She Didn't Fall

Caldwell, Paul

She has a fractured hip – I’m sure of it.  She’s lying on the floor in her bedroom, face up, arms out at her sides, fingers clawing at the carpet in pain.  She rocks her head side to side, eyes closed, teeth bared, face twisted tight.  She doesn’t acknowledge me as I kneel down beside her.  She is dressed in her usual attire – dark blue track pants and a lighter blue sweatshirt.  Her left leg is splayed out, the foot hanging limply rotated on the side.  She won’t let me touch the leg, any attempt makes her scream out in pain.

I reach for my bag, and ready a syringe with subcu morphine and as I do, the ambulance attendants arrive, noisily wheeling their aluminum stretcher loaded with equipment, stamping the snow off their heavy boots, unstrapping bags of gear, taking charge and asking what happened?

“I think she fractured her hip,” I say.

“A fall?” they ask, bending down to the floor where we all kneel on the carpet.

“Well, no – a push,” says the nurse, looking over at them, now at eye level, still holding her hand, “she was pushed by another resident”.

Slowly, sadly, the story comes out.  My patient was in her room, just looking out the window at the snow when another resident came in.  In a nursing home such as this, with so many demented patients, that’s quite common.  One resident will enter another’s room and usually it’s not of any significance – a little touch on the hand, a cradling of the elbow, a little redirection with soft words spoken and everything is okay.  But not this time.  My patient objected to the intrusion.  Maybe she saw him (the other resident) as a threat, or perhaps he was just too close in her personal space.  At any rate, there was shouting, then a scuffle.  The staff came running, only to watch as the intruder pushed her violently against the wall, leaving a little blood stain on the yellow-flowered wallpaper.  She fell awkwardly to the floor, then started screaming.

The ambulance attendants roll her carefully on her side, slip a red plastic carrying board beneath her and lift her gently onto the stretcher.  She is beside herself with pain.  Shrieking, thrashing, her eyes winced tight.  She grabs the arm of the ambulance attendant, crinkling his winter jacket.  They cover her with a far-too-cheerful blue blanket, strap her down, trying to make the situation ordered, finite, controlled, cinching the straps and snapping them down with a businesslike metallic click.  They wrap her head with a white towel, “for the snow” they say, but she doesn’t hear them.  Swaddled like a baby on their stretcher, but still sobbing in shrill, wordless agony, they wheel her out of the bedroom and down the hall.  The place goes quiet.

In another room, my other patient, the intruder, is sitting quietly on the floor in the corner, a PSW holding his hand.  He is severely demented, non-verbal, won’t look directly at me, but his animal eyes narrow when I enter.  He draws his knees up, turns away, rocks back and forth, hands holding his knees, trying to make himself smaller – as if he knows.

What will I say to the families?  How will I begin these conversations?  Families that trust us to ensure that their loved ones – their father and their mother – are safe.  Which family do I phone first?  How do I word this?

“Yes, hello… it’s Dr. Caldwell at the nursing home… just phoning to say your mother fell – actually, she was pushed… we think that she has a fractured hip… I have just seen her and sent her over to Emerg…”

“Yes, hello… it’s Dr. Caldwell at the nursing home… your father was, well, angry… he pushed another resident… fractured her hip… she is in the hospital now… I think he is quite upset but…”

I feel the weight of this burden – even the fact that I already know what happened, and they don’t know; but it’s my responsibility to tell them.

There are so many victims here – three, if you count me, just trying to ensure in this most desperate of diseases that there is comfort, dignity in such decline.  I feel like I am working in medieval conditions, patients wailing with pain they feel but cannot possibly understand, attacking each other, or cowering in the corners.  There is such suffering here – so huge a need for care.  Not the acute suffering of the emergency room, but a much more insidious, slow unrelenting torture of decay, of loss.  We try as hard as we can but it is still a joyless place.  Wheelchairs, lined up like pupils in a bizarre, futile school room, all facing the wide screen TV showing daytime interview shows.  The residents are fast asleep, some leaning to the side, some with their heads down and drooling, some leaning way back,  their heads extended, mouths open with little bits of breakfast on their shirts.  There is always the smell of feces and failure, and, of course, Fabreeze.

Why can’t we do better?

In this, the most debasing of diseases, the slowest in its progression, we have little to offer.  I have the clumsiest of drugs, many of them completely useless.  Though we have the most patient, most caring nurses and attendants, we are horrendously understaffed.

Why don’t we see this as a priority in our care?  Why do we do such a poor job?  The ideal solution here is simple – human contact.  Someone to touch them, settle them, sing to them to relieve their suffering on a moment by moment basis.  Someone to rub their backs, to breathe life back into the faded photographs on the wall, to tell their stories again, to listen to their babbling speech, to help to settle the unimaginable sadness in their hearts; to dry their tears.

Back at the nursing station, I open up the charts, write down the families’ phone numbers and, feeling angry and sad and overwhelmed, I pick up the phone.

Theme: Community | Communauté
Theme: Death and Dying | Décès et le mourir
Theme: Family | Famille
Theme: Health Care Delivery | Prestation des soins de santé
Theme: Relationships | Relations

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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