Posted on 01/18/2007 2:21:14 PM PST by 60Gunner
Recently, I received an elderly patient brought in by the medics who was “found down” (unconscious and unresponsive) by a neighbor who had passed by her apartment and noticed a foul odor. She had fallen for some inexplicable reason, and lay immobilized on her right side for what we estimate to have been about a week. Her entire right side from her knees to her shoulder was burned by the chemicals in her own urine. Her right hip looked like a rotten apple, bruised and mushy, destroyed to the bone under damaged skin. The wasting of her muscles caused a massive dumping of creatinine into her bloodstream, which in turned completely destroyed her kidneys. Nobody knows who the hell she is. She will almost certainly die tonight from Multiple Organ Dysfunction Syndrome (MODS), Acute Respiratory Distress Syndrome (ARDS), and septicemia. This was somebody's daughter, best friend, sister (?), mother (?). She must have been somebody to somebody on this earth at some time. And now it is very likely that she will die alone.
I wrestled with a lot of anger and remorse with this case. I was angry that someone could be left alone for a whole week, and that the only reason that EMS was called was because of the odor coming from the apartment. Had there been no odor, how much longer would she have lain there? It was likely that she would have died that night anyway, since by then she was in full-blown respiratory arrest. She had no paperwork, and when we notified her next of kin (after finally tracking them down due to some brilliant work by our social worker) they were completely shocked that their mother was ill, much less dying. After all, she had just walked around the lake with the daughter a week ago, and she was independent. What happened?
Elderly persons who are able to maintain their independence are generally encouraged to do so for as long as possible by their families, their friends and by their healthcare providers, with certain exceptions. The reason for this encouragement is simply that "if you don't use it, you lose it." It's a quality of life issue. If a person in her 70s or 80s is able to perform the basic activities of daily living as well as remain active in the community, then in my opinion, he or she should be openly encouraged to do so. Our society is all too ready to shunt the elderly, even independent elderly, off into "retirement communities" where the Baby Boomers and Generation X-ers don't have to deal with them. America is unique among nations in our treatment of the elderly. But I'll save the scathing indictment of our society’s treatment of the Greatest Generation for a later date.
My theory is that an independent person of any age becomes just another commonly-perceived thing in our busy world. We, being entertained by the unusual, tend to ignore the normal. We are thus attuned to exceptions rather than norms. So unless one is accustomed to watching the elderly (as a nurse or other provider would be), the independent elderly person simply does not draw one's attention. The person's neighbors, children, and friends become accustomed to the person going about his or her daily life and they do not become worried if the person does not call or is not seen for a few days. The more diligent people call the elderly person regularly. Still, everyone gets distracted by the demands of the world now and then.
But whether independent or not, an elderly person is at higher risk for injury in the home because his or her body, as high-functioning as it may be, is still old. Reflexes are not as quick. The heart loses its resilience. Arteries lose their flexibility and vascular resistance increases, causing hypertension. Bones lose their inherent toughness due to calcium loss (in men as well as women, but more so in women). Depth, contrast, and light perception are diminished. Hearing is not as sharp. Balance deteriorates. So one day, our elderly subject is at home and suffers a transient ischemic attack ("mini-stroke"), or a heart attack, or gets up too fast after taking medication for blood pressure and gets dizzy. Or maybe her bones have become so brittle that the simple act of pivoting shatters her hip. Or maybe she has had a martini or two, or three, with her lunch and is now a little tipsy. But down she goes. And she has no "life-alert" call button around her neck (comparatively few do), and either the phone is out of reach or she is in too much pain to crawl to it. Or she has hit her head on the floor and sustained a concussion, or any number of other factors.
Meanwhile, nobody comes around to see about her, or if somebody calls, when she does not answer they simply assume that she is out and about. She could cry out for help, but may not be heard if she is in a room where her voice will not carry. The days go by, with no help. But then somebody begins to notice that something is amiss. It takes awhile for us to perceive these things when someone is usually so independent...
"I haven't seen Aunt Louise lately. Have you?" "Now that you mention it, I haven't. But you know her; she's always out doing something." "Yeah, you're probably right."
