Sibling Flare/ Health Care Worker : New thread/update

[Mommydoc]

I realized the old thread was getting too long, and wanted to share a positive update.

First, I want to extend my deep gratitude to everyone on this site and particularly those who read and responded. Thank you so much.  Your support, insight, advice and kindness have helped me get through some very tough times.  I hope to pay it forward and  contribute and support others on this site, as I continue to learn and grow.   I have a long way to go!

Brief summary of the situation:
I am a physician and in an important leadership role at my hospital, which required me to be make difficult decisions and lead a group of 4000 physicians, staff and nurses through the pandemic.  We were hit hard, and endured a lot of challenges.   It took all my energy and attention 24/7, with no real respite for a prolonged period of time. I am the primary caregiver and health care POA for my 90 year old mother who has advanced Parkinson’s and now requires 24/7 assistance.  She lives in an Assisted Living( AL) Facility close to my home.  During the pandemic, my mothers condition worsened, they went into varying degrees of lockdown at different points; her ability to communicate ( voice almost a whisper) and self feed diminished significantly and she also experienced cognitive decline.  Her care team is recommending additional support and moving her into the memory unit within the same AL.  Not surprisingly, my uBPD sister flared and I experienced a lot of verbal abuse. She vehemently hates the AL, presumably because it is close to my home and I helped my parents select it.  During the pandemic, she accused me of parental neglect, has been seeking to move my mother out of the AL, threatening legal action and trying to block the move to a higher level of care within the same facility.

The update:
The pandemic is  contained for now. We have been successful in immunizing hundreds of thousands of our patients. The current focus is on deferred surgeries/procedures, screening and care (and it is a lot!) .  We are also being intentional about healing, resilience and post traumatic growth for our entire workforce. I am in therapy and continuing to improve my personal self care.  It feels good! 

After 2 weeks of “transition” time for my mom, I moved her permanently to a new apartment in the memory unit a couple days ago.  We made it a very special day, with balloons, decorations, special treats and decorated her new apartment with many meaningful photos, art and mementos spanning her life.  She is thriving in the new environment and I am so grateful. I notified my uBPD sibling via email and so far, she is NC. To be accurate, she is continuing to cc me on emails with our realtor but NC related to my “decision” email from early last week.   I feel great about the decision, and very prepared to use my new tools when the inevitable explosion occurs. 

My plan:  I want to keep my sister informed and connected to my mom.  I need to protect myself in the process and I am not ready to be on the phone with her right now.    My son is going to help get facebook portal set up for my mom’s new apartment, so she can connect with her more easily and he will coordinate directly with sister (she adores him).  A close family friend will visit my mom and help her call my sister to maintain contact, and I plan to send a weekly email, short, transactional to keep her informed of mom’s progress/status.  My son and husband blocked her on my cell phone ( messages still go through to iPad and they monitor it so they can prepare me when I come home at end of day) so far nothing.    I am loving the NC!

Question: Other Advice?   NC is currently her choice, not mine, but my goal is LC.  I am thinking email may be a good way to transition, but this is new territory for me.   Do I wait for her to respond, or should I go ahead with the update email this week? 

[kells76]

Hi Mommydoc, I'm over here from the coparenting board.
My husband's kids' mom has many BPD type traits, so I hear you, communication can be a minefield!
You're wondering whether you should wait for some kind of response/acknowledgement from your sis before emailing the update about your mom.
I've found, when it comes to routine communications with the kids' mom, that doing whatever schedule and format I feel best, no matter what she does or doesn't do, works best for me and my sanity.
She decided to "homeschool" DH's oldest (my 15 year old stepdaughter aka SD15) this year, and math instruction was not on the agenda. Long story and much drama short, I've been teaching her 9th grade algebra this year (which is really fun!). In our state, both parents may "inspect and receive" school records.
I decided to send a weekly email about SD15's assignments and grades to her mom (and to DH, to "keep it fair", even though I tell him in person, ). At first she responded a couple times but after a while she didn't. I have no idea if she reads the emails any more. But that's not the point.
Business-like / logistical info needs to be shared from a "normal" person to a pwBPD. I'm with you there. If I were in your shoes, I'd stick to a schedule no matter what (like, Tuesday is email day), and would have a really neutral, bland, boilerplate format. It's sad that you can't share your emotions about your mom with your sis. She isn't the right person for that, sounds like. So, keep it professional, keep it email, keep it on a schedule, and do what YOU know is right whether or not sis ever responds.
Have you checked out "BIFF" communication? That stands for Brief, Informative, Friendly, and Firm. Emails about Mom's status to BPD sis sound like perfect candidates for BIFF. If you google "biff communication" you'll get good examples.
Hope this helps;
kells76

[Notwendy]

Kells makes a good point about deciding on your own behavior- schedule of communication- regardless of how your sister reacts. It's about boundaries and values- your own. Acting on your own conviction- what do you feel is best - and not reacting to her. One of the lines from the 12 step ACA group states. " we became reactors rather than actors" as something to work on. When this happens, it's like giving the sails over to a disordered person and riding their emotional waves. Take the sails back and lead your way.

