The Dagley Dagley Daily  

By Janet Dagley Dagley
Covering the world from the waterfront in Hoboken, New Jersey, USA

ISSN 1544-9114

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The Dagley Dagley Daily

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Fallen: Part 2

"Good morning, St. Pseudonymous Hospital."

"Good morning. I'm calling from Hoboken, New Jersey. My mother is a patient in room 1313a, she has multiple fractures and can't get out of bed, and the person who just took her blood pressure left her call button out of reach. Would you see that someone goes in there and gives back her call button? She's absolutely helpless without it. Fortunately, they didn't take the phone away from her. I'll hold."

"What room was that?"


"I'll connect you to the nurse's station..."

Much as we'd like to stand guard over Mom 24/7 while she recuperates from her injuries, all of us, Mom especially, have had to accept the disconcerting fact that we have no choice but to leave her in someone else's care. While our natural instinct might be to pick her up and take her home, we know that would not only worsen her existing injuries, it might well cause new ones. Right now she needs 24-hour care by people trained to deal safely with people in her condition. That includes most, but not all, of the workers in the skilled nursing facility she was transferred to a few days after her surgeries. While we, and she, can remind the nurses and aides and complain to supervisors and insist that a note be made on her chart that she can only be moved in certain ways without causing her further injuries, she is at their mercy most of the time. If a temp aide on the night shift doesn't bother to even glance at the chart, there could be terrible consequences. Fortunately, Mom is alert and able to speak for herself, even at 2 a.m.

It does get a bit quieter in the nursing home at night. The TV in the lounge is muted, the workers aren't shouting to each other across or down the hall, and there's nobody yelling "Bingo!" The dementia patients, however, don't really know day from night, don't seem to know much of anything except that they're unhappy. While they may be in wheelchairs, their joints twisted by arthritis, their lungs and vocal cords are healthy: perhaps because of all the exercise they get.

"Who's in the living room? Who's that in the kitchen? Who's in the hall? Who is that out there?"

She can't see much anymore, doesn't seem to know where she is most of the time, but Anita still has a voice like Ethel Merman's -- and she uses it incessantly.

"That lady must have had a real big house," one of the aides says to another as they pass out dinner trays. "She musta had maids or something; she's sure used to bossing people around."

In her more lucid moments, Anita knows she's in a nursing home. Then, she switches to a different refrain:

"Nurse! Nurse! Come in here! Come here right now! A patient needs you! Come here! Get in here and act like you've got some sense!"

Sometimes Anita goes on to fantasize that she just read an expose of the nursing home in The New York Times, and she threatens to call the newspaper to complain that the nurses don't always come when she calls. Based on what I heard in just a few days, it would take thousands of nurses to respond to Anita's calls, and not one of them could do anything about her dementia. Nor can they do anything to shut her up: that would be considered excessive restraint. So everyone in the facility has to listen to her hollering at the top of her powerful lungs, day and night.

Anita isn't the only dementia patient who won't shut up. Another wheelchair-bound woman who must be at least in her 80s wags her head back and forth, back and forth, chanting the same thing over and over:

"I want my Mommy! I want my Mommy! It hurts! It hurts! I want my Mommy!"

Don't we all, ma'am. Don't we all.

Mom uses her television to blot out some of the hollering from down the hall, as well as the loud voices of the staff, who speak to the residents like they're addressing hard-of-hearing kindergarteners, and communicate amongst themselves in even louder voices.

"There are no gloves in this room. Do you have any over there, Sheila?"

"No, you'll have to go to the storeroom."

"Never mind. I found some."

"Who's in the kitchen? Come in here right now!"

"I want my Mommy!"

At least Mom hasn't come to this place to live out the rest of her years. She's just passing through. In a few weeks, we hope, she'll be moving on to a rehabilitation facility, and eventually, home. That is if they don't drop her in the middle of the night.

