Skilled Nursing


Years ago we lived in the high desert of Arizona. Jack planted a garden of okra and tomatoes in raised beds inside what had once been a small corral. His hard work proved a boon for the local bunny population. He tacked chicken wire to the lower fence in an attempt to keep the cottontails out. The bunnies dug under.

He then bought an air gun.

“The rascals are eating my ‘maters’. I’ll shoot the sons-a-bitches.”

He positioned himself for a clear shot of his precious tomatoes and waited for his adversaries to expose their twitching noses. The bunnies simply waited him out. Some weeks later, when all Jack’s squash and okra had filled the tummies of the bunnies, Jack looked out the window to see a rabbit munching on his last straggly tomato plant. He grabbed his air gun, eased open the kitchen window, took careful aim, and pressed the trigger.

The bunny jumped straight in the air and came down dead as the proverbial door nail.

“Oh, no. I think I killed him.”

Turned out this was the first living thing Jack had intentionally killed since returning from Vietnam. Well, that may not be true strictly speaking, but in Jack’s mind at least any previous living thing that died at his hands deserved his fate.

My reaction to Jack’s remorse over the death of Peter Rabbit’s cousin was less than supportive.

“You went to six stores to find a gun powerful enough to kill a rabbit. You bought ammo, loaded the weapon, laid in wait for your prey, and then deliberately shot the thing. No, you don’t now get to claim you’re sorry for its death. Go and dispose of the body.”

Jack dug a hole deep enough to keep the coyotes away, buried the bunny while it was still warm, and stacked penance rocks on the tiny grave. He never tried to grow anything in Arizona again.

This week I have come to realize I may have been overly harsh with Jack that day.

Several months ago, the VA social worker suggested I familiarize myself with the local skilled nursing facility that Jack would be placed in when I can no longer provide him the care he needs.

“Do it now,” she advised, “before you’re stressed out over having to make the decision.”

I figured visiting the place would either ease my mind that Jack would be well cared for when the time came, or it would inspire me to make sure, no matter what it took, that he would never go into the facility. As it turns out, the only thing I could find wrong with the facility or the care was that it’s twenty miles away.

Shortly after my original visit, Jack stopped using his walker and went to a wheelchair for part of the day. Now, a mere two months later, he is using the chair fulltime and can no longer push it with his arms because of injuries sustained to his shoulders from several bad falls, and he can no longer propel himself by pushing with his feet because his hip is giving him constant pain. He cannot use a power wheelchair because his sight and his tremors are too bad.

This is beginning to sound like the old saw, “For want of a nail the shoe was lost, for want of a shoe, the horse was lost, for want of a horse the . . .” well, you know how the story ends.

Because Jack’s brand of PSP has also affected his urinary system, he makes frequent trips to the bathroom. Since he cannot push the wheelchair, someone must help him get to the toilet, and help him quickly. At home that someone is me. During the day this is not too bad. But I am not capable of getting up with him five or six times a night and still being able to care for him during the day.

He has fallen trying to get himself in and out of bed and to the bathroom without help.

And then there is the issue of how long it’s going to take to get us the attendant-controlled power wheelchair the VA has ordered. I am thrilled the occupational therapist ordered it. Not only will it save my back, which now requires twice the maximum recommended dose of Aleve each day – to be honest on most days I supplement with Tylenol – but a power chair will let me take Jack for walks in the woods, to the store, to festivals and outings of all kinds that since he went to the wheelchair fulltime, are off limits for us.

The glitch is that this chair is still three, probably closer to four months from being in our house. Will my back last that long?

Just as importantly, because Jack knows how tired I get, how much pushing his 320 pounds in the wheelchair hurts my back, he doesn’t always call me when he needs help. He gets up, takes those two or three steps himself, or uses his walker to get from his bed to the toilet. He falls. Not every time, but once a week or so, he falls. In the past, his falls required the EMTs to get him on his feet, but he was rarely hurt badly. Now, with his shoulders and hip injured from previous tumbles, the damage from these falls is escalating.

After her last visit, his doctor mentioned she thought it might be time for him to go into skilled nursing where he will have a whole lot more people to meet his needs.

Jack and I went to the VA approved facility, I pushed his chair around, we talked to patients and workers, spoke with the head nurse. We got all our questions answered. Tried to picture ourselves in this new situation. Jack in a double room in the odd combination of hospital and home that is skilled nursing, participating in the many activities, going on outings to the fair and out for pizza, even fishing once a year or so. Me twenty miles away driving back and forth each day to see him.

My head knows it’s time to pull the trigger. I’ve seen the facility. Jack is agreeable, if reluctant, to making the move. I understand that his safety is the most important concern. That one more damn fall could do him in. I see first-hand the damage that has already been done by previous falls. We have the assurance of the nursing staff that they will come as soon as possible each and every time Jack needs help going to the toilet. That they will do everything for him that I do and do it better as there are a dozen of them.

And yet, I cannot make the decision.

Friends point out that Jack going into skilled nursing too soon is preferable to waiting too long, to putting it off until that last bad fall before making the move. I KNOW this.

But I cannot squeeze the trigger.

The counterpoint to all these goddamn facts is that he is my husband and I want him with me. I do not want him to live in a nursing home with strangers. I do not want our life together to end. I’m not ready.

I’m not ready.

About Author and Speaker Pamela Foster

Pamela Foster is a speaker and author. Her first book, Redneck Goddess, is available at local bookstores and on Amazon. Her second book, Bigfoot Blues, will be available in August 2012.
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4 Responses to Skilled Nursing

  1. Maryanne VanDyke says:

    Hugs and a thought: I moved to Tennessee when my daughter said “it’s better to move BEFORE you have to go on a gurney”

  2. I had to make that decision and its not easy. I was thankful he was happy there. We were married 32 years and he was almost 90. I shouldn’t be commenting. Sorry.

  3. Beverly Litzinger says:

    Two things: 1. There is Tylenol Arthritis 650 over the counter that lasts 8 hours. REALLY. You take 2 every eight hours. It is worth a try. 2. This is really not of my business, but since you mentioned how hard bathroom trips are, why not get Jack a urinal that he just uses at night? (It is a like a long plastic glass.) I even used one when I cracked my pelvis. TMI, but I wanted you to know it is not without experience that I speak! Your writing is fabulous, and I think of you often. Wish we had gotten to be closer when you were here; I didn’t recognize how much of a kindred spirit you really are!

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