Old People and Hospitals

It would seem silly to suggest that hospitals are not good for the elderly, because where else would they go when they, for example, fall and break a vertebra in their neck, like my mother did last Monday?  Curiously, though, it seemed that her overall well-being took a rapid and steep decline after she was admitted to INOVA Fairfax Hospital.

Perhaps it's more reasonable to say that INOVA Fairfax Hospital is not good for the elderly.  When we brought my 91-year old mother to the emergency room there after a fall, her only complaint was sharp neck pain.  After an hour or so of sitting, she was poked around a bit by a nurse and got a CT scan, where she was lifted up on the table by two technicians and pulled and prodded on to the machine, reloaded back into a wheelchair, and returned to the hallway, where we sat for a while.

After about an hour, a nurse came rushing over to us with a cervical collar and told my mother that she didn't want to scare her, but she "needed to use a little tough love" because my mother had broken a bone in her neck and it was a serious injury that could paralyze her.  Well, now you tell us.  One might think that medical professionals should respond proactively to an elderly patient who had fallen and was complaining of severe neck pain by putting on the collar proactively instead of taking no consideration at all to the potential vulnerability of her spinal cord.  And is it too much to ask for a hospital to have the right sized collar to fit someone who is petite?

My mother made it to her shared room in the Intermediate Care Unit late Monday night.  We were told by the emergency room doctor that given the nature of her injury, she probably would be sent home the next morning with the collar.  The next morning, we were told that the attending trauma physician (the Trauma Department was in charge of her case) was ready to send her home, but the neurosurgeon assigned to her, Dr Jae Lim, wanted my her to have an MRI and that he had ordered her to be confined to laying flat on her back until she had one.  We were told getting the MRI would take a few hours, so we left with the full expectation of taking her home that evening after she got the MRI.

I called the IMU on Tuesday afternoon and was told that she had not had the MRI but should have it in the next hour or so, suggesting that we not arrive earlier than 6 pm to pick her up.  We arrived around 6pm, and still no MRI.  Worst of all, my mother was a basket case, extremely disoriented and fidgety with a thin hold on reality.  Three things contributed to this--being flat on her back for an extended period of time; not sleeping well; and being given Percoset for pain.

I was told that my mother's disoriented condition was typical for elderly hospital patients.  In other words, the staff accepted severe disorientation as the norm rather than considering the potential for disorientation as something to anticipate and try to prevent, for example by avoiding giving them narcotics.  I told the nurse not to give my mother any more narcotic pain killers without consulting me and to opt for Tylenol first.  This is another thing that seemed automatic at INOVA Fairfax--opt for the hard drug instead of other potentially effective options that don't have risky side effects (my mother was to get Ativan, which is strongly discouraged for elderly patients to keep her from moving during the MRI).

The medical staff noted that there was no immediate necessity for the MRI--it was something that could be done as an outpatient--an appointment that I could make for the next day.  They told me the dirty little secret about INOVA Fairfax and its MRI machines--they are reserved for outpatients who made an appointment, ER patients, and patients that were deemed as medically needing one.  My mother fell in the ER category the previous night, but it was not ordered for her; when it was ordered for her, she was constantly put at the bottom of the list because she was not considered to require it as an in-patient, and she couldn't get one as an outpatient, because Dr. Jae Kim wouldn't let her out.

I asked to talk to Dr. Lim, but was told that he does not answer pages after 5 pm.  A nurse was able to contact his physician's assistant (PA), but she said that the MRI decision was up to Dr. Lim, who was unreachable.  The nurse called the MRI department and came back to tell us that they had assured her that my mother would have her MRI at 1 a.m.  We left the hospital with great relief.

When we returned Wednesday morning, we were shocked by two things:  the continued decline of my mother's mental condition and the fact that she had still not received the MRI.  She had spent two useless nights in the hospital SOLELY WAITING TO GET AN MRI THAT SHE NEVER GOT.  I was unhappy.  I spoke to the attending trauma physician, who was unhappy about the situation too.  He had already put a page into Dr. Lim, who had not answered, so he paged him again.

