Who Should Care for Grandma?

[The Mystery Machine]

Well then you have nothing to be mad at sil for.. its not Dawns fault its gma's .. people can not be mind readers... ask her to help out more.. maybe she thinks everything is taken care of and there isn't anything she can help out with... Good luck.

Right.

OP, you are young, we are old and have been there done that and I am taking care of 2 incompetent parents right now.

You have to stop fighting and resenting your family and begin to WORK WITH THEM.

There is is fine line between treating people with dignity and allowing them to manipulate you.

If you feel like you are "in charge" of grandma, then you have to be a better manager. If you have to let things go, then communicate with people, including grandma.

You can work this out, but you have to work at it with your family. Good Luck!

 

[angwill]

I'm looking for some outside, unbiased opinions on a situation in my family having to do with the care of a senior.

First some background info on who in the family:
Grandmother - Estelle, age 83
Her Daughter - June, aunt to the grandchildren
Estelle's Three Grandchildren:
Josh - has a wife and two kids.
Marnie - college student
Me, Abby - unemployed twenty-something.

Everyone except June lives in the same town. Josh and his family live next door to grandma Estelle.

June lives in MO, the rest of us are in FL.

Grandma Estelle's other daughter, my mother Sara, passed away a year ago after a three year battle with cancer. Sara lived next door to her mother Estelle and was the 'caregiver'. Grandma Estelle lives alone and didn't need supervision or 24-7 care, but she is elderly and needs help from time to time. Sara was her go-to person for many years due to the proximity, but obviously that situation has changed because Sara died before her mother.

My siblings and I spent the last three years acting as caregivers to our mother while she was battling cancer. In the last six months of her life, she required 24-7 care, so we three children took turns caring for her. Her sister June flew down occasionally to help out several times over the course of Sara's illness, but it was mainly me and my sister, Marnie, who provided the bulk of care for our mother.

My mother's death has dramatically worsened grandma Estelle's health. She's still living alone and I try to go over a couple times of week to help her with chores she can't do - things we call 'tall person' jobs, or things that require strength in the hands since Estelle has arthritis.

Due to the fact that I am jobless and have the closest relationship with grandma, I am the one who helps her and cares for her a good 70% of the time that she needs it. However, looking for a job is a full-time job, and I lose days of searching when I have to take grandma to the doctor and such.

My sister Marnie is a student, but she only took two classes last semester, and is in the three this semester. She will graduate in April.

Josh works full time, and has two grade school aged kids. His wife, Dawn, doesn't really work (she is a massage therapist, but only gives a few massages a week - so a stay at home mom for the most part).

In the past month, Grandma Estelle has been in the hospital three times and she's there again now.

The family is angry and resentful of each other because everyone feels like the other members aren't participating in Grandma's care. The one area where the three grandchildren unite is that we think June, Estelle's daughter, should be more physically involved. She is on the phone with Grandma several times a day and they are close, so I don't want to make it sound like she's uninvolved. But she lives 1000 miles away....so she's not the one who gets the call in the middle of the night when Grandma needs to go to the hospital or during the week when Grandma needs groceries and isn't up to shopping for them herself.

June has a husband, a house, and a life in MO. Grandma has the bulk of her family, her house, her pets, and friends in FL. She is an extremely stubborn lady and is attached to her home of 35 years.

What happens when I finally find a job? I won't be available to take grandma to the doctor. I will only have weekends to help.

Should June have to move here to take responsibility for her mother? Should Grandma be forced to move to live with June? Should everyone be splitting the care equally?

A nursing home is out of the question, due to cost, and mainly Grandma's complete unwillingness to even consider ever living in one. She isn't at the point yet either....but she does need a lot of help.

Me and my siblings feel like we have done our duty in caring for our mother in her last years. I think we all feel like the bulk of burden with Grandma shouldn't fall on our shoulders since we are her grandkids, not her children.

What is your opinion on the matter?

I agree with looking into an assisted living facility or looking to see if insurance will cover someone part time to help around the house and take her to appointments. Her doctor will probably have to approve it for insurance to cover it so call the insurance company and inquire. You grandmother needs to realize she needs to do something for herself even if that means moving and selling her home to cover the cost.

