Essential Skilled Workers Must not be Cut

American Journal of Nursing doesn’t give it away for free, so I can’t re-print chunks of ‘Patient’s Perspective: Hard Lessons from a Long Hospital Stay’. Michael Ogg, author and subject, along with co-author Lisa I.Lezzoni describe the sequence of events that put Mr.Ogg in the hospital where he got first-rate high tech medical treatment, almost undone by lack of nursing staff to care for him as he recovered.

Michael Ogg has a form of multiple sclerosis that leaves him almost completely immobile. A badly placed cushion on his wheelchair, and lack of attention to his complaints of pain led to a pressure sore so deep it required surgery. As Ms. Lezzoni says, “it shouldn’t have happened.”

Michael Ogg has posted online an unsparing and harrowing journal of the challenges of depending on total care.

Before she leaves, around 7:45[am], Nelita [home health aid] sometimes helps me get breakfast or does other chores, like laundry or taking out the garbage. After she leaves, I’m alone.
No other personal care assistant comes until Serge arrives at 9:28 p.m. Of course, they could: It’s only a question of money. But I can’t afford more care, so I must make do. Sometimes, when my right arm is too weak to lift a cup or grab a snack bar, I must wait for Serge to arrive to have water or food. I’d be safer with some care during the day, but if something goes seriously wrong, I can count on my personal care assistant agency to provide emergency help.

In a recent week, I had two experiences that underscore these concerns. I’d just heated my dinner—chicken curry with a nice, steaming hot sauce—and was moving the bowl from the stove top to my lap tray. I dropped it. The sauce doused my left hand. Because of spasticity, I can’t move my left arm or hand, and the steaming sauce began scalding my flesh. I couldn’t put my hand under the cold water in my sink. I tried using my right hand to direct the faucet hose onto my left hand, but I succeeded only in soaking my clothes and wheelchair.

I called 911 with my cell phone, and the police arrived right away, followed by emergency medical technicians (EMTs). I’ve registered as disabled with local emergency services and given them the digital lock combination for my front door. The EMTs immediately applied an ice pack, stopping the burning, and my left hand appeared relatively unscathed. There was no blistering, and the ice pack eased the pain, so I declined their offer to take me to the hospital. Because I was soaked and the kitchen a mess, I dialed the agency’s number. I reached the on-call supervisor, and Serge arrived within thirty minutes and cleaned me up.

A few days later, I positioned my wheelchair seat in maximum tilt, about 45 degrees, which I do periodically to take weight off my buttocks and to prevent pressure ulcers. Coming out of tilt, my wheelchair lost its power. It was dead. Unmovable. With my cell phone, which I always have with me, I called the wheelchair vendor. It doesn’t have emergency service, and all it could offer was to send a technician to my home as soon as possible.

I was completely stuck, staring at the ceiling. My laptop computer was a frustrating three inches from my fingertips, and I’d forgotten to place a book in my wheelchair’s pouch. Food and water might as well have been miles away. After two hours of sitting, stranded, I called the agency to see if they could send someone over.

The whole of Michael Ogg’s blog post is here–it’s intense and difficult reading.

A person who is paralyzed requires skilled, vigilant care to prevent the kind of injury Mr.Ogg endured. As in other situations, prevention saves suffering and money. Staffing cuts and benefit cuts put the most vulnerable people in jeopardy. By sharing his experience, Michael Ogg exposes the consequences of understaffing and speaks for many who have been voiceless.

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