Monday, September 12, 2011

No TLC for the Transitional Care Unit

Her grandmother came to California in a covered wagon; her grandfather fought in the war...not World War II or I, but the Civil War; her mother was 103 years old when she passed away and lived in three centuries; and her father suffered from “lumbago” and died from “consumption.”  This was more than just curious information told to me in my first encounter with Emma, as her past painted a parallel picture of our evolving nation.

Emma was the first woman in her family to graduate from college, receiving a degree in English, and periodically she reminded me of her involvement in The Daughters of the American Revolution.  When I first visited her home to see her ailing husband twenty years ago, they proudly displayed an oversized American flag on their porch.  After he passed away, I didn’t hear from her for about five years until a phone call requested a medical visit.

Time did not age her, although because of her infirmities she was now using a walker.  Our discussion noted no life-threatening conditions, yet emotionally she was indifferent except for the roses she tended around the fencing of her small house.  “Roses are fussy and difficult to grow, but I pamper them with gentleness and kind words enticing them to fill my home with their sweet aromas.”

As with many of my senior patients, I encouraged her to find “purpose” and broaden her social community by returning to church, volunteering at the senior center and hospital, and exploring her previous writing talents.  She obliged me, but I knew there was a spiritless shell struggling with internal battles. 

At the same time in early 2006, Robin Clough, Volunteer and Activity Director at the SCV Senior Center, and I learned the Henry Mayo Hospital Transitional Care Unit (TCU) would be closing.  For many of our elder seniors, it served as a stepping stone after discharge from the hospital, allowing them to gradually return to normal health and go home as opposed to going to a nursing home.

Within a few weeks, we organized a steering committee, had a “Rally in the Valley” meeting, then protested the closure with pickets in front of the hospital.  We chose the day and time to coincide with the hospital Board of Directors meetings, which was mid-to-late afternoon.

The call went out to our elder seniors in Santa Clarita to come to these hospital rallies, and I was happy to see Emma on the first day.  It fit her character when she claimed the picket sign that read:  “I’m the Little Old Lady from Santa Clarita”!

Over the next year, seniors rallied at the hospital five times, spoke at City Council meetings, and publicized the plight of the potential loss of the TCU.  One scorching Santa Clarita day, we were forced to bring the rally and our picket signs into the hospital.  We had already discussed the legality of this with the SCV Sheriff’s office, so we knew our rights, yet hospital security came to put us back on the street. 

In the main lobby, as one hundred seniors (some on oxygen and in wheelchairs) lined the hallway and quietly stood with their signs, the head of security came with an entourage of seven other officers and emphatically told us to leave.  Knowing the law, I told him we wouldn’t, and then he threatened to take our signs.  Unfortunately for him, Emma was standing next to me, and this 100 pound, 92-year-old clinging to a walker, shook her sign in his face and said, “You’re not going to take this sign away from me!”  (There were a few extra words I left out which were not a part of her degree in English.)  I knew Emma had not only found “purpose”, but had passionately grown sharp thorns like her roses!

At the third hospital rally, Robin noticed a change in Emma and pointed it out to me...she was wearing makeup!  Curiously, I went over and asked if she was okay.  She said she felt fine, but after a few moments confessed, “I think I’m in love”.  “His name is Don, and he’ll be here in a minute”, as she told me about the kindness and commonality of her 95 year old friend.  In the next moment, she looked worried.  “I am afraid though...”  as I cut her off and said, “You mean of him passing away?”  Without hesitation she retorted, “Of course not...I’m afraid and worried one of these pretty ladies here might take him away from me!”

Later that day as we marched, I noticed them holding the sign together, and the wording was changed to “I’m the Little Old Lady & Man from Santa Clarita.”

Eventually our efforts allowed the TCU to remain open for 19 months beyond the Board’s directive because of community and city protest.  Don though had indeed been hospitalized twice, and in failing health was placed on hospice in the TCU just before it closed.  He passed away with Emma at his bedside.

Emma continued to have purpose and give her opinions.  It was difficult for her to understand how the Board of Directors ignored the plight of the community they serve and look at our elder seniors as only numbers to balance their books, and not as people who have history and emotions.  She insisted the TCU allowed for seniors to stay close to family and friends in our valley, receive care from their longtime local physician, maintain their dignity and hope, and especially not go to a nursing home.  I could only agree and knew the money saved by the hospital was minuscule compared to the financial and emotional stress seniors now face.

For several more years I continued to see Emma at her home, and she continued to tend her roses.  Next to her American flag was the picket sign she and Don carried during our rallies.  Emma became ill earlier this year, and was hospitalized several times.  Finally, she requested in-hospital hospice care which was granted.

Although weak and fragile, Emma was still lucid and clear.  She was comfortable and without pain, and was not suffering.  On a Thursday evening, I came to see her...and she had makeup on!  I told her she looked great, and she told me she wanted to look good when she saw Don. That evening, Emma passed away.

Periodically, I go to Eternal Valley to see Emma...and I bring a rose so she can smell the sweet aroma.  I also make sure the rose has a lot of thorns...I know she would like that.

Gene Dorio, M.D.- Guest Commentary

Gene Dorio, M.D., is a local physician. His commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with including the Medical Executive Committee and Medical Staff of Henry Mayo Hospital, or those of the West Ranch Beacon.