Chapter 8 - THE HOME HEALTH NURSENurse Rachel Alvarez arrived Thursday morning.
She was forty-six, practical, observant, and impossible to rush.
Monica disliked her immediately.
Rachel checked Beatrice’s blood pressure.
Asked about bowel habits.
Looked at medication logs.
Then weighed her.
The number made Rachel frown.
“When was her last weight?”
Monica looked at a folder.
“Three weeks ago.”
“She’s down nearly seven pounds.”
“She’s been refusing food.”
Rachel looked at Beatrice.
“Is that true?”
Beatrice stared at her.
Rachel had worked with stroke patients for eighteen years.
She did not assume silence meant absence.
“Blink once for yes.”
Beatrice blinked.
“Can you understand me?”
One blink.
Monica shifted.
“Her responses aren’t always reliable.”
Rachel glanced at her.
Then back to Beatrice.
“Are you having trouble swallowing?”
Two blinks.
“No?”
One blink.
Rachel smiled.
“Good.”
She tested several more simple questions.
Beatrice answered consistently.
Monica folded her arms.
Rachel reviewed hydration.
“Her mouth is dry.”
“She hates water.”
Tyler was sitting nearby pretending to read.
His head snapped up.
“No, she doesn’t.”
Monica’s eyes flashed.
Rachel looked at Tyler.
“What makes you say that?”
“She asks for water all the time.”
“How?”
Tyler hesitated.
“With her eyes.”
Monica laughed.
“He thinks he can read her mind.”
Tyler looked down.
Rachel did not laugh.
She gave Beatrice a cup with a thickened liquid preparation appropriate for her swallowing plan.
Beatrice drank eagerly.
Rachel’s expression changed.
“When did she last have something to drink?”
Monica answered quickly.
“Breakfast.”
Tyler quietly said:
“She didn’t.”
Monica turned.
“Tyler.”
“She didn’t.”
Rachel watched the exchange.
After the assessment she asked Gavin, who had come home from Norfolk early that morning, to speak privately.
They stepped onto the porch.
Rachel kept her tone neutral.
“I’m concerned about weight loss and hydration.”
Gavin frowned.
“Monica says Mom refuses food.”
“That may happen.”
“Is it serious?”
“Not yet.”
Rachel paused.
“But I’d like to increase monitoring.”
“Okay.”
“And I want feeding to be slower.”
Gavin nodded.
Rachel continued.
“Your mother appeared tense when your wife picked up the spoon.”
His face changed.
“What are you saying?”
“I’m saying I observed tension.”
“Are you suggesting Monica—”
“I’m not suggesting anything beyond what I saw.”
Professional.
Careful.
That made Gavin more nervous.
“Who usually feeds her?”
“My wife.”
“Any aides?”
“We have them several days.”
Rachel looked at her records.
“Agency shows fewer hours than last month.”
Gavin frowned.
“What?”
“I’d confirm your current schedule.”
That evening he asked Monica.
“Why are aide hours down?”
She barely looked up.
“They raised rates.”
“You didn’t tell me.”
“I told you we were spending too much.”
“We have money.”
“That isn’t the point.”
“It’s my mother’s care.”
“And I’m the one managing it.”
Gavin stopped.
She sounded defensive.
Very defensive.
Then Monica softened.
“I’m sorry.”
She rubbed her eyes.
“I’m tired.”
Gavin remembered Rachel’s warning.
Remembered Tyler.
Remembered Beatrice clinging to his sleeve.
Three separate facts.
May you like
Not proof.
But no longer nothing.
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