There are construction noises during the day, also, and men walking around on the roof. The nursing home is adding another wing, part of an expansion plan to make room for the Baby Boom generation. Across the street, there's a conveniently located funeral home and cemetery, and overlooking that, an assisted-living facility for senior citizens who don't quite need to be in a nursing home but aren't able to be fully independent. It, too, is expanding.

While we're counting our blessings and looking for bright spots in this bleak picture, we're glad that Mom at least has family to visit and call and do what we can to look out for her. The hollering ladies don't seem to have anyone, nor do many better-behaved residents whose closest relative is a great-nephew in Iowa or a third cousin in California. Her children are handy for listening to complaints and trying to do something about them, but it's the grandchildren who really make a difference. When she sees one of them, or picks up the phone and hears their voice, her mood brightens instantly, as she forgets all about her own concerns for a moment to spoil them as best she can in her condition. Based on what I've observed, one call from a grandchild eases more pain than a couple of Vicodin, without any gastric side effects. If that poor woman with dementia knew that, she wouldn't be hollering for Mommy. Instead, she'd be chanting, "I want my grandson! I want my granddaughter!"

It figures, doesn't it? Mom spent seven years of her life providing 24-hour care for her "longtime companion" (he seemed too old and frail for the term "boyfriend"), employing and supervising three shifts of home health care aides to spare him the kind of hell she's going through right now. Eventually, she may be well enough for that, but since there's no one to play the role Mom did for him, so it's going to take awhile longer. We just hope Mom can hold out till then.

Fallen: Part 1

  posted by Janet Dagley Dagley @1:06 PM


Not much time left to protect overtime pay

The second installment in the Fallen series will appear tomorrow, but today we have an urgent message for all readers on a familiar topic: overtime pay. Even though both the House and Senate voted in 2003 to preserve the right to overtime pay for millions of workers, last-minute back-room wheeling and dealing caused that provision to be deleted from the final version of the current appropriations bill. We have just one more chance to get the overtime-pay protection back into the bill: the Senate will vote on the measure on Tuesday, Jan. 20. If we win there, then the battle goes back to the House. If we lose there, the fight goes on to the White House -- that's the source of the plan to change regulations that have been in place for nearly 70 years. The Labor Department is scheduled to change those regulations, without so much as a vote or a hearing, in March.

So it's up to us: click here to send a message to your two senators, with a copy to Mr. Bush. Urge your senators to join the efforts of their pro-labor colleagues to filibuster if necessary to preserve the right to overtime pay for millions of workers. A filibuster could have some beneficial side effects as well: we need all the hot air we can get to fight off the current cold spell.

After you contact your senators, don't forget to sign the e-petition to protect overtime pay. So far, more than 280,000 people have signed.

Remember, overtime work is not threatened by these changes, just compensation for that work. If you'd rather not put in extra hours for no extra pay, speak up while there's still time.

  posted by Janet Dagley Dagley @5:00 PM


Fallen: Part 1

Her name is Hope. And the name fits, even though her day-to-day life doesn't seem to offer much: she's on her feet from the beginning of her shift to the end, or to the end of the next person's shift if she has to work overtime, emptying bedpans, moving patients who can't move themselves, checking vital signs, dispensing meals, listening to complaints -- the jam-packed to-do list of the lowest-ranking aide in a small suburban nursing home. If she pauses to sit, it's most likely at the bedside of one of her loneliest charges for a few moments of friendly conversation, or in the TV lounge while keeping watch on a half-dozen or so wheelchair-bound elderly residents. She hopes someday to become a full-fledged nurse, but for now she's studying and learning on the job. Even though she's in school full time, she's still years away from reaching that goal. First, she has to finish her last year of high school.

