Mind and Body

If it takes a village, what happens when the village is too small?

A windy day, a fall, a head scrape, a seven-hour trip to the ER, all part of a journey which began as a shopping trip to buy groceries

Photo by Nancy Thomas

Aunt Alice, 92 years old, spent seven hours in the Rhode Island Hospital emergency room, only to have her scrape treated with steri-strips and discharged.

By Nancy Thomas
Posted 4/22/19
When a gust of wind sweeps up a frail 92-year-old, a shopping trip for groceries turns into a seven-hour ordeal in a busy emergency room, exposing the weaknesses of the health care delivery system in Rhode Island.
Why are hospital EDs in Rhode Island still going on diversion on a regular basis? What urgent care options are available to Pawtucket EMS as a potential alternative to hospital ERs? How has the strike by workers at Stop & Shop disrupted the business of grocery shopping in Rhode Island? As Pawtucket rethinks it future economic development plans, what kinds of opportunities are there to reinvent the communities of residential high-rises for the elderly in the city? Who is responsible for monitoring the performance of medical professionals in the ER, regarding such things as wearing masks, the privacy of patients, and the thoroughness of medical exams? What will be the medical bill for services allegedly rendered for Aunt Alice’s time in the ER?
Much of our health care delivery system is designed around responding to the urgency of care, not around prevention and public health. Urban hospital ERs are the modern day Holden Caufields, attempting to rescue all those being thrown into fields of despair. As we design our future innovation economy, we need to think more about how we include the aging Baby Boomers into those calculations, and how we define community and neighborhood as being more than where jobs go to sleep. The same is true for the social conventions of shopping and the collisions that occur on Main Street as well as behind the sleek new edifices of innovation palaces. Conversation and convergence are as important as convenience.

CRANSTON – On this, the 11th day of the Stop & Shop strike, I ponder how the little things in life that should not impact you in a significant way can strike at the heart of your stability.

[Editor's note: The end to the Stop & Shop strike was announced on Sunday evening, April 21, with 31,000 workers expected to return to work on Monday, April 22.]

Where it comes to my 92-year-old aunt, stability is not a word that describes her life, either physically or in mental acuity. Avoiding a broken medical system seems to be key to keeping things on an even keel.

About once a month I go to her high-rise in Pawtucket to take her out to Stop & Shop. This supplements her Meals on Wheels and my prepared food deliveries. It’s usually quite an adventure, as time is of no essence to her as she wanders around the smallest market I can find, in Attleboro, Mass.

A wasteland

Pawtucket is a wasteland of primary grocery stores. There is Aldi’s and PriceRite in her area. Not user-friendly for an elderly person to bag her own groceries. We look for the more familiar experience and take a short trip to Attleboro, with a cut through Slater Park to make an outing of it.

In contrast, in my hometown of Cranston, in very close proximity, there are: a Shaw’s, a Stop & Shop, a Dave’s, a Whole Foods and another independent market nearby, as well as a Trader Joe’s a few minutes away in Warwick. We don’t have a lot of senior high-risers here; but we have a plentitude of grocery stories.

“Of course we won’t cross the picket line,” my aunt tells me, postponing the shopping trip. “We’ll just wait a few days.” Days go by. OK, let’s go on an adventure, I said. We plan an early evening trip to Market Basket – in nearby North Attleboro.

I drive up to her building around 5:30 p.m. and call her to come down, with her little shopping rolling cart. It is very, very windy. As soon as she comes out, I sense that she will be no rock of stability, all 96 pounds of her, against this wind.

I get out of the car at the end of the short walkway but I’m already too late. In a vision of a Mary Poppins moment, she is whisked along with her rolling cart faster and faster until she is “tuchas over teakettle,” slammed between my car and the yellow-painted curb at the wheelchair cut.

After the fall
She’s quiet, so I can tell the injury isn’t terrible, and more embarrassing than anything else.

A woman pedestrian comes rushing over to help, and we disentangle my aunt from her cart and help her up. I gently move her white hair back off her face and her blood drips down my hands and clothes. She has a nasty gash over her eye and a pretty big bump starts to form on her forehead. The rest of her seems OK.

Knowing that adrenaline can mask a host of problems, I slowly check out one limb after the other and get her seated in my car. The helpful woman has already called 911.