Dr Lim decided to wave the MRI but required a back X-ray instead.  This was done relatively quickly, but unfortunately, we were back in the hands of Dr. Lim, who had to read the X-ray.  Three hours later he read them and ok'd her for release.  By that time the attending physician had changed, and the new one decided that my mother needed to eat and urinate before he would release her.  She had no trouble eating, but peeing was a problem.  The attending physician assumed that she had a condition that often develops with the elderly who have been confined to bed for a few days that makes their bladder become "lazy," so he told us that if we wanted to take her home, she'd have to wear a Foley catheter for about a week and then come back for a test to see if she could then pee.

The nurse, who clearly did not want to install the catheter, and I argued that my mother could not urinate because she had no fluids in her bladder.  The doctor decided to do a bladder scan, which proved that the nurse and I were correct.  But the doctor still wanted her to pee or wear a catheter before leaving.  So she spent another useless, expensive night in the hospital while she was pumped full of fluids.  And she peed.

I described these circumstances to my mother's new neurosurgeon, a gentleman who is rated as one of America's top neurosurgeons.  He noted that my mother's treatment was deplorable and now sadly typified patient care at INOVA Fairfax.  He also noted that he had other patients at the hospital who offered similar complaints about Dr. Lim.  He told me that he no longer associates with INOVA Fairfax and gave me the names of two of the hospital's senior administrators, encouraging me to tell them about my mother's treatment.

Aside from the apparently low patient-care standards at INOVA Fairfax, in general it seems that hospital care of the elderly is a woefully undeveloped field.  Baby-boomers be warned--your time is coming; take note of how your parents are being treated and be proactive in demanding that they are looked after in a way that fosters their overall well-being.  Change will only occur if we push for quality care.

My mother at last is allowed to sit in a chair.

Our Country 'Tis of We

Williamsburg was not our first thought when Tom, our son and his wife, and I tried to figure out a winter break destination.  For a while, the Florida Keys was the front-runner because it was warm and three of the four of us had never been there, but the cost and distance led us to brainstorm closer spots, and ultimately Williamsburg won out.

Come to find out, we were not the only ones to reach that decision.  The staff members we talked to said that the week after Christmas was one of Colonial Williamsburg's peak weeks for visitors, and I could see why, since it's not that long a drive from a number of major US cities, has tons of activities, and the odds are that the weather will be somewhat better than it is in the Northeast.  Not for us, though--much of a five-inch snowfall remained on the ground, revealing a new truth about the colonists:  they don't like to shovel snow and aren't going to waste valuable salt on it either.

As we trudged through the ice and snow along the miracle mile of Virginia's journey toward liberty, I distracted myself from my paranoia about falling and breaking an ankle by trying to define for myself the difference that social networking as we know it would have had on the Virginia branch of the Founding Fathers back during that pivotal time when they were deciding the future of their relationship with Great Britain.  I think my subconscious was recalling a parody of FaceBook that featured a Status + Comments of Ben Franklin, Thomas Jefferson, etc., but I was trying to be serious about it.

My conclusion was that Virginia's decision to take actions that in effect supported the Boston Tea Party and to author its own constitution, a precursor to the US Constitution, was a model of effective social networking and that Twitter and FaceBook probably would have contributed very little and might have undercut the effort:

• The communications methods of the day enabled the colonists to have a surprisingly thorough understanding up and down the eastern seaboard of the central issues relating to their colonies' interactions with England.  A range of opinions was continuously discussed and debated, even after Virginia's colonial governor disbanded the House of Burgesses.  Twitter was not required for word to spread quickly to Virginians about the Boston Tea Party or the taxes that led up to it.

• The young history major who guided our tour through the Capitol made the point that Virginia's colonial leaders weren't all that original in their revolutionary thoughts--that they drew heavily from the great political thinkers of Europe like Locke and Rousseau.  This suggested to me that even the primitive circumstances of the American colonies still allowed for the transmittal and discussion of important ideas.

• Even when the Members of Virginia's House of Burgesses decided to support independence, they had plenty of disagreements among themselves, and the dissolution of the House of Burgesses forced them into meeting secretly.  I can't help but think that Twitter and/or FB would have made these disagreements even more difficult to resolve by turning them into soundbites; by adding more opinions to weed through from well-meaning "friends;" by undercutting the perceived need to meet face-to-face (which I think was critical to coming to closure); and by increasing the colonial leaders' vulnerability to being caught in the act of sedition, since one false sharing of a FB chat or Twitter trend would have provided the British hard evidence of the full scope of the plotting against them.

