Family, Food, Health, home, Kids, Uncategorized

Caregiver Update

106 Comments

The orthopedic office was busy but inside the treatment room, it was pretty quiet. “In 99% of these kinds of breaks, we put on a cast and they heal up on their own.”  I was momentarily elated.  Then he turned to YA and said “Unfortunately, you are in the 1%.”  Surgery is scheduled for Tuesday.

She is in better shape than a week ago, but both ankles are still quite swollen, sore and hideously discolored, so for the most part she is hanging out on her bed, using my studio chair to roll herself down the hall to the bathroom and back. For the two doctor appointments this week, she literally had to scoot down the stairs on her backside and then use the crutches to get to the car.  This takes quite a while.

Even if she gets downstairs, she’s not stable enough on the crutches to do anything, so all meals are being prepared by me. I’m doing all dog and cat duty as well as YA’s other chores (vacuuming, garbage/recycling, poop patrol in the yard, mopping) as well as her laundry and, it goes without saying at our house, her dishes.  In addition, because her dog (Guinevere) has a teeny tiny bladder, I’ve been going home over lunch every day to let the dogs out.  I’m also the go-to for discussions of workers’ comp, insurance, appointments, etc. None of this is physically taxing work but I’m tired anyway.  When the alarm went off this morning, only the knowledge that my alarm clock is a fancy-dancy expensive thing kept me from sweeping it off the nightstand!

My kudos and admiration to everyone who has ever had an extended period of care-giving. Real heroes in my book.

Have you ever had to be a care-giver? Been the care-give?

106 thoughts on “Caregiver Update”

  1. Boy, what a kick in the pants that is, VS. I’m hoping that the surgery will lead to a quicker, cleaner recovery. That said, I’m also mindful of the fact that your house isn’t especially well suited for someone with a broken ankle and on crutches. Have you considered the possibility of a rehab facility following the surgery, at least for the first week or so? Is there anything that I or anyone else can do that would be helpful?

    I’m still dying to learn how the heck the accident occurred. Did she fall off of something, trip over something, or just take a spectacular pratfall for no good reason?

    I have been a caregiver a lot more than I have been on the receiving end. For that I’m grateful for a number of reasons, but, especially since husband makes a pretty lousy caregiver. When I returned home from the hospital two days after the hysterectomy, I made the mistake of putting on my normal street clothes rather than lounging in my pj’s all day. He took that to mean that I could also assume all of my normal cooking and other activities. Fortunately, I had several good women friends who understood what I was going through, and they provided great support and care.

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  2. My dad was pretty self sufficient when he lived with us after my mom died. He mainly needed company and assistance getting to appointments and things. It has been 5 years since he died. It doesn’t seem possible that it has been that long.

    When my parental grandmother was in the hospital getting her gallbladder out, I was volunteered by my parents to stay with my grandfather.I was about 14. He had a prosthetic leg due to losing his to diabetes, and he was paralyzed on his left side due to a stroke. I mainly had to cook for him and help him put his leg on in the morning and empty his urinal that he used at night. That was the worst part of it.

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        1. I had older male cousins who weren’t ever enlisted to help out with things like that, and my dad’s sister had two daughters who were my age but also never were considered as helpers. They lived in Sioux Falls, and my mother thought my aunt and her daughters were terribly spoiled. My aunt was a homemaker and could have easily spent a few days with my grandpa, but I was enlisted instead.

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        2. Your parents must have had great confidence in your maturity and ability to handle it. I hope you weren’t volunteered without input from you?

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        3. Well, no, I wasn’t consulted. I was just told that I had to spend a few days in Adrian with Grandpa until Grandma got home from the hospital. I wasn’t upset about it, though. I got along pretty well with him, even though he was a difficult, bad tempered guy at times. He had lots of books I liked to look through.

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        4. The fact that your two older cousins weren’t even considered is likely yet another gender related bias that few thought about at the time.

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    2. When my folks got married (1948) dad’s parents were in the house along with Grandpas mother.
      Dad only had brothers so his mom was thrilled to have a daughter in the house and she and Mom got along well. Great Grandmother was sick and bedridden. Mom spent a lot of time taking care of her. When G. Grandmother died, Mom helped prep the body. She always says that’s where she learned not to be afraid of death or dead people.
      And in her 60’s Mom was a home health aide for the county. Moms a good caregiver.
      I love how the things your learn at some point come back around later.

