28 August 2015

Friday

I'm back, when I've really been nowhere at all

After reviewing my blog site http://behindtheseeyes-john.blogspot.com and a bit of honest reevaluation, and discovering that I can link the blog posts to Facebook, I am once again writing to the blog.

and 

Since I receive so little human contact in this facility ( family and friends rarely come around or call on the phone) and this blog has generated minimal input from others, I decided to investigate Facebook for a while. FB does have more immediate feedback, although there are times when even FB is flat. For awhile I was exploring making movies on my computer and posting those on FB, but I soon found that when I wanted to (for the sake of creativity) make videos over a certain minimal length, FB wouldn't accept them. Free hosting only goes so far.I don't really want to compete with Kitty videos either.

There is so little to do here in a nursing home. I really am not rehab material either, since my condition is not expected to rehabilitate or get better (that is not the understanding of how MS works). When I first got here I was once a day having appointments with physical therapy and occupational therapy. Other than making me tired ( I used to have to nap in the afternoon for an hour everyday)there were no changes in the traditional physical therapy sense of demonstrating incremental positive changes. After a month of daily strapping my feet onto a bicycle crankset connected to a computer console, while still seated in my wheelchair, my measured output was the same on the end of the month as on the first. So Medicaid decided that in the interest of no medical changes, and fiscal responsibility, to stop my daily bit of large muscle movement. My concerns about moving my muscles and joints were discounted. I was told those were not an issue, but if I wanted they could put me on blood thinners to make sure my circulation would not be impaired and arthritis medication in case my joints seized up.

I am told that the CENAs can perform range of motion on my legs daily, while I lay in bed. Everyone of them tell me how they were trained in how to do this during their certification classes. The nurses tell me how there is even an order for R.o.M. daily in my file, but rarely does it ever happen. There are two CENAs of larger than average size who do R.o.M. On me, but they don't work every day and often they are too busy working on staff shorted schedules per administration operations. When I do get some range of motion applied, my legs and ankles have a warm glow for half an hour afterward. Its wonderful, I can actually feel my legs, as if they were a part of me again.

Today, once again, the facility in its wisdom has scheduled too few CENAs. Last night on the overnight shift there was only one, today, first shift there are two. Which meant that there was no CENA that could be spared to give/supervise my shower today. I am still getting used to only two showers per week as normal expectations, but when the facility goes into save-their-cash mode, I am one who gets to feel like a scrunge ball. Last Spring the facility went through about six weeks of staffing too few CENAs, consequently I was getting one shower per week, some weeks none. Bed baths don't count, especially when I can't scrub my scalp, washing my hair.

I have had a neighbor, a real prize to have in the room next door. He has some sort of closed head injury that shapes his behavior in a negative way. Since the facility hides behind HIPPA laws like mother's apron, there is no way to determine exactly what is the cause for which behaviors. He does exhibit some closed head injury behaviors. For example he refuses to use the call light to request some help, even though many instances of training for this have occurred. His special technique is to begin repeating a phrase several times, gradually reducing the modifier words while ramping up the volume, 'til he begins screaming as loud as he can. The phrase is repeated quickly as if no response were expected, there are sometimes added modifiers inserted of the expletives deleted sort, the type that are often overused for greater emphasis so often that any emphasis has leached away long ago. The tone of voice used often contains a mix of angry frustration and just a touch of fear. This elicits an immediate response but the CENAs and nurses have grown weary of this animalistic form of requesting their help. Last night, at three AM, when there was only one CENA scheduled on the floor. He went off about something that was worth it to him that it meant all of us nearby were awakened while he fussed in his usual fashion.

It is now two in the afternoon, the neighbor is going at it again. Something about having only one pillow, repeated several times over. Inserting the fact that he “only has one fucking pillow” and after repeating that tidbit several more times, he breaks into admonishing no one in particular to grow up. Repeated several more times escalating in volume and ferocity ending with shouting, “Grow the fuck up!!” Now that the incoming shift CENA has responded to him, he is now pleasantly using his electric razor for the fourth time today. Before he got the razor, and was shaved by hand by the CENAs, he never showed a heavy beard before. I think he enjoys the playing-with-toys feature of the shaver.

For this kind of care my retirement stipend was claimed by the facility, saying that this is the amount set for my care by the state, who monitors medicaid. $738 per month I have been charged for this form of mistreatment. When I complained about the poor quality food and the lacking care features, I was told that the state sets the amount. In a way absolving anyone here from responsibility for such outrageousness.

