An Ode to Vacation Eating

Apologies that this week’s Food Friday isn’t going up until Saturday, but Owen asked for us to drive straight through Thursday on the way home from picking him up from his freshman year at school, and what should have been about a 13 – 14 hour trip turned into a 17-hour odyssey (I drove all of it) and us not pulling into the driveway until nearly 1 a.m. on Friday. As a result, what I was hoping to write when I got home Thursday night had to wait through a Friday consumed by unpacking, returning the rental mini-van, catching up with mom & dad, and the long-awaited family viewing of Avengers End Game.

Now, at 10 p.m. on Friday, I can finally gather my thoughts and start waxing poetic about my week in food. I love cooking at home, but when I’m on a vacation like this, I like to lay down my chef’s knife to explore local restaurants. So when we were down in the mountains of western North Carolina (with a stop-over in Winchester, VA) this past week, I took every opportunity I could to check out some new spots, from coffee to breakfast to lunch to dinner and there was a treat at every turn, even if I was left wishing for 6 stomachs and another week’s worth of time – there’s just never enough.

Coffee

It seems that in just about every place I’ve been, good coffee isn’t hard to come by anymore; and, with apologies to all the Dunkin fans out there, I don’t mean Dunkin. I’m not bashing them. I just prefer foods and beverages that aren’t mass-produced and homogenized into repeatable, predictable submission, but I recognize that some people like to know exactly what they’re getting. Every time.

For coffee lovers on the road – actually for all food and beverage lovers – Yelp, in my opinion, is the best invention ever. It’s like word of mouth times a thousand, and it has never steered me wrong. On this trip, it was 3 at-bats, and a 1.000 average: Steamy’s in Winchester, Dynamite Coffee Roasters in Black Mountain, NC and The Beehive in Arden, NC. I should probably be more scientific about my coffee excursions than I am, but I’m not on a quest for the best coffee in the country, just a place that gives me some meaningful choices as far as origin, type of processing, roast, sourcing standards, etc. When I say “scientific,” I mean maybe only ordering a pour-over every place I go, or the same type of bean, but that second one is way too variable and would come down to a meaningless comparison of apples (Macoun) to apples (Delicious), and would definitely alienate way too many baristas and patrons waiting in line behind me, which I’m just not that into. So I’m perfectly happy to roll with a nice, simple, unadorned black cup of the brew of the day, and enjoying the amazing variety in fruitiness, earthiness, acidity, etc, of a wonderful range of options. Steamy’s also makes a great bagel (in-house); Dynamite has a can’t-go-wrong featured brew of the day and yummy scones, and The Beehive makes a mean cold-brew.

Breakfast

When you only have a few days someplace with a lot of other attractions (such as, um, some of the most beautiful mountains in the country, and one of the most scenic roads ever built to get you to them), unfortunately, carving out the time to check out different breakfast spots each day may not be realistic. As much of a morning person as I am, alas, a sit-down breakfast every day just wasn’t in the cards. I’m thrilled to report, though, that the one place we did indulge ourselves with was so wonderful that I might not be able to venture anywhere else the next time I’m in Black Mountain. That spot was Louise’s Kitchen. I’m usually more of a savory-breakfast person than sweet, but this time I went for broke with the blueberry waffle and it was excellent – perfectly crispy on the outside and light and fluffy on the inside, and the locally made sausage patty that was one of the side options was unique and delicious. Washed it all down with a “mega-mosa” (because what’s better preparation for a 90-minute drive and sometimes chest-clutching hike to a waterfall?)

Barbecue & Smokehouse

No shortage of either one of these things in and around Asheville, that’s for damn sure. The two we got to experience on this visit were Luella’s BBQ in North Asheville (melt-in-your-mouth brisket, baby; plus hush puppies and collard greens – braised southern-style with that nice, vinegary bite – I was one happy camper!!) and, on our last night in Black Mountain, Foothills Butcher Bar, where I had one of the best pork chops of my life (it was the blue plate special). These guys source everything locally – they know the farmers who raise their meats, and they run their own butcher shop and smokehouse, where they also produce their own cold cuts. My dad is a huge bologna fan, so I snagged a pound and can’t wait to give it a try when I bring it to him tomorrow (because I forgot it in the fridge when I went over to see them this morning). They also made a version of poutine that was incredible – fries done in beef tallow with the obligatory cheese curds melted on top (from locally made cheese, of course!), topped with their own not-to-be-sneezed at “pulled beef” with a beef demi-glace in place of the usual gravy, some sriracha aioli, and, to break through all that richness, pickled red onions and a nice sprinkle of fresh cilantro.

Other Notables

We kicked off our trip on, of all days, Cinco de Mayo, so I think we were all kinda leaning toward margaritas and Mexican food (if we could find a good spot at our stop-over in Winchester, VA). Turns out that we’d just missed the fracas that is the Shenandoah Apple Blossom Festival in town this past weekend, and many of the locally-owned establishments were plumb tuckered-out from the Shenandoah-shenanigans of the thousands of visitors that had overwhelmed them from Friday night through Sunday morning. Thankfully, there was a good Mexican option that picked itself up, dusted itself off, and carried on gallantly, in the rain. And, as it turned out, El Centro in Old Town Winchester makes some pretty mean carnitas, and a decent top-shelf margarita. I’m as picky as they come when it comes to carnitas, to which I was introduced on a visit to southern CA many years ago, by friends who ventured over the border into Mexico fairly regularly, and were capable of finding a truly authentic Mexican restaurant inside of hours of arriving in any unfamiliar city. Those first carnitas were memorable – soft, juicy, just a little fatty, and crispy all at the same time, perfectly seasoned, though I had no idea at the time with what – I just knew that dish would more or less haunt me for years – I never could find anything that came close to it anywhere (even on many visits to Mexico!!). Then, a few years ago, I came across a recipe for it in the New York Times and decided to give it a go. The result was so close to that first taste that it was nearly a religious experience. That doesn’t stop me from trying them at restaurants that offer them though, because, well, you just never know. And this time, while they weren’t quite the originals (or the NY Times version), they were pretty great – they didn’t go all the way to crispy, but they were tasty and clearly the result of the long cooking process and absorption of spices that makes the best carnitas.