More days go by. But then the neighbors begin to notice something. The mail keeps piling up in front of her door, or in her mailbox, but her car is still parked out front. Her dog has been outside for days. People have come by, but she doesn't answer her door. It was guessed that maybe she had decided to go on a trip. She did that before, and she can afford it.
All the while, the person's body is breaking down under the enormous strain that forced immobility places on it. Skin breaks down and ulcerates as pressure cuts off the blood supply to the surface. The body begins to break down muscle tissue (and not fat) in order to maintain the supply of nutrients and proteins that the body must have to function. The major products of this process are ketones and creatinine kinase- both of which are lethal in high concentrations. The longer a person stays in this predicament, the worse things get for the body as it tries desperately to keep the important functions going. The buildup of ketones makes the blood acidotic. The pH of human blood has a very narrow normal range (7.35 to 7.45), and to go beyond this range in either direction is incompatible with life. The kidneys will secrete bicarbonate in order to buffer the blood, but only for so long before becoming overwhelmed. And when all that creatinine kinase produced from muscle wasting reaches the kidneys, it clogs the glomeruli and the kidneys are no longer able to filter out the sludge. From that point, the downward spiral becomes more precipitous. Since the person has not had anything to drink for days, there is no way to flush out this destructive substance that clogs the nephrons. So the kidneys simply shut down. Lethal toxins begin to build up in the body at a more rapid rate. But that's not all by a long, long way. Our subject has more misery to experience before she intersects with my life.
Human waste excoriates the skin on contact, and after days without being washed away, whole areas of skin are completely gone. Infection sets in, and within days the person becomes septicemic- that is, the infection reaches the bloodstream and is carried throughout the body; from this point, all major organs are affected except for the brain (for awhile), thanks to the blood/brain barrier. Septic shock occurs. Acute respiratory distress develops. The major organs begin to shut down, one by one. The kidneys have already failed, and now the other major organs become utterly ruined.
Finally a concerned neighbor, or the mailman, or a family member who can't stand it anymore, calls the police. They arrive, talk to whoever called, look in the mailbox, look at the outside of the house, and knock on the door. And knock again, and again, and again. At some point, they decide to go into the house or apartment. And the first thing they notice is the smell. The medics are called, and soon the person is lying in our treatment room.
Could this have been avoided? I don't know. I suppose if our lady was in a nursing home or some other facility, it could have been avoided. Putting Aunt Louise into a nursing home or adult family home is a difficult decision, particularly if she appears perfectly healthy for her age. In her case, would it have been appropriate? I don’t think so. But could something have been done to prevent this poor lady from suffering for as long as she did? I certainly think so! But it requires that everyday people- including me- to do something that has fallen out of style in our selfish society. That thing is called being a good neighbor. It involves getting to know the people who live around us. The more we know our neighbors, the more likely we are to notice when something is wrong. Unless we know our neighbors, we will not be able to avert a disaster like this.
But one must come to grips with the fact that sometimes otherwise independent elderly people just go down, and where they go down will make no difference regarding prevention of the event. It’s what happens after the event that serves to indict or uphold us. We must not allow the media, the movies, the magazines, the TV shows, and our own "busy-ness" to blind us to the lovely human beings who live right next door. The price we have paid is that our own neighborhoods turn against us because we decide not to "get involved". And people like this dear old lady show up in my Emergency Room covered in week-old filth to die long, miserable deaths.
So I challenge the dear reader to do something completely opposite what our society and our media tell us that we ought to do. Don't live unto yourself. Make friends with your neighbors. Get involved. You can be a hero!
Please note that I realize that not everyone's parents were ideal. I know mine made mistakes. But for all their flaws, they really did okay, IMO. But if the situation allows, it's a great thing we can do for them.
You are on. Thanks!
Now I'm going to finish reading this story.
You are on the list. Thanks for your encouragement!
This could so easily happen to my dad (knock on wood). It's why my sister moved him up to Wisconsin, near her... his caregiver was never around and was ripping him off (he lived in a Chicago suburb).
Thank you for this post.
You are most welcome. Thank you for sharing your story!
As far as placement in a nursing home is concerned, I don't know that it would have been to her benefit, considering how independent she was. Either way, that's a very difficult choice to make.
