This is the seventh in my "Virtual Sitting Shiva" series of Blog postings of memories of Violet (Stark) Glickstein, my dear wife of 57 years, who sadly passed away November 27, 2021. [The first posting in this series is Here].
Our Political Views
2021 turned out to be an especially difficult year for us. Violet’s fatty liver disease progressed to cirrhosis of the liver. (Not from drinking alcohol – Violet drank even less that I – but from her diabetes).
She had what is called Ascites. Violet's liver was leaking fluid into her body cavity. That fluid caused her abdomen to expand and her ankles and feet to swell, making it difficult for her to walk.
The treatment for Ascites is paracentesis, which is poking a hole in her abdomen and draining fluid (around 3-4 liters or approximately 6-9 pounds each time). I drove her to a medical facility for paracentesis every week, and to physical therapy a couple times a week to strengthen her muscles and help reduce the swelling.
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| Each container holds a liter of fluid (about 2.2 pounds) that was removed from Violet's abdominal cavity, by a procedure called "paracentesis". |
In May, Violet lost her ability to walk any
significant distance. I purchased a folding transport chair (like a wheelchair,
but with small wheels). Violet was strong enough to be able, with some help, to
get from a couch into that chair, and out of the chair into a car seat.
A potential treatment for her condition is
called “TIPS” surgery (see Transjugular
intrahepatic portosystemic shunt). This involves placing a shunt in the
portal vein near the liver. I watched as Dr. Eric Schwartzberg examined the
situation via sonic imaging during a paracentesis. He told us he had done
several dozen TIPS procedures successfully. However, he added, Violet had
“occlusions” {blockages} in her veins, and, of the half-dozen TIPS patients
with occlusions, only two had been successful. “So,” she replied brightly,
“I’ll be the third”. Alas, it was not to be. The odds were against her. Sadly,
her TIPS procedure, at Leesburg Hospital on 14 September, was not successful.
On 16 September, two days after her failed
TIPS procedure, Violet slid out of bed in the middle of the night and landed on
the floor in our Freedom Pointe (FP) apartment. With my help, she attempted
to get back on her feet, but we were unsuccessful.
Fortunately, FP Independent Living provides 24/7 security with at least two employees on duty. At least one person is at the Concierge desk in the FP lobby, and at least one additional security person is on duty to help. In response to my call for help, a wonderful night security woman came up to our apartment and, very skillfully, helped Violet get back on her feet.
Our Final Weeks Together
Less than a week later, on 20 September,
Violet got out of bed around 2am to get a snack for herself. On the way back to
the bedroom, holding the snack in one hand and a foam cup with soda in the
other, Violet’s foot slipped out from under her, and she landed on the floor of
the living room, waking me. We were unable to get her on her feet. So, I laid
the couch cushions on the living room floor, and Violet slept atop them.
We knew she had an early morning appointment
for a paracentesis procedure at Lake Sumter Imaging, and I was worried she would
miss it. Happily, by morning, Violet had recovered sufficient strength such
that I was able to help her back up on her feet and transport her in time for
her appointment.
The following day, 21 September, I had an early
morning appointment for a medical procedure with my urologist. I got home a bit
after 11am and found Violet on her butt in our Guest Bedroom. I could not get
her up on her feet. She called for help and a couple of workers from the Maintenance
Department came quickly. They called the FP nurse who checked Violet’s vitals. Her
blood pressure was very low, so the nurse called 911.
The EMTs arrived very quickly, put Violet on a stretcher, and transported her to the Emergency Department at The Villages Hospital, just across the street from FP. Our good friends and fellow FP residents, Bunny and Bob Adler, accompanied me to the Emergency Department. (The Adler’s are retired from medical careers, he an eye surgeon and she a maternity nurse-practitioner). However, due to Covid restrictions, only I was allowed into her room, ED11. Her blood pressure was in the 70/45 range, lower than "normal" 120/80.
That evening, I updated our daughter Lisa, who lives in Andover, MA. I also alerted our good friends and fellow FP residents John and Diane Griffin. Using the "Color Note" app on my cellphone, I began documenting Violet's interactions with the nurses and doctors, a project that resulted in many pages of quite specific information. Bottom line, Violet had serious liver and kidney problems and needed the services of good doctors in those areas.
The following morning, 22 September, Violet was admitted to the hospital and moved to room 3604, where I visited her. Parking a car at the hospital can be a problem, with either a long walk from the parking lot to the entrance, or a long wait for the shuttle service. I noticed there was a golfcart parking area quite close to the entrance, so I began using our golf cart for my twice daily visits.
The doctors told me she had either septic shock or hypovolemic shock. Lisa's reaction to that news was that it seemed to be treatable. Violet was cared for at the Hospital until 2 October, when she was well enough to continue recovery at the skilled nursing Healthcare Center on the FP campus that we call "Rehab". I'll leave out many specific details, but the following days and weeks were rough for Violet. [NOTE: To make photo larger. tap it and turn cellphone sideways.]
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| Lisa and Ira in "Full-PPE" (Personal Protective Equipment) as we visit Violet at FP Rehab. On the right is my collection of stickers, confirming that I passed the Covid temperature screening at the Hospital (strip with date) or at FP Rehab (sticker with name). |
Brief Summary of Hospital to Rehab and Cycle Back Again
Cycle #1 -- 9/21/21. 911 call. Hospital ER room 11, 9/27/21 Hospital room 3604, 10/02/21 FP Rehab room 122.
