The Kindness of Strangers
“Whoever you are – I have always depended on the kindness of strangers.” ― Tennessee Williams, A Streetcar Named Desire
As we age, we need to be more careful of many factors, from diet and exercise to balance and injuries from falling. According to the Centers for Disease Control and Prevention (CDC), falling is the primary cause of fatalities from injuries in individuals after our mid-sixties. Breaking a bone is always a terrible injury, but for those of us in our later years, when our bones are more fragile and take longer to heal, if they heal at all, a broken bone can mean permanent, serious disability or even death. That’s what happened to my mother. Unfortunately, medical care for the elderly can be a terrible experience because of ageism, poor training, or lack of sufficient resources, but sometimes the kindness of strangers can make it all just a little less difficult.
I’m not quite sure why my 89-year-old mother fell. She was walking into my parents’ bedroom, using a three-wheeled walker when it tipped over, and she fell. My father was walking behind her and caught her head. Unfortunately, she broke her shoulder in the fall. Did she trip? Faint? Grow dizzy? There was nothing obviously there for her or the walker to have tripped over. She’d been prone to dizzy spells, which I suspect were an effect of the metoprolol her cardiologist prescribed. She’d had a heart attack, stroke, and high blood pressure over the previous years and was taking metoprolol for high blood pressure and chest pain. Her pulse often dropped to dangerous levels while taking this drug. We’d spoken to the cardiologist about this in a previous check-up, suggesting she take a smaller dose, but he blew off our concerns. “She has so many problems,” he said waving his arm dismissively in the air, “I’m not worried about that.” We’ll never know for sure what happened. My father remembers only seeing the walker tip and my mother falling.
An ambulance took her to the hospital. By the time I got there, she was stabilized in the ICU on pain meds, but her dementia had grown more noticeable. She’d been growing more and more forgetful over the past year and had lost her ability to do even basic math, which was devastating to her. She’d earned a BS in mathematics from Rosemont College in 1951 and then worked as a mathematician at the Naval Air Development Center in Johnsville, Pennsylvania, where she’d met my father. She’d also been a voracious reader for all of her life, but reading had become more difficult, too. She’d refused to talk to a doctor about these things. None of the specialists she’d seen for her other problems, nor her family doctor, had picked up on any of that. Now, however, she was also having difficulty remembering where she was and what had happened, becoming confused and agitated. My father and I sat with her till about 11:00 p.m., then left, thinking she was asleep.
As I walked in the door of my parents’ home, the phone rang. I picked it up; it was my mother. “Where are you?” she said.
“We’re home, now, Mom. We’ll be back tomorrow morning,” I said.
“What do you mean? Get back here. Take me home,” she said.
“You have to stay and heal,” I said. “I promise, we’ll be back first thing in the morning. Visiting hours are over.”
“No. You can’t leave me here,” she said. “I’m all alone. You have to come back.” The conversation went like that for a few more minutes.
I panicked. “Okay,” I said. “I’m coming back. I’ll be there in about 15 minutes. I’ll stay for a few hours till you fall asleep.” She hung up and I drove back, quickly, through the fairly empty, dark streets.
When I walked into the ICU, a nurse was standing next to her bed talking to her. Mom was happily chatting away, telling her about growing up in Philadelphia. The nurse was surprised to see me. “Hi,” I said. “She called and insisted that I come back. She was confused and angry. How’s she doing?”
The nurse smiled sympathetically. “Oh, I didn’t realize she’d called you. I’m sorry about that. Next time, call the nurses’ station, instead, tell us what happened, and one of us will sit with her till she calms down and sleeps. She was anxious and upset when I checked on her, but she calmed down fairly quickly. She’s sundowning. We see this a lot in older patients.” This was the first I’d heard that term, sundowning. It’s a deceptively simplistic word for a difficult, complex aspect of dementia that would devastate all of us over the next four months until my mother died.
The nurse wrote down the number for the nurse’s desk on a piece of paper for me. “Don’t worry,” she said. “Go home and get some sleep. I’ll be here all night. I’ll stay with her till she falls asleep and keep checking on her in between my other patients. She’ll be fine.”
“Oh, hi,” my mother said to me. “I thought you went home.” I took a deep breath, said, “I’m going now,” to her, “thank you,” to the nurse, and left.
The next morning, by the time we arrived at the hospital, my mother had been transferred from the ICU to a regular room. That same nurse was sitting next to her bed, reading to her from a magazine. The nurse looked up and smiled. “I’m actually not on duty now, but I wanted to make sure she was okay and settled here before I left. She was fine last night. She woke up a few times, confused and scared, but I was able to calm her and get her back to sleep.”
I thanked her. She said good-bye to my mother and left. I regret that I could remember only her first name when I emailed the hospital to tell them how kind that nurse had been. There were many other extraordinary, patient, kind people who helped us through those days, including the aide who patiently came at my mother’s call to help her onto the portable toilet by her bed almost every hour. (Having to urinate very frequently is an aspect of aging few people talk about, but it’s an unpleasant reality for many of the elderly, male and female.) This was a huge contrast to her previous stay at the same hospital the year before, when the aide at that time actually yelled at my mother for disturbing him so much, telling her he couldn’t stop everything every hour, and she couldn’t possibly need to go so much; he reduced her to tears. I ended up helping her onto the toilet, myself, much of the time, which wasn’t a safe thing to do. I was grateful that this time her aides and nurses weren’t fazed by her needs and helped her patiently and compassionately.
Unfortunately, a broken bone for an elderly person often means time in a rehabilitation center after hospitalization, many of which are just extensions of nursing homes, also known as old-age or retirement homes. The kind of care someone receives in such a place is a huge factor in how well that person heals and recovers, and many such rehab/nursing homes are a nightmare. Unfortunately, our experiences at the rehabilitation home, which should have been the next stage of her healing process, was a disaster and the opposite of healing. More about that in another post.