April 15, 2011

USA: Lost in the Emergency Room - Her Dignity

NEW YORK / The New York Times / Health / April 15, 2011

Another Night in The Emergency Room
By Jane Gross

My mother fell in the bathroom and cut her head. The overnight receptionist at the assisted living facility, a dim bulb, phoned me to say an ambulance was on the way. I knew exactly how awful the next however-many hours would be: enduring my mother’s crankiness, masking my own with brittle good cheer, struggling with the medical people. The emergency room ordeal would leave my mother, and to a lesser extent me, limp for days.

Getty Images

The gash on her head was, to use my mother’s phrase, “a big nothing.” As a former registered nurse, she knew the difference between a cut and a cut, and had no patience for the policy of so many assisted living facilities: calling 911 at the drop of a hat rather than risking the wrath of a litigious family.

She not only understood she didn’t need an E.R., she also knew that each of these visits is a disaster waiting to happen. A tear in her paper-thin skin, moving her from gurney to wheelchair, could lead to cellulitis. A catheter, should they decide to insert one, might cause a urinary tract infection.

Even a “routine” E.R. visit — and there really is no such thing — left a little less of her than there was before and drained her dwindling supply of energy. She was aware of this loss of resilience, comparing herself to an old brassiere that has been washed so many times that the elastic just gives out.

That night, she tried to explain to the gum-cracking receptionist that minor scalp wounds produce alarming amounts of blood. But at her advanced age and in this environment, my mother was no longer a respected professional, her intellect and judgment intact; she was that cranky old woman in Apartment 321. Old, sick and helpless, she no longer had the confidence to put up much of a fight.

The ambulance workers saw right away that the wound didn’t need a single stitch. But now that they’d been called, their job was not determine if the 911 call was warranted, but to whisk her to the nearest emergency room.

By now, my brother and I had the E.R. drill down pat. He lived in Manhattan, and thus I, just a few minutes away from my mother, was the logical person to speed to her side. His job was to call the emergency medical technicians, or E.M.T.’s, and jawbone them until I got there.

We knew the paramedics had the option of taking her to either of two equidistant hospitals, one in a tranquil suburb, the other in a slum and sure to be bedlam. This was no time for political correctness. The E.M.T.’s wouldn’t care where she went, provided I got there fast enough to call the shots.

That winter we spent so much time in emergency rooms that I made sure the driveway was always shoveled and I wished they gave frequent flier miles. Whichever E.R. we wound up in would be too noisy and too bright. The rooms would be windowless, like a casino, so there’d be no way of telling day from night. People would be running all over the place, screaming.

E.R.’s are dreadful places at any age. But for the elderly, they’re depleting and disorienting, sometimes permanently. Their reaction to this environment even has a name, I later learned: emergency room psychosis. Experts in the field do anything they can to keep their own relatives out of this cruel chaos.

My brother’s chit-chat with the E.M.T.’s kept them occupied long enough for me to arrive. With the destination agreed upon, I was free to fixate, irrationally, on something else: the fact that my mother’s do-not-resuscitate order was useless in an ambulance in New York State. By law, the emergency team would have to paddle her back to life unless she also had an out-of-hospital D.N.R.

Even if she had had one, how preposterous to think she’d have remembered to bring it with her, as a bunch of uniformed strangers, moving quickly and explaining nothing, loomed over her, tightening a blood pressure cuff, running an intravenous line, covering her nose and mouth with an oxygen mask, strapping her onto a stretcher and jostling her down the corridor, as nosy neighbors peered through their peepholes gathering gossip for the next day. Ridiculous.

Ignorant of the out-of-hospital D.N.R. but aware of the medics’ legal obligation to keep her alive at all cost, I was hellbent that some well-meaning, hunky E.M.T. didn’t paddle her back to life. She’d be enraged. This, after all, was a woman who had end-of-life paperwork in order long before it was fashionable. She liked to call herself a card-carrying member of the Hemlock Society — an exaggeration, but not by much. Unwanted ambulance heroics simply were not O.K.

Once, my brother asked how I intended to prevent them. I hadn’t thought it through but had faith I’d improvise. Maybe, driving behind, I’d ram the ambulance long enough to at least distract the paramedics. We never had to try.

Excerpted from
“A Bittersweet Season: Caring for Our Aging Parents — and Ourselves”
by Jane Gross.

Copyright (c) 2011 by Jane Gross.
Excerpted by permission of Knopf, a division of Random House, Inc.

© 2011 The New York Times Company