Subject: Dying by inches

Date: 24 Nov 1998 00:00:00 GMT

From: jimvan@gate.net (Jim Vandewalker)

Organization: http://extra.newsguy.com

Newsgroups: alt.foot.fat-free

I was going to post this at alt.slack in response to Lurch's

request for something funny.

Well I went out to the nursing home. Sometimes the scrawnied-up

little old ladies getting their permanents are good for a couple

of yuks. I always wonder how many of 'em check out while under

that big beehive-shaped dryer. They look like death anyway, and

with the dryer roaring the beautician couldn't tell if they were

breathing or not. Be pretty funny to die of massive heart

failure while waiting for your shampoo and set, too. Keeled over

among the large-print Readers Digests.

But the beauty shop was closed. They don't call it the beauty

shop at this nursing home anyway. It's a personal care facility

or something. Euphemismistics run amuck. The physical therapy

room was closed too. Earlier in the day you got your little old

ladies shaking their way between the parallel bars or lying on

platforms doing leg-lifts, with a big crowd of healthy, non-old

people in bright-colored scrubs TALKING REALLY LOUD: "That's

good, Ellie, THAT'S REAL GOOD. Now the other leg, NOW THE OTHER

LEG."

My mother has a room to herself because when she was in the

hospital getting her leg amputated she tested positive for MRSA,

which is antibiotic-resistant staph, i.e., flesh-eating bacteria.

They said at the hospital they hoped they'd gotten it all when

they amputated the leg, but she still cultured positive when they

discharged her. (Six days in the hospital for a below-the-knee

amputation: drive-by surgery -- now THAT'S pretty funny)

What's REALLY funny is how much of your faculties you can lose

and still not die. My mother's had a whole series of

cerebro-vascular incidents over the last few years. At first she

just got a little simple minded. Then with the good one she

couldn't walk or use her right hand. She was kind of a pain to

have around because of the wheelchair and the deafness, but I

dutifully went and hauled her over to the house a couple of times

a week for dinner. I even built a ramp to run the wheelchair up

to the back door. She was living in what Florida calls an ACLF or

adult congregate living facility, with a lot of other old people

of varying degrees of disability. Nine to one female to male

ratio.

Then in June she had another good stroke and got discharged from

the hospital (four day stay for $10,000+; your Medicare dollars

at work) to Highlands Lake Center. These nursing homes all have

names like that: Highlands Lake is run by Genesis Eldercare;

other places around here are named The Grove Center, Meadowview

Life Center, Palm Garden, Dove Healthcare. Makes you feel like

you're turning into a little garden gnome.

She could still talk a little then, but in a few weeks she

couldn't do any more than echo whatever you said to her. She had

to be fed pre-chewed food and finally wouldn't eat much of

anything except dessert (why the hell not, after 89 years of

eating what's good for you, I thought). This nursing home was

pulling down Medicare bucks so they had to pretend that they were

doing rehabilitation. They'd get her up out of bed and prop her

in a wheelchair and wheel her down to PT. Finally they did a

swallow test (x-rayed her throat while making her swallow

radio-opaque stuff of consistency varying from ground to pureed

to nectar) and decided that she couldn't swallow anything without

aspirating.

This meant "alternative methods of nutrition," which in more

ordinary English means a feeding tube, and here I found out that

there are right-to-lifers at THIS end of the turnpike, too -- not

just guarding against the horrors of abortion, but also making

sure that God's plan to maximize your suffering in old age is not

tampered with either.

Doctors go out to nursing homes and sit at the nurse's station

once or twice a week and look a charts and bill Medicare/Medicaid

and very dam' seldom, so far as I can see, ever walk down the

hall to look at the actual patient. Dr. Botardo, who from her

voice on the phone is a middle-aged Cuban lady, told me that a

feeding tube was merely a comfort measure and would "not prolong

jore mother's life," and I guess I bought it despite the Advance

Directive/Living Will she'd signed which clearly said "no feeding

tube when I've turned into a rutabaga."

Dr. Botardo called me up in at 10:00 o'clock of a Friday night

and said she was going on vacation and wanted to arrange about

the feeding tube and also Mom need to have her right foot looked

at, possible amputation, which hospital do you want, do the tube

outpatient at Bartow Hospital, or have her admitted to LRMC and

get a surgeon to look at the bad place on her foot. Like a brown

spot on a banana.