Also, as if the Universe were actually paying attention to stuff I write about, I finally got to try a spot on Tuesday night in Asheville that’s been on my list for a while – The Blackbird Restaurant, and what did they have on their menu that night? Roasted marrow. It. Was. Heavenly.

Our post-waterfall hike lunch was at HomeGrown in Asheville (we went to the one on Merrimon Ave.), which bills itself as “Slow Food Right Quick.” That’s exactly what they do, and they do it spectacularly. They balance a lot of challenging variables: practically everything locally sourced; soul/southern food; simultaneously vegan- and omnivore-friendly. The result could be disastrous, but it’s far from it, and I pretty much inhaled a scrumptious buttermilk fried chicken sandwich with incredibly fresh lettuce, pickled onions, sprouts, and horseradish honey-mustard, set off with a side of sautéed ginger-spiked, sesame greens (kale) unlike any I’ve ever had, and I’m a greens-lover. Tim had their cheesy grits as a side to his “Redneck Cuban.” I could have married those grits, or at least slept with them. O.M.G.

Finally, helping to make the 17-hour trip home at least not THE worst travel experience of my life, we found our way to Metro Diner in Middletown, DE sometime around 7:30 Thursday night, after close to 12 hours on the road, and one speeding ticket. One of their specials was a homemade turkey pot pie, which was almost perfect (including the crust, my only criticism for which was that I wished there were more of it). It helped me keep it together for the 4 ½ hours of driving (and crawling through construction within the last hour of the trip) that still faced me. This was the one “chain” I succumbed to (besides the quick in/out fast food stops for breakfast on the way down and lunch on the way back), and it was really OK. Or at least my pot pie was.

Through all of it, we didn’t have even one bad server. Here’s to all of them, and the chefs, and roasters, and everyone else who makes and serves, and cleans up after the food and drinks that speak the deeper language and culture of a place, and make the travel experience that much richer.

Happy Food Friday!!

Mmmmm. . . Roasted Marrow. . .

Done, and Yet. . .

We’re on a short hiatus this week, down in the mountains of western NC, picking Owen up from his freshman year in college. It’s so incredibly beautiful and peaceful here, so far from the dust and decisions of working on the house. I’ve been looking forward to this trip, along with some Blue Ridge hiking for months (I’m typing this on the back porch of the house we’re renting, listening to a symphony of birdsong, led most vocally by 2 male cardinals who are clearly drawing the battle lines around their spring conquest). Thankfully the weather is cooperating, though truthfully, I brought my rain gear because I wasn’t going to let the opportunity to hike these mountains pass if Mother Nature decided on 4 more days of precipitation. I’m hoping for everyone back home that the sunny weather we had here yesterday and, so far, this morning, is gracing them as well, because it has been so incredibly rainy for the past several weeks at home that people are starting to lose their shit.

But, since this is a page dedicated to what’s going on with the renovation, an update: aside from a GFI outlet (and switchplate cover), one or two last pesky plumbing joints to tighten up, and, oh yeah, the door (which means the hallway also has to be finished – a small task I’d all but forgotten needed doing) the bathroom is DONE!! I’ll share the photos in a minute, after I explain how I could have forgotten about the hallway, or why *that* has to be done before we can call the bathroom done.

So first, what does the hallway have to do with the bathroom? Since you asked (ha 😉), I’ll tell you. When we changed the bathroom doorway and made it wider, we had to remove the entire frame (and trim, inside and out) of the previous doorway (recall the
Dr. Jekyll & Mr. Hyde intro from several weeks back). I’d like to say that was the only factor that began the cascade of re-doing the hallway, but in reality, that began at least a year ago – maybe more, but neither of us can remember the point at which the hallway went from finished to unfinished. All I know is that the doorway from the dining room into the hallway was similarly taken apart and, looking at it, it appears that we added some structural 2 x 4’s around the door frame. However, they’ve been flanking the hall-side of that opening, exposed like the cutaway view of bones in an anatomical model, for so long that they’ve become invisible to us, and clearly those 2 x 4’s are too new to have been there since the original house was built.

I think there must be a condition – I’ll call it “Renovator’s Amnesia,” which kicks in as a form of emotional self-preservation when a renovation project hits flood stage, flows over its banks, and messes up parts of your house you never really anticipated it would; and the project, which you thought would take “x” amount of time, grows and morphs into something with a life and a personality all its own as it approaches “x-squared.” You no longer remember all the details, or when you did what, or even why. You’re just happy when you can call something – anything – “done.” Thus it is with that hallway: I’m so used to it in its partially-torn-apart state that when Tim asked me last week what color I wanted to paint it, I was taken entirely by surprise.

