NIGHTMARE: OLD, SICK AND INSTITUTIONALIZED, Pt. 2

Is there anyone who can help?

Again, I desperately sought help. A promising suggestion to contact an emergency service found it to be a victim of budget trimming. Other calls drew a blank. Despite the urgency, the clinic operated by Gertrude’s insurance refused to help, insisting that only her primary care physician could discuss it. Told her arrival was imminent, I waited, eventually reaching her office through the difficult switchboard to be told that the doctor would get back as soon as she finished with her current patient; a call that, after waiting hours, never came.

Completely at my wits’ end, I looked up Barbara, last year’s angel of mercy at the hospital. Suggesting that I call the psychiatric unit, my worst fear was confirmed; the only option was the emergency room; the psychiatric unit had closed for the day. If I had known earlier; if her doctor had only returned my call.

However repugnant, it was a direction. Now to deal with Gertrude in whatever mood or condition I’d find her. If she refused to cooperate, the only alternative was to have the police take her forcibly; a horrible thought, but a distinct possibility. With this weighing on my mind, I dashed out into the ice storm that had been raging all day to find my car solidly encrusted. Clearing enough for bare visibility, I rushed as fast as conditions would permit, arriving to find Ruth desperately trying to keep her calm. Much to my relief, once she saw me she settled down, apparently considering my presence a rescue from the perceived terrors closing in. Her friend helped her dress and I brought the car to the front. Not having faced inclement weather for years didn’t seem to matter as I helped her wade through the slush, leaving her Bensonhurst home for what was to be the final time.

The horror of the emergency room

We reached emergency at about 3:00 P.M. In dire need of expansion and grossly understaffed, it was always filled well beyond capacity and conditions outside caused it to be completely deluged. Advised that someone from the psychiatric staff would meet us, it never happened. Some information noted, Gertrude’s belongings were checked in and she was assigned a “quiet room”, a small, bare cubicle with windows in the door and wall and only a tiny, uncomfortable cot; the place they contain criminals and psychotics. Space was so confined that beds were everywhere; one placed against the door of Gertrude’s room so that in order to open it, the unfortunate man was constantly being shoved back and forth.

Still relishing her escape, Gertrude was in good spirits as we settled in. Surely, her dementia and psychotic symptoms spoke for themselves; her admission to a psychiatric ward expedited. Time in the bedlam of emergency would be minimal. It was naive however, to think that there was any order to this chaos. Gertrude was now in the institution, where nightmares are reality.

Considering prevailing conditions, it is surprising that more mistakes aren’t made but it is very apparent that care is compromised. Except for the prescribed tests, spread out over time, Gertrude was largely ignored. Shortly following her placement in the room it was suggested I could leave, before ascertaining vital information; insurance provider and next of kin; or acknowledging whether she would be admitted. And if I didn’t grab a tray, she wouldn’t have had anything to eat.

After several hours, cold and uncomfortable, Gertrude was becoming restless and cranky. The reasons for her initial elation drifting rapidly from her consciousness, she was becoming insistent that I get her clothes and take her home as she grew ever more agitated. Efforts to calm her going for naught, I could do nothing but seek help. Convincing a nurse of the urgency, a shot was administered, described as a mild sedative; not too strong for they wanted her awake for further testing.

We had now been there for about six hours and I was out on my feet. Not wanting to leave without knowing my aunt was comfortable and assured of admission, I lingered in the hallway, waiting for the sedative to calm her. Reentering her cubicle, she again flew into a tantrum, the drug obviously having no effect. Again I walked out, positioning myself in a spot where I could observe without being seen, to witness in horror as this formerly sophisticated professional raged like a caged animal, attempting to pry open the locked door or smash it down. Struggling with unrestrained fury, the flimsy hospital gown fell to the floor, leaving this proud, modest woman totally naked as she battled futilely to escape.

This was simply part of the existing chaos however, and went unnoticed. It was painfully clear that this would have continued until she had expended her energy, dropped from exhaustion and possibly expired. Finally corralling the doctor, without turning to look, she yelled at a nurse to administer another shot. I could only wait out of sight until assured she would be admitted. It was close to 11:00 P.M. before I finally dragged myself home to find a nonchalant message from Gertrude’s doctor.

