Sunday, January 18, 2009

Dead on arrival or why I'm so slow to call it a duck

In the time before children, cell phones and laptops, I was a physical therapist working for a home health agency. My job was to address whatever physical needs a person might have with a goal of optimal safety and functioning in the home. My...clients, patients, whatever...were usually elderly, but sometimes I'd see some homebound younger people.

On this particular day there was a man on my list who was a new patient. He was just home from the hospital that very day. I was the first in our agency to go and see him, get the 'admittance' paperwork done. His referral said he was about 50, had had a heart attack and coronary bypass surgery.

The door was slightly open when I arrived. Inside the front room was an elderly woman who I startled, and two big dogs. She said that her daughter, my patient's wife, was en route from California. I got the impression that there'd been an emergency of some sort, and this lady was staying with him to help out.

She showed me to his room and left. Ah, shoot. I hate having to wake people up when they're probably enjoying some relief from their discomfort. So I gently said his name, and when his eyes didn't open touched his shoulder. Patted his shoulder. And then realized this man had died.

I dialed my office. Asked to speak with my supervising nurse. Put on hold. While waiting, I looked at him and wondered if I should do CPR, or rescue breaths at least since chest compressions on a healing chest seemed a recipe for more harm than good. (Debora, the man is dead. He's beyond first aid!) I could not bring myself to do it. Even as I wondered if maybe there was still an ember of life deep inside of him, which was going out as I stood there on fucking hold! (Mental scenario: it's possible that he'd expired just as I walked into the room and still could be revived; should I make an effort, just in case? Yeah, the odds of that were low since his color was bad and his skin cold, but still...)

I depressed the receiver to call back. Was pushing in the numbers as I brought the phone to my ear and realized I'd started dialing before getting the dial tone. Depressed the receiver again and listened this time. No tone. Pressed the button again, held it down longer. No dial tone. Hung up for a moment when the elderly woman came to the bedroom door. I told her that he had died and she gasped, "Ohmygod!"

This time I had a dial tone and started pressing the number. Hands shaking I misdialed. Hung up. No dial tone when I raised the receiver. Hung up again. Dialed, answer. Hung up the phone. Next try got me through to the receptionist who said she'd transfer me to my supervisor. Limbo. Limbo. Hung up. Tried again. Said it was very important that I talk to my supervisor. Transfer, pick up. Not my supervisor. She's stepped out. Did I want to leave a message? I told her I'd just arrived at the home of a patient was was dead and I needed to know what one is supposed to do when one has a dead patient. She said she thought I should call the patient's doctor and she'd go find my supervisor. I swear this was not the last iteration of this. I've had dreams where I'm trying to make an urgent phone call and keep having frustrating delays--a mistake pressing buttons, accidentally dialing the wrong number, no dial tone, circuits overloaded tone. This was my waking nightmare. I gave up on my office and looked on the chart for the doctor's phone number. Of course this guy had a list of physicians, various specialists, a mile long; I finally found where someone had penned his cardiologist in, almost an afterthought.

Dialed. Receptionist. Transfer. Doctor. Doctor! First try! I told him his patient was dead, that I had come to evaluate him and found him dead. "You poor thing", he said. Tears came to my eyes. He told me I needed to call the county coroner. He didn't have the number. Now anyone who has ever tried to look up any government service in a phone book understands what a maze that was, but I finally got their office on the phone. I spoke with the man who took the address and said he'd be over within the hour.

I'd been at this house for an hour already and I had other patients so it didn't seem feasible for me to wait. The mother-in-law was sitting in a recliner in the living room, smoking. I asked her if she would be okay waiting alone for the coroner. She said she would. I left, and as I made my turn onto a main street I saw a county vehicle heading the direction I'd just come. I was glad. End of story.

But there's another version to this story.

Wife of patient comes home from work. She'd gotten out early in order to come and care for him. Her mother was sitting in the chair. She looked in on her husband, saw that he was asleep, closed the door to not wake him.

