Look, I Shrunk Grandma: A Psychiatrist's Guide to Nursing Homes, Dementia, and End of Life

by Karen Severson

Overview

Karen Severson, M.D., has spent the last twenty years as a Geriatric Psychiatrist wandering the halls of those dreaded destinations called nursing homes. She became mentally exhausted from watching people with Alzheimer's disease decline and suffer. She wrote about the unnecessary suffering caused by doctors, nurses, and families who are on totally different pages regarding end-of-life issues. She realized doctors tend to avoid these conversations and families can remain in extended denial of dementia. This book is intended to help families understand dementia and its associated behaviors in a down to earth manner. Dr. Severson uses a great deal of humor as not to scare people from the subject. She also discusses several other important issues, but mainly how we can better allow families to learn to let go of those with end-stage illness. Dr. Severson hopes to prevent unnecessary and potentially harmful medical interventions as well as allow more geriatric patients to die in peace.

Product Details

ISBN-13:	9781620067529
Publisher:	Sunbury Press, Inc.
Publication date:	05/29/2018
Pages:	146
Product dimensions:	6.00(w) x 9.00(h) x 0.34(d)

About the Author

KAREN SEVERSON, M.D., was raised near the University of Connecticut in Storrs, famously known for cow tipping during down times. She grew up with her mother, father, and four siblings. They all played sports and had some wicked good snowball fights. She went to Ithaca College to become a Physical Education teacher. After hating that major and switching to a Biology nerd, Dr. Severson went into medical school on advice from a Chemistry teacher. He said she had a good memory! Dr. Severson's world changed after her mother developed breast cancer and died in medical school at the University of Connecticut. She really was impacted by her death and suffering and swore it would not be in vain. Dr. Severson later went to Brown University to complete her Psychiatry Residency training. She decided early she wanted to help the elderly and spent even more time completing a Fellowship in Geriatric Psychiatry at Albert Einstein College of Medicine in New York. The next 20 years of her life was spent treating elderly in hospitals and nursing homes. Dr. Severson never stopped thinking about how to make the lives of people suffering from terminal illness better. She had to write this book before she herself died.

Dr. Severson is married to an amazing wife with three daughters and she makes sure to teach them girl power daily. She still plays flag football, tae kwon do, and soccer, but needs to tone it down. She keeps breaking bones! Dr. Severson works more in the addiction field now, wanting to try to save young lives. One day she will retire in that Woodstock Nursing home, always trying to laugh and have a good time.

Read an Excerpt

CHAPTER 1

Let the Shrinking Begin

* Finally, a tell-all book from a doctor who works at the heart of this situation

* It is important to help Grandma. She is a "love nugget"

* The importance of perspective and humor when dealing with dementia, death, and dying

* The QQ equation: Quantity versus Quality

"Do They Think I'm Crazy?"

It's time for a psychiatrist to do a "tell-all" book on nursing homes, dementia, and your grandmother. Yes, grandma needs shrinking, and I am more than willing to do it. I've seen thousands of elderly in nursing homes at this point. I have been up and down every urine-decorated hallway and food-splattered dining room. I am actually pretty tired, but not giving up. I am ready for the next customer. The next customer could be your mother.

You never know how that first minute will go with a new elderly patient until you walk into the room. I wish I could record the look on some of their faces when they realize I have been asked to evaluate them. No one ever tells them that I am coming. "Why do they think I need you? Do they think I am crazy?" is the usual response. I have developed several appropriate answers to that question, one being, "I hear you are crazy and I came to see with my own eyes." No! Of course I don't say that! I say, "Is it true what they said about you?"

Okay, I will be serious (which I find completely boring). I always do the mature thing and educate them that we really don't use the "crazy" word any longer. I may tell them "I consider crazy running down the halls naked, and as you clearly have clothes on, all is good." I know, it's a broad definition of crazy, but it always makes them laugh and it gets me in the door.

I realized very quickly that people are afraid of psychiatrists in general and even more so in their grandmother's bedroom. I thought we were not worse than the dentist, but I think we are — somewhere in between a toe clipping and tooth pulling in order of avoidance. I have had families ask me, "What's the point in seeing a psychiatrist?" Yes, it is hard not to feel totally useless at that point.