Back to the bathroom door: the hallway side of it needs new trim (which also needs to be painted) before we can hang the hardware for the barn-style sliding door (and the actual door itself, which cannot be hung until it’s ordered. I will now go inside and remind Tim that we need to do this, though it probably won’t happen now because for some reason he’s vacillating on the style of the door, meaning that it could actually be weeks longer before this project is finally, fully complete. Sigh). Further, because that doorway needs new trim, the trim in the entire hallway needs to be torn out and replaced. That’s because the style of the old trim is so completely different than the style of the trim in the rest of the house (see what I mean by “cascade?”). To be fair, he actually did put up the new trim around both the bathroom doorway and the doorway into my office, plus the baseboard on 2 of the hallway walls, Saturday afternoon. He even humored me and put up samples of the 3 possible paint colors I picked up late last week.

Meanwhile, though, I’m thrilled with how this bathroom turned out, even if no one will use it until it has a door.


Parenting the Parents – Part XII. The Cataract Chronicles, continued.

The Friday before mom’s second cataract surgery, as I mentioned in my post a couple of weeks ago, was her first appointment with the geriatric psychiatrist, Dr. M. We came away from that appointment with a prescription for a medication to treat her depression, with him telling mom that any side effects were rare and, if any appeared, typically very mild, tending toward those of the gastrointestinal variety. He recommended that she take it in the morning with food to avoid any of those potential side effects. I swung by the pharmacy first thing on Saturday morning to pick up the prescription, and since by now we were back on the 3 eyedrop-a-day regimen for the second pre-surgical eye (while still administering 2 a-day for the first eye), I dropped it off when I delivered the first round of drops for the day.

There were 2 dosages of the depression medication: a lower dose to start for the first week, then a higher dose she was to take for another week and ½ before her follow up appointment with Dr. M. I put the higher dosage bottle away in the cabinet, leaving the lower dosage one on the kitchen counter where she would see it in the morning when she made her breakfast. I left all the standard literature that comes with any new prescription off to the side on the kitchen table. I came back in the early afternoon for round 2 of the daily eyedrops to find my mother somewhere well-beyond agitated, bordering on the accusatory:

“I’m not taking those new pills.”

Instantly I knew what had happened.

“I read those papers and it said there could be eye problems so I called Dr. M’s office and told him I’m not going to take them.” She didn’t want to risk messing up the surgery.

I started to remind her that Dr. M had said that the side effects were rare and mild, but thought better of trying to talk her into it at this stage given her frenzied state of mind. She continued, attempting to convey her concerns, her frustration building , unable to extract and articulate the thoughts in her head. I quickly put it all together based on the sentence fragments she was hurling at me. Her eye doctor didn’t know about this new medication because she hadn’t been on it when they last reviewed her medication list. Then she wasn’t sure *who* she’d called, causing her more frustration, so I looked at the call log on the phone. Turned out she’d called the eye surgery center. I told her they weren’t open on the weekends so they wouldn’t be getting back to her until Monday morning, but also conveyed not to worry about it – if she wasn’t comfortable taking it yet, then she shouldn’t take it. We’d wait to hear from the surgical center or the doctor on Monday to be sure it was OK, and if it was, she could just start it on Tuesday, since she had to fast Monday morning before the surgery.

Monday morning the surgical center called back and told her the medication wouldn’t interfere with her surgery. I did the drops, later than normal, just before we left for the surgery, which, this time, was scheduled for noon. All went well, and, because she now knew what to expect, though I offered to stay over again this time, she was comfortable with me spending that night in my own bed. I reminded her though, that if anything was even a little bit off, she should just call me.

I arrived the next morning around 9:15 to help her remove her patch and dressings and to be sure she ate something and took her first dose of her new medication. Her appointment was at 10:15, so we were planning to leave a little after 9:30, so I was surprised to find the place eerily quiet. I called out. No answer. I wondered if she’d overslept.

I went to their room to find her sitting in the chair next to her dresser, in quiet tears. She seemed shaky and weak. Panic rose. She said she was feeling dizzy and strange and that she didn’t think she’d be able to go to the appointment. I felt her head for fever as I ran through the list of post-op complication warning signs I’d since memorized: bleeding through the dressings (no); fever (no – though she was a little sweaty); chills (she said no); nausea (no); vomiting (no); pain at the surgical site (it felt like the other eye had, so no). I asked her if she’d eaten anything (no), so I went out to the kitchen, peeled her a clementine, poured a fresh glass of cold water, and brought them in to her.

It was imperative that we see the doctor that day for the post-op follow up, but I told her not to worry – that I would call to change the time to later. While she ate the clementine, I called the doctor and left word on his assistant’s voicemail with what was happening and asking if we could bump the appointment to later.

After a few minutes, mom seemed marginally better. I made her some toast. Hannah had arrived so she helped her finish getting dressed. They came out to the kitchen and I went back to get my phone off her dresser, distracted for a minute by a reminder that had popped up on my screen. I came back into the kitchen to butter the toast. By now she was sitting in her spot at the table, so I washed my hands in preparation for removing her patch and dressings and doling out another dose of eyedrops. The eye looked red, as the other one had the morning after surgery, but nothing alarming. I decided to wait on the eyedrops until after she’d finished her toast.

As I went back over toward the sink to grab a napkin for her, I saw the bottle with the new medication on the counter, so took one out and brought it over to her to take now that she was eating something a little more solid. As I laid it on the table next to her plate, she said, “Oh, I took that already.” (What?!?)

