Winning My Battle with Osteoporosis, Part 2

I'm Not Slowing Down
by Ann Richards, Richard U. Levine, M.D.

(Page 2 of 2)

Mama's new apartment was really quite pretty. It was important that she have the option to prepare her own meals or choose to go to the central dining room because I wanted to be certain that she could remain independent for as long as possible. At first, Mama was adjusting well and I think having other people around gave her back some of her confidence, but then she fell and broke her hip. I do not know how long she lay on the floor before someone found her. Now, for anyone to experience an accident is difficult, but for older people, it is traumatic. There are so many different stages of treatment that require different facilities, different doctors, and multiple medications. They lose track of where they are and for what reason. They go to the emergency room and there is one set of doctors and nurses. Then, from the emergency room they are moved to a regular hospital room and there is another set of doctors and nurses. If they need to have a bone set or have surgery, there is another specialist and a new group of nurses. Once past that, they are moved to a rehab center, where there is a new group of therapists, nurses, and physicians. For those who leave the rehab but are not well enough to go home, there is a way-station facility and another set of personnel. And then by the time they get home, if they get home, there is a home-health care nurse and a rehab therapist. And on top of all this confusion, they have to decipher the label on the medicine bottles that instructs them on what to take, how much, and when. It is no wonder my mama became terribly confused when she broke her hip.

When Mama got out of rehab, she was unsteady on her feet and could not return to her go-go apartment, so while she recovered, she stayed in the slow-go section of the assisted-living facility. We all wanted what was best for her, but looking back, I think moving around like that caused Mama a great deal of confusion. Even in the go-go apartment that was furnished with her things, she sometimes became puzzled about where she was. When she left the central dining room, she would get lost looking for her apartment. As Mama was shuffled around from one place to another after her accident, her confusion escalated. When she was in the rehabilitation unit, the doctor would question her and Mama would answer, "Well yes and thank you"-always very courteous-but after he left the room she would say, "Who was that?" And I would say, "Well, that is the doctor here in the rehab center." "Oh," she would say with resignation.

Mama had to use a walker and she hated it. Now began a real, real serious loss of cognizance, and this time in her life is a very painful memory for me. We visited her a lot, but she would forget anyone had been there and the very next day after one of us had been there, she would ask why we never came to see her. She would call me or my daughters and say, "I am at a hotel downtown. I need somebody to pick me up." I put some of the furniture from her go-go apartment into the slow-go room so she would see familiar things. When she would call me in confusion, I would try to talk her through it. I would say, "Mama, you see those chairs there? You remember we got those chairs covered in that new fabric?" And she would say, "Yes." "So you know that those are your chairs and you are in your room." And she would say, "Well, I guess I am." Once I went into her room and found she had written "help me" in lipstick on the mirror in the bathroom. My heart broke when I read her message. I just know that she got up in the middle of the night and did not know where she was.

I thank God for the slow-go nursing-care unit in the assisted-living complex because I never would have wanted to move her to yet another location. The facility was really nice, but I had a sinking feeling of sadness every time I walked out the door and left her there. Except for the delusional periods, Mama was not afraid. She did not talk much in those last months, but she wanted us to talk to her. We talked about the weather, what the weather was yesterday, what the weather would be tomorrow, what the children were doing, and what the grandchildren were thinking. Mama did not complain, and she would not have wanted us to complain on her behalf, but she did not have any control over her situation or an opportunity to alter her circumstances. For a woman with Mama's spunk, I sometimes think it might have been worse than dying.

We would take her out for Sunday brunch and that really cheered her up. We would go to Luby's, where she could get her favorite vegetables, and she would tell me that some of the people in the nursing home were really crazy! There was a woman who shouted all the time and a man who never talked at all. The complex had a minister come once a week, and she would attend even though she said he was boring. And a church lady came and sang songs that Mama enjoyed. I remember her seated in a circle with a group of other women. They were rolling a red ball back and forth to each other, a form of exercise I suppose. Even with the walker that she hated, Mama tried to participate in life until the end, but it was obvious that she was dying. I was still commuting between Austin and Washington, D.C., and I was giving speeches all over the country, so I hired someone to stay with Mama all the time, and we got hospice care.

My mother told me at some point in those last few weeks that she had seen her mother, although in reality she had been dead for many years. My mother loved her own mother dearly. She said that my grandmother had come to her room and sat with her.

