A Daughter's Journal

Saturday Night Fever at the Nursing Home

by Ann D. Gross

In this column, New York City-based health care consultant Ann D. Gross chronicles her experiences with her mother, who recently moved into a nursing home.

When I got to the nursing home on Friday evening, I went directly to the dining room to share our Sabbath evening dinner with Mom; I had been there for a Sabbath evening meal before and the food (usually chicken, or pot roast if the residents asked for it while there was any left) was always the best of the week.

I loved the people from Mom's floor who all squeezed in their wheelchairs around the table. I thought they sat together by choice, but it turns out the nutritionist tells the CNA where to seat everyone, so she knows whose plate is whose when she does her post-meal census of what was consumed by whom. I didn't know if I felt that was wonderful and competent, or sad and controlling. I think it depends on how Mom is feeling at the time.

Friday Night & Feeling Fine

Mom hardly looked up from her chicken and mashed potato buds when I walked in, but some of the other residents--Rae and Danny and David--greeted me heartily. I think Mom feels it gives her higher status among her peers if she doesn't get all excited about a visit from her daughter--as if my showing up in the dining room is such a normal event that it doesn't even warrant a reaction. Or maybe she was just finally enjoying a meal and couldn't be distracted. Her non-display of affection hurt my feelings and frightened me somewhat, so I lapped up the greetings from Mom's neighbors at the table.

I slid in to my seat at the head of the table, the only pair of legs without wheels, and joined them in the meal. My friend, Louis, the kindest, most handsome gentleman (and the CNA assigned to the dining room), winked at me and brought me dinner. It was only when I was among the drooping white arms of my table mates that I realized I took special notice of Louis's thick, strong, tanned forearms. They looked better to me than anything on the plate.

The only menu item I couldn't bring myself to consume was the lukewarm chicken soup that tasted like a mixture of industrial shavings and chicken fat.

"Oh, no thank you," I said. "I never drink soup before a meal. It spoils my appetite," I explained in response to the stares from our friends at the table. They were clearly waiting for an explanation of a soup refusal, and that one seemed to suffice.

"Do you want an extra piece of gefilte fish?" asked Rae, my favorite friend in the residence. She looked at me so intently with those dancing, dark blue eyes. At 92, she looks like a beautiful little elf with white hair and soft skin. You always know where you stand with Rae, and she is my lifeline to joy in the residence. She is beautiful even with the green-tinged small plastic oxygen hose hooked into her nostrils like a misplaced pacifier.

"No thank you, honey. I'm full," I lied. I thought of the chocolate melting in the car that I would gobble down when I got to leave that night.

Mom and the others at the table finished their meal. The discussion turned to why we couldn't have cake or pie for dessert; turns out that the kosher kitchen was serving up baked apple slices. The buzz that the apples "are undercooked and hard and not sweet" hit our table, so we decided against having any. Actually, I would have loved some fruit, but didn't want to go against the vote. And the nutritionist had already started circling other tables, pencil to clipboard, noting every plate and glass and its remains, so we knew we were about to be escorted out. One by one, our friends wheeled away and I wished them a good-night at 6:30 in the evening.

Stomach Ache on Saturday

By the next day, Mom started complaining that her stomach hurt. My ears pricked up, as she was never one for vague complaints without meaning; when she complained lately, it seemed there was always some underlying, some significant etiology. And she was now branded as a nursing home resident with recurring Clostridium Difficile ("C. Diff" for short), which meant that she was always at risk for the C. Diff spores overtaking her intestines again, like so many giants attacking dwarves, with no chance for the weak to survive.

As lustily as she'd been eating last evening, she was now equally uninterested in her food. When I entered her room late morning, I noticed an untouched breakfast tray.

At 119 pounds soaking wet, my Mom doesn't have much margin for error when it comes to not eating. She needed to eat, but more important, she needed to drink. I'd come up to the room during another visit once, and her occupational therapist, Kathy, who I swear was sent to the residence directly by angels, was coaxing Mom into drinking a nutritional supplement. Mom was milking the situation for all the drama possible; she loved the attention she got from Kathy, and "acting out" was surely a way to prolong Kathy's visit.

Where was Kathy now? I thought in a panic. It was Saturday and she wouldn't be there until Monday.

"Mom, you know you have to drink," I ventured. "You have to stay strong, and you have to drink to keep up your strength."