Expediency equals abuse

The next morning, a call to the hospital found that no record of Gertrude existed. Eventually traced to emergency, she had never been admitted. Not wishing to provoke her with my presence, I checked regularly throughout the day only to hear the same thing each time. At about 10:00 P.M. she was finally assigned a room, having spent about thirty‑one hours in the mayhem of emergency.

Arriving the following day, I was shocked to find that rather than place her in a psychiatric ward for evaluation and treatment, Gertrude was provided a bed in a medical ward, dosed with Haldol, a strong psychotropic drug, and held in restraints; something we read of in history books; methods of far less enlightened times. But on the cusp of the new millennium, in a major medical center in one of the greatest cities in the world, they drugged a sick old woman and tied her up, never even allowing her to use the bathroom.

Now Saturday of an extended weekend, the only staff available until Tuesday were the duty nurses who would tell me nothing more than that this was for her own safety; a term I would hear often, the institutional reasoning for expedient, often abusive treatment. Thus, my poor aunt would have to remain in this pathetic state at least until then; a state I feared would only serve to worsen her condition.

Returning each day, there was nothing I could do but sit with her and describe the wonderful home in New Jersey near the family. Gazing down upon her though, I had grave doubts whether she would ever see the outside of an institution again. And everyone seemed to concur. But a small ray of hope still lingered. Gertrude was in excellent physical health; the dementia not so overwhelming that she couldn’t manage with a bit of care and her psychotic behavior controllable with treatment.

When Tuesday arrived, I was delighted to learn that Barbara was once again involved; a familiar face, a trusted friend. But as hard as she tried, she too was frustrated. Among the hospital personnel are patients’ representatives whose job is to protect their rights and assure comfort and care. Feeling they might be of assistance, Barbara made the request. Taking his time to arrive, Victor turned out to be nothing more than an apologist for the hospital, quoting rules and offering excuses. While patients suffer a shortage of facilities and personnel, Victor is paid for excusing the inhumane treatment meted out to the helpless and infirm. A request to obtain a copy of Gertrude’s records, to which, as next of kin, I was entitled, was dismissed out of hand; refusing to allow me to even take a look.

Found most often in bed, sometimes in an adjacent chair, Gertrude was kept in a drugged stupor and strapped down for her entire stay at the hospital. One afternoon she indicated that she had to go to the bathroom so, with no one watching, I released her. A bit wobbly on her feet, as I helped her rise, I was repulsed to observe that on the chair was a sheet stained with feces. They had allowed her to sit in her own filth!   

It was becoming more and more apparent that proper care was secondary to the financial bottom line, especially for the mentally impaired. But I did need cooperation, having received directions from the assisted living facility for the hospital to forward their report. What they sent was almost as repugnant as their treatment. Never seen by a psychiatrist nor actually treated, Gertrude was described as psychotic, requiring strong psychotropic drugs, needing restraints and incontinent. The facility was not about to take a chance. The staff of the hospital had signed off on her life, condemning her to spend her final years within an institutional nightmare in order to excuse their abominable treatment.

Institutionalized

On January 22, I was notified that Gertrude was to be discharged, leaving virtually no time to prepare. There was no other option but to arrange placement in a nursing home, at least for the present. Relying on Barbara, we researched the best situation based on assumed quality of care, location and availability of space. The most appropriate chosen and a brief call confirmed admission. So, after waiting through the afternoon, on a gloomy, rainy evening, we departed for the next stop on our journey; she by ambulance as prescribed by the hospital and Medicare.

Arriving shortly before the ambulance, I was able to provide some comfort as they rolled Gertrude into the home. From the outside, the building was not unimpressive. The lobby could have been a bank, tastefully conservative, with plaques of the founders on the walls. Living quarters on floors two through five however, were drab and faded, creating a most dreary atmosphere, like an old hospital or prison. But everything was spotlessly clean.

The ambulance gurney carried Gertrude to a room on the third floor where she was lifted onto a bed. Next to her was a shriveled old woman repeatedly moaning shrilly, “Help me, help me…” In her drugged stupor though, she didn’t seem to notice. An aide entered, asked a few questions, I bid farewell and left. It had been another excruciatingly long day and leaving my aunt in this dismal environment made it exceedingly depressing. I drove home through the chilling mist that January night in a mood as foul as the weather.