Back to school?

It’s been very quiet here in Rome this month. The relentless hot sunny days, when you barely hear a dog barking, the deserted city with neither tourists nor residents, lend an eerie quality to the few left behind, sweating in their face masks and just trying to get through another day.

Against this backdrop, and the daily rituals of caring for my mother who continues to show signs of improvement from a fever and possible lung infection a few weeks ago, I have been thinking about the whole business of reopening schools and universities. Although I now wear the eldercare hat, my teacher identity can’t stop thinking about the impending nightmare of what will happen when and if children, adolescents, and educators return to their school buildings this fall.

 

Let’s recap first though. The short term solution during the height of the COVID-19 worldwide pandemic was a stay-at-home-lockdown, forcing workers and students to do everything online. For some, it was an easy transition. Italians called it “smart working” but most parents struggled to do both work at home and tutoring of students online. Some found the humor in the awkwardness, like this Italian actress who taped some scenes with her two children (watch even if you don’t understand the Italian, the humor is universal) and others who created hilarious commentary on the new busy-at-home-schedules like Italian comic Paolo Camilli. Aside from humor, there were a few other unexpected positive aspects to the world coming to a screeching halt. We discovered the planet could heal surprisingly quickly. We found ways to be grateful despite our fear, and to reach out more in our isolation to others.

 

For some it was a dark time of grieving and loss without the customary comforts and rituals. Many lost their jobs, and some saw their careers in peril, with no clear sense of what would happen next. Theaters, restaurants and bars, stadiums, tourism all shut down; our social lives suddenly existed only in a virtual sense.

 

But I think no one was prepared for what it would mean for our way of life, and for the health of our economies, to shut down schools and universities. These are places we take for granted, like supermarkets and pharmacies (which mostly remained open during the lockdown). We entrust our children to the people that work in education for almost more time than we spend with them at home. The age at which we send children to school keeps dropping too, so that parents of even young babies can return to work. Schools are engines of socialization, humming with group activities from laboratories to sports fields, places for quiet reading or writing, for conferring with a teacher or colleague, for eating and playing and laughing together. Meetings on Zoom and other platforms were a very poor substitute, but everyone tried to make the best of it, if they were able to get online access, which many could not. It was only meant to be temporary. 

 

Now as the death toll from COVID-19 nears 200,000 in the United States, and the economic toll the lockdown has taken comes starkly into view, even as indoor dining and sports stadiums remain forbidden, schools and universities are starting to reopen. The justification has become politicized, with the incompetent administration in Washington D.C. claiming children are not so likely to get or spread the virus, while we know that some are at risk of MIS-C, a severe sometimes fatal complication. The president continues to lie that outbreaks are under control, that plans and procedures for reducing risk are in place and will be effective. UPDATE Sept. 19: College and university cases are growing nationally. New York City's schools delayed reopening again, causing anger, frustration, and confusion. 

 

Some teachers have decided to quit, others to retire early. Some are preparing to go on strike. Many are torn between wanting to return to the work they love and to serve their students, and wanting to protect themselves and their loved ones from the risk of illness, even death. Most are justifiably terrified that they simply don’t have the resources to handle the situations they will face, and that administrators haven’t carefully thought through the scenarios that are likely to play out immediately, leading to chaos and confusion. They fear they will bear the brunt of the blame. No one is really prepared for what to do if there is an outbreak of COVID-19 cases. In fact a freshman at the University of Iowa who tested positive days after arriving faced a horrifying lack of support when she was forced out of her dorm room. 

 

In some countries, provisions have been made for plexiglass cubes around individual desks, for headgear with propeller-like extensions to train children to keep each other at the right distances, even for adjacent classrooms connected by video cameras so the teacher is with half the class and an assistant with the other half, allowing students to spread out. Some districts in the US are proposing hybrid schedules with students alternating in person and at home days, which creates a nightmare for teachers with children of their own, and for those parents who are expected to return to a work environment that is not home-based. Universities, who were already moving many courses online for the convenience and ability to register more students in courses, are more prepared to shift to computer-based classes, even though it is widely acknowledged that learning that way for many subjects is less than ideal. Teacher and renowned blogger and author Mercedes Schneider put it bluntly:

 

“I am the teacher, and I am supposed to limit my movement in my own classroom. Is every conversation with a student to be said loud enough for all to hear? Am I to teach without being able to walk up to my students or have them walk up to me? Apparently that is the expectation. But let’s not pretend that what I will be able to do for my students in my COVID-era classroom is remotely on par with normal teacher-student and student-student interaction.

