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In The Midst Of Human Tragedy ...

In The Midst Of Human Tragedy ... image In The Midst Of Human Tragedy ... image In The Midst Of Human Tragedy ... image
Parent Issue
Day
14
Month
December
Year
1975
Copyright
Copyright Protected
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Donated by the Ann Arbor News. © The Ann Arbor News.
OCR Text

In Carol Yoakum, nursing care supervisor on Ward Al-2 at Ypsilanti State Hospital is the same spirit that moves many into. health care professions. "I want to be able to help people," she says simply. In the 11 years that Carol has worked at Ypsi. State, she feels that she has "helped" two people. For her, "to help" tneans to assist a patient back to a normal life in the outside world. And the cold, harsh realities of the prognosis for most of the patients on Ward Al-2 is perhaps better expressed in the jargon in which the describes the ward's function - sub-acute treatment for the geriatric psychotic - "custodial care." ■ There are 27 patients on Al-2. The mental disorders which dictate their placement in a mental hospital like Ypsi rather than a nursing home or other type of facility range from manic depression, organic brain syndrome and paranoid schizophrenia to senile dementia. Almost all suffer serious physical maladies as well - Huntington's disease, renal failure, stroke, diabetes, cardiac conditions (two are on pacemakers), post hip fractures, cancer. Of the 27 patients, 14 are immobile, 11 must be spoon-fëd, five require assistance in feeding and two are listed as "untidies." All must be bathed, dressed, toileted, lifted, medicated and observed - day in and day out. This demanding routine is handled on ; the average day's shift by five full time staff members - ,a registered -nurse, a nursing care supervisor, a licensed practical nurse and two nursing assistants. It's not surprising that staff turnover on the ward is high. There have been four different RNs in two years. and only two of the present ward staff have been there for more than two years. One does not get any articúlate answers if one presses the question "Why?" on those who do continue to work there every day. "Oh, I'm a glutton for punishment, I guess." "Well, because somebody has to do it." But a regular visitor to Ward Al-2, watching these casually ciad, and often disconcertingly youhg, women move through their back-breaking work, will i not accept mechajiical force of habit as the motivation forihe presence there. For in unguarded moments, he will also hear their ariger, see their concern, and their tears. "When I hear from someone that' we don't do anything for these people out here at Ypsi," says one young staf f member, "I get so mad.Tve had my nose I've been bitten twice, scratched, punched, and I come home ' every day smelling like shit. ' ' But you see the pleasure on a nursing assistant's face as she spoon feeds.a third serving of strawberry ice cream to an old man who is unable even to hold up his head. "We have a lot of little mothers out here," says the ward's registered nurse, Jeanne Henderson. "Working here puts a terrible strain on your values," says Jeanne. "Your religieus beliefs, psychological beliefs. moral beliefs all come under question. Especially when you realize how much pain the patients experience and can 't even express." Watching someone suffer immeasurable pain which they can do little to relieve, is sometimes played out for the' staff against a scenario of a "patient's own expressed wish to die. But if a wish that such a patiënt could be relieved from that pain by death finds a place in the minds of the staff, it is not something that would happen through neglect or condoned as the path of mercy. Says Carol Yoakum, "If a patiënt died, there wouldn't be a dry eye on this ward." Öbserving patients who sit endlessly in stony silence amid the ever present din of the screams and moans and cries of others, one cannot make a pretty picture ofWardAl-2. But the concerned efforts of the people - who staff it, as they move through a , ly job with many headaches, more t aches and seemingly few rewards, frame the picture with an affirmation of the dignity of life. "Patients wiü be more jcrowded. The staf f to patiënt ratio will be decreased. Services will be decreased. "There will bé a higher noise level. More tensión. More stress. More disturbances. Less bathing. "There will be fewer opportunities to break up the large numbers of patients into small groups and have the staff interact with those small groups. "And U's in those small groups that people begin to act in more normal ' ways." Is there any possibility of opérating the wards more effectively and efficiently with less staff? "I Avould say 'yes' if they were wèlldesigned units," Dr. Stehman answers. By "well-designed," he means one and two-bedroom units instead of "dormitory" sleep arrangements, dressers and mirrors for patients, places where patients can sitjwhen they want to be alone, rooms with small nooks to provide for small conversational groups to sit and talk together. But Ypsilanti State Hospital is not a new facility, and some wards still retain the old, dormitory sleeping arrangements and cávernous dayrooms. An earlier attempt by Dr. Stehman to stretch budget dollars for making the kinds of renovations he describes backfired last summer when he purchased more materials and then used hospital maintenance personnel to do the necessary work instead of paying higher priced outside labor. The practice was called into question and eventually declared to have gone beyond the legislative intent of his appro, priation. Dr. Stehmán also expects to fiave to lay-off a substantial number of housekeepers. Housekeeping at the hospital is definitely not a luxury. It is a necessity to maintain health standards. And if , after taking all the above measures, he still doesn't have enough money, 1 Dr. Stehman says, "I will continue to abolish othier, non-nursing jobs until I . can get enough money back to fill the nursing positions." But even as ne piays the dollars-andcents game, Dr. Stehman retains the ability to stand back and look at the situation objectively, or perhaps at least philosophically. "State hospitals as they. traditionally have existed are no longer consistent with our social aims, aspirations and thinking," he says. "It's quite proper that they have got to change. "First, we're talking about more services in the community. Second, we're talking about redoing state hospitals into socially responsive agencies, responding to a genuine social need. "that presents a lot of problems in transition - a geáring up in the community, determining what the valid uses - if any - for state hospitals are or whether they are going to go.. "f here are all kinds of ideas - many of them good ones. "But no decisions have been made. In states of flux, there is always unrest. We are seeing some of that now." "Unfortunately, it happens to be coming at a time when we are in the worst fiscal situation we've been in since the 1930s."