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Saturday, November 14, 2015

Infarctions and Kalashnikovs (and false alarms?)

"That's some catch, that Catch-22," he observed.
"It's the best there is," Doc Daneeka agreed.
     Things seem to be OK with Ma.
     Today, after class, I dropped by the folks at about 12:30 just to check in. It seemed to me that Ma's speech was much more slurred than it was yesterday. Further, the right corner of her mouth drooped subtly. So I tried to get this crew to think hard: has there been some change? Am I looking at something that's been going on for days and days or is this something new? It was like pulling teeth--plus herding cats. Pa had trouble focusing. Hilda seemed pretty fuzzy.
     I emailed Dr. N, the neurologist (I haven't heard back). Then I got on the horn with the Triage Nurse (or whatever) over at Kaiser. She gave me precisely the load of CYA I figured I'd get. She asked me a series of questions. In the end, she advised bringing Ma to the emergency room, the usual default.
     As I got ready to round this crew up, the nurse called right back: “call 911. That's my recommendation,” she said.
     "Yeah, but I can get my mom to the hospital a lot faster than those guys."
     "No, call 911, that's my recommendation. Do you understand?"
     "Yeah. I'm driving her over right now."
     So I did, leaving Pa here to keep things going (he wasn't ready to leave, too many loose ends). I urged him to just stay; I said I'd call him soon. I implied or said that we were just exercising an abundance of caution, etc.
     So off we went. Got there fast. Ma seemed pretty danged good, aside from the slurred speech. Hilda was good company for Ma and for me. She's from Juarez, murder capital of the world. I joked about the nature of medical care: "poking and guessing," I called it.
     So we hung around like people do at the Emergency Room (Ma got a private room right away). After a while, they X-Rayed her chest, and that didn't show anything. Then, after an hour or two, they Cat Scanned her skull, I guess, and that didn't show anything. So they were getting her ready for the final test, the MRI.
     At that point (about 5:00 p.m.), I drove Hilda back to her car and picked up Pa, and we headed back to the hospital. It was about 6:00.
     Soon after we got back, the doctor said that the MRI showed that Ma did indeed have a small stroke. Later that night, we were told it was an “acute infarction.”
     So she's staying over at the hospital tonight. Drat. 
     I'm back home again—to get meds, feed cats (including TigerAnn, since Annie took her ill-timed trip this weekend), etc. I'll be heading back to the hospital at about 9:00 to pick up Pa.
     So things aren't terribly worrisome, as these things go. She's had these little strokes before (this latest one isn't the nasty hemorrhagic kind). I'm hoping they'll turn her loose again tomorrow. We'll see.
     Meanwhile, Ma has been in great spirits all day. She did a fair amount of talking—with me, with Hilda. I got her to describe her trip to Poland, etc. It was good.
     In the hospital room, at one point, I turned on the TV, where we encountered non-stop news about those terrorist attacks in Paris today. You know how that is.

P.S. [Saturday, Nov. 14]: Got a call from Pa who was at the hospital. According to him, "the neurologist" (not Dr. N) came in, took a look at the various images, and declared that they had been misread and that Ma had had no stroke. "There's no reason to keep her here," declared he (according to Pa). I waited for hours at the house for Ma and Pa's return, but nothin' doin'. 
     Later, I learned that Ma had become agitated, raising her pulse and blood pressure; hence, she was not stable enough to leave the hospital. No doubt, she is upset because she's in the hospital. If she were home, she would not be upset. And so she can't go home, where she'd cease to be upset, 'cause she's at the hospital, which makes her upset. 
     It's Catch-22, the best catch there is!
     Ron told me, "This hasn't been a good day for Ma." (I joined him, late in the day, for a couple of hours. Ma mostly slept. Ron and I mostly talked about the decline of the Honda Motor Corp. and the oddness of needless, forseeable, yet unstoppable, calamity. Aren't we clever.)