“You did? When? Like before I got here this morning, or just in the past few minutes?” (Could she have taken it in the time it took me to get my phone?)

She thought for a moment. “Before you got here. I was up early and walking around and I saw it so I took it.”

“Did you eat anything when you took it?”

“No.”

“I think that’s why you were feeling so dizzy and strange! Dr. M said you should take these with food or they might make you feel funny. How are you feeling now that you have some food in you?”

“Better.”

My phone rang. It was the doctor’s assistant. I explained what I thought had happened and that I thought we may still be able to make it but we might be a few minutes late. She said not to worry and did some re-arranging of the schedule, working us in after 1:00 that afternoon instead. Perfect.

Mom finished her toast, now on the upswing. I plopped in another set of eyedrops and headed home for a couple of hours before I’d be back for the post-op appointment, which went not unlike the one for the left eye. Another week of 3 drops, 3 times a day in the right eye until we were back for the second follow up appointment. We could stop the drops for the left eye, which felt like a small victory.

At the second follow up, the doctor noticed some swelling in the left (first) eye, so my small victory evaporated as the regimen was shifted again: 2 drops, twice a day, in *each* eye until the final follow up appointment at the end of April. As I’m typing this, we’re counting down the last few days before what should be the final follow-up appointment, the much-anticipated measurements for her final eyeglasses prescription, and The End of the Eyedrop Episodes. There’s a part of me that will rejoice, and another part of me that’s already working on a reason to go over there every day anyway. Maybe just not twice a day. . .

Eyedrop 2

Confessions of a Conscientious Carnivore

I admit it. I’m a fat-lover.

I am a meat lover. To be even more specific, I am a fat-loving meat lover. Fat has always made me happy. And so far, it seems to also be keeping me healthy, which isn’t something I’m sure would work for everyone. (I have a theory about diets in general and why there is no single “best” or healthiest diet that is the right one for every person – I’ll post about that sometime in the not-too-distant future).

Full disclosure though, I am also a vegetable-lover, so perhaps that’s my nutritional saving grace – who knows? The only vegetable I’ve ever tried that I didn’t like was okra. Bitter greens, like mustard, dandelion, broccoli rabe? Bring ‘em on. Brussels sprouts? I can hardly get enough. I’m crazy about kale; cuckoo for kimchee (technically a fermented vegetable, I know – I’ll do a post about fermented foods sometime in the future, too). But nothing makes me drool more than a well-seasoned ribeye, freshly sizzling off the grill, and the near-swoon of anticipation I feel slicing into that first, beautiful, melty piece of salt & peppered fat.

True story, just to put a needle-sharp point on my borderline obsession: we, like millions of others, had a ham for Easter this year. Because we were a small crowd, I got a quarter ham, bone-in. Until the end of the day, when I was cleaning up and putting away the leftovers, I had not considered a truly wondrous thing: in order to have a “bone-in” quarter ham, the bone would have to be cut, too. And, there, as I lifted the ham by its partial shank bone to nestle it into a storage container, I spied it. Shimmering unctuously at me from the cocoon of that split shank was that grail of fat-lovers everywhere: the *marrow.* I stopped dead in my cleanup tracks, gasped at my fortune, then proceeded to scoop and slurp up every last molecule of it. Yes. I LOVE fat. (If that just grossed you out, my apologies. On the other hand, if you have a leaning toward fat and you’ve never experienced the sublime joy that is marrow, go forth and find yourself a great restaurant that serves osso bucco. Your life may never be quite the same again).

But I’m not mindless about it.

With all of that said, I have to share something else that has grown to be a part of my life and routine, though I must admit that I’m not always able to follow this perfectly: when I buy any kind of animal protein (meat, poultry, eggs, fish, even dairy products), I spend the time to find, and the extra money to buy (though often to buy reduced quantities of) products which are grass-fed, pasture-raised, free-range, wild-caught, hormone- and antibiotic-free, etc. I don’t do this because I’m a food snob or an animal rights activist. I do this because I believe that animals raised eating the foods *they* were meant to eat (cattle eating grasses & hay, as opposed to grains, soy meal, and God-knows what else; chickens tapping around and eating insects, seeds, and worms; etc.), and in surroundings they were meant to inhabit (cattle in fields, rather than crammed into muddy, manure-filled pens; ditto for chickens or pigs, or even fish) are inherently healthier themselves, and by logical progression, their meat is also healthier when we consume it.

Grass-fed, free-range: really healthier?

This is borne out by studies of cattle fed grass diets versus grain diets. The concentrations of, for example, healthier omega 3 fatty acids are consistently higher in grass-fed than in grain-fed beef. While omega 6 fatty acid concentrations don’t seem to change significantly with the different diets, as I noted a couple of weeks ago in my
Step Away From the Canola post, we should be after ratios of omega 6: omega 3 more in the range of 4:1 or lower (ideally, 1:1), whereas now, our typical ratios are sky-high (15:1 or higher). Grass-fed beef provides a better ratio. It also has higher concentrations of antioxidant enzymes, among other benefits. While grass-fed and free-range animals do tend to have lower overall fat content and slightly different flavor profiles, I’ve been perfectly happy with the fat they do have, and have grown accustomed to the flavor profile.

I also think there’s something to be said for “happier” animals in terms of the eventual healthfulness of their meat: in the same way that elevated stress hormones are known to have deleterious effects on humans and our propensity for all sorts of disease, animals under chronic stress respond similarly. Keep subjecting them to stressful situations; drive up their stress hormones and, not surprisingly, you will decrease the quality of their meat.

