Trouble in Two's

This time the “trigger” was the pureed diet. Patients with dysphagia that require pureed foods are at nutritional risk. But not all patients requiring pureed foods need that texture modification because of dysphagia. Some just don’t have any teeth.

There was a speech pathology evaluation scheduled. That procedure would determine the patient's swallowing ability and risk for aspirating food into the lungs, and therefore, what texture modifications and liquid thickeners to use.

When I knocked, and heard a loud audible “come in,” I entered. The lady in the first bed was more or less non responsive at that moment. But it was the lady in the second bed that I was intending to visit. This lady was hidden behind the curtain separating the two beds. I could tell the nurse was there. The nurse was finishing her procedure, took one look at me and gave me a look I could not recognize, and she quickly left.

“Well, you are the handsomest young man I have ever seen in a long, long while.” Ms. [ ], the patient, chuckled.

By now, my attention had shifted from the nurse to the patient propped up in bed. A rotund little thing, Hillary Clinton cheeks, toothless grin, thinning gray hair.

My head is spinning for some kind of response. I dare not agree with her, for that would be a blatant lie . . . not about to confirm that I am both handsome and young. And I didn’t want to provoke a fight by disagreeing with her . . . got to keep the clients happy.

“Well, I will just have to tell my mother that, it will make her feel good,” was the only thing that somehow blurted out of my mouth.

She chuckled in that way that made the covers bounce.

And we proceeded with some kind of a joking nonsensical conversation that just sort of spontaneously erupted. And in the midst of the bantering back and forth, I did learn that she does very well with her pureed foods, that she has no teeth, and that she has a great appetite. It was just her old breathing that was getting her down, and that being the reason for her admission to the hospital.

However, I didn’t learn about a very important physical state that would affect her nutritional requirements. At least not yet. It was not mentioned in her chart.

And she looked at me again.

“You are the youngest, handsomest man I’ve ever met.”

“Well, I don’t know about the young part, and not too certain about the handsome part as well.”

“But you are a hell of a lot younger than me!”

I knew her age. I looked down at my sheet of notes I had made from her chart that I will use in forming and documenting her nutritional care plan.

She was 89 years of age.

“OK, I know how old you are. And you are right, I’m not quite there yet.”

And I’m wondering how is it that I get myself into these jams? Here I am, an ugly old gay man being hit on by a toothless, jovial, 89 year old woman! It is not in my heart to break hers.

And I stammer some more, looking for any excuse for an exit.

“OK, Ms. [ ], it sounds to me like you are having a jolly good old time.”

“Oh, I am! And you are the youngest, handsomest man I have ever seen!”

I laughed. What else could I do?

“Now Ms. [ ], you stay out of trouble now!” And I turned to make a quick exit.

Her response struck me as being quite profound. I just didn’t know it yet.

I got back to the nursing station.

“Well how did your interview go?” the nurse with that-look asked me with a besmirched grin on her face.

I had to chuckle. “Well, she is one character.”

“Yeah, and did she tell you she is pregnant?”

“Pregnant?”

“Oh yes. She is very certain that she is pregnant. Thought you might need to know that as you recommend how many calories and grams of protein she needs!”

Well, yes, there are incremental requirements in the second and third trimesters of pregnancy.

“And just which trimester might she be in?”

And the banter at the nursing station took off on other stories of elderly, delusional patients who have thought they were pregnant or inflicted or blessed with a myriad of other anomalies.

And Ms. [ ]’s parting comment to me now hit me with a poignant stab.

“It takes two to stay out of trouble!”

The Refectory Manager

Whirling Spots of Entity

The ghoulish part of me was piqued. A blog entry about how the funeral industry was adapting to the changing needs of the persistent dead. Things like incorporating the cremated ashes into a cement plaque, or making biocadaver paper out of the pulped cremated remains, so that an everlasting bibliocadaver book could be used to hold the memories of one’s self. Or a geek entrepreneur’s wet dream . . . maintaining a perpetual web page of the deceased.

It struck me as to the ends that marketers will go to sell the permanence, the immortality, the immutable identity of one’s very persona to those who crave permanence, immortality, immutability of one’s very persona.

And I ran across this ghoulish blog in a diversion from some heavy studying of “domain-driven design” – a concept in software architecture and design that relies heavily on the concept of “entity.”

Not to get into the esoterics of just what an “entity” might or might not be, especially when contrasted to a “value” object, suffice to say that an “entity” can be a thingy, real or imagined, virtual or physical, that uniquely exists and may even need to be remembered with its own identity.

Take a child. When she is drawing with markers, she cares about the color, about the sharpness of the point. And if there are two markers of the same color, the same point style, it matters not which of the two she uses. The marker is a “value.” It is not unique. If it is lost or dries up, and is replaced, there is still a marker. It will be used with the same functionality.

But put that same child in front of the refrigerator, and with no hesitation what-so-ever, she will give a detailed critique as to which drawings are hers, and which are her brother’s. For the drawings are now “entities.” Unique. They have an “identity.”

And take that same child again . . . this time within another “domain.” The child herself can be an “entity.” A unique, one-of-a-kind thingy with a specific one-of-a-kind identity. A number in the Social Security Administration’s collection of one-of-a-kind human thingies. But in yet another “domain,” she is but a “value.” Just one of 30 monoclonal first-graders on a school bus. In the “domain” of the transportation system, the school bus is the “entity” and the kids are “values” identifying the characteristics of the school bus.

