My dad and I were saying goodbye, knowing this would be the last time we would ever see each other. While in an embrace, a hospital employee was tugging at his arm trying to get him into a scheduled session with other patients on the floor. There apparently was a very strong emphasis on interacting with other patients as part of his “program” – whether he liked it or not. I was appalled at their insistence and lack of empathy in not allowing us some privacy and a little more time to say goodbye to each other. Admittedly, they did not know (as he and I did) that this was to be our final goodbye.
Several days earlier, I had entered the hospital where Dad was admitted and was directed to the 8th floor – the psych ward. What was Dad doing on a psych ward? As I walked down a long hallway off the elevator, I passed by a woman who approached me and told me that the only reason she is still there is so the hospital could make money. She seemed desperate to warn me that the same could happen to me. I was quickly rescued by the the ward clerks who escorted her back to her room. As I continued to walk toward Dad’s room I could hear another patient in one of the far off rooms screaming loudly about something I couldn’t make out. I again asked myself, Why was Dad on the psych ward?
Admittedly Dad had been exhibiting some unusual behavior prior to entering the hospital. From an outsiders point of view he at times appeared to have been drunk in that he was not as coherent as usual (although he never drank). He seemed to have lost his inhibitions as well, undressing in front of us kids to try to find the medication patch that he had put on himself but forgot where. He had no previous signs of dementia. From the hospital staff’s perspective he exhibited a lack of interest in interacting with others which they interpreted as a symptom of depression, possibly requiring changing up his medications.
As I turned into Dad’s room what I saw – was depressing! He sat in a chair, head down and arms folded. The room was stark containing two hospital beds, a cabinet and a chair, that’s it. There was no television, no clock on the wall and no pictures. If he wasn’t depressed now, surely he would be soon. Why was Dad on the psych ward anyway?
As it turned out, Dad was admitted to the psych ward of this small Mississippi hospital in order to get a handle on his medications. Medications had been prescribed for various conditions, typical for an 86 year old man but primarily, the pain medication related to his recent diagnosis of mesothelioma. Getting the correct medications right involved 24/7 observation while changing dosages and prescriptions. He was there so they could observe his change in behavior so as to measure the results of the prescription changes. I was told that Dad’s “perceived” depression could be a result of improper medications.
Complicating possible improper medications, he had just found out he had mesothelioma and then there was the other factor. Mom had died just several weeks earlier (they had been married for 67 years). No wonder they thought he might be depressed. I spoke with the supervisor on the floor and heard his explanation that one of the measuring sticks as to how depressed Dad was, was his level of interest (or lack thereof) in interacting with other patients on his floor. They had scheduled group sessions that he was required to attend where they played cards or learned flower arranging. I pointed out to them that Dad in his best retirement years would never have played cards nor attended a flower arranging class, let alone interact with strangers, unless Mom made him. And he was not depressed then.
Dad derived joy out of life in other ways. I felt that measuring his willingness to attend such sessions should not be the measuring stick by which they were deciding if they got their medication doses right. Dad however was more understanding than I. He felt that he had been admitted into a “system” that had a life of its own. The hospital and physicians had a system of policies and procedures and the staff needed to work within that system in order for them to do their job and find the answers. I was loathe to keep Dad there. I knew he had already come to terms with his diagnosis of mesothelioma and I knew that he knew he didn’t have much time left. I also knew that without Mom he really didn’t want more time. I chose not to bring this up to his attending physician. Who am I to say what role medications or depression (if there was any) had in his current outlook? And what could they do with this information anyway? They, as healthcare professionals, were required to try to make him “better” – or get sued for not trying. After all, that is our system.
There are many directions this story could take from here but I will just point out the one which I am most qualified to speak on. That lesson: “Maximizing the quality of care of an individual requires “knowing” that individual. A systematic approach to caregiving where all patients are treated the same cannot possibly be the optimal solution because all people are unique.”
It is this uniqueness where I have decided to focus my attention for the remainder of my own existence. My goal, both within institutions and to consumers directly, is to help people share stories of their life experiences so that others will have the opportunity to know them as unique individuals rather than just patients or as just parents or grandparents.
I myself regret I did not ask the questions and spend the time to get to know Mom and Dad as individuals earlier. Had I done so, I surely would have enriched their lives just by showing an interest. I would have better understood who I am as an individual for all of us are in part a product of who we came from both genetically and experientially. And last but not least, by sharing their stories and my own stories with my kids and grandkids they would have a family narrative that would allow them to feel a part of something much bigger than themselves. They in turn would care more and that is something worth pursuing. Maybe Dad was on that psych ward to teach me this lesson.