But what about the environment?

Finally, I return to one of the areas I said I’d focus on at the outset of writing this blog a few months ago, and a huge reason I buy carefully: environmental impact. The production of animal protein, no matter what, has a larger carbon footprint than the production of most plant products (though that does start getting more iffy with some monoculture crops, many of which are produced for what? Animal feed. But I digress). However, the negative environmental impact of grass-fed/pasture-raised/free-range meat production is significantly lower than high-intensity “factory farming” techniques. There’s a great book about this called Farmageddon: The True Cost of Cheap Meat, by Philip Lymber with Isabel Oakeshott, which, despite the alarmist title, does a very balanced job of laying out the horrific environmental impacts of factory farming, along with a very solid argument for how, despite broad belief to the contrary, expanding global populations do *not* demand more such intensive farming techniques. You can find a good overview and review of the book here on The Guardian.

Our choices, our future.

It’s critical that we all understand the absolute power we wield to shape our own futures, whether carnivore or vegan, not only by how we eat, but by how we spend our money. We’re seeing more food retailers adding organic options to their shelves, and many manufacturers shifting to non-GMO ingredients. They aren’t doing that just for yuks or out of a sense of environmental stewardship or social justice. They’re doing it because of consumer demand. That demand, my friends, begins and ends with you and me.

Parenting the Parents – Part XI. The Cataract Chronicles.

If you have aging people in your life, at least one has probably had cataract surgery. I think I might even know a few people who’ve had this often life-altering procedure who don’t fall into the “aging” category. In either case, you may have heard about the procedure, and the preparation and follow up care that is required. For people without cognitive impairment (or unsteady hands, or eye/ eyedrop phobias), I’m certain the whole thing barely rises above a minor inconvenience, especially considering the abundant payoff.

With mom’s particular brand of dementia, no appointment or procedure can be taken lightly. Leading up to even routine doctors’ appointments, she scrutinizes the weather forecast for a week in advance; lays out her clothes the night before; and asks me at least twice in the two days ahead of time what time we’re going to leave. When you’re talking surgery, especially not long after having had an unscheduled pacemaker implantation, the unknowns gather themselves into a category 5 hurricane of anxiety. The eyedrops; the preparation for the surgery and the surgery itself; the immediate post-surgical follow up; the eyedrops; the ongoing follow up appointments; the eyedrops. . . none of it can really just happen “in the flow.”

The surgeries were going to take place a month apart: left eye at the end of February; right eye at the end of March. They would be performed at an eye surgery center about 15 miles away, where our ophthalmology group, and apparently several others, perform various procedures all day, every week day. (At the second visit, my curiosity piqued by the volume of patients who moved through the waiting room in the time between our arrival and post-operative departure, I asked how many surgeries they perform in a typical day there. I was astounded to learn that it was between 40 and 60).

Before the first surgery we needed a pre-operative physical, which had to be completed within a week of the first surgical date. Mom kept getting confused about the timing of that appointment and worrying that we hadn’t scheduled it at the right time. Once it was clear the timing was OK, the worry shifted to whether there would be something wrong that would prevent her from having the surgery, or if her pacemaker would present an obstacle. Could they do cataract surgery so soon after she’d had a pacemaker? (It would be 7 weeks post-pacemaker by the time her first eye was on the docket). I assured her that doctors perform cataract surgery on people with pacemakers all the time. I’m not entirely sure her anxiety allowed her the luxury of believing me.

So yes, complicating this was also the fact that we were still in the wake of post-pacemaker implant follow up appointments, and while I was keeping it all organized, it was thoroughly overwhelming her. It didn’t help that the hospital’s cardiology group, not realizing mom now had her own cardiologist, had scheduled a series of follow ups before mom was even discharged from the hospital that were then also scheduled separately by her cardiologist. It took me a couple of rounds of appointment change and reminder calls from the hospital’s group to figure out that these were duplicate activities and that I could cancel the ones with the hospital’s group, but with the calls coming in to my parents’ phone rather than mine, poor mom was completely confused. I think I’ve now informed all her doctors that appointment reminder calls should come to me. If you are in the world of caregiving for someone with dementia and haven’t yet managed to get yourself on the HIPAA privacy releases at their doctors’ offices and those reminder calls switched over to you, my advice is to try to get that in place sooner than later. It’s a sanity-saver. For everyone.

A week prior to the first surgery, mom was supposed to stop taking one of her over-the-counter supplements because of a potential complication that could arise with it. The surgical center had apparently informed her of this when they called her to tell her what time to plan to arrive on the day of the surgery, but somehow that directive escaped her. I discovered it when I saw that she’d written some notes down about an arrival time and the address of the center on a random slip of paper, so called them myself to confirm what she’d written. They mentioned the over-the-counter medication to me. It was now 5 days pre-op, and I asked if that would pose a problem. They said it wouldn’t.

She was supposed to fast from midnight the night before each procedure. She had written it in her calendar, and I reminded her when I left after administering her last round of eyedrops the previous evening. For good measure, though, I arrived early enough on the day of each surgery to intervene as she woke up, just in case.