My musings got me over the precarious footing I faced in Williamsburg, and it also increased my respect for the sophistication of thought and actions of a relatively large number of people in colonial times who sought and achieved change.  I can't really say that I'm as impressed with their current political heirs--all of whom are well-equipped with FB, Twitter, and every other social networking tool.  Of course, I love FB and am slowly acclimating myself to Twitter, but I don't think we should assume that the spectacular increase in the quantity of communication through these tools has led to a net increase in the quality of communication.

Why Won't Janie Read?

As an only child on vacation with my mom and dad, I had the whole back seat to myself as we drove hundreds of miles.  We never flew, because we never had flown and because my dad loved cars and driving.  One of the foot wells in the back of the car would contain at least a dozen library books, and I  would routinely finish reading them during the week of the trip, undoubtedly missing a fair amount of scenery in the process.  When we returned home and returned the books, I would check out some more, and so on and so on.

At some point early in my adult life, I abandoned the library and started buying books--I suspect this was when the Crown Bookstore chain--the first to popularize the sale of discount bestsellers--opened up in the Washington, DC, area.  At a certain point, I continued to buy books, but I stopped reading most of them.  I now read less than a dozen in a year.  I think the main benefit for me in getting an iPad is that the books I buy but don't read will no longer take up space and gather dust.

And speaking of gathering dust, I just filled three boxes with some of my Dad's books, most of which remain on the shelves he built that span a wall in the basement of his house in Terre Haute.  Most of the books I boxed today were biographies of American Presidents or books on US foreign policy.  I know I will never read any of them, but my dad read them all.  He remained a voracious reader until macular degeneration's toll on his eyesight slowed him down about a year before he died at 88.

Reading wasn't my dad's only hobby or occupation.  He owned and maintained rental property.  He did a considerable amount of plumping, carpentry, and woodworking, including finishing the attic and basement of the house in Terre Haute.  He was political science professor until he retired at 65.  But he always found time to read.

So what is my excuse for being such a slacker in the reading department?  Too much time on the computer playing Bejeweled Blitz?  I continue to buy.  I start to read.  I enjoy what I read.  Then I put the book down, and it collects dust.  Some times I think my brain has lost the plug-in for where the book is supposed to go.   Or the plug-in is loose, and the book falls out.  Perhaps the iPad is a better solution than I think.

The best excuse I can come up with is that I work too hard.  My eyes scan a lot of words when I work, and by the time I get home, they aren't willing to focus on words.  I challenge myself to read a few pages a night anyway, but by the time I finish playing Bejeweled Blitz, I'm tired, and a few pages equals three.  Maybe.  At current count I am in the process of reading six books.  I keep them handy in case the urge hits me.  The only one I'm confident I'll finish is Breaking Dawn--I've read the rest of the series and just wouldn't feel right going to the movie with out finishing the book.  Plus, all my other women friends have read it.  Maybe I need peer pressure to get me to finish the other five.

Bringing Down the House

I've mentioned before that we're having a new house built where our old house stood.  Undoubtedly I will repeat some details.  The old house was built in 1964 out of blocks that had a pale blue glaze on one side. The house needed saving or destruction when we first bought it in 1993. We saved it by doing extensive renovations and repairs. Even then we were well aware that the lot was worth more than the house, because the lot is on Annapolis's South River where it enters the Chesapeake Bay.

We didn't put a new roof on the house even though it was not long thereafter we bought it when the wind started blowing shingles off. We were planning to build a second story when we accumulated enough money, so why waste the money on a new roof? But living near the water is hard on roofs, and periodically Tom would climb on top of the house to put roofing material over the bare spots. Fortunately, the roof was simple and had a low peak, so Tom did not risk his life doing this, and he could take advantage of a great view of the water from up there.

Ultimately, wind and water took its toll on the roof and the rest of the house, with leaks especially apparent in our bedroom, where a hole steadily expanded in the cathedral ceiling, letting in insulation and cold air. The crawl space, which we had had waterproofed and was nice and dry for the first ten years or so thereafter, eventually took on water from plumbing leaks and snowfalls. Mice and raccoons also intruded. It was not unusual to see a mouse run across the floor of the family room in the evening while we were watching TV. Raccoons in the roof and under the bedroom floor would rustle around at night disturbing our sleep until we finally realized the source of the noise.