In short, what I will be offering in my room is a form of distance learning to students who happen to be seated in a space in which they can see me and I can see them.”

A retired teacher friend, Gail DeBonis Richmond, posted on Facebook some comments she has been hearing from colleagues in New York State: 

“We were told we can’t wear scrubs.”

“The ventilation in our school is old and horrible.”

“They’ve laid off custodians and are not rehiring.”

“I have to buy my own cleaning supplies.”

“Kids don’t have to wear masks during instruction.” 

“I was told I WILL be having choir. Instead of 100 kids in choir, they’re breaking it up. I’ll have 85 in one, 15 in the other.” 

“Our faculty was just told there isn’t enough money for sanitizer in classrooms. There will be a dispenser at entrances.”

“I was told I have to clean every student desk in between classes. I’m not sure the PPE I bought for myself is medical grade and will protect me. I’ve never been trained in infectious disease cleaning.”

 

It’s probably even more dire in other situations where extreme funding cuts, political pressure to get back to business as usual, and propaganda believers that the COVID-19 is somehow a hoax abound, make for a toxic mix. Leaving everyone to fend for themselves, coupled with a lack of expert guidance and leadership, is going to lead to many more deaths. How do I know? Look at what happened to the elderly in nursing homes. When the virus arrived, it swept through those places leaving mayhem in its wake. Yes I know we’d like to ignore such unpleasantness. But we know it is true. If this happens to our children and youth and those who seek to educate them, we truly may not recover from the grieving and trauma this will inflict on our society.

So what alternatives are being proposed? Predictably, some administrators are just trying to kick the can down the road, such as this report of principals in Brooklyn from Chalkbeat New York.  In Iowa, where schools defied the governor’s order to reopen, the Associated Press was reporting that administrators could face having their licensure revoked. It’s about to get really ugly out there.

One of the emerging ideas among affluent parents is to create a local pod. I first learned that podding was a trending education jargon term of the moment from the excellent Jennifer Berkshire and her podcast partner Jack Schneider in an August 6^th episode of Have You Heard?. Sit down with a strong drink of choice, listen and learn all about the craze for pandemic pods, opportunity hoarding, worsening inequality issues, and more from the hosts and their superb guests, Jessica Calarco, L’Hereux Lewis-McCoy and Jon Hale. There’s also the June episode on distance learning to listen to after that where they explore present day and historical efforts to teach individuals by correspondence or online. As they say, “learning alone has never worked for the vast majority of students.” I fear that we are already moving backwards thanks to standardized testing. Take, for example, this quote from a 2011 Washington Post article by Marion Brady:

My school board member-friend concluded his email with this: “I can’t escape the conclusion that those of us who are expected to follow through on decisions that have been made for us are doing something ethically questionable.” 

He’s wrong. What they’re being made to do isn’t ethically questionable. It’s ethically unacceptable. Ethically reprehensible. Ethically indefensible.

Think of where we are now nine years later. Drowning in a void.

I think it would be irresponsible of me to leave you on such a bleak note. So here are some of the ideas I have been thinking about, given what we know from researchers like Barbara Rogoff about group learning, especially for children from underserved minority backgrounds:

Outdoor education! We need to rethink the potential of the great outdoors. Forward-thinking schools in places like Reggio Emilia here in Italy, in Sweden, and Finland are taking even very young children outside to learn and to immerse them in exploring the natural world. A recent NYTimes piece on history of educating New York’s children outdoors during flu pandemics from Ginia Bellafante explores whether such ideas would be feasible today in New York City. I am not just talking about laptops outdoors, but creating curriculum and experiences based on outdoor environments both urban, rural, and everything in between. Study wetlands and woods, rivers, tidepools and beaches, help advance awareness of climate change and how to conserve and protect nature and animal habitats. 