As for those confounded eyedrops, most unimpaired people likely don’t give them a second thought. If we lived under the same roof, I might not have either, but I don’t. Even though I’m only 3 minutes away,  the “Eyedrop Episodes” were folded into the overall outline of my days. For each eye, we began a regimen 3 days in advance of the surgery: 3 different drops, at least 5 minutes apart, 3 times a day. Each morning I’d motor down the hill, typically sometime between 9 – 10 a.m., to administer the first dose. Then, between 1:00 and 2:00 came the second dose, with the third usually falling between 5:30 and 7:00. We were supposed to administer at least the morning drops the day of the surgery; because the first surgery wasn’t scheduled until mid-afternoon, I did two rounds. I figured more would follow after the surgery.

The pre-op instructions from the doctor suggested that the patient have someone stay with them the night of the surgery in case of any complications, so that morning I packed my things. I included my muck boots, because light snow was forecasted for that afternoon and overnight, another factor stressing mom out, and, if I’m being totally honest, me too – even light snow falling at the wrong time of the day could sometimes spell a 2 hour odyssey for what should normally take 35 minutes or less, and we’d be getting out of there right in the thick of rush hour. I didn’t really relish the thought of being stuck in traffic in the snow on the way home from surgery, so with an abundance of caution, I left all my overnight stuff in the back of my car. Worst case we’d stop at a hotel. Gratefully, the weather gods smiled and the snow had no impact.

The next morning she was supposed to remove her eye patch & dressings, and I was to give her another set of eyedrops before we went to the doctor for the post-op follow up visit. She wasn’t allowed to bend over (i.e. let her head drop below the level of her waist) for at least a week, which might alter some aspects of how she helped my dad when their caregiver Hannah wasn’t around (helping him with his socks and shoes, or the assists I knew she sometimes provided when he was changing a Depends). All of this made the next morning somewhat eventful for me as I tended to both of them before Hannah arrived. We saw the doctor and all appeared well; he instructed us to continue with the 3 drops a day regimen until the next appointment, a week away. On the way home I asked mom if she wanted to go out for breakfast – an unexpected treat.

Back at home that day with Hannah, the two of them came up with some revisions in how she helped dad with his footwear (and Depends) so they could manage safely on their own: mom would sit on the fold-down seat of dad’s walker and he’d lift a foot (or both feet, one at a time, in the case of a Depends) high enough for her to grab it and guide it to the edge of the seat where, from her sitting position, she could help him with socks, slippers and shoes. With the Depends, as long as she could help him get them to knee level, he could deal with the rest on his own.

At the follow up appointment a week later, I expected to be done with the drops until the next surgery, but alas, that was not in the cards. The nurse said it casually, at the very end of the appointment, after the doctor had left the room: “So you’re going to continue the drops,” thinking she was confirming something the doctor had said, but he hadn’t. The exasperation lurched out of me before I had the wherewithal to stop it: “Really?? All of them?!? 3 times a day?!?” I felt the same burning frustration I did when I used to do the Jane Fonda workout back in the late 80s and she’d pretend the excruciating set of donkey kicks was ending as my glutes were bursting into flames: “5 more! 4! 3! 2! 1! Annnd another 5!” One of the drops was eliminated, and the frequency dropped to 2 times per day, but the Eyedrop Episodes were to be a part of my life for at least another 4+ weeks – after the second surgery.

The twice-a-day routine settled itself into my life. Once or twice I had James, my 22-year-old, pinch hit. This worked once and failed once, when we’d pre-planned that he’d head over between 6 and 7 p.m. because I would be out at a dinner engagement. I arrived home at 8:30 to discover that he had completely forgotten (calendar reminders, anyone??). I yelled at him for lapsing in the one responsibility I’d asked of him that day and Tim threatened that he’d better get down there and do it. Because I hadn’t even left the threshold yet, as he emerged from his room to head down the stairs, I snarled passive-aggressively that I’d just do it myself. This was getting to me, but this was my reality, so I vowed on my drive down the hill to just suck it up and deal with it. With a smile. I needed to remind myself of the advice I gave out all the time: the secret is all in the attitude. The more I fought it, the crankier it made me. Yes, there was still another eye to go. So be it.

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Border Patrol

A few weeks ago in the post I dubbed “The Call of the Wild,” I mentioned the black border I had planned around the perimeter of the bathroom floor. At that time, and in the weeks leading up to it, it would be fair to characterize Tim’s enthusiasm level for my vision as maybe a “2” on a 10-point scale: “tap cold,” though admittedly not quite a “fresh-out-of-the-fridge-dispenser-1,” or, a “solid-ice-0.”

In the intervening time, he’s finished up the rather extensive job of tiling the walls: 3 of them, including the longest one in the room, are tiled almost floor-to-ceiling with 4 x 8” Carrara marble. “Almost,” because anchoring the entire perimeter of the walls, in the first row along the floor, are larger 6 x 12” Carrara tiles, topped by half-round “pencil” molding, to form a baseboard. He also did a lovely job on a soap and shampoo niche in the shower, finished with the same pencil molding, which has a shelf. It’s set so the lower portion is accessible to someone who might be showering while seated, and the upper portion will be the right height for someone standing.

I’m trying to make this bathroom all about accessibility (though my grab bars still haven’t arrived). The concept of accessibility was the first of several battles we fought over the plan for this room, but a few key skirmishes cascaded from my audacious accessibility plan: widening the doorway; having a roll-in shower (which came along with its own set of special challenges); making the shower head a height-adjustable, removable, hand-held on a vertical bar.

