The last months have been a surreal ride on the merry-go-round and I’m still trying to process it. The one part that haunts me that I haven’t shared with you was the time I spent in a skilled nursing facility. I wasn’t on the rehab unit or the short-term unit; I was on the one-way-out unit with the folks who will dead-end there. It touched me in ways I’m having trouble understanding.
My first sight was of a long hallway lined with old people sitting in their wheelchairs in front of the doorways to their rooms. Then I went into my assigned room and found my roommate sitting in a wheelchair, making rhythmic groaning and moaning noises, in front of a television set playing cartoons.
When the doctor came to see me, she looked tired and her eyes were bloodshot. She’s been working there for twenty years. She explained it in a single phrase—not even a full sentence—that I can’t remember, but the gist of it was very clear: “Nobody cares about these people. I’m somebody; I have to care.” It was Friday night, seven o’clock, and she was still at work.
The most frequently heard alarm was the “stand-up” alarm. A pad with electrical wiring is laid on the seat of a wheelchair before the old person is settled down. If the person starts to stand up, the pad senses loss of pressure and sends the alarm. There is no one who has the mental or physical competence to stand alone. They are all in wheelchairs.
There were thirty-two people on my unit. Only about fifteen made it to the day room for meals; the rest were bedridden. Of those who came to meals, only one or two could carry on a bit of conversation. Placemats were put on the tables. When the trays came, aides would put napkins or bibs on the residents and then take the meals off the trays and set them on the placemats. They would open containers, take covers off straws and put utensils into plates and bowls.
After the aides had served everyone, they would sit between two residents and spoon-feed one while talking another through the meal—“Swallow, Mary.” The long, pocketed bibs seemed infantilizing, but the fact was that a lot of food—about a quarter of all served—ended up down the front of people’s clothes.
The food was terrible—scorched thick-crust pizza, cold canned wax beans and canned fruit cocktail. Did it matter?
About two-thirds of the residents were old white women; one-third old white men; one old black person, sex indeterminate. Most residents were over seventy-nine years of age. Few had visitors. It was a 455-bed facility.
The unit nurse manager has been there thirty years. She knows everybody and all the rules. She is energetic, positive, cheerful and a real problem-solver. When both my pairs of slacks got soiled by catheter failures, she took them home, laundered them and brought them back the next morning. In my sixty-five years of varied institutional experiences, I’ve never had any employee extend that sort of kindness.
The place was damnably hot. I perspired a lot. Showers only were scheduled for once a week. In the middle of the night I slept in undies and a T-shirt, no bedclothes, with the window open. My roommate slept in flannel pajamas under a sheet, blanket and quilt. She did not carry on any conversation and seemed to be wholly removed from reality, spending hours making repetitive sounds—and then she would utter one simple, entirely cogent sentence: “You can’t go in there—they’re cleaning.”
The windowsill in my room was lined with stuffed animals. The first full day I was there, an aide made my roommate’s bed and placed a yellow cat in the middle of it. The second day, it was a white sheep. My roommate was in the hall or the day room all day and never saw it.
An aide drained my catheter bag and emptied the urine into the sink where I was soon to take out my dentures and brush my teeth. He spilled urine on the floor and didn’t notice. When I called both things to his attention, he promptly cleaned it up.
The furniture, food and equipment all scream lack of money. Decades ago, my grandmother tugged on her gray curls and said, “Child, don’t you know they don’t want to take care of us? They only want to take care of younger people who will get better.” A new $6000 bed in the hospital; an old $300 bed in the nursing home.
Why are these people here? Why are they alive? What does it matter? Where are their families? They cannot talk. Do they think? Do they feel? Are they happy, in pain, numb? Does it matter?
A weekend spent in a nursing home challenges everything you believe about the meaning and value of life. It challenges the fundamental concept of what is life.