Massive effort to involve non-teachers in education! Paid or volunteer, working adults (and those out of work) have much to offer young people. Create a new civic sense of duty to help save public education, appeal to parents, aunts and uncles, grandparents, even the childless. Maybe hours accumulated could count towards greater public assistance for those seeking employment. Have the volunteers work in tandem with expert support; don’t set them up for failure, and you could create an international movement that would energize learning globally.

Cross-grade partnering and tutoring! We know there is much learning in teaching others, even for children. Under adult guidance and supervision, these partnering and tutoring experiences could even count for course credit. Partners can be established online across diverse communities. Check out the AMAZING Creative Arts Team Youth Theatre and their  international collaborations.

 

Learn about food and where it comes from! Inspired by Edible Schoolyard, create vegetable gardens and outdoor food preparation sites for making school meals a curricular opportunity. Learning to prepare food safely during a pandemic is a vital skill for everyone to obtain. 

Arts education is more important than ever! With so many theaters and concert halls and museums closed or with reduced access, now is the perfect time to partner with arts and cultural institutions to create online and in-person outdoor learning experiences that are interactive and designed for group activities. See for example this 2013 video introduction to the work of Lincoln Center Education, which has a long illustrious history of partnerships with artists and schools across the globe. The Lincoln Center YouTube channel has a wealth of resources for at home use from concerts and performances to pop-up workshops. 

 

Now, go get some kids outdoors where there are flowers growing, bring along some simple collage materials and your laptop/tablet/phone, and follow along with teaching artist Barbara Ellmann to make collages of spring flowers. Don’t you feel a little bit better?

My mother can't answer those security questions

Is there a caregiver of an Alzheimer's patient out there who hasn't had to deal with the hassles of financial paperwork despite having power of attorney? Lucky you! 

Here's my rant: 

1) I have power of attorney. I should be able to get statements, get questions answered, have help when I need it from customer service, without having to pretend to be my mother. I can answer their security questions, she cannot. Yet, I get locked out of online account access. I get blocked from making financial decisions on her behalf, like which bank account to use for deposits. 

2) I have escalated these issues to senior executives, who tried to be helpful by sending me coded letters than I cannot access from my mother's online accounts. Oh the irony! 

3) In the latest debacle, my calmer sister negotiated a return to paper statements mailed to her US address. Here's hoping the US postal service will still be working in the coming months. My last two packages to the US arrived drenched, destroyed, saved by an interior plastic shield and waterproofed address. All sent with a tracking number, arriving two months later. By the way, they left Italy in less than 4 days. 

4) With a growing elderly population with dementia-related illness, which financial company will step up to the plate with a sane and safe policy in place for those with power of attorney? C'mon, you'll snatch up all the business from the useless and unhelpful competition. 

Meanwhile, how to cope with the frustrations?

This blogger has a few suggestions 

NIH says to take care of everything in advance. Yeah, good luck with that. 

This NYTimes article talks about how sometimes people just have to "wing it" when institutions try to protect themselves from liability by claiming they require their own forms. So this is supposed to be a helpful solution to a growing problem? (I unsubscribed to the NYT but for many other reasons so do not bother with a paywall for this article). 

As for me? I made apricot jam despite the heat wave in Rome. Smashing that fruit was very satisfying.

Quarantine Daze

Grass is growing in Piazza Navona

It’s been a little more than three weeks since my last post, and now half the world has joined in the COVID19 quarantine protocol: stay home; wear a mask and gloves; wash your hands; don’t touch your face; disinfect everything. As the coronavirus hit countries in waves, so too did the harsh reality of the major disruption, despair, and sorrow it brings. Fortunately for us, Rome and its environs have been spared the devastating death toll in northern Italy, and as of today there are 2,340 positive patients; in the region of Lazio there have been 212 deaths due to coronavirus and its complications. 