P.P.S.: [Sunday]: at long last, Ma was released. Ron, who had stayed with her overnight (Susan and the kids are away in Northern Cal), drove her home by about midday. She seems good, but very weary. I made her her favorite lunch (spicy ramen). She resisted efforts to get her to exercise. Still, all is well. Maybe. I left the three of 'em in the livingroom, with Ma sleeping, Ron doing something on his computer, Pa doing I know not what. 
     Back to the "Hilda" routine in the morning. That's good.
     Unclarity about what happened to Ma this weekend. "Acute infarction"? Or no? I think I'm less likely ever to call the "Triage nurse" again. Sheesh.
     It's just started to rain. It's cold. Teddy says "hey."


Wednesday, November 4, 2015

Wish me luck (resorts)

c. 1950
     Gosh, what a time. A very difficult time.
     By Saturday, Ma started slurring her speech slightly. By Sunday morning, the symptom grew worse, and she was back at the emergency room at Kaiser on Alton (in Irvine). Pa, Annie, I—and Ron, who had arrived for his weekly visit—accompanied her. Eventually, it became clear that the recent and successful effort to thin Ma’s blood to prevent clots and strokes (the bugaboo of the early weeks of this ongoing crisis) had now produced a feared consequence, some sort of hemorrhage. A glob of blood the size of a marble was growing in her brain and damaging (or just affecting?) muscles or functions involved in speech. So it became necessary to reverse gears and to quickly thicken her blood—a situation that would, of course, increase her chances of suffering strokes of the kind that occasioned the thinning efforts.
     A Catch-22.
     A doctor took Annie aside and said something like, “I’ve seen this sort of thing before. This usually doesn’t end well. Be prepared.”
     Good grief.
     Late Sunday, the doctor(s) decided that it would be best to move Ma to the hospital in Anaheim (on La Palma, near Olive Hill), owing to the availability of neurosurgeons (I think that was it) there. So she's been staying there for several days, and so the rest of us have been driving to Anaheim when we can.
     At the Anaheim facility, Ma has done lots of sleeping, much of it bad. She has generally been confused to some degree, and her ability to speak intelligibly comes and goes. Sometimes, she makes no sense at all; at other times, she manages brief coherent remarks. She shows glimpses of her old self, I think. There’s pressure from some of the staff for her to do substantial “oral” exercises several times a day, but Ma generally isn’t inclined to comply with the nurses’ entreaties. She is a difficult patient.

They might be giants
     She has had a tendency to become angry, even agitated. I have not experienced anything I would call "violence." (I’ve seen her angry, but not aggressive.) On Monday, Annie reported that, according to nurses, Ma had been very agitated, at one point even throwing things around the room and pulling out her IVs. Yesterday, she was much better, and she ranged from friendliness to annoyance. When I visited her at the end of the day, she was mostly reasonable and cooperative.
     Today, however, she returned to agitation, even violence, or so I'm told. She took a swing at Annie, hitting her. She pulled out her IVs. Unfortunately, this was witnessed by the case worker. It appears that the professionals (case worker, et al.) will now pressure us to move Ma to a facility for those special (difficult) patients of Ma’s category. The aggressive kind, I guess.
     It is obvious that Ma is continually confused about her stay at the hospital, and it is clear that she badly wants to leave. (Oddly, she often insists on “going to the hospital.”) She often tries to get out of bed to leave. She becomes very annoyed when we tell her that she ain't goin' nowhere. Sometimes, I think, she is furious. It's hard to watch.
     The professionals have seen her at her worst and they’ve decided (I do believe) that she must be moved to facilities designed for such patients. “No,” they say, “it would be seriously ill advised to try to take care of this kind of patient at home. Trust us. She must be moved to that facility. It's what is best for you—and it is best for her.”
     I'm not so sure. She's in a kind of hell now. Shall we move her to a lower circle of hell?
     To my way of thinking, she may be exhibiting aggression exactly because she is confused and desperate, and she is confused and desperate because she is in the hospital. For all that we know, if she were back home, her unfortunate behaviors would largely subside. And, surely, if we move her to the “right kind of facility,” she will become more confused and desperate—and perhaps more aggressive/violent. I am horrified at the thought of moving her to the special facility. I do believe we should at least try to take care of her at home, see how it goes. If we need help, we can hire that. If we need to move her, well, we'll do that.
     But surely that should be, as they say, the last resort.
     So, tonight, I shall arrive at the hospital with the intent of raising some difficult questions—for Pa and Ron—about the professionals’ difficult and perhaps utterly wrong advice.
     Is it time to say "No" to the medical profession?