I too had to take care of my grandmother before she died and my mother at one point. What is important to remember is that what each of you chooses to do for your grandmother is your choice and you can not resent others for not doing as much. If grandma is calling you to take her to the store at a specific time and you are busy learn to say no and give her an alternative time when you have to go shopping yourself. Tell her what day works best for you for doctor appointments and let her schedule them on that day. My granmother resented when I did that but I had to work around the other things I had going in my life too so she learned to live with it or call someone else. It was never a life or death situation she usually just wanted to get out of the house. There is always senior busses and senior centers where she can make friends and go shopping with others who may have similar interests and take some of the burden off her family. They also drive seniors to doctors appointments if they call ahead for a ride. Make a list of all the services available to seniors in your area or call the local senior center and see if they can send a list out or have an advocate come talk to her about what is available.

As for your Aunt and her daughter what she does for her mother is between them and again can not be expected. If you think she could do more and might be available for an extended visit then ask her about that possibility. You can not expect her to give up her life to move to Florida however. I would think it would be your grandmother who should have to move to her if they are both willing. Honestly, if there is that much tension about who helps her now there is going to be hell to pay when she passes and everyone wants to know who gets what. Don't let that tear apart your relationships with your siblings it is not worth it.

 

[weeluvdisney]

OP
I don't think I have advice, just words of encouragement as I am going through the same thing. I am in my 40's with 3 children. My mother also died of cancer when I was in my 20's. Her mother, my maternal grandmother has been widowed for a few yrs. My grandmother lost her drivers license a few yrs back because of eye sight problems. She has 5 children, 2 out of state. She has alot of Grandchildren including myself. Besides me, her other grandchildren barely come to visit her let alone do anything for her. I left my job 2 yrs ago and am looking for another one. She now calls me for everything from grocery shopping to her many doctors appointments. She was always a wonderful sweet grandma but has changed a bit since my grandfather died. Since she doesnt drive she can get kind of demanding when she wants or needs to go somewhere. She lives on her own but her memory is getting bad and she had a terrible fall a while back. I live the closest to her and then my uncle who does less and less to help. He would rather write her a check for money as like a payoff and be left alone, or so it seems. She is 83.

Add that to the fact that my elderly inlaws have lived with us since 2000 in an inlaw suite in our home (fatherinlaw died a few yrs back ). My mother in law isin her 80's...she is pretty self sufficient but the things we have to help her with are growing. She has recently had some heath problems and she has fallen several times lately and I just dont know what the future will hold. Her grandchildren also dont come to visit her but like once a year and my husbands sisters visit her but it seems to be less and less but they do nothing to help.

Recently my paternal grandfather needed help...my aunte was his care taker but had some health problems and my father (lives out of state) asked me if I would temporarily be POA just to pay his bills. So I run over there often.

Long story short...I commend you for what you are doing. It isn't your responsibility and some family members don't even recognize nor do they care that you are helping. If you want to help then go for it. If it ever becomes too much, you are still a shining star for what you have done so far especially at your age. I often sit and wonder how others can turn their back in my family and why they dont help but I'll never know. I'll do what I can and when I'm done, I'm done and I'll know I did what I could, especially when no one else would. I can't help like this forever as I dont want to slack taking care of my own family but I can't imagine being as selfish as to not come around and visit them and help a little bit. If no one helps, what happens? I try to tell myself everyone is different and no one has to help, but really, how can they live with themselves. I often think about how much better my life would be if all of us in the family took turns helping but that is a dream that will never come true. Good luck and hang in there...its not easy being compassionate and helpful but its rewarding!

 

[cbg1027]

Thank you for the encouraging words.

June is here now and we want to try and have a family meeting to discuss everything. I'm pretty close with her too so we can talk freely with each other.

She did mention that her husband, my uncle is totally on board if we ever need to move grandma to live with them. He even said he would build her a greenhouse! While it's great to know Uncle Steve is so caring, I don't like the thought of grandma moving away. I've lived in the same town as her almost my entire life and she is almost like my third parent.

She came home from the hospital today, after they literally almost killed her. I've never wanted to sue someone before, but if this crap happens again, I would look in to it.

To make a long story short, Grandma started to have an Addison's crisis and they wouldn't given her any more of her medication for it because the doctor had only authorized a certain dosage she already took. She would have to take an incredible amount to OD on the drug. The general guidelines are to TRIPLE a normal dose in a crisis situation.

