I went to north Austin yesterday. Mother called. She has a friend, Irene, who had been rushed to the hospital after a fall in her bathtub. They think it was her bathtub. Nobody is really sure. Odds are, even Irene isn’t sure; she’s 102.
Irene and her husband have been married since 1932. They’re from east Texas. They met at church. They’ve been together ever since. It’s just been the two of them, but that wasn’t the plan.
When they were young, Irene and her husband tried to have children, but she had miscarriages, a number of miscarriages. When it became clear she wasn’t going to deliver a child of their own, she wanted to adopt. But he didn’t. So they never had children, just nephews whom Irene and her man have done a pretty good job of outliving. All that are left are my mother and a financial adviser, one nephew who lives out of town who doesn’t see them very often, and some people who showed up and said they’re long-lost relatives but whom strike Mother, instead, as opportunists who read about Irene and her husband’s shared 100th birthday party in the newspaper – the story that mentioned they have no children.
The night before last, when Irene fell, she broke her spine at the C2 level. C1 and you’re dead. (It seems reasonable that C2 at 102 will have the same prognosis.) But somehow Irene isn’t paralyzed. In fact, from what I was told, she spent most of her day kicking her legs and demanding to get up. Mother said, “She’s really strong!” And she is alive. She’s also restless and confused, and she wants to go home. But even more than a trip back to the assisted care facility, she wept that she wanted God to take her to her real home. Yet as of this writing, God isn’t ready for her, not yet.
My mother is 90. She still drives around her small town, still works a part-time job, still teaches Sunday School, and still makes four hour road trips to Houston (with her 91-year old friend, Doris, manning the GPS and telling Mother where to turn). Around their town, Mother takes Irene and her husband to eat fried shrimp and to Wal-Mart, and she buys Irene underwear and clothes that she then never wears – which irks Mother to death, like it would any daughter. And when Mother was notified yesterday morning of Irene’s fall, she ran to her car and met the ambulance driver at the retirement center. She told him to drive as fast as he needed to, that she would be right behind him, and she was for the 30 mile drive to the emergency room. In the ER, Mother sat with Irene, held her hand, and talked to her, although Irene didn’t hear. (Her hearing aids were at the retirement center.) Mother finally called me at three.
By the time I arrived, Mother had handled most of the issues, but there were others she wanted help with. Mostly, she wanted me to ask questions, tons of questions. It didn’t take long for me to understand why: There were issues.
First, I found Irene’s ICU nurse and told him that she was trying to turn her neck and sit up in bed. “She has a C2 fracture,” I reminded him, “and I’m afraid she’s going to paralyze herself.” He looked at me like I was speaking Greek. “When are y’all planning to take her to surgery?” I asked.
“The surgeon’s seen her. They’re not doing surgery. She’s too old.”
“Is she on pain medication?” His answer was no to that, as well. At her age, he said, she couldn’t excrete them through her liver or urine. They would build up. ”So no surgery and no pain meds for a 102 year old woman?“ No, her nurse repeated. I wondered if the doctor who prescribed this plan would have wanted his 102-year old grandmother going through a spinal fracture without pain meds, but I couldn’t know. He wasn’t there, nor did the team of doctors that the ER promised ever show up. (A lone internist would make his way to Irene’s room at 5 o’clock. He would speak English, sort of.)
My first question was the immediate one, “How will you keep her still?” The nurse followed me to Irene’s room and watched her move her head. He said she needed a vest that would immobilize her neck. He would order it. “Why hadn’t this been done before?” A C2 neck injury on a 100-plus woman with dementia and enough spunk to get in and out of her bathtub alone made the question a no-brainer, but the vest still hadn’t arrived when Mother and I left two hours later.
“What about bed sores?” I asked. Irene had been on her back since ten that morning. The nurse gave me a tacit admission that maybe they should roll her to her side, but that turn hadn’t happened by the time we left. She’ll have a sore by tomorrow morning. You watch.
“Who has the medical power of attorney?” The nurse and the staff at the nurse’s station didn’t know, and so Mother and I had papers faxed from the retirement center so they would know. “Do you see who has the power?” I asked them after the faxes arrived. They said it looked like it was her 102-year old husband. “He isn’t in a position to handle that,” I told them. “He won’t understand.” (How can a hospital have a 102-year old patient in their care and not have the protocol in place to immediately discover who possessed the authority to make the medical decisions for her?) We had Irene’s power of attorney conveyed to Mother.
“Does she have a Do Not Resuscitate order?” I asked. They didn’t know. We made sure she had one before we left. We also made sure she had an order for pain meds.
“Do you know what medications she’s on?” They didn’t know she was on any meds. Would their assumption have been yours, that a 102-year old woman was cruising along without any medication at all? A fax we asked for provided them with a list.
I’m not positive that Irene had eaten when I arrived or that she had been provided any other form of nutrition that day. It’s to my shame that I just now thought of that, although you wouldn’t think that would be a question you would need to concern yourself with in this situation. That is what professionals are for, right?
A couple years ago, this same hospital chain began prepping my mother for surgery when she was an inpatient in their care. Thing was, she wasn’t scheduled for surgery. They tried to give her pain meds during another visit, pain meds that she was allergic to and which were listed both in her chart and on the white board mounted on the wall at her feet. Thank God Mother was alert.
Twenty years ago when my father was a very weak and sick patient there, the hospital went three days without giving him any of his meds. He died on the fourth day. Yet this chain, local to Austin, runs half the hospitals here and in the region. They don’t deserve to, of course, but who’s going to stop them? Death, I suppose, but nothing else.
This is a post script to my post:
I spoke to my mom after writing what I wrote above, after she spent a second day with Irene, after the small lady had been transferred from the ICU to a standard ward. Mother said that on the standard ward Irene’s care/neglect was even worse than in the ICU. That’s hard for me to believe, but my mom isn’t into hyperbole, and it makes me wonder if I won’t stand a better shot at getting well next time by staying at the house and using home remedies. While I’m at home sucking down tree bark and ginger root, and while American citizens continue to give their money to insurance companies and profiteering hospital management companies that suck money from the system, every other industrialized country will be spending less on medical care than we do and getting far better results.
But I didn’t write this post to propose solutions. I wrote it to tell you what happened to Irene. And if she had not been extraordinarily lucky, the lack of attention she received would have left her paralyzed from the neck down or, more likely, dead. And despite being 102 and without children to love her, she deserved better than that, even if she is ready to see her Lord. My mother deserves better than that, as well. And you and your family deserve better than that, too.
