Acute  Hospitalization  through  the  Ethnographic  lens  of  the  Geriatric  Patient  

Ethnographer  Sophia          This is my story. If it were not for the sweet language teacher; known to the staff here at Shady Run, as the speech language pathologist; my story would remain untold. She has given me voice and the ability to communicate my message to all that will listen.

My name is Sophie and I am told that I am 89 years old now, though the years are a cluster of bottled up memories to me. I have been alone for fifteen years; since I lost my husband Jack, the man who stood by my side through wars, births, deaths, poverty and sickness. The long white coats and multi-colored scrubs tell me differently, that I am never alone. Perhaps they have not experienced loneliness as I have known it.

Five years ago Shady Run became my new “home”. Although, nothing here at Shady Run provides a semblance of home as I knew it. Home is the now battered cabin Jack built for me, that overlooks my garden and acres of land nestled in the mountains of

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Shadduck County. Here I go rambling again, it’s hard not too divert to much happier times.

I can’t remember a lot of things, since I suffered a stroke five years ago. Dr. Benton and the white coats called it a Left Temporal Hemorrhagic Brain Infarction. It just sounds like some fancy mumbo jumbo medical word play to me, to say in kinder terms perhaps; that I am paralyzed and lost my tongue and even my marbles. I think those white coats can’t tell their left from their right because it is the right side of my body that doesn’t seam to get the message of what to do.

If it weren’t for the sweet angel faced language teacher; as known as the, “Speech Language Pathologist” ;I would have no voice. You see this patient, kind woman created a message board for me to communicate my thoughts, feelings, but most of all my message which you may choose to hear or not.

My language teacher is the only one who believes, I have not lost my tongue. She uses a homemade talk board to help me get my thoughts across. Everyone else I try to communicate with looks at me with concerned and puzzled faces . My language teacher says , I have a condition known as ,” Expressive Aphasia”, another fancy term to say that I know what I am saying but others don’t hear the words in my head. I guess my words just come

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out wrong. This damn “Left sided brain infarction”, ironically has left my entire right side paralyzed. Even my smile is crooked, although it’s crooked on the right side of the mirror. This is one of the few things that makes sense out of this whole medical ordeal to me.

To make matters even more trying, I get sick a lot more. In fact, I woke up just yesterday morning dripping in sweat vomiting “coffee grinds”. Now, these smart medical folk have missed the mark on that one because I haven’t enjoyed the wholesome French press taste of coffee in 5 long years.

Shady Run transferred me to the hospital for a “Suspected Gastrointestinal Bleed evidence by coffee ground emesis.” All I recall from the transfer is feeling my belly and throat on fire, with the constant urge to vomit.

The white coats and multi-colored scrubs treated my situation like it was life or death when I was wheeled via stretcher into a blinding bright lit medical room. The light pierced through my cataract ridden eyes. The white-coats, yelled out,” Her blood pressure is tanking, get some saline, stat CBC, Metabolic panel and type and screen STAT! I had no idea what on earth these folks were talking about. I tried to ask but even my words would not come out.

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Once I was “stabilized”, a sweet young nurse that reminded me of my own granddaughter said,” We need to place this Nasogastric tube down your nose to help you feel better.” Just looking at the long yellow beige thick worm like tube made my stomach quiver. To add insult to injury she was aiming that monster down my nose! I felt like I was chocking to death on a giant worm as she shoved the worm monster further and further down. When I thought things could not get any worse, angel faced nurse and the white coats said,” Sophie, it won’t go down unless you cooperate, now tilt your head downwards and swallow …swallow …swallow…” That’s when my fight or flight kicked in, thank god they couldn’t hear the words my inner mind was calling them, as this was a catholic hospital and just thinking those words might be enough to swear me to damnation. I kicked hard with my entire left leg aiming my left foot for the long white coats knapsack. I raised my left arm with strength long forgotten and pulled that long ugly worm tube from my nostril.

I felt free and exhausted for a brief minute that stretched like eternity. The brightly lit medical room was fading in an out like a strobe light malfunction caught in slow motion. All I could think to my self was ,”Is this some damn new ambient light treatment.” I wish I stayed on top of those medical dramas with myrtle as she

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often cautioned me. Well it was too late now…!!it has already hit the fan, literally and figuratively.

As the room continued to fade in and out, the sweet angel faced multi-scrub said, ”I need to put these restraints on you to keep you safe ,Sophie.” Nothing about these ancient primitive looking shackles disguised as blue and white accessories appeared safe. In fact, as I was placed into these shackles, my mind went to my 16th year under the football bleachers with quarterback Chase. His words came back to me like it was yesterday,” Sophia, just lay still stop wiggling, you are safe, this won’t hurt.” All I could hear from the corners of my mind was the word NO, shouted and echoed.

At some point, I must have regained consciousness because I would hear the voices of the white coats and multi-colored scrubs. White coat yelled,” She is pulseless in V-tach get prepared to shock, “Clear”. With each shock, I could see my Jack standing in front of our home smiling and waving at me. The coffee was hot and the corn was high. Every shock brought me closer to Jack and all things home.

Ironically, I heard the white coat say sadly; “Time of death ,lets Call it 1636.”

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The medical team moved slowly and solemnly now, taking extra time to touch my forehead, gently removing my restraints. Defeat stricken faces. “What a shame, said the white-coats and multi-colored scrubs.” “We almost had her back.”

When I crossed that day, I embraced Jack’s hand feeling a freedom from the loneliness, pain and suffering, I had experienced in the last fifteen years.

Before crossing completely, over, I paralleled in alignment with my lifeless, pale body, seeing the puncture markings from needle sticks, bruising on my chest from the CPR and a face I did not recognize.

The only regret, I left on this earth, was having to struggle the last five years with a voice known to just one person, my language teacher.

Afterthoughts;

This was somewhat of a free-write. Any actual resemblance to people living or dead is purely coincidental.

Sophie’s character can be representative of almost any hospitalized patient with or without communicative challenges. As healthcare providers, we must remember,

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We speak our own jargon, language that can be highly confusing to those we are providing care for. It is my belief that when a patient is most powerless, we need to provide them with as much choice and power as possible. Communication is powerful. Was it Shakesphere that was quoted, ”The pen is mightier than the sword.”

Thank you for listening to my story,

Sophie

Written by Rosanne Hilliker

Questions for Discussion:

What challenges do you face with restraints in acute hospitalization?

Do you believe there are alternatives to restraints in acutely ill patient presenting delirium or confusion?

How do you feel when you have to restrain a confused patient?

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