I have been a resident here long enough to have seen several state inspections of this facility. Always the CENAs are reflecting the attitude of the administration, saying in hushed tones, “The state is here”, “they're in the lobby” or “They're on the second floor” with that tell-tale tone that implies no one is safe, we're all gonna get swept up in the net. Beware! When I was employed as a county worker in Lansing, I had many interactions with various state workers from all sorts of departments. I think the tones of implied omnipotence toward the state is similar to that given to various federal systems. Something about the overwhelming greater power of state and federal systems compared to local operations strikes fear and loathing into those on the outside of such organizations. The CENAs often said they hoped the state investigators would come and speak to me. Somehow there was this unspoken understanding that through speaking with me the truth about this place would come out. I got the feeling that if the state would just figure out (through me) what was really going on around here, then things would straighten out. Many of the CENAs would seek me out to find if the state had been to see me yet.

Finally during one inspection that lasted over many days, a state investigator spent a couple of hours with me, over two days. As a result there have been no changes. Not one. Showers are still skipped due to lack of enough CENAs, the food is still lousy, and barely varies. Certain nurses still maintain that I am getting enough care services, or if I am not to just speak up and they will look into it. Looking into it means using tough sounding language but there is no follow through. The CENAs all know which nurses have any CENA background at all (two or three, I think) The rest seem to look down on CENAs and distinguish the work relegated to CENAs as beneath them. These nurses are great at delegating to the CENAs in a very dismissive fashion. Its easy to see in person or hear over the two way radios the facility uses.

On one of these state inspections, as many residents as possible were gathered in the main floor day room, in which the state inspectors held a meeting to assess residents satisfaction. Having had prior experience with state workers, how they too feel trapped in a non-responsive, nearly intolerable system, they have figured out how to tick through the list of chores while actually doing very little that can actually be useful after they are gone. I have seen it happen many times, in various circumstances.

 

One state worker lead the meeting, asking for any comments regarding a list of items she moved through quickly. At one item, Eight fingered John, raised his good hand signaling that he had an issue on a certain item. When called upon to elucidate, John tried with what few abilities he still had available to him. John struggled and stammered, stopped to find just the right word, drooled a bit then tried to regain a composure that had not been available for years. It was obvious that John had an issue, and it was important to him. He wanted to bring up his input, but speaking was no longer one of his forte's any more. John was dependent on the understanding and careful deliberation of others to get his point before he himself would ever get to it. If you spoke his thoughts before he got to them he was immediately grateful, it could be seen on his face. This is often the method that many people in nursing homes use for communication. It truly does utilize the other person to effect full communication. It is a special person that can effortlessly do this with another.

The state worker showed her mettle as well as her lack of ability to work with the residents, after John had begun his moment to participate, when it had become uncomfortably obvious that he was probably never going to reach a statement on his own, she cut him off saying that we could come back to this later, at the end of the meeting. You could feel the energy leaving John upon hearing this. He was ramping up to make a comment as he had been invited to do. The sense of deflation in the proximity of him was palpable, it felt like a defeat, probably like a thousand other little defeats he had sustained prior to this.

It was obvious that John had sustained a stroke and was nearly aphasic, but not fully so. His lower lip often hung loose, saliva often pooling onto his shirt, he never seemed to be able to close his mouth to swallow in a timely fashion. He often was appreciative when one of the CENAs or other staff members would deftly use a napkin and wipe the accumulation from his face, on its way to the gathering puddle on his shirt. You could sense that in those moments he felt positive at the small gestures done for him by others that confirmed he was still a member of the human race, in spite of his limitations.

When that state worker showed the degree to which she was willing to engage the residents on the issues on her fishing list, I leaned over to Big Bob sitting next to me in the back of the meeting room, and said, “ let's wait until everyone clears out after the meeting, to see just how much John's issue is going to be attended to.” He agreed, adding that he bet there was not much to show, on her part.

Sure enough, John's issue was never approached, everyone cleared out and Bob and I got to the lobby in time to see the state workers gathering together to walk to their car(s) joking and deciding which watering hole or restaurant they were going to frequent after such a grueling day, much like so many other state workers I have known many years ago out of town on a fact finding mission.

