Once upon a time in America, about 20 years ago somewhere in Atlanta Georgia, an elderly man was very ill and suicidal.
His healthcare nightmare began with whatever was happening that required him to be placed into an ambulance for emergency transportation to receive emergency services.
But instead of simply going directly to some place to be cared for, he took a detour down a rabbit hole.
For the next 20-some hours he would be on that ambulance.
He would be shuttled from one hospital to another to another because he was poor. He was even white. Nobody wanted to provide this man more then a severely limited token of attention that complied with the law back then and that quickly got him back on the ambulance and down the road searching for another hospital where he would get real care.
He became The Man That Nobody Wanted.
Luckily for him,he ended up FINALLY being accepted at “my hospital”. I was working the day he arrived at what I will call “my hospital”. I didn’t own it, obviously, but it was where I worked for a couple years, as a glorified orderly called a Mental Health Clinician. This is my way of taking ownership of what I do.
So here he was, accepted at “my hospital”, ONLY AFTER being shuttled from pretty much every other hospital in Atlanta. Apparently even Grady wouldn’t take him. I don’t know what to say about that. I remember this because the nurses were commenting disparagingly on what they had heard.
I don’t know what was going on in the days before he got in that ambulance, but he was suicidal by the time he showed up in the ER of my hospital. They stabilized him down in the ER and then our Psychiatrist met with him to evaluate the complaints of suicide and wanting to die. She ordered him to be on our acute unit. The Psychiatrist told us he would be coming up and we made preparations for a physically-disabled man with suicidal ideas.
When he arrived, he was a mess. He had basically been naked for the duration of his ambulance experience, covered only in an inadequate hospital gown. I don’t remember if it was summer or winter. He was exhausted. He was grouchy. He was severely depressed. He was miserable.
This poor man was at least 70 years of age, I think. He had suffered from diabetes most of his life and by the time he arrived in this hospital, he had a below-the-knee amputation on one leg, and half his remaining foot also amputated. He was quite obese. He was really sick.
And 24 hours riding in an ambulance being told he wasn’t worthy of care did not do him any good either.
He was what one calls “total care”. He was so big, heavy, and so mobility-challenged that he was not able to get out of bed for the first few WEEKS of his hospitalization. He could not transition from bed to wheel chair. He could not take care of himself.
He had to use bedpans and he could not clean himself up afterward. He had diarrhea early on which caused a lot of repetitive cleaning him. As in several times a day. He was completely unable to assist.
Take a moment and imagine the guy’s experience. You’re sick as a dog from diabetes issues, you’ve been through a traumatizing ambulance-rejection experience; you’re sick and miserable. You have bowel and bladder issues. Strangers are taking care of you like a baby. You can’t help at all. Nobody comes to visit.
It pretty much sucked to be him.
I worked with a male RN named Anthony who was ex-military. We chose to do the kick-ass job for this guy. We developed a routine for getting this gentleman cleaned up fast and efficiently with team work. And we made it a point to do what we could to bolster the guy’s self-esteem. We talked to him, got him talking to ua and made it a guy thing.
We would make several of these special bed care roll-up things that we would place under him while he was clean. They kept the bed clean even if he had a “faux pas” as it came to be called. One of us would roll him to one side and the other would unfurl the things we rolled up in spare time and kept handy by his bed. We got this down to a science and we able to keep him clean and proper all the time and minimize his jostling and the whole intrusion. This is what it took to provide care to this person at that time.
Cleaning and medical care and diabetes management and medicines and anti-depressant meds and counseling, and proper conversation for several weeks, oddly, made him get better and healthier. As a therapist… I think the general positive regard he experience while being cared for helped as well. The hospital staff and other patients became his social life for a few weeks.
And along the way we all developed a rapport and the miserable old grouch turned out to be a reasonably cool old dude with a brain in his head and stories to tell.
The Difference between Existing and Living
This was 1989, I think, and America was gearing up to cease all smoking in buildings and the Hospital had formally banned it weeks before this gentleman arrived.