     Wish me luck.

P.S.: Turns out that Ron and Pa were on the same page and they agreed that we should get Ma home as soon as possible. That's what happened, though we had to overcome pressure to send her to a "facility." We got her home, albeit with hired caregivers, and, so far, things are going well (11/9).

P.P.S.: Ma and Pa and caregiver Hilda seem to get along famously. Things seem to be going very well. Ron, Annie, and I are taking turns staying over in case things go south (Hilda's here from 9 to 5). We're hoping that that will cease being necessary. Ma's doing much more walking and talking--she joins in cooking and such--and, generally, she seems much more active. All good. (11/11)

Saturday, October 24, 2015

Without my walking stick: Ma recuperates

     A couple of weeks ago, it was judged necessary to bring Ma to the emergency room, whereupon tests revealed a significant heart arrhythmia. Doctors decided that she should remain in the hospital until her heartbeat became consistently regular, something to be achieved through drugs.
     Her hospital stay lasted about five or six days. While there, she seemed to be in reasonably good spirits, if a little confused. She started to complain of significant back pain, and so she was given an x-ray, which revealed spinal stenosis. (Spinal stenosis was the stated reason for my first back surgery, more than twenty years ago.) Dr. C commenced addressing that problem aggressively, putting Ma through various exercises every day. That latter included a walk through Ma’s wing of the hospital. 
     Ma tended to lapse into her familiar “good girl” mode during these episodes—i.e., she was determined to please her handlers and not make a fuss. (I had the opportunity to follow her during one of these sessions, unbeknownst to her and her therapist. It was good to see Ma trying so hard to be good.)
     Perhaps it was during the hospital stay (not sure) that it became clear that the onset of Ma’s mental issues had been clouded by a stroke, or a series of small strokes, and these perhaps were brought about by her heart condition. That is, possibly her extreme fatigue which so worried usI speculated that it was depressionlikely had nothing to do with her mental condition but was entirely attributable to her arrhythmia and stroke.
     I’ll see if we can gain clarity about that.
     At the hospital, Dr. C explained to me that Ma’s heart issue would be fully addressed by new medicines. That was a relief. "Not to worry," he seemed to say.
     Naturally, Ma’s hospital stay was taxing on everyone, especially the family. Pa, Annie, Ron, and I  visited her often and often for long hours. I think that we generally felt that Ma was doing well. With some exceptions, she exhibited little of that terrible confusion mixed with anger with which she is now susceptible.
     So, at long last, Dr. C decided that Ma was good enough to return home, though there were provisos: Annie was tasked with administering a “bridge therapy”—a twice-a-day injection to thin Ma’s blood until the drugs kicked in (I think the “bridge” period was supposed to be about five days). Further, a nurse (or some other) would be coming to the house each day to check up on her and to take blood—to monitor blood viscosity, I think. Getting that viscosity right is all important—to avoid more strokes.
     On that great day, taking a break between classes, I ran over to Kaiser at 11:00, to assist with the move, but, when I got there, Ma was off with her physical therapist and neither Pa nor Annie (nor Ron) was around. Evidently, release time had been changed.
     In the end, Ma was released at about 3:00, and she made her way down to the car with the help of Pa and Annie. Everything seemed to go well until later that night, when Ma was to receive her first injection. She wasn’t too pleased about that, though Annie and Pa managed to have Ma lie down and take the shot. Whew! Since that day (about five days ago), the injections have occurred more-or-less without incident (though with some complaint).
     On the first full day at home, Ma balked about the very idea of a Kaiser person visiting the house, but that all got sorted out somehow. It wasn’t easy, I’m sure.
     Pa’s obviously got his hands full and, of course, he is not 100% these days. I’d have to say that, in general, he has really risen to the occasion and has been managing to care for Ma admirably, with Annie’s assistance. (A do what I can, but I do work five days a week.)
     Yesterday, Annie and I spoke about the possibility of her becoming more formally responsible for Ma at least during the week. It’s pretty obvious that formal arrangements will be necessary, for Ma really does require near-constant monitoring, and Pa isn't always up to the task (plus he has things he feels he needs to do). Evidently, one of the strokes that Ma suffered (none of which we detected by the family at the time) injured some of the muscles used for swallowing, and so Ma is vulnerable to choking immediately after meals. She's not supposed to sleep after eating, but just try an' tell her that. 
     Yesterday, just as it was getting dark, I found Ma walking up to my place, alone. I immediately turned the situation into a pleasant “Teddy visit.” That went well, but then she insisted on continuing with her walk alone. I let her go—with the idea of calling Pa immediately. But, just after she left, Pa showed up looking for Ma. So we got in my car and drove down toward the gate, where we found her, just below Annie’s place, stoically marching up the road. Evidently, she had fallen down and had had difficulty getting back up. She didn't seem to be injured.
     The good news is that Ma seems quite capable of walking significant distances at speed, albeit with the help of a walking stick. (I don't think she actually needs it, but who knows.) Her back pain seems to come and go, though it doesn’t seem significant these days. She still struggles with fatigue, and she isn’t always the most cooperative patient.
     Still, all in all, things seem pretty good right now.
     Ron will be visiting in the morning.
     In a few minutes, I’ll roust Ma and encourage to her take a walk toward my place—to visit The Boy. She just loves that guy.
     Who don’t?

