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October 29, 1999
DR. KEVIN'S COLUMN
Home Away from Home
The difficult move to a nursing facility

photo: J. Kevin Shushtari

Louise invited me into her room in the same way she would have invited me into her home. She glided down the shiny floors in her wheelchair, and we chatted about the weather. I was grateful for this casual conversation. For years, I was Louise's physician; now we were friends. I asked what she thought of my tie, and she said it was unusual. "A gift from your mother-in-law, no doubt," she said accurately. "What I really want to know," she said as we reached her room, "is how those three beautiful children are." I produced a photo from my wallet of my three kids, and we talked about how each was doing.

The room was as homey as a nursing home room could be. In the hall outside the door was a photo of a strikingly beautiful young woman with her arm around a soldier; beneath the photo was the name "Louise Steinfeld." A curtain with a bright floral design separated two single beds; Louise had the one closest to the window. She had decorated the room with her favorite furniture: an armoire, an overstuffed 1970s-style bright orange velvet armchair, an old self-contained stereo that she called her hi-fi, and old black-and-white photos of her family. On the walls hung original artwork in gold frames. "Are you eating right?" Louise inquired, "because you're looking awfully thin." She handed me a box of peanut brittle and stated simply, "Eat."

After Louise's husband died, she stayed in the house they had purchased shortly after World War II, where they had raised their four children. Then 82, she drove her own car, kept her own house, and even mowed her own lawn. Her family was the center of her social life, and she thrived on visits with her 12 grandchildren. Moving to the nursing home was a tough decision.

I remember well the call I received in the middle of the night from my answering service. Louise had fallen. She did not want to worry her children, so she called me, her doctor. She had managed to crawl on her belly across the bedroom to pull the phone off the night table, which bruised her head. "Doctor, I am so humiliated. I've soiled myself," she said quietly. "I've been on the floor since noon." I called 911 and met her in the emergency room. Louise had broken her hip.

There was no plan in place for her care. Louise's four children-a stockbroker, an attorney, an accountant, and the youngest, a playwright-looked to me for a solution. We discussed home-care, assisted living, and nursing homes, but the children couldn't agree. Our meetings often ended in anger, frustration, and tears. Louise was distraught but remained strong. She ultimately asserted herself and decided to be discharged from the hospital directly to Aqua Gardens, a nursing home where she had visited friends who resided there. She made a list of the possessions she wanted to take with her. And she never went home again. "The decision is made," Louise said unflinchingly. And it was this same strong will that would get her through the difficult transition and ultimately help her thrive in her unfamiliar surroundings.

Louise became a leader at the nursing home. She started a women's reading club and arranged lectures by her children, who spoke about living wills and estate planning. The playwright even put on a one-man theatrical production. Louise wrote an article for the local newspaper about the importance for seniors to prepare for the future. She made a point of saying that physically she was no longer completely independent, "but mentally I run my own show."

When I complimented her on all she had done at the nursing home, Louise often said, "What else can I do?" She confided in me that she missed her home and then encouraged me to get home and have dinner with my family. I remember her saying, "Cherish the moments because you still have control. It won't last forever." To this day, even when I get home from work after midnight, I check on my kids, watch them sleep, and cherish the moments. And I think of Louise and the wisdom she shared with me.

 J. Kevin Shushtari, M.D., is Rx.com's Chief Medical Officer and a co-founder of the company. He is also a board-certified internist with a medical degree from Dartmouth College. In Dr. Kevin's Column he will share his own experiences as a physician, a family member, and a patient.