If it wasn't for the fact that Gram carries extra medication with her, and I live close to the hospital and carry her meds...then she could have died. It's pretty sad when you can't trust the hospital to do their basic job. Poor June was driving in after a day of traveling and had to go straight the hospital. We were battling with the nurses all night to get her more meds and they basically told us their hands were tied since they can't give more meds until a dr orders it...and the on call dr wouldn't order any more since he wasn't familiar with the patient. Seems like a hospital should have a doctor there at night to deal with this kind of thing.

 

[angwill]

Thank you for the encouraging words.

June is here now and we want to try and have a family meeting to discuss everything. I'm pretty close with her too so we can talk freely with each other.

She did mention that her husband, my uncle is totally on board if we ever need to move grandma to live with them. He even said he would build her a greenhouse! While it's great to know Uncle Steve is so caring, I don't like the thought of grandma moving away. I've lived in the same town as her almost my entire life and she is almost like my third parent.

She came home from the hospital today, after they literally almost killed her. I've never wanted to sue someone before, but if this crap happens again, I would look in to it.

To make a long story short, Grandma started to have an Addison's crisis and they wouldn't given her any more of her medication for it because the doctor had only authorized a certain dosage she already took. She would have to take an incredible amount to OD on the drug. The general guidelines are to TRIPLE a normal dose in a crisis situation.

If it wasn't for the fact that Gram carries extra medication with her, and I live close to the hospital and carry her meds...then she could have died. It's pretty sad when you can't trust the hospital to do their basic job. Poor June was driving in after a day of traveling and had to go straight the hospital. We were battling with the nurses all night to get her more meds and they basically told us their hands were tied since they can't give more meds until a dr orders it...and the on call dr wouldn't order any more since he wasn't familiar with the patient. Seems like a hospital should have a doctor there at night to deal with this kind of thing.

It is good to hear that June is there to relieve some of your stress for you and that you are close enough to talk honestly with her.

Having worked in a hospital what you said happened happens all the time. The doctors are rarely there because they work in their offices all day and are on call for the hospital unless they are there visiting and a nurse can not legally give meds without a doctors permission. You might want to talk to your grandmothers doctor about the situation further and ask him what he might suggest to prevent it from happening again.

Good luck with your granmother. Get some rest and relax and let Aunt June take care of grandma while she is there.

 

[The Mystery Machine]

Thank you for the encouraging words.

June is here now and we want to try and have a family meeting to discuss everything. I'm pretty close with her too so we can talk freely with each other.

She did mention that her husband, my uncle is totally on board if we ever need to move grandma to live with them. He even said he would build her a greenhouse! While it's great to know Uncle Steve is so caring, I don't like the thought of grandma moving away. I've lived in the same town as her almost my entire life and she is almost like my third parent.

She came home from the hospital today, after they literally almost killed her. I've never wanted to sue someone before, but if this crap happens again, I would look in to it.

To make a long story short, Grandma started to have an Addison's crisis and they wouldn't given her any more of her medication for it because the doctor had only authorized a certain dosage she already took. She would have to take an incredible amount to OD on the drug. The general guidelines are to TRIPLE a normal dose in a crisis situation.

If it wasn't for the fact that Gram carries extra medication with her, and I live close to the hospital and carry her meds...then she could have died. It's pretty sad when you can't trust the hospital to do their basic job. Poor June was driving in after a day of traveling and had to go straight the hospital. We were battling with the nurses all night to get her more meds and they basically told us their hands were tied since they can't give more meds until a dr orders it...and the on call dr wouldn't order any more since he wasn't familiar with the patient. Seems like a hospital should have a doctor there at night to deal with this kind of thing.

Let her go and let June take care of her mother. I know you don't want to but it is time.

 

[deegack]

It is good to hear that June is there to relieve some of your stress for you and that you are close enough to talk honestly with her.

Having worked in a hospital what you said happened happens all the time. The doctors are rarely there because they work in their offices all day and are on call for the hospital unless they are there visiting and a nurse can not legally give meds without a doctors permission. You might want to talk to your grandmothers doctor about the situation further and ask him what he might suggest to prevent it from happening again.

Good luck with your granmother. Get some rest and relax and let Aunt June take care of grandma while she is there.

