Monday, January 19, 2015

TIA

Mom’s brain inexplicably shifted into overdrive on a Friday evening two weeks ago.

Did the argument with her caregiver upset her? The package sitting by the post boxes in the care home wasn’t from me for Mom, as she insisted, it was addressed to someone else.

After a few exchanges, Mom’s caregiver Cindy said, “okay,” and let Mom take the box. Placing it on her walker seat, Mom pushed the walker to her apartment, let herself be given her pills and put to bed as usual. Cindy returned the box and went home.

Seven hours later, at one in the morning, Cindy was waked by a call from the nurses at the care home: Mom, in her underwear (which meant she had taken off her nightgown), had walked to the nurses’ station in another wing intending to pay her bill.

Mom doesn’t pay bills. She hasn’t for years.

Cindy raced to the care home.

Mom had ransacked her apartment, torn her bed apart, unrolled toilet paper from room to room and thrown her many books from the coffee table to the floor.

It occurred to me as I’m writing this to wonder if Mom had remembered the box (unlikely, we would have thought) and was looking for it.


Eighteen months ago, on a Sunday morning in July 2013, Cindy arrived to find Mom sitting in her chair with her head back and unresponsive, catatonic. The ambulance arrived, took Mom to the nearby hospital where she was not hooked to a telemetry device but was monitored and a CT scan was done. We all thought she was dying. She slept, or was semi-unconscious, but picked at her hands and moved her feet in the bed like she was walking.

Due to fly to New York the following day, I changed my plans and left very early Monday morning for Nebraska. While connecting in Denver, I called my sister. Mom was sitting up in bed, as if nothing had happened, demanding breakfast and to go home. It was too late to try to get to New York so I continued to Nebraska. Mid afternoon, I arrived to find Mom sitting in her chair, as she would normally have been at that hour, reading a book.

Mom had no memory of her experience and was puzzled for two days as other residents in the care home expressed surprise at seeing her going about her normal routine. Everyone thought she had died.

Reeling from the emotional whiplash, my sister and I found ourselves Googling Transient Ischemic Attacks also known as TIAs.

Since that episode, Mom has lashed out in anger, argued with Cindy, done and said peculiar things we attribute to her dementia. But she’s not had another incident that required hospitalization.


Responding to the nurse’s call two weeks ago, Cindy arrived in Mom’s room about 1:30 AM and tried to get her back to bed. Mom was having none of it. As the night wore on and Cindy pieced the apartment back into order, Mom began methodically dipping her fingers into a glass of water and licking them. She was “taking her pills”, she said, and angry that she had so many to take.

This went on for hours.

She refused to eat, drank very little water and chose to poor her coffee on the cereal Cindy prepared for her. But, aside from her anger about the pills, Mom wasn’t upset. She knew who she was, where she was, knew Cindy. And she certainly wasn’t unresponsive as she had been the first time something unexplainable and unending happened.

Mom didn’t want to speak with me at our regular morning chat time but was encouraged to do so by Cindy. The conversation lasted only seconds and Mom, “furious about all the pills,” went back to the ordeal of taking them.

Mid morning, without warning, the pill taking ended.

Mom began obsessing about numbers, black cards and red cards, touching her fingers and hands as if pushing buttons. The verbal monologue about card colors and numbers didn’t seem related to pushing buttons.

Around ten, not knowing what else to do, Cindy and my sister took Mom to the emergency room. In her hospital gown, patterned with little squares and circles, Mom began pushing those “buttons” while chatting about black and red cards.

“You can have the black nines, Cindy.”

Still understanding perfectly who she was and where, Mom recognized her doctor and asked about his family. But the bizarre behavior continued.

Blood work and a CT scan showed nothing unusual. After four hours in the ER, my sister opted to take Mom back to her apartment and leave her in Cindy’s care. There was nothing the hospital could do but recommend we discontinue one of Mom’s drugs on the off chance this second episode wasn’t a TIA but something else.


In October, I visited at the beginning of the month and again at the end for Mom’s birthday. Sparing the details, after my second visit we added an incontinence drug to Mom’s limited medical cocktail. She received it once a day in the mornings and it proved extremely effective. One of the side effects we were cautioned to monitor was confusion.

We have been extremely careful with Mom’s medications. She is on very few. When adding one, we measure pros and cons and do our own research in case of contraindications. We had a few extremely distressing incidents with Daddy when we blindly accepted a doctor’s recommendation. We no longer do that. Skepticism is now our watchword.

Was it possible that after only two months this incontinence drug, which had made such a positive difference in Mom’s life, could cause this schizophrenic behavior? 


Leaving the hospital two weeks ago, my sister took Mom to McDonald’s to try to get her to eat. When offered food or drink, Mom very calmly refused saying, “I just have to get this done.” In her mind, she had some sort of project to accomplish but we never learned what it was. Our only clue was her obsession with cards and numbers and her constantly touching her hands and fingertips to themselves.

This went on all day. Mom did not sleep. Typically she sleeps, naps or lies in bed an average of fourteen hours a day. Towards evening, still without food, drink or sleep, Mom decided that she and Cindy were going to “wash walls” in the apartment. Mom stood for hours scrubbing the walls with her dry hands. Her stamina was unbelievable.

Finally about 5:30 Sunday morning, after what we can guess was about thirty hours, Mom, nearly falling over in her exhaustion said, “I can’t go any more” and Cindy was able to get her to bed.

Rest was what we’d all been waiting for to see if her brain would reset while she was asleep.

The episode eighteen months ago lasted less than twenty-four hours and Mom was nearly catatonic rather than manic. Since this second event was so vastly different from the first, we had no idea whether sleep would perform its miracle a second time.

But it did.

When Cindy woke Mom about 1:30 that afternoon, in the hopes of getting her back into her routine, Mom had returned to what now passes for normal. With Cindy’s help, she showered, dressed and ate a bit of stew and cornbread that Cindy’s daughter had prepared. Then had ice cream as a treat.

I spoke to Mom mid afternoon. Despite obviously fatigue, she was cheerful and alert. Our conversation touched the usual topics and went round and round familiar circles.

It took another day and a half for Mom to become fully rested and back to her routine, for Cindy to cease round-the-clock care that she’d organized with her brother and her daughter.

And for two weeks, Mom was chipper and sweet, loving and happy, alert and lucid.

Then, after a follow up appointment with her doctor, we chose to put Mom back on the incontinence drug. Within thirty-six hours she became extremely confused: “where am I, what do I do now, have I had breakfast, can I put the blanket over my legs?” Again she was wandering the halls overnight but this time arrived, showered and dressed, at the dining hall at five in the morning thinking it was time for supper.

Again, Cindy was called and, in turn, called me.

Hours later, by the time I spoke to Mom at our regular morning chat, she was perfectly normal again. She had eaten breakfast from a tray Cindy brought her and rested for a while.

Needless to say, we have removed the incontinence drug from her regimen once again.

What is this?

We know, we’ve been warned, that transient ischemic attacks, known as “aspirin failures” because prophylactic aspirin has failed, predict the possibility of a full on stroke sometime in the future.

Are these TIAs? Or are two of these mysteries reactions to a medication?

We don’t know.



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