John's issue is circumstantially resolved, as he died a couple of months ago. His concerns are now moot. The state inspectors still enjoy power and status far beyond anything they have earned. The neighbor is once again using his razor insuring that no stubble has crept on on his chin since the last time he played with the razor. There are only two CENAs on staff this afternoon, which means I won't have any interactions with anyone until dinner is delivered. Right now Pandora is playing quietly on my cell phone, drowning out the neighbor's incessant radio tuned night and day to the country station featuring those Naishvill cowboys in the big hats that all wanna sound like Tennessee.

Just another lousy day in Nannyland.

26 October 2014

Sunday

Yet another example of Nannyland ineptitude

Lunch has been served and duly eaten. A sandwich, three slices of ham lunch meat and one piece of American cheese (which has never been milk in its entire existance, hence the misnomer of cheese). A small cup of three bean marinated salad, and a small cup of chunks of pineapple round out the meal. There was no soup. A packet of crackers was included in the condiments, but there was no soup. A lunch often is compromised of soup and sandwich, except here at Nannyland where everything is tempered by the mantra of “Save a penny whatever the result”.

I have been here too long. I remember the day about year ago when as many of the residents were gathered in the first floor dayroom for a meeting with the new kitchen director, a woman who came on board this floundering ship of warehousing and greif. The company had let its former kitchen staff go and hired on a new company to deliver the food services, Sydexo. The plan was decietful in its practice in that the former employees were all rehired as Sydexo employees. This has been done by many organizations I order to make even greater savings than could be achieved than before. Often the pay or benefits are diminished of the old, rehired employees. In the end the employees are the ones who endup hurting as a reasult of this kind of skulduggery. But to the larger organization the attractiveness is the promixe of a significant cost savings. This sort of business switching has gone on across the country, most recently in the state of Michigan's Prisons. Which have been in the news quite a bit recently for the employees of the food service company caught bringing contraband into the prisons, having sexual relations with peisoners on site, serving tainted meat and other raw food stores found to be infested with maggots.

Most often the efforts to save money end up harming the original recipients of the service being pruned.

During that meeting years ago we, the residents, were told that there would be soup served every day, homemade soups, not out of a can. My initial thought went to the prisoners of the German Third Reich, whose meals often were nothing more than thin, watery soups of dubious background, many times bearing naught of a vegetable or meat ingredient. Then I thought of all the commercial canned soups that are needlessly thickened with wheat flour, that I can't eat. So, although I greeted this homemade soup everyday announcement with guarded acceptance, I took a “Show me” attitude.

So far the 'soup a day' promise has been carried through about two or three days a week. The variety shows little imagination as the same varieties rotate through chicken noodle, cream of musroom or cream of broccoli, minestrone (which looks surprisingly as if made from leftover veggies served earlier in the week), and tomato soup. There never is any black bean soup, white bean soup also known as Senate Bean Soup, even seasonal specialties like squash soup , or even pumpkin soup. Due to these vagaries I tend to disbelieve the homemade soup designation. It was probably a bit of hyperbole lifted from the pracise of American deciet and public relations.

Its a nice clear, sunny autumn day. I can see it out my window. Just the kind of day for a big draught of hearty homemade soup. I got the crackers served on my tray, but the soup has come up missing. The CENA made two calls to the kitchen. One said the soup was chicken noodle. They must have decided that I couldn't eat it due to the noodles, Ihave told them before that I can drink the soup from the bowl leaving the noodles behind. The next call resulted in no soup.

Yet another nice day made a little more unbearable by someone making decisions for me that limit my expeiences. Just another day in Nannyland, sigh!

And they call this caretaking. 

25 October 2014

Saturday afternoon

Yesterday was another bad day here at Nannyland. I was originally schedyled to receive one of the only two scheduled showers a week. The CENA I had for the morning was new to me. She asked what time I wanted my shower, I responded “ten o'clock” that morning. That allowed time to retrieve the breakfast trays after breakfast, a chance to attend to the other residents under her care, and anything else that may come up, then there would be time for my shower before lunch. I busied myself with things that needed attending to from my in bed position, my horizontal office. I looked up occassionally and noticed the clock creeping steadily up to and then past 10 o'clock. By the time the clock read a quarter to twelve, I knew ther was going to be no shower today.

