If I were not a [Jewish] Buddhist, this would be my Mad As Hell and I Can’t Take it Anymore moment.
It is 3:04 AM. I am making coffee. Washing the dishes. A shower is overdue. At 8:10 a Cataride para-transit bus will pick me up here in Downtown State College where parking (believe it or not) is a problem.
This is the parking lot at Addison Court–a residence for low-income elderly and disabled: A ghetto by any other name is a ghetto.
After riding through the astonishingly beautiful countryside of Centre County, PA, I will be arriving at HealthSouth, Pleasant Gap–one of an empire of 123 U.S. physical and rehabilitation hospitals based in Birmingham, Alabama. Coming soon, as a result of a recent merger, HealthSouth will have a new name: Encompass South. [East, West, and North still in the planning stage.]
Whenever possible, always go to the Securities and Exchange Commission 10-K form.
This is what the parking lot at HealthSouth is like when I arrive before 9 this morning.
At 9, I will begin the routine Pittsburgh-trained Occupational Therapist Christine Vuchenich has established. The routine consists of:
Stretching exercises at her wooden table.
Use of the Baltimore Technology shoulder stretching wheel
Push ups and other exercises.
On Friday, progress stops. Then, I have to resort to in-home exercises. No sophisticated equipment. No informed instruction. Just hours a week of exercise exercise exercise.
Last week, I completed the 28 weeks of physical therapy with Shannon Duranko who received her doctorate from Slippery Rock University. For the first time (last week) I walked the length of the parallel bars and back.
I do not have parallel bars at home.
What I have at home is persistence. Think of Medicare as city hall. I have already begun my plan to fight city hall. Medicare’s short-sighted cutback of physical and occupational therapy means that using movement to relieve pain likely will be replaced with using Oxycontin to relieve pain. Instead of continuing progress so I might use Lofstrand crutches and a walker for mobility–with the eye on the prize of being able to walk again–Medicare may once again spend unnecessarily for frequent trips to the emergency room or for hospitalization.
The pretender to the Emperor’s throne  stood in the innermost sanctum of the deposed ruler’s palace  and listened, beaming with pride, as the younger of his ten-year-old twin daughters finished reading the framed poem aloud. The poem had been left behind on the wall when the deposed ruler fled into the night.
“‘Yours is the earth and everything that’s in it,”‘ she read, “‘And–which is more–you’ll be a man, my son.'”
The ten-year-old girl had read Kipling’s “If” with what at one time was called expression. The Filipinos in the line behind her applauded enthusiastically. She turned, curtsied prettily–despite the jeans she wore….
“Very, very nice,” said [her father] Artie Wu who stood six foot two and three-quarter inches and weighed 249 pounds….
His younger daughter made a face at the poem on the wall. “God that’s dumb.”
“Mr. Kipling had an unhappy childhood,” Agnes Wu explained. “To make up for it he sometimes became a trifle optimistic and overly sentimental.”
Her daughter nodded wisely. “Mush, huh?”
“Mush,” agreed Agnes Wu….”
The older of the twin daughters (older by 21 minutes) turned on her sister. “It wasn’t as dumb as ‘Invictus’ that you got out of and Mrs. Crane made me memorize last year. You want mush? ‘Out-of-the-night-that-covers-me-black-as-the-pit-from-pole-to-pole-I-thank-whatever-gods-may-be-for-my-unconquerable-soul.’ That’s mush.”
Ross Thomas created Artie Wu to be the kind of hero who runs away from a Methodist orphanage with his self-respect so firmly in tact that he humorously refers to himself as next in line to be Emperor of China (even though China does not have an empire).
This scene takes place in the Presidential palace of Ferdinand Marcos, a garish dictator of the Philippines who was removed from office in 1986. After Marcos fled, tourists (as in this vignette) flocked to his palace to see how he lived.
I know. Footnote three does not refer to anything.
Regarding: Pleased to be back at physical and occupational therapy
This is the abrupt transition I warned you about. I was reading Ross Thomas as I packed and prepared to arrive at Health South, a for-profit hospital in Pleasant Gap, Pennsylvania nine miles northeast from my apartment. I began writing this post after checking in to my mountain view room on Sunday night April 24th.
I have been in a state of physical decline following my return home to State College, Pennsylvania after spinal surgery in New York City. This state of decline (despite periodic ups and downs) has persisted from December to the present. My admittance to HealthSouth, I hope, marks a new beginning.
Background: My Previous Hospitalizations at HealthSouth
This is my third hospitalization at HealthSouth in the last 12 months. Below is a video I made in October. I spent three weeks in hospitals that month. My first stay was a consequence of breaking my left ankle. Mount Nittany Medical Center transferred me to HealthSouth where I learned to transfer from the bed to my scooter without putting weight on my foot. Essentially, I was hopping as I saw the rabbits do on Monday night while scooting around this building.
My second stay at HealthSouth followed my hospitalization for a dangerous MERSA infection. At Mount Nittany Medical Center [where the food–surprise surprise–is superb] the doctors saved my life. They did so my draining the puss from oozing wounds on my body and providing massive doses of antibiotics (first through an IV; then pills).