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  3. Good thoughts to you VS! You’re doing a huge job (and blessings on you for doing it!!) and it’s no wonder you’re tired.
    Care takers are hugely underrated.
    I’m not very good. I run out of sympathy quick.

    Kelly was great taking care of me earlier this summer with my leg infection. I call her nurse Kelly.
    The only lingering thing I had was two little “wounds” behind my knee. Just open sores from the initial swelling. But we’re talking 1/2” and 1/4” sore so nothing major. Daily dressing with ‘Medicinal honey made by bees from New Zealand!’ How could I not try that??
    And Nurse Kelly thinks a couple more days and they’ll be all better.

    You hang in there VS. give yourself breaks when you can. And YA too! She’ll run out of patience before you? Maybe?
    Try not to kill each other.

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    1. … from your AND YA’s friends? Or can you hire any help short term?
      I’ve written lots about our involvement with our friend W here, but that is not usually caregiving – we help a lot.

      When Husband came home from heart surgery in 2011, I wrote this blog post about caregiving https://trailbaboon.com/2011/03/page/1/

      I’m pretty sure that what we baboons could do to help is to step our involvement in providing blog posts this month, so VS doesn’t have as many of those to think about.

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        1. I just read your post-surgery guest post, BiR, which predates my time on the trail. The post had some great suggestions, and several baboons provided some additional ones in the comments section.

          While I was back there, I also read Dale’s post on Arthur Hoehn’s passing, and I’m reminded how I miss Dale’s presence here on the blog. It was good to get to hang out with him a little at Edith’s celebration of life and to hear that he’s enjoying retirement.

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        3. dale has a special voice in his head that he brought with him everyday. i wonder if it’s gone silent or if he talks to himself nowadays or if he’s found another outlet

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        4. When I asked him at Edith’s celebration how he was spending his time, he said he was focusing on down-sizing. Claimed not to be doing any writing, and that he was really retired. I’m pretty sure, though, that Dale spends a good amount of time talking to himself. What sane person doesn’t?

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      2. i miss lots of those good old times with former baboons
        man in the hat
        bib
        jim
        clyde
        joanne
        that girl with the dog from the up then ashland
        the lady folksinger or oldtimey singer
        the winged poet lady
        we scared a couple off and others just migrated
        dale needed to get a life
        he had a good excuse

        i do like what it has become thank you again to vs and renee

        the trail lives on

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  5. She came down wrong on a roundoff double back handspring. This was at work so workers comp is involved. Actually we’re doing pretty well with the layout of the house since I’m willing to do all the work. My office chair on wheels is living in her room right now and she uses it to get from her bed down the hall to the bathroom and back pretty easily. She’s not good on crutches yet because both ankles still hurt so that may be a bit.

    She doesn’t need constant attention which means I can escape from the house for work or for errands which helps me a lot.

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      1. Well technically her gymnastics days have been over for a while. She hasn’t been in competition or on teams since she went away to college. My guess is that once she is healed up she’ll be able to go back to coaching fairly easily. That’s the most ironic part of this whole thing, that she never got seriously hurt during all of her years in competition and now as a coach she gets a biggie.

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        1. when you start a sentence with she landed wrong on a round off double back handspring you know it’s not gonna be good
          my first wife is a perennial garden design person with a gorgeous garden and last year she was up on a ladder pulling down the previous years morning glory deadwood off her trellis and the ladder tipped and broke her leg so the bone was sticking out in the freshly fertilized garden below. she was unable to move for a long time and had such severe complications with the recovery and the leg needing to be fused that she decided to have it amputated
          my son had moved to arizona my daughter lives a mile away and got hung with the caretakers role and still has to help more than a little in return for the two days a week of grandma day care he gets over there.
          ari is a ball of fire and i can’t imagine how she keeps up with him on her stump. he must live a different life at her house than he does at mine. i encourage him to explore and push his boundaries. she has to make sure he doesn’t get around a corner or near a staircase
          i’ll bet she’s in for it once he learns how to work doorknobs and locks. my daughter said last week she fell and hurt the stump and had to get some special help
          care taker and being taken care of is part of the deal sometimes too

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  6. We’ve already had a couple of discussions about attitude. On Thursday I suggested to her that she tried to imagine that her boyfriend was out of commission and she was the full-time caregiver. How would she feel if he treated her the way she treats me when she gets testy. It’s been better since then.

