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Wednesday, September 29, 2010

Do you want to kill my mother?

“Hello?” A man answered the phone. 

“Mr. Myers?” I asked. 

“Speaking,” he said, in a curt tone.  

“This is Doris, the social worker. I’d like to set up a care plan meeting so we can discuss your mother’s medical changes” 

“Again?” Mr. Myers queried in an explosive tone of voice. “I already got a phone call from a nurse telling me that my mother is getting worse, and that she needs to be on hospice. What’s the deal with you all? Haven’t you read her Advance Directives? This is unacceptable. Do you want to kill my mother? Is it what you all want?” Mr Myers screamed, as he hung up the phone. 

I was astonished. Not so much with his poor acceptance of his mother’s condition as I was with his questions. “Haven’t you read her Advance Directives?” echoed in my mind. 
To me, that was a bizarre question. An Advance Directive is the document that reflects one’s wishes concerning medical treatments at the end of life. Most of the Advance Directives I had read gave clear instruction of what medical procedures were to be “withheld.”   

What did I miss? I pondered.  

Mr. Myers’ mother, Daisy, was a resident, with a very poor medical prognosis. She needed total care. She was confined to a wheelchair. She was non-verbal. Her eyes were normally closed, even during meal time. She needed to be fed by the staff and only ate small bites with much encouragement.  

But now Daisy was not eating at all. She had become more lethargic. Her weight loss was significant. In an inter-disciplinary meeting, it was suggested that hospice would be on her best care choice. 

With Mr. Myers’ admonishment still ringing in my ears, I looked for Daisy’s medical chart immediately. I read her Advance Directives and living will carefully. It was a thick document brimming with legalese.  

“Oh my goodness!” I exclaimed. I hadn’t noticed the “not” word that changed the whole context of the living will: “..not  to be withheld.” 

The following day, Mr. Myers came to the facility and dropped a five-page letter to the nursing home administrator on the receptionist’s desk. It was a very hostile letter, questioning our phone calls and the interpretation of his mother’s Advance Directives. He had sent copy of the letter to state offices and other overseeing institutions.  

I panicked. My worries grew as I thought of the consequences of misreading the document and making the wrong phone call.  

But I also wondered why Mr. Myers had overreacted. He could have simply declined the option of hospice, and educated us about the content of her living will. 

Our corporate legal office followed with its own investigation and sent a response to Mr. Myers. In the meantime, Daisy continued getting worse, and had to be sent to the hospital. Sadly, Daisy spent her 87th birthday in the ICU where she remained for a couple of weeks, on a ventilator, tube fed and on IV fluids. 

Until the Lord had mercy and took her to heaven.  

Weeks later, a well-dressed and polite lady came to my office. She introduced herself as Lois, Daisy’s daughter. I was taken by surprise because I never knew about her. “I live out of State, and my brother didn’t let me get involved in any issues regarding our mother.” She said. “I know all about my brother causing trouble. My sister-in-law told me. I am really sorry for you all having to put up with my brother’s behavior.” 

Lois explained that her brother had lived in their mother’s home for many years. Daisy had set up a trust which provided that her assets were to be equally divided between the two children after her death. Somehow, Mr. Myers had convinced his mother to sign an Advance Directive with instructions to extend her life. A living will that appeared to merely reflect the son’s wishes. 
And certainly his greed. 
"Wow!" I mused, and sighed. 

I felt some peace of mind in learning the truth that fired Mr. Myers’ reaction to our concerns for his mother’s care. I hoped that someday he got on his knees and asked for forgiveness. 

And for the Lord to have mercy. 

Monday, September 20, 2010

Wisdom Sister Margaret taught me

“Doris, keep your composure!” Sister Margaret said to me.  She was my fourth grade teacher.  I was quite upset and argumentative that day, defending my idea of what the art group should have worked on to present at a local art festival.  I was outraged when the group rejected my idea.
I was a top student, earning high grades.  My family wouldn’t stop bragging about “how smart” and “what a good girl” I was.  But my pride stumbled that day. 
“The world doesn’t revolve around you,” Sister Margaret told me.

I sulked.  Sister Margaret’s words shook me.  I felt embarrassed.  I realized that my pride had grown into arrogance and poor self-control.  Sister Margaret gave me a stern scolding, and now, more than three decades later, her firm words still echo in my mind, reminding me to keep my composure.

Sister Margaret was trying to, and succeeded in, teaching me about reasonableness, patience, and self-confidence.  And I am thankful for it.  I’ve thought of her during a handful of events and incidents where I realized that keeping self-control and prudence had led to positive outcomes. 

One event that I recall involved a resident’s family member.  As I was ready to head to a care plan meeting, Mr L, whose father had recently been placed in the nursing home, showed up in my office, anxiously asking to talk with me.  

“Mr L, I only have a couple of minutes,” I told him.  “But I can meet with you after my meeting,” I offered.  