Hope is one of the real-world angels now taking care of my mother, who fell and broke numerous bones just before the year began. There were angels looking after her in the hospital, too, but those didn't seem as hopeful. Busy to the point of frantic, the hospital staff didn't get around to dealing with many of Mom's less life-threatening needs: they knew she'd be discharged before they could ever find time, and patients were ringing their call buttons all up and down the floor. Sometimes they got confused, like the nurse who insisted Mom would have to walk from her bed to the bathroom 2 days after her surgery, even though the doctor had written "NON WEIGHT BEARING FOR 3 MONTHS" on her chart. "Oh, that must have been another patient," the nurse admitted after Mom dug in her uninjured heel and refused to attempt walking. The nurse's beeper went off and she left without either apologizing or accomplishing the task she come to do: tending to the patient's toilet needs. At that point, I taught Mom a word to say loudly and clearly whenever she felt the treatment she was getting was doing her harm: IATROGENIC. Literal translation: "caused by the doctor." They may be angels, but health care workers are human, too.

Everybody makes mistakes, of course. One wrong decision, and any of us could end up just like Mom, our lives changed in a split second, with months and years of hard work required just to get back to the way things were before that mistake, or as close as it's possible to get.

Mom's trip to the hospital, and then the nursing home, showed me that she isn't the only one who has fallen. Our nation's social support network has fallen, too: stretched too thin and overloaded. So have our standards, and our expectations. Parts of it are still intact, of course, and I am so grateful to the farsighted, fair-thinking legislators of her and her parents' generations, who built the Social Security/Medicare system that has softened the impact of her fall.

But it isn't just the health care system. We've all fallen behind in one way or another. Those without jobs are giving up searching for them; those who have work are putting in longer hours than ever before, bringing work home in laptops, on call 24/7 by Blackberry. (Remember when only doctors got interrupted by work during their time off?) High school students with full-time jobs aren't even all that unusual these days, and they're working not just for pocket money but because their families need their income to make ends meet. College? They can only hope.

The other day, I wrote here about Philip K. Dick's novel Time Out of Joint, in which people live in a different time than they think they're in. But when schoolchildren are working full time at some of society's most unpleasant tasks, that's not a Philip K. Dick story: it's a Charles Dickens tale.

And like Mom's injuries, the damage to our nation's social and medical infrastructure will take much longer to repair than it took to inflict. It's going to take no less than a new New Deal. And that has to take priority over going back to the moon and on to Mars. Mr. Bush's telling the nation that we're going to the moon sounds to me more like Ralph Kramden than John Kennedy. At least he's not claiming Mars has weapons of mass destruction.

Ya wanna go to the moon? Ya wanna go to the moon? Ya wanna go to Mars? OK, Ralph. You can go to the moon. Mars too. But you have to wait, not just until Hope gets her high school diploma. Not just until she gets through college, somehow, and becomes a nurse. You have to wait until Hope and people like her have some hope that their world might offer a standard of living at least as good as the world her patients knew when they were her age, and some hope that years from now when she finds herself in their position, there'll be a Hope by her bed, too, and a support network that will pay for both.

Meanwhile, we've already made it to Mars: Spirit is rolling around there right now and sending back snapshots.

  posted by Janet Dagley Dagley @5:04 PM


Emergency leave

The Dagley Dagley Daily is on a brief hiatus due to a family medical emergency. Thanks for your patience, and look for a new post on Jan. 15.

  posted by Janet Dagley Dagley @4:42 PM


Emergency leave

The Dagley Dagley Daily is on a brief hiatus due to a family medical emergency. Thanks for your patience, and look for a new post on Jan. 15.

  posted by Janet Dagley Dagley @4:42 PM


Emergency leave

The Dagley Dagley Daily is on a brief hiatus due to a family medical emergency. Thanks for your patience, and look for a new post on Jan. 15.

  posted by Janet Dagley Dagley @4:41 PM


Emergency leave

The Dagley Dagley Daily is on a brief hiatus due to a family medical emergency. Thanks for your patience, and look for a new post on Jan. 15.

  posted by Janet Dagley Dagley @4:40 PM


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