When I got the call back in June from the speech therapist at ManorCare, I must have been in denial.
“She’s not eating well. She seems to be having trouble swallowing,” the soft-spoken, kind woman said to me over the phone. I didn’t believe her. I didn’t want to anyway.
“I don’t think she has a problem swallowing. You just have to understand that she’s like a child during mealtimes. She doesn’t focus and she’s easily distracted. You have to keep her focused on eating.”
“Perhaps putting her on a mechanical soft diet would help,” she went on.
“We’ve tried before and she hated the food. ‘That looks like shit,’ she’d say. But I guess we can try again.”
I agreed to it, but then the next day called the speech therapist back and changed my mind. I just knew she wasn’t going to eat her food that way and I didn’t want to put her through that again.
I decided instead, to spend more meal times with Gram and bring her food that I thought she might like. Historically, I hadn’t visited much at mealtimes unless we were having a family gathering. When it was just the two of us, I was a distraction. Gram would constantly try to give me her food instead of eating it. “Here, it’s yours,” she’d say as she tried to hand things to me from her tray.
“No, that’s for you. Go ahead, eat it,“ I’d urge.
“No, that’s for you. Go ahead, eat it,“ I’d urge.
In August, I got another call. This time it was a nurse. She said Gram lost five pounds in the last month. She wasn’t necessarily asking for action or making suggestions, she was just expressing concern. I had to step up my efforts. Gram was always trying to “fatten up” other people. Now it was my turn to fatten her up.
Around that time, I had read an article regarding Alzheimer’s patients and their eating issues. The author suggested minimizing the number of things on the patient’s food tray. The article went on to suggest that too many items can be overwhelming for the patient. They don’t know where to begin. Minimizing the number of items helps them focus. The article was timely and made sense to me. It was certainly true for Gram. When she would get her tray, she was immediately interested in all of the things on it – the carton of chocolate milk, the soup, the pudding, and the coffee, etc. “What’s this?” She’d say as she picked up each item and held it in front of her or tried to hand it to me.
I tried this approach during the recent visits at mealtime. First, I removed everything from her tray but the main course. I helped her focus on that. Once she was finished with the main course, I would remove it and bring forth the next item. It seemed to work, but I only had a few tries at it before she just didn’t want to eat at all anymore.
I started bringing milkshakes and burgers or fish sandwiches and french fries from McDonald’s. At first, she’d eat most of the burger or sandwich and some of the fries, but soon, it was only a few bites, then eventually, none. She’d still drink the milkshake though and I was happy to get at least those 670 calories into her.
I began to add things to the milkshakes as she drank them down. I added chocolate milk at first, and then I began using nutrition drinks. Each of these had 325 calories. Sometimes I could get her to drink all of it - the milkshake and the nutrition drink. It was close to 1000 calories. That made me happy. And when she seemed disinterested in drinking any more, I’d wheel her around the floor. Having the drink in her hands and being distracted while I wheeled her, she would inadvertently drink it down.
Over the weeks since the calls from the speech therapist and the nurse, Gram’s appetite waned as did her strength. On some level I knew what was happening, but denied it. She had gone through periods before of not eating and she always regained her appetite. After all, she was on hospice twice and discharged!
I was hoping my attempt at the extra calories was helping, but Gram continued to lose weight. On October 5, during my routine visit, I asked the nurse, Rachel, to check to see when she was last weighed. It was the day before. She was 105 pounds. I asked about her weight history. She was 117 on July 23 and just as early as a week ago, she was 107. She had lost two pounds in the last week. It seemed my efforts were futile.
“Maybe I should engage hospice,” I said to Rachel.
“Do you want me to call them?” She asked.
“How about having the doctor see her first?” I replied.
She submitted the request.
Thank for sharing this beginning. I have heard you speak often of these things, but my first chance to read it.
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