Saturday, August 27, 2016

A St. Thomas Social Worker wants to kill Louella

“Kill” may be a little strong. The St. Thomas social worker did not say “kill;” she said “let her go.”

Sue and Louella on May 6, 2016
They share the same birthday of May 6th

People don’t like to use harsh words. In polite company one certainly does not say a woman killed her unborn baby; one does not even say, “she had an abortion.” People are most likely to say “she terminated the pregnancy,” or “took care of the problem.” In war we do not like to say a lot of civilians got killed, we say “there was collateral damage.” We even say we put the family dog to sleep. It is so much easier to put harsh reality into pleasant terms, but we all know what we really mean.

 Louella is my wife and has been suffering from dementia since at least 2004 when she was mistakenly diagnosed with Alzheimer’s, but has probably had dementia since 2001. Louella went into St. Thomas hospital recently on a Thursday. The only reason we put her in the hospital is that her new primary care doctor said he did not prescribe psychotropic drugs and we needed to have Louella seen by a doctor who could. I don’t know if  her doctor could not prescribe the drugs she needed or was not comfortable doing so, but in any event, he would not.

Louella had been experiencing periods of absolute rage. She would fuss at the top of her voice for up to two hours at a time, with her face red. There was no placating her, no comforting her, or calming her. Finally exhausted, she would calm down. When not in the full-on rage mode, she was agitated and unhappy most of the time. She had also had some sleepless and restless nights. This had been going on for about six weeks.

After our GP told us he would not renew her medicine, which had been prescribed by another doctor, we began trying to get her an appointment with a psychiatrist. (The “us” and “we” are Sue, her caregiver for the last five and half years, and me.) We tried without success to get her an appointment. Some psychiatrists were cash-only, some did not accept Medicare, and some would see her but an appointment was six weeks to two months away. Her medicine was about to run out. The office of her doctor suggested we take her to Parthenon Pavilion but that is where we took her in August of 2014 where, when she was supposed to be on one-on-one supervision, they allowed her to fall and break her ankle in four places and she never walked again. I was not comfortable taking her back to Parthenon.

We were running out of options when her doctor’s office called and said St. Thomas had a Psyche unit and they had an opening and his office told us we needed to take her to the St. Thomas emergency room. We did and they discovered Louella had a severe urinary tract infection and she was hospitalized for that and by the time she was mostly cured of the UTI, the bed in “Behavioral Health” was taken so we had to wait another day or two before a bed in Behavioral Health opened up.

We took Louella to the emergency on a Thursday and sometime early the next week she was moved to Behavioral Health. During the end of the week in which she went to the hospital and all of the following week, Sue stayed with her during the day and I would come in the evening after work and stay with her. Sue was gone on a well-deserved vacation the second week of Louella’s stay and the weekends that bracket that week and the following Monday of the next week.

On Tuesday of Louella’s second full week in the hospital, Sue returned to work. On that Tuesday the social worker at St. Thomas pulled Sue aside and started asking her questions about Louella’s care. She then asked Sue, “Why does he not just let her go?” Sue, at first did not fully understand the question and said, “What do you mean?” And the social workers said, “Well, she has no quality of life and she is dying. Why don’t he just let her go?”

On Thursday of that week, the social worker pulled me into an office and went over several issues related to Louella’s release and future plans for Louella’s care. One of her items of discussion was what would I think, or would I agree to putting Louella back under hospice care. I said, “No, I would not.” She said, “Well, you know she is dying.”  I said, “She is not dying right now and while I know she could die at any time; she could have a stroke or a seizure that killed her, it is not like she has a terminal illness with only days to live.” I said, “Under hospice care, she could die from a urinary tract infection. I don’t want that.” Then she said, “She has no quality of life.” I didn’t say anything else and we moved on to the next topic on her list.

I know it is true that Louella is dying, just as we are all dying from the moment we are born. Louella could die tonight from a stroke or a seizure but I could die from a heart attack or an auto accident. While she cannot get well, she does not have a killer disease with only days or weeks to live. Her dementia could reach the point to where she cannot swallow or there could be other symptoms that end her life, but we are not experiencing those symptoms now. If “no quality of life” is the standard, well we should kill all babies who are colicky or are cutting teeth. We should kill all children born with severe mental disability. We should kill all prisoners. We should kill people who just went through a divorce, lost custody of their child, and lost their job and have a car that constantly break down.

Anyway, it is not true that Louella has “no quality of life.” For about the six weeks prior to going to the emergency room during her awake hours she was agitated a lot and had those periods of real rage. That extreme rage may have been due to having a urinary tract infection. She cannot tell you what is wrong. She may have been in pain.

For about a month prior to the period of the extreme agitation, Louella was a delight and joy. Louella is “total care,” and cannot talk, but during the month period prior to the weeks of agitation she was engaged. She laughed, she smiled and she was sweet. She noticed things and made eye contact. Her mumbling of nonsense syllables had words mixed in and she was not just chanting syllable; if you did not know, you would have thought she was speaking a foreign language. She spoke with inflection and punctuation, and she said some complete sentences and phrases. She enjoyed “talking” to people. She was happy. She had “quality of life.” I hope those times can return.

