• A man on a walker

      Reg Green, three weeks after the orthopedists at Huntington Hospital, Pasadena operated on his broken hip (Photo – Martin Green)

      A few miles from my home, in an upscale area just north of Los Angeles, is a registered nursing home. Its rating in that loose industry is respectable; it seems to conform to all the regulations.

      By Reg Green

      It is operating, however, as a madhouse. Few days ago I was released from it after a frightening week. I have Medicare, supplementary insurance with Blue Shield of California, long-term care with Genworth and doctors affiliated with top hospitals in Southern California. I did everything by the book. What happened to me could happen to you.

      I was taken there from the gleaming hi-tech of Huntington Hospital, Pasadena, following a successful operation to fix a broken hip after I had fallen while hiking in the Angeles National Forest on Friday morning, October 22. As it happens my fall was seen by another hiker who immediately called the medics and I’d guess I was in Huntington within an hour or so.

      I spent the entire weekend — the rest of Friday, all Saturday, all interminable Sunday and all Monday until 5:00 pm — lying on my back, either numbed by painkiller or unable to make more than the most tentative movements because of excruciating pain.

      All that time passed because, as for millions of other old people — I’m 91– the daily dose of blood thinners I take that guard against blood clots had to be stopped to allow a return close to normal clotting to minimize the risk of uncontrollable bleeding on the operating table.

      The home like others in the nation

      Because this was a rational balancing of risks, it was bearable, but it was when I agreed to be moved to a nursing home to recuperate that I went from a sensible if joyless environment to one teetering on the edge of chaos.  This nursing home, like others all over the country, is chaotic because it is filled with patients in the deepest throes of dementia.

      As I was wheeled in, the corridors were echoing from a voice begging for help, loudly and insistently. It was just one word — it sounded like “darfair” -and it was repeated over and over and over — “darfair, darfair, darfair, darfair, darfair.” It was the kind of unending call that you hear from beggars in the world’s most wretched places.  It was the wheedling, pleading, threatening cry of those who have given up hope of getting what they want but don’t know of anything else to do. “What does he want?” I asked one of the staff. “We don’t know,” she said “He’s Armenian. He shouts like that all night.” “Can’t someone help him?”  “No, papa,” she said.  “He’s very sick.”

      Suddenly, on top of the cries of the Armenian, from a nearby room there came a roar of rage, like a wild beast. I lay there helpless on my back, holding my breath waiting for some violent crash. Then another roar, and another. I waited and waited but still nothing happened.  I slowly relaxed. It was turning into a pattern I recognized: the impotent bully. In time most people learn to ignore his threats, but he keeps it up because he doesn’t have anything else to relieve his own misery.

      Flourishing

      Because of restrictions due to the coronavirus, no visitors are allowed who might have curbed excesses like these. Without checks, they had flourished and the roars were loud enough that over the phone my wife could hear this fake king of the jungle making life miserable for the smaller animals. “I’m not staying here another night,” I told myself. It was bravado but it gave me a goal.

      My bare room included two beds, one of them, mercifully, unoccupied. The door was either open to all the comings and goings in the corridor or a solid barrier that isolated you from everything.  If the door was shut, you were completely dependent for help on a call button to reach a harassed staff member who had no way of knowing if it was being pressed in an emergency or, much more likely, just one more obsession. For the patient, it was another taxing balancing act: lie there at the risk of being forgotten or call again and risk being categorized as a difficult patient, a condition much to be avoided.

      The Venetian blinds were never opened in all the time I was there. Without a special effort I couldn’t tell if it was morning or night.

      A place of a few words

      During one long night of the shouting, I’d had enough. “Shut up!” I yelled at the top of my voice. Immediately there was a silence so profound that for the first time I heard from one of the other rooms, a mouselike sigh that had obviously been going on for hours. “Ai, ai, ai,” repeated — as usual — over and over.

      I permitted myself a sick joke: “This certainly is a place of a few words,” I said out loud, but the relief was short-lived. “She’s 104,” the nurse who’d come hurrying in told me. “What a long way you’ve traveled only to be abandoned in a bleak nowhere like this,” I said to her in my mind.

      Time wore on, hours and days of boredom, lying on my back, reading books held face down to avoid any movement of my lower body.

      Pushed out into a home

      All these patients were alone because their families couldn’t or wouldn’t help, the coronavirus restrictions only reinforcing what was already a bitter fact. For many it didn’t matter: they wouldn’t have recognized their own children. And anyway, it was some of those children who had put them there and pushed them out of their lives.

      The staff worked hard and with admirable sympathy, but they were completely out of their depth. They were called nursing assistants, but the training of the ones who looked after me had lasted all of a month. I don’t suppose any of them had had more than a primary school education. Their strength was the resourcefulness, stoicism and rough give-and-take in coping with the harshness of everyday life in the third world countries they came from.