"I can't, Ann." Already this was a bad sign. Why couldn't she? What was going on in that little body, and how had the giants snuck back in with no warning and without my slaying them first?

"How about some wine?" I asked, trying to humor her. Usually, whether or not she saw the humor in it, she would smile at the mention of wine.

Nothing.

The rest of the day passed with my trying to coax her to eat and drink, until she lost patience with me. "Stop hovering over me," she yelled.

Feeling helpless, and wondering what I'd studied for three years for that damn degree in gerontology, if I couldn't even get my own mother to eat and drink. I went out to the nurses' station, and found the woman who was serving as supervisor for the evening. Ah, I thought. I'll get the help of real professionals. They'll know what to do.

An Exercise in Futility

"Um, help," I said, trying to get Abigail's attention. "My mother doesn't feel much like eating, but she needs to eat. What should she eat?"

"Anything she wants," she replied, not looking up from the chart she was working on.

"But she doesn't like anything she's been offered and she won't eat."

She looked up. "Well, you could go out and get her something."

"But she's just not interested," I said, pleadingly, feeling the panic grow, as Supervisor Abigail was not hearing me. She may as well have been a clerk at a local store in Denmark, Maine for the help she wasn't offering me.

"Well," she said. "We can't make her eat."

I threw my hands up in frustration and walked away, not even trying to hide my anger at the nurse supervisor for refusing to participate in my problem.

And all of a sudden, I realized I was quite alone, there on a Saturday night, surrounded by exhausted nurses and CNAs running the corridors. I remember standing in the middle of one empty corridor with the bright lights, some soft pleas from Rose's room, for "nurse, nurse..." and only the sounds of Lawrence Welk blaring from Mom's TV set and a few others on the floor to remind me where I was.

I re-entered Mom's room, not 10 steps away from the nurses' station, and Mom was sitting in her wheelchair, her head drooping, her body twisted at an angle. She had fallen asleep.

I couldn't understand how I could be in this long-term care facility where I couldn't find anyone to care. My "friends" in the administrative offices were at their homes being wives and husbands and parents, and not the arbiters of comfort and kindness as they were all week during the daylight hours. I was on a survival mission, responsible for my Mother's and my own, and I was losing altitude fast.

Both newcomers to the residence--my Mom as an accidental resident, and I as the baffled daughter from New York--I started to think about what I was doing wrong, and what I was missing.

The CNAs are there to help change diapers and do all of the stuff no-one wants to do--help residents to the toilet, back to bed, out of bed, and into wheelchairs. It seems that many work "a double," meaning two shifts back to back in one day; that's 16 hours of work, not sitting at a typewriter and typing, but being up close and personal with what goes into and out of stranger's bodies.

And what do the nurses do, I wondered? Do they offer medical care? Do they diagnose or observe, and say, "Hmm, she was eating last night and now she's not interested in eating or drinking. And, AHA! She's also complaining of a stomach ache. Maybe the C. Diff is coming back. Let's call her doctor and get him to authorize taking a stool sample."

And still a rookie at life in the residence, I convinced myself that they do diagnose and observe and cajole doctors to do what's needed on site. But it seems to happen in the most excruciating slow motion, as if in human time compared to dog years. That is, it seems it takes seven days to make something happen that should happen in one. I started calculating Mom's age--83--in dog's years, dividing by seven. I was jolted out of my ridiculous calculations when my mother sat up in her wheelchair, opened her eyes all of a sudden.

"Oh, hi Ann," she said. "My stomach hurts. And I have to get to the bathroom."

I went over to her and felt her forehead. She was burning up and shivering. Oh God, she has a urinary tract infection, I thought, on top of all of this. She has all the classic signs of a UTI, which means she needs antibiotics, which means the C. Diff will come back for sure, as the antibiotics she needs to cure the UTI will kill off all the good bacteria, giving the C. Diff full rein of her insides. Barbarians at the gates of the bowels.

"OK, honey," I said. "Listen, I want you to try and drink something. I'll go and get the nurse."

At that, Mom started mumbling something about a church full of thousands of people, beads of sweat pouring down her face.

I felt a quickening of panic in my stomach, as I walked quickly down the corridor, hoping to find a caring face with an RN badge and a loving heart on a Saturday night at the residence.

back to top