As Tim rolled into the homestretch on the wall tiling, though, he abruptly changed his tune about my crazy notion of the black marble tiles around the border of the floor. He was actually excited about it, and, while I was slightly mystified, that didn’t stop me from pointing out that a few weeks earlier, he’d thought this was the stupidest idea ever. Suddenly now, he thought this was going to look really cool. (Um, yeah . . . that’s why I wanted to do it?) Go figure.

All good, because we were more or less roped into it at this point anyway, with him having laid down the rest of the “field” tile for the floor weeks earlier, leaving an empty space around the perimeter which would now be impossible to handle in any way other than, well, installing a border. I guess we could have used the 6 x 12” Carrara tiles as the border pieces, but I also had 2 boxes of that black marble, called “Nero Marquina,” sitting here waiting, and they were special-order, so there was no returning them. (I didn’t tell him that part).

So, last Tuesday, he began cutting the border tiles, which were also 6 x 12,” to dry-fit them into place. The border isn’t fully 6,” so there was a lot of cutting to do, and, as I’d done with the ribbon board around our front porch several years ago, I insisted on mitered corners – a small detail (and another thing we initially argued over), but one that would matter in the end, even though there would be 8 of them to deal with in this room (2 extra because of the shower, and 2 more extra due to a little jog on the left side of the doorway).

The field tile on the rest of the floor has a black and white basket weave pattern – the same floor tile we used in our master bathroom. I had decided on black grout this time, both because it wouldn’t discolor under traffic, and because it would make the basket weave pattern pop. Tim’s experience told him that he wanted to cut the perimeter edges of those tiles in such a way that only white tiles were at the edges, making for a clean line around the entire border. That was fine, but it meant that the size of the border would vary slightly around the room – there was no way to lay the field tile in such a way that the border would be exactly even around the entire room (unless we’d built the room to fit around the tile, which was not only silly, but impossible). With that, every border tile had to be cut to size for its own individual spot. Tim labeled them as he cut and confirmed their fit. Every complementary angle at the miters was also unique, and I don’t think a single one of them was the typical 45-degrees you’d expect at a mitered corner.

With all the cutting and fitting complete, we had one more hurdle to jump: the Nero Marquina tile was *slightly* thicker than the basket weave field tile, so we had to figure that out. Having a little edge sticking up around the entire perimeter, *especially* at the doorway, would be a problem – an open invitation for chipping. At first Tim thought he’d be able to pitch the thinset inward, making it slightly thicker/deeper at the walls, and angling the border tiles down to where they met the basket weave tiles. The theory proved better than the reality though, so that idea was abandoned after 2 or 3 tiles. The only option remaining wasn’t pleasant: grinding the tiles down to the right thickness. Hours of work ensued, but finally, every tile fit the way it needed to, and, just yesterday, in they went.

Tim spent today working on the sheetrock, smoothing the walls and ceiling, cutting and installing the window trim, and touching up the grout on the walls. Now that he has his sheetrocking stuff out, he’s going to hang the little bit of it that’s been missing around the doorway from the hall into the dining room. Neither one of us knows *how* long that’s been showing its skeleton of studs and header, but we’ve gotten so used to it that it will probably look really weird when it’s finished.  I’m so accustomed to that hallway being partially torn up, in fact, that I was shocked today when Tim asked me what color I wanted to paint those walls. I had completely forgotten about those. Back down to mom’s to (re)borrow my Benjamin Moore paint fan.

The floors will need to be cleaned (of course) and sealed (maybe not-so-obvious) before grouting, to prevent the black grout from staining the Carrara in the basket weave tile. That might happen tomorrow. Then the walls will get their paint. Maybe, just maybe, by Hump Day next week, we’ll actually be installing fixtures.

Parenting the Parents – Part X. How do you Solve a Problem Like Dementia?

If you’re of a certain age, perhaps the title of this week’s blog puts a certain song from “The Sound of Music” in your head. Sorry if that now becomes your earworm du-jour.

Going back a few weeks, I shared how mom’s post-surgical home-care occupational therapist performed a cognitive screen with her and her scores indicated fairly significant dementia. I wasn’t there when the O.T. (I’ll call her Nina) did the screen, but knowing how my mom had been struggling emotionally with all the challenges aging suddenly seemed to be throwing her way, I worried that she’d internalize this, adding it to her growing list of worries, fears, and perceived shortcomings. (Among them: her need for a pacemaker; a recent visit to the eye doctor that resulted in her being scheduled for upcoming cataract surgery on each eye, along with 3 separate follow-up appointments for each surgery; her ongoing bouts of word-loss – being able to picture something but not give it voice). No amount of reassurance or logic seemed to change the self-critical frame into which she painted these facts.

I asked Nina how mom had reacted. She told me she (mom) knew she “hadn’t done well,” but Nina reassured her that there was no “well or not-well,” and that it had nothing to do with her intelligence. I knew my mom. I knew she’d hear the words; but I also knew they’d likely bounce uselessly off her looming sense of diminishment. I pressed, “how did she feel about *that?*”

“Well, she wasn’t too happy, but I talked to her about it and by the time I left she seemed better.”

Nina suggested that I get mom in to see the geriatric psychiatrist my dad had been seeing (“Dr. M”). I promised I would, and wondered out loud how on earth I was going to bring this up with her. Nina reassured me that I shouldn’t feel like I had to do that right away, and that when I did, I didn’t have to make a big deal about it. The reality was that it was important that we get it checked out because we might be able to do something to improve it. My dad did seem to be doing fairly well on the medication he’d been taking, but mom’s “presentation” was so different that I was skeptical the same thing could work for her.