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      1. That, and pain. Neither are conducive to improving human behavior. But I’m glad you had that conversation, and that it helped improve the situation.

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  7. I’m not sure why WordPress in my cell phone aren’t getting along today but my replies seem to be getting placed in all the wrong places. So I’ll leave it up to baboons to figure out which reply belongs to which comment.

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  8. When my family and I lived in Michigan, I had a car and could drive. My daughter, unable to find employment, had unlimited time to assist me. I did my own grocery shopping until that became unworkable. Molly took over my grocery shopping and sometimes cooked for me. She performed simple nursing care twice a week. She did my laundry. Gradually she became my chauffeur for medical appointments. We enjoyed seeing each other so often, which was a joy.

    Everything has changed. Now Molly works a fulltime job while continuing her responsibilities as a wife and mother. I no longer drive. Without getting into boring details, I can say that we are doing our best to adapt to life without the help Molly once gave.

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        1. hope you have amazon prime. also has same day delivery now. check it out. meds delivered is a thing too.
          most of those dancing girls drive them selves don’t they steve??

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        2. Thanks, tim. Amazon provides the only way I can shop. My pharmacy delivers. My grocery store delivers, too, and I’m exploring that. Alas, my life includes no dancing girls.

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  9. OT – This little tidbit caught my eye, and I thought I’d share it for the benefit of all of the bakers in this group

    Anastasia Arellano of 12Tomatoes wrote:

    “Journalist Annemarie Dooling posted a picture on Twitter which shows that the Ludington Library in Bryn Mawr, Pennsylvania, has a baking pan section. You can actually check out specialty baking pans for your own use at home. It’s such a clever idea. We’ve all been there where we need to bake a cake or something and we rush out to the store to purchase a pan of some kind only for it to be used the one time than sit in the back of the drawer collecting dust until it inevitably ends up in the donation pile. So being able to borrow a fun-shaped pan and then return it saves everybody stress.”

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    1. what a marvelous idea, i will forward it to friends of the hennipen county library.
      a while back i brought skillets i was taking to storage because my pantry was overflowing with my goodwill tuesday finds
      i can’t wait to get situated in my own kitchen sometime in the future. i have a stash of rice cookers and specialty implements i bring out at special needs times. my favorite is the electric non oil deep fryer i got from pj years ago i thought i would use to make beer. it didn’t work for that but it make the best smoked turkey ever. so moist and wonderful it’s worth the trouble of stepping around it in the garage the 362 days a year it goes unused

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        1. 3 times christmas easter and thanksgiving
          turkey at 99 a pound causes an extra bird or two because everyone loves the result. always get the 24 lb monster bird and it’s always all gone

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        1. its a funnell shaped heat element that wraps around the bird. heats is very evenly in an insulated double wall tom tom drum sized contraption that has a spot at the bottom where they provide a small recovery pan that overflows with the big birds i tend to cook so i replace it with a 2 qt sauce pan and make gravy with the drippings the temp of 25 -275 is real easy to hit and maintain for a good slow cook and ther eis a smoker drawer when you cna put wet hickory or mesquite to fill out the taste of the bird i am told. works gooood

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  10. Rise and Lend a Hand Baboons,

    I have been mulling this over all morning. Caretaking my father, grandfather and my mother was my childhood. I do not want this reply to be riddled with self-pity. Rather I want to say this just was the way things were. I did not find helping my father and grandfather a negative at all. They were both just such wonderful people and they appreciated anything anyone did for them.

    As ever, the one I cannot understand was my mother. What was she thinking? Some of her decisions and behaviors bring up the parents in “The Glass Castle.” It seems that her highest value was to ask for help only within her family, which included her small children.

    My dad was diagnosed with MS when I was age 5. He lost his drivers license and his job within several years. That diagnosis was quickly followed by my mother’s pregnancy, her third, with my brother. They knew immediately that this would a high risk baby due to RH factor, the treatment of which was brand new at that time. And all this happened at the end of Kindergarten which I told about several days ago when there was ALOT going on at school. When Mom went into labor in April, 1959, she drove herself 40 miles to Council Bluffs, Iowa to give birth, refusing to ask any adult to drive her. He was transferred to children’s hospital for a full blood transfusion, which saved his life.

