Today I paid a nursing home visit to my morbidly obese patient with COPD and asthma who was only a month ago intubated in ICU with a recalcitrant asthma exacerbation. Obese, asthmatic, agoraphobic, diabetic, depressed and anxious, she is generally stuck in her dusty bedroom which reeks of urine, unable to summon the strength of will and body to do much else. Several of her children are now on the same self-limiting path, and she blames herself for not empowering them to take charge of their lives. She knows that she has clung to them too rabidly, just as her parents did to her in Puerto Rico. But alas, the cycle continues, and now several of her grandchildren are demonstrating the same pattern. Nature or nurture?
I had not seen her for nine days. The last time I came to this nursing home, she had just been transferred from the hospital to this facility for some reconditioning and rehabilitation. After four weeks in the hospital---one of which was in ICU---she needed some time to gain back some strength. Today, two days before Mother's Day, I find her in her room with three of her daughters. They have brought all of her jewelry for their mother to select from, and I see my patient---all 375 pounds of her---perched on the edge of her bed. She is smiling, bedecked in pointy brown leather shoes, fishnet stockings, a skirt, a low-cut blouse, several gaudy necklaces, earrings, and a hat on her head at a jaunty angle. She beams at me as her daughters argue over some jewelry.
"Girls, muchachas---I'm not dead yet! That's MY jewelry anyway!"
The women continue their good-natured dispute, one daughter pocketing a key-ring she'd been eyeing.
"I'm not getting involved in this family argument, " I say, taking my place near the window.
We chat, and when questioned, my patient tells me that there's a Friday afternoon concert at 2pm downstairs, and she wanted to look nice for the occasion. With most of the residents of this home 20-30 years her senior and confined to wheelchairs in the hallway, my patient looks like she's from another world. And indeed she is. An enormous Latina woman relegated to this facility of mostly white elders with various diseases of the aged, she is out of place, I must admit. There just don't seem to be any rehab facilities specifically for the younger set. Not much money in it, I guess.
As we talk some more, her daughter admonishes my patient for talking to me from under the visor of her hat with her eyes hidden from my view the whole time. She tips the hat back and smiles sheepishly.
I wish her a fun time at the concert, a lovely Mother's Day with family visiting her with homemade Puerto Rican food on Sunday, and I promise to stop by every week until she comes home. She thanks me, her daughters turn back to the jewelry, and I make my way back down the hall among the maze of dazed-looking residents parked along the walls in their wheelchairs. I picture my aging parents in such a place and cringe. The ubiquitous smell of urine and feces is a reminder of where I am.
Outside, the rain pours down, and I open my umbrella for the dash to the car. A few more home visits and then back to the office. Another day in the life.....