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After the April disaster in Miami, something had changed. It wasn’t really obvious at first, but in hindsight, Ralf’s disease presentation had begun to change. But he is not the only one: my mom has cognitively declined for a while now. People around her didn’t pick up on it but I know her good enough to see the changes. I call her pretty much every day, and I started to monitor her emails since she has now the tendency to buy things online but then forgets to pay for them. Over time, she forgot how to properly use the landline telephone, pushing random buttons to make a call, then declaring that the phone is broken… I used to have someone, who got paid very well, to look after her, clean her place, and took her to doctor’s appointments. I heavily relied on her because I couldn’t be in two places on earth at the same time. Ralf was still not well after the hospitalization in April and my mom had an important appointment with the neurologist coming up May 27th to go over the brain MRI results. But then I found out that the lady I trusted my mom’s care with was stealing from her, so I had to cut her lose. Awesome. The only lifeline I had to make sure my mom was taken care of. And not only that, my mom was of course attached to her by now, and trying to explain to her why she is no longer coming was a difficult and hurtful task.

But the full disaster hasn’t even unfolded yet: beginning of May, I called my mom on my way to work when she said “I have nothing to eat or drink… and I am having a rash that really hurts”. Turns out, she had shingles. And because of that, she became weak and disoriented even more, unable to go to the grocery store. And nobody noticed, even though she lives in a Red Cross facility (independent but under “assisted living”). So in my desperation, I called Roswita, a very kind and helpful friend, who works part-time for the Red Cross. She brought my mom food and water and promised to take her to her appointment. However, I already knew in my heart that something was seriously wrong, and if I don’t fly to Germany now, she may not make it. But what about Ralf? He was not doing good at all, and I really didn’t want to leave him alone either!!!! Pick and choose? Clone myself? Who would die first, him or her? So I made a compromise: I booked a flight to Germany for 6 days, hoping it would be enough time to stabilize her, take her to the neurologist, and put reliable resources into place. Six days Ralf was alone at home, and all I had was Facetime to keep connected. But it had to be done, and he was so supportive – despite his own fears and separation anxiety.

So on May 24th, I had to leave Ralf behind and fly to Germany, with my return flight booked for May 31st. When I arrived in Hamburg, I already knew things were bad because Roswita picked me up from the airport without my mom. My mom would never ever not come to the airport – this was usually non-negotiable. And I was right: when we arrived in the parking lot of the Red Cross complex, I saw her pale face behind the living room window (facing the parking lot). Then my mom shuffled outside to greet me…. She looked like a skeleton, with sunken eyes, collar bones sticking out… it was awful. I almost burst into tears but held it together, supported her frail body while leading her back inside to lay down. I knew in my heart that she was on the brink of no return.

Over the next couple days, I cleaned her place and threw out all the spoiled food in her fridge, which had expired in chronological order. I found pans with molded food in it, covered up by more pans with molded food... it was awful! I went grocery shopping and nudged her to eat... I wasn't hungry myself, but I noticed that she would eat if I ate...

One pre-existing issue in her apartment was the toilet, which was installed too high, and since the Red Cross marked it as acceptable when my mom first moved in, they refuse to fix it. The previous renter must have installed a higher toilet to suit her needs, but it was never reversed. My mom is 5 feet tall, so she has to slide with one side onto the seat, which naturally doesn’t work out very well, leading to urine running down the rim often. So, with nobody cleaning her place anymore for weeks, one can imagine what condition I found her bathroom to be in. And it’s really not her fault at all, that stupid toilet is even too high for me, and I am 5’6!

It was May 26th, my birthday, which my mom also forgot, when I scrubbed her place… and now I know it was my last birthday I would have had with Ralf. I didn’t know, but it didn’t change the circumstance anyways... I found her blood pressure pills and other medication under her bed and in other random places, so she wasn’t able to manage her meds anymore either, so something needed to be done. Ralf and I facetimed, he gave me a gift virtually: a gift certificate for a tandem parachuting jump, including video. A gift I have yet to redeem. God, I love him so much, and he was suffering with vicious digestive issue, afraid to end up in the ED again without me being at his side.

But I had to pivot and focus on the task at hand: putting lasting resourced into place in less than five days. It was Monday morning, the day I was taking my mom to the neurologist. It’s something she was dreading because she was always so afraid to get dementia. This morning started already in the most cruel way: my mom and I have this ritual in the morning, where when we wake up, I take my blanket to her bed, then we have coffee in bed together. She looks forward to this every time I come. This morning was no different, however, I had to make sure we were up and ready to go by 8 AM for our appointment. So I hand her a cup of coffee, and she was all happy and giggly… I asked her how long she would need to get ready because Roswita is picking us up at 8 AM… she looked at me wide-eyed, asking me “why is she picking us up?”, I said “well, remember, today is the appointment with the neurologist…”, she looked at me with a blank stare “huh?”, “remember, the appointment with the neurologist to go over the MRI results…”. Finally, I saw acknowledgement in her eyes, her face went from smiling to a deep frown… “Oh”, she said, put down the cup, rolled on her side, and cried. I felt like the biggest asshole on the planet, but what was I supposed to do??? It NEEDED TO BE DONE! Damn it, life sucks.

Long story short: we went to the neurologist, got the (not surprising) diagnosis of intermediate dementia. From there, Roswita drove me to the AOK health insurance agency office in Heide, where an admin person took mercy on me and filled out the paperwork, applying for disability. After that, Roswita took me to the Red Cross main office to try to initiate services, such as medication administration and cleaning service to start with. I am now the official caregiver for my mom and Karl-Heinz. And this is just the cliff note version.

