Dead Letter Department #126

weather report

It’s been a clinging on with fingernails couple of months. First there were my mom’s emergency surgeries (multiple), followed by a lengthy hospital stay, and then the sort of nightmarish scramble that our health care system is designed to produce, like a bureaucratic Saw trap: here’s a sheet of Medicare-rated skilled nursing facilities. Some of them have two stars (horrifying); some of them have five—now you have to pick your top two before you get another badgering call from the relevant people at the hospital and hope that one of them has the space to take her. No one knows when she is being discharged, but you will need to be ready immediately when it happens. No, the first one, the really good one, isn’t available, I guess you just move on to the second. You hope intently that you do not have to jump down to the third, where the star ratings take a mighty, frightening tumble.

The nurses on her floor, when asked, say it is a ‘fine’ facility in the tone of voice suggesting that there would be a number of words other than ‘fine’ used if you were talking to them in a personal capacity, but also that fine is not a lie, either, given the alternatives.

“I know people that work there,” one of them says, with admirable honesty. “It’s not one of the bad ones.”

It is difficult, in the first few days, to imagine that it could be worse. Medicare does not pay for transportation from the hospital to skilled nursing facilities; did you know that? It turns out you can get private ambulance transportation, but they all share the same phone number so even organizing that becomes something of an ordeal. It is also expensive, and slightly heart-rending to load your freshly discharged, fragile mother up onto a private ambulance and then speed walk back to the hospital parking garage to meet her at this unknown facility so she does not have to arrive by herself.

Now that she’s been there some matter of weeks, it is a familiar entity: the sign-in sheet, where you try and fail not to think about how many people never, ever get visitors, the front desk where you can leave treats for the staff (Lafeen’s donuts are a huge hit), the code for the front door so cognitively impaired patients don’t leave the premises on their own, the housekeeping staff that decorates for even the silliest holidays.

The first few days, though, are bad: no one seems to know when she will be getting pain medication, or dinner. No one seems to have looked at her open heart incision, so you are constantly taking pictures of it in bad lighting and comparing them to each other to make sure it seems like it’s healing enough. No one knows what sternal precautions are, the ones that are meant to keep her wired-together chest from tearing open while she’s healing, and they keep violating them (unintentionally), so you keep repeating the importance of sternal precautions to everyone you encounter until someone finally listens and produces a sign to put up above her bed. You are extremely sick of the phrase sternal precautions & suspect you will be saying it in your dreams.

The admissions process involves a lot of confusing paperwork for you to sign, and then a demand for her power of attorney form, which you do not exactly carry in your wallet, and then it turns out she was supposed to sign all the paperwork herself anyway; they just assumed she was not able to do so, even though she was sitting right there asking pertinent questions.

There is a wide, wide range of people in the facility: hard of hearing but genial patients in wheelchairs, ready to shoot the shit whenever you pass by; disoriented, distressed voices belonging to people you never see, only hear calling out from their rooms at all hours; the ones who never speak, but move themselves from location to location during the course of the day, including the guy who salutes you from the lobby couch now that he knows your face; younger or more agile patients striding down the hall with walkers, the grim determination to escape this place all over their faces. You can practically hear their internal monologue of what they’re going to do as soon as they get sprung.

The first roommate is lovely and keeps giving advice.

“You can bring her food, but you can't heat it up,” she says, and the demonstrable badness of the cafeteria food is evidenced by the spice containers laid out on her bedside tray. “You can hide that chair in her closet—it’s the first one, mine’s the second, and then it’ll be here when you come tomorrow. Tell her they’re slow here, so press her call button as early as she can when she needs something.”

The first roommate also listens to the TV at top volume for 20 out of 24 hours, and it is hard to begrudge someone the need for a little distraction in a place like this, but also really something to sit next to the blasting heater (there is also an ongoing dispute about the windows) trying to produce comforting conversation while old westerns and Bette Davis movies rage behind you. You bond with the first roommate over your love for Bette Davis, truly one of our great cinema queens, which seems to help the overall vibes.

The next roommate, in the new room, is a horror: genuinely mean, and that’s when all of the relationship building shows its teeth. You are able to get her moved almost immediately, and the staff tells you that your mom has seniority in her room, which shakes out to a useful iota of stability. Also a window, which feels important.

The third roommate is nearly silent, and then moved on to her own window, and then there’s a COVID outbreak, and then there’s a HMPD outbreak, both of which you find out through a robocaller voicemail, but at least that means there’s no fourth roommate yet. You get sick, but it’s not COVID, so that’s something, too.

It turns out they do refill the bird feeders that hang outside all the windows. They also give out little bags of gifts for Valentine’s Day. Most everyone who works there is as compassionate & helpful as they can possibly be, given the fact that many of them are working 80 hours a week, double shifts every day, given the the fact that the patient/staff ratio is objectively insane, given the fact that the blood pressure cuffs routinely do not work on the first try, and the physical plant is gleamingly clean but crumbling in the corners.

Revision: they are as compassionate as they can possibly be whenever they can squeeze out the time, but they are working 80 hours a week, and the patient/staff ratio is insane. They are all very professional, but you have been around long now enough to hear the workplace rumblings, to glimpse the iceberg of bad policy and under-funding directly beneath your feet. All you can do is try to insulate your particular person as much as possible from the iceberg, and also talk to the staff like they are human beings, both because they bloody well are, and also because it sometimes reminds them to talk to your mom more like she is also a human being, when they can squeeze out the time.

You think about what it would be like to have the bones of your chest knitting back together while strangers are wiping your ass and lifting your own personal body parts to wash them for you in a shower room; to be stuck eating weird cafeteria fish when you are used to making your own dinner; to be away from your comfortable home and stuck in a strange plasticky bed with the bed controls and the light pull and the call button all clipped to the thin, over-bleached sheets. You try to remember that when you get frustrated, or tired. You assemble any number of lists: bills to pay, household chores to keep up with, lists of things to buy for the room, to bring her for lunch, appointments to get her to.

Hours are eaten by this, and days, and weeks. You say you are happy to do it, which stays true, and also does not change the devouring jaws, the time sliding helplessly into the maw of this experience. You get up on Mondays and make another list, promise yourself to get more work hours in, more writing, maybe even some time with your friends, but it’s pretty hit or miss. You tell yourself you will limit the amount of emotional support Cheetos eaten, or the number of [redacted coping mechanisms] per day. That’s pretty hit or miss too.

More soon, and in the meantime may your own sternal precautions, whatever they are, be meticulously observed by those around you.