      But nothing had prepared them to understand the world of delusion, terror and isolation where their patients lived, let alone how best to guide them through it with the minimum of fear.

      All the patients were presumed to be harmless and most were too pathetically weak to hurt anyone, except themselves. But how can anyone be sure? There were certainly hidden depths. “Hey there. Stop that. Don’t you go there. That’s not for you,” I heard an uncharacteristically sharp tone and saw a grave respectable old man in a wheelchair with a homemade knitted rug round his legs being firmly turned back from trying to escape through a back door.

      Breaking point

      One night the breaking point came. The door of my room was thrown open and two paramedics bustled in with an old man strapped to a gurney. He was in the furthest stages of dementia.

      His skin, deathly pale, was stretched so tight that his skull seemed to shine through it; his open mouth, breathing hard, was toothless, his lips were so thin they were virtually non-existent. As I leaned over to look at him, his face a few inches from mine, his eyes were glittering wildly. It was the bony face of a terrified bird. It turned out he was previously a patient who had been taken to hospital for a temporary ailment and now, cured of that but uncured of his main affliction, was being returned.

      The awful truth dawned: he wasn’t in my room; I was in his. As the paramedics loosened his leather straps and slipped him into bed, he immediately began to flail around punching the air. “Get me outta here,” he shouted, writhing uncontrollably. Those were the only words I ever heard him say but in the next few hours he bellowed them dozens and dozens (and dozens) of times.

      “I’m not staying in the same room with him. I’d sooner be out in the corridor,” I said to one of the overwhelmed night staff. “There’s nothing we can do, papa. All the other rooms are filled,” she told me. It was no use arguing; she couldn’t do anything. I called my wife who contacted the front desk who promised to do what they could.

      an older gentleman with walking canes on a steep hill

      At 91, until his injury, Reg Green hiked every day in the mountains north of Glendale (Photo – Dallas Raines)

      The latest big mouth

      I’ve learned in life, however, that front desks are at the mercy of the latest big mouth. Although I’d been solemnly warned never to get out of bed, I heaved myself up and, shuffling and gripping whatever I could, pushed my way to a wheelchair a few feet away, sat down in it and instantly felt a rush of empowerment. I wasn’t helpless on my back anymore.

      I wheeled my way down the corridor lined with old people with expressionless faces. I reached the front desk, and I became the latest big mouth.

      “I’m not staying in that room tonight with him,” I said with more conviction than I felt.  “Yes sir, your wife called. We’ve found another room for him.” I felt the elation bigmouths feel when they have won a battle — and, in this little world, this was a big win — but also a sense of shame at being so overbearing.

      The more you get, the less available for others

      In fact, throughout this whole ordeal I was acutely conscious that the more I could get for myself, the less was available for everyone else. It’s a humiliating feeling especially as everyone else was much worse off than I was: sicker, much less education, virtually no experience in dealing with bureaucracy, no support from outside.

      As I wheeled my way back to the room, they were bringing him out and, although they were giving him what he’d been crying out for, he was still shouting “Get me outta here.” But then, of course, the ‘here’ he was so desperate to get out of wasn’t the room or even the nursing home but the prison in his head peopled by devils who never stopped tormenting him.

      “Is anybody there?”

      With him out, a stillness settled on the corridors so unbroken that I could hear the staff talking to each other as they tidied up the rooms down the corridor. Then in the silence I heard the first educated voice that I had heard since I’d been taken in. It was saying plaintively and, in a whisper, “Is anybody there? Hello. Is anybody there?” No one answered. “I can hear someone,” he said. (Yes, the same people I could hear.) “Won’t you help me? I know someone’s there. Please help me. My back’s hurting. I can’t get out of bed.” His voice was so mild and gentle that I broke protocol again. At the top of my voice I roared “Nurse! Nurse!”

      I heard hurrying footsteps and one of the tiny nursing assistants put in her head. “Can’t you help that man? He just needs a few words of assurance” I said, basking in the thought of how responsibly I was behaving. I soon learned otherwise. “I go in his room a hundred times a day, papa,” she replied “and as soon as I come out, he says the same thing.”

      Last day of school

      Oh, yes, my repaired hip. Almost every movement hurt, but a doctor, whom I liked and trusted, looked in a couple of times and found nothing to worry about, and a physiotherapist showed me a few foot and leg exercises then left. It was probably enough, but in that atmosphere of doubt some extra reassurance would have been worth its weight in gold. After all, I hadn’t had a bowel movement (as we nursing assistants say) for more than a week.

