NaJoPoMo 2013 The Art of Death 29
Posted Nov 29, 2013
Customer Satisfaction Survey
No hospital-type situation is perfect and I do have complaints now and again. To quote Mark Anthony (because pebbledrook's Shakespeare journals have earwormed me with Will's stuff), "the evil that men do lives on after them, while the good is oft interred with their bones." There are things I do not like about being institutionalized.
Privacy, lack of. Not something the staff can do much about. They must make their appointed rounds, emptying wastebaskets, delivering laundry, administering meds and so on, during the day. Icy North posted a link to a repository of classical music (#27) and I was just floating away on a piece by Vaughn-Williams this afternoon, when there was a knock on the door. Some mail for me. Back to the music, the violin singing to the cello, and there's another knock on the door. Supplies check.
Visitors can be rude. Oh, one can understand about the kids, they'll stare at anything. But some adults act like they're at the zoo, entitled to peer into all the rooms as they saunter down the hall. I glare. I make eye contact and scowl, except on Halloween night, when I put on some sort of costume. I don't mind it so much with other residents, who just like to keep up with what's happening in their facility. We wave or nod to each other.
Silence, lack of. I've said all I can say about that. You know my feelings. Eventually the whole facility will have televisions mounted on swing arms, with headphone jacks and free earbuds, and the cacophony will go away, but other expenditures have priority. Sigh.
Jeers to needles! I hate them. I just gave blood for a potassium check and now I'm told to expect a cholesterol in a few days. There was a thyroid lab just a couple of weeks ago. Why can't they save up and do all these tests in one poke? And then there's this thing called redirecting, when they reposition the needle once it's already in your arm. I still have a big bruise from the thyroid poke.
The only good thing is that you get ambushed at 6 am or so by the vampire techies, which means you're too groggy to be frightened.
Lack of space. Remember the conflict between Money and Original Design? There are a few private rooms, but the rest are "semi-private" and were designed that way. The beds were meant to sit cross-wise, with light fixtures mounted on the wall over the patient's head. Well. The beds don't really fit in the rooms that way. It can be done, but then it's difficult to open the drawers of the furniture at the foot of the bed, and you certainly can't get a hoyer lift or a scooter to the farther bed if the first one is cross-wise. And so the lights are in a less-than-convenient position. Staff bang their heads on the sharp corners when moving around the bed. The on-off pull cords all have extensions so that the patient can reach them, but the extensions can't be too long or else the pull is at too sharp an angle to be effective.
Compatibility. While the staff have an excellent awareness of residents' personalities as well as their medical profiles, there is no system for putting like with like -- and it would be difficult to put something in place. I got this bed the weekend after the former occupant died. That's the only way a bed becomes available in long term, when the occupant dies or is "sent out" (to hospital), which often amounts to the same thing. Re-arranging patients to create better matches is complicated by the fact that a resident cannot be moved without their permission or that of the POA contact.
Administration does try: the two Navajo ladies are together, for example. But across the hall there is E who only speaks English and Anna who only speaks Spanish. Or there's me who firmly believes that rooms should not be overheated, and J, who can't stand it when the temperature goes below 80°F. But even when there is an extreme of incompatibility, the combatants have to wait until staff work out how to juggle everyone around.
The things I have complained about in this journal are problems at Ladera, but they are not vices ~of~ Ladera. In the reading I've done this month, I've learned about nursing home vices, most of which seem to come from entrenched bureaucratic stupidity, and that doesn't happen here. Another thing to be thankful for.
NaJoPoMo 2013 The Art of Death 28
Posted Nov 28, 2013
I'm Thankful for Herman
It's Thanksgiving Day in America and so we must count our blessings before we start passing the serving dishes.
Some fellow researchers are aware, from my postings here and on FaceBook, that the kitchen at Ladera went through the Valley of Badness this year. The quality of meals was rather eccentric under the old regime, and, with the departure of the manager, "Dietary" became unable to plan meals to the end of the same day, let alone properly cook whatever they could find in the pantry. I, squeaky wheel, could be heard yelling things like "How can a cook live in Albuquerque and not know how to make quesadillas?" or "Jeez, how can you screw up instant mash?" or "Can I have a baloney sandwich instead of this, please?"
Bad food is something that can ruin your day even if you aren't immured in a nursing home. For too many patients, the arrival of the meal tray is a high point of the day; some of us have run out of other vices and have nothing else but gluttony left. It became so dire that I suspect residents' council meetings were postponed because administration didn't know how to handle our ire. Most of the time, kitchen staff really tried but couldn't seem to remember the most basic lore. Drain noodles before serving them. Remember to check whether you have hot dog rolls before offering hot dogs for dinner. Add salt to rice when cooking it. If you put a butter packet on a hot plate, the butter will melt.