But back to that child. That Social Security number still does not make her “unique.” Errors have and do happen. Social Security number identities even get stolen.

And just what is it that does give a person a unique identity from that first baby picture – the sonogram, to something far beyond the cement plague of congealed cremated remains. Can’t be a name. Names change, get changed. Can’t be finger prints. Tragedy does happen with amputation of hands, arms. Can’t be dental records. Things happen over time there too.

Can’t even be DNA. Although rare as it is, human chimerism does exist. [A chimera is the result of fraternal twins fusing together at a very early stage in development. The offspring can have different DNA in different tissues of the body.]

So what might it be? What is it that makes me me. You you.

Remembering the mirror on the bathroom wall, it placed me somewhere between my eleventh and fourteenth birthdays. There were several occasions when I stood before that mirror. Pinching my face. Feeling the physical reality. Asking, pleading with that reflection in the mirror. “Who are you?” “What are you?” “Why?” “How is it?” “How can it be?” And I would finally give up with a head-spinning wonderment of things far beyond my comprehension and understanding.

“Who are you?”

“What are you?”

“And what makes you unique?”

“And what is the entity key that identifies you throughout eternity?”

“At the resurrection, what will it be that instantiates that entity as me?”

In that ghoulish world . . . it is ashes to ashes incorporated into cement or paper. It is DNA scraped from the inside of a cheek, analyzed, and incorporated into a DNA database. It may even be sperm or eggs harvested immediately after death and frozen. It may be a web page that hangs around until a server crashes. It may be the images as photographs, or voice prints. It may be the reciting of oral history.

A person as an entity. A permanent, immutable, identity.

In that software world, that person as an entity is nothing but spots of magnetism whirling on a disk drive platter. Some unique arrangement of spots, with their only characteristic of being magnetized or not. Spots are values. Values that give identity to a personified entity.

But for that child. She too is spots. I am spots. You too are spots.

But spots of what?

And when the ashes wash away . . . and then are assimilated into new living things . . . and the soul doeth sleep . . .

Of what are spots?

For those spots existed in some form from the beginning of time and will continue to exist on throughout the duration.

Whirling spots of magnetism on a disk drive platter.

Whirling spots of unique identity whirling in the dust of whirling stars within whirling galaxies within realms of heavens beyond comprehension.

And always remember, that God made you as a truly special and unique human being, just like everybody else.

The Refectory Manager

“Hey! I’m not a part of this!”

The gray-haired lady was distraught. Struggling with a wheelchair that she had just extracted from the front lobby of the North Entrance to the hospital. The passenger-side door of her car was open. The wheelchair, however, in just obeying the laws of gravity, insisted on rolling down the gentle slope.

I’m walking up the driveway of the hospital’s north entrance, pulling my computer case, thinking it was going to be another great day. Yet quickly becoming aware there is something a little intense unfolding in front of me.

The gray-haired lady is getting highly distraught. Frustrated. Befuddled.

Being super cautious about lawsuits and liabilities of what a contractor person could or could not be doing on the front steps of a hospital is the first thing that pops into my mind. But I realize I can at least keep a law-of-gravity-abiding wheelchair from frustrating what is apparently an already frustrating experience.

The gray-haired lady is muttering something about pillows. Extracting pillows from the open car door. What actually needs to be extracted from the car and transferred into the wheelchair, I have no clue. But I assumed it would be an elderly person with some kind of infirmity . . . for that is pretty much the demographics of this hospital. Hence my fear of liability.

But what emerged was a young lady, bare midriff about to explode, frustrated that she had now dropped her cell phone and could not bend over enough to get it.

The words “maternity,” “third-floor,” “can’t leave the car here,” “how to get there,” rolled into a confusing conversation between what I now presumed was an about-to-be grandmother and an about-to-be-new mom.

I volunteered to push the wheelchair with the about-to-be-new-mom into the hospital lobby, to at least get that part of the immediate crisis resolved, and to get help from the Volunteers manning the lobby. The gray-haired lady grabbed my computer tote-case and insisted on bringing that into the lobby as well. I attempted to reassure it that it would be just fine, nobody was going to drive over it. It could momentarily stay where it was.

Then, through the revolving doors, another woman frantically waving. “I’ll take care of it. I’ll take care of it.”

Take care of what, I am not certain.

I continue to push the wheel chair with the young lady who is now having a contraction. The gray-haired lady abandons my computer tote bag and returns to her car. The frantically-waving new lady grabs my computer tote-bag. We all make it through the revolving door – in serial fashion.

And the frantically-waving lady says that she will take my computer tote-bag to the third floor and hastily starts to lead the way.

Whoa!

I look at the young lady having a contraction. She looks at me. Somehow, we both know the ridiculousness of this little twist in the scenario. And we both manage a laugh.

“Hey! I’m not a part of this!” I blurt out.

Now I am the befuddled one. How in the h – e – double-toothpick do I graciously get out of this!?

And the frantically-waving lady, who I have quickly come to the conclusion is probably the nurse-midwife, turns with a look of embarrassed astonishment on her face.

“Oh! I see.” She stammered.

Please! Mercifully! I hope she thought I was at least the grandfather!

The Refectory Manager