This. Nurses cannot order meds or adjust the doctors orders. When I was in the hospital to have my dd my doctor wrote an order for percicet (however you spell that) but all I needed was Tylenol. The nurse had to get permission to give me Tylenol but could give me the other without a wait. Sonic it happens again you should ask for the doctor on call. They can make adjustments. Giving medication out of your personal supply should not happen because then te medical record is inaccurate and the chance of overdose is increased.

 

[Lionqueen2]

Let her go and let June take care of her mother. I know you don't want to but it is time.

This is good advice. It is time for June to take charge of her mother.

 

[torinsmom]

This. Nurses cannot order meds or adjust the doctors orders. When I was in the hospital to have my dd my doctor wrote an order for percicet (however you spell that) but all I needed was Tylenol. The nurse had to get permission to give me Tylenol but could give me the other without a wait. Sonic it happens again you should ask for the doctor on call. They can make adjustments. Giving medication out of your personal supply should not happen because then te medical record is inaccurate and the chance of overdose is increased.

This drove me crazy after I had brain surgery! I knew something was wrong 2 days after surgery when I got a terrible headache and could not even get out of bed. We kept telling the nurses to call the neurosurgical resident, but 2 hours later, we still had no results. Finally my sister paged the NSG number herself and got them there in 15 minutes. My brain was swelling and I could have gone into a coma if it wasn't treated and the first day after surgery, they wouldn't bring me ibuprofen until they got permission. I wasn't using the morphine pump as it made me feel weird. My sister had to sneak in ibuprofen and I hid it under my pillow.

 

[cbg1027]

This. Nurses cannot order meds or adjust the doctors orders. When I was in the hospital to have my dd my doctor wrote an order for percicet (however you spell that) but all I needed was Tylenol. The nurse had to get permission to give me Tylenol but could give me the other without a wait. Sonic it happens again you should ask for the doctor on call. They can make adjustments. Giving medication out of your personal supply should not happen because then te medical record is inaccurate and the chance of overdose is increased.

True....but we should not have needed to do it in the first place. If we had waited until the doctor finally ordered more, Gram would have died. She started having symptoms around 9:30pm and the doctor didn't come to see her until mid-morning the next day. We asked for the doctor on call and he refused to authorize more medication since she's not his patient.

Our problem is that no medical professional seems to understand Addison's disease or the severity and urgency of an Addison's attack. It should be treated with the same urgency as a heart attack....and most doctors don't have a freaking clue about it.

This drove me crazy after I had brain surgery! I knew something was wrong 2 days after surgery when I got a terrible headache and could not even get out of bed. We kept telling the nurses to call the neurosurgical resident, but 2 hours later, we still had no results. Finally my sister paged the NSG number herself and got them there in 15 minutes. My brain was swelling and I could have gone into a coma if it wasn't treated and the first day after surgery, they wouldn't bring me ibuprofen until they got permission. I wasn't using the morphine pump as it made me feel weird. My sister had to sneak in ibuprofen and I hid it under my pillow.

Ugh, I'm sorry this happened to you! Unfortunately, I have had several experiences similar to this in all the hospital stays my mother had while she was sick with cancer. It's like nurses and doctors don't trust a patient to say 'Hey I know my body, and there is something wrong". They completely ignore the patient and can't seem to accept that fact that we might know something they don't!

 

[torinsmom]

True....but we should not have needed to do it in the first place. If we had waited until the doctor finally ordered more, Gram would have died. She started having symptoms around 9:30pm and the doctor didn't come to see her until mid-morning the next day. We asked for the doctor on call and he refused to authorize more medication since she's not his patient.

Our problem is that no medical professional seems to understand Addison's disease or the severity and urgency of an Addison's attack. It should be treated with the same urgency as a heart attack....and most doctors don't have a freaking clue about it.



Ugh, I'm sorry this happened to you! Unfortunately, I have had several experiences similar to this in all the hospital stays my mother had while she was sick with cancer. It's like nurses and doctors don't trust a patient to say 'Hey I know my body, and there is something wrong". They completely ignore the patient and can't seem to accept that fact that we might know something they don't!

The stupid nurses(sorry, but they were not listening to me or my family) were almost yelling at me to get out of bed and walk and to eat something, and I would feel better. I HAD been up and walking for more than 24 hours before this brain swelling started. To me it's obvious that if there is a dramatic change in what someone can or will do, the doctor needs to be called.

