and I had clothes ready for the next day, and finally settled into bed for the night. It had felt good to cry. I fell into a very deep sleep...not for long though, I woke up to her grunting at 2 am.  She was on the floor again. I helped her to the bathroom and back to bed.  At 5 am, I woke up again to her crying, I step out of my room and there she was on the floor again.  Finally fed up, I text my boss and said I didn't know what time Id be there, but that I was taking Granny to the hospital. 

     Three times she fell on the way into the car, once in the house and twice in the ice cold front yard.  Not really fell, but just kind of weakened and "sat" on the floor/ground.  Holding back the tears, I just kept telling her "It's okay"  Once in the car, I instructed my boys to get back in the house, get ready for school and that I would be back and everything would be okay.  On the way up my street, I  texted my mom, then called my Uncle Ken to let him know what was going on, I assured him he should go to work. At a redlight, while waiting to get on Old Galveston Road, Granny said " Is your momma coming?" I had told Mom that I thought it was just a UTI and that Id call her when I knew more, there was no sense in all of us piled up there waiting, not until we knew if she'd be admitted or not.  But I told Granny "Of course, she is on her way now."  I texted my mom again "Granny is asking for you....im scared."  And I was scared. MY Granny doesn't get sick, so I don't know how to deal with it.  So many guilty thoughts were going through my mind.."Why did I take this management position at work? Since then Ive been at work more than ever"  "Why have I been so mad at her for aging?"  "Is this it?"

     Turns out this was not it.  Once we got to the ER, the triage nurse was being charmed by my little Granny. LOL.  She loved to ask questions.  For every question he asked, she had one back....example "How old are you, Mrs. Miller?"  Granny: "Well, 86....and you?"  LOL She was such a hot mess!  When they finally got her situated in an ER room and medicated with morphine she really got going, her pain was relieved and she was observing the world around her as only she could.  "I sure could eat some breakfast!"  I was so relieved to hear her sounding like herself.  I told her that once they'd ran all the tests that she would be able to eat.  "Huh?" She was so hard of hearing, bless her heart.  " I sure could eat!"  This time the hints were directed at the nurses. "Mrs. Miller, as soon as we've got some results back, you'll be able to eat once the doctor says you can" Granny: "Hmmph!  Mrs Miller!  Mrs. Miller's gonna be starve to death by the time she gets a biscuit!  Boy, a good ol' biscuit would be so good right now, with a bacon and egg!" 

     I went home to "get dressed for work" once she was settled in and we were sure she would be admitted.  When I got home, I passed out from sheer exhaustion, mostly I think because I was relieved that I knew she was in good hands and that she was okay.  I woke up later, and returned to the hospital, this time with my kids.  We walked into her room and she hadn't eat much of "aw! that ol hospital food taste like SHIT!" I sat in the bed with her and, knowing my Granny so well, told her I had a surprise for her.  I reached into my purse and pulled out a can of potted meat and a long pack of Saltines and her face lit up like a Christmas tree!  Her and I ate that together like 2 country bumpkins from Jennings, lol.  The nurses looked at us like we were nuts, but we didn't care.  My mom just giggled, probably from embarrassment, but also, I'm sure, because Granny was Granny, if only for a little while.

     That hospital stay was a week long and had nothing to do with her death.  She did, in fact, have a pretty nasty UTI (urinary tract infection....glorified bladder infection) and she also had 2 blood clots in her left leg. So, no hip fracture like I had dreaded and Ol' Granny was gonna be okay...for now.  She charmed the scrubs off of everyone that walked into her room.  When we would visit, she would introduce us to all of the staff she had made friends with, and as soon as they'd leave the room, she'd tell us all of their business, because God knows she interviewed the poor things. 

     One thing I loved about my Granny was that she was herself, no matter where she was.  I like to think I got that from her. I cant put on airs and, later in Granny's life, she couldn't either. That's one of the most valuable lessons she taught me, without ever realizing it.  People are going to see who you really are, at the end of the day, so why act like something/someone you are not? When someone put on airs in front of Granny, she knew it.  "Aw, them?  They think they somethin', yea! Boy, them!"

     Today was a really hard one.  It didn't have much to do with Granny not being here.  It was just one of those days where everything that COULD go wrong DID.  But her being here sure would have made it a tad easier.  I would take "caregiver burnout" over "grieving granddaughter" or feeling like a lost child anyday.  After this kind of day, there would have been something that lady would have said or done that would have made me laugh so hard I wouldn't care anymore about day I had.  Caregiver burnout?  Who am I kidding, it was always SHE that was the caregiver.  Even when she thought she had nothing left to give......