    My parents moved to NW Iowa to a larger town, closer to mom’s parents, and near a college so mom could teach and finish her college degree. And into this my diabetic grandfather came to live. It became my job at ages 8 and 9 to monitor him for insulin shock. If that happened, which it did fairly often in those days of poorly monitored diabetes, I went to the fridge, poured orange juice into a small glass, and somehow got Grandpa to swallow it. Sometimes when this happened, he had fallen onto the floor, so I would turn him over and lift his head to a point he could take the OJ until he snapped out of it. I also helped him load his insulin syringe, then watched him give himself a shot.

    My sister and I could operate a wheelchair, fetch dad his urinal and empty it, change my brother’s diapers, warm a bottle feed my brother, and make coffee for the adults in an intricate dance of a drip coffeepot, boiling water, and coffee grounds. My Aunt Donna and Uncle Jim, who lived 6 blocks away with their 4 children, were so much help. Our neighbor, Harry, a retired minister, was the one person outside the family that Mom would accept help from. He was invaluable to all of us, and so kind and loving to us. He would appear at our house about 3 times a week after school and “supervise” us, talk with us about our lives, and parent everyone while teaching us to play cribbage.

    Grandpa went to a nursing home after about 18 months because his diabetes was brittle and unmanageable. That was a difficult loss for me because we did everything together. He died in November of 1964. Dad lived until 1998. My siblings and I had to jointly intervene in our mother’s insistence that he live at home and insist that she move him to a nursing home for her own health. He lived there for 13 years.

    So yes, I have been a caretaker. VS, take care of you during this, and ask for help if you need it.

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    1. My-oh-my. My caregiving seems pretty tame compared to some of these stories. And I might need help from baboons to come eat sweets. I’m finding that baking is keeping me calm. So this morning I made lemon zucchini bars and right now the apple cake is in the oven. If this keeps up it will result in there being way too many deserts in the house for just the two of us.

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      2. Your care-taking stress is important, no matter what I went through as a child, so do not downplay how you feel. Caretaking an ill person is a hard thing.

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    2. Sounds like much of your childhood was usurped by responsibilities way beyond your age, Jacque. Like so many others, you have muddled through and persevered, but don’t you sometimes wonder how different your life might have been had you had a more “normal” childhood? I know I do. Of course, what constitutes a more “normal” childhood is debatable. I am glad, though, that you had that wonderful neighbor to provide some much needed love and support. Caring adults are really important in how children develop.

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      1. We really had some wonderfully supportive people around us, to be sure, for which I am grateful. My music teacher is still in my life. He was so supportive and present as he watched all this go down. And so patient with me.

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      2. you two had some serious stuff to get through (vs and pj)
        sure made you strong and wonderful in the end though.
        wouldn’t wish it on anyone but look where it led you.
        independent, and able to figure it out for yourself
        life works in mysterious ways
        but glass castles was over the edge
        i just found another book by janette walls in a box of books from my mom
        it’s in my bed stand to get to
        i must feel better after reading about my june cleaver mom

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        3. I always hesitate to tell about this because it causes people to pity me, and I don’t want that. I did my therapy about these issues years ago and came to appreciate those that assisted us, and to at least empathize with my mom’s situation somewhat. I still find some of her decisions bewildering, though. Weirdly, despite it all, we turned out OK, although I suspect my brother is struggling with alcohol use.

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      1. oh yeah i miss donna of south dakota from the old trail. anyone ever hear from her? i was sorry to miss storm lake outings.
        my theater daughter has a serious boyfriend whose family summers at clearlake and she said the 4th of july festivities were just eye opening with trump backers in a 80 20 majority
        his family tried to warn her but she didn’t get it fully until they started up the festivities

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        3. The Iowa Democrats live primarily from Ames to Iowa City to Cedar Rapids. The rural areas are far more conservative. However, in the 2018 election Steve King was the only Rep representative left–the others flipped to blue, and King did not win by his former margins.

          Lou’s cousin’s son was elected State Auditor there. Joni Ernst has been sending “spies” to all his town hall meetings (about MA fraud) because she is terrified that he will run for her seat. There is a lot going on politically in Iowa at this time. He keeps saying he has a young family and he wants to live in Iowa, but she is really threatened and keeps spreading rumors.

          That July 4 must have been a shocker for your daughter.

