Thursday, December 6, 2007

Kindred Spirits

Kindred Long Term Acute Care Hospital is located only a few blocks from where I grew up, in Ladera Heights. It sits on a busy street at the edge of the neighborhood, next to St. Mary's Ethiopian Orthodox Tewahedo Church.

Trudy was right. The lobby is nice. It is sunny, clean and when I arrived there was snack cart offering flavored coffee and pastries. There was also a welcoming and well-coiffed receptionist who handed me a name tag and directed me toward John’s room. It was downhill from there on out.

I walked around the corner and into a hallway where I found a nurse standing in front of her station. I asked for my father’s room and she pointed directly in front of her. John’s cramped, dingy, double-occupancy room was about 10 x 10 feet. There were tiles missing from the floor and the particleboard closet was crumbling in places. A privacy curtain was pulled back to reveal his roommate and the one television set they would share, which hung in the far corner of the room. The beds were fewer than two feet apart.

John’s roommate was unconscious and breathing with the aid of a ventilator. Various tubes and IV's invaded his body. He was lying on his side, kind of bunched up, and he looked like he’d been left that way for decades. He was basically a pile of mashed potatoes hooked up to machines that occasionally made scary alarm noises, which everyone pretty much ignored.

The first thing I did after greeting John was to close the curtain far enough to block our view of Potatoes, while leaving it open enough so John could see the television set. Right away, John asked me for something to drink. When I buzzed the nurse for a pitcher of water, she informed me that the doctor had ordered no liquids until the occupational therapist determined whether or not John could swallow properly. This order was put in place upon my father’s arrival the day before, but no therapist had been in to see him yet. In other words, John had been denied liquids for over 24 hours. The nurse assured me that the feeding tube was providing him with adequate hydration. I complained that he was thirsty and explained he had been allowed liquids and food at USC. She carried on about procedure, and, “the way we do it here,” but I got irritated and stopped listening. Unaware of our argument, Dad turned to me and said, “How about a cup of coffee?” I remembered the beverage cart in the Nice Lobby so I grabbed a cup of hazelnut blend and brought it back to him. The nurse gave me a dirty look but, having been trained by the best in dirty looks, I was not dissuaded. I fed John sips of coffee while glaring at her until she left the room.

The nurse returned with an elderly, bearded doctor. Smiling cordially, Dr. Axelrod extended his hand and welcomed me to Kindred. He told me he had already had the pleasure of meeting my charming mother and explained that he was an associate of her physician, Dr. Mulvy. I shook his hand, told him that his hospital was filthy and asked why no one had been in to examine John in a day and a half while he lay there begging for water. Taken aback, he assured me John was getting enough fluid through his feeding tube. He boasted that the care at Kindred was among the finest in the city, assured me the hospital was clean, and blamed the appearance of the room on Federal Medicare cutbacks. Handing me his card, he withdrew.

Soon after, a jovial occupational therapist appeared. He made John repeat the phrase, “Captain Crunch!” several times and chew on ice, then he felt John’s throat when he swallowed. The therapist’s determination was that he would allow John liquids as well as food, if it were puréed.

The next day when I returned to Kindred, I saw that John had been given a haircut, a shave, and his eyebrows had been trimmed. Throughout his stay, I realized that although the place is a dump, the staff is very dedicated and mostly friendly. It became clear pretty quickly that the nurses were unaccustomed to family members hanging around, getting in their way. This is where people leave their aged and decaying relatives to die. Like poor ol’ Potatoes in the corner, for instance. They kept him in existence with machines, but no one ever visited him that I saw.

I sent out an email to Trudy, Karla and Leo, again telling them that we should make up a schedule for visiting John so that no one feels overburdened, and so that John has some contact with at least one of us every day. I wrote that he no longer wants much company, he just needs to know we are around and he is safe. I asked Trudy to please update everyone with news from the doctors, so that I would no longer be her only confidante. Karla responded immediately, offering three days that week she would come by the hospital. Leo didn’t respond to the email but he did visit.

One morning I arrived at Kindred and found my aunt Ruth sitting in the lobby, looking quite elegant in a black turtleneck and slacks, her silver hair swept into a barrette at the back of her head. She couldn’t see me waving from across the room, so I approached her and said hello. “Mary, is that you?” I came closer and told her it was. She craned her neck forward and peered at me. “I like that dress. It’s cute on you. You look good in that color. Did you dye your hair? It’s too dark. I like it lighter.” As I sat beside her, she reached into her cluttered purse, pulled out a mini dark chocolate Hershey’s bar and pressed it into my palm. I thanked her, but said I didn’t want it. “Why? Are you on a diet?? Dark chocolate is good for you.” I told her I wasn’t on a diet, but I hadn’t eaten breakfast yet. She rifled through her bag. “You want another kind? Here’s one with nuts.”

My Mormon aunt Shirley and her daughter Jenny (who had been parking the car), arrived, and we all filed into John’s room. I tried to wake him by telling him he had company. He struggled to open his eyes but they rolled back in his head. Jenny stuck some freshly cut flowers under his nose, but he just frowned and squeezed his eyes shut tightly, like a stubborn kid.

We reconvened in the lobby and all agreed that Dad was worse than ever. I told them that Trudy had allowed insertion of a feeding tube against my, Karla’s and Leo’s wishes and that I was afraid she would continue with further life support as he got closer to death. Shirley knew first hand how awful ventilators are because her 85 year-old husband Bruce had been placed on one after he drunkenly drove his car into a tree on the way to meet his young Asian mistress a couple of years ago.

(Bruce was an alcoholic, chain smoking, philandering Mormon. He was also a, “career soldier,” flying planes for the U.S. Air Force until retirement. My Dad thought he was hilarious and called him, “The General.” Throughout my childhood, Bruce arrived at our house every Christmas Eve in his mobile home, carrying 6 packs of malt liquor in a brown paper bag. Aunt Shirley followed timidly behind carrying the gifts. One year, having whipped through his supply, he hopped into the mobile home and headed to the market to buy more refreshments before dinner. (For some reason, we didn’t usually serve malt liquor at our house.) Nothing out of the ordinary there, except Bruce never returned. Eventually, John was sent to look for him. He noticed the mobile home was parked up the street and realized Bruce must have knocked on a neighbor’s door by accident. As luck would have it, Mrs. Shogrin, a fellow alcoholic, answered the bell and invited him in for cocktails. The two of them were sitting in her living room, boozing it up, when my Dad arrived to bring Bruce home. John loved that story. He would shake his head, laugh and say to himself, “Ah, The General.”)

The following morning I woke up to an email from Trudy saying that John's breathing had been labored the evening before. She said that he was given oxygen and by the time she left he was breathing easier, but she was worried. I wrote back asking her to please make sure Kindred was aware of our wish that John not be placed on a ventilator.

Within the hour, Trudy replied, "I don't want to think about that right now."

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