Amanda Anderson, BSN, RN, CCRN, works in critical care in New York City and is enrolled in the Hunter-Bellevue School of Nursing/Baruch College of Public Affairs dual master’s degree program in nursing administration and public administration. She tweets at @12hourRN.

Old Woman Dozing/Nicolas Maes

Old Woman Dozing/Nicolas Maes

At work the other day, after almost seven years as a nurse, I had an experience that completely floored me. While connecting a bag of cefepime to my tiny, elderly, blind patient’s IV, I spotted a cockroach making its way across her pillow. And then another on her lap. And then they were on the wall behind the bed, coming out of the closet where her belongings were stored. Another nurse had just handed her the pocketbook she’d requested, and the host of insects that apparently called it home were now scurrying quickly around the room, and around me.

I consider myself a fairly brave woman. I can kill a bug if I need to, I see rats quite frequently, and come on, I’m a nurse—there have been some pretty gory things to pass these eyeballs and touch these fingers. But this was different; it was not the hospital grossness that I am a seasoned veteran of. This was a glimpse into my patient’s dirty home. I ran like a little child.

When the situation had calmed down, I talked to my patient about her home, an apartment in Manhattan. How did she get around? How did she get food? She told me that her quest for survival had grown more challenging—that, with no family to care for her, she depends solely on Meals on Wheels, and that she might, after so many years, need to cave in to the pressure and move into an assisted living facility. Although, based on my assessment, she clearly qualified, no doctor had ever offered her a home health aide or visiting nurse.

Cockroaches aside, she is not the first elderly New Yorker I’ve cared for who has no web of support. Living precariously between the poles of health and complete collapse, many of them walk through the city streets for groceries, live on next to no money, and have very little reserve when sickness finally overturns their delicate homeostasis.

I was curious about the ins and outs of delivering food to a blind woman who has no home services. Where does the food that she doesn’t eat go? Is she able to clean it up adequately? I called City Meals-on-Wheels and learned that volunteers have to deliver food quickly and that it must be kept within a certain temperature range to prevent spoiling. All food is issued in disposable containers and no cleanup services are offered. How could they be responsible for that—they deliver food to 18,000 elderly New Yorkers each day? It’s a wonderful service, but in some conditions may also be a perfect recipe for bugs moving in.

Mostly, I’m just sad that the system we call health care—words that imply positivity and protection—has failed this patient for so long. I contacted the unit’s social worker on her behalf, but with CMS tightening its belt and pushing for sicker people to stay at home longer, I fear for her chances of finding a new, more appropriate home or reliable assistance in her current home.

I watched her later, when I brought her dinner. A tiny scared creature, she devoured her food, coughing in her haste, unaware of my presence. I can imagine one reason she eats this way—with so many competitors for her meals at home, she may have forgotten the simple pleasure of leisurely eating the meal before her.

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