I called Dr. M’s office to see if I could schedule an appointment around the same time my dad was slated to go back for another follow up in late March (it was early February). Though the practice wasn’t taking new patients, they were accommodating considering that dad was already a patient, and even maneuvered things to schedule mom’s appointment in the time slot immediately prior to dad’s. They asked if we’d had any MRIs or CT scans and I shared with them her fainting episodes prior to her pacemaker implantation, and that 2 CT scans were done prior to her surgery. They said they’d arrange to get the images from her doctor. I was happy for all of it, but inside I was still fretting about how to tell her.

I called my sister and filled her in. She had no difficulty relating to my concern about bringing it up, so we agreed that I’d bide my time and wait for the right moment to “go there.” Several days later, I decided to write the appointment onto their two calendars, in plain sight, as a possible catalyst. It was scheduled for a Friday afternoon – as it happened, the Friday before the Monday she was scheduled for her second cataract surgery, so I figured she’d be checking the calendar as the date of the cataract surgery approached. I wanted to let it come up in the natural flow of things. Eventually, it did, two days beforehand.

Mom: “Hey, how come I have an appointment on Friday with Dr. M, too?”

Me: “Remember your occupational therapist Nina? And that test she gave you?”

“No. . . not really.”

“That’s OK. Anyway, she shared the results of that test with Dr. K, and Dr. K recommended that we get you in to see Dr. M, too. You might not remember because of everything else that was going on, but in one of our follow up appointments with Dr. K, she recommended that we have you see Dr. M.”

“Oh. Okay.”

When I headed home a little while later, I wondered if that was it – all that worrying over nothing. The next day (the day before the appointment), she revisited it: “I remembered that test Nina gave me. So what’s going to happen on Friday?” Her voice was slipping back and forth over the fine lines between curiosity, fear, and irritation.

“Well, you know how you’ve been getting frustrated over losing words sometimes? Seeing Dr. M will help us start to figure out what’s going on with that. You’ve noticed how daddy’s been doing pretty well on his medication from Dr. M, right? They may be able to do something that will help you, too, but they need to see you in order to do that.”

Once again I was relieved that she seemed to accept this explanation with little angst.

When I arrived Friday prior to the appointment, however, the angst level had clearly ticked upwards, evidenced with mom’s defiant announcement: “I don’t know what they’re going to ask me today but I may not be very nice about it. They might just kick me out.”

“I don’t think they’ll do that mom. Remember, this is exactly their specialty. They’re here to help figure out what’s going on, and to come up with things that might make it better.”

As we pulled into the parking lot of Dr. M’s office, she declared, “I just want you to know I’m not very happy about this.”

“I know you aren’t, but we trust Dr. K, and she wanted to make sure we did this.” It was helpful to fall back on Dr. K, for whom mom had developed great affection – she recognized that Dr. K’s actions the day of the pacemaker implant had probably saved her life.

The first 30 – 40 minutes of the appointment were tough. Karen, the therapist, administered another SLUMS test. In many of the areas, mom did fine, but it was hard to watch her struggle with others – not for the fact of any cognitive deficit on its face, but for how hard it was for her to wrestle with the emotions that came up when she had a tough time with something. Karen was patient and careful, reminding mom that there really were no right or wrong answers. When mom would struggle she’d sometimes prompt gently, following, I’m sure, administration protocol for the test, as eventually, it seems that scoring weighs out the differences in how questions are answered (straight away; with prompting; or not at all). She also went through a series of depression-related questions. We talked about mom’s hearing, which had also been problematic.

Ultimately, Karen walked us gently back through the results of the SLUMS test and depression screen. She shared that there were some areas where mom’s scores indicated normal cognitive function, and others where there were challenges. She also highlighted that mom’s score on the depression screen fell just below the threshold for clinical depression. She assured mom that this was not at all unusual, and that depression could be a significant factor in cognitive functioning. Very often, she noted, treating the depression made a big overall impact.

We talked. I reinforced how glad I was that we were there and how it hurt me to see mom beating herself up when she couldn’t remember things or when words wouldn’t come out. I confessed that it seemed to me that she felt it meant that she was somehow “less than,” or not smart, and how untrue that was. We cried. We hugged. The whole mood shifted – so much lighter. Karen reiterated the importance (as she’d done in the past with dad) of physical exercise and doing new things to stretch the brain. We made a list of things we might be able to do: playing set-back and re-learning cribbage. Making bird houses. Getting some new CDs to listen to. Dr. M came in and, as he reviewed the scores (and likely Karen’s notes), he echoed Karen, stating that he’d like to take a shot at treating the depression first, to see how that might go. Mom was on board.

Dad arrived for his appointment right on time thanks to Hannah, their caregiver. I brought him in to mom’s appointment, as had been the plan, and we brought him up to speed with the findings and the plan for her. Dad was his characteristic, agreeable, low-key self. We rolled from mom’s appointment into his, which was a basic check-in. It went smoothly. We made follow up appointments for both of them.

While Hannah took dad home, I took mom, stopping on the way home for some groceries. She told me, more than once, how much better she felt, and how good it was to get all of those feelings out. I told her how glad I was, and how optimistic I felt that we were on a more positive path.

I walked away enlightened about depression and its link to dementia. Everyone’s is probably slightly (or a lot) different, and determining other areas of potential impact (such as depression) is important to coming up with a plan to manage it with the most appropriate approach. Now to get them to exercise, and to their proverbial, Sound of Music Switzerland. . .

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