Your posts really contribute to FR. :)
Did this lady die?
Anyway.... on the topic of independence. Our dad was a lawyer but everything changed when he got bacterial meningitis. That week, I flew out to Chicago on an emergency when the nurse told me, "Your father is blue." We thought he would die. Instead, he was in basically a coma for a few weeks.
In any case... the oxygen deprivation to his brain left him a very different person. And now, he's deteriorating.
It's very sad. The other day, I mentioned to my sister, "Dad doesn't call me anymore" (he used to call me every day, and I would call him). So she said, "Dad, call Julie", and he said, "Julie who?"
Anyway... I call but when he doesn't answer I don't know if it's b/c he can't hear the phone or if he's slipped and fallen. He doesn't want to go into a home (though we're working on it), and doctors have said he's not technically incompetent so we can't make him do it. Anyway, if we were to apply for guardianship, it would devastate him. He's still a lawyer and he knows what that means. He still communicates with his lawyer friends (or, they communicate with him, I should say). He just watches t.v.--Matlock. :)
Anyway... this was a long-winded reply, but you may have saved a life by posting this story about the elderly woman. You never know! :)
So is my father--pls see the previous post. I have to get to work shortly... but I think 60Gunner's post is food for thought on how society treats people after they're no longer productive citizens. In some cultures, the elderly are revered for their wisdom and live with their families. We tend to move them away somewhere where we don't have to deal with / see aging and death.
And I'm not trying to be critical. My dad visited for a week and it was very hard, for tons of reasons, particularly emotional ones. I'm not sure I could take it if he lived with us. In today's world there are so many pressures, and caring for aging parents on top of kids... it's overwhelming. I know it's been very hard for my sister (she lives closer to my dad and has born the brunt of all this). (Okay I'm rambling... I need some coffee, LOL)
He lives alone, doesn't drive anymore but has a housekeeper and meals on wheels for supplements.
Truth is, there are various Senior Citizen housing options available, that he is too stubborn to take advantage of. He wouldn't be as lonely with friends his own age to socialize with.
Assisted living apartments offer the Senior Citizen a chance to be checked on daily, interact with people and live independently. Services such as hot meals and transportation are usually offered as an alternative if desired.
The problem is convincing a parent to move from the old house.
sw
Being an EMS, you see the absolute worse outcome of possible neglect situations. You don't necessarily see all the situations that are averted every day by caring people. You're doing a job not many people can do, thank you and God bless you for that.
Megadittos!
Thanks for posting, Gunner.
I had friends who wound up in "family therapy" because a son was on drugs. After a few sessions of hearing what a horrible parent he had been the father said, "I haven't been a perfect father but I've put more effort into it than you have put into being a good son, so don't call me again until you don't want something."
Another father I knew said that when his kids were growing up and he was putting in 16 to 20 hour work days, all his kids thought about was what kind of high dollar cars they wanted. After they were grown they griped about how he was never there when they were growing up -- but didn't care where he was when they were growing up.
Oh! the trials and tribulations of being parent and/or child. LOL!
I was lucky when it came to parents but I didn't appreciate how good they were until I was grown. I guess that's "normal."
Hi, folks. I've been embarking on a quest of becoming spiritually-fit. I've been into a book called The Power of Now. I highly recommend it. It has encouraged me to love without judgment; to not get into my egoic mind, where pain lives; and to stay out of the future (where there is anxiety) and the past (where there is remorse). I try to stay only in the timeless Now, where there is Joy.
A question to ask yourself is this: "What, this very moment, is lacking?"
I've had people criticize me here and elsewhere for this new path I am on, and that's okay. 1st, their opinion is none of my business. 2nd, their comments show their own level of spiritual fitness. And 3rd, I don't really get to judge where they are, because they are Perfect Expressions of G-d and are just where they are supposed to be.
Ah. Good for you!
I was wondering where you went. Your posts surely reflect a change. Don't worry, Be Happy.
I thank you. Everything looks differently to me.
Everything.
I tried to do just that, but Brigette Bardot's attorneys slapped me with a Cease and Desist.....
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