Prissy Smith, Public Health Nurse

I was admitted to the hospital but had to stay in the emergency department for two days to wait for an available bed.  Finally a bed became available on an off service unit which means a specialized unit for a a specific diagnosis or disorder other than the one I have.  I was admitted to a gynaecology unit and I was a neurological or medical.  I waited on this off service unit for three weeks for an appropriate bed to become available.

During the early days of my hospitalization I noticed that my condition continued to deteriorate.  I found that I could no longer stand on my own so I was glad to be in the hospital.  The unit I was on was a little short on insight into care necessary for a patient that had immobility problems.  I know what I needed though, and I asked for a wheelchair and a commode to be positioned by my bed.  I put my wheelchair on the right side of my bed and the commode on the left.  I had an over bed table as well on the right side and so getting into my wheelchair became an exercise of moving my over bed table out of the way far enough that I could get from my bed into my wheelchair.

Getting onto the commode from my bed was frightful as the only thing working by now was my arms.  I pulled myself up to a sitting position using the bed side rail.  Then I  widdled my way to sit on the edge of my bed then grabbed the arms on the commode, managed my clothing, and swung my rear end around so that it was positioned to plunk my butt down all in one motion.  If I was not positioned correctly to the commode or the breaks on the commode were not on I risked falling to the floor.  Being incontenent I had to do this maneuver quickly.  Often I would not make it and the nurses would have to change the sheets on the bed and mop the piddle on the floor.

Using the commode was terribly embarrassing.  There were three other patients in the room, the closest right beside me.  Although there was a curtain that separated us, my commode was right beside my neighbours night stand and it was embarrassing to piddle on the commode knowing how close I was to my neighbour .  The hospital staff were not careful to leave my carefully positioned wheelchair and commode in place.  If the commode got in the way of the gaggle of physicians making rounds, they would move it and not put it back when they left.  They would also leave the drapes separating the beds open.  I spent my whole day getting my commode back in place and applying the brakes on it, pulling the drapes back in place to give me the illusion that I had personal space, and going for multiple tests.

My immediate neighbour was crabby and her interaction with any one was aggressive.  She was not gracious to me.  My over bed table became full of things.  I was not hoarding things but because I could not walk and getting into my wheelchair was frightful and laborious I did not throw empty containers in the garbage  which could not be placed within reach because of the placement of the wheelchair and the over bed table.  I completely lost my appetite so often when dietary staff picked up my meal trays, they would leave a juice or a yogurt container on the table.  I also had some magazines that my sisters brought me, tissues, glass cleaner and a sundry of other things on the table and it became cluttered.  The policy of the hospital was that if there was no room on the over bed table to place the meal trays, dietary did not leave the meals.  On one occasion I was away from my room to have a X-ray in the radiology department.  When I got back every one was eating lunch.  I asked my neighbour where my lunch tray was.  "They didn't leave it because your over bed table is dirty" she said.  "Dirty?" I questioned myself.  It was cluttered, not dirty.  Interesting choice of words but then she was there when the public health nurse came in with documents declaring my house condemned.

The public health nurse came through the door, came straight to my bed and asked me if I was Autumn Balm (my pen name).  I was afraid to say I was.  She looked stern.  Her brows were furrowed and her eyes were so squinted that I could hardly see her pupils.  Deep wrinkles appeared on each side of the bridge of her nose.  Her lips were pursed hiding the pink of her lips.  I could not hide since my name was on the end of my bed  and I could not run so I said that I was who she was looking for.

"I am Prissy Smith", she said (not her real name but that is what I heard), "and I have documents for you to sign officially designating your house as condemned."

"Oh yes, I've been expecting you" as I recalled that my sisters told me she would be coming.  My sisters were the ones that called Public Health.

She found a place on my overbid table to place the papers and she pointed to where she wanted me to sign.  I borrowed her pen and complied.  She then signed her name as a witness and dated the document then turned around and walked away.

I could understand her disgust with the condition of the house and at first I excused her harsh interaction with me. "I deserved being treated this way" I thought.  But I realized I was left feeling hurt and discarded by her.  Then I concluded that she was a nurse and should have been at least professional if not compassionate with me.  If it is in the public health mandate to "deal" with people like me they should have the education to the point of understanding hoarding so they see hoarders as real people.  Be disquested with my house, not me I thought.  I thought of the hymn that I've sung at church called "He looked Beyond My Fault and Saw My Need".  My only resolve with this hostile interaction is the vision of the public health nurse as an old person with crevices on each side of the bridge on her nose and craters on her upper lip like a child would draw as rays around the sun which is entirely possible if she keeps that face on.