“No, it has to be right now” he demanded.  “Just come with me. I need to show you something,” he said. 

I followed him down the hall.  I could hear his heavy breathing.  I could see that his face was flush.  I sensed what he wanted to show me would be an unpleasant sight.  

We walked into his father’s room. Mr L opened the door to the bathroom.  He then asked me to step in.  He stood over the toilet, pointing toward the bowel, with a stern expression and arched eyebrow.  The toilet that was dirty. It clearly had been used and not flushed.  

“Do you see this #%!@? Mr L yelled at me while pointing to the toilet with his outstretched index finger.  He then brought his finger close to my face.  His glaring eyes reflected his rage.  It was almost as if burning embers had replaced his eyes.  

“I am tired of this @!#%” Mr L exclaimed. Then he started making all kinds of threats.  
Amazingly, I was not scared of him, but rather annoyed. I felt humiliated. I wondered why we put up with his uncouth behavior which was not new, coming from him.  But I remembered these incidents were to be handled professionally.
I looked at him.  I didn’t say a word.  I flushed the toilet.  Then I looked him in the eyes, 
shaking my head, and showing my understanding of his frustration.  His outrage was not diminished.  

“Don’t you see that you have to hold the handle down or it won’t flush?  he screamed. 
Mr L seemed to enjoy proving that there was something wrong with the toilet that would justify his hatefulness.  

“I will address this, Mr L,” I said, in a calm tone, even though I felt a growing turbulence inside me.  Mr L gave me a doubtful look.  I did my best to disregard it. 

We both left the room and headed off in different directions.  I reported the problem with the toilet to maintenance.  While walking the hall, I was immersed in my thoughts, reminding myself to keep my composure.  I remembered Sister Margaret. And I was grateful again because she taught me wisdom. 

After addressing the incident with some of my co-workers, the issue was resolved within a few hours. The toilet was actually replaced with a new one that worked properly.  

Surprisingly, Mr L came back to my office, with a grin on his face. 
“Thank you for taking care of the problem,” he whispered, and left.  
Mr L was well-known for being a difficult and demanding man who often laced his 
lashings with profanity.  Listening to his “thank you” was definitely a reward—even if it was just for that day. 
Yet my true reward was remembering the lesson Sister Margaret had the patience to teach me. A lifetime lesson that the world doesn’t revolve around me, but those that I am here to help.  Every day. 

Sunday, September 12, 2010

Treasured people

“We’re in the dark,” my fellow worker Jane told me on the phone. 

“Come again? What happened?” I asked her, becoming anxious.  

“There was a power outage and we are running on a generator.” 

“Oh my God!” I exclaimed. 

It was a stormy day. I was away from the nursing home at a seminar. During a break, I had called to the facility to check on pending issues. The bad news only increased my worries. 

“The administrator is here doing his best. The maintenance guy is working hard to find the problem,” Jane stated. 

A nursing home without electric power on a summer day means no hot water for showers, no ice, no cooking, no television, no computers, no copy machines, no faxes, and, worse, no air conditioning. 

“Jane, that’s critical!” I replied, shaking my head. 

The generator only provided power to a few areas of the halls, and supplied electricity to the emergency outlets, mainly for oxygen concentrators.  

I worried about the residents and how they were coping with something new and unexpected in their day.  

After the seminar I stopped by at the facility. It was still raining and misty outside. The once well lit halls were filled with shadows and it was muggy inside. I started my rounds. 

I glanced at my residents. They looked worn out, but they were calm, and patient. They were hopeful things would return to normal soon. In the meantime, they savored ice cream that was brought in. 

Mr. Stephens, one of the residents, appeared in good humor.  “We’re okay; we’ll do what we used to do back in the days when we didn’t have electricity,” he joked. It was a blessing that someone could put on a smile during these hours of crisis.  

I observed the staff. They looked sweaty and tired, but I didn’t hear one complaint. I looked at the administrator. He moved fast throughout the facility, checking every resident room and station, giving instructions, making phone calls.  

Then I glanced at the maintenance man, Mr B. He remainedas usual quite  serene despite he critical situation. He ran in and out of the building, checking the electric system, digging in the ground, running cables, plugging and unplugging machines. Although soaked and wet from the rain, he kept his focus at all times.  
Mr. B always amazed me with the way he handled the stress of his work.  

“You are always fixing problems,” I told Mr. B one day. “I don’t know how you hide the stress,” I observed.  

“I do get stressed!” he replied.  

“Really?” I grinned, doubting.  

“Of course! But I have to control myself. If I don’t control myself, how am I going to resolve the problems?”  

How clever! I mused, looking at Mr. B. 

I had previously learned that Mr. B, a tall man in his 50s, had served in the Army in his younger days. Although he rarely talked about his personal life, I surmised the discipline of the military trained him well and carried into his work ethic of tackling every problem with vigor.  