Meanwhile, my mother has been making slow and steady progress in her recovery. It’s most easily measured in things like what she is able to do once a week with a physical therapist. Last week, it was managing to stand up from the wheelchair and hold onto the bed frame for as much as two minutes at a time, for a total of six times. This week, she held

Helping Maureen in PT

onto her rollator and walked several steps, first in her bedroom, then in the kitchen, also for a total of six times. This required a team of helpers that physically and emotionally supported her trajectory across the floor. She has also been using a mechanical pedaling bike out on the terrace for half an hour a day, helped by the patient nurses who guide her weaker left foot and encourage her to keep going.

Daily pedaling outside

Improvement is also noticeable in her transition from sippy cup to glass, and in the number of hours she can tolerate being out of bed either in the wheelchair or electric recliner. She’s easily managing 4-5 hours, some days even more than 6, with an hour outside in the afternoon sun on good days. 

We are fortunate that we continue to have excellent nursing care in afternoons and nights, although two of our regular nurses have been reassigned to COVID19 patients in hospitals. It breaks my heart to know they are putting themselves at risk of grave illness, but I also tell myself that those patients deserve and need the very best care to recover, and good nurses are their first line of defense in fighting the virus. 

Like others managing the quarantine, I pass the time

Yummy muffins

cooking, and even baking, and have discovered my gluten free banana chocolate chip oat muffins are quite popular with the nurses (muffins are just catching on in Italy). I got two Ottolenghi cookbooks from my sister, and with friends in California and one in New Zealand we share photos and recipe experiments in a WhatsApp group. I try to give Maureen tasty, easy to eat food, and balance her diet with fresh market vegetables, beef and chicken in small portions, and rice or potatoes. I make a fruit puree with apples, pears, ginger, honey and spices that she loves as a snack. Eating requires a lot of focus for her, as she carefully chews slowly to be sure everything in her mouth is safe to swallow, and sometimes if her eyes close and she gets sleepy she needs to be reminded to stay awake and alert. I leave much of the task of feeding her to my helpers as I’m usually still in the kitchen working on meal preparation. So far she has had minimal digestive issues and all her tests point to no more problems with diverticulitis or bleeding. I still make sure she has a daily probiotic VSL3 mixed in her morning brew with aloe and fresh orange juice.

For me one of the most remarkable things is that all of her medication with the exception of her asthma inhalers has changed. In addition to stopping the Alzheimer medications of donepezil and memantine, she is not taking previous blood pressure medications or montelukast for asthma. She takes a daily diuretic, Lasix, a beta blocker for her heart, an anticoagulant, and a blood pressure medicine. Her kidney function has improved, her blood pressure is stable, and her heart and lungs are working fine. There has been some notable decline in terms of Alzheimer’s symptoms, but some improvements as well, so it’s hard to say what will be the lasting effect of both her health trauma and suspending the two medications. To help her sleep, and to calm the agitation she experiences in the middle of the night, we use a low dose of Lexotan (we tried Xanax, but it didn’t work) in combination with natural sleep aids valerian and melatonin. 

Mimi helps me with my ankle magnet therapy,
now dubbed Mimimagnetoterapia

Like others looking for creative ways to pass the time at home, we listen to a lot of different music throughout the day: Yo-Yo Ma’s Bach recording;  Frank Sinatra from the late 40s-early 50s with the swinging Harry James Orchestra; Ella Fitzgerald’s live concert in Rome recording; Morabeza, a new recording by Italian singer Tosca (and we have tickets to hear her live in Rome in mid-May); in the evening to wind down, Stan Getz, Bill Evans, or Oscar Peterson. We also tried a collage activity exploring concepts of isolated, tangential, and overlapping led online by our artist and teacher friend Barbara Ellmann, offered through Lincoln Center’s education program, and hung our collages

My collage had a Roman theme

on the wall across from Maureen’s bed. We avoid the news now, and prefer concerts or classic films, limiting TV watching to less than an hour or two a day. There’s always daily chores and now we’re starting some spring cleaning and closet reorganization projects too. 

I know I am blessed to be spared the common hardships of the quarantine in that I don’t have to work from home and schedule online meetings or classes, I don’t have to homeschool any children, I am not ill, and I can get whatever food and medicine we need with relatively little effort and low risk of infection. Even my gyrotonics teacher is offering free classes through Skype, so I’m getting my weekly exercise. But I am blessed in another way, that fellow caretakers will probably recognize. I am used to this feeling of staying close to home, attending to domestic chores, slowly feeling the passing of time, because my mother is my number one priority. It’s been three years. I can handle whatever quarantine time is still to come. Every day with Maureen is precious. 