A few minutes later the CENA came in to apllogize, it seems the state inspectors were in the building once again. This puts everyone on edge as the state regularly comes to catch the staff doing infractions against the rules. If the state finds an infraction, the facility gets penalized and possibly the CENAs involved get a reprimand, or worse. Meanwhile the facility constantly hires less CENAs than most of the older CENAs are used toworking with. For the number of residents on this floor the administration now schedules three when they used to schedule four. Some residents are llisted as two person assists, others only one person assist. Personally my rating has been updated from a one person assist to a two person asssist. No one has discussed this change with me, I have had no problems or issues being assisted by one person. When the CENAs get second to assist them, the other CENA usually is a bystander, doing nothing just staying out of the way.

Waiting to do anything until an extra CENA can be rounded up is just a waste of CENA time, which is already short because of scheduling less CENAs than used to be scheduled.

So, my shower was administratively changed to a bed bath, if that would be alright with me. No, I'm not pleased, but what does complaining do, I might not get any cleaning at all.

Earlier last week I found that due to bureaucratic bungling, my request for an absentee ballot for the upcoming elections, was mishandled and by the time I straightened it out the time to register to vote in this township had passed. The result is that I am not eligible to vote for the first time in my adult life. I am not pleased with this development.

The food is consistantly unappealing, tasteless, and presented poorly. I am tired of having to always battle to just maintain life somewhat similar to what I used to have. I am tired of always being diminished in nerly every action that I do. The constantly dehumanizing method that I have to stoop to in order to try to make any decisions or to do anything here in this facility is beyond my swiftly ending capacity to tolerate any more.

Before when I had to deal with unintelegence or stubbornly held ideas and behaviors, I would just leave the fools to sit in their own backwardness. Now, I can't leave. I have to remain a captive of that same stupidity as it plays out around me and effects nearly everything I do or receive. This is not a very caring thing to do to people. It is a kind of bullying, keeping at someone until they no longer speak up and give their response to the treatment they are receiving. I am tired of speaking up, pointing out how the style of help is not helpful, or appreciated. But they never stop, or learn from the things I point out to them. The onslaught just keeps coming, it is so misguided, but they don't understand or try to see another's point of view.

It is easy to see that the staf here for the most part has no idea how to deal with the likes of me. I don't act like the other residents with their dimentias, or stroke inhibeted minds. But that is the treatment that is used on me, speaking to me slowly as if I need the extra time to make sense of what is being said to me. Its insulting, I can see all to clearly what they are saying. I can also see deeper than they can that they would rather continue treating me in the fashion the administration sets, rather than stand up for the better way to treat residents because they are afraid of losing their job. People are not units or the resident in bed number so and so, they are persons and should be treated as such.

Things are not going so well here in Nannyland.

Leaf memories, too many leaves remembered

5 October 2014

Sunday

 

Just a few of the varmints

Ah yes, the ubiquitous leaf blower, a special tool developed too late for my leaf raking experiences. As a kid the adults in my life had an idea of unique labor designated for children of my age. My grandparents owned a cottage at the lake. This was a summer home purchased as a leisure recreational building for members of the family to use for recreation, no one lived there, although everyone had spent the night there at least once. Everyone had special memories for this place.

The lake was a natural feature that had been built up and a part of the local area community for decades. Many of the houses built on the shores of the lake were substantial and had been in families for years. The property next to ours had an ice house on it set back from the lake front several hundred yards. Several of the long, deep properties had antique outbuildings like this which showed the different lifestyle that was the norm back in those days. The ice house had walls that were four feet thick from outer surface to the inner surface the insulation poured between the walls was dried sawdust, sealed from the damp atmosphere from the outside or inside.

In the days before refrigeration, people had ice boxes to keep perishable foods around longer. Those who lived on the lake cut their own ice from the lake in the winter time. Pictures of ice saws and teams of horses on the lake ice to pull the large (often 300 pound blocks of ice) from the water once cut from the surface. It was a local industry. People cut their own, companies cut for the retail trade. Since this was a seasonal venture, some long term safe storage was needed to keep this commodity until well into the warm season. Toward the end of a long,hot summer, ice prices fluctuated upward as the amount of reserve ice for sale dwindled.