There's a man at the door. Oh, dammit--he's a county guy. I can see a bit of his car through the window. One of the damn dogs must have got loose again and someone complained, again. Opens the door, thinking she's talking to the dog catcher...

You know, this poor woman must have been pulling up just as I was leaving. God knows how long the grim comedy of errors went on with her thinking the coroner was the dog catcher, and him perplexed because I'd passed on the misinformation that the wife was on her way back from California. Maybe he thought she'd arrived early. Anyway, this is how she learned that her husband was dead.

She called the doctor's office hysterical, and I received a barrage of questions the next day from that same office. Slowly the doctor's nurse and I were able to piece together what really happened:

The mother-in-law was demented. Seriously, she had Alzheimer's. In fact, where I'd gotten the impression she was looking after him, he was supposed to be babysitting her. The wife was not en route from a trip to California; she'd been at work. (I'm picturing a map from above with dots marked, 'wife', 'coroner', 'therapist' moving around, unknowingly crossing paths.) I called her to tell her how very sorry I was, first that her husband had died and secondly my part in the dreadful way she'd had to learn. "I thought he was coming about the dogs, and then he kept telling me I should sit down, and I couldn't understand why he would be saying that when he was there about the dogs."

A series of coincidences had led me to believe I was dealing with a very different context than I was. Because the mother-in-law was functional and appropriately answered my questions I'd taken her as a credible narrator when she said her daughter was away. Though my interactions with her were brief, she said just enough in just the right tone that I didn't detect that she was wholly unreliable.

That's what kept me from concluding I was being used by Carpool Family. What if it was just a series of coincidences and misunderstandings that was adding up to the impression I was getting and they weren't users at all?

Then again, there are limits to the benefit-of-the-doubt rule: I'd have been doing rescue breaths on a dead man if I applied that rule as far as I did Carpool Family.


Douglas W said...

Oh dear! How terrible! And to make it even more terrible - it's the kind of story that bizarre comedies are based on.

Perhaps that's one way we cope with such tragedies - we eventually try to see the funny side.

I am at this very moment trying to see the funny side of a bizarre story that I seem to be the centre of. I am sure I will write about it soon.... but in the meantime I just need to survive until the end of the saga that is unfolding around me. I am, through no choice or action of my own, at the centre of it yet I seem to be having no impact upon the direction the story goes or the possible outcomes.

I will keep you posted... but in the meantime I will remember to be wary of people suffering dementia... and, as in my current situation, women suffering from paranoia.

Lori said...

It's wonderful that you are conscious of why you had a hard time calling it a duck (great metaphor, too).

I think we have this idea that we can get our "mesh," what we use to keep the bad out and let the good in, so finely tuned that it will do just that.

But the tighter the weave, the more we keep out -- good and bad. The looser the weave, the more we are susceptible to both good and bad. We are constantly adjusting the mesh, in reaction to our most recent experience.

I, for one, would rather err on the side of too loose. Perhaps it is this tendency that makes duck- identifying a bit more painstaking.

Does this make sense in light of your story? I read it last night and I'm answering today, so I'm not sure how coherent it is.

Martha said...

I did homecare for many years, I've had my share of DOAs. No fun.

excavator said...

Doug: Oh dear yourself! I'm sorry that you're caught in a bizarre story and hope it resolves itself in the best possible way: vindication. And, if needed, exoneration.

Lori, what a cool image, the "mesh" to strain. For some reason this reminded me of sensitivities, and allergies, and it occurred to me that an allergy is where the mesh gets so fine it's straining its own organism. Or reacting to elements of its own organism as if they are 'bad' which must be kept out. It occurs to me that in a sense that's what my 'mesh' was doing with my feelings that were meant to protect me. Maybe I'll make a post about that someday...

Martha, fortunately this was my only DOA in about 17 years of home health. It'd be fun to swap stories with you someday. I'll bet you have a lot. It was a cool line of work, though...I liked seeing people on their own turf and in their own surroundings.