McCleary MRSA Prevention

This is Blog #3 about the my home town Millinocket , Maine’s  growing and reproducing COVID 19 outbreak.  My heart breaks for the people up home and all of their families.  I am frustrated, but at the same time I want to be fair.

In my last blog, I mentioned a suspect  pastor.  I really wonder about his compliance with COVID preventative steps and seemingly  cavalier attitude about the outbreak from the wedding where he officiated.

I came up with a list of fair questions for him and for all of the other guests and venue workers who attended this wedding, which in turn became a super spreader event.  Granted some of these questions perhaps only the State officials could answer.

1. Were you tested?  Was every other guest and venue worker tested?

2. Were you asked to quarantine for 14 days because of your close and lengthy contact with someone who became sick with COVID?

3. Were you told that a negative test does not mean that you can come out of a 14 day quarantine?

4. Did you quarantine for 14 days from time of contact (Wedding Day)?

5. How long were you asked/required to quarantine if you tested positive or became ill with COVID?      ie. was your quarantine extended and did you comply?

6. Did your household or Church members also become ill?

7. Was the difference between quarantine and isolation explained to you  and did you observe the rules and differences? Information below

I think I find a lot of the answers right here in this Bangor Daily News article that was just sent to me today, but it is not fair to make assumptions.

Still, I fear that we have a Public Health menace in our midst.

https://bangordailynews.com/2020/08/29/news/york/5-people-associated-with-a-sanford-church-have-tested-positive-for-covid-19/?fbclid=IwAR1KlTFkrRoogtaNbArtOc48IAGw8stetD4ZclZ72o6TND6ripstt1hg-f0

If these folks from the wedding did not know about their exposure for 5 days or a week, then nobody can fault them for what they did during that time.  If however they continued to gallivant around the town, State or country after being told to quarantine, that is a different story.

There is still a lot we don’t know about the movements of the wedding party, guests and venue workers.  All of us are angry and sad about this.  But, someday we will need to heal, and getting answers is part of that. It’s hard to get past that they ignored a lot preventative rules for the wedding church and venue.  If they continued that careless attitude after learning there was an outbreak, then they need to be accountable to the State of Maine and to all of the people impacted.

The only online conversation by the bridal party that I have seen told me a lot.  They talked about how unfair the media is and how they are like vultures, how persecuted they feel,  how they already had to postpone their wedding once and how they whittled down the guest list.   Some other pretty dismissive comments were made about the outbreak like how it was just like a mild cold or most people don’t even get sick.

They did not mention the poor lady who died, or others who were very sick or mention any feelings/emotions about that.  It would be my extreme pleasure to sit down with the young women who conducted this conversation and give them some lessons on COVID and life in general.  We all have to grow up some time.  And for these girls, now would be a great time for that.

I would like to see one representative from wedding group, come forward.  I would like to hear their side of things, like some answers to the questions I have listed above.  I’d also like to learn about what they are going to change in their own behavior, both personal and professional, to keep this from happening again.  Maybe the pastor could tell us how he will mandate masks at his services, and how he will wear one himself, and offer hand sanitizer, and how he will require members of his flock to sit 6 feet apart.  He could explain how much cleaning and disinfecting he is doing in his Church.  He could tell us how he is educating his flock to prevent anything like this from ever happening again.

But most of all, these folks could say something, anything about how bad they feel for the deceased, her family, the others who needed to be hospitalized, and all of the other people who became very sick at home.   They could also apologize to my home town for their carelessness.  And they could offer prayers or some other kind of compassion for all of them.

I don’t think it is too much to ask for .  124 people in this state spread out over many miles,  have been impacted by this single event. Thousands of others around the infected victims have also had their lives altered because of them.   Someone needs to answer some questions.

https://www.mayoclinic.org/coronavirus-quarantine-and-isolation/art-20484503

“These terms describe approaches for limiting the spread of disease during epidemics and pandemics:

• Social distancing. Keeping space between yourself and other people outside your household to prevent the spread of disease.
• Quarantine. Separating people and limiting movement of people who have or may have been exposed to the disease to see if they become ill.
• Isolation. Separating people who are ill from others who are not ill to keep the disease from spreading”.

Information below from the CDC.

Rules for Quarantine

Jul 22, 2020

When can I stop home isolation after a confirmed case of COVID-19?

If you are a healthcare provider, please follow your supervisor’s recommendations. If you are immunocompromised, please discuss this with your medical provider. Otherwise, if you will not have a test to determine if you are still contagious (most people will not) you can discontinue isolation when:

1. You have had NO fevers for at least 72 hours (3 full days of no fever without using fever-reducing medicine)
2. Other symptoms have improved (i.e., your cough or breathing have improved)
3. At least 10 days have passed since symptom onset

If you had a positive COVID-19 test AND have remained asymptomatic, you may discontinue isolation when at least 10 days have passed since your first positive COVID-19 test. It is important to still wear a face cover over your nose and mouth in public settings after isolation is discontinued.

https://www.maine.gov/tools/whatsnew/index.php?topic=Portal%20News&id=3198521&v=article-2017&fbclid=IwAR18BFK6tl-GUiTvZsG6xlYkwNILWlf6CNSBL6opIWHLr5YkrgbGfsp1gJg

Millinocket facing Mount Katahdin

Preface:  I love my beautiful hometown.  I liked it better when we all talked more about the beauty of the region, good times, the resilience, integrity and warmth of  the citizens,  instead of COVID.  We will all work really hard to make it that way again.

