It’s a bad day that starts with the voice on the 6:30 am phone says, “This is the Life Alert operator, is this Andrew?”
I thought about it for a moment and admitted that, yes I was in fact Andrew. The call was to alert me to what might happen – my older brother needed to get to a hospital now as the pain had become unbearable, and the life alert button was the fastest way to get the paramedics to his apartment.
My older brother, “Wild Bill,” has cerebral palsy and for the last fifteen years has been confined to a wheelchair. At one time he was married, drove a car and lived very independently. Independence is a constant theme in his life – that is the struggle to remain independent, live in his own apartment and make his own decisions. However, his medical problems have been slowly eating away at independence and more and more I’ve had to step in.
That call. That Life Alert button are symbols of his loss. It underlines Bill’s failure to tell me sooner of his problem and makes me wonder if we’ll be keeping the appointment with his regular doctor scheduled for next week.
I remember a time when I was nineteen and had bought this old junky car. I kept a tool box in the trunk with a few extra parts. One Saturday afternoon the car’s engine died and I was stuck in a shopping center parking lot miles from home. Walking to a pay phone, the first person I called was Bill and he came out to rescue me. Yes, he could drive back then and had a beat up green station wagon that he and I tried to keep in repair.
On that Saturday, nearly forty years ago, he came to my rescue, with a ride to the parts store, a little cash to help buy a new fuel pump and great sense of humor.
Now, it’s reversal. As the baby brother, I am the care giver, the rescuer, the healthcare agent on the advanced directive and the person Life Alert calls.
“What hospital are they taking him to?”
Flashbacks race into my brain. The day thirty years ago a hospital called saying Wild Bill had been in a minor car accident. The day Bill called after he fell and was bleeding. The day his wife was taken to the hospital.
Memories of times when a younger stronger man would answer the phone and of times when I had the illusion that I could fix things.
Now I sit in the hallway of the county hospital emergency room, waiting for the overworked staff to order tests, get results and find just five minutes to talk to us. We’re near the nurse’s station and I can watch all the activity. A never-ending line of ambulances bring in the victims of accidents, diabetes, heart attacks, alcohol, drugs and life on the street.
A doctor speaks kindly to a handcuffed inmate from the county jail saying, “The methadone clinic can help you. It can give you a second chance.”
Wild Bill stirs in his bed, the morphine they gave him in the ambulance is starting to wear off and he is waking up. An x-ray technician appears and starts asking me questions: “Can he lie still?” “Can he raise this leg?”
Bill tries to answer and his body language tells me he’s annoyed with me as I answer as though he’s not there. His agitation grows as I tell the tech that he’ll jump when they touch him or make a loud noise – it’s the CP and involuntary spasms. As they wheel him away, I tease him with the line he always laughs at, “Dude, remember, I’m here to comfort and support.”
A new patient is parked next to me in the hallway waiting area. The doctor comes by to do an exam and after a few questions turns to a nurse saying, “5150, check when they’ll have a bed available.” The man is given a meal, an aid is sent over to watch him and in due time a hospital police officer arrives, checks the paperwork, and gets a wheel chair. The officer asks the nurse, “Restraints?”
“No, he’s been good.”
Bill returns and the doctor brings the news – x-rays don’t show what is causing the pain in the hip. Now we need a CT scan, and no, he doesn’t know how busy the CT department is today, so it’s back to the waiting game as Bill’s next shot of morphine sends him back to sleep.
And me back to wondering if I still have the strength to wait for the wheels of the hospital to slowly grind on. Our other brother calls again and I still have no news. It doesn’t take long for a page to come over the hospital’s speakers, “Any tech, 1x to CTA.” The doctor smiles at me from the nurse’s station saying, “That’s you.”
It takes 30 minutes and two more pages for the charge nurse to finally find someone to push Bill’s bed to the scanning room. I wait, on a chair that an aide stole for me from the nurse’s station because, “You’re a nice person.”
Watching the other patients flowing in and out, I am convinced that my mere presence is causing the staff to work extra hard for Bill. Few patients have family with them and some patients are greeted by the staff with, “Back again?” Sitting and waiting I notice that there are as many police officers there as there are nurses. Some are unarmed hospital security, there to protect the staff from patients or patient’s families. Some are city cops following up on car accidents or crimes. Some are officers from the county jail transporting inmates.
When Bill comes back from CT, a new wait starts for test results. It’s at this time that I know the ER isn’t going to fix Bill. There will be no cure here. That’s not their job. They are crisis handlers and sorters. They identify, stabilize, categorize, disposition, and disperse elsewhere.
Bill’s lying quietly when the doctor walks up. The news is what I feared, the tests show nothing conclusive. No broken bones, nothing acute that demands immediate admission to the hospital. All they see on the scans is some arthritis and pins, screws and other hardware from his hip replacement eleven years ago. The best explanation is a failing hip replacement coupled with advancing arthritis.
We’re given a script for pain medication and what sympathy an overworked ER doctor has left at the end of a long shift.
So now it begins again – the search for a solution, an adaptation that will take away his pain, but yet leave Bill with independency and some control of his life.
Till next week,