‘Alert and chatty’ is how the palliative care doctor describes my mum, in her log book, after her weekly and sometimes bi-weekly home visit. Positive and encouraging words. Optimistic adjectives. Happily, also true.

My mum is sharp witted and cheeky with her answers and responses to questions and queries posed by her palliative team. She has an almost familial and casual relationship with her very attentive doctor and nurse team, who attend to her on-going ailments and concerns. The duo, from Beacon Hospital, came on board in October. A timely palliative care service at this stage of my mum’s life.

Briefly, right until August of this year, my mum was relatively well for her age. That is for an 88-year-old with heart disease, Chronic Obstructive Pulmonary Disorder (COPD) and arthritis.  She hasn’t cooked, cleaned or wash-upped in a long while but she was in charge of her own personal care.

August 10, she fell off her bed. Her health took a turn for the worse. Medical exams were done. Echocardiogram, CT brain and CT abdomen and pelvis scans revealed distressing conditions. The Echocardiogram was the most worrying. Her Left Ventricular Ejection Fraction (LVEF) was at 28% in August. From 35% in June of 2021. Drastically down from 54% in 2019. EF is the percentage of blood the heart pumps with each heartbeat.

My mum’s earlier/initial memory loss and confusion, not vascular dementia or early on-set dementia like I wrongly labelled, was due to her weakened heart, fluid retention and medication. She also appeared to be disorientated and disinterested. Thankfully, the palliative doctor was quick to diagnose and solve my mum’s medical problem. My poor mum was debilitated.  She was unable to eat, walk or sleep comfortably because she was weighed down by fluids. The prescribed diuretics regime worked in three short days. That was the turnaround she needed. I like my mum’s palliative doctor. I trust her judgement. She has my confidence, and my mum’s interest at heart.

Today, my mum’s appetite, thanks to diuretics and sister number 3’s cooking, has returned. She can walk more steadily, with assistance. She needs help with her personal care – toilet and bath. She’s lost a lot of weight. A featherweight at 35kg. She has constant phlegm in her lungs and throat. Her COPD has not gone away. Aches and pains plague her. Her arthritis has not gone away.

Her night sleep is now mostly uninterrupted. With the help of Xanax, a prescription sleeping medicine. But, she tires easily, and still needs hours of sleep during the day to recover.  She sleeps immediately after her morning shower as the process and hot/warm bath exhausts her. A long nap follows after lunch to replenish the energy used to digest her meal. Her scarily low EF has not gone away.

Despite the mixed symptoms, my mum is making progress, albeit slowly. Last week, I asked the palliative doctor if she had a mobile echocardiogram machine that could test my mum’s latest EF. In August, it was 28%. She very gently said that it would have certainly dipped further. Having already ruled out invasive medical treatments especially at my mum’s age, knowing her EF would be purely academic. The other consideration was how the EF might impact us – my mum’s children. Emotions, sensitivities and practicalities in dealing with my mum’s condition. My mum doesn’t quite understand the significance of EF but is aware that her heart is very weak, and she needs the oxygenator 24×7 to help her breathe normally.

Sister number 3 and me, on the other hand, understood immediately the doctor’s reasoning. My mum’s heart is failing. That’s a given. How quickly? We don’t know. Just hearing her rationale made me gloomy and teary. I was instantly sad. My chest felt tight. I knew I had to quickly shake off the feeling of dread that was clouding my head and heart in order to concentrate on was being said.

I thought about that EF number. My mum’s palliative doctor was/is right. Knowing the number was irrelevant. What’s important is helping my mum stay comfortable and happy for as long as possible. Any stress unsettles and regresses her progress. Anything new and unfamiliar is disconcerting and overwhelming. My mum’s health is fragile, and will only become more fragile. Her heart is weak, and will only become weaker. Her mind, gratefully, remains lucid, and she smiles easily and is content.

My mum is hugely important to me.  Her deteriorating health is a persistent worry. What can I do? The plan is to enjoy her every day. To care for her. To cook Indian food that she prefers although not quite the delicious variety sister number 3 whips up. To identify Tamil comedies she can watch on TV. To maintain a familiar and happy home for her. And, to always love her.