My previous blog was about the ongoing heart breaking tragedy in my hometown, Millinocket, Maine. My town  is in the midst of a growing  COVID 19 outbreak.

On August 7, a young couple were married at the Tri Town Baptist Church in East Millinocket, ME. Then they moved the gathering to the Big Moose Inn on Millinocket Lake about 15 miles away.  This should have been a fun, beautiful celebration. The  happy couple, their families and guests should have been able to enjoy this special occasion without a care in the world.  Party on…right?

Wrong, there is a COVID 19 pandemic.

Churches and reception venues are under strict State preventative guidance and regulations.  Safe happy celebrations are possible, but unfortunately, they all must be done with special hygienic precautions in mind.  Nobody likes this, and nobody wants to put this cloud over any celebration, but this is life right now. Lives literally depend on everyone following rules.  Deniers of science, and defiance because of God given “rights” to gather and assemble can and will cause very serious problems for people around and with them, and in this case, far beyond. Every single one of us has a responsibility to not only keep ourselves safe, but to also keep everyone around us safe.  We all have this huge responsibility for each other.

According to witnesses, rules were broken.  Distancing, face masks, and  and other mandated precautions were not consistently followed.  The State rule is that 50, NOT 65, people or fewer are allowed for inside gatherings at any venue.  The reception venue was cited and warned, but it remains open.  There has been no citation for the Church, yet.

As a result of this celebration, 60 people in the Millinocket region have been infected, one woman has died, and 2 others have been hospitalized.  Beyond Millinocket, there have been 2 related satellite outbreaks, one in at the York, County Sheriffs department (18 victims) and one at a nursing home in Madison (6 victims).  There are primary, secondary and tertiary cases. I don’t know what they are called beyond that even though I am an RN and a certified COVID contact tracer.    I really don’t want to think about “beyond that”.

So, from one person, a wedding guest, who was sick the day after the wedding, several more became ill by the 4th day after the wedding and now, 2.5 weeks later, there are at least 84 people infected if I have calculated this correctly.  And it won’t stop there.

I am sad for every single one of those infected.  The suffering and fear must be overwhelming.

Consider this. If the celebrating guests followed just one of the rules, like wearing masks ,could all of this suffering have been avoided. Certainly a talented seamstress could have made some snazzy wedding masks.   We will never know, but my guess is that YES, it could have prevented this.  In fact, I believe that if ALL the mandates had been followed that this outbreak was 100% preventable.

There was no evil intent in what has happened ‘up home’. There was irresponsibility and selfishness. However, some things that are emerging from this disaster are enraging.  Others are heartbreaking.   I have spent the past week talking with friends and family from home.  I have absorbed their fear, pain, and frustration.  One person in particular has suffered immeasurable worry and pain.  Two of his relatives have been infected and the results tragic. At the same time he is obligated to be in a different state because his business was impacted because of COVID.  I can’t imagine the pain or frustration.  An he and his family is just one of the many who are hurting.  I am working very hard to encourage all of these people, who have been so horribly affected, to share their stories with all of us through reporters and social media.  Their stories teach us all things about keeping ourselves and our own family’s safe.

All of the above information was found on his personal FB page (now purged)  and /or his school’s  and church’s webpage (some information still exists).

Going forward we need to use the philosophy of lessons learned, lessons taught. Every single one of us has to take what we have learned from this outbreak, and use it to be responsible for our own, and our community’s safety.   We will all be happy to see this pandemic behind us so we can have a change of subject.  We can talk about the beauty around us, and awesome people again.  Most of that is still around us.

https://bangordailynews.com/2020/08/29/news/how-a-single-wedding-changed-the-complexion-of-maines-coronavirus-outbreak/

https://www.cbsnews.com/news/coronavirus-maine-wedding-covid-outbreak-jail-indoor-reception-millinocket/

https://www.bostonglobe.com/2020/08/25/metro/millinocket-maine-wedding-covid-19-outbreak-linked-clusters-nursing-home-jail/

https://www.facebook.com/calvarybaptistmaine  demonstrates how busy Rev Bell was for 2 weeks after his exposure

https://wgme.com/news/local/two-maine-school-closed-due-to-flu

In 1970, I graduated from nursing school.  Before our graduation, my best friend and room mate all through school had asked me to be her Maid of Honor.  I was so excited to do it.  So, we packed up our stuff and went home to Millinocket, Maine to prepare for her big special event.  I had also been hired to work as a nurse at the Millinocket Regional Hospital, my first nursing job.  I got sick the day before the wedding.  My throat was killing me.  I had a fever.  I was a mess.  But, I made a promise to my friend and I kept it.  I walked down the aisle ahead of her.  She was a gorgeous happy bride.  I dragged my sorry butt through the reception after.  I hugged and kissed people.I hope nobody got sick because of me.  I had Strep throat.

The day after the wedding I had to travel to Augusta, Maine and stay 2 days to sit for my RN nursing license boards.  I stayed alone (thank goodness) and I sucked down aspirin the whole time.  The next two days, I filled my pockets with tissues, took my aspirin, and sat in a roomful of other new graduates and started my 2 day long test.

When I finished my second day of testing, I drove home to Millinocket and went to bed for a few days and got antibiotics.  How many people did I expose to my Strep throat? How many got sick. I’ll never know.  I was a dumb kid, and nursing school never discouraged us from showing up for classes if we were sick.  In later years my places of employment were irritated if I missed work because I was sick, so I showed up. So I went to places like my friends wedding and my testing site with my germs and exposed a couple hundred people.