Emotionally and behaviorally, my mother was also at the extremes during my father's illness. She disowned me when he died, then changed her mind apparently. I never considered NC with my mother, and I wanted to have a relationship with my father. At this point though, I could have done it if I wanted to, but I didn't want to do that. However, I also needed to have my own boundaries with her and she didn't like that.

A wise friend at the time suggested I call her on a schedule. This way she could expect my calls and if she called at another inconvenient time, I could say " I can't talk now but we will talk on Saturday". If she didn't pick up or want to talk I could leave a message " sorry I missed you, I will call next week". She could decide to speak to me or not. I still made the call.

You understand your mother's condition, and what medical care can and can not do. When my father was ill, it also brought out the disordered thinking on the part of my mother. When he physically could not do something for her, she saw it as "refusing to do this for her on purpose". On the Karpman triangle, the position she was used to was "victim" and my father was "rescuer". In this situation, he was the victim of the illness, but she could not perceive it that way. She also didn't fully understand the medical side of what was going on, not due to lack of intelligence but I think her emotional thinking affected how she interpreted things. She would also paint some of his medical team and caregivers black.

On one hand, being a physician helps you to manage your mother's care and you understand what is going on with her. On the other hand, it may prevent you from getting the emotional support you need during this difficult time. You are losing a mother- you are losing her cognitively before physically but it's a loss to you. Nobody is an expert in this. Your mother's medical team may treat you like you are- because intellectually you are an expert. Don't let this stop you from seeking and accepting emotional support for you.

Your sister is going to process this emotionally in her own way as well. In addition, she doesn't understand the medical aspect as well as you do. Don't get on the Karpman triangle with her and try to be her emotional caretaker and explain things to her. Your mother's medical team can do that and if your sister goes off the rails with them, they know how to deal with disruptive family members. In my situation, my mother behaves better with non family members than with me. Ideally, what you wish for is for you and your sister to be supportive of each other, but I don't think you can expect emotional support from someone who can't manage their own feelings well.

Since you are the manager of your mother's care, I think weekly emails to your sister to keep her informed is a great idea. Keep drama out of them. Make them more like a newsletter and tell her what your mother did that week, what she likes to eat, or watch on TV. Make them short, non emotional, and stick to the schedule unless you need to report something unexpected.

[Mommydoc]

Thanks Kells and Not Wendy. I like the idea of the weekly newsletter by email.  Interestingly on the last phone call (almost 2 weeks ago) we had when she told me she didn’t want to be my sister and hung up on me, at one point she said, “just email me” I don’t want to talk to you. In retrospect, we have been down this path before, explosive unpleasant phone or in person interaction, and then we end up communicating by text or email for a period of time.  I have sent the email updates in the past and she never responds, so I always think, why am I spending so much time on them.  I think what I am hearing is don’t spend a lot of time, be brief. She honestly doesn’t care about the details. 

She also didn't fully understand the medical side of what was going on, not due to lack of intelligence but I think her emotional thinking affected how she interpreted things. She would also paint some of his medical team and caregivers black.

On one hand, being a physician helps you to manage your mother's care and you understand what is going on with her. On the other hand, it may prevent you from getting the emotional support you need during this difficult time. You are losing a mother- you are losing her cognitively before physically but it's a loss to you. Nobody is an expert in this. Your mother's medical team may treat you like you are- because intellectually you are an expert. Don't let this stop you from seeking and accepting emotional support for you.

There is splitting going on here too. She has painted the medical team and me “black” and portrays herself as the thoughtful spiritual and emotional expert who can better care for my mother.  Unfortunately, the medical team has  involved her as a way to “ support me”.  Since I am POA, they are not really obligated to deal with her, and they have expressed that they don’t want to deal with her anymore as they feel manipulated and attacked by her.  I spent so much time “ in doctor mode” trying to explain or justify my actions and decisions.  It is very helpful to realize that none of the objective information is helpful to her, as her “ emotional thinking” is what is guiding her reactions.  Her emotional framework, is “ I am depriving her” from being with and seeing my mother, and any decision that isn’t to move my mother across the country closer to her is bad. 

It’s been hard but I have accepted that the role I have played in my family and my work as “ caregiver”  /“ big sister” is not serving  me in this relationship. It was never my parents intent to for me to spend so much energy on her wants and needs that I neglect my own.  Even as my mom drifts a way cognitively, she has been able to express that to me in her own way.  I don’t talk about this with my mom at all, but she is incredibly perceptive.  I have a lot of emotional support from my immediate  family, the care team, and my friends and I have a lot of positive  things to refocus my energy on and am trying to do so. 

I think I am going to craft the first “ weekly update” via email today.   Thank you both.