Now that I set everything in motion, I was busy trying to organize and improve the medication situation: I got the orders for all her meds, went to the pharmacy to refill what was needed, bought a new pill box system, and got everything ready for when nursing service would finally kick in.

Then came the pain. My mom’s shingles had resolved (no longer contagious), but the severe nerve pain was hitting her now in waves. I already made an appointment with her primary care to get her pain medication prescribed, but it was just awful to see her suffer so much. All I could do was hold her when the waves came… meantime, I was also so worried about Ralf.

In the end, it all turned out ok. In those six days, I made sure my mom ate, had a clean place, I sat with her on a bench outside in the sun, managed her meds, took her to all necessary appointments, applied for disability, and just held her when the pain came. It was a miracle that she was looking so much better by the time I had to leave, and now a nurse would come every morning to give her her meds. She even came to the airport this time to drop me off – a huge turnaround, I would say. Crisis averted, now back to Ralf.

I am resuming to update my blog in hopes that it may help me process and come to terms with what has happened. I will have to do this in increments, as I am in a very dark place right now. It is already February 2025, but during the remainder of 2024, my world was ripped apart… I was ripped apart, so I wasn’t able to bring any of it “to paper”.

Let me start with our trip to Miami to renew my German passport. Unfortunately, there is no way to do that online, so I had to show up in person at the German Consulate on April 26th, 2024. Ralf’s last hospitalization was only in mid-March, but he insisted on coming to support me. The German consulate staff is rather difficult to work with and I don’t remember a single appointment that went smooth. I was very hesitant though, given the long car ride and being so far away from home.

The drive to Miami was long but Ralf tolerated it pretty well. We stayed at a hotel in Brickell again, the neighborhood Ralf and Ponce used to live at for a while, long before we met. It was lovely weather, so we strolled through the streets, and he showed me around, telling me stories about his past. We ate something light at a Mexican street café, and he so enjoyed the food so much, even though he picked his meal carefully due to his sensitive digestion.

But then he paid the price: during the night, he started showing symptoms: abdominal pain, nausea… so at 1 AM, I started researching local ERs close by and looked up reviews. By the time I picked one, Ralf was in dire need for steroids, Zofran, and pain medication. So I got the car from the valet, took my documents for the upcoming appointment at the consulate, and drove to Florida Mercy Hospital ER in Miami. They did take good care of him, and thank goodness, didn’t give us a hard time about the interventions he needed to treat his particular presentation of bowel obstructions. They also had single occupancy rooms with a nice view.

Even though I was not just so very tired and concerned, I still needed to get to the appointment at the Consulate. If I missed that one, I wouldn’t get my German passport renewed, which I needed to take care of my mom and Karl-Heinz. When I got there, I had to wait in the lobby forever until I was allowed up.stairs. When I checked in, I naturally got the lucky number 13… and it went down from there. Long story short, that lady who served me was snippy and gave me a hard time – regardless of my circumstances. I left with a 50/50 chance that my passport would be processed without issues.

I had a good cry in the car, pulled myself together, and drove back to the hospital to be with Ralf. He had to stay for two nights, especially since the ride home was 4 ½ hours long, which really concerned me. I had to extend the hotel stay as well, and they let me keep my room. After discharge, we started the long drive home, and we made it somehow… but what I didn’t realize at the time: something had changed, signaling the beginning of the end.

2

I can’t believe it’s already April. It’s been an intense year so far, and the twilight-feeling – with all the uncertainties – is still part of our lives. I was hoping things would get more “stable”, but so far, it has just gotten more… let’s call it complicated.

I am actually one day late with this update, since it was yesterday (April 4th) when my ADR surgery took place six years ago. I just didn’t have it in me. But better late than never, right? Well, with everything else going awry in my life, I am beyond grateful that my back (and LP-ESP) is still unchanged. No pain or limitations; in fact, I started working with a personal trainer to safely get back in shape and lift weights. I am hopeful that this part of my body will hold up like this for years to come.

Even though we are barely in month four, a LOT has happened – from work-related travel (twice!) to more hospitalizations (also twice!), a destroyed kitchen (again!), and serious health issues for myself (for a change).

The first trip was to attend and present at the IMSH 2024 Annual Convention in San Diego in late January…

… followed by a trip to the hospital with Ralf (sudden-onset bowel obstructions) beginning of February…

… followed by my second trip to implement my Introduction to Clinical Simulation course in Las Vegas mid-February (that included arriving on Super Bowl Sunday, a wedding, and zip-lining with Helen)…

… followed by me getting REALLY sick with a respiratory infection the week after I returned…

… followed by Ralf’s second trip to the hospital with another round of bowel obstructions…

… followed by severe water damage manifesting in our kitchen ceiling, caused by a leaking pipe from the upstairs bathroom. Apparently, the water has ever so slowly leaked into the ceiling for a long time, before it finally reached the threshold and ultimately cause the plaster from the ceiling to collapse. Repairs are underway as we speak – with no idea what the financial damage will be yet. At least we were able to safe the stove and cabinets. Not having a functional kitchen poses a significant challenge, especially when it comes to maintain Ralf’s nutrition and food-related limitations. But, we can shower again, so that’s a plus!!

In the meantime, I finally got my lung CT done, in an effort to find out why I have been coughing for a year. Results suggest permanent scaring and damage to my lungs due to Bronchiectasis – a rare chronic condition that is usually observed in patients with cystic fibrosis. That most likely is the reason why I had so many respiratory infections (including flu and covid last year), and why I was so sick in late February. Got my appointment scheduled with a recommended pulmonologist in a week from now, so I am anxiously waiting to find out what this means for me in the future.

Now I can print myself a t-shirt with “it’s NOT Covid!”, to wear when I cough my lungs out in public.

Stay tuned, 2024 has barely gotten started yet!

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