Of course, he smoked tobacco. It drove him crazy to not smoke and we made the decision to break the rules and allow him to smoke in his room, with supervision. As I supervised his tobacco smoking he’d talk about a thousand things.
He liked music and told me about skipping school in the late 40s or early 50s and sneaking off to Chicago to see ….. Benny Goodman and other Big Jazz Bands. He talked about how cool it was to be able to see that live.
He talked about hanging out with friends in Chicago and once they stumbled onto a dead body on the Lakeshore. “That was creepy”.
Its been 20 years and really I have forgotten most of what he talked about, but there was one thing he said to me that stuck….
He told me once as I lit a cigarette for him “You know… it may seem odd to you, but this cigarette is the difference between just existing and actually “living”. I know it’s bad for me, but I like it. It’s my choice.”
It took me a moment to understand what he meant and once I figured it out, it was like one of life’s lessons to me. Even the slightest hint of choice can help a person feel more ’empowered’ and/or in control of things.
He was partly depressed in that his 24-hour ambulance ride drove home to him a sense of overwhelming powerlessness. He was sick and tired and stressed and he gave up.
He became stronger and was able to start transferring himself out of bed, into his wheelchair and to the toilet by himself. He could get dressed. He started hanging out in the day area, and was nice to other people even though he could be as wry and foul as yours truly. He was becoming more independent.
The Safety Net
While he was systematically turned down for what was pretty close to life-saving care, once in the hospital he entered a safety net.
I don’t know who paid for his bill. It had to be a whopper. Probably some Medicaid, maybe some hospital write off or some indigent slush fund – who knows? He would never be paying a penny for all the care provided to him.
We got him cleaned up, nourished and nursed back to health, able to socialize in a setting where he was more or less equal with other people. His dignity was respected, even bolstered as we got creative in trying to accommodate his choice and make him comfortable.
Once he was better, the psychiatrist was more therapeutic, meaning confrontive, pressing him to make choices and placing some realistic stress on him, preparing him for whatever discharge would be for him (probably a nursing facility, but I don’t know). This was because he was able to think more clearly and critically.
This is how I think a safety net should work.
And with a proper healthcare system – like one we are fighting for – he might not even have needed it at all.
And he might not have become The Man Nobody Wanted.
Postscript: Why are Americans slagging off on the NHS?
I have always meant to write about this guy’s story, short as it may be, but never got around to it.
President Obama will be giving a speech about healthcare reform, the single-most contentious issue in the country at the moment – and now seemed like a good time to tell his story.
I had planned to writer it anyway but last evening I spoke with a friend of mine in Scotland. We “chatted” via the InterTubes!
She asked me “why are Americans slagging off on the NHS? I love the NHS. Free medical care is GOOD. I should know – I have had them treat me many times. I did pay for an ear specialist once, but everything else – even when the ned (horse) rolled over on me – all treated, all free”. “What is their problem with it?”
I briefly explained it was a mix of money-driven politics (capitalism) and racism. These Americans (she’d heard of the town halls too – she thinks we’ve gone mad) are being told the NHS and the Canadian healthcare systems are shoddy and ineffective. I said “If you listened to them, you’d think half of Europe lays dead in the streets.”
“How do they get away with that? They’re lying!”
She continued “Is it true they make you pay before you get treated in America? They ask you about paying status or something”?
“Yes”, I said. No insurance means you either pay out of pocket or you go without.
“That’s evil” she said “Cold and heartless”. “I don’t understand.”
I’d say she understands it very well.
A “public Option” or “Single Payer” or “Medicare for All” – whatever – would have most likely prevented this gentleman from having to go through what he went through.
The folks fighting against [whatever you want to call proper healthcare access] are fighting to keep a system that will do this to people over and over and over.
Maintaining that system should NOT be an option.
[If you can, would you please BUZZ! this @buzzflash? Thanks!]