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  11. i’ve had a fair share of each in my life but nothing serious and life infringing yet. when my dad started to fade my mom had him up at leech and had her hands full til she had to put him in a old folks home up there in back country usa where they couldn’t get people to show up for work and the horrible care ended up contributing to his quick death spiral. took two months. my mom is doing the slow fade now but in a fragile hunched over way rather than any mental degradation nice but certainly frustrating for her. to get from her car to the concert is like a long distance run. my sister the recently retired school teacher retired at just the right time as far as i’m concerned. my guess is that she’ll find something to plug into her void but in the meantime her being there for my mom is working great for me. i remember sitting in the barber shop about 1980 reading readers digest in the waiting chair. the article was about the 108year old man who still lived in his own house and it was remarkable and he was sharp as a tack and enjoying life but there was a side note about his so who was half complaining about how his dad who he loved was doing good but he did need help with getting boxes off the top shelf and lifting boxes back up off the floor , going to docter’s and keeping up the yard, the son said i’m not resentful but i am 88 years old and need to get a life of my own one of these days and i just started laughing. the barber got a kick out of it too. my wife just had her hip operated on but she is the german hausfrau will never give in. i can offer to carry the laundry up the stairs but usually i am too slow. i’ve also reacted the age where organ recitals are a regular topic of conversations. operations medications therapy and recovery are not as much a inward upheaval as conversations about the state of the world but they certainly hit a raw nerve. vs has an interesting intro to empty nesting. most folks go through loneliness and empty ness, vs is tied up in sharing life’s chores as well as it’s heartstrings. maybe ya will realize how much is involved in living alone and hang out until absolutely necessary i have the son in the basement who will be discovering that in the next little while. we are starting to hear rumbling s that he’s ready to go. then my daughter suggested we think about plugging my mom into out mc mansion in one of the soon to be vacant bedrooms…. good thing it’s a gentle pre thought for right now. i’m not quite ready for today but i do acknowledge that 5 years from now it will certainly be either front and center or past. ride it out as it rolls on in and do your best is what i say. batten down the hatches nose to the grindstone only do the unavoidable until the smoke clears and learn more about sequencing life’s little hurdles

    the only thing worse than having to look after someone is needing looking after.

    the person who has no one to ask for help when you go down is screwed.

    my dad always said he was sure i would take care of him when he got old when he watched how i looked after my dog when it got old and had difficulty. it’s a bitch to have to deal with all the new inconveniences but the options are what. i used to think youth in asia was like the ymca in china. dogs i’ll know the right time. mom probably not … ya hopefully will be getting better soon vs. hang in there. if you need anything holler. maybe we can work in shifts and have ya get set up in the kitchen tovdo canning and out in the yard to do an in depth yard mainlands. maybe take the laptop out there and stream back episodes of frankie and grace while she isnt able to get around. marie what’s her names organizing the back of the closet and sock drawer might be fun assignments as the trade off in doing the daily requirements in september 2019. maybe she’d like to learn piano tuning on you tube. it could be a wish list dream come true . daily check list for monday through friday would be almost inexcusable this week but by next week skill be ready and you’ll have time to detail the finer points of organizing the garage. 🙄

    tim jones

    >

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    1. Oh my! My head is spinning. What does this mean, tim: “i used to think youth in asia was like the ymca in china.” ? I’ve scratched a hole in my scull trying to figure it out.

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        1. 🙂 Thanks, Renee. Despite my reaction to another comment in tim’s post, that just never occurred to me. 🙂 That’s really funny. Guess my brain is old and tired, but please don’t put me down just yet.

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  13. I’ve just been informed that YA doesn’t really like desserts that have fruit in them. So the lemon zucchini bars and apple cake were not a big hit. If anybody’s in Southwest Minneapolis tomorrow during the day stop on by, I’ll serve you up some fruity sweets.

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  15. I swear (not profanely, of course) this blog provides some occasional guffaws. tim’s “youth in asia,” and admitting that’s how he heard euthanasia for several years just cracked me up. tim you’re a natural wonder and a mystery to me, and if I lived with you, you’d drive me absolutely bonkers, and vice versa.

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  17. I wonder if folks today know how many women devoted their lives to caring for their parents in the 19th century. Women, especially if they were not married, were expected to put aside any personal ambitions and become unpaid caretakers for aging parents.