Monday, October 5, 2015

1948: bad girls fly through windshields

     Just in case I’ve never told it, here’s Ma’s “flying through the windshield” story. She's told it often. Here's what I remember.
     By 1948, Ma was fifteen years old and was apprenticing to be some kind of City Hall worker, a bureaucrat. There are photographs (see) somewhere of Ma with the three or so other “students”—all of them men—and their teacher. It’s impossible to view these photos without thinking: “hey, those are guys and she’s the only girl!” But Ma always seems to depict the setting as professional; no hanky panky occurred. 
     Ma had friends, of course. She was attractive and unattached and so guys would hang around like they do. At one point, she was with one of these guys—he may have been in his early twenties, maybe a cop. He had a car, and Ma bragged that she, too, knew how to drive. (Implausible.) So he let her drive his car. That went pretty well for a few seconds, but then she plowed the dang thing straight into a tree. She went through the windshield and was pretty badly cut. Not sure about the young man. He was OK, I guess.
     The two were conscious and climbed out of the wreck. They set about stemming the flow of blood from Ma’s forehead and then they walked to someone’s place. Eventually, they took the necessary steps to get her to a hospital. The nearest one was miles away by train or car. And so she/they made the trek. 
     She stayed in the hospital for over a month. She says that her injury was pretty severe: her skull was "cracked open" and surgeons had to piece it back together. She has never reported anything about comas or psychological effects. She has always told this story sans "brain" injury. Nothing psychological.
     Obviously, I’ve always known Ma to have a scar atop her forehead, though it is hardly visible (it is faint, and very near the hairline). She has always seemed somewhat ashamed of it. She's certainly not proud of it.
     A peculiarity of Ma—or of people of her generation, or maybe of German women of her generation—is a tendency to place some events into this odd category: “here’s when I was a bad girl and I paid the price for my foolishness.” There’s a certain head-nodding, finger-wagging, and pouting involved in the telling. 
     UPDATE: I spoke with Ma this afternoon and she has filled in some details. The scene of the crash was along the border of some sort of military instillation, by then taken over by the Americans and other allies. There were two boys who were with her, and both were in the car when it crashed. Ma says that she did indeed fly right through the windshield, but the two guys--I believe she said they were in their mid-20s--remained in the car and were essentially uninjured. They immediately jumped out of the car and carried or led her to a nearby water pump by the side of the road, washing the wound on her forehead. Then they literally picked her up and ran to the nearby village. Eventually, they got her to her home (in Soltau?).
     At some point, Ma's mother (i.e., her Aunt Marthe) came upon the scene and accompanied Edith on the train to the hospital, which was perhaps "30 miles away." Marthe was frantic, inconsolable. Possibly, Oma Losa went along, helping Marthe "keep it together."
     I think Ma said that one of the guys with the car worked for some kind of auto shop; the other guy may have had a taxi (and he was known to give English soldiers useful direction in finding, um, companionship).
     The car was likely a pre-war model held together with spit. There were no parts available at the time. People patched things up as best they could. Ma says that she heard that the car was in pretty bad shape after the wreck, but that she heard that it was made to operate again.
     Evidently, Edith and the others were compelled to fabricated a "story" about how this whole thing came down to keep everyone involved out of trouble. Ma was coached by her mother before she was interviewed by "the detective." In the end, everything worked out. Whew.