So, when I read about the COVID19 outbreak in Millinocket after a wedding with 65 guests, I paused.  How could I be ticked off at this bunch of folks when I did the same thing as a younger woman..a nurse no less.  Well, let’s see.   COVID19 is different from Strep or the flu or a cold.  It is much more deadly and contagious. There is no cure or vaccination.  170,000 Americans have died because of it since March.   I’m not excusing my irresponsibility , but honestly?  We have all had this kind of information fed to us daily for months!   Maine has been one of the best 2 States for preventing the spread of COVID.    There is a reason for that.  Our Governor Mills has taken it very seriously from the beginning.  She has met resistance,hatred, threats and lawsuits the entire time.  But, she has followed science and made recommendations and mandates based on science.  Her compadre Dr Nirav Shah is one of the smartest, kindest, most diplomatic infectious disease experts I have known.  He is the Director of the Maine CDC.

Articles in the Bangor Daily News have revealed that 65 guests were at the event.  It was held in East Millinocket at the Tri Town Baptist Church.

  The reception party moved to a gorgeous venue at Millinocket Lake called the Big Moose Inn. My guess is that they had a wonderful time and the photos are gorgeous.  I congratulate the Bride and Groom and family.

But someone was irresponsible. Maine mandates that any commercial events held inside must accomodate 50 people or fewer.  Guests must be distanced and wear masks unless eating.  Outside events can be up to 100 people, with similar rules.  It seems that somebody fudged on the rules.  These events take special planning now…and rules are shared and should be enforced.  Who was responsible for this scary mess…the family?  the happy couple?  the venue?  WHO?

The COVID 19 virus rode into that wedding in a human body, either a guest or a worker, where most likely rules for prevention were broken. According to the latest CDC report, one person became sick the day after the wedding.  He/she was likely the source, and was probably asymptomatic on the day of the event.  Covid then hitched a ride in another person, and another and another until most of the party was exposed, and 32 people tested positive.  That 32 people went in multiple directions after the wedding.  Then the COVID spread itself into 32 homes (assuming none of the positive victims were couples) and into 32 or so workplaces, and a multitude of businesses and offices, ball games, parties etc. At the end of this blog there is a letter from Millinocket Regional Hospital CEO, Dr Robert Peterson dated August 20, 2020.  So far I know of 3 close communities affected and possibly a more remote one.

3oo people tested, 190 tests pending, 32 people tested positive and 1 so far, has been admitted to the hospital.  The median age of the victims is 42, and 87% of them are symptomatic.  This will change.  4 days after the event, several more people became ill.  That is a common number of days from contact to sickness (incubation period), but it may go up to 14 days.   The State of Maine has issued a imminent health hazard citation for Big Moose Inn.

Wow. This is what rule breaking can get you. Now this business’s future relies on them following the rules. This has made tons of people sick and interrupted the lives of thousands of community members, businesses, churches, town offices/services, and hospital and medical services.  The impact is on public health and economic health.

This Millinocket outbreak was preventable.  We have all been warned about COVID19.  We have been constantly and doggedly educated about how to stop the spread.  Everything was shut down to stop the spread back in March and April and then later we were given guidance on how to re open safely.  Anyone who follows the news on TV, in the newspaper, or on social media knows about all of this..about the risks and the lives lost.  They also know what the recommendations are to stop the spread. Little kids get this.

Individuals have been asked to do simple things to protect ourselves and others.

1. Socially distance when outside your home and wear a mask.

2. Wash your hands frequently

3. Stay home if you are sick.

Special more complicated guidance is given for places of business, schools and such.

We are warned and taught these things at our workplaces, in our schools, at our doctors offices and hospitals.  It is pretty hard to escape a good solid education about the prevention of COVID.

For the average individual citizen,this is not rocket science.  It is all pretty simple stuff.  Even as a new RN in 1970, I didn’t have this kind of guidance.   I have never seen illness like this, all around us, in every corner of the State, Country and World.  COVID spreads like wildfire and it can be deadly, especially for vulnerable people like the elderly, disabled, and chronically compromised.

People have chosen to defy and deny these simple instructions for prevention.  In fact there are groups who actively do sketchy things to avoid the rules, and the result is more COVID infections.    Here is a Facebook post from a woman who wanted to help new brides to have safe weddings…and this is what she found.

“I have a good friend who’s a florist who joined a Covid Brides group thinking she could help people. She said that what she learned was horrible. Most of the brides were exchanging ideas of how to lie to venues, get false test papers for out-of-state guests, appear to be following guidelines while not, etc. and demonstrated horrible disregard for the venues, vendors, communities and guests. They included “cheat sheets”  and also black-balled businesses and vendors who wouldn’t comply with demands and worked together to bomb those businesses’social media with negative reviews. She left the group.”

Other examples of this kind of behavior are displayed in videos of customers fighting with retailers for enforcing mask rules, and others coughing or spitting on them.  This is not only sickening, it is assault.  And it is incredibly stupid.

I am sick over my hometown’s suffering because of irresponsible rule breakers and defiance of science.  The rules are to protect ALL of us.  COVID doesn’t care who you vote for, what color you are, what church you go to, how smart or dumb you are….it will infect you if you are careless.  If you are infected and you defy the rules around others, you WILL infect someone else.

If you care about staying COVID free yourself, follow the recommendations.  If you care about others, do the same.  It is the only way we will put an end to this nightmare.

https://bangordailynews.com/2020/08/19/news/did-they-have-to-have-their-wedding-katahdin-region-comes-to-grips-with-virus-outbreak/

https://bangordailynews.com/2020/08/20/news/penobscot/inn-that-hosted-millinocket-wedding-reception-cited-for-violating-maine-virus-gathering-limits/

ADDENDUM:

One victim from this COVID outbreak has died.  Here is today’s notice from Millinocket Regional Hospital. 

