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Luisa Margolies

My Mother's Hip
Lessons from the World of Eldercare

Luisa Margolies

Luisa Margolies discusses the lessons she learned writing her book, My Mother's Hip: Lessons from the World of Eldercare

Q: In your Introduction, you write, "My mother's hip is every mother's hip." What made you decide to write this book about your caregiving experiences, and why did you choose both the diary and lesson format?
A: My point was that the typical patient does not exist—women who break hips tend to be in poor health to begin with and have various medical problems that complicate their recovery. I wanted readers to understand how complicated a hip fracture could be, and thus I chose to tell not just my mother's personal story, but also about the issues that invariably crop up.

Q: There are some incredibly tense moments in your experiences caring for your aging parents and handling the stress of dealing with your family, caregivers, as well as the hospital and nursing home staffs. How difficult was it to recall these events, memories and conversations? Was it therapeutic at all?
A: I think I ran on nervous energy as I tried to juggle the many responsibilities of caring for my family. I had to be strong for my ailing father and put on a good show for my mother too. You don't want your own anxiety about the outcome to be reflected in your mannerisms. I knew I had to be charming to the medical staff no matter how upset I was so that my mother would receive the best possible care. Some of the memories are still so painful, I'd like to bury them, but time does help and I felt that a burden had been lifted when I finished my book.

Q: Your book describes some pretty detailed surgical procedures and shows the physical effects of medicine and treatment. You did not shy away from showing illness at its worst. This is truly one of the strengths of your book. Can you discuss why you decided to tell it like it is?
A: I knew that if I were to write credibly about hip fractures, as I did in Lesson 1 (Hip Fracture, The Silent Killer), I would have to start with surgical procedures. So I scrubbed up and took my notebook and pencil into the operating room. I wanted everybody to know how devastating a hip fracture can be—not just the trauma of emergency surgery, but also the loss of independence because one happened to have had the bad luck of falling and breaking a bone. But the broken bone is just the start of a long medical adventure; the hip fracture is a sort of metaphor for what happens to older people when they get caught up in the medical merry-go-round because of an acute illness.

Q: So you're not only talking about hip fractures when you show illness at its worst?
A: No, almost every issue I've discussed in regard to hip fractures could be said for elderly patients with other advanced debilitating diseases. Elderly patients do not have the resilience that younger patients have, and often find themselves helplessly mired in a series of medical crises that can contribute to their swift decline. It's important for the patient's caregiver or advocate to be aware of the issues before they crop up.

Q: Your book raises awareness about hip fractures, osteoporosis, eating to live, and most significantly, the importance of maintaining one's mental health when dealing with disease. How knowledgeable were you about these issues before you began this book? Did any of your findings surprise you?
A: I think I earned a symbolic Ph.D. in hip fractures while working on My Mother's Hip. I spent many months in the medical libraries of New York City and interviewed dozens of specialists. And I also followed a lot of patients around to see how they dealt with their hip fractures. I was shocked by some of my findings. I did not know, for instances, that because people are living longer, the number of hip fractures has doubled over the past twenty years, I did not know that only about 25 percent of hip fracture victims recover, and I did not know that it is the one orthopedic injury that can lead to death.

Q: There are some very interesting scenes of you dealing with your family and/or caregivers in which you (or they) do not come off in the best light. Did you have any concerns about writing so frankly about these arguments? What did your family think about being the subject of My Mother's Hip and the approach you took in depicting personal conversations?
A: I wrote My Mother's Hip to inform the public about critical medical issues, not to harm to anybody in my family. My mother would have approved and that was enough for me. I wrote frankly about sibling dissension in Lesson 3 (Who Cares?), because it is so common. Caring for an ill parent is extremely stressful; it is not the same as planning a happy occasion like a fiftieth wedding anniversary. The issue of family disagreements has to come out of the closet, because we will all be better caregivers in the end.

Q: Perhaps the most important question you ask in My Mother's Hip—and a constant refrain—concerns hospital policy. From "Why didn't the medical staff prepare us for this?" to facts about early discharges as being a big contributor to the failure rate in hip fracture patients.
A: Medicare reimburses the hospital for five days of acute care for a hip fracture. After that, the patient becomes a liability because the hospital must pick up the tab. So hospitals are motivated to discharge patients sooner rather than later. Premature discharges are often detrimental to the patient's best interests. That's where the nursing home comes in—patients are not ready to go home, so they are discharged to a nursing home to continue recuperating.

Q: How do you feel people with ailing parents can best provide for the stress and strain of dealing with nursing homes? You write that you rarely found anything positive about American nursing homes in your research.
A: Nursing homes are undergoing a revolution because they are picking up the slack from early hospital discharges and learning how to specialize in all kinds of complicated medical care. In this sense, the nursing home has an important role to play in the American medical system. But the traditional nursing home, the type discussed in Lesson 4 (Nursing Homes are Dangerous to Your Health), has received the scorn of numerous muckrakers. Even after sweeping reforms and controls were instituted, the traditional nursing home continued to offer little nursing and was repeatedly cited for deficiencies like neglecting patients' needs, disregarding their rights, and providing substandard care.

Q: Is that the reason why you talk about alternative forms of residential design for the elderly?
A: Definitely! I am horrified by the notion that people are sent to nursing homes just because they are old and frail. Our society can definitely do better for their aging citizens. We can make provisions for allowing the elderly to "age in place" by bringing supportive care into the home and building residential communities that offer a gamut of services.

Q: You debate the issues of prolonged living and prolonged dying. This addresses your Lesson "Who Decides?" How have your attitudes about these issues changed as a result of your experiences/writing this book?
A: I still don't have any clear answers for determining whether medical professionals prolong living or prolong dying. The tendency is to err on the side of prolonging living. I've suggested some formulas in lesson 5 (Enough is Enough) for weighing the benefits of treatment against the disadvantages. People should make their wishes clear in their advance directives and discuss these matters with their physicians and families when they are fairly well so that technology is not overzealously used in the midst of a crisis to prolong dying.

Q: One of the most moving sections of My Mother's Hip is your relationship with your mother. You describe her as "two separate entities": "vibrant," and "sick, trapped in a failing body." Perhaps the most telling comment in your book is when you write "In truth, I did not feel anyone would watch over Mother the way I could." This speaks to the fact that you are a "dutiful daughter." What can you say was most rewarding about caring for your mother?
A: I was lucky to have had a lovely woman for a mother. She was way ahead of her times and supported me in all my endeavors without qualms. I didn't have to think very hard about caring for her when she needed me; it was something I had to do. I guess that makes me a "dutiful daughter." Perhaps I alleviated some of her suffering because she knew she could count on me. I'm still convinced that hired hands and institutions cannot replace the warmth of one's own family.


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