Thus the farmer or person of means who built their own ice house could fill it up during winter when prices were low, to use throughout the coming year. With the arrival of cheap electricity and refrigeration, the ice harvest slowly disappeared as people rushed to modernity. No more hauling ice, no more emptying heavy drip pans from the ice box. Everyone wanted a Fridgidaire. The neighbor's icehouse stood toward the back of their property growing moss on its cedar shake shingles and young sapling trees in its nearby grounds. The building was solid in its construction, owing to the importance of the task for which it was designed.

Through many of the properties near where the lakeside cottage was sited were old and very tall oak trees, they appeared to be red oaks. As I recall it seemed as if years before the lake became a human mecca, before the earliest uses of the lake, before the two dueling steamboats vied to haul the summer trade to their summer retreat homes that lined the lake, the oaks began to grow. Like oaks the world over, these oaks left a chemical in the soil from their roots that made difficult the act of growing for anything other than other oak trees. The trees grew tall and unmolested, creating a solid grove of oaks that were very old, and due to their close proximity, very tall. Most of the lowest branches began fifty feet or more above the ground. They were like columns of gray bark that disappeared further up than most people are comfortable craning their necks.

There was one oak in the front of the cottage on the slight rise that came up from the water's edge. From its one low branch some fifty feet up from the ground, some earlier owner had fastened a rope tied off around the branch. The rope extended down to the ground where a board seat had been fashioned to make a tree swing. The rope was a huge hemp type of cordage about two inches in diameter. The length was so long that the swing arm was as long as a Foucault pendulum in some gothic church. Indeed among all of the stately oaks that swing seemed as if set in some natural cathedral of a different sort. The distance traveled on each traverse of that swing seemed to go through several time zones.Come Fall, and it was always late in the season, as oaks tend to hang on to their leaves more into November than October. The leaves would descend from on high with a suddenness that left no doubt the season of green was over. The leaves from those oaks would pile three feet deep, everywhere. They were deep up near the shore, in the front yard, the back yard all the way to the back property line several hundred feet from the shore.

We knew we had to get them raked up before they got wet and sodden from the autumn rains and the winter snows. There were so many of them that if the wet weather got there first the effect would be like several wet newspapers pegged to the ground to smother anything else that was there. Between the extensive shade from the canopyand the previous leaf litter smothering the ground, not much could grow there. The grass was thin and not very thick in the sandy soil. Our fall chore was to go to the lake by noon and rake and haul until dark, to get the leaves away from the shore side of the property. If the leaves were to be blown by the gathering equinox driven zephyrs onto the lake, they would become waterlogged , then sink. To disintegrate on the shallow lake bottom near shore, which would create a muck bottom where the sand and stones were now, killing the clams and crayfish we little boys loved to find on an early summer morning.

Just a quarter mile west along the shoreline from the property was the only spot along the lake that was not built up. The land was low and prone to swamp, the lake was shallow from quite a way from shore. The lake bottom here was mucky and a great hiding spot for snapping turtles to hide sunk down into the soft bottom. We called it “Turtle cove”. The property next to Turtle cove on the other side from us was about as low as one could build without sinking. They had a dock and a motor boat, but the water was so shallow that there was a trench below water that had been dredged from the lake proper in to where the boat was tied up next to the dock.

We didn't want that to happen, so we diligently drove out to the lake every fall armed with split bamboo rakes and 16 foot burlap sheets with ties at the corners to convey those thousands of leaves to the back of the property here we made huge mounds to collapse and decay in the seasons to come. We made a festival out of such a tiresome task, packing along hot chocolate, snacks and lots of soda pop. The technique was to first walk in striaghtline with shuffling steps so a to move as many leaves as possible to see the grass on the ground. Nex the rakes were employed to enlarge the narrow strip of grass into a wide patch of grass. Then the tarp was laid down and from all sides the leaves were raked, kicked, shoveled and in any manner possible moved onto the tarp. Then two or more consecutive ends were gathered and even more leaves were encouraged to join the pile growing within the burlap fibers. A third corner was gathered as even more leaves still were crammed into the burgeoning bag. Finally the burlap could contain now more. The four corners were gathered tight and the next lucky contestant would drag, haul and otherwise remove the next load of leaves to the far edge of the property. The tarp had the weight of an eighty pound bag of water softener salt. A few trips hauling the leaves soon lost its allure. But there wer many loads to move. A gsrden cart was way too small, it would be crushed by the size of those burlap bags, the wheels could not turn. The option was to pull the corners of the burlap tarp ove r the shoulder and drag the offending leaves to the approved site. It became easy to formulate tunes of heroic proportions in one's head when dragging those leaves. When I got to Michigan State and saw the grounds department dragging a power take off driven fan behind the large tractors used for grounds work, I knew that I had been born just a few years too soon.