Saturday, October 3, 2015

Said she: "It's too late now"

     A lot’s happened, I guess.
     WEDNESDAY. During the pivotal meeting with the neurologist ten days ago (a Wednesday), it became clear that Ma suffers from dementia—not that there was much doubt about that for Annie and me. The neurologist, Dr. Carolyn Nxxx, I’m told, referred to the then-recent CAT scan, which, she said, showed clear evidence of damage, probably scar tissue, likely from Ma’s head injury of 1948, when she flew through the windshield of a car, cracking her right upper forehead (she spent over a month in the hospital). Based on that information and information provided during this meeting (Annie was present to provide more or less coherent sentences), Nxxx became convinced that Ma is indeed suffering from dementia and that, likely, there are frontal lobe issues—possible “seizures”—that are contributing to her behavioral problems, namely, confusion, self-identity problems, changes of mood, curious shaking, imagined strangers, etc. According to Annie, Nxxx suggested that the especially bad five-day periodabout a week or two previouslywas a “fugue” state.
     My dictionary provides this definition of the psychological term “fugue”:
...a state or period of loss of awareness of one's identity, often coupled with flight from one's usual environment, associated with certain forms of hysteria and epilepsy.
     Nxxx told the three, and especially Annie—evidently, Ma and Pa were visibly “out of it” for much of the meeting—that it is possible that there are two issues here, including the lobe issue caused by the old injury plus more ordinary causes of dementia (a more typical presentation of Alzeimers?).
     Ma received a prescription for seizures. The trio was told to wait and see if symptoms changed.
     (According to Annie, Nxxx directed her remarks to her and suggested that Pa had substantial dementia issues as well. Evidently, he was displaying his familiar stupefaction behavior: staring blankly, evidently unaware, etc.) 
     (Nxxx seemed to suppose that Annie was at a crossroads and that she would need to abandon any notion of becoming the "caregiver." It was time to bring in the professionals for these two, insisted Nxxx. Later, when Annie reported all of this to me, I was a little concerned that, for Nxxx, Annie had become the point person re the Ma/Pa care issue. Annie does OK, but she doesn't always separate fact from theory. Like her parents, she tends to embrace a theory and then enforce it in their perceptions and thoughts.)
     SATURDAY. The subsequent Saturday morning, Pa called me and seemed to be overwhelmed by Ma’s aggressive and accusatory behavior toward him. Evidently, she was complaining about being left in the dark about “things.” I hurried overwith Teddy the therapy cat.
     I saw that Ma was confused and angry. Her agitation, if you could call it that, seemed to be about Ron, whom she spoke of sometimes as if he were a child (when he was a little kid, we used to call him “Roonikin,” and that was the term she was using) and sometimes as if he were the adult he is today. Ma seemed particularly confused when Pa or I suggested that these Ronnies are one and the same person. Speaking with her about Ron produced hopeless and repeating circles of conversation, and so we dropped the subject.
     Nevertheless, it seemed to me that Ma had calmed down quite a bit. After a few minutes, she was no longer angry. Remembering what Annie had told me about Nxxx’s directions from three days earlier, I drove down to Annie's place and apprised her of the situation. “We’ve got to take her to the emergency room,” she declared, as per Nxxx’s directions (according to Annie). So that’s what we did.
     Pa resisted, but not much.