Okay, okay, um, well, have her admitted to LRMC. But it's on a

Saturday, and over the weekend and through the week there is an

incredible confusion of doctors. Finally she gets seen by a

cardiac surgeon, which has me scratching my head for a while.

But actually this guy is a cardio-VASCULAR surgeon and has been

called in to consult about re-vascularizing the foot/leg. She

doesn't, frankly look like she's going to live out the week, so

the consensus is don't do nothin' about the foot. The tube gets

installed okay. The nurses inform me with satisfaction that

she's tolerating feeding very well. No one except me seems to

think this is a strange thing to say. She gets discharged back to

Highlands Lake Center.

I hate going there. It's all bright wall coverings and light

paintings on the walls and clean floors and it smells of shit and

piss. They have demented old people propped up in wheel chairs

in the halls. There was one ferocious old black guy with

four-inch leg stubs who sat bolt upright in his wheelchair and

hissed with unremitting fury at other patients parked near him.

Most just sat slumped while relatives burbled. Mom doesn't get

taken down to the dining room any more. One Monday I hadn't been

out there since the preceding Thursday. My brother had been on

Friday, and I just couldn't make myself go on Saturday or Sunday.

But Monday after work I went. She was unresponsive, propped up

in bed with a tent over her feet. The room stank of rotting

flesh and death. I tried to talk to the nurse about it but

nobody seemed to want to hear.

If this were a military outfit, doctors would be field-grade and

above officers, RNs would be lieutenants and captains and LPNs

would be non-coms, E6, E7 and above and the nurse's aids would be

PFCs and SP4s. These are the people with the least training, who

get paid the least, and who do virtually all the actual patient

care in terms of feeding, hauling the body in and out of bed,

changing the diaper, bathing.

The LPN is always leaning over the meds cart, scribbling. The RN

stays close to the nurse's station, deciding what other people

should do. Sometimes it seems as if no one wants to admit to

being responsible for a particular patient. I told as many

people as would listen about my mother's rotting foot. Nothing

changed for a week.

Finally again on a Friday night, Dr. Botardo called up to tell me

that my mother has a gangrenous foot and needed to have it

amputated. I told her that we'd already been through this once

and I really didn't see the point in hauling her out to the

hospital just to have the surgeon decide that she was too fragile

for surgery; couldn't a surgeon take a look at her there at the

nursing home?

Well, no in fact a surgeon couldn't. It turns out that if you're

in a nursing home the way you get any actual medical treatment is

to be taken to the hospital. Instead of a doctor coming out to

the nursing home to look at a patient, at a cost of three or four

hundred bucks, the patient gets put in the hospital at a cost of

several thousand smackers. Oh well, it's just Medicare; it's not

like it was anybody's actual MONEY.

She got put in the hospital and I went around and made sure that

there was a "Do Not Resuscitate" order in place. A DNR order is

as evanescent as the dew; it must constantly be renewed. Nobody

beleives that just because you said LAST WEEK don't try to bring

me back that you still feel that way THIS WEEK. And there has to

be a special kind of DNR to prevent the ambulance/EMS crew from

doing CPR on you even when you're obviously cooling meat.

Well, they did the ampuatation, and got the right foot, too. And

less than a week later she was ready to be discharged. This time

we went for The Arbors at Lakeland, and I went out and spent a

good part of a day signing papers, most of which had to do with

the nursing home making sure they were going to get paid by

SOMEBODY, although they couldn't tell me exactly what rate they

were going to charge. I went around and made sure of the Do Not

Resuscitate order again, and thought I made them get the billing

address right.

She's in a room by herself because of the antibiotic-resistant

staph and it's close to the entryway so I don't have to walk

through long halls, so if The Arbors smells of shit and piss,

it's in some other part. There always seemed to be a lot of

people, nurse's aids, rehab people, cleaning staff, circulating

in the halls at the other nursing homerec. The Arbors is quieter.

I don't like it any better.

---

Jim the Prophet

Licensed SubGenius Preacher

jimvan@gate.net