Helping Grandma

Grandma is old, but she is not beyond helping. Age doesn't always make you set in your ways. Well, time does seem to settle things, but it does not always cement things. I saw in a feel-good magazine once how a ninety-year-old woman stated she always wished she would be learning till the end of her life. She would appreciate a good shrink. What an awesome attitude. I hope I end up feeling the same way too at her age. Although there are days I think, this woman needs to take a break from time to time. Doesn't she get tired?

Oh my friend, there is so much to tell. I want to take you into the world of nurses and doctors, what they say and think. Yes, you all see the nurses and aides staring back at you from the nurses' station when you walk in the home. Many times they stare at me too. Sometimes maybe they just have gas — who knows. Maybe, it is something deeper. You don't really know what the staff in nursing homes are thinking. Well, I am going to take a stab at interpreting for you what they might be thinking. It may be good, possibly bad, or it may be as useless as adding gravy to the nursing home mystery meat to make it taste better. How do I know all this? I have worked in nursing homes day in and day out for the last twenty years. I see the sick and dying to the wild and rowdy. I have always struggled on how to refer to them. They all hate the words "geriatric," "senior," "elderly," blah blah blah. There is no perfect word, but I like to think of them as my love nuggets. Why nuggets? Well, we do shrink as we age, hence the "nugget" factor. They are little nuggets of love. I can't lie, there are some mean nuggets too — but most I love. This book is for and about my love nuggets.

Now for the serious side. It's so hard to be serious in this world. If you see and take everything seriously, you'll burn out fast. Actually, I did burn out eventually, but I think I squeaked out a few more years with being able to laugh. Humor is one of the highest coping skills we can develop. Laughing at ourselves and others must happen. Even in death and dying I can find humor. Don't worry; it takes a while to get there on that one. Once you get over the initial shock of all these life and death subjects, it is easier to laugh. We watch as people become ill, suffer in pain, or die. You have to admit, it's hard to cope with it all. Even the subject of dying: it doesn't seem like a laughing matter. Trust me, I will find a way to the humor in just about any situation. Apparently this is how my brain works; I just decided to accept it. It will take a while for you to get there, to discover the light and humorous side of a difficult situation, so sit back and enjoy the ride.

There are several other issues we have to cover. Life in the nursing home, what is it really like? I have the behind-the-scenes undercover view. I have been in all kinds of homes. Rich ones, poor ones, good ones, and really smelly ones. By the way, the sniff test is not always the best indicator of good and bad homes. It might just mean the builders chose carpet not realizing people would be urinating in the air conditioning units and in decorative trees in the corners. Carpets sure hold smell. I offer a chapter about how to pick a home; I have done this work so long, I wanted to offer my advice.

However, this book is focused on exploring dementia and what its like for love nuggets with dementia to be in homes. If you think about it, we get to leave, and the residents have to stay all night. I know, you feel guilty. I wish I could help you on that one. I think they have books on dealing with guilt. But I can actually make you feel even worse. Not only do the residents have to stay, but they also have to deal with brain and body issues on top of it. I know, you would not be reading this book unless you did have some degree of guilt.

Making the "Right" Decisions

All kidding aside, I'm not trying to make it worse. I just want to explain what dementia really looks like and issues that arise with dementia. I think in the end, it will actually help your guilt. I know what you are dealing with — you will hopefully be a pro and make the best decisions for your family. There really are no "right" decisions, there are only well thought-out ones. It's weighing all the facts and coming to what is best for your parent. It will sometimes be for situations that seem impossible, probably because they are impossible. You just have to make some sort of decision and go with it. Get used to the guilt and learn to ignore it as much as possible.

Another way I deal with guilt is by trying to build up good karma. I figure I may end up as a nursing home resident one day. I get asked that repeatedly by my patients, "Wouldn't you be depressed if you were here?" Here is how I would love to answer that question in my head. My thought is that if I am going into a home, I am going to go out with a bang. I want at least one food fight. I will look for a gay nursing home as well, since gay men do the best decorating and party planning. I am also hoping they will legalize marijuana in nursing homes. I will look for a home called Woodstock Nursing and Rehab. I one day may actually say this to someone to just see their reaction. I am hoping most would want to sign up. I would remind them to hook up with a crafty family member who can sneak scotch into your bedside Styrofoam cup. Plenty of homes have bars, but trying to get much alcohol with the eight to ten other medications, you have to take is not so easy.