Even when having periods of agitation, she enjoys eating. She will stop fussing to eat. Since she has difficulty swallowing, we have to feed her very slowly and it takes about and hour to feed her. She is happy when she eats. At night before bedtime, I always feed her ice cream and she loves ice cream and makes appreciative “uhumm” sounds as she eats. She at times enjoys watching the squirrels and birds at the bird feeder outside our front window. She loves Sue’s little dog, Beauty. She notices the dog. Louella can propel herself in her wheelchair, and she will try to go to the dog and will say, “Come her, you.” When she came home from the hospital, she was happy to see Beauty. Sue held Beauty up to Louella and Louella kissed her.

Louella's mind may be gone for the most part, but she still has worth and she still has personality. Even when she is mad, she is sometimes cute.  She will fuss in non-sense syllables and and then emphatically say, "And, I don't like it!"  She also has a since of humor.  She will rapidly babble a series of syllables, "bing, bing, bing, bing, binb, bing, bing, bing, bing, kaboom!" She will then rare back proudly and then have a mischievous smile on her face and then laugh and we laugh with her.  She has a couple variation on this. The social worker only saw her in the hospital when she was sick. How dare her suggest Louella's life is not worth living!

We had a really good night recently since she has been out of the hospital. She smiled a lot and leaned toward me and put her head on my shoulders and nuzzled me and kept given me kisses. She was happy.  It was sweet and romantic.  She has  “quality of life.”

Louella was under hospice care from March 13th 2015 until December 5th 2015. She was put on hospice because while in the hospital with pneumonia she failed three swallow tests on three consecutive days. A palliative counselor told me, Sue, and my sister Kathleen, that the choice was to put a feeding tube down her throat or send her home with hospice care to die. I opted for hospice care. They said she had days or weeks to live and that she would die of starvation if something else did not kill her first. At first we gave her just thickened liquid like water or juice but we then started giving Ensure and chicken broth and other liquids with nutrition and she got stronger. After a couple weeks we started giving soups and pureed food such as mashed potatoes or pureed veggies and she kept getting stronger, then we moved to soft but solid foods such as hamburger or shredded chicken and then to regular solid foods. On December 15th 2015 she was dismissed from hospice care.

I know hospice care has been a blessing and comfort to many people. My father who died about 26 years ago was under hospice care for a few days before he died. I am not against hospice care, but the goal of hospice is to keep the patient comfortable as they die, not to help them get well. While Louella was under hospice care, they did not even take her temperature telling me they just did not do that, that a fever was just part of the process of dying and could be a comfort to a dying person.

If a person was caring for a loved one on their own and was just worn out, or if they stood to inherit some money and needed it, it would be so easy to put their loved one under hospice care and just let her die from some mild aliment that could otherwise be treated, when hospice care was suggested by a social worker. One could just assume the social worker knows best. Social workers who suggest that someone like Louella be put under hospice care should be ashamed, should lose their job, and maybe go to prison where they would have no “quality of life.”

My anger has been directed at the particular social worker who tried to talk me into putting Louella under hospice care and "letting her go," but after reflection, she is probably just a cog in the wheel. The problem is most likely systemic and part of a societal disregard for human life, a disrespect for the elderly, and a dysfunctional healthcare system in which the patient does not come first.

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Thursday, August 25, 2016

Mayor Barry proposes expansion of the Urban Services District

While Nashville-Davidson County has a metropolitan form of government, we still have two taxing districts. Most of the counties population lives in the Urban Services District (USD) where they have a tax rate of $4.516 per $100 of assessed value.  In the more rural areas and some suburbs, people live in the General Services District (GSD) and have a tax rate of  $3.924 per $100 of assessed value. The only thing the people in the USD get that people in the GSD do not get is garbage pick-up and street lights. They still get the same library services, police services and fire services and of course we only have one school system for the county.  Mayor Barry is attempting to annex into the USD some of the developed suburbs.

While I generally oppose tax increases, I do not oppose this effort to bring into the USD those highly developed suburban areas.  I think it makes sense.  I see it as an equity issue. It appears the GSD area gets services they do not pay for subsidized by the USD ratepayers.  I would like this proposal better if it was revenue neutral and if tax rates were rolled back so that after paying for expanding street lighting and trash pick up in the annexed areas there was no net increase in revenue to Metro government.

For many living in the suburban communities to be annexed, the increase in taxes will be less than the cost they currently pay for private trash collection. To learn more about this issue see this link and this link to Tennessean stories.  For those who want to delve deep into the issue, here is a link to a Metro Planning Commission staff report beginning on page 156.
Below is the mayor's letter to the Planning Commission requesting the annexation be deferred to the first meeting in October.


Below is the map showing the proposed expansion of the USD. The light brown areas are the areas of the proposed expansion.