Socially distanced pool crowd

How NOT to party

Disclaimer:  I am not promoting big parties or gatherings for vulnerable people, I am only making the point that it can be done safely if the proper steps are taken.

I can live without big parties these days, but boy oh boy, did I love a big ole loud party when I was young.  We listened to music, danced, ate great food and drank (just a little).  We met and made friends, and we loved being with our old friends. The best party I ever went to was my own wedding reception.  It was a great combination of my young partying friends, and my family, altogether in the same big room, dancing, laughing and celebrating. Imagine, that was almost 50 years ago.  My parents might have disapproved of some of my earlier parties!

Partying now isn’t the same, and maybe it will never be?  I hope it can be, because everybody deserves to be able to safely get together with their family and friends. Most of us are social creatures.  We crave being around others, especially family and close friends.   But, COVID has changed what we do so much, including how we gather with our favorite people.

This article is an example how NOT to party.  This family in the photo looks like a bright loving group…I’m sure they are.  However, they did not take proper party precautions.  And unfortunately, the result is that 18 of them tested positive for COVID 19, and Grandma and Gramdpa were hospitalized with very serious infection.  The last I knew, Grandpa’s life was very much in jeopardy.  I know none of this was intentional..and this family is feeling the grip of the horrors of the pandemic, but it could have been so different had they heeded warnings about close up large gatherings.

https://www.newscentermaine.com/article/news/north-texas-family-shaken-after-18-relatives-test-positive-for-covid-19-following-surprise-birthday-party/287-ea8960ea-4c3c-40c1-b75e-f4437fe6f836?fbclid=IwAR01SwBYDdf77IzSJ57q307MdjsI015rTEaO2PHFQ0_tUSXUyD5wegBX7tE

We don’t know who tests positive by looking at them. Unless they are displaying symptoms of active infection, people can be infected and have only subtle or no symptoms at all.  That is very important to know.  And that is why wearing masks, particularly out in public closed in spaces, is so important.  Wearing a mask is the socially responsible thing to do. It is to protect our public health.   Unless you are wearing an N 95 mask like healthcare providers do, you are wearing your mask to protect others, like Grandma and Grandpa.  Right now it is the most important and simple thing we can all do for each other.  Also, it is the kind thing to do. Maine Retailers actually started this Be Kind campaign.

https://www.newscentermaine.com/article/news/health/coronavirus/customers-harassing-workers-over-wearing-masks-leads-to-launch-of-lets-be-kind-campaign/97-5532fc64-c48b-435f-a85d-9eef1ffbef13

A week ago, my youngest son (45yo) held a backyard  pool party for his friends birthday, here at my home.  He asked about it a few weeks prior to that, and I told him it was fine, but he would have to keep it under 20 people,  they would all have to stay outside and use the basement bathroom.  Plus he would have to clear some basement stuff out of the way and clean the bathroom before hand!   There is an outside entry to our basement from the back yard.  He agreed to our terms and he set a whole bunch more terms for his guests.  His responsible middle aged friends gathered here and practiced every precaution in this Bangor Daily News Article.  The article’s author was actually a guest at my sons party. It was so fun to listen to the party in my back yard.  It has been so long.  Everybody had a great time, proving you can  enjoy yourself during a pandemic and not get sick.

https://bangordailynews.com/2020/06/27/news/state/no-hugs-or-plus-ones-and-stay-outside-how-to-party-safely-during-the-pandemic/?fbclid=IwAR1jSjgeSakVWlH9rIAOhcW-VoG_RWn7Wk1pKx-yS1m6MCCww8e6H4sUnrs

The birthday of our Independence is coming next Saturday, July 4th.  It will be quiet here, but I know that many folks will want to celebrate somehow with family and friends.  Please, read the BDN article.  The author, Emily Burnham consulted with the former CDC director of the State of Maine and she/they produced a great guide for all of us.  Dr Dora Ann Mills talks about ‘layers’ of protection and it is very easy to follow.

It’s not really that hard, and the effort to stay safe is definitely worth it.

How do we mesh these two images?  We don’t, because they don’t mesh.

I am a 71 year old nurse.  I graduated 50 years ago and our nursing school class was set to celebrate this year, but COVID 19 put an indefinite delay on that.  Who would have guessed any of us would see anything like this in our life times?

I have socially distanced with my husband and my dog for about 6 weeks now.  Early worries were about having enough food and toilet paper, but like most things those things have worked out.  My greater worry now is will our society condone that older citizens are disposable.  It seems that some sectors do believe exactly that.

While this pandemic continues to ravage some areas of our country and on a smaller scale, my home State of Maine, crazed citizens are loudly and in some cases threateningly demonstrating in our Capitols and on our streets to “open America”.  This is a chant that their hero, President Trump, has continually hammered home for weeks now.  He hasn’t grieved the over 60,000 dead or offered condolences or contacted any of the surviving families. Instead he repeatedly tells us we must open up, and at the same time he ignores the warnings about the steps to take that will make this opening safer for all of us.  He makes false claims that testing is robust, and huge numbers of citizens will be tested before opening. And he has repeatedly given all of us lousy medical advice, ie. injecting disinfectants to cure COVID.   More recently, his followers have said that the vulnerable (like me)  can continue to “isolate” if they don’t want to get infected and die.  Isn’t that special of them?  It seems a better approach would be to make it safe for all of us to be back to our normal lives eventually.