Life During Wartime

“This ain’t no party, this ain’t no disco, this ain’t no fooling around” – Talking Heads

If you are one of those people who still thinks the COVID-19 virus is unlikely to change your life, think again. We are witnessing the worst-case scenario of a global war against a highly contagious virus that requires all of us to do our part to contain its spread, particularly to the most vulnerable among us. Here in Italy as of today there are more than 15,000 known cases of the Corona virus, 11,000 of which happened just last week. 

From New York Times March 13, 2020

Hospitals in the north where the spread began are overwhelmed, desperately seeking to create intensive care beds for the overflow of dying patients. This New York Times piece (no paywall on Corona news) provides a grim glimpse into the future scenarios likely to expand globally.

Italy has now taken the most drastic measure of putting the country on pause – no school, no work, no play – and is using celebrities and doctors to spread the #IoRestoACasa message that staying put, in the safety of one’s home, is the best way to contain the spread of disease. Now only supermarkets and smaller food stores plus pharmacies are open, and you have to wait your turn to get in. When I ventured out to the pharmacy yesterday, there were about ten people waiting not in line, but with the required meters between them, each new arrival confirming who was the last person so as to keep track of turns. This sort of civility is rare in Italy where cutting in line, especially at airports, is more the norm. Masks and gloves are everywhere, and supplies of hand sanitizer seem to have run out.

Against this surreal backdrop, my life as a caregiver goes on with the daily joys of watching my mother get better and better with each day. Even her bloodwork yesterday shows dramatic improvements in the worrisome numbers. When we first got the hammock-like lifting machine to transfer her from bed to reclining electric armchair, she actually loved the whole experience, and stayed in the chair for 30 minutes. Just yesterday she stayed for three full hours, eating dinner in the chair, and during her physical therapy session managing to stand three times holding on to the bed frame while we supported her on either side. For the first time we saw her move her feet on her own, taking little steps as we pushed the armchair into position, and turning her ankles in circles to stretch the muscles. This morning I left her room for a few minutes and returned to find her sitting up, legs hanging down the side of the bed, torso up, with only the yoga belt barrier I put in place as support for her hands. She is ready to, as she says, “get out of here.”

Also remarkable is the dramatic difference between her speech when she is lying in bed compared to when she’s sitting up in the chair. Moans and groans turn into full-blown phrases of thoughts her brain has been likely storing up for eventual use. Her physical therapist recommended putting

Maureen loves the armchair

objects she enjoys out on a table in front of her, so I got out her box of costume jewelry necklaces and bracelets, and she reached forward with delight, holding each one as we talked with her and had much more meaningful social interaction than when we are leaning over her in bed, taking her blood pressure or helping her to eat and drink something.

I shudder to think how all of this would have been different if we had decided to put her in an ambulance and take her to the Umberto I hospital when she first had the crisis after her colonoscopy and endoscopy hospitalization. I doubt she could have survived. Alzheimer’s patients are particularly prone to terrible disorientation and panic attacks in hospital settings, and she would have increased her risk of exposure to germs, bacteria, and of course, the COVID-19 virus. With her weakened lungs and heart, she wouldn’t have had a chance.

So please, take this pandemic seriously. For you, for your loved ones, and for those who are most vulnerable. They need you.

Nursing Back to Health

Nurses, like teachers, are some of the hardest working, underpaid, under appreciated professionals and they are on the front lines of health care with the most direct contact with patients. Here in Rome, just as in New York, they come from countries across the globe, many hoping to earn enough to help family members they left behind. Their hours and shifts are crazy, well beyond a straight 12 hours, and often requiring being awake all night.