The QQ Equation

You would think I was a total addict and partier, but I am actually not. I just believe in what I call "the QQ equation." This equation is just something I invented to help me make decisions about life in a home. It actually is the quality of a life versus quantity of life, hence the QQ equation. Let me give you an example of what I mean by this equation in a scenario that comes up frequently. I have seen diabetics who love chocolate. So say this diabetic keeps eating chocolate and then develops poorly controlled diabetes. Should they stop eating chocolate? Your gut response is: "of course!" Your diabetic may lose their eyesight or kidneys if they don't control their sugars. Now what if they have lost a foot to the disease or a kidney because they have been ill for some time. So at this point, do you avoid all foods that give you pleasure if your quality of life is suffering? What if I am that same diabetic with horrible heart, kidney, or circulation issues? Does the situation change for you? Maybe you need to hand over that chocolate nice and slow? I personally, at that point, would just go for the Oreos. I don't want to know I have an expected short quantity of life and avoid anything that gives me some quality. Others may see the solution differently, but again there are no "right" answers. This is just one small example of hundreds of decisions we have to make on daily basis. I like to use my QQ equation as one factor to consider.

I do run into opposition when I try to apply the QQ equation. There is sometimes a price a resident pays for going for quality of Let the Shrining Begin 5 life over quantity. Let me explain. I get all kinds of requests to see "noncompliant" residents. No nursing home wants a person who can't follow the rules. If you don't follow the rules, the home gets in trouble. The state surveyors are looking at every decision made and the consequences of those decisions. The diabetic with the high blood sugars makes it look like nurses are not doing their jobs. The complications of the diabetes make it look even worse. What if the patient develops a foot ulcer or pressure sore from the poorly controlled diabetes? You now have a wound care issue. The state surveyors, who visit on a regular basis, look at wounds closely. Surveyors finding wounds can ruin the home's reputation and open doors to the lawyers. The Oreo cookie is becoming less and less appealing for the facility. I get called in to make that person "behave" and follow the diet. Of course, families are also not happy when a non-compliant resident develops complications. I would not expect them to be! Sadly, there is not a perfect way to make a resident be compliant! We can't hide every cookie in the building. Trust me, I have seen diabetics wipe out cookie trays. As you can see, there are always constant issues that have to be weighed and reweighed. The decisions for me always go back to what improves the quality of life, regardless of whom it upsets. The resident determines what is the quality of life they seek. Each decision a patient or family makes is very interconnected to a number of other issues — whether it is obvious or not. I think this is why I made the QQ equation. It helps lead to solutions in some horrible situations.

In the next chapter, I'll tell you a bit of my personal story. You may find in it parallels to your own life.

CHAPTER 2

My Personal Journey: Exposure to Dying

* Facing mortality

* Mom's troubled life

* Childhood with my mother

* Mom's cancer — waiting for a cure from God

* Frank honest talk with a dying parent

* Letting go

Before I go on to talk about nursing homes and dementia in a deeper degree, I want to tell you a story about me. If you know my story, you will see how I have formed the opinions that lead me to where I am today. But first a quote to get you in that mental space:

Everything that is born from causes and conditions is perishable. Impermanence contradicts our feelings of the lasting quality of time and our human desire for immortality. It is the unbearable for the ordinary beings that have not trained their mind to conceive of the world's absence of reality. Denial of impermanence represents one of the main causes of suffering in our existence.

— His Holiness, the Dalai Lama

Oh! I said I would start slowly. Oops! Well that quote is about as serious as a punch in the gut. The denial of death. But he is right, we need to think about these issues,so let me begin softly and slowly to take you there. This is your second warning in case you want to back out now.

Mom

My story is where all our stories begin — with our mothers — the first relationship we form and, to me, the deepest. She is also the person with whom I first experienced what death was like.

Mom passed away many years ago, but her life taught me so much about death and illness. She died of breast cancer while I was a medical student. Of course, as a doctor, I wanted to use what she taught me for my patients. I don't know if she ever knew I was watching her so closely.

