Wednesday, February 17, 2010
Baby Boom Delusions and Solutions (Chap. 1, Final)
Final Installment of Chapter 1, "A Baby Boomer's Life and Death". See previous posts for Parts 1 and 2.
One morning the other bed in Deborah’s room was empty and neatly made. She haltingly asked an aide where the other woman was; the aide said that Deborah “needn’t worry about it” and quickly left the room. Death was not spoken of in this place, although it occurred regularly. Two days later, another woman moved into the room with Deborah. The new roommate was ambulatory, talked incessantly about the same topics over and over and pawed through Deborah’s chest of drawers when she thought that no one was looking. She took clothing and small items. The aides recovered most of Deb’s stuff but it was a constant activity. Deb had never suffered fools gladly but here, she was forced to endure them; and, to endure this place along with them. They were all inmates.
Because Deb’s step-daughter made regular and unannounced visits, Deb was kept relatively clean and dry. When the daughter considered her mother’s care unacceptable, she made a fuss. The aides soon learned that Deb’s daughter could be a problem if they didn’t attend to her mother’s needs. Since there were too few aides for this 120 bed facility, taking good care of residents-- especially those who had regular visitors--meant that those residents with no one routinely stopping in for visits received less care. Often, when being wheeled past particular rooms along the long linoleum corridor, Deborah could smell the residents who were left to marinate in their own filth until the aides could find time to clean them up, sometimes hours later; too much work, too few workers.
In mid-September of 2035, Deborah developed an infection in an ankle wound suffered when an aide accidentally banged into her with the footrest of a wheelchair. The infection spread up her leg and proved resistant to the regime of antibiotics. After years of taking antibiotics for various infections, Deborah’s bacteria were well armed to resist eradication. The infection turned ugly and her leg gangrenous. Deborah was sent to the ICU at a large Atlanta teaching hospital. Her leg was amputated at the knee. The surgery site contracted another and different infection, a bug from within the hospital. The new infection spread to her lungs and they quickly declined in function. The medical team, none of whom her family had known prior to this hospitalization, recommended that Deborah be placed on a ventilator to “ease her breathing”. What they did not tell the family was that it was very unlikely that Deborah would ever breathe on her own again, ever.
Deborah’s kidneys began to fail. A young resident arranged for her to be gurneyed to the dialysis three times a week. Her daughter agreed.
The amputation site was painful and Deborah often teared silently and furrowed her brow when the doctors or nurses asked her how she was feeling. Pain medication was administered but never enough to do the job.
The wounded stump required another surgery to clean up additional gangrene. Deborah’s eyes were now sunken hollows, seeing little but still registering pain and misery. Her med-student grandson argued with one of the residents about failing to provide sufficient pain medication. The resident insisted that to give Deborah more drugs would make her dependent on the morphine; he said that she would become addicted. The grandson also argued with his own mother about her decision to allow Deborah to have dialysis. His argument was based on the medically obvious; Deborah was dying; doing anything to prolong that process was simply extending her suffering.
The daughter called Deborah’s doctor for his advice. He deferred to the hospital’s medical staff. It was clear, he felt that his role as a healer was over because Deb couldn’t be healed. Cure trumped care.
Deborah had never filled out an advance medical directive, although such forms were readily available. She had not discussed her end-of-life wishes with anyone, including her doctor. She had given her daughter a medical power of attorney but she never talked with her daughter about her wishes for care when her condition became terminal. Perhaps Deborah wanted every treatment available regardless of the expense, discomfort or likely outcome. Or, perhaps, she wanted the dying process to be comfortable, without intrusive and futile medical interventions. Her family was left to guess, because Deborah was no longer able to communicate.
As it was, Deborah experienced the first kind of dying; lingering, painful, undignified, fearful and lonely, in spite of the best intentions of the medical staff and family.
Dozens of friends, former employees, business associates and family members attended her memorial service. She was fondly remembered by these people. Most, except for the immediate family, were unaware of the details of Deborah’s life during those final few years.
No one from the hospital team attended nor did her family receive notes from any who had served her in the medical or care community.
Deborah’s rich and meaningful life spiraled into ignominy during her final four years. When she lost independence, she was swept into an elder care, health care and dependent living systems that were fragmented and awash in state and federal policies that frustrated proper and affordable care for the dependent elderly. In general, it was a dysfunctional, multi-layered system, ill-prepared for the tsunami of dependent elderly still known in 2035, ironically, as the Baby Boom.
Health care professionals, politicians, federal and state bureaucrats plus the voting public had seen the elderly tidal wave coming years before but, for various and not always altruistic reasons, had chosen to avoid big fixes. Instead, there was patching here and there hoping that it would somehow all work out. It didn’t. It was a delusion to think that it would work itself out.
The biggest delusion was that of the Baby Boom. They allowed themselves to believe that they would never grow old and dependent.
By 2064 there were but a mere handful of centenarian Baby Boomers left. The majority of the cohort had already experienced much the same kind of physical decline, sub-optimal care and poor dying process that Deborah had experienced. Their education, money and reputation didn’t alter the nature of the outcome. The Baby Boom failed to take control of its own inevitable future back when it still had political and financial clout. The generation’s lack of political will and action sealed its fate. It should have been different. It could have been different.
Coming next: Chapter 2 "A Greater Generation?"
Observoid of the Day: Growing old is an accumulation of small indignities.