     At the hospital (Kaiser, on Alton), Ma continued to be pretty reasonable, not angry, but she remained confused about Ron when the issue was raised. Her sense of the past was somewhat scrambled or blank. Still, she was calm and pleasant and untroubled. We tried to keep her that way. 
     You know how it is at the hospital, especially the emergency facilities. It was your standard “hurry up and wait” scenario. Nothing happened quickly. Our visit lasted five hours, which comprised a consultation with the "on call" doctor, a visit from a neurologist, and an MRI. Sheesh.
     Right away, an attempt was made to contact Dr. Nxxx, but Kaiser could only locate Nxxx’s “partner” (?), who, we were told, was on her way.
     After a couple of hours, the "partner" arrived. She, like Nxxx, is in her late forties. I recall that this doctor's name was something like Haxxx. So, just now, I did some looking and it appears that this partner is none other than Parissa Hxxx, MD—who, curiously, seems also to go by the name P J-Hxxx. (Nxxx and Hxxx, who are affiliated with Kaiser, share an office in Irvine with five other neurologists.)
     Hxxx ordered an MRI. But, before that, she put Ma through some “tests,” with which Ma seemed to do fairly well (she did have trouble remembering one of three words: "Cadillac, ball, dog"). Aside from confusion about Ron, she seemed almost perfectly normal.
     Hxxx also spoke with Annie and me in the hallway. Annie commenced referring to Ma’s earlier “fugue” state, but Hxxx seemed surprised or troubled by that. Evidently, Hxxx was disinclined to suppose that Ma would have experienced a "fugue." Annie also referred to Ma's earlier "profound agitation." I said: It was certainly not profound. Perhaps not even agitation. 
     Accuracy is important, is it not?
     It became clear that Hxxx disagreed somewhat with Nxxx’s preliminary guess as to Ma’s issues. I think her take was that Ma was not suffering from "seizures" at all but that she was suffering from a more ordinary kind of dementia and that, quite possibly, she has suffered a series of minor strokes. (She asked the expected questions about episodes resulting in numb arms and such, but we could recall no such occasions.) 
     Based on her diagnosis, Hxxx prescribed anti-psychotic drugs. 
     Later, an hour or so after we returned home, Hxxx called and reported that the MRI had turned out as she expected. She said, I believe, that there was evidence of some small strokes. At any rate, we were to commence giving Ma the anti-psychotic drugs, which are often given to Alzeimers patients. The "seizure" drugs, she said (I think) would not help.
     (A few days ago, Annie and Ma had one of their usual tense exchanges, and Annie told Ma that she was suffering from "psychosis." Naturally, Ma regarded that as absurd and Annie as obnoxious. I explained the technical nature of the term and that, indeed, some of her symptoms were in the "psychosis" category. She seemd to take that well.)
     I should mention that the last thing Hxxx said to us as she left us in the hospital room was, "I think your mom will be OK." She was attempting to be reassuring. Not sure quite what she was trying to say though. "Could be worse" maybe.
     Predictably, Ma and Pa are a bit untethered and creative in their grasp of the doctors’ reports/guesses thus far. Ma, for one, keeps referring to her old injuryshe points to her foreheadas the simple cause of her illness, which she takes to be temporary, something to be overcome through medicine or surgery. Pa seems to go along with this (not sure). They seem incapable of taking in the divergence and complexity of medical opinion so far. They need simplicity, I guess.
