Habit (21 page)

Ma shares her therapist with an elderly gentleman who can barely speak—
stroke,
I think. When they're parked opposite each other during a lull, he leans toward Ma gamely and makes a quavering attempt at small talk, as if they've been seated together at a formal dinner party:

—Do you know what day it is?

—What? says Ma.

She progresses from tedious ankle weight reps to the big stuff—walking between the rails. For this, I pull out my cell phone to get some videos for siblings. We have been hearing the rumblings about Ma not liking the way exercises are being doled out. We want to know what's up.

The exercise routine is hard, complicated by something wrong with Ma's disposable briefs—they seem to be poking her somewhere and it hurts to move her leg. She stops, shifts her skirt around, and fiddles with her undergarments, while the stroke gentleman politely averts his eyes. There is no real privacy in nursing homes.

It's time for the big Care Management meeting in the conference room, so I leave Ma and hurry down the hall.
Run Susan run.

In the conference room, I meet what I guess is the “team” of supervisors—therapy, nursing, social work, nutrition, at least six ladies and me. I think they must be bound by law to invite me to this meeting. They don't look all that excited to see me.

I take out my list of questions. I'm working on switching Ma from her HMO back into Medicare with an American Association of Retired People's supplemental, hoping to get out of the seventy-five-dollar daily co-pay for skilled nursing. I want to know if the HMO will remain in control till this particular incarceration period is complete. It's becoming more and more clear this HMO is for the birds.

But what Carol (head of therapy) wants to talk about is that Ma is not cooperating. Carol says she has to send weekly reports to Ma's HMO. (You only have to send them monthly to Medicare, which is another good reason to switch.) If they sniff a lack of progress, they will cut Ma off from rehab exercises just like that. And in a split second, she will become another old lady in a wheelchair forever and ever, amen.

This is bad, so it's
stop Susan stop.
The meeting shifts to why Ma is not getting with the program and what to do about that. I thought I was just checking on how they are treating her, but it seems I have turned up at a major pivotal moment in Ma's recovery.

I explain that she is definitely motivated to get better and has always worked hard on her exercises for past injuries. But I do have the feeling that Ma is not getting along with this particular person she has been assigned. Carol takes this well. She offers to give her another therapist and see if that helps.

Meantime I get the full explanation of how if Ma doesn't knuckle under
now,
her HMO will pull the rug out. Also Ma will lose the tiny window of opportunity she has to build muscles around her new partial hip replacement and get back on her feet.

So we're at a critical moment, and it's a really good thing I'm here. Ma stuck in a wheelchair for good means figuring out what to do when she leaves here (or even if she'll
ever
be fit to leave).

Run Susan run,
back to Ma, who's on a break and seems a little tired. We look for somewhere quiet to talk on the phone with AARP about the new coverage, something I can't do without Ma there to give permission. They tried conferencing her in when I was home yesterday, and I think we caught her just as a pain pill kicked in:

—Is this Marjorie von . . . Mouse-swizzler?

—No, it's not; it's Mother Brigid.

—Ma, it's about medical insurance, she needs your legal name.

—Oh. Let me see . . . mumph.

—Ma'am, I have your daughter on the line. Can you give me your social security number please?

—It's . . . um.

(
Sounds of rustling around. Some snoring.
)

—Hello? Ms. von Munk-schnitzler? Ms. BRIGID?

(
Snoring.
)

—MA!!!

—Oh! Yes . . .

(
Rustle rustle, then the BONK BONK of Ma's phone receiver falling on the floor where she can't reach it. . . .
)

Hopefully, Ma won't need the pain pills for too much longer.

The Kate Incident especially concerned me. Ma's friend Kate recently moved into a retirement community just outside Philadelphia. The other night, Ma woke up from a dream: Kate was visiting. When she looked around the room and couldn't find her, Ma decided Kate must have stepped into the bathroom. Ma waited politely for an hour or so, and then began to worry. She pressed her call button. It was almost midnight, and when the aides couldn't find Kate in the bathroom, Ma got really concerned. She sent everyone on a hunt through the whole place, looking under beds and in closets. Finally, she thought to call Kate's place in Philadelphia. And wake her old friend out of a sound sleep.