My aunt tells me: “No! They will keep me, you know they will.” I explain that you have to be near trauma these days for that to happen. But she remembers years of psychiatric hospitalizations against her will, from a long ago past where white straitjackets and men in “ice cream trucks” really existed. I promise her I will stay with her and will not let that happen.

To the rescue
The rescue guys are as they usually are – exactly who you want in a crisis. And, of course, she responds well to their voices of certainty, combined with smiles and gentleness. She will go and I will follow close behind. We’re off to Miriam Hospital, because no hospital ED exists anywhere near Pawtucket now, with the closure of Memorial Hospital.

To the ED

I arrive at The Miriam Hospital ED, find a spot to park and nearly get blown away myself by the wind, walking toward the packed waiting room. The security desk attendant tells me that my aunt is not there yet.

I wait. Half an hour goes by. I go up again and explain to the young man whose job it is to tell family members when they can “go back,” asking if he could please go look for her. He does.

He comes back and says “he” is not there. My aunt’s first name is Alice. This is the first sign something is amiss. I persist. He asks me to write down her full name, and I do on a sticky note and also write “Pawtucket” under that, because she came in on a Pawtucket rescue, I tell him.

He comes back again and tells me: we don’t have an Alice Pawtucket here. I ask him if the hospital is on diversion. Yes, yes, we are, he says.

OK, can you please find out where she went? He comes back to tell me that she is at Rhode Island Hospital. Oh, no. Gun shot, heart attack, stroke? Go right to Rhode Island Hospital, do not pass go; otherwise, stay clear.

Busy ED scene
Wishing the wind was at my back and I could fly over there with my own umbrella, I drive as fast as possible, and find I can only park in an underground garage – not something that is in my stay-safe-Nancy rule book. But there is no choice.

I enter the ED and it is full. There is nowhere to sit. The security woman says I cannot go back [to where the patients are]. I explain that my aunt is not all that stable, mental-wise, and I promised her I would not leave her. Back and forth this goes on for about another hour. I finally seek out a nurse who seems to be going “back” a lot and plead my case. She brings me right in, explaining: all the gurneys are lined up and we don’t usually let people back there, but I’ll take you back.

There she is with a white turban of gauze bandage wrapped around her head – white hair sticking out all around, with her bright red lipstick. I sense she is not seriously hurt, but I also know how a disruption like this could result in an incident that could have her in bad psychological ways that could go on for days.

Life in the ER
Her eyes are darting from gurney to gurney: to the man in wet pants staring blankly into space; to the man totally disheveled who is spewing obscene comments at everyone who meets his eye; to the young woman I won’t soon forget, with a head of strawberry blonde curls, who is on suicide watch and appears at first to be the healthiest person in the room.

The doors open and the cold breeze blows in. A security guard comes over with a warming blanket. She’ll do this more than once for the older people held “hostage” in this medical drama TV show we seem to have fallen into and can’t leave.

More gurneys come in. There is a woman who wants to know if she’s in Rhode Island; she is talking on her phone but wearing a johnnie, not her street clothes, apparently transferred from another hospital.

There are men held down by leather restraints, some with towels seeping blood from where they are pressed against their chest. They come with a contingent of male and female security. We read other shirts as they come in with their transports – NPFD, North Providence. CFFD, Central Falls.

Strange days have fallen
A young girl comes in, with a guard carrying her black platform shoes with six-inch heels. She sits down. The intern, or attending, says too loudly: she’s a stripper.

I quietly tell my aunt that she is a dancer as I notice her eyes resting upon this girl’s shoes. “How can she walk in those things? Did she break an ankle?” No, Alice, she’s a dancer.

Then the strawberry blonde woman starts getting very agitated, saying she never intended to kill herself – she only wanted to jump in front of a car last week – but not today. She has kids at home that need to be fed, she says. She has a “sitter” with her, whom I believe might be a volunteer. She starts to pace.

All of a sudden there is a change of atmosphere, and a young male doctor takes over and tells the strawberry blonde she must immediately change her clothes, everything off, and put on blue scrubs.

I wonder if this is to prevent her from running. But no one has talked to her in all the hours I’ve been there. Before she changes, she insists to know why; the intern yells across the room for all to hear – because you wanted to kill yourself.

