lest i forget

October 17, 2007

I was growing increasingly frustrated today as I spoke with Miss Charlotte’s sister today. It began as what I assumed would be a straightforward conversation. After visiting Charlotte for a check-up last week, I had nearly keeled over as I walked in. Her apartment was filthy with a build-up of human waste and insects, and the odor completely overpowering. And she had no idea. She was even soiled herself, yet she spoke with me in a relatively coherent conversation, chattering on in a blissful oblivion to her surroundings.
As we have volunteer student nurses who come periodically, I made sure she had a visit the next day and I spoke with the nurses afterwards. They told me what I suspected they would: that she could not take care of herself any longer. Up to now, Miss Charlotte has been headstrong in her independence, so I was relieved to hear the report that she had also admitted to them that she knew she needed to move out of her own place . . . “It’s definitely time for her to go to a nursing home,” they concluded as the nurses left my office.
The first step in this move is to contact the family, so I made a few phone calls to her relatives and was referred to her main caretaker—her sister. Each day I had left a message for her, since that day, explaining the situation, telling her it was up to her now to make the decision, and asking for her to call me back. But I still had not heard from her today; I was thrilled, then, to hear her answer the phone this time.
My excitement promptly turned into frustration. She almost brushed me off immediately, saying she was tired today and would call me later. Not trusting a return call, and anxious to get something moving, I quickly explained to her my reason for calling [she had told me she did not check her messages so had not gotten any of my prior ones]. My assumption was that she would immediately realize the urgency of the situation and respond accordingly. Instead, she told me that nursing homes “didn’t take care of anyone,” and their food was awful. She said she’d just try to find someone who would come and help Charlotte in her apartment.
I tried to explain to her that the waiting list for in-home care was a year and a half long at this point, and that Charlotte was really needing more than that anyway. She repeated her feeling about nursing homes, citing her bad experience with one in particular, and rushed off the phone. Before she hung up, I convinced her to promise to call me back as soon as she heard back about the in-home care; she clearly was not going to consider a nursing home.

What was so distressing to me was that she was not truly concerned about the needs of her sister; all she cared about was her own idea about nursing homes. Had she had the financial resources to afford top-notch in-home care, that would be one thing. But this was a lady who occasionally came to visit her sister, and who had refused to help financially [when I called to tell her that her sister did not have a mattress—hers being soiled beyond use—she had told me she couldn’t afford one, and couldn’t do anything about it at the time. I had been left to scramble with a hunt at all the donation locations to try to locate a mattress by the time she was ready for bed that evening].
In short, I was left with the unmistakable impression that Miss Charlotte’s sister simply did not care enough to do what needed to be done.
The normal procedure in this case is to let the family make the decision, which means taking the individual to the hospital. The hospital then refers them to a nursing home, so that Medicare has the “official” word to cover the costs.
In this case, I need to decide how long to wait for Charlotte’s sister to respond. If she does not, I’m afraid I will need to have Adult Protective Services intervene, in lieu of Charlotte’s family. It is distressing to think of having the state do what the family should be doing for her. But the alternative is worse: the idea that no one cares enough to make sure that she is not left alone in her increasing senility and infirmity.
I left work today saddened at the lack of care that is so prevalent in this world. And then I reminded myself that I probably need to be faced with such blatant selfishness in order to take care to guard against my own such tendencies. I pray that I can spend a lifetime cultivating a heart that is willing to break over all that is heartbreaking in life as we know it.

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