Sunday night meals became legendarily bad; you couldn't tell the residents lies, we knew the Sunday night kitchen staff were far more concerned to get out of the building by 7 than to serve palatable food.
Finally, Corporate hired Herman, and slowly matters began to improve. Kitchen staff were accustomed to a despotic hand and I suspect they thought they could blow off the new guy with the quiet demeanor. They turned out to be wrong. A few weeks ago, one of the cooks failed to follow the instructions for cooking country-fried steak, and our trays arrived with hard, curled-up chunks of breaded meat. I took a photograph and showed it to the concierge, who notified Herman, who came down to my room to see it. We discussed time management and recipes and the like, and then he headed back to the kitchen... only to return in order to borrow the camera. Somebody tried to weasel out of responsibility, and failed!
It'll be turkey and stuffing and cranberry sauce and pumpkin pie for lunch, and all the residents are thankful for Herman.
Coda: I was advised this morning that bacon is off the menu. Corporate says it's too expensive. Booo!
NaJoPoMo 2013 The Art of Death 27
Posted Nov 27, 2013
Rite of Way
I was by way of discussing death in various cultures and paused after several paragraphs in to fact-check something I remembered from when I buried my step-father. Instead I found myself reading a website with increasing incredulity and a perverse delight. I cannot wait to share this with you. If you don't find this as odd and sometimes funny as I do, then I suppose we will never be good friends, and you should go watch the first season of "Six Feet Under" instead.
It cost me about $8,000 to bury dad in 1997. This included a funeral service led by a minister who had never met my father. The funeral director, son of a funeral director who was a good friend of my parents, advised against a viewing. Although the casket was open for the funeral, dad's body would never have stood up to close, protracted inspection by a woman like Great-Aunt Ethel Oberholtzer. Dad died in Florida but was buried in his native Pennsylvania and federal law requires that a cadaver be embalmed before it may cross state lines. I was not consulted as to who should perform the embalming, and the job was done rather indifferently.
By the way, Great-Aunt Ethel wore a pink dress from the 1930's that must have had some sort of crinoline underneath because its mid-calf length stood out like a bell.
I came north several days before the funeral and visited Williams' Funeral Home to make arrangements. This was easy; I told them to give dad exactly the same sort of casket that he got for mom. It was metal, spray painted just like a luxury car in a light copper shade, with chrome fittings and cream-colored velvet upholstery. Call me superstitious! Dad was pretty pharaonic about his own death and I wouldn't have dared short-change him. Anyway, it was a Batesville casket. I will come back to that.
In 1925 my dad's family purchased six deluxe sideways-on slots in a brand-new mausoleum that became the centerpiece of an older cemetery. It had been on the outskirts of town, this cemetery, but in 1997 it was a mid-town park, and the little granite mausoleum looked a bit shabby. Dad's parents were placed in the bottom two places, in 1960 and 1965. My mother got the next vault in 1984, and Dad showed me where the deed was kept for the remaining berths so that I could put him there in chronological order and then use one myself. "Oh dad," I remember exclaiming, "I don't know where I'll be!" It was the most diplomatic thing I could think of to say.
And so dad got the 4th bunk and nothing but vacant places above him. We were met inside the mausoleum by a faint charnel whiff and an old fellow who looked after the site all by himself. Pieces of broken slab and grit were all over the floor, and he was very pleased at having discovered a newspaper page dated 1925 inside the vault. Insisted on holding my arm and showing it to me. We, the funeral party, left before they slid the casket home.
Batesville caskets come with a 50 year guarantee. If you will open your hymnals to http://www.batesville.com/what-we-do/burial-caskets/116-2/ , you can discover features which Batesville consider makes their product superior, in particular the MemoryShelf® feature. In this sample of what you might consider salient about your Loved One's life, they have elected to show a passport and some spare change. Possibly some tickets as well. Your Loved One was evidently planning to scarper, and had emptied his or her pockets on the bedside table just before Death showed up. And so you place these proofs of perfidy on the MemoryShelf® so everyone will know that your Loved One almost made it to Belize.
Well, you spin a better story.
Anglo burial rituals are kind of skimpy. If you die here, staff will lay you out then get you out of the building as sneakily as possible; they don't cover the face because then people will twig to the fact that there's a death here, and we Anglos are so in denial about death.
NaJoPoMo 2013 The Art of Death 26
Posted Nov 26, 2013
In Which Lil Throws a Fit
This past Friday night / Saturday morning of the day I was to have my MRI, our well-known co-resident, E the hospice patient, was feeling more uncooperative than usual. After midnight the aides would go in and ask her to turn her television down. She would turn it down. Then, only a few minutes later, she would turn it back up to its previous level. This kept happening. Several times I hit my call button, and on one of those occasions the charge nurse came back to talk about it. I like Alia; originally from Afghanistan, she is content to work graveyard shift on weekends, in addition to working North Hall during the week. She was completely sympathetic to the problem and quite exasperated with E.