My mother came home from the hospital on February 13^th, and all was going pretty well until a few days later when she became bedridden. Her doctor came for a visit when a nurse was here and they determined she needed a catheter, so I raced to the open pharmacy to get supplies and after a tortuous few minutes it was in and there were within minutes two full liters of urine filling up the bag. Apparently the bloating resulting from the endoscopy and colonoscopy perhaps coupled with side effects of anesthesia caused her bladder to back up, which might also explain her high creatinine level above 3. It was touch and go for the next several days, requiring sleepless nights, gas pain, difficulty breathing, anxiety and delirium. I feel as though I have jet lag from a trip to Los Angeles for about two weeks now, and I am definitely feeling that I am too old for this.

I have learned a lot about nursing and caring for an elderly bedridden patient in the past weeks. The doctor has been in constant contact through messages and took a one-problem-at-a-time approach, so first we worked to stabilize lung edema issues using intervals of oxygen, the diuretic drug Lasix, and extra inhalers beyond the ones my mother usually has for asthma. Then once her breathing improved, we shifted our focus to her heart, slightly modifying the medication regime (she had still suspended many of her previous medications) and taking her blood pressure regularly. I kept charts of all the data including what she ate and drank and anything else noteworthy. Once I became incapacitated by sleep deprivation, I hired night nurses so that even though I woke up regularly anyway, I was sleeping in my bed more than I had been in the makeshift one next to my mother.

This all paid off and slowly but surely, we turned a corner and she seemed out of immediate danger. Her bloodwork numbers were going in the right direction. We had avoided an ambulance and hospitalization through teamwork and good communication, and Maureen’s ability to fight the impulse to give up. Every day she ate more, gained strength, was more present and herself, giving sweet hand caresses to the faces of those caring for her, winking, smiling, sometimes even singing. Frank Sinatra is an excellent healer. There were also battles to move her body, when she would threaten with fists clenched, “I’ll kill you!” but once in a comfortable position she settled right back down.

I worked in the kitchen and in my shopping to make smooth, easy food taste good, while following dietary guidelines for kidney problems and diverticulitis. Squash, carrot, and sweet potato soup. Omelets with cheddar cheese. Lemon flavored meatballs. Juice mixes with the sweetest fresh oranges and pure aloe plus her usual morning probiotic. Hot Irish tea with milk and sugar. Creamy yogurt in her favorite flavors. Cooked pears and apples pureed with banana. Lots and lots of zucchini minus seeds drowning in delicious olive oil. Thank God for soft sippy cups that made drinking in the inclined hospital bed we rented possible with little mess.

Finally, four days ago, my warm and creative physical therapist agreed to work with Maureen and see if we could get her to sit up on the edge of the bed with her feet down. Since it was close to our regular happy hour time, I told her she could even enjoy a few sips of wine if she’d try to do it, and we put on some upbeat jazz music. We slowly progressed from massage, to movement, to pillow readjustments, to a three-person (assisted by the nurse moving pillows) maneuver that slid her into position with an armchair pillow rest cradling her back. For the first time in over a week she had a different perspective out her bedroom window, and she seemed surprised to see it. I gave her the promised sips of wine, I cried, composed myself, took a picture to send my sister, and just marveled at what all that hard work had produced.

In addition to learning to do belly injections the right way with no pain and no black and blue mark, to change a really messy diaper (double gloves!) without taking forever, to treat bed sores (a rotation of three products seems to work best) and foot blisters, to get creative with pillows of all shapes and sizes, to administer oxygen with a patient determined to remove it, to change and reposition my mother all by myself (THAT was hard but now I’m a pro), to manage a catheter, and to not lose my patience every time I had to get back up just after falling asleep (I really understand those new mothers who look at their newborns in exasperation), I learned that I had to also administer some self-care. I thought about that airplane safety rule about putting on your oxygen mask before helping someone beside you. So I returned to doing my gyrotonic exercise hour with my teacher, crying with joy at my ability to do the familiar movements after my ankle surgery. I made a point of shopping at my favorite market, and chatting as I always do with the vendors I have befriended who make this chore so pleasant. I didn’t try to do everything, and trusted that Irene and Arianna were perfectly capable of being in charge of things too. I took time to make myself some comfort food, to watch my favorite Italian show, to even have my weekend martini.

And finally, blissfully, I got some badly needed sleep.

