The Space Between Sickness And Death

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A physician sings the praises of a much maligned medical institution.
A physician sings the praises of a much maligned medical institution.

There is much to deplore in our medical system.  Atrocities abound in the dark recesses of hospital wards, the packed waiting rooms of outpatient offices, and the algorithmic hum of insurance claim denials.  However, the vilest of  insults are frequently hurled at one setting in particular.  I'm talking of the place cursed by emergency department physicians when admitting yet another poor soul with a sacral ulcer; a place spoken of by patients and families in the most hushed and fearful of terms.

I am talking of the modern day nursing home.

Allegations of abuse and neglect flourish.  The New York Times is littered with stories and editorials claiming inappropriate use of medications.  The view of nursing home owners is of a bunch of fat cats, deceiving our elderly and neglecting the flesh in favor of the all-important bank account biopsy.  And no doubt, as with any reputation, some of this is true.

Nursing homes endure, however, because there is no other setting for such patients.  Long after the hospital has discharged and the family has gone home, someone has to take responsibility for our most downtrodden: the poor, the frail, and those maimed by disease.  The extraordinary complexity of the average nursing home patient has leaped forward over the last few decades.  The staff pivot from the average knee replacement rehabilitation to a paraplegic with a stage 4 pressure ulcer, intravenous feeding, and no understanding of the meaning of a POLST (physician orders for life-sustaining treatment) form or DNR (do not resuscitate) designation.

Our society has chosen to see ultimate darkness in this place it so desperately needs.   Yet, if we are searching for humanity, we must crawl to the places into which no light is willing to shine.  We must wade through the morass and stench of human decay.  Down here in the space between sickness and death you will find us. On our knees.

Nursing assistants, nurses, social workers, administrators, dietitians, therapists, and—yes—physicians.

Singing, crying, laughing, and comforting; and perhaps holding your loved one's hand.


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