“Freedom” lovers want what they want…..crowded bars and sports games, all businesses open and rolling in dough.  I want that too.  I want everything to go back to normal, but I don’t want MY life, or my husbands or any of my loved ones lives sacrificed for it.  I am one of those libs, or cowards or Commies, whatever the gun toting, swastika carrying, ranting and raving lunatics call me…and I want my LIFE.  I want to live and I want to do it without the experience of COVID 19 and all of the perils it carries.

So, if we “Open America” without taking the necessary professionally recommended steps, who will die?  Well, if I don’t stay in my house all the time…ME.  I could die, and my husband could because we are seniors.  People who work in meat plants could die, because their bosses won’t be doing the recommended testing and other screening.  Some have already become ill, but our President used the Defense production act to make them reopen, regardless of the threat of more illness and death.  And of course nurses,doctors and other first responders are dying.  They have been forced to work without adequate Personal Protective Equipment, but the president would not invoke the Defense production act to get more PPE manufactured and distributed.  Instead he has set up a situation whereby States have been forced to find their own gear, and to compete against each other for needed medical equipment.  When governors ordered Chinese masks and they  arrived at a port of entry, they were seized by the federal government.  Then of course essential retail store workers will die.  Those familiar grocery and Walmart clerks will be at increased risk of the infection.  Prisoners and homeless people will die too.  People in Long Term care and assisted living facilities will also die, but according to some, this is an acceptable loss, because we need our freedoms.

If President Trump and his crazed gun lovin’ n totin’  demonstrators get their way, there will soon be campaign rallies again.  After all, it is his favorite thing to do…sucking up as much attention and adoration as he can.  Pack em’ in he says, and get them all riled up.  I am curious about that first rally.  Will there be social distancing?  Will they wear masks?  Will they screen people who are entering to see if they are sick?  Will they get sick after the rally because of exposure to COVID 19?  We know that ministers who bucked the advice of doing remote services, and insisted on in person salvation, caused COVID 19 outbreaks.  Will President Trumps rallies cause outbreaks and death of his supporters?

This is how I see it.  Vulnerable high risk individuals are put between a rock and a hard place. Workers from factories with known COVID 19 outbreaks,  illness and death..are being forced back to work. Inevitably some of them will die but Americans can’t do without their meat!  Old people like me will have to stay inside indefinitely to avoid infection.  Businesses small and large will be opening in the MIDST of this pandemic and the hardest hitting time of it, because being closed infringes on their “freedoms”.   A spike in COVID 19 cases is inevitable if we do not  “Open America” very carefully. I offer this warning to the demonstrators.   I’d bet, with confidence, that victims of this extremely horrifying infection beg for death at the end, and death is the ultimate “freedom”.  Is that what you want?  If so, they you can be the test cases for all of us.  I will stay safe by socially distancing for as long as it takes.

I don’t pretend to know all the answers, but I do know this.  We have amazing experts on infectious diseases in this country and the world,  who are making solid scientific recommendations to our President and to our country, that are being totally ignored.  Ignoring science is stupid.  People who don’t care about other people’s lives are ignoring pandemic science.   Yes, reopen, and do it soon. But do it gradually and cautiously by following the advice and steps of experts.  Don’t listen to the President because he ignores warnings and science, and he makes up his own narrative. Our lives do not mean a damn to him. Money and winning elections do!  And please, stop the asinine demonstrations.  Who the hell are they demonstrating against…a virus? dying people? caregivers?   That is just insanity.  You can’t stop a virus by shooting them with an AR 15.  Our State leaders, or at least most of them, are working extremely hard against some steep odds and with limited resources,  to do the best they can. Their priority is public health and the lives of their  residents.

As much as we may hate it, we are all in this together.  What we do as individuals can determine whether or not our neighbor lives or dies.  What we do as a society can determine whether or not whole sectors of our population live or die.    Give that some thought, settle down and do this right.

Last week, while my husband Mike walked our little shih tzu, a car pulled in about 2 spaces over from our truck.  I watched while a young mother got her beautiful baby out of the back seat and her significant other (SO) got the umbrella stroller out.  The SO stayed back and I watched while mother and baby walked by.  That baby was beautiful.

The next thing I heard was the SO yelling to her “get back here right now.  He won’t wake up”.  Simultaneously, my husband arrived back with our pup and said, “there is some kind of trouble over there”.  He thought the trouble was with another child.  I immediately got out of the truck to see if I could be of assistance.  I always offer to help in medical emergencies, because I have the knowledge and the willingness to use it. Not everyone agrees with me that that is a good idea.

As I approached, I saw that the person who would not wake up was a young (26 years old) man seated in the back seat. He was the SOs younger brother.   His head was lolled onto his chest and he was completely non responsive and not breathing.  I advised him to lift his chin and straighten his neck to see if he would breath.  He did not. I asked if his brother used drugs and he said yes. I noticed a tightly rolled $100 bill in his hand and assumed he had snorted something very recently.   He vigorously rubbed his chest and slapped his face, no response. I checked his radial pulse and it was strong, regular and a good rate.  It remained so all during this horrible event.   In the meantime the lady had EMS/911 on the phone.  They got the needed information and had help on the way.  Then they gave her step by step instructions to relay to her SO to do CPR.  He lifted him from the car and onto the ground.  This was the first time for him.  He was incredibly heroic for his brother.  He did mouth to mouth respirations and I watched the young victims chest rise and fall. He then did compressions…stating “I am losing my shit here”.  I encouraged him and said he was doing an tremendous job.  I continued check his pulse and stimulate the victim and eventually he only slightly opened his eyes and moved.  EMS arrived and took over.  They gave him Narcan intramuscular.  The young man immediately woke up.  He was placed on a stretcher and taken away.

