Saturday, December 16, 2006


At 1 am, a caregiver on the night shift went to the break room to fix her lunch. She put her food in the microwave, quickly entered 2.0 minutes, and left the room for a few minutes.
Accidentally, however, she had entered 20 minutes.
Soon her food was on fire and smoke filled the room.
Suddenly the fire alarm system was triggered, and a loudspeaker was heard in every bedroom on all floors: "Emergency--proceed to the nearest stairwell and exit the building."
This is a fine message for residents in assisted living who are fully sensible and mobile. They can proceed to the nearest stairwell, and those who need wheelchairs can be assisted by caregivers on the night staff if all goes well.
But what about the 28 residents on the dementia floor (a.k.a "the Reminiscence Neighborhood" or "the Memory Care floor"), and those among them who use wheelchairs?
There are only two caregivers on the 10 pm to 6 am shift, and there's no way they can run around and take care of all 28 agitated people.
But they tried. They were gathering those who could walk into one room, determining if this alarm was a real fire requiring evacuation, and checking on those who could not walk.
Almost immediately they came upon Ralph, a tall handsome gentleman with vascular dementia who had been the first Marlboro man, riding on a white horse in front of dramatic Arizona mesas in television ads during the 1950s.
Ralph had leapt out of bed and tried to "proceed to the nearest exit" but instead had fallen and hit his head against the sharp corner of some furniture, causing a severe gash.
Paramedics, already in the lobby of the building because of the fire, ran up and cared for Ralph; after arriving in the ER, he was hospitalized.
The staff didn't reach my mother until 1:15 am, but she was fine, lying awake in her bed still listening to the command to go to the nearest stairwell. (The loudspeaker continued to bellow this message for twenty minutes, even though the staff had figured out fairly quickly that this fire had been easily contained and did not require evacuation.)
Tracy Stone reassured Mom and continued on to check on other residents. Then she and her coworker began the job of putting the gathered residents back to bed, but first she decided to make a second round of checking on all those without mobility, still in their beds.
At 1:30 am she entered Mom's room and found her fallen on the floor, crying for help. Apparently Mom had decided to obey the loudspeaker and try to get to the nearest stairwell.
She had scooted to the edge of her bed, pulled herself to a sitting position using the bar along the top half of the bed, and then slid to the floor, sitting with her back against the foot of the bed.
Apparently, though, she had held onto that bar while sliding to the floor and pulled her shoulder muscles and ligaments.
Tracy checked Mom's vitals, determined that she was okay and not seriously injured, and then called her co-worker for assistance in putting Mom back to bed.
When things quieted down, she filed a report on the incident in the log book:
"At 2 am resident was found on the floor. She said she was trying to get out of bed and fell. She said she is ok but feel a bit cold. We put her back to bed & covered her. Temp 97, BP 88/66, Pulse 103."
At 11 am the lead caregiver on the 6 am to 2 pm shift called me on my cellphone, but I didn't answer because I was in a meeting. At 1:30 pm when the meeting had been over for an hour, I remembered to check my messages and learned that Mom had fallen. I called the residence and heard the story, but being reassured that Mom was fine, did not go check on her until 3:30 pm.
As soon as I entered the room, I could see all was not well. Mom was shaking uncontrollably, especially her right hand, and she was agitated.
With difficulty I got her into the wheelchair and onto the toilet, where she usually tears 12-24 neat squares of toilet paper while hoping her bowels will move or her urine will flow.
But today she could not tear properly. Her hands were shaking so much that the toilet paper turned into a jagged mess. A caregiver came to help me and provided more details of the previous night.
When we tried to transfer her to her wheelchair, she screamed with pain.
I wondered if she had broken a bone in her fall and realized that a trip to the Emergency Room was in order. She needed at least an x-ray, possibly other care.
At 4:15 pm we were out the door, wheeling to the hospital and ER one block away.
Six hours later, after an exam and an x-ray and a CT scan of her brain, she was admitted to the hospital for observation, getting a medication for pain by IV.
Later I heard that the director of Ocean View Assisted Living had removed the microwave oven from the break room and had informed staff that they will no longer have access to a microwave.

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