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Ketron: Voter fraud compromises the electoral process

Sen. Bill Ketron
by Tenn. Sen. Bill Ketron, The Tennessean Op-ed, Aug. 23, 2016 - In 2005, I sat in a Memphis courtroom with many of my Senate colleagues to hear a case of voter fraud regarding the election of Ophelia Ford to the 29th senatorial district of Tennessee.  .... The returns indicated that Ford won the election by only 13 votes over opponent Terry Roland out of the 8,653 cast for the Democrat and Republican candidates. ...investigation that showed voting by felons and nonresidents of the district, as well as ballots cast by dead voters. ... I was astounded that this kind of fraud existed and took action to put measures into place to protect the integrity of Tennessee’s elections by introducing and passing a voter ID (identification) law. ....

Voting, however, should be conducted according to our laws and our Constitution so that is not compromised by those who would cheat and suppress the vote of another. (link)

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Shelby County Democratic Party "decertified"

Memphis Flyer - ...the Shelby County Democratic Party has ceased to exist, having been formally decertified last Friday by state Democratic Party chair Mary Mancini of Nashville. .... one of the known factors in forcing Mancini's hand, and likely the precipitating one, has been the Shelby County party's months-long impasse over what to do about the case of former local party chair Bryan Carson, who resigned last year after an audit turned up evidence of unexplained shortages in the party treasury. (link)

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Tuesday, August 23, 2016

Tim Kaine’s ObamaCare is Collapsing in Tennessee

Press release, NASHVILLE, Tenn.-August 23, 2016--Democratic Vice Presidential Nominee Tim Kaine comes to Tennessee this evening where the latest damaging development about ObamaCare is reverberating throughout Tennessee. This is the the law Kaine has called a "great achievement."

Tennessee's Insurance Commissioner Julie McPeak has said the ObamaCare exchange is 'very near collapse', as reported by the Nashville Tennessean. On a related note, the Chattanooga Times Free Press reports ObamaCare rates are set to skyrocket by the "biggest amount since the program began three years ago." U.S. Senator Lamar Alexander told the newspaper these rate hikes are "only the most recent proof that Obamacare is spiraling out of control."

Tennessee Republican Party Chairman Ryan Haynes discussed the Virginia Senator's woefully-timed fundraising visit to the Volunteer State. "While the Democrat Vice Presidential nominee is here to prospect for checks, Tennesseans are dealing with headlines that ObamaCare's exchange in Tennessee is near total collapse. This isn't a 'great achievement'--it's a failure. Democrats passed this law based on false promises and now it's hurting our citizens who deserve better than government mandates and higher taxes. Yet, as part of the Clinton campaign, Tim Kaine wants to double down on this disaster. That can't happen," stated Haynes. "Republicans are ready with an alternative that allows for higher quality care, more choices, and lower costs. It's time to put patients back in charge of healthcare, not the government."

Online: ObamaCare will be known as a ‘Great Achievement’: During an interview with CNN's State of the Union, Sen. Kaine remarked about ObamaCare: "I think health care reform is going to go down in history as one of the great achievements of this president." (1/2/11)

On Health Care, Kaine said when the American people “Immediately see the benefits,” then Health Care would be “a great thing politically for the Dems.” AMANPOUR: “You mentioned health care. I want to say something that you, yourself, said about this issue when it comes to elections.” KAINE: “OK, great.” KAINE: “When make this happen, and people immediately see the benefits that are going to come their way, I think this is going to be a great thing politically for the Dems. And we’re trying to show members that they’ve got their constituents behind them if they vote with the president.” (ABC’s “This Week,” 10/24/10)

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Monday, August 22, 2016

U. S. District Judge temporarily blocks Obama's transgender bathroom policy

U.S. District Judge Reed O’Connor of  Texas has temporarily blocked President Obama’s directive that boys who think they are really girls be allowed to use girls restrooms in public schools across the country. Texas and 12 other states including Tennessee had challenged the Obama administration’s unilateral move, calling it unconstitutional. Here is how it was reported in Politico:

Texas Attorney General Ken Paxton, a Republican, immediately cheered the decision.
“This president is attempting to rewrite the laws enacted by the elected representatives of the people, and is threating to take away federal funding from schools to force them to conform,” Paxton said. “That cannot be allowed to continue, which is why we took action to protect states and school districts.”
The federal government told U.S. public schools in May that transgender students must be allowed to use bathrooms and locker rooms consistent with their chosen gender identity. That announcement came days after the Justice Department sued North Carolina over a state law that requires people to use public bathrooms that correspond with the sex on their birth certificate, which U.S. Attorney General Loretta Lynch had likened to policies of racial segregation. Republicans have argued such laws are commonsense privacy safeguards.
Schools were not explicitly told to comply or lose federal funds. But the Obama administration also didn’t rule out that possibility in court documents filed in July, saying recipients of federal education dollars “are clearly on notice” that antidiscrimination polices must be followed. Texas alone gets roughly $10 billion in federal education funds.
Read the judge's order.

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