    Of course, that was before people had help from Social Security, pension plans, nursing homes, health aides, insurance and all the governmental programs that make it easier for the elderly to get by now. One reason people used to have large families was the need to produce at least one child who would care for her parents when they got old. Our resident expert on the 19th century, Bill, could say much about this. Not surprisingly, few women caretakers became famous, which is one reason we don’t know much about that cultural pattern. Emily Dickinson was an exception. She was a caretaker who did become famous (albeit after her death).

    I have known one person who lived to serve others this way. She was in her late 60s when I met her, I think. She cared for her very old parents and toiled daily to take care of the students in a graduate program at the U, working always behind the scenes and getting little recognition. When I saw how hard she worked for others I felt sorry for her. In time I realized she had very consciously chosen to be a caretaker. Living any other way would have been troublesome and less rewarding.

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  18. My mother swore she would never expect me to take care of her or my dad, as she remembered all the stress of her mother caring for her grandparents.

    Only one of my 4 grandparents ever went to a nursing home. Three of them lived independently and died at quite advanced ages while living in their own homes. My parents had only short , temporary stays in nursing homes after medical issues requiring rehab.

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    1. Most people believe strongly that they “don’t want to be a burden” to their children. That’s a strong value in the culture. Historically, few folks got through those last years without help. Good planning and discipline can reduce the chances of children caretaking aged parents. A lot of luck helps, too. Modern medicine props up people who are very old and sick, keeping them going long after they would have died without so much medical intervention.

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  19. This weekend, sort of in tribute to my father, sort of out of a sense of having had enough of filth, Husband and I cleaned the garage. My dad carefully organized our tool bench when he lived with us. He had an extensive collection of tools, coffee cans full of carefully sorted nails, nuts, bolts, drill bits, plumbing stuff, metal washers, etc., that we moved up with him from Luverne. He directed us in putting up pegboard and shelving, and he hung up all the tools on it. The tool bench became a catch all for everything, but we got it all reorganized. I even embraced my Dutchness and washed the garage floor. Dad would be happy.

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    2. i envy you
      i have my hodgepodge of tools in this garage and in my warehouse in 3 buckets two tool boxes 4 shelves and a makeshift bench flanked by office file drawers filled sockets circle saw blades and grinders waiting for mr yo get my act together enough to set up shop again
      this house is ok the last one was not and holy cow it’s already been 4 years since i left my loosely organized workshop and threw it all in the buckets with the best intent of getting back to it. getting there slowly but surely

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  20. I have a dear friend who is single – no children, family is either cousins in Wisconsin or brother in CA. I have already been here “here in MN” family for awhile for everything from the annual Christmas Eve dinner to “can you help with ____ task” that is often only asked of those very close. She recently moved to a new apartment – thankfully it offers cleaning services and laundry on the same floor, so that will help with some tasks I have sometimes been called upon to assist with (her last place had laundry in the basement, no elevator…and she has bad knees…), or at least I won’t get called upon for those things in particular, probably something new. She has tipped north of 60, so I would be lying if I haven’t already thought about what will come as she gets closer to 70 and beyond (at what point do we have the discussion of whether she should move closer to her brother in CA, who has power of attorney for her…does she have a living will…). The caretaking I have done for her has not been the “live in” kind, but it has occasionally veered into tasks that you only do for those who are truly dear, close friends or family. Most days I am happy to be that friend – other days, it’s hard to balance with the everyday stuff of being a mom and spouse (though, thankfully, child and spouse are understanding).

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  21. I have had to prevail upon various friends many times to drive me home from hospitals after various surgeries. Fortunately the surgeries have been pretty easy to walk away from, and I haven’t needed assistance walking, although they always insist on putting you in a wheelchair when you leave the hospital.

    The surgery that gave me the most difficulty with mobility was a fairly unremarkable hernia surgery that just gave me quite a bit of pain for the first few hours. The friend who drove me home had thoughtfully brought ingredients for black bean soup and simmered it on the stove while we had a chat. Mostly, though, I feel I’d rather be alone when I get home. When I’ve had sedation or anesthesia, I don’t feel up to having company. It’s one thing if you live with someone, but if you live alone, it’s hard to feel relaxed with someone else there.

    Never been the caregiver, unless it was in a very small supporting role, like picking up a couple of things from the grocery store, or feeding pets during a hospitalization.

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