I walked away to my car.  I was an emotional wreck and began to cry, with relief, frustration and disgust.  I was relieved that the young man woke up, even though he would go to jail after medical treatment at St Joseph hospital.. He had only been out 2 days and was on parole. This will be one more opportunity for him to get clean and sober.  I was frustrated that I couldn’t get on my knees (arthritis) and do more to help with CPR and that I did not have Narcan to give him immediately.  I was disgusted with the entire opioid epidemic and the loss of young lives, just like this young man.

A young female police officer came to our truck and asked our names and addresses.  I asked her how many times she sees this. She said it was her first one that day, but she had just started her shift.  She said average was 2 a day, right here in Bangor, ME…a small city and only one police officer of many.

Then the young mother came to us before we left and thanked me for helping.  I told her that her SO did everything that needed doing and he did a great job. He is a good man and a good brother.  I knew how frightened he was.  She told me that the young man would be going back to jail.  They hadn’t seen him for 2 years, and they spotted him in a Bangor park and picked him up.  She didn’t know he had done drugs until this all happened.

I learned 2 things that day.  I need to get Narcan and learn about using it.  It is available without a prescription for free at any Maine pharmacy according to the Bangor Fire Department.  The local Health Equity Alliance teaches about using it and I have already made an appointment to go with a friend to learn about it.  It is a nasal spray, but there are instructions and precautions that people need to learn.  If I had had it on me that day, we could have administered it immediately and avoided doing CPR, although he still would have had to go to the hospital.

I also learned that I need to get a new CPR mask/barrier to carry.  I’m not sure I could have used it that day because he was on the ground, but there may come a circumstance that I could, and I would like to be prepared.  I could also have offered it to this victims brother to use.

These two items are essential when helping unresponsive people who are not breathing in the community, and my plan is to have them with me at all times soon.  However,  I hope I never encounter this kind of situation again.

I ran this experience by a group of nurses on Facebook.  The discussion was alarming.  Most agreed that I did the right thing to help this young man and his brother.  Others said they would never give Narcan in the field/community.  They worried about liability and possibly a violent reaction from the victim.  I was blown away.  I know in my heart that I could not stand by and withhold something…my skills, my knowledge and a freely available and effective medication…all tools that could save a life!  I have stopped at accidents, and helped sick or injured people on airplanes and in stores, at conferences, etc.  I don’t always do a lot, and sometimes I just stand by, but how could a nurse walk past something like what I saw?

What would you do?  How would you handle this?  I am very interested to hear from some of you who read this.

The young physician’s assistant met me in Mum’s room on April 3.  She was bright, and thorough.  She found a cerumen (wax) impaction in Mum’s Rt hear, so that may be compromising her hearing  in that ear. It takes many months for wax to build up to that degree and it makes me wonder why it was missed at her Assisted living. They will use Debrox and irrigation to clear Mum’s ear.    She also said she would order blood work to follow up on her low blood sodium and high blood potassium levels.  It sounded reasonable to me.  I find that Mum continues to be sleepy most of the time, but she awakens when touched and spoken to loudly.  Her caregivers have told me how great she is doing, helping with her own hygiene and toileting. One even said she pushed herself up and down the hallway in her wheelchair.  Considering Mum’s level of somnolence and weakness,  I’m not sure I totally believed that she went in the hallway at all.  I have been visiting Mum every day at different times of day, excluding early mornings.  So, perhaps she has more energy in the mornings, that I haven’t witnessed.

April 4, 2019  I went in to visit close to lunchtime.  Mum was upright in her wheelchair sound asleep, which seems to be the usual.  An occupational therapist came in and said that she had gone to the dining room for breakfast, but the CNA said she had difficulty eating and spilled her food and drinks on herself.  The plan was to take her back this noontime.  She was barely awake.

The occupational therapist came for us to go to the dining room for lunch.  I was seated next to Mum at a dining room table while we waited for her food.  I laid out a hand of solitaire to see if it sparked any interest.  She continued to sleep, with her head lolled onto her chest.  A full tray of food was delivered.  I woke her but she went right back to sleep.  I tried to get her to hold a fork, but her hand fell.  Then to OT came back and sat next to her in my chair, prodding her and urging her to eat.  I know this is her job, but considering Mum’s condition, and deteriorating health,  I found this undignified and I truly believe it is disrespectful.  I had to leave because it was too painful to watch. My mother is a very private and proud woman.

I got a call from Mum’s PA that afternoon.  She was alarmed that Mum’s blood sodium is so low at 117.  She said that this could explain the somnolence and weakness, but it also could lead to seizures.  As I have observed and guessed,  Mum is very very sick.  So, the choices were to give her IV saline in the facility or take her back to the hospital.  I chose the first option.  If she gets sicker, we may have to make a decision about moving her to the hospital. Why is life (and death) so cruel?