I reasoned that idea would take off, soon there would be leaf blowers of every size for every kind of lawn job, and portable leaf vacuums too to get into the shrubbery where the leaves love to hideout, safe from the vagaries of any November wind. Wouldn't you know it, my father has one of these handy tools now. I used to have to make sure my leather work gloves were up to the raking task, those blisters were terrible in the web be tween the finger and thumb. Now you just give the pull cord a rip and blow or suck those leaves away.

Where to fit in?

4 October 2014

Saturday evening

Hearing the neighbor's television broadcasting Saturday evening's college football game. I heard the sportscasters take a break to bring the audience up to date on the baseball scores. I was taken back to this time many years ago in seventh or eighth grade, junior high school, at a time when one was trying to determine who one was and what was going to be important to them. I knew what baseball was, but was never that good at it. I thought maybe I would be a fan. But no matter how much I managed to stay up on the most currant scores, it never held much for me. Those who memorized stats and records, finding out the score part way through the game during study hall, or hearing who just won the game after school. I just couldn't get any internal motion going over it. They were just numbers telling about a game, nothing more.

Its funny how during those times we try to assume a persona that we think might be the thing that will set us apart,or at least give us some thing to differentiate us from everyone else. I was not really cut out to be a sports fan or even a commentator for that matter. I just never had the flair for it no matter how much I tried to put myself into it. I didn't have a favorite ball glove, or the hat, curved just so with the most cavalier, rakish slouch to impart that just so look of practiced ease and disregard that said “cool” whenever it was worn. No, I never had those things or any of the other stuff that went along with being a sports fan.

I spent my time in the woods, listening to the trees speak in that voice that few could hear. I spent time watching squirrels, chipmunks, birds and the forest denizens. I watched the way the clouds told of weather to come, the invisible winds blowing that were unseen, except for the things they moved about. I heard the symphony of the night sky coming from the Milky Way, when it seemed no one else listened. I noticed the poets listened but not many people seemed to care. The sounds of secrets told, that had been revealed to those who listen, but few do. The world was so rich and so unsought, but it was magical to me. It still is.

I need to get out more.

Coming soon

2 October 2014

Thursday

A nicely overcast morning here in Michigan, the land down wind from a huge natural cauldron for producing water vapor through out the winter season. As the atmosphere cools the summer warmed water of lake Michigan rises up to join the prevailing westerly wind ghosting over the surface. By the time that moisture laden wind makes it over the state, the moisture has cooled, condensed and is no longer able to remain aloft. This kind of weather always reminds me: Winter can't be far off!! Snow comes soon.

I may be older, even no longer able to play in the snow as I used to do, but the childlike joy of winter snows still strongly reside in me. It does not take much to recall that delicious wet wool mitten smell, the quietly zipping sound that snow flakes falling as snow is flying past your ear, that strangely muffled sound of a winter scape gleaming in the bright sun after a snowfall has blanketed the outdoors.

I know the powers that be, the ones whose fears governing the care features of my life, will balk and pitch a fit. But I intend to a least sit outside in the winter as much as I can when the time comes. My winter scape will be penetrated with the sounds of automobiles and the city more than I would like, but I plan on getting as close as possible to actual winter weather. Not just gazing at pictures of it. A trip outside is invigorating, it makes returning to the confines of four walls a much more interesting contrast. I'm looking forward …

Good for one is not good for the other - Death is no secret

1 October 2014

Wednesday

I often spend long hours in bed, sometimes whole days at a time. There are two reasons for this: 1) Once I am up in the wheelchair, when I grow weary and tired, it can take an hour sometimes more, to get a CENA to use the machine to get me out of the chair and back into bed.

The reason that this is because the venture capitalists who bought the company who operates these nursing homes are demanding that this facility save more money (in their expenditures) by hiring less CENAs. The push is to get three CENAs to do the work that four used to do. While the cost to me doesn't change the facility is paying less for CENA work, thus the unseen, unknown overlords receive more money, that which is now buying one quarter as much labor. Somehow these powers that be believe they are making more money off a previously inefficient operation, they win and nobody pays a difference.