Susan Hartman is the C.E.O. of HealthSouth at Pleasant Gap. “As chief executive officer… for the past nine years, Susan Hartman oversees the day-to-day operations of the 70,000-square-foot, 73-bed inpatient rehabilitation hospital,” writesTown & Gown Magazine. “Located at 550 West College Avenue in Pleasant Gap, HealthSouth Nittany Valley serves patients across the region, offering comprehensive inpatient and outpatient rehabilitation services designed to return patients to leading active and independent lives.”
I met Susan on the last day of my first stay at her hospital. I suggested that HealthSouth consider working with companies constructing housing for the elderly and disabled. I was impressed by the skill of occupational therapists (OT) on her staff especially in their use of activities of daily living (ADL).
Following my hospitalization at Mount Nittany for MERSA, I was released from the hospital, but was unable to bandage my wounds adequately. At a loss for how to take care of myself, I wrote my children expressing pessimism. I copied Susan in my email. The following day, a HealthSouth administrator called to tell me that my admittance had been approved. What a relief!
Digression: How Healthcare Expertise Is Useful in Designing Housing
Here I will digress on the significance of activities of daily living. In the kitchen, for example, ADLs are useful for breaking down into definable units how to make breakfast. With my work with Dr Sonali Kumar using virtual reality for elderly and disabled residences. ADLs are essential for building design.
“Experienced-based design” is the term of art for an approach to architecture where the residents requirements determine how a building is constructed. I am hopeful that a consequence of my meeting with Susan that HealthSouth will form an alliance with the Penn State Department of Architectural Engineering where I work.
Yes it helps me to know that in HealthSouth’s occupational therapy kitchen, the distance from floor to sink is 36 inches. My experiences during my three times as an in-patient have ranged from the useful to the dramatic. It was dramatic for me to have a near-death/out-of-body experience when my second stay at HealthSouth came to an abrupt end.
I had awakened on a Thursday morning with chest pains. HealthSouth’s compassionate Medical Director Richard Allatt ordered an ambulance. Doreen, my nurse held my hand until the attendants came with a gurney. As I watched (mistakingly believing I was going to die from a heart attack), I felt myself to be a third-party observer as I was being loaded onto the ambulance en route to the emergency room. I marveled at the beautiful early morning mountain scene saying to myself, “This would make great video.”
At the time I had been making videos. At first I produced elaborate architecture videos as enhancements to my column for e-architect UK. At HealthSouth, I made cinema verite videos (yes, I know this sounds pretentious) to provide short unedited perspectives on the mobility disability experience.
Leaving HealthSouth, I was thinking about Megan Brown, the “star” of the above video. I was filled with a sense of profound gratitude to Dr. Allatt, Doreen, Megan, and the other physical and occupational therapist and staff at HealthSouth. Consequently, months later after I found my health to be in distress. I was pleased to be back here.
My April 24th to May Second stay at HealthSouth
The single most significant aspect of my stay is the time I have been spending on the parallel bars.
Standing is special for me. So is “walking” upright, even if walking simply consists of moving between two parallel bars–using the strength in my arms to keep me upright and get from here. I wrote that I hoped my stay at HealthSouth would reverse the decline in my physical health. Central to achieving my goal is a broader range of mobility and the necessary strength.
In the report I have been writing on designing housing for the mobility disabled, I emphasize the notion of transparency. Access in the home should be so readily available that the resident is reminded as little as possible that she or he has a disability. For example, for a two-story house an elevator or a wheel chair lift is far preferable to a stairlift. For a stairlift one has to transfer, and the less transferring the better.
Transparency relates to my physical therapy goals. For the past 21 years as a paraplegic, I have managed to compensate for my disability by relying extensively on mobility devices such as scooters and power chairs. These are extremely helpful tools. When I first used a scooter I was in my forties. Working was essential for paying the mortgage and supporting my family. The speed and appearance of the scooter made my disability seem less disturbing. My employers, co-workers and children regarded the device as a neat technological solution.
A few years ago, I teamed up with a local supplier of mobility equipment to show disabled members of my synagogue the freedom these devices provide. One elderly woman expressed concern. Her inability to walk trapped her in her home. She worried that dependence on the scooter would result in her losing what mobility she had. I pointed out that while exercise is important fatigue is counterproductive.
I was correct (of course). Mobility devices do provide freedom. Any physical therapist will tell you that fatigue is debilitating. Yet my argument was fallacious because I had failed to be moderate. I was lazy. I did not exercise. Twenty years ago, a year after I lost the ability to walk, a physical therapist prescribed fore-armed crutches (above) and braces (photo above crutches).
Through lack of use, I have lost the strength and balance to use the crutches. The braces prevented my toes from dropping–I had dislocated my right shoulder when I tripped over my toes. The braces also kept my legs steady. As the photograph shows, through lack of use my leg muscles have shrunk.
My major accomplishment at HealthSouth was my ability to use this tool. I am not strong enough to use a walker. This platform above a standard walker made it possible for me to cross the floor from one end of the room to the other.
HealthSouth’s Pleasant Gap facility has a number of excellent physical (PT) and occupational (OT) therapists.
Hic Haec Hoc
Orientation for new patients
To be discussed is the especially significant “happy wheels” designation.
Meanwhile, in an unrelated event, nurse Sydney pushed me in a wheelchair and weighed me. Minus the weight of the wheelchair, I weigh 143 pounds. I have lost over 30 pounds in the past year. Dinner will arrive shortly. Then a friend. Tomorrow is another day.]