Then two people come up to her and her sitter and ask for their phones, and demand, very aggressively, to know if they have taped anything in the ER. I am sorely tempted to take out my own phone. I do not know the whole story here, but the treatment of her appeared to be unkind, unhelpful, and a bit shocking. Not even the men in the breathalyzer line-up were being treated like this woman.

The squeaky wheel
The hours go by. My mother was my aunt’s sister, and now my mother’s voice is raging inside my head. It is all I can hear. “The squeaky wheel…the squeaky wheel…”

I jettison myself from my seat on the edge of the gurney and go to talk to the nurse, who is tapping on the computer by the door. “She’s 92; she just needs a few stitches; maybe a head CT; but she’s going to get very upset with all of this.”

Finally, after trying to get someone to take her to CT, the woman, going on her break, takes my aunt herself. I rush to keep up. We get the CT; then we are taken, in high contrast from the ER, to a private room that is quiet and seemingly un-staffed. There are few rooms with patients in them. I see no doctors. One or two nurses walk by.

High security
It strikes me that most of the staff in attendance during our saga are security guards. We saw one doc who tapped Alice’s toe saying the CT looked OK. We are now on hour number four.

There is a new nurse, a filler or floater, she said, and she becomes our lifeline. I try to be nice and ask what we can anticipate. She answers: a long wait.

After another hour, and a too-long waited assistance call to the bathroom, Alice has wet herself and is being given a hospital “diaper.”

It’s hour five. No one has come in, short of a very brief check of my aunt’s blood pressure. I pace back and forth. My mother’s voice keeps growing louder: squeaky wheel, squeaky wheel.

I go to the desk, and say: I need to know now what is happening. I want to take my aunt home. It’s been so long that her cut has stopped bleeding on its own.

Another half-hour goes by, and I go back; the nurse tells me “they” are dealing with an emergency airway obstruction, and “our doctor” is involved in that.

“Then get us another doctor,” I demand. “And find one now.” As I say this, “our doctor” walks by with a cup of coffee in his hands.

Within minutes, “our doctor” comes in. “I usually start by apologizing when I come in,” he says. “I know you’ve probably been here for a very long time.”

He is as pleasant and professional as anyone could ask for; he treats my aunt gently. He unwraps her turban and there is almost no blood. “I don’t think you need stitches,” he tells her. “Let me clean this up and put some steri-strips over it and you are good to go.”

Waiting for discharge
That gets done quickly, and we wait again, this time for discharge, now six hours into our not-so-excellent adventure.

I leave to get the car; I ask a security guard if it’s OK to go in the garage at 1 a.m. A female guard instructs the male security guard: “Walk with her,” and he does.

A nurse brings Alice out in a wheelchair and off we go. She’s very quiet, looking around at empty highways and reflections of light. She’s very uneasy being “up there” on the highway.

We pull in to her apartment building, and I get out to help her, and she says: “OK, thank you, good night.”

I walk her up and to her apartment door, and she tells me: “I’ll take it from here.”

More than band-aids needed
My aunt Alice did quite well after spending nearly seven hours in the ER to get a band-aid. The next day she noticed that both her knees were scraped, as well as her elbows. In all that time in the ER, no one had taken her clothes off to examine her – just in case. She had had a CT scan done fully clothed.

Two days after my visit with my aunt to the ER, the exp;erience gives me a gift – a ravaging flu like I’ve not had for 20 years. Five days out of work. I still feel punky, and I am not able to help my aunt out as she recovers. I don’t remember people wearing masks in the ER, except for some of the security guards.

My aunt Alice is just fine. No cold. Healing. She’s fixated on “the wind” now; it's all she talks about in her circular conversation patterns.

The delivery system
On Easter morning, ordered food from Walmart Groceries in Massachusetts was delivered to my aunt. They go up after she rings them in and place the bags right inside her apartment. It takes a village. Her village is much too small. And so is mine.

I told the doctor in the ER: “I would have taken her to a smaller hospital. No one should have to bring a very elderly woman here for two stitches in her eyebrow. How did that happen?”

He responded: “We’re trying to figure out how to make this better.”

Editor's Note: In the Wall Street Journal story, published on April 21, reporter Beth Howard details how some health systems are redesigning their ERs, giving them a makeover for elderly patients, with the goal of having no seniors wait longer than 14 minutes to be seen. See link to story below.

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