And people wonder why the electorate didn't trust Mitt Romney, another venture capitalist, you know, the one who thought it was a good idea to put the family dog on the roof of the car for a long road trip. Must be chasing other people's money weakens the brain from making other good decisions.

EXCEPT, there is no mechanism for measuring the rise in dissatisfaction this causes in the CENAs or the residents. The CENAs recognize right away that they have no time between caring for residents. Their tasks are now curt, short and finished sometimes before everything is completed as they hear the call lights buzzing and are off in as quick as can be. Lots of mistakes are made due to this. Some residents believe the call lights are their personal signal to a maid or butler, or someone to keep them from getting lonely in this strange place, they hang on the button constantly. The CENAs have no idea what the problem may be without going to the room to find out. When there used to be four CENAs scheduled they would often cover the call lights for one another, no more. The administration has taken to measuring the length of time it takes to respond to the call lights, if the number gets too big a reprimand is in the future. Too many reprimands can result in fines. In some places this is known as motivation of employee behaviors.

2. Once I am in the wheelchair my hips, legs and feet no longer move. But I still have a limited sensory system. The feelings may be hot, cold, electric, dull, sharp, narrow, wide, pulsing, or a combination of many at once. After a period of time with no movement certain aches begin to grow and take over my senses. About four hours into the chair and the various body parts affected are screaming for relief. A change of position usually does it. Sadly wheelchairs are not designed for wiggle room, and I don't wiggle any more.

When I do spend a long time in bed, one moment can grow to be quite like all of the previous ones. I try to keep myself distracted entertained. My neighbor uses his facility supplied television for this purpose. I do not particularly enjoy daytime programming; The Maurey Show, The Price is Right, the noon news – complete with a cooking segment, Judge Judy, Judge Ross, America's Courtroom all add up to a pretty sad commentary on the state of the Union these days.

I retreat to the earbuds and my iPod. The earbuds partially mute the seeping television as it comes through the door. The rest is blocked by my extensive collection of music. However after a few years, I have begun to down load and listen to podcasts. I have heard more interesting podcasts than I ever had before.

Earlier today I was listening to NPR's TED hour, there was an episode about privacy that drew my attention. The old notion of privacy is beginning to turn slightly, or quickly depending on the circumstances. Some ideas regarding privacy are pretty stilted. Here in this facility they won't reveal anything about anyone for fear of HIPPA laws. I used to help administer security and HIPPA compliance in the clinic I helped run, I know about HIPPA and the way this place operates is way too overboard in the failsafe mode to the point of being punitive. We are all residents here from different backgrounds, thrown in together for better or worse. Then we are told to get to know one another. First thing people do when they get to know each other is to exchange names and the reason that brought us all here. Then we gradually get to know each other. Except the lawyers who I have met here, they insist that no one know their names, what brings them here, or anything else about them. Then they complain about how lonely it is here.

When a woman I befriended here disappeared for a while no one would say a thing, citing HIPPA laws. A week later I just happened to see her in a new room. I was so glad to see her again, and told her so. She was a good friend, facing cancer and lots of chemotherapy. She had few visitors and fewer family. A few weeks later she disappeared again. Same as before my questions were answered with the dreaded, “We can't tell you, HIPPA laws” response. Everyone played silent for weeks afterward. Then I found her name listed in the obituaries of the local paper. When I confronted some of the administrators with this information, they all knew all about it, and were surprised that I had found out. Those fools were willing to continue playing games with the information as to my friend's whereabouts and what state she was in, even after she was deceased. Says a lot about how they value me, or any of the rest of the residents here.

These folks encouraged me to interact with her initially, saying that she could use some good intellectual stimulation. You know she did. But when she was out of sight the staff here suddenly played stupid, citing the HIPPA law for their apparent ignorance. You know that voluntary lack of intelligence leaves some residue behind each time it is invoked. The folks that occupy positions of power here often strike me as not knowing much beyond their limited original knowledge. I'm afraid they aren't capable of learning very well due to the rules they follow.

And yet the HIPPA law is not universally invoked, I am subjected to strange women coming into my room and performing the most personal tasks on my body, my private parts and absolutely no care is taken to hide or protect my privacy. I didn't think that laws could be arbitrarily invoked, guess I was wrong, or it depends on who has the money behind them to pay for the biggest lawyers.

Well, back to noticing the inequities of the situation.

This has been resident 322b2