I didn’t realize how quickly it would arrive. But the price Mom and Dad pay to get to live another day — their deal with the devil that is chemotherapy — is numb hands and feet. No matter how many rugs and mats, flip flops and open-heeled sandals I disappear out of their home, or the type and variety of trekking poles, canes, tripod canes with seats, straight walkers, wheeled walkers or other assistive devices they have, my parents keep falling.
If the little landmines aren’t in the house, my parents discover them outside. The lemon under the lemon tree that just needed retrieving — Mom fell. The dirt path from the curb to the pavement near the beach that was under construction — Dad fell.
The falls continue unabated. But Mom’s fall on Mother’s Day, that left her with a broken pelvis and put her in the emergency room, was a turning point: the first fracture.
As a primary care physician, I know that most of my older patients are just one fall away from severe disability and even death. Ever since their grandkids were old enough to play with Legos, I’d ask them, “What will happen if you leave your Legos all over the floor for Dada and Dadi?” They knew the right response: “Dada and Dadi will slip and fall and break their hip.” I did not spare them the data on poor outcomes of a broken hip for a geriatric patient.
So when I found myself in that too busy ER for 18 long hours with Mom, the one where staff had recently lost a colleague by suicide at a sister ER a few counties over, the one so understaffed that I changed my own mother’s bedpan, I braced myself for the worst.
When the physical therapist came in for her evaluation in that ER room the next morning — we were still there since the hospital had no available beds — she brought reassuring news. Mom had a fracture that can heal well. With enough physical and occupational therapy she could make a full recovery.
Mom met criteria for a skilled nursing facility, a place where she could rehab for a while and then be sent home once she was better. The physical therapist asked me whether we wanted to go with that option or bring her home.
I dropped my voice and said, “I have personally seen patients after discharge from SNFs and I don’t have the greatest impression of them.”
With their low reimbursements and high staff turnover, skilled nursing facilities are the settings with the highest care expectations and the fewest resources.
She nodded and explained in hushed tones, “If I were you, I would not send her there. I can’t vouch for the quality of the one she ends up at and even though they are supposed to give patients daily therapy, some of my patients report back that they only got worked out once or twice a week. And they are so understaffed right now, I think patients are just left in bed.”
For the millionth time, I was thankful to be a medical insider, one who could find a way to protect my loved one in a system that can often do so much harm. Fortunately, I have given up feeling guilty about the privilege of this, but I still have rage every time I have to interact with the failings of our system.
I brought Mom home. It felt like an echo of when freshly minted parents usher in a new era of their lives — but instead of a stroller it was a wheelchair, and instead of a plastic potty, it was a bedside commode, and instead of a baby cruiser it was a walker — all the new equipment Mom would need to navigate an instantaneously more cumbersome world.
At night, we kept on the special lights we had built into the bedroom wall that lit up the path to the bathroom. I kicked Dad out of their bed and slept beside Mom for the whole first week so that I could get up with her when she needed to pee at night. I was terrified she would fall again. She of course refused to use the bedside commode — her sense of dignity would not permit it. And there were only so many fights to be had. So she would wake me up and I would hover my arms around her as she slowly shuffled her way to the bathroom with her walker. “Push, right, left. Push, right, left,” I would whisper in her ear. I must have been a baby the last time I slept next to her for a week, when she was the one waking up when I peed.
We got through that first week day-by-day, juggling the different schedules of physical and occupational therapists, figuring out how to get her to the lab and to chemotherapy, finding ways to deal with the reality of a newly acquired disability. I dropped everything else. The rest of the world seemed to disappear in the urgency of all her immediate needs. The mass shootings of that week were by a white supremacist at a grocery store on the other coast and one closer to home at a church near my hometown. And though the horrors of the world would trickle in, all I could focus on was that long distance between the edge of the bed and the toilet.
We are getting through it, with bumps on the road, and at every turn, I can’t help but imagine what the Season of Parental Falling looks like for others. For the ones without my resources, without my medical knowledge, without my ability to drop everything, including my work shifts, for my loved one. And with each challenge, I think of what the other path looks like, and I play something of a perverse mental game of Choose-Your-Own-Misadventure where I am not a doctor, where they don’t order the CT scan after the initial X-rays were negative, where they don’t treat me like a partner in my mother’s care, where the physical therapist sends my Mom to an understaffed rehab facility.
Every encounter with our medical system feels like it’s a fight for our lives. The Centers for Disease Control and Prevention states on its website that “every second of every day” in America, someone over 65 falls. But what they don’t tell us is that our health care system isn’t designed to help them get back up.
Dipti S. Barot is a primary care physician in the East Bay. Twitter:
@diptisbarot