Cycle #2 -- 10/06/21. Hospital room 2212. 10/14/21 FP Rehab room 133. [Lisa visit 10/14/21-10/17/21] Violet's cellphone and Libre blood sugar sensor were somehow lost during the move from Hospital to Rehab. Thank goodness Lisa was able to get them replaced relatively quickly. Violet seems much improved. She is moved to nicer room 154.
Cycle #3 -- 10/20/21. Hospital room 2408. 10/27/21 FP Rehab room 133 again. 11/04/21 Moved to nicer room 151. 11/09/21 We treat Rehab nurses with 3 dozen bagels, cream cheese, and lox! [Michaela visit 11/13/21-11/14/21]
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| Our good friends and fellow FP residents, Bob and Bunny Adler and John and Diane Griffin, visit Violet at FP Rehab through the window of room 151. (Individual visits were limited due to Covid restrictions, so Violet and her visitors communicated by cellphone and saw each other through the window of her room.) The building in the background is The Villages Hospital, just across the street from FP Rehab. |
Our Final Week at Home
Tuesday, 11/16/21, Violet was released from FP Rehab to FP Independent Living! Home in our own apartment!
Our friends at FP are mostly married couples who have been very generous with their time and emotional support for me in the trying months of Violet’s critical illness. They helped me retain my sanity as she was admitted to The Villages Hospital, discharged to skilled nursing at the FP Rehab facility, and then cycled thru Hospital and Rehab three times until she returned to our apartment in the Independent Living building.
Looking back, what turned out to be her final week at home was a glorious time. Violet was warmly greeted by fellow residents and staff as we ate our big meal of the day in the Dining Room, and as we passed through other public areas.
We hoped the doctors had come up with the proper mix of medications that, along with weekly paracentesis, would enable Violet to live a more-or-less normal life at FP for some number of years. We scheduled regular visits to our apartment by physical therapists to help Violet get stronger.
On Friday, 11/19/21, Violet fell in our apartment. I could not get her up. If we called FP staff for help, they would have been required to call 911 and Violet would have been sent off to the Hospital Emergency Department again. So, as pre-arranged, we called our good friends, the Griffins, and they helped Violet get back on her feet!
On Sunday, 11/21/21, which turned out one of the last days of that most wonderful week, the Adlers drove us to the Fenney Springs Nature Trail. Violet sat comfortably in her wheeled transport chair as we pushed her along the paved trail, enjoying the birds, turtles, fish, and a sleepy alligator. Earlier, we had stopped by a fast-food place and picked up the Chicken Sandwich Violet had begged for all through her Hospital/Rehab confinement. We consumed our chicken and fries in the shade of tall trees. [NOTE: To make photo larger. tap it and turn cellphone sideways.]
Our Final Day at Home
Alas, in the mid-morning of Wednesday, 11/24/21, Violet was confused as I tried to communicate with her. I called the FP nurse who came quickly, checked her vitals, and called 911. The EMTs did their thing and took her to the Hospital ER.
Violet's Last Days
Violet was getting
a CT-scan when I arrived at the Hospital.
When I was allowed into her room in the ER
area, she was completely non-communicative. Her eyes were about ¼ open. Her
pupils were rolling side to side. She did not respond to my request that she to
move her tongue. Squeezing her hand yielded no response.
She was admitted to the Hospital Intensive
Care Unit. They told me her liver and kidneys were failing. Ammonia and
creatinine were high, blood pressure low. At her age, she was not a candidate
for liver or kidney transplant.
The nurse and doctor suggested she should be put
in “comfort care”. Should her heart or breathing stop, they would not
resuscitate her. I reviewed the “Living Will” document we recently updated. It
called for comfort care in these circumstances. I called our daughter Lisa in
Massachusetts and she spoke directly to the nurse and doctor. She agreed, and I
signed the papers.
Lisa and our son-in-law Jerry live in Andover.
Their children, our triplet grandchildren, are 23-year-old college grads, each
employed in a different state. Via cellphones, each of us “talked” to Violet.
We hoped that, somewhere beyond the non-responsive exterior, there was still
some “Violet” there who heard us in some way.
On Thursday, 11/25/21, Violet was moved to Cornerstone Hospice, about four miles from FP. I had sent an email to the President of Temple Shalom, the Jewish Reform synagogue of which we are founding members. He contacted Rabbi Zev and we arranged for him to meet me in Violet’s room at Hospice.
Rabbi Zev “talked” to her and said the appropriate prayers. He was wonderful! I had last seen him some two years prior, but, due to Covid, we had not been going to services. Throughout this ordeal, through the funeral and beyond, Rabbi Zev and our Jewish congregation has done very well by us.
I visited Violet at the Hospice a couple of times. Violet
passed away there on Saturday, 11/27/21.
Violet's Interment
On Thursday, 12/02/21, in a private service conducted by Rabbi Zev and attended by family (our daughter Lisa and son-in-Law Jerry and their children Alex, Michaela, and Samantha, as well as our son-in-law David) and a few close friends, Violet was buried in the “Garden of David” Jewish section of Hillcrest Memorial Gardens, a tranquil, tree-shaded cemetery in Leesburg, FL, about a half-hour south of Freedom Point. May she rest in peace.
We plan to have a “Celebration of Life” for Violet at Freedom Pointe in a few months. Tentatively, it is set for Wednesday, 04/27/22 which would have been Violet's 80th birthday.
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