A Story for the Madman

By the time I decided against medical school, I had decided one thing: doctors control the devil and therapists are in control of god. That is to say that doctors keep you from dying and therapists make you stronger. To be honest, I didn’t really believe that. Hell, I didn’t even believe in god at the time. I just think it helped me to justify my decision. I guess it made me feel a little more adequate when in reality, I just didn’t have what it takes to go to med school. Either way, I became a physical therapist. I went to school and thereafter, I started working at a nursing home rehabilitating the elderly. And it’s that decision which led me to cross paths with this guy … .

Dr. Sargent Paul Benson Jr., MD, JD possessed the most impressive resume of any man I had ever met. It was written on the back of a cocktail napkin and it read like this: “lawyer, medical doctor, Korean War and Vietnam War veteran, bronze star, silver star, medal of honor, professional swimmer, judo and karate master, Florida wildlife officer, Holiday-on-Ice professional figure skater, and tap dancer.” He was the world’s most interesting man, but his resume was missing two crucial details: shingles and dementia.

“Oh mamsita,” he said, “Oh mamasita. They better get something for this pain, and they better get it pronto.” He used to roam these hallways freely with a walker, blue jeans, nubuck cowboy hat, and black leather boots. And way before that he used to break broncos on a ranch somewhere in Florida and he spoke highly of his quarter horse named Tilley. Yet at the time, Paul was unable to walk, let alone attempt activities like riding crow hoppers. He was in a weakened state, a common consequence of having shingles in old age.

Luckily, we were dealing with the world’s most interesting man, a man who spoke nearly 7 languages and a master of the martial arts and karate. Paul underwent a strict rehabilitation program, personalized to incorporate Paul’s own very unique skillset. “First judo cup the ears, then judo chop the neck … or you can stomp the foot and Judo chop the Adam’s apple … oh mamasita.” It was a learning experience for all involved.

During that period, Paul had recovered enough to leave his wheelchair behind and stroll around the facility. The scabs of shingles healed over and he was getting closer to his old self. One day, he gave us a fair warning, “Promise me one thing, if you ever see me out in the wilderness with a mountain lion, DO NOT INTERFERE. I know how to talk to animals. It’s a gift.” To some people that may raise slight concerns, but when you really know the world’s most interesting man, you know that’s a really good sign. And what’s more, it looks great on a resume: “ability to talk to animals including mountain lions.” Oh mamasita … oh mamasita … mission accomplished!

That was one of last year’s success stories. The company I work for has me write two success stories a month for the corporate marketing agenda. I always try to slip in as much of the absurd reality as possible, just to make the corporate goons look bad. That’s how I feel working for a bunch of gold-digging stumblebums, but that’s just profit-based healthcare. It all starts at the top and trickles down from there. That’s why they’re after me again to take another look at Benson. In reality, I’d like to leave this guy alone, just let him stay pleasantly demented. Yet somehow or another, the company makes more money with the Medicare B patients so they want me to stockpile the caseload. Hell, they’d have me pry the Medicare dollars from the hands of a dead body if they thought they could get away with it. So they want me to go slunk into the old man’s room and conjure up some phony excuse to start doing physical therapy with this guy on a daily basis. When in reality, he’s at his max potential. But it’s quantity over quality, success stories over clinical ethics, and putting up with the head nurse’s sexual ambivalence on a daily basis. That is in fact how they expect me to play the game.

The head nurse always comes into the rehab gym and asks me how I even have sex since I’m such a germophobe. By germophobe, she’s referring to the fact that I glove up while treating patients with C. diff. And today she wants to know if I’d hypothetically rather eat a bull’s testicles or a bull’s tongue. “Alright, Mr. Richmond,” she calls me. “Which would you eat? At least the testicles are clean because they’re inside of a pouch. Don’t tell me you don’t know where that tongue has been.” She’s 64, looks 90, and knows nothing about medicine. Like most people here, she kinda just does a lot of mindless chitchat and brushes things off as she passes the time. And then the new young administrator comes in and starts talking about how much he hates Parkinsons and MS patients because they don’t make us any money and he’s not letting another one into the facility. “Those shitbums never do any therapy. We can’t make money if they don’t do therapy. What do we bill for? Bunch of little milkshits,” he says. “A pulse is a payor, my ass.” Meanwhile, here we are in the middle of the rehab gym. I’m right here with a patient who hears and comprehends all of what they’re saying. They just don’t seem to understand that they’re interfering with treatment or rather they just don’t care. I pull Bernie’s leg out into abduction to get a nice stretch.

Bernie had visited the facility before, back when he had two legs and one monkey. Nearly a year later, he returned. This time around, he had one less leg and one more monkey. They were plush stuffed animals. The big one was called Chinagirl and the little one was Diane. And if there’s one thing I learned about this whole situation, it’s that you never underestimate a man with one leg and two monkeys.

In the state of Virginia, you get to keep your amputated leg. It’s your right if you want it, and they’ll box it up and stick it on your front doorstep. But Bernie didn’t want his leg. The old leg was infected and it had a club foot. Bernie just wanted a new leg that he could actually walk on. Of course, we all just want to pop on a new leg start strutting around, but it’s not that easy.

A lot went into the process: wound healing, pain control techniques, stretching, strengthening, and a whole lot of TCMB—taking care of monkey business. That’s right. Of all the incredibly strong muscles in a monkey’s body, they have particularly weak glutes. Just like Chinagirl and Diane, Bernie lacked those specific muscles.

After weeks of hard work and determination, Bernie finally received his new leg. Within moments of donning the prosthetic, Bernie took his first few steps, and they were beautiful steps. Before long, he began taking long walks throughout the facility while wearing his aviator shades and red bandana. That new leg changed something about Bernie. It helped to bring out his eternal sparkle. Bernie wasn’t just Bernie anymore, he was a man with two legs, two monkeys, and two thumbs up.

The young administrator is still complaining, but now it’s about the lawsuit. One of the LPN’s has been busy smacking CNA’s on the ass. One of ‘em fired back and now there’s a lawsuit. And to top it off, last month a floor tech accidently put a burrito in the microwave for 20 minutes and caught fire to the break room. With all these setbacks, we’re not pulling in enough money and corporate is getting pissed off. They want me to pick Benson back up onto my caseload. They say he’s had a physical decline, but the man walks 3 miles a day at the age of 97. Hell, half the nurses in here couldn’t walk that.

The head nurse and the administrator leave. “Alright, Mr. Richmond, don’t do anything I wouldn’t do,” she says.

The door shuts.

“What do you think?” I ask Bernie.

“I wanna take a bomb to this place,” he says. It’s nothing too serious. That’s just how he is. And for a second I put myself in his shoes, being in a nursing home for the last 20 years, your mind starts to get a little warped. Not to mention he has one leg, Klinefelter syndrome, congestive heart failure, diabetes, hypertension, and he’s never come close to kissing a girