When they pityingly told me I was getting the crazy lady in
bed 20 I quailed. I hate taking care of
crazy people. She’d been transferred to
our neurosurgery service after a CT scan at an outlying hospital revealed a
big, wobbly aneurysm behind her right eye that could pop any second. Blood pressure control was paramount. Great. She’s old, gets upset easily - I’m
going to go in there and she’ll flip out because I’m a male, her blood pressure
will skyrocket, that squishy blood balloon will pop and she’ll die immediately.
She’d
already slammed a nurse against the wall (she liked to lift weights at her
assisted living home as a hobby) and threatened to leave AMA (against medical
advice); she’d acted so irrationally that they assumed she was incompetent to
make her own decisions and filed involuntary commitment paperwork with the
magistrate, meaning they could legally do as they liked with her. I braced myself for a wild-wigged harridan
and gently knocked on her door.
We hit
it off immediately; I spent the next two days just listening to her life story.
Let’s call her “Lydia” - wasn’t crazy,
she was a fiercely independent, proud, stubborn, Southern, nearly 80 year-old
woman with recent tattoos and zero tolerance for political correctness. She’d lived alone most of her life and liked
it. A year back she’d fallen, broken her hip and neck; while she was
hospitalized her daughter had cleaned out Lydia’s apartment and had her placed in
assisted living without telling her. When the pain meds wore off Lydia found
herself in a regimented residence with a gloomy roommate. She hated it, was powerless to change it and
began asserting power where she could.
She broke three different wrists with her aluminum cane in the first six
months.
The
assisted living facility called to let me know they wouldn’t be taking her back
after her discharge. Now she’s not only irascible, she’s homeless. I don’t tell her this news, or the fact that
she’ll need to go to a skilled nursing facility (SNF) after she recovers from
surgery. A SNF is far more regimented
than assisted living. She will not be
pleased. All she wants is to be
independent – and left alone.
What
struck me was how her situation precisely paralleled the revelations I’m discovering
in Atul Gawande’s Being Mortal: Medicine
and What Matters in the End. Her
longing for autonomy is shared by most elderly people – it may be, Gawande
argues - their most fundamental desire.
Such freedom is intolerable in a safety-conscious culture where the
infirm are carefully packed away in regimented facilities – involuntarily, if
they don’t meekly knuckle under. In these institutions residents survive
without thriving, joy and adventure are stripped for safety’s sake and gradually
the light in their eyes fades out. Lydia knew this, raged against it, and
placed all her fierce hope in the belief that surgery would allow her to go
back to living independently in an apartment.
I wasn’t brave enough to shatter that illusion.