10 days after I was discharged, I had the same symptoms. I called my NSG who was in surgery. The nurse help up the phone and he told me to go to the ER and he wanted to do a spinal tap and a CAT scan. I got there and noone knew anything. They put me in the hallway under a bright fluorescent light for 2 hours, and said they were calling but not getting an answer. Finally, my sister threatened taking me to another ER and told them they better hope I made it there. Then she went outside and called the NSG on call number and someone came right down to the ER and started the process.

I don't understand why 2 separate times, a person off the street could get action when nurses could not.

 

[bettymae1121]

For about 2 years before my grandmother died, we had a woman come in 3x a week to clean, run errands, and take grandma to appointments (medical, dental, vision, salon, etc.). I'm not sure what she was paid (my aunt took care of that) but it was certainly cheaper than a medical aid and grandma refused to go into assisted living. That sounds like it's about the level of care you need at the moment.

Later on if she needs more specialed or daily care, you may need to look into other options, but for now a part time caretake may be just what you need. If you split the cost among yourselves it should be affordable for all of you.

 

[Pea-n-Me]

Giving medications without a physician's order is a good way for nurses to not only lose their jobs, but their nursing licenses.

Staff nurses cannot prescribe or dispense medications, those roles fall to physicians and pharmacists.

 

[cbg1027]

The stupid nurses(sorry, but they were not listening to me or my family) were almost yelling at me to get out of bed and walk and to eat something, and I would feel better. I HAD been up and walking for more than 24 hours before this brain swelling started. To me it's obvious that if there is a dramatic change in what someone can or will do, the doctor needs to be called.

10 days after I was discharged, I had the same symptoms. I called my NSG who was in surgery. The nurse help up the phone and he told me to go to the ER and he wanted to do a spinal tap and a CAT scan. I got there and noone knew anything. They put me in the hallway under a bright fluorescent light for 2 hours, and said they were calling but not getting an answer. Finally, my sister threatened taking me to another ER and told them they better hope I made it there. Then she went outside and called the NSG on call number and someone came right down to the ER and started the process.

I don't understand why 2 separate times, a person off the street could get action when nurses could not.

Sounds like you and I have had a lot of unfortunate hospital experiences! I'm glad you're ok now! You really have to speak up, to the point on being pushy and annoying, to get what you need in a hospital. It shouldn't have to be like that.

Giving medications without a physician's order is a good way for nurses to not only lose their jobs, but their nursing licenses.

Staff nurses cannot prescribe or dispense medications, those roles fall to physicians and pharmacists.

I know that, and we didn't expect the nurses to give medication without doctor's orders. What we did expect was a prompt response and visit from a doctor in order to get what was needed....and that didn't happen. And the nurses are the ones on the front line, so to speak, so they are the ones who had to deal with us being upset when our grandmother was put in to a simply prevented crisis situation.

 

[Pea-n-Me]

I know that, and we didn't expect the nurses to give medication without doctor's orders. What we did expect was a prompt response and visit from a doctor in order to get what was needed....and that didn't happen. And the nurses are the ones on the front line, so to speak, so they are the ones who had to deal with us being upset when our grandmother was put in to a simply prevented crisis situation.

To make a long story short, Grandma started to have an Addison's crisis and they wouldn't given her any more of her medication for it because the doctor had only authorized a certain dosage she already took. She would have to take an incredible amount to OD on the drug. The general guidelines are to TRIPLE a normal dose in a crisis situation.

If it wasn't for the fact that Gram carries extra medication with her, and I live close to the hospital and carry her meds...then she could have died. It's pretty sad when you can't trust the hospital to do their basic job. Poor June was driving in after a day of traveling and had to go straight the hospital. We were battling with the nurses all night to get her more meds and they basically told us their hands were tied since they can't give more meds until a dr orders it...and the on call dr wouldn't order any more since he wasn't familiar with the patient. Seems like a hospital should have a doctor there at night to deal with this kind of thing.

We asked for the doctor on call and he refused to authorize more medication since she's not his patient.

So the nurse notified the doctor of your requests and the doctor wouldn't order more.

We were battling with the nurses all night to get her more meds

I agree the doctor should have come to see you, at least. But if the nurses had notified the doctor and the doctor refused to order something, the nurse cannot just go ahead and give someone more medication. I hear your frustrations and I have been frustrated from the patient side myself, but I think you're barking up the wrong tree here. That was a medical decision, not a nursing decision.