In the last days of her life, hospice caregivers told us that even though Mama was in a coma, she might still hear and understand what we said to her. The night my mother died I talked to her. I said, "Do you know how you told me you saw your Mama? Maybe you are really going to get to see her." I said, "You know, Mama, I do not know what heaven is like, but if it is there, then Daddy will be there and Grandmother and Aunt Elta. You will get to be with them." My children talked to her, too. Whether that was any reassurance to her or not I do not know, but I like to think it was.

I have come to the conclusion that not only do we have to learn to live well during the years we have, but we also have to learn to accept dying. We should be allowed to live out our last days with dignity. Mama had signed the power of attorney and the power of medical decisions and every necessary document because she did not want to die an ignoble death, but her death was hard. She went through all of the sad, gasping death throes. I keep thinking that as time passes, that memory will fade, but it has not. In her last days, Mama was not conscious. She had to be turned to avoid bedsores. The day before she died, I came into her room to find one of the staff members at the nursing home spooning a black substance into her mouth. Mama was semiconscious and unable to swallow because her mouth was so ulcerated. I was shocked and upset so I said, "What are you doing?" And the woman replied, "I am giving her vitamins." I could not believe it-Mama was dying, but since the doctor had not marked "vitamins" off the chart, the woman had mashed vitamins into chocolate pudding and attempted to administer the stuff even though my mother could not swallow.

I did not realize how strong our bodies are until I watched my mother die. Dying is hard. Shepherding her through those last years was traumatic. The last lesson I learned from my mama was to put my health first. I do not want my kids to remember my last years the way I remember Mama's.

Mama died on February 15, 1997, just after midnight of Valentine's Day. For a long time I felt untethered from the world, like a balloon whose string is suddenly severed.

I often think about what I should have done or could have done when she was dying. I think that I did all I could. It is just that she was failing more rapidly than any of us were willing to accept. I do not think most of us want to admit that our mother is dying. I kept thinking that with every illness, she was going to spring back, because she always had. I would not have wanted her to live one minute longer the way that she was. That is no life. When I think about this sad time, I realize the real regret I have about my mother is that she had to move into assisted living. Not long ago I bought a new condo. It has a spare bedroom I call the nurse's room, and I intend to make the place easy for me to negotiate in my old age. I want to live as long as possible in my own home.

After Mama died, I talked a lot about my mother's aging and dying in speeches I made around the country. I talked about how we have to take responsibility for our own health. We can give no greater gift to those we love than our good health. I tapped into something with those speeches. Women came up to me afterward and talked about their own fears of aging and remaining independent. They talked about their situation with their own aging parents and I realized that there is little shared information about our feelings when our parents need care.

I do not know why I have such a fear that my children might have to be responsible for me when I am old, but I do. I hope I am still doing the same thing I am doing now when I am eighty, but I may not, so I need money in the bank that can support my needs and will let me travel, and indulge my children. I do not want to be limited by the lack of money or by my physical health. These are the two things that women think the least about when they are young. Women are always caring for somebody else. I do not know why it is that way, but it has always been that way.

Mama held on to her gumption for a long time, but her body and mind had given up. If I had known then what I know now about osteoporosis, years before my mama had broken that first bone, I would have insisted she get a bone-density test and from there, choose a regimen to strengthen her bones. It would not have kept her from dying, but her last years would have been better. Watching Mama, I knew I was seeing myself in a few years, and it motivated me to become aggressive about taking care of myself.

Osteoporosis makes living difficult and that is why it is so frightening. The good news though is that new medical information and medications offer women the opportunity to overcome this disease. What matters to me is being independent for the rest of my life, able to do whatever I want without being held back by infirmities. I do not want to end up in a trailer in my daughter's driveway. I have tried to lead an active, productive life, but I did not always take care of my health. I want to keep doing the things I enjoy; so today I make my health my top concern.

From I'm Not Slowing Down by Ann Richards with Richard U. Levine, M.D. by permission of Dutton, a member of Penguin Group (USA) Inc. Copyright © Ann Richards, 2003. All rights reserved. This excerpt, or any parts thereof, may not be reproduced without permission.

About the Author

Ann Richards was governor of Texas from 1990 to 1994, and has been active in politics for over half a century. In 1988, she gained national prominence with her keynote address at the Democratic National Convention. She divides her time between Texas and New York City. Her personal osteoporosis regime includes a careful diet, weight-bearing and aerobic exercises, vitamins, and Evista.

Richard U. Levine, M.D., is a Clinical Professor of Obstetrics and Gynecology at the Collage of Physicians and Surgeons of Columbia University and Attending Physician at New York-Presbyterian Hospital, where he serves as Vice-Chairman in the department of Obstetrics and Gynecology. He has provided the medical expertise in I'm Not Slowing Down.