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. |
