Crowds and Control
From: James Algiers <james.algiers@gmail.com>
Subject: Crowd Control
Date: March 19, 2009 at 7:55:23 AM CDT
To: Louie
Dear Louie,
I‘ve got a good one for you.
Crowds and Control
As the world population has grown, now by alarming numbers, one is left with fear and alarm at gatherings of any major magnitude. One’s mere presence in a crowd becomes the cause of some degree of fear, especially as one ages, as one becomes less agile, and as one loses the strength and ability to respond to changing circumstances. Crowds are unpredictable, controlling, and digest the members who constitute the crowd. One loses identity in a crowd, individual space is surrendered to elbows, butts, and bad breath.
The center of a crowd is frightening, there is no escape.
To fight to the outer edges becomes harder as one ages.
And so meetings, congregations, and celebrations are youthful events. If elderly persons attend crowded events, when leaving, the last statement is so often, “that’s the last time I am going.” Speakers control assemblies, doctors and scrub nurses vie for control of surgical suites, mothers control homes and families, teachers sometimes control classrooms, and pastors think they control souls and sinning. Doctors also think they control patients. But many times events are controlled by the least likely individuals.
One such person was Annie.
I initially met Annie one August morning in my first office. She entered, a small thin woman, short of breath, clinging to her husband Nic, who was really short of breath. She was wild-eyed, he was calm; she was initially demanding to be seen, he remained cool and rolled his eyes, and stated, “Oh Anna, be patient.”
She ignored him and turned to me. “Doctor, the only reason I am here is that this is the only office on the ground floor, all the other doctors are on the second floor, and at my age of 60, I cannot walk up the flights of 18 stairs. I counted them all. I want you to take care of me.” She said all of this without taking a breath and with little evidence of her shortness of breath.
This began an interesting 39 years of care of Annie, and 15 years of Nic.
Annie and Nic had moved from a poor farm in the north to Hartford, where they bought a small, 15-acre plot of land with a barn and a home. It was on the north side and overlooked a marsh and a waterway. There they lived for ten years and then sold the place, and built a small 1150 square foot home over a drive-in basement garage. They had no children - Annie had had poorly prescribed surgical abdominal procedures when very young and just married.
From her descriptions, I believe she had had tubal pregnancies and endometriosis which resulted in a sterility problem. She regretted the surgery until her dying day. She was small, thin, and apparently fragile.
In fact, she was small, thin, and anything but fragile.
Historically Annie had a problem with Supraventricular Tachyarrhythmias. She periodically developed alarming, frightening episodes of rapid heart action; pounding in the chest, shortness of breath, wide eyes, and death-defying fright. These episodes had been present for years and had occurred in the morning, afternoon, and evening. They occurred in spring, summer. fall, or winter. She could never tell when, but always anticipated a “spell” at any time. These were the days before right atrial mapping and electrophysiology and ablation - present-day treatment of the problem. Those were the days of house calls, carotid pressure, sedation, and reassurance; the days before beta-blockers and calcium channel drugs. Those were the days of sunshine and dark ages.
Those were the days of Annie Control, of crowd control by Annie - of Nic and me.
It was a well-known fact that after our annual two-week family trip to the East or West, on arrival home at 3 p.m., even before unpacking the telephone would ring and Nic, in his appealing voice would ask for a house call.
“Annie has another spell, in fact, she has had five spells during your vacation. This time it is real bad, the priest just left.” I was always amazed what fifty milligrams of Demerol, reassurance, and twenty minutes of bedside care would do. She relaxed, she slept, and Dorothy and the kids unpacked.
Nic, who had severe chronic lung disease, developed pneumonia following the Swine Flu inoculation. He became progressively more incapacitated and died. Annie became more dependent, and in the days before nursing homes, went to the hospital for acute care and eventual placement on the first floor of the “old hospital” - the domiciliary wing.
There she lived, thrived, and controlled the crowds; the doctors, the nuns, the hospital administrators, the nurses, aides, and kitchen help, the cleaning staff, and the visiting Joint Commission of Hospitals. Her room was in the west wing of the first floor; an area which over the years went through modifications and revisions. During those changes, rooms were made into offices, offices into suites, and constant turmoil as the character and practices of the hospital changed.
Throughout these changes was one constant - Annie.
When she had been admitted in long term care she had, during one of her terminal episodes, convinced the Nuns that she should stay for her dying care. She not only convinced the Mother Superior but had the arrangement placed in writing. Her recovery was amazing. Her room was moved as progress was made in the hospital. The hospital was enlarged, the structure was changed almost constantly during the next twenty years, but the one constant was Annie. She had an amazing facility for having an episode when the census was low, she improved, almost dramatically, if the beds were full.
She proved to be an asset and not a liability to the hospital. She convinced the social services that a move to another care center, would kill her, and she was allowed to stay for “near terminal care.” This lasted for another seven years. And, during that time, her room was moved to a small, windowed room, directly across from the administrator’s suite. She was finally in control; she was like an eighty-five-pound “gorilla” - eyes and presence, observing and never challenging, always available to take up space in the acute hospital, when the census was low. That little old woman worked the system like no one else. The administrator was watched, he subjectively was chagrined; he was, without his knowledge controlled, by “the eyes and ears” of the hospital.
Each new administrator would set about to remove “the presence” from the hospital, or at least from the room across the hall. But, somehow she remained. Her room opened on the main entrance hall to the administration, to the records room, and unto the doctor’s check-in board. In that strategic position, she was able to see all and to know all. She heard discussions, was aware of problems, noted a romance or two developing within the staff and nursing department, became aware of the hostility as the two groups in the city vied for power.
That old woman knew all.
I always made rounds early in the morning, checked in at seven a.m., and rounded on the medical floor. Each day I either saw, spoke to, or answered a message on my check-in box from or about Annie. Being her physician, she thought I was at her beck and call; and I suppose I was. I responded to all sorts of complaints, but the greatest response was to the almost daily conversation, and sometimes night conversation initiated by Annie as I checked out at ten o'clock. Before leaving I had to check her pulse, look at her tearing eye, or note the inflammation of the bunion. This was a ritual, but what the heck, the old woman needed some attention. I was rewarded by a cup of tea, a moment of rocking in the old oak rocker and she had a moment of attention. Slowly she revealed her past. Nothing sordid, nothing to be embarrassed about, but not an ordinary past.
She lived there in the hospital for the remainder of her life. She lived, controlled, and moved in and out of the crowd. She was “crowd control” of the personnel of the hospital, of the administrators, of the physicians, of the nurses, of the kitchen help; when all were accounted for, Annie was “Crowd and Control” of herself and her space.
Eventually, at the age of 100 years Annie died, she slept away one night.
In her will of one page, she left me her old oak rocker, it still rocks in the family.
See this story read in an interview on YouTube!