We were losing the battle to both species despite persistent trapping efforts. One raccoon trapping experience resulted in the humane capture and release of a mother and her babies (years later, the release of captured raccoons became illegal out of fear of the spread of rabies). Since we had stopped living in the house during the work week in 2002, the critters had more opportunities to execute their attack than we had to defend against it. The mice built nests in a computer printer and in a sofa, among other places, shredding paper to make them cozy. Mice poop became so common in the kitchen drawers that we took the stuff out of them and stopped using them.

The house had outlived its natural life span. Our architect determined with the help of a structural engineer that the house could not support a second floor. It was time for change. It took about two weeks to take the house down to the foundation.

Here are a few things I learned during the process of house destruction:

1. Mice do not need to taste non-natural fibers to know they don't like them. Wool items stored under the house were well-eaten, but the polyester things were untouched. I don't think they care much for granola bars, either, based on similar observations.

2. Plastic shopping bags are nearly indestructible. Many were in our crawl space and even though they got wet, they remained intact and structurally as good as new. Even the ink was stable. This is why it's important to recycle plastics rather than bury them or otherwise discard them.

3. Plastic garbage bags seem to biodegrade when wet. I guess they make them to do that. Why can't them make all plastic bags biodegradable?

4. Do not store things in cardboard if there's a risk of its exposure to water. Cardboard is biodegradable and vulnerable to attack from mold and mildew. If breakable objects are in a cardboard box that has been wet but then has dried, remove the objects before lifting the box.

5. Raccoons have a high-fiber diet and tubular-shaped poop. They enjoy watermelon but spit out the seeds.

6. Raccoons are not always as cute as commonly portrayed. A raccoon living out in the wild can look pretty scruffy.

7. Some artificial fibers seemed immune to mold, mildew, and other causes of decay. I found this especially to be the case for knit scarves and hats. These came out of the worst possible conditions looking nearly as good as new with just a slight smell of mildew as a result of exposure to less durable fabrics.

Let It Go

I accumulate things that I should let go. I always have a reason for keeping them, but they are not good reasons. Some of these reasons are: One of these days I might be interested in this again (to justify retaining books and papers on topics I used to work on); I want my grandchildren to have this (to justify keeping my kids' toys and clothes); my parents gave this to me (to justify keeping clothes I can't wear any more or other items that no longer fit my lifestyle); or this will be worth something some day (to justify retaining old video game systems and their paraphernalia).

The unfortunate fact is that the accumulation of large amounts of unused stuff results in every item having the same low value. The things get stored in bags or boxes out of sight and difficult to reach. The one or two things that actually might be worth keeping for posterity or resale get lost in the crowd. Moreover, the storage sites are probably spots in your house, like the attic, basement, garage, or crawl space that are vulnerable to heat, cold, water leaks, insects, etc., that can damage or destroy. Your stashing of stuff in these places is not attractive to prospective buyers if you're trying to sell your home. If you are moving, they cost you time, effort, and money at a time when you are already under a lot of stress.

Take for example, my kids' stuffed animals, which were in excellent condition when they were stuff in supposedly secure trash bags and stored in our extremely dry crawl space. Then came a record-breaking snowfall, and the crawl space wasn't so dry any more and the bags not so secure. Mold on a cute stuffed animal is particularly ugly, especially when you're moving out of the home your kids grew up in and seeing the decay of their toys somehow makes you feel that you are an irresponsible parent.

So I am intent on learning my lesson. I will no longer store en masse. An item that I can care for and display is enough to hold many memories of other things that I will give away, throw away, or sell. When we move into the new house, I will diligently, promptly, and systematically let go of possessions and let someone else have their benefit.