I wheel Ma past her room. The TV in there is blasting. Ma's roommate, Evelyn Sue, is sweet as can be. Even more deaf than Ma, Evelyn Sue likes to watch loud television all day long. She has MS and has been at Cloverfield for twenty-five years. Imagine twenty-five years of roommates filing through for rehab or dying or whatever; it boggles the mind. So TV is Evelyn Sue's comfort. I've been hearing it starts in the morning with the Latin Mass (
SO misguided, the Catholics
) and then
The Price Is Right.
(
My brain is turning to oatmeal. I can't read my prayers. I can't even hear myself think.
) And by afternoon, it's
that show about the people going west—you know, the one with the man with the battered hat and that thin woman with the scratchy voice.

—The Beverly Hillbillies, Ma?

At the end of the hall is a little sitting room for private visits. When I close the door, suddenly the blare of Evelyn Sue's TV and the parakeet lady's shrieks stop cold. I'm so used to the noise, I've forgotten it was even happening. It's not till you get into an oasis like this, alone, that you realize how draining it is just to be in a bustling nursing facility. The unexpected quiet comes as a complete shock, like when you're on a train and everything's rattling like crazy for hours and then suddenly you go through a tunnel and there's this vacuum. Silence.

Such a relief to Ma, that she immediately falls fast asleep.

It's awful to have to wake her but there is not much time left. We phone AARP and get that sort of settled (famous last words). Then there's this pivotal therapy thing to discuss. Is she giving up the fight to get on her feet again?

—No. It's that therapist's voice, she speaks though her nose and it hurts my ears. She pushes my kneecap. Very ignorant.

Ma crosses herself a few times during my lecture telling her how crucial her cooperation is, and we agree it would be good to try a new person.

Passing the ecstatic lady with the parakeets, we go back to Ma's room.
Bonanza
is blasting. There is a sudden appearance in the doorway: an agitated occupational therapist, who has been hunting Ma and wants to show her how to get into bed with only one helper. I sort through Ma's drawers and listen.

—Please take off my skirt now, says Ma.

—Why? asks OT lady.

—This is when I go to bed.

I look at my watch. Three-thirty! It's past my chance to make it home before the boys. I REALLY have to go so I can get dinner on the table. But this three-thirty bedtime doesn't sound right.

The OT lady cocks her head at Ma.

—You have dinner in bed? Can't you sit up for dinner? It would be good for your circulation.

—Yes, I can sit up, but they never seem to take me to dinner, so I have it here.

I dart out into the hall and find
Frohn
ces.

—Who should I talk to to make sure Mother Brigid can have dinner sitting up in the dining room from now on?

—She wants to get up for dinner??!!

Frohn
ces looks delighted—like she actually is interested. That's nice. It's amazing how much you can accomplish in a three-hour visit.

Okay, time to kiss Ma good-bye, wave to Evelyn Sue, power-walk down the hall and jump into the car. I can get on the highway just in time to beat rush hour traffic, zoom home and feed the boys.
Run Susan run.

Colette will be so impressed: the fact that I'm doing the Dreaded Walk Down the Hall all the time now doesn't even register with me anymore. It's wonderful what a comfort Ma's church friends are and how happy she is to be near them—almost like this wasn't an accident after all.

Lola's belly-button tattoo would not be a good look for me. But still, something tells me we've got just enough lives left to make it. At least, to the next level of the game.

M
E
(
on the phone to Colette
): Ma had Medicare with a state Medigap when she first got to the Nork. Then I switched her to an HMO. LTC worked out great once we proved her ADLs were messed up. Unfortunately, that nightmare Alf experiment was a total fiasco. So Ma had to go home and that's why we didn't want her to do the TATA. Now that the co-pays have gone up so much, I've decided to switch her out of ESD to Medicare with an Arp Medigap, which may help the Arnack at her Sniff to get her PT and OT paid for along with her OxyIR and the other Rxs. What we should be thankful for is that her mini-mental was almost perfect.

Colette: What?

