Saturday, February 25, 2012

With their boots off

Life in the ER is a thing of many parts.

Of course there is the dramatic stuff, major trauma, saving lives and so forth.  That's why we have an Emergency Room, and when all elements of the system are working as they should it is an impressive thing to behold.

Then there is the mundane stuff, colds, ear aches, minor injuries.  I did this for a quarter century before switching to ER, so this is second nature.  It can be enjoyable, I have many interesting conversations while awaiting test results or putting in nice neat stitches.  And the younger kids are always fun.  As you can see from the occasional photo I allow, I rather resemble a comic pirate and can play that role with Shatnerian subtlety when appropriate.

But there is also the difficult-perhaps insoluble-set of problems.  And the hardest is the Failing Parent.

It is mid 80s Mom, or less often Dad.  They are almost always brought in by a daughter or daughter in law.  Sometimes the superficial issue is clear cut-a fall with a major fracture for instance-but more commonly it is for vague issues.  Weakness, confusion, medication errors, or "just not right".

If things are overly busy, or if you are distracted, you can easily miss the cues.  A minor skin tear that only needs a band aid for instance.  But the real issue, the often unspoken issue, is that the Failing Parent can't be at home any longer.  This is hard.  Not all that hard for the elderly patient, often they are not fully grasping the situation and sometimes they are more than ready for a change.  But hard for the "child" who is facing the first concrete evidence of that hardest of Losses. 

And for society is is damnably hard.

We lack a system of easy transition from home to Alternative (even out of work mode I have a hard time speaking the phrase Nursing Home).  There is paper work to fill out.  There is funding, such as it is, to arrange.  And there is even a ridiculous Medicare rule that says that for Nursing Home admission you must first stay three days in the hospital.  Why?  This is an artifact of a medically ancient time when we often had people in for "rests and tests".  I have shipped out a person with an acute heart attack and had them stop by to say thanks two days later, their coronary angiogram and stents all accomplished in under 48 hours!

So the Hobson's choice is to either be strict, and to deny admission when there is no specific illness or malady, or to find various ways to tip toe around.  If you do enough testing you will usually find something.  Is that potassium a little low?  Might that chest x ray have just a shadow of pneumonia?  No doubt this gentle subversion of the system saves individuals-I live in fear of sending an oldster home and seeing them back next shift with a hip fracture-but the collective fiscal impact on our poor medical system is huge.

It gets surreal sometimes.  During a raging blizzard a stylishly dressed daughter home from the big city for the holidays.  Mom had been let out of a Nursing Home a week before.  Now there was vague weakness, an increase in anxiety, a fearfulness to try and use the walker.  Could I arrange admission to a Nursing Home?  Not the one she had been in, she did not like that one.  How about one in a nearby town?  Yes, the one her sister was in.  And could I arrange a private room?

It's funny and sad and frustrating and time consuming and impossible.  It throws a huge monkey wrench into the usually well running ER machinery.  Other patients wait longer.  We never solve it in a satisfactory fashion.

We are living longer.  Better in some ways but against the life saved by preventing a fatal heart attack at 50 we have to acknowledge the unhappy twilight world of a 90 year old with Alzheimer's, dignity fallen, unaware and incontinent.  We no longer have large families that stay close to home.  That tireless saint of a daughter or daughter in law of a bygone era is now a bank vice president.  Or perhaps not, the hardest situations of all are where mental health and substance issues strike across multiple generations.  When parents age, especially when one dies and leaves the other, there is no sufficient safety net.

So we soldier on as best we can.  In half serious moments I wonder if we need a sort of Isomeric Boy Scouts where a younger, fitter scout master is in charge of a troop of elders.  They would help each other out, go on camping trips.  Maybe there would be merit badges.  No s'mores at the campfire though, a nice glass of single malt please.

Unless and until some happy variant of such appears I vow to never personally reside in a Nursing Home for a single day. 

1 comment:

Anonymous said...

I just read your article. Very interesting because I just went through 3 hospital stays the last month. The difference is I am the daughter and already gave up everything 20 years to care for a mother who at 52 had a major disabling stroke. Your article makes it more clear to me why nothing made sense. I can only assume the hospital care workers knew less then me about medicaid and medicare law. In the USA there are federal laws to protect the elder and in some round about way the caregivers. The states ignore then all and simply balance their budget's on the backs of the "soon to be impoverished" daughters who will eventually will be a welfare participant due to the instance gratification of balance budgets by putting off the long term cost of abusing the predominatly women caregivers both emotionally and finanically. If I could figure out a way to bring a case to the supreme courts under "equal rights" and could find an attorney I would do it in a New YOrk second. There are no equal rights for us caregivers when compared to our "brothers" who have the guilt free opportunity to contribute to their retirement accounts and succeed at their high paying jobs on the backs of their soon to be poor sisters. It is so medieval and so unfair in the USA how the men in Washington DC just use and abuse this group of caregivers who are not strong enough to fight back.