House under Construction

Emptying our house in preparation for new construction revealed just how ready it was to become part of our memories and make way for our future.  The leaky roof, which Tom had patched repeatedly over the years, had allowed water to penetrate the ceiling in a number of spots, most notably in the master bedroom, where a steadily widening hole allowed insulation and cold air to come in.  Mice poop was everywhere and throughout the house along in various corners and cubbyholes, the little critters had made nests.  The crawl space had let in melting snow that saturated the huge amount of stuff that we had stored there--books, baby clothes, toys, etc.--to the point that it succumbed to a coating of black mold.  We had caught numerous raccoons over the past several years that had made their home in the attic and the crawl space and let them go miles away, but apparently our hospitality was well-known among the greater raccoon community.

It struck me as I walked in for the last time before demolition that the house was reverting to the way we found it back in 1995, when the bathroom and kitchen floors were soaked to the point that the toilet had almost fallen through and termites had occupied the crawl space from the surface of two and a half feet of standing water to the underside of floors and were eating the wallboard in the living room, kitchen, and dining room, and had already consumed the metal screens of the back porch.

We revived the house then by doing extensive renovations, but it seemed that its life span was destined to be 50 years.  The contractors were salvaging a few things--bookcases built by my dad, our natural cherry kitchen cabinets, the four load-bearing Doric columns, some light fixtures, some hand-painted crown molding, and a unique curved wall half-wall--to remind us of the home that was, but it was time for a more durable structure to take over.

Musings on Holidays, Sports, and Terrorism

Back before the end of the Cold War during the time that communism and dictators controlled Eastern Europe, my family and I lived in Munich and I spent a lot of my week days in German classes along with several refugees from Poland.  I was the only American in the class and so was of special interest to these immigrants who had never had a chance to talk to an American before, or at least not freely.  My German could not handle sophisticated conversations about the United States, but I did my best to give them an idea of why I was proud of my country.

One conversation focused around American holidays, and as I attempted to explain the 4th of July and Thanksgiving as being very important to Americans, one Pole said to me accusingly, "Your country does not celebrate Christmas."

I was taken aback.  What one earth was he talking about?  I had celebrated Christmas along with most Americans every year of my life.  Then I realized he was saying that unlike Thanksgiving and Independence Day, Christmas was not a declared US national holiday, and that meant to him that the US Government was discouraging or even prohibiting the celebration of Christmas.  Interesting perspective of a Christian from a communist country--that the US Government was no better than the Polish Government because neither government officially acknowledge Christmas as a national holiday.

My limited German vocabulary allowed me to explain the difference well enough that we moved on to another topic, but the conversation has stuck in my mind for almost 30 years.  And while I sit here watching the NCAA men's basketball tournament,  it occurred to me that Americans have created a number of secular holidays that thrive despite their lack of acknowledgment by our national government and even though not all Americans celebrate them.  They are occasions when Americans get together and focus on the same thing, and occasionally their devotion rises to the equivalent of secular worship.

 I know this is not a uniquely American phenomena--plenty of countries have large portions of their population who view soccer as a religion.  Americans seem to have taken the concept farther than the rest, thanks to the diversity of our sports and the seasons when they are played.  I've already mentioned March Madness.  The Super Bowl is widely celebrated.  Tailgating is a ritual at most American football games.  The World Series is perhaps not so much an occasion for parties, but even Americans who are not regular season fans will devotedly watch the games.  Viewers of NHL and NBA games are often more dedicated than many baseball or football fans.

Fall offers plenty of activities that can fill up more of an American's Sunday than a couple of hours of church.  State, county, and street fairs, craft sales, wine festivals . . .  These inexpensive opportunities to mingle, relax, listen to music, and eat unusual foods constructively occupy the time of Americans of all ethnicities and socio-economic backgrounds.  And then there are charities, clubs, and classes--painting, drawing, sewing, pilates, yoga, jazzercise, tennis, swimming, golf, genealogy, books, bowling, darts, pool.  Something for everybody.

What are the consequences for American cultural and society of these good times and these non-religious opportunities to develop loyalties based on sports teams and to attend gatherings to pursue common interests?  It is possible that they have undercut support for organized religion by keeping people busy and constructively occupied.  They can also provide a sense of community that would otherwise be sought out through membership in a church.  They might result in breaking racial, ethnic, and cultural divisions.

They might also help deter political extremism and violent extremism.  Is it too flip to say that just maybe if you are eagerly waiting to see who makes it into the Final Four, you are unlikely to be eagerly planning an attack on your local shopping mall?