 

[cbg1027]

So the nurse notified the doctor of your requests and the doctor wouldn't order more.

I agree the doctor should have come to see you, at least. But if the nurses had notified the doctor and the doctor refused to order something, the nurse cannot just go ahead and give someone more medication. I hear your frustrations and I have been frustrated from the patient side myself, but I think you're barking up the wrong tree here. That was a medical decision, not a nursing decision.

I know it was not the nurse's fault. I'm not blaming them. I don't know who I'm blaming...the doctors, hospital administration, ????.....but if a patient says they're having chest pains, don't they get to see a dr immediately?

An Addisonian crisis is in the same league. If it's not treated, it can be fatal. If a patient says they're having one.....then someone needs to pay attention and get something done. Everytime my grandmother is in the hospital, it's like they think we're all idiots since we walk in and tell them how to treat it since they have no clue what to do. I know medical professionals don't like being told how to do their job by the patient. But if the doctor, or nurse, is ADMITTEDLY not familiar with the disease, shouldn't they put some stock in to the prior experience of a patient who has been dealing with the disease for 12 years??? Or at least go read up on the treatment guidelines before dismissing the request?

 

[SandrA9810]

My grandmother had TIAs a lot, it puts on a lot of similar symptoms of other things. My aunt works with doctors that work with certain hospitals in the area. Her files are easily available when she arrives, and the ambulance knows to only take her to that hospital.

One good advice she's gotten, is any drugs that don't interact well with her, or don't work, are listed on her allergy list. There's one med that's supposed to stop hallucinations, instead created them in her. So my aunt has it on her allergy list so they don't give it to her and make things worse, since she has dementia and doesn't know what's going on during a TIA episode.

 

[Pea-n-Me]

I know it was not the nurse's fault. I'm not blaming them. I don't know who I'm blaming...the doctors, hospital administration, ????.....but if a patient says they're having chest pains, don't they get to see a dr immediately?

An Addisonian crisis is in the same league. If it's not treated, it can be fatal. If a patient says they're having one.....then someone needs to pay attention and get something done. Everytime my grandmother is in the hospital, it's like they think we're all idiots since we walk in and tell them how to treat it since they have no clue what to do. I know medical professionals don't like being told how to do their job by the patient. But if the doctor, or nurse, is ADMITTEDLY not familiar with the disease, shouldn't they put some stock in to the prior experience of a patient who has been dealing with the disease for 12 years??? Or at least go read up on the treatment guidelines before dismissing the request?

It's not that simple. You can't say they don't know what to do. They don't pull things out of a hat and decide to do things any which way. They're obligated to do things according to established guidelines. If they go outside of stablished guidlines and something goes wrong, guess who gets the blame there? I can only talk generalities because I wasn't there. But my guess would be that the on call doc wasn't comfortable with what you were asking because it fell outside established guidelines of accepted practice. Obviously, experience and judgement is involved. Sometimes good judgement is to not act as much as it is to act. But I don't think it's fair to say that nobody knew what they were doing. It may have seemed that way to you, but heaven help us all if nobody in hospitals knows what they're doing.

What I would do if it were my grandma and this was an issue would be to have the doctor who manages her Addison's write out a "protocol" that you can keep in the medical record that others can refer to if a situation like that presents itself again. That way it becomes "accepted practice" for her because it comes from her own physician, and everyone is then comfortable with the plan of care even if it's outside the norm.

 

[npmommie]

It's not that simple. You can't say they don't know what to do. They don't pull things out of a hat and decide to do things any which way. They're obligated to do things according to established guidelines. If they go outside of stablished guidlines and something goes wrong, guess who gets the blame there? I can only talk generalities because I wasn't there. But my guess would be that the on call doc wasn't comfortable with what you were asking because it fell outside established guidelines of accepted practice. Obviously, experience and judgement is involved. Sometimes good judgement is to not act as much as it is to act. But I don't think it's fair to say that nobody knew what they were doing. It may have seemed that way to you, but heaven help us all if nobody in hospitals knows what they're doing.

What I would do if it were my grandma and this was an issue would be to have the doctor who manages her Addison's write out a "protocol" that you can keep in the medical record that others can refer to if a situation like that presents itself again. That way it becomes "accepted practice" for her because it comes from her own physician, and everyone is then comfortable with the plan of care even if it's outside the norm.

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