E didn't care. Never mind the aides' time being wasted. Never mind whether anyone was being kept awake.
Finally, both aides came in together (each usually has one side of the hall), to apologize. This was at about 1:15 a.m. "We asked her again," they said, "And this time she just said no. She said she's listening to it and--" They got no further with the story. Their eyes went very round with surprise, like a person discovering a new law of physics by dropping a frozen turkey into a vat of hot oil. You could liken my physical reaction to that vat of hot oil.
I cupped both hands around my mouth and shouted, nay, hollered at the top of my lungs. "I'M LISTENING TO YOUR DAMN TELEVISION TOO, E___!!!!" A little-girl voice from across the hall could be heard saying, "Whaaaat?" So I hollered some more. "WILL YOU PLEASE TURN YOUR TELEVISION DOWN!!!!!!!" I wish I could print the word 'down' in red bold 36 point gothic, because that is the sort of emphasis I gave it.
Several things happened next:
The volume of E's teevee went down.
Interestingly, both aides turned and fled the room. If Pamela is on tonight I'm going to ask why. I used to teach riding and can still give most Drill Instructors a run for their money, so perhaps my hollering hurt their ears. I will let you know what I find out.
I apologized to Gretchen, who laughed and showed a full awareness of the situation. "Ya had ta do it," she said, laughing.
Louise in the next room hit her call button and asked to know what was going on.
And I felt ~great~. Not one iota of remorse did I feel. In fact, now I know I have an inner berserker, and I am all for self-knowledge. But I am not going to thank E for acquainting me with this facet of my personality. I'll just wait till tonight and see whether I need to set the flying monkeys loose again.
NaJoPoMo 2013 The Art of Death 25
Posted Nov 25, 2013
Betty (names changed) lives next door with Louise. While Louise's hobbies are smoking, watching fish and complaining about the fact that she is still alive, Betty is more profoundly impaired with a neurological disease that looks to this layman like Parkinson's. Very occasionally I see her in the day room. The rest of the time, apart from showers, she remains in her room, sitting in a wheelchair and watching the television.
When I first moved in, I became aware, after the meal, of a quavery soft voice like that of a distant goat. "He-e-e-e-e-e-e-elp," called the voice in disconsolate tones. "He-e-e-e-e-e-e-e-e-elp!" I asked an aide what was going on and was told, "Oh, that's just Betty." What must visitors think when they walk down the hall and hear that, with aides moving about, showing no concern? Well, there is no emergency, in fact; Betty is hand-fed all her meals, and her other needs are attended to around the clock, but now that everyone understands that she just likes to cry help, they merely glance in as they pass, just to make sure she's squarely in her chair.
Lately, Betty has changed her callout. Now she quavers, "I need a girrrrrrrl!" Betty would probably like company. But we don't have that luxury here, with staff struggling to meet the needs of eleven other residents besides ourselves. The only time we get one-on-one is if we're a Problem.
As I mentioned in a previous journal, restraints are not used at Ladera. If you cannot be sedated or do not respond to sedatives or are allergic to them, then -- assuming this is a situation where staff really really wish they ~could~ sedate you -- you will receive constant attention. You might get one-on-one if:
-you stand on your chair, looking in an imaginary cupboard for an imaginary bowl or imaginary hammer (no folksinging please);
-you disrobe completely and refuse to remain in your room;
-you smear your sleeping room mate with toothpaste;
-you throw your pitcher of water at the aide or try to beat up said aide;
-you pack your things and attempt to leave the building wearing just a robe and slippers;
-you experience intense hallucinations that cause you to scream and struggle, or;
-you are just damn rude and aggressive and loud and mean.
I remember the fellow who was admitted on a Friday, while I was still on the skilled hall. The haldol wore off Saturday night, during the graveyard shift. In the end, three aides held him down, on a mattress on the floor (he kept pitching himself out of bed, seeing his spirit ancestors) until the police arrived, followed by the ambulance. Think about how two aides were not available for their regular patients until that was resolved.
Here on South Back, my own aide, Alice, found herself having to watch a wheelchair-bound wide-awake woman from Skilled even while she was attending to us. The following conversation took place right outside my door:
"Stop pushing me!"
"I'm not pushing you, I'm keeping you from getting up."
"You're holding me down!"
"Yes, that's what I said."
"I will not tolerate this, you are restraining me! You're not allowed to restrain me!"
"Nooo--"Alice was laughing by now -- "I'm restraining you from hurting yourself."
"This is abuse! Call the authorities! Help! Police! Help! Police!"
And all the woman's expostulations were delivered in conversational tone, including the calls for help, as if the police were in my room, ready to walk out and apprehend Alice.
So sometimes getting the full attention of the staff is a bad sign.