I Kicked the Doctor, and the Doctor Cried

After waiting in the emergency department for six hours my name was finally called  by a nurse and I and my sisters were lead by her to a cubicle containing two stretchers, one of which was occupied by an elderly lady with her family sitting around her and the other offered to me.  There was only drapes handing from the ceiling that separated that patient who was a complete stranger to me, and my stretcher.  I was given a hospital gown (certainly not a gown for a red carpet appearance) with the fastener at the top of the back, leaving the rest of the back open. I was assisted to the stretcher where I laid down.  After a moment I asked my sisters to raise the head of the stretcher  because the hard pillow supplied no comfort.  I folded my pillow  in half to support my head in in my semi-sitting position. Diana and Trisha continued to keep me company seated at the side and end of my stretcher. The nurse took my vitals and documented my history. I reviewed the evolution of my current mobility impairment as well as any previous surgeries, allergies and previous conditions which included high blood pressure and severe acid reflux and long standing depression.  All the while the person in the other bed in the cubicle and the visitors were suddenly quiet as they listened with interest.

Diana bagged my clothes "I'll take these home and wash them" she said.  I knew she did this due to the smell from my house permeated my clothing. After a short wait, the emergency resident came in and asked me to describe the progression of my mobility impairment again. I repeated to him the exact description I had given to the nurse.  He then began strength and sensory testing of each leg. As he moved each of my legs in various positions and asking me to push as hard as I could against his resistance I was focused on my unshaven legs appearing as porcupines; And then there was my lengthy toenails which captured and held dirt. Reality broke through my embarrassment as I realized my strength was impaired as I could not resist the emergency resident's push on my legs in the various positions. During the sensory assessment I did not think about the unkempt hygiene of my legs as I became more and more impatient with answering whether I could feel him moving my toes, ankles and knees which I could not. Then I answered whether I could feel him touching various spots on my legs which I could not. He asked me when my last drink was. As a medical professional I knew they had accessed my history on my electronic medical record and saw that I had previously been diagnosed with alcoholism.  Still, the patient and the visitors in the next stretcher were privy to my assessment.

Im sure that my poor hygiene was documented on my emergency paper record.  I can almost with certainty predict what was written by the nurses; "Thin middle aged women arrived with sisters complaining of inability to walk. Patient was unkempt.  Sisters reported that patient was found in her home on a make shift bed which was a broken chair, on the floor.  Patients home was reported to be filled with garbage with little room to move around."

Not determining whether I would be going home my sisters remained. The nursing staff told us that the emergency resident was making a referral to neurology. I was not surprised at this because I knew my strength and sensory assessment of my legs revealed grave results.  As my sisters watched the assessment from the foot of the bed they became aware of the gravity of my condition with horror.

After a while the neurology resident came, asked me to again repeat my history and then began a neurological assessment.   The testing the neurologist did was exactly the same as what the emergency resident did.  I took deep breaths and sighed with impatience and frustration while complying to  repetitive demands of reporting whether I could feel the pokes and prods,  or resist resistance through various positions. On one occasion, the neurologist while resting my leg above the bed on his arm, did something that caused my leg to jerk and kick him in the stomach, or I think maybe a bit lower.  "Ouch," he cried, "you kicked me." " I didn't do it on purpose"I replied.  At least I responded to something."  He then left without telling me about his findings or what he had planned for me.  I felt satisfied that the assessment resulted in me kicking him after all the repetitive assessment I endured but glad it was not intentional and a response he caused himself.

By the time the neurologist did his assessment it was revealed that I was a hoarder; a new diagnosis along with my alcoholism was on my electronic medical record that will follow me forever.   The details of the revelation my sisters made to the hospital staff about the condition of my house was recorded on my emergency paper record secured on a clip board and kept on a side table beside my stretcher.  No one asked me about my house or asked  me questions about my behaviour or hoarding tendencies,  All it took was the mention of the aberrant condition of my house by my sisters to the nurses and doctors and there it was, I am a hoarder.  No one asked me why my house was such a disaster or made a referral for me to talk to psychiatry.  The omission of a referral to psychiatry made sense to me at the time because my physical condition was a greater concern to both me and the medical staff.  I quickly adopted the label of hoarder and I became quick to admit it or reveal it from then on.  I felt that I needed to be completely honest about this in order to provide insight into my condition.  There was no point in denying it.  Appropriate intervention would not come unless I accepted it and owned it I thought.

Finally Diana asked a nurse whether I would be going home.   Only upon the enquiry by my sisters of what was ahead for me, the nurse told us that the neurologist wanted to admit me for further testing and treatment to improve my mobility.  Once the notification was made that I would be admitted to the hospital my sisters left and I remained becoming part of the hub of activity and the noise of indignity in the emergency department.

As I look back through all the medical intervention I received throughout what became a very lengthy stay in the hospital, my hoarding was never addressed.  I didn't know it then at the beginning in the emergency department, but admitting to hoarding only labeled me.  It became a descriptor such as thin or obese, a judgement as is a drunk instead of being addicted, and not a condition that needed to be addressed.  I think my readiness to admit to being a hoarder was a cry for help which was unanswered; a cry that that said it is not my house that is a disaster but my life.  Help me.  The garbage in my house is desperation and I am on my way to destruction.  My cry was not even noticed because there were no tears.