     At least as far as I can tell, the two neurologists presently disagree about Ma and her troubles. One seems interested in that old scar tissue; the other, not so much. (Perhaps it is difficult reading the dark spots on the scan.) On the other hand, they now have more data, including an MRI. Next up—on the 13th—will be an EEG, which might give us a better picture of what actually goes on in Ma’s brain (CAT scans and MRIs, of course, are “snapshots”; the EEG will provide info during extended consciousness; "real time" info).
     In recent days, I'm told, it has been decided that the anti-seizure medicines just aren’t working; we’re waiting to see what the anti-psychotic drugs do. It's too early to tell.
     Because I work, I don’t see Ma but once a day between Monday and Thursday. Annie, who does not work, reports that Ma often starts the day pretty strong but sinks into being difficult and even agitated later in the day. (I don't notice this pattern. I typically catch up with Ma late in the afternoon, and I don't see agitation.) 
     Yesterday, Ma seemed to do well. Or so reports Pa.
     THIS MORNING, Pa seemed to have a good report of Ma’s state, though, he said, she insisted on sleeping all morning, waking for lunch at about 12:30.
     It is difficult watching these two interact with each other. Pa has his own issues. His hearing is poor and he makes no effort to adust by listening carefully. He is in the habit of uttering “huh?” with everything that anyone says or any noise they make, inspiring endless annoyance and strain. He is more likely to be confused than to understand others’ remarks, many of which are not even directed at him though he invariably takes them to be. Ma regularly rolls her eyes. Their confusion routines would be hilariousmuch like Burns and Allen's old schtickif they weren’t, in fact, a likely portent to a sad and dismal decline.
     At lunch today, Ma seemed pretty normal, though she expressed confusion and frustration over Ray's relationship to Ron and Susan and the kids. Somehow, she had the notion that Ray's genetic information (sperm?) is, or must be, involved in the production of Susan and Ron's children—and yet Ray never met Susan. It's a paradox, in her mind. I gently suggested that Ray made no kind of contribution to producing the four grandkids. "Susan and Ron," I said, "managed to produce those four kids all by themselves." That, I said, is normal.
Young Teddy
     Ma complained that nobody had explained the situation to her. I said, "well, you were there, as we all were, when these events unfolded. Really, you weren't left out of anything and everything is OK." She was unconvinced but ceased carping.
     After lunch, Annie came by to work on "the meds" (this seems to take about an hour or two out of each day; not sure why). I helped her as Teddy patiently (and sometimes impatiently) waited for his usual brushing and tickling session with Annie. Pa went off to supervise Luis, who was clearing away branches from oak trees.
     Ma decided to go back to bed.
     After an hour or so, it was finally time for Annie to play with Teddy—in the living room, which is customary (for Teddy, customs must be followed!). But it soon became clear that we were keeping Ma awake (such noise has never bothered her in the past). We quieted down. Nevertheless, she soon grumpily stalked out of the bedroom and commenced busying herself with cleaning sinks. 
     I asked her if everything was OK, and she said that she couldn’t sleep “because of all the noise.” I said that we would leave her now. Said she: “It’s too late now.”
     It's very unlike her to say something like that. It's the angry Edith.
     Annie and I decided to take the boy and leave, and so we did.
     Ron will be coming by tomorrow morning. Annie worries that he will get Ma upset, what with his quasi-psychiatric probings and efforts at reordering Ma's mind. "The doctor said that she's not supposed to get upset in any way," said Annie.