When I returned to the facility later in the afternoon, the nurse was setting up Mum’s IV.  As always, she was sound asleep, but comfortably so in her bed.  Apparently she woke up long enough to ask the nurse “What the hell are you doing?”   I expressed my concerns to the RN about Mum being hauled off to a Family meeting that she slept through and to a dining room full of people who were awake and feeding themselves  where she was  being prodded to eat while she slept upright in the wheelchair.  Everyone except my mother was awake and alert.  I told her I was so hurt to see them do this undignified thing to my mother.  I want her treated with dignity and respect, and common sense.  If she is somnolent, she will not eat.  If she is weak she will not lift a fork.  Let her rest.  Give her ice cream, pudding, boost, juices, water…things that she can handle when she is alert…..and forget about getting her to eat a full course meal with noodles, meat, and sliced beats , or even dry chocolate cake!  It will not work.  It will not help.  It is disrespectful, impractical and just wrong. My sense is that these well meaning therapists and assistants need to learn some lessons about Patient/Person centered care.  Recognizing the patient in front of them with all of their idiosyncrasies and specific needs and abilities is essential to quality and effective care.

This nurse understood. She has 30 years of geriatrics under her belt.  She said that on her watch she will not allow those things to happen to my Mom.  She encouraged me to speak up and advocate for my mother because nobody else will.  She is so right.

I don’t want to alienate my mothers caregivers, because they are dedicated professionals,  but I must speak up for her.  I am prepared for any outcome, and I am pretty sure which one to expect.  In the meantime, I want her to be comfortable and treated with respect and dignity.

April 5…..I will go see Mum this morning.

April 2.  I got a call on April 1 to set up the Family Meeting.  Apparently this is part of every new Stillwater Health care patients admission.    The social worker, RN , Physical Therapist, and I will all be there.  My younger brother will be called in on a conference line.  I will meet one of them in Mum’s room at 230 today.

I hope I am prepared.  I have written my concerns on paper to try to organize them.  I have also listed all of her health and dementia issues, her likes and dislikes, diet needs and preferences, usual activities, etc.   I have spent a lot of time at the Assisted Living facility and I have done my best to keep abreast of Mum’s current status, in all things.  That was with no help from the Assisted Living staff.  I don’t think they really knew much at all about what Mum was up to, and if they did, they did not communicate it to me.   Not to rehash old grievances, but they simply did not have the time because of short staffing.

I met the Occupational Therapist in Mum’s room at 230pm.  While I sat there alone waiting for them, Mum napped in her bed.   While she napped, she chewed like she had something in her mouth.  When the OT got her up, she made her spit out some ground up meat that was in her mouth from lunch.  This is a bad sign that she is not chewing and swallowing well.  Holding this food in her mouth is called pocketing.   It is part of end stage dementia. Mum acts like she is in pain when she sits then stands.  Once in the chair, she just nodded off again, and I wondered if this wasn’t a bit cruel and pointless to bring her to our meeting.  But she was wheeled into a small conference room with us to attend.

The meeting was about an hour long.  We discussed her hearing, fatigue, lack of interest in food, difficulty swallowing, and other things.  The Occupational therapist seems to have hope that she can do well.  They will continue rehabilitation level of care for one more week, and at that time will determine whether or not to continue or change her level of care to Long Term Care, with less intensity of Occupational and Physical rehab focus.  She would remain in the same room, but with a different level of care, and a different payment source.  This would mean applying for Mainecare/Medicaid.  Medicare pays for rehabilitation but not for Long Term Care.

Mum was completely exhausted and disinterested in this meeting and she slept through most of it. Even so, the group set goals for her to be accomplished through PT and OT.    I was quite surprised that they brought her there in her wheelchair.  She had been napping peacefully when it was time, and she continued to nap while sitting upright in her wheelchair.    At the end of the meeting someone ordered her a small bowl of green jello and I spoon fed her the whole thing, but she lost much of it down the front of her pretty top.  This is such a drastic and frightening change from my mothers usual demeanor and level of health and engagement.

I got the names and contact information for all of the participants.  And I spent some time after it was over talking with the social worker.  She is also a Millinocket girl and we had that connection.  I gave out my business cards at the meeting and she wanted me to explain my volunteer work in patient safety.  I told her about my patient safety advocacy and I also told her I was writing a blog about Mum’s journey.  She said, “so, you are putting us on notice”.  I told her “not necessarily” but yes, I expect safe high quality care.   However, I do not expect miracles.   This was not a contentious conversation but expectations were laid out and very clear.  She was very receptive and said she would look at my webpage.

I asked when I could actually meet the facility doctor in person and they said to be there at 10am next day to meet with the PA from Penobscot Community Health Care.  This is the same Geriatrics practice that cared for Mum at Winterberry Heights.  I’ve had both  good and bad experiences with that practice.  In just under 4 years, the visiting geriatric NPs changed several times.  The various Geriatric Nurse Practitioners who visited Mum in Assisted Living knew that Mum has dementia and is a poor historian about her health, her problems and other issues.  I  asked in the past to be included somehow in their visits or at least get a call about any visits.  That rarely happened. I often learned about their visits to her when  I got her Medicare statements in the mail explaining the insurance coverage of the visits.  I wondered about the value of those visits. You cannot learn everything about a patient with blood and urine tests (which were often performed) without the benefit of an accurate history of symptoms.   I  hope it will be different at Stillwater Healthcare and that PCHC will have open communications with me.

Next, the PA’s visit with Mum…..

Note:  I have decided to continue writing about my mother’s final journey,  in hopes that others can learn and better navigate their own end of life.

March 28.  I am starting to have hope.  I may  have to change the title of Part 4.  Mum’s new caregivers at Stillwater Healthcare are not warehousing her, they genuinely seem to care.  These CNAs are sweet, young, energetic and kind. The RNs and LPNs by in large also seem involved and caring.  They know more about Mum in just a few days than any of the assistants at the assisted living facility ever did in almost 4 years.  They care about what she likes to do, to eat, to read and to play (cards games if she gets better).  They are working to accommodate her hearing loss..writing notes if she can’t hear them, making sure her amplifier is in and that they speak loudly.  They suggested a TV with subtitles. They are even trying to accommodate her napping schedule.