      At last my intransigence worked. “The bloodwork is ok. You can go home this afternoon,” the doctor told me. I felt as if the last day of school had arrived. The hours flew by and my wife arrived. I was heaved into the wheelchair and rolled past people I’d seen before, smiling a goodbye. None of them gave the slightest sign of recognition.

      The room with the little mouse was what you’d expect, dark and silent, with a small silhouette barely visible sitting upright on a chair. In another room a bundle of sticks lay on top of the bedclothes, with the television full on and sunshine pouring through the window, jerking convulsively and crying “I’m freezing, I’m freezing.”

      Within fifteen minutes I was home. My wife had rented a hospital bed and a wheelchair; the insurance company had arranged for physiotherapy at home; the nursing home had handed me a supply of medications and written down clear instructions of dosages and times. At last the system was working as it should. There was something to live for again.

      The life she dreamed of a hundred years ago

      Then I remembered that at that very moment ill-trained, confused, overworked, middle-aged women whom life had already knocked about were heaving obstinate bodies into and out of bed, that the sun was losing its heat on the bed of a man who had fallen into despair because even in the hottest part of the day no one would warm him up, and a tiny creature was painting pretty pictures in her mind of the life she dreamed of a hundred years ago.

      I’d come out of it. So, probably, will you unless you’re unlucky. But who’s going to help them? And who is going to help people like them in every city across the nation?

      > Anyone who has similar experiences to Reg may contact him at at his website, NicholasGreen.org.


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      Comments

      1. Janet Olenik says:

        There are good facilities and bad ones. Ironically, I observed that the expensive ones gave worse care than the Medicare facilities. Medicare facilities are monitored more closely. I also learned that expensive furniture and elaborate dining rooms are misleading. One needs to observe first hand the actual care patients receive in a facility.

      2. Nancey Murphy says:

        One of the things leaders of groups for girls, such as Campfire Girls, thought was a valuable experience for the girls and others, was to spend an hour every week visiting the local nursing home. I felt entirely incompetent to help anyone, and developed a great fear of ending up in such a place myself. This fear was encouraged by a woman who nearly became my mother in law, and I stuck with her longer than her son did. She had terrible back pain, but her stomach couldn’t tolerate the amount of pain killers she needed. She finally sold her home and moved to a nursing home, that appeared to be quite fine. But she couldn’t walk, and attendants kept forgetting to wheel her to the dining room for meals. I finally got a phone call from a niece of hers telling me that she had died, and she had done it herself–she stored up enough pills so that if she took them all at once, she would finally escape her unbearable life. I would do the same, but fear that my precious pills would be taken away from me by the staff.

      3. William Shaw says:

        I think all of our Legislators who are against assisting people to die, should spend a few nights in such a nursing home. I’m 66 and live in fear of becoming my mother who developed early onset Alzheimer’s starting at the age of 55. She lived, if you want to call it that, to the age of 74, about 16 years longer than the average length of life with the disease. She had said many times that she didn’t want to outlive her ability to think and remember. She would have much preferred to have the money spent on her, spent instead on pre-schools for black and brown children. What a waste figuratively and actually.

      4. Lee Johnson says:

        Wow Reg!
        You have surely given a wake up call for the needs of Nursing Homes! My heart breaks for those pitiful lost human beings in their Demented fog! Also I’m so sad for the uneducated overtaxed care givers!
        I’m VERY sorry to hear of your painful fall and injury!
        God Speed to wellness and back to your beloved trails!
        Your neighbor on Briartree; Lee Johnson

      5. Egbert S. says:

        Wow! A powerful account from a man who is clearly more capable than most to get out of this terrifying circumstance. I hope we all can see this as a call to improve our healthcare system to be more humane.

      6. Julie Ringo Battaglia says:

        An alarming and moving story.

      7. Kristine Hutchinson says:

        This is so often exactly what you experience if you’ve ever spent time visiting a relative. Between visits, I would pop my heard into a doorway to day hello, or walk across a room to ask if I could do anything. Often, just holding a hand or offering a smile made a difference in somebody’s miserable existence.

      8. Cindy Kloman says:

        This is indeed a very sad story. I would remind everybody that you don’t have to stay. It’s not a Gulag, it’s just a hospital. You can leave anytime you like even if the doctor says no.

      9. Henry Rex Greene says:

        I practiced medicine in Pasadena from 1975-99. Although an oncologist I managed my nursing home patients. Over this time period I found only 4-5 facilities that passed scrutiny. Among these I only rated one an A. It was depressing to visit my patients that had to be in other facilities, however this phenomenon is widespread in America: we warehouse our elderly. They become invisible. We see this in the failed response to the coronavirus pandemic as our federal government has sacrificed our elderly to the illusion of “herd immunity.” People who claim to be “pro life” readily accept this fact. Like in Orwell’s “Animal Farm,” some Americans are more equal than others.

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