Vol. 17 •Issue 18 • Page 34
Home Zone War Zone
There Is Safety in Familiar Places
Last July, I delved into a new venue of respiratory care. At the time, I had worked in an emergency department for many years and had grown accustomed to being in charge of patients in my own environment. That was just the way things ran in my orderly world. My new part-time endeavor provided far more experiences than I anticipated, however.
Just one year ago, I began doing in-home oximetry and limited pulmonary function testing for a company owned by some long-time friends. The idea was to qualify patients for oxygen so insurance carriers would reimburse the DME, provided the patients met the criteria.
Going into other people’s homes was not a new experience for me. I had spent 21 years in law enforcement and a year in home care already and had never felt threatened by meeting people on their turf. What I didn’t anticipate was some of the totally unexpected incidents that can occur in home care.
In early September, for example, I drove to an affluent area of northern Manteca, Calif., to complete testing on an 82-year-old woman with a COPD diagnosis. With my medical bag and clipboard in hand, I walked to the front door and rang the doorbell. That simple action set in motion a 30-second rendition of the theme song from “Hello, Dolly!”
In the middle of the musical, the resident watchdog chimed in with an accompaniment of loud, irritating yaps. Now, don’t misunderstand me. I’m a dog lover. I have two great dogs, each weighing more than 90 pounds. But as this overgrown rat scampered around the corner, losing total control of its rear end as it slid across the slick wood floor toward the door, I knew I was in trouble.
Meet the Lady in Red
I peered through the window and saw a tiny monster dog with painted nails and red ribbons in its hair. Behind the dog, a little old lady shuffled slowly to the front door. She was expecting me and was dressed for a party, wearing a bright red dress and matching red ribbons in her blue, piled-high hair. When she opened the front door, I noticed she had missed most of her mouth with the bright red lipstick that seemed to be smeared everywhere but on her lips.
She giggled loudly and looked fondly at the irritating little mutt that was at that point focusing its attention on my left leg.
“Don’t pay any attention to Misha. She won’t hurt you,” promised the aged lady.
More irritated by the incessant yapping than fearful of this poor excuse of a dog’s teeth, I entered the home. At that point, “Misha” struck with lightning speed, glomming onto my left pant leg. I tried shaking the little rat off, but to no avail.
The lady in red kept on walking and talking at a record-setting snail’s pace.
The louder I yelled, “Lady, hey, Lady,” in an attempt to get her to pull off the hound, the louder she talked. She was oblivious to the fact her precious little “Misha” was milliseconds away from death.
We continued down the hallway leading towards the living room, my client shuffling along, talking at the top of her voice, and me trailing along after her, dragging little “Misha” on my left leg.
A Narrow Escape
As we neared the living room, I saw my golden opportunity for escape in the form of an open closet door. With Speed Racer about 5 feet ahead of me at that point, I positioned myself parallel to the door, opened it wider, stuck my left leg inside and shook it violently.
Misha tumbled to the floor and immediately began yapping again, eventually retreating to the corner of the closet. I closed the door as quickly and quietly as I could and reached the couch just in time to be seated with my patient.
I began the testing procedure, and during one break, the patient remarked in amazement: “Misha must trust you. She’s gone to her room for a nap.” Meanwhile, Misha’s muffled yaps protesting her incarceration were barely audible over the drone of the television. I finished all the testing within 45 minutes and thanked the tiring patient as I got ready to depart, advising her I would fax the results of her tests to her doctor.
You would think that after 45 minutes of barking to protest the violation of her constitutional rights, Misha would be tired. Not her. She was still in high gear.
The little old lady in red tottered down the hallway toward some unknown back room to find the princess, with me on her heels. As we passed the closet door, I asked the aged one some silly question, hoping to drown out the sound of the confined Misha.
I halted until she was well down the hall before I reached out and opened the door. I had already darted ahead for a mad 5-yard rush to the front door when Misha leaped from the bowels of the darkened closet and without touching the floor grabbed onto the same leg that she had attached herself to before.