Mum was delivered to a bed by the window at Stillwater Healthcare on March 28.  She accustomed to a big apartment with separate living room, dining area, kitchenette and bedroom with bath.  She now shares a modestly sized room with a roommate.  Her roommate is non verbal but she screams.  It is not her fault and my heart breaks for Mums roommate, but it is very difficult to both deal with Mums challenges and this screaming.   Mums hearing loss is quite convenient now, because this does not disturb her.  I can’t say the same for me.   Mum seems content, but also very tired and confused.  She is unable to manage an apartment anymore , and she is certainly too weakened to get around in one.  These new digs are small, clean and organized.  She has a tiny bureau and closet, and bathroom.  Her walker and wheelchair take up any leftover space.  There is one chair for any visitors.  Things fit  there kind of like a puzzle, but the staff works to keep it neat and organized.

My early impressions about this rehab/nursing home is that the staff is professional, caring and kind.  They are meeting her new dependency and needs with skill and efficiency.  Her CNAs do most of the hands on care.  Mum is up and dressed each day in her own clothes in warm layers.  She looks brighter and cleaner than I have seen her in a while. Right now her food is served to her in her room.  She is eating very little, but is certainly spending more time up out of bed each day.  One day she is  engaged and curious, but the next she may be sleeping and not eating.  Her health,status and progress is a roller coaster ride for sure, and I know I need to be prepared for any outcome.

I want her healthy, funny, sassy and asking questions again.  I hope the staff and my frequent visits can accomplish this, but she is almost 93, and it could go either way.  And if she is just too worn out for recovery, I don’t want it forced.  She has been my strong amazing and healthy Mum for a very long time.  She deserves a good rest, or a recovery, whichever comes.  I will be appreciative to this staff for either.  They seem to be doing their absolute best for Mum.

Next.  The Family meeting……….

On March 25, two Resident Assistants at Winterberry Heights helped me to load my Mom into my car and bundle her up to take her to St Joseph Hospital Emergency Department.  I brought along the urine sample in case it could be used.   It was a relief to see WH in my rear view mirror.  My husband, son, and brother would spend a good part of the next three days moving my mothers belongings out of Winterberry Heights.  Also, later I picked up her medications which she had paid for.  When I got them home I found 3 full cards of bubble packed prescription medications that belonged to a different resident.  Big mistake, and a very careless mistake.  We returned them that day.

At St Joes I asked for help to get her out of the car and into the building.  Both of the nurses wore masks and I asked immediately if there was an outbreak of flu or anything else there, because I feared for my elderly mother.  I was assured that they just wear the masks as a precaution.  She was delivered to registration, where they could not find any of her old information in the computer because they entered a space between the two Cs in her name.  Because of that, she ended up with 2 separate medical records that had to be merged to one….at least I hope they did that eventually.

She was immediately taken to an ER exam room, where she was gently helped onto the stretcher.  Her triage nurse and her primary ER nurse were both men and both very professional and skilled.  She got blood work, IVs inserted, straight catheterization, chest and left leg xray.  She has pneumonia in her Right lung.  That would certainly answer why she was feeling so weak and poorly most of the week.

Mum was admitted to the Hospital as an inpatient (as opposed to a Medicare Observation patient).  This was a relief because I was pretty certain she would need at least rehabilitation if not long term memory care. There is a trick with Medicare that they will not pay for rehab if the patient as not been admitted as an “inpatient” and been in the hospital for 3 midnights.   Her young foreign doctor was very kind and thorough.  I was pleased that they did not do a lot of expensive and unnecessary testing, and he considered Mum’s age and condition in all decisions.

She was moved to the 6th floor, where she spent 3 days.  She was cared for by RNs, CNAs and nursing students.  Each and every one of them were respectful, funny, engaging, kind and skilled.  They all work very hard.  This work is not for sissies.   I had no complaints about Mum’s care there except that she was left upright in her chair for far too long one afternoon.  She was extremely exhausted.  Also, she got a stage 2 pressure bedsore on her tailbone that we hope will heal and not get bigger or deeper.  The sore was first noticed later, on admission to Stillwater Healthcare.

On days 2 and 3, Mum perked up a bit.  She got a little testy and sassy. When I told her to be a “good girl” when I left one afternoon, she stuck her tongue out at me (this is a little ongoing joke between us).  Also when I was leaving another time, she asked me what the syringe full of saline on her over bed stand was.  I picked it up and said it was a SHOT and I  teased her that I was going to give her a SHOT.  She looked at me and began fiddling with her hands and fingers and finally with a lot of effort, she flipped me off!  That’s my mother and her wicked sense of humor.

OT, PT and Speech therapy all evaluated Mum at St Joes.  She was extremely weak ,but they gently helped and encouraged  her to walk with a walker, to the bathroom.  The speech therapist recommended soft solids and liquids for diet because of a swallowing test they did on her.  We do not want to risk another pneumonia from aspiration.

The Social worker and nurse case manager both worked hard to get Mum into Stillwater Healthcare which was the facility of my choice for her rehabilitation.  I have heard good things from family members who have had people cared for there, and it is literally 2 minutes from my home.  I am so exhausted by now that I need things to be a little more convenient.

A very kind gentleman with a wheelchair came for Mum, and took her to the wheelchair transport van. He transferred Mum to Stillwater Healthcare on March 28.  Next chapter……..