I could never have rattled on like this a couple of years ago. Now I barely need all the notes I carry around. I can do it in my sleep; the people I talk to on the phone all day have taught me. I am very careful to write down everything they say, and I delight in showing off my new vocabulary to Colette when I give her my daily reports. Being mostly British puts her at a slight disadvantage, though. I'm thinking about making a little glossary so we can communicate more efficiently:

• TATA:
  The Wizard's miracle surgical procedure for rectal tumors.
  
• Medicare:
  Government-run health insurance for senior citizens. Ma quit traditional Medicare years ago for fiscal reasons, and now we want it back. Medicare pays doctor's bills, but there are limits so it's good to get a supplement.
  
• Nork:
  Naturally Occurring Retirement Community, like the senior-friendly Mills House apartments.
  
• ADLs:
  Activities of Daily Living. Eating, dressing, bathing, transferring (which is getting in and out of beds and chairs), and toileting. Those are the big five. You need to be really bad at two of them in order to get your LTC to pay for the Alf or the Sniff.
  
• Alf:
  Assisted-Living Facility, like Happy Hide-Away. One step up from a Sniff, meaning you have to be somewhat self-sufficient.
  
• Sniff:
  Skilled Nursing Facility. Like Cloverfield. This is where you go to recuperate from broken hips or if your ADLs are really out of control or something.
  
• LTC:
  Long-Term Care insurance. Pays for home health aides, Alfs, and Sniffs not covered by the HMO.
  
• HMO:
  Health Management Organization. With an HMO, you get marvelously low premiums in exchange for their right to poke their nose into your business all the time, looking for excuses to not pay for your treatment and generally rough you up. We now think they should be avoided like the plague they are. If you get anything out of this book, it would be to get the heck out of your HMO. Now. Just stop reading and do it.
  
• ESD:
  Eat Sh— and Die. From here on out, this is the pseudonym I'll be using for Ma's HMO.
  

When you go to the doctor, you hear people moaning about their insurance. They used to play Muzak in waiting rooms, now mostly you just hear the soft drone of voices telling their sad stories: They'll be switched out of this on that date; they
called the doctor; did the fax come through; Blue Cross blah blah deductible co-pay referral primary group number
. Sort of like when you get caught behind someone with a lot of coupons and discount cards at the market. You're envious and slightly resentful of their determination to be thrifty, embarrassed that your business does not need to be as complicated as theirs—you feel like a slacker. But their life looks so tedious, and you sort of wish you didn't have to be in line behind them with their red tape all over the place. Mostly, you hope to God this is not going to have to be you someday. Well, Someday has arrived.

It has been a nuisance to have to follow ESD's rules about getting specialists referred by the primary doctor. Because the premiums are fixed and a lot cheaper, I've put up with ESD, but boy do they sock it to you when your medical needs intensify. Ma's hospital and skilled nursing daily co-pays increased dramatically this year. Now, the saving on premiums is so far outweighed by the maximum yearly output for co-pays that we've got a whole new set of worries.

• Co-pays:
  Your share of the bill after the HMO pays. This keeps you from making wasteful health decisions, supposedly.
  

It would have been better to switch out of ESD in between calamities. Last fall, we got notices about the co-pays going up, and I knew they had a special window of time when it'd be easy to revert to Medicare. But back then, the cancer was cured, the crisis was behind us, and it was just hard to imagine the soul-sucking cauldron of indescribable looking-glass bureaucracy we'd find ourselves in. Now that it's about a month after the accident, I've decided to tackle an insurance swap.

Ring. Ring.

(I get out my notepad every time the phone rings these days.)

—Hello?

—Is this Susan Morse?

—Yes?

—This is Maxine, the Arnack at Cloverfield?

• Arnack:
  Registered Nurse Assessment Coordinator at a Sniff. This is a sordid job some nurses opt for. As far as I can make out, they have no hands-on contact with patients. Instead they spend their days on the phone with the HMOs trying to get them to agree to pay for things. These nurses get it from both ends: HMOs on one side and people like me on the other, each alternately screaming about their rights. I guess this job is a reasonable option if you're so burned out from nursing you can't bear the thought of it anymore.