Being Mortal: Medicine and What Matters in the End

They had to solve numerous problems on the fly—how to feed the animals, for instance. They decided to establish daily “feeding rounds.” Jude obtained an old medication cart from a decommissioned psychiatric hospital and turned it into what they called the bird-mobile. The bird-mobile was loaded up with birdseed, dog treats, and cat food, and a staff member would push it around to each room to change the newspaper liners and feed the animals. There was something beautifully subversive, Thomas said, about using a medication cart that had once dispensed metric tons of Thorazine to hand out Milk-Bones.

 

All sorts of crises occurred, any one of which could have ended the experiment. One night at 3:00 a.m., Thomas got a phone call from a nurse. This was not unusual. He was the medical director. But the nurse didn’t want to talk to him. She wanted to talk to Jude. He put her on.

 

“The dog pooped on the floor,” the nurse said to Jude. “Are you coming to clean it up?” As far as the nurse was concerned, this task was far below her station. She didn’t go to nursing school to clean up dog crap.

 

Jude refused. “Complications ensued,” Thomas said. The next morning, when he arrived, he found that the nurse had placed a chair over the poop, so no one would step in it, and left.

 

Some of the staff felt that professional animal wranglers should be hired; managing the animals wasn’t a job for nursing staff and no one was paying them extra for it. In fact, they’d hardly had a raise in two or three years because of state budget cuts in nursing home reimbursements. Yet the same state government spent money on a bunch of plants and animals? Others believed that, just as in anyone’s home, the animals were a responsibility that everyone should share. When you have animals, things happen, and whoever is there takes care of what needs to be done, whether it’s the nursing home director or a nurse’s aide. It was a battle over fundamentally different worldviews: Were they running an institution or providing a home?

 

Greising worked to encourage the latter view. She helped the staff balance responsibilities. Gradually people started to accept that filling Chase with life was everyone’s task. And they did so not because of any rational set of arguments or compromises but because the effect on residents soon became impossible to ignore: the residents began to wake up and come to life.

 

“People who we had believed weren’t able to speak started speaking,” Thomas said. “People who had been completely withdrawn and nonambulatory started coming to the nurses’ station and saying, ‘I’ll take the dog for a walk.’” All the parakeets were adopted and named by the residents. The lights turned back on in people’s eyes. In a book he wrote about the experience, Thomas quoted from journals that the staff kept, and they described how irreplaceable the animals had become in the daily lives of residents, even ones with advanced dementia:

 

 

 

Gus really enjoys his birds. He listens to their singing and asks if they can have some of his coffee.

 

The residents are really making my job easier; many of them give me a daily report on their birds (e.g., “sings all day,” “doesn’t eat,” “seems perkier”).

 

M.C. went on bird rounds with me today. Usually she sits by the storage room door, watching me come and go, so this morning I asked her if she wanted to go with me. She very enthusiastically agreed, so away we went. As I was feeding and watering, M.C. held the food container for me. I explained each step to her, and when I misted the birds she laughed and laughed.

 

 

 

The inhabitants of Chase Memorial Nursing Home now included one hundred parakeets, four dogs, two cats, plus a colony of rabbits and a flock of laying hens. There were also hundreds of indoor plants and a thriving vegetable and flower garden. The home had on-site child care for the staff and a new after-school program.

 

Researchers studied the effects of this program over two years, comparing a variety of measures for Chase’s residents with those of residents at another nursing home nearby. Their study found that the number of prescriptions required per resident fell to half that of the control nursing home. Psychotropic drugs for agitation, like Haldol, decreased in particular. The total drug costs fell to just 38 percent of the comparison facility. Deaths fell 15 percent.

 

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