Without saying a word, I hobbled to the front door and opened it. Then executing a jump that can be performed only by ballet dancers, I landed with most of my body outside with just my left leg inside. Of course, attached to it was the angry Misha. Once again I shook my leg violently, and the little mutant lost her grip. I slammed the door shut and drove away, happy the elderly patient never knew what had happened.
The funny side of this is that the patient later told a DME driver that her dog had never trusted anyone the way she had me that day. “She just went into her room and went to sleep,” she said. “And she was so excited when he left.”
My Next Stop
My next stop was a home in south Modesto. As I said, there’s not a lot that intimidates me. But the view from the outside was pretty scary. Cars in various stages of disarray were strewn about the yard along with a collection of empty beer cans bearing the brand of every imaginable brew ever bottled.
A sign on an old, worn-out lawnmower read: “for sail cheep.” A gorilla that answered in response to my knock was clad in the dirtiest old t-shirt I had ever seen. It was torn near the top and again at the bottom. His jeans, soiled with months of grease and grime, were well frayed around the bottom. The man’s hairy belly poked out from under the smallish t-shirt, showing off an obvious hernia. Gorilla man led me into a combination kitchen-living room where the odor of decaying food was prevalent. Dirt and litter were everywhere. My aging patient was dressed in a uniform of torn t-shirt and frayed jeans, similar to that of gorilla man.
When I shook his hand, he feigned a smile, and I noted his lone tooth was in need of dental care.
He spoke slowly with the drawl of a man who had spent too much of his life in the South. His nasal cannula was darkened from months of use and what appeared to be tobacco stains. He was lying on a makeshift bed/couch, on top of a sheet I would have been embarrassed to use to cover even a garbage can.
He told me to be seated, but there was no chance of that happening.
I placed my clipboard on the floor and knelt down with my knees on top of it instead, wishing I would have thought to bring some gloves.
The house was dark, the sun unable to penetrate the dingy curtains and unwashed windows. I concentrated on reading the oximeter that was fluctuating in the mid 80s. When I was bent over, I could feel the hair stand up on the back of my neck. I had an old cop’s feeling that someone was watching me, and I didn’t like it.
Another Family Member
At that point, my patient peered over my shoulder and said, “Judyann, what are you doing here?”
Without turning my body I looked over my shoulder, and there she stood, all six feet, 250-plus pounds of her. Her scraggly, long, brown hair may have been washed once that year. Her dirty flowered dress was torn at the sleeve. No shoes.
And then she smiled. When she did, the two and a half teeth in her mouth showed through her crusted lips.
The next thing that happened, I swear is true. I heard the music from the movie “Deliverance.” If I remember correctly, it was “Dueling Banjos.” At that moment, I asked myself an important question: Why did they call it “Dueling Banjos” when it was really a banjo and a guitar?
My patient explained: “She must like you. She doesn’t come out of the shed much.”
Forget the gloves. Why didn’t I bring a gun? I asked myself.
I resumed my work and was explaining the spirometer to the patient when I felt a wisp of air behind me. I slowly turned only to find the mountain that had only seconds before stood behind me had disappeared. I felt relief, sure the danger had passed.
Five minutes later, I was telling the patient about ambulation when he looked over my shoulder and began to smile.
The Mammoth Returns
Fearing the worst, I turned and discovered the mammoth had returned. This time, she was wearing a bright pink dress, equally as grimy as the first. Her greasy hair was piled higher on her head, adding height to her already tall stature. She smiled. I cringed.
My patient started to say something but was interrupted when he went into a severe coughing spasm. I busied myself, trying to ignore the potential threat that had fixated herself on me. The patient then sputtered, “We may have to keep you. She got all fixed up for you.”
I grabbed my cell phone off my hip and shouted, “Hello.” Then I engaged in a hurried, make-believe conversation. I snapped the phone shut and said: “It’s an emergency. I have got to run.”
I gathered my equipment, sprinted to the door and told the patient I would fax the report to his doctor. I never once looked back as I made the record 25-yard high hurdle to my truck in three seconds flat.
I returned to the emergency department the next day. I was safe there. Guns, knives, drugs and violent patients. I sure did miss them!
Larry Ferriera is a California therapist.