My mother was a real firecracker, always outgoing, and she loved to say things to startle people. She used to smoke a cigar for the shock and awe effect. Back then, women just never did these things. I think her personality reminds me of the many elderly I see now; anything they think of will come out of their mouths — for better or worse. She was a beautiful Italian woman, with voluptuous lips and high cheekbones. She was a natural beauty, and she looked very Sophia Loren. She had had a few modeling stints, but she threw away all the pictures. She never really appreciated her own beauty. As with many models, her self-image was horrible. She was emotionally needy and reliant on others to prop her up and boost her self-image.

She had a horrible upbringing, and later she married to find love. She had three children but abandoned them to foster care. She was not emotionally available for them, and she was so wounded. After meeting my father, he did help her get back two of the three children. The third, no one heard from again. That very sadness of losing her son tore at her soul to no end. She would tell us it was her biggest regret.

My Childhood: The Deer Head on the Wall

I was born in her second batch of kids, the middle child. I always saw her sadness even when I was very young. I intuitively knew she had us to help give her the love she so desperately needed. I was that shy and introspective kid. I observed everything, even when no one knew I was looking. I watched what made her happy and what made her sad. I tried to make sure she had more of the stuff that made her happy. She thought of me as most like her. I had her high cheekbones and big smile, a smile that felt like it took up most of my face. I was her mini me. My siblings were not happy about my status. They did not know that it came at a high price.

My real dilemma started when I was about sixteen, when she developed breast cancer. I had no idea what was really going on, as no one would explain it to us kids. She came home one day with a large surgical incision, and her breast was gone. I honestly had no clue what that was about. I just felt a little queasy looking at it. So as you can see, obviously my family did not discuss feelings a great deal. It was like when you walk into some home and see a dead deer head on the wall. You want to say, "What the hell is that god awful thing," but you have to keep your mouth shut so as not to offend anyone. The deer's head stares right at you and you feel completely uncomfortable. Okay, let's just look away and try to avoid it. That was what her cancer was like to my family, the big dead deer's head in the room.

She was cancer free for some time. It did return in about five years. She had waited too long to get it treated in the first place. I later asked my father why she didn't try harder to treat it earlier. My father told me she kept waiting for God to heal her. Hmm ... waiting for God to heal her. Figures my Mom tried that — conventional was never her.

Later on in life, I remember reading a story that reminded me of this situation. It was about a man who asked God for help heal his serious illness. His wife sent him several doctors to see if he could be cured. He refused to see the doctors. He was sure God would help. He ended up dying and going to heaven. When he arrived there, he asked God why he had not saved him. God said, "I sent you several doctors to help you but you told them no." I realized then that God sends to you what you need: it's up to you not only to see but to be open to the help or accept it. Well, I guess I could be angry with my mother for just waiting for God to heal her. There were times my heart ached with why she waited for a holy cure. I know how much God meant to her, and this was her chosen path. This was her destiny — the way it was supposed to go. People have to learn things how they need to learn them, not how we think they need to learn. I always knew things happened the way they were supposed to, and I am at peace with that now.

After the surgery, she did finally try a combination of both medical and natural treatments. She had a very quiet oncologist. (I think all oncologists are quiet. I have never met a loud, boisterous one ever.) He did try chemotherapy and radiation on her, but honestly, it was a horrible experience. When you are trying to kill cancer cells, you kill many other cells — that you kind of need. It's like taking a machine gun and blowing apart an ant on the ground. I am not an expert in the field of oncology, but this is just what I learned from my experience with my mother.

(Continues…)

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Excerpted from "Look, I Shrunk Grandma"
by .
Copyright © 2018 Karen Severson, M.D..
Excerpted by permission of Sunbury Press Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Chapter 1. Let the Shrinking Begin

Chapter 2. My Personal Journey: Exposure to Dying

Chapter 3. What Is Dementia?

Chapter 4. Nursing Home Dilemmas

Chapter 5. Pills, Pills, Pills

Chapter 6. A Typical Day

Chapter 7. Letting Go

Chapter 8. Letting Go, Part 2

Chapter 9. How to Choose a Nursing Home

Chapter 10. Advice for the Baby Boomer

Chapter 11. Happy Endings