“Did you learn stress management in the Service?” I dared to ask.

“Definitely. If you don’t keep self-control, you can get killed. That’s how serious it is!” he asserted. 

Serious he was. Mr. B normally looked serious. Even when joking around. He was always polite and respectful. He kept busy, never wasting time, or slacking.  

“But Mr. B, you can’t tell me that you don’t feel anxious and nervous when you’re stressed!” I challenged him. 

“I do feel anxious and nervous,” he admitted. 

“So, how do you control those feelings?” 

“Breathing!” he pointed at his nose. “By knowing how to breathe.” 

Mr. B gave me a good lesson. Not only about the breathing technique to manage stress, but also by making me realize that everyone around uspeople that we may easily overlook have important jobs and lessons to teach us.  
The electric crisis was resolved after several hours successfully. No more darkness. No longer muggy. As the lights returned and brightened the whole place, and the cool air returned comfort to us all, I recognized that I was surrounded by many amazing people. Treasured people.  

How fortunate I am.

Sunday, September 5, 2010

Angel dogs

“Can I bring my dog with me?” 

“No, Mrs. Johnson, pets are not allowed to live in the facility.” 

Mrs. Johnson’s health had significantly declined in the past year. She had tried very hard to stay at home. But multiple falls and her increasing need for daily assistance forced her to make the decision that no elderly person wants to make: moving into a nursing home.  

Mrs. Johnson was ready to give up the home she had rented for years. Although she cared about her furniture, clothing, books, photos, jewelry, and everything else that reminded her of her life, nothing would compare to her prized poodle, Gizzie.  

“I came into this world with nothing, I can leave this world the same way,” she commented. “But I just can’t abandon Gizzie. She is my baby,” She said, determined. 

Mrs. Johnson had been a widow for many years. She had no children or close family. “Gizzie is my family!” Mrs. Johnson exclaimed with tears in her eyes. “She has been my companion for fifteen years.” 

Dogs have played a special role in my experience as a nursing home social worker. I remember one woman who came to a facility where I worked, wanting to talk to the administrator. She told the administrator that her grandmother had recently died, and the family wanted to donate her dog to the nursing home.  

“She likes older people, and is really good to them.” the woman stated. "She is up-to-date on her vaccinations and is well trained." 

“I will be glad to take her,” the administrator replied. That very same day Koya, a beautiful black and white Collie, was brought to the facility.

An odd resident, I mused, grinning.

Koya was, indeed, a good dog. Calm, kind, obedient. She loved the residents and some began giving her dog treats. Soon Koya had established her daily route down the halls, collecting her treats from the residents she knew would have them. 
My son Ernie was a high school student and worked part time in the nursing home, helping in the kitchen. Ernie joined the club of Koya’s fans, petting her and handing her treats. Suddenly, Koya started to follow Ernie on his way home as we lived within walking distance of the facility. The next I knew, Koya was spending nights on our porch, and days later, she was comfortably sleeping in our house. She became our part-time pet. 

Koya alternated her time in between the nursing home during the day, and our house at night. She gave companionship and love to the residents. And to Ernie and I as well.  

Koya had been like an angel to her former owner, and her mission was not over after the elderly woman died.  

She is now our angel dog, I thought.    

After several months with us, Koya, who was already elderly herself, became very ill and had to be taken to a vet hospital. She spent a few days there and, sadly, had to be put to sleep. This information was handled with caution as we didn’t want the residents to get upset. But in my times of solitude, I shed several tears. 

“When will Koya be back?” Ernie had asked. “I don’t know,” was all I could say. 

I didn’t let Ernie know she was put to sleep until I was certain he was used to her being absent. For a while he continued thinking she was in the hospital. By the time I revealed the terrible truth, he seemed more prepared to handle it. Or perhaps I was more prepared to tell him. 

I understood why Mrs. Johnson was so heartbroken about giving up her dog, Gizzie.  

“I’m so sorry, Mrs. Johnson,” I sympathized. And I felt so helpless.  

But something wonderful happened.  A home health nurse that had assisted Mrs. Johnson for a long time, and who had bonded with her, offered to take care of Gizzie, and to bring her to the facility for frequent visits.  

“Thank you!, thank you!” Mrs. Johnson exclaimed with excitement, and tears rolling down her face.  

Thank you, God. I silently prayed.  

Mrs. Johnson transitioned well into her new living environment, and enjoyed Gizzie’s visits almost daily. Mrs. Johnson voiced no more worries. 

Months later, Mrs. Johnson’s health declined rapidly. In her final days, the administrator made an exception and allowed the dog to stay with her in her room. Gizzie watched over Mrs. Johnson with tenderness. She laid in bed with her at night, like in the old times, as Mrs. Johnson had mentioned.  

Mrs. Johnson’s angel dog, I mused.   
With her hand on Gizzie’s soft and warm body, Mrs. Johnson took her last breath.