As it turned out, the first facility that we beggared my grandmother to get her into, did not know how to handle Alzheimer's patients. So...we found one that did. A nice little group home with full time nursing and an expectation that the tenants would stay to the end of their days. They were lovely and my grandmother was happy there and was progressing peaceably, perhaps even cheerfully through the disease.
One morning, as she sat up in bed before going to breakfast, my grandmother suffered a stroke. Having spent her whole working life in a doctor's office, she knew what to do and signaled the staff who were amazing on the response. As this was a major event, however, it required immediate transfer to the hospital. Thus began nightmare number 2. What happens to the destitute in an overloaded, overpriced health care industry? It was NOT a pretty thing.
My grandmother's Day Nurse and PA were amazing!! Her doctor...not so much. I cut her slack as I am sure that as a doctor in public practice she is tremendously overloaded. To be sure I witnessed her on multiple days working shifts that have to have been 14-16 hours or more. Precious little of that was spent with my grandmother. The night nurses.....eeeyah...umph.
I joined my family on day two in the city where my folks reside and where the hospital is located. At this point, they were keeping my grandmother heavily sedated so they could do some basic treatment and assessments. I was told that there was substantial paralysis on the left side, but that she was apparently exercising quite the vocabulary on the staff when brought in ( I think I mentioned that an Alzheimer's patient handled improperly is frightened, unhappy and often belligerent). Certainly my sailor father was impressed with the both the depth and breadth of her terminology. They were hydrating with IV as strokes frequently disable the swallow reflex that keeps us from choking on our food and drink. They would wake her up every several hours to test her swallow reflex. We were playing a balance game. Go through the procedure to insert a feeding tube (not simple and quite stressful), or give her a bit of time to recover in hopes she could be fed by mouth. She is small and 88 years old, so they could not wait long to make a decision. So far so good.
Problem 1) Overloaded staff. The doctor was frazzled, the night crew seemed mainly interested in keeping the patients quiet so medicating/sedating was routine number one. Couple of problems with that. To begin, Morphine made grandma itch, which made her want to pull her tubes out. All of them. She was on massive, post-stoke anti-coagulants so this was extra dangerous in the case of the IV. Secondly, Morphine knocked her out completely. So, every time the doc came by to check her, it was early morning and she was sedated to the point of unresponsiveness. The doctor apparently never bothered to spend time (I can only cut her so much slack) to touch base with her own PA or the Day Nurse, so assumed that what she saw coming off the night shift was reality. It was not.
When my grandmother was not sedated, and once she had figured out what had happened and where she was, she was much herself. Her speech was largely unimpaired and there was no sign of cognitive impairment (beyond the native Alzheimer's). In fact, the PA and the Day Nurse both commented on what a pleasure she was to deal with. Full of stories about the depression era. Full of old songs which she was happy to sing to them and, as always, full of the snarky wit that we all know and love. The PA felt the morphine at night might be keeping her down far enough to affect the swallow tests and so he ordered that she be given no more morphine (she was not in pain and told us so). The overworked night crew ignored this. EVERY night. And the overworked doctor continued to not take time to find her staff and chat with them about what the actual status of the patient was.
Problem 2) The Real Deal Death Panels. The overworked staff who did not communicate between shifts nor, indeed within teams, led to the following events. On day three, after much browbeating by the family on the subject of my grandmother's actual status, the doc was talking about getting a temporary feeding tube put in to give her nutrition which might get her over the hump into more solid recovery. OK..all good, though really I don't think that the family should have to ride the medical staff (the experts we rely on) as hard as we did to get basic things taken care of.
Day 4. Grandma is running out of hospital time according to Medicaid. They MUST discharge her within the next couple of days. Net effect. The doctor is now recommending that we pull out the temporary feeding tube that we just got into her, as no facility to which she could be discharged will deal with them. Let me be crystal, icy clear here......The doctor is now recommending that we take a conscious, cognitive, communicative human being (she kept telling us exactly what she wanted) and STARVE HER TO DEATH because she/we could not afford the insurance required and Medicaid would not cover further hospital treatment. Tell me THAT is not a death panel Palinite lying assholes and defenders of the insurance industry!! And it already exists in our current system. Further, I believe it exists BECAUSE we do not have single payer healthcare. BECAUSE we are the only developed nation in the world which still believes that healthcare for profit is both adequate and humane.
S'cuse me...got a little hot there...but it still horrifies me and pisses me off that the system tried to starve my still aware, interactive and communicative grandmother to death. Over money. In no reasonable world is that either adequate "health care", or humane dignified treatment of any human being. And this is the system that the reform nay-sayers claim is hands down the best in the world.
To brighten the end of the tale... Fortunately, the Day Nurse and Discharge Nurse knew waaaayyyyy better than the doctor what resources were available. In, I believe less than 12 hours, they had arranged for an evaluation and transfer of my grandmother to an excellent facility which specialized in stroke treatment and rehabs. Interestingly, regarding the feeding tube, the facility rep said "Of course we can put in a permanent feeding tube! No problem, we do it all the time! In fact, we'll do it tomorrow morning." Thank the PTB for nurses!!! So to this day, though she cannot walk or grasp well with her left hand, my grandmother can enjoy her favorite beverage (Coca Cola) by mouth. She continues to join the singalongs and amuse the staff at her facility with her wit and stories.
As a final wrap up. Many of you saw Keith Olbermann's incredibly candid accounts of his father's final days. If you have not, you can find it on You Tube. I recommend it as a fine counterpoint. As K.O. said , it was bad for his family and they had all the money required to get the very best care available. Always. Now you have a story from the other end. Caveat Emptor, let the buyer beware. I think its time we stopped literally and figuratively "buying" into the system of "health care for profit", which victimizes us all in our extremities of health. Perhaps, instead it is time for us to invest in each other and ourselves and press our politicians to make some actual reform in our pathetically broken, inadequate and worse, inhumane, health care status quo.
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