Hospitalization and Frailty

Maureen in the afternoon sun

Aside from the two times she gave birth, my mother has never had to stay in a hospital. She has had cataract surgery, Mohs surgery for skin cancers, and she has been treated in an emergency room and in an urgent care facility, but as of this week, she has never been hospitalized overnight for illness. Now that she has Alzheimer’s, I have dreaded the possibility of having to either call an ambulance, or admit her to a hospital, as I feared the resulting anxiety and disorientation would be more debilitating than whatever affliction might befall her. So last weekend when she began to have serious rectal bleeding, I made a round of phone calls and found that my anesthesia doctor from my recent ankle surgery was also practicing geriatric medicine and could do a house call that same afternoon. Imagine that! 

He immediately had me suspend four of her medications. Two were her Alzheimer’s medications, donepezil and memantine, here in Italy known as Aricept and Ebixa. For some time I had suspected they were doing more damage than good. In fact I recently read that memantine and donepezil should not be taken together, and not by patients with heart conditions. My mother has both high blood pressure and a heart arrhythmia. Donepezil is also bad for people with asthma, which my mother has had all her life. The other drug was warfarin, which thins the blood to presumably prevent strokes and heart attacks, but it carries a risky potential for causing internal bleeding. We agreed that hospitalization was not yet necessary, and might make matters worse for her. When her symptoms persisted the next day, he had her admitted to a private hospital not far from where we live.

Her hemoglobin was dangerously low, so she was given blood and plasma transfusions in order to prepare her for a diagnostic endoscopy and colonoscopy the following day. Thankfully with the help of some fantastic nurses, I got her through the prep and we had generally good news from the procedures: no tumors, no hemorrhoids, no need for any surgery. However, she had diverticulitis, and the working hypothesis was that her worsening anemia coupled with the impact of that cocktail of medications caused internal bleeding that eventually led to the hemorrhaging. Luckily a careful diet can help the intestinal healing, and now we will work to figure out how to improve her heart and lung health. 

I imagine readers of this blog are well aware of the dubious results of these two widely prescribed Alzheimer’s medications, and of the many undesirable side effects. Dr. Dale Bredesen whose work I have previously written about, posted on his Facebook page about a year ago about a meta analysis:

a recent study showed that patients treated with standard Alzheimer’s drugs donepezil (Aricept) or memantine (Namenda) actually declined more rapidly than those who were not treated with those drugs (Kennedy et al., JAMA Network Open. 2018;1(7):e184080. doi:10.1001/jamanetworkopen.2018.4080

What may be less understood by caretakers and even medical professionals is how the frailty of old age can mean unseen vulnerability that is not diagnosed with typical bloodwork and routine doctor visits. I think of myself as a pretty well-informed caretaker, someone who has done a lot of reading about Alzheimer’s, but I did not go to medical school, so I put a great deal of trust in doctors. When I saw symptoms like nighttime coughing, complaints of feeling cold, rising creatinine levels, increased sleepiness, breathlessness with fatigue, I did not pursue the possible reasons, even though I wondered about the medicines that negatively impacted kidney function. My mother’s doctor most recently diagnosed a flair up of asthma and prescribed prednisone, and it reassured me the chest x-ray showed no change from the previous one and therefore she felt the heart was not to blame for her symptoms. In retrospect, I am shocked that a simple online search turned up the fact that iron-deficiency anemia (which my mother has been taking iron supplements for since late fall) is almost always due to blood loss, and a simple test can determine if there is blood in the stomach or bowels. 

Lessons learned the hard way always leave a residue of guilt. I am grateful for the happy outcome of the procedure, for a trustworthy and competent doctor and his colleagues at the hospital, and for a mother who is a stubborn warrior and even in her most distressed state was willing to fight through it. I am more skeptical than before all this happened about the medical establishment, which seems even more dysfunctional than the really messed up field of education that has been my life's work. I see disturbing parallels. We know from replicable and reliable research that these medications are not working and are even dangerous, yet millions continue to take them in the hope they'll do something for their loved ones. We know that the toxic testing culture taking over educational settings is not improving learning outcomes and is actually harmful to students and teachers, yet we persist in ranking, sorting, praising and publicly humiliating people. We have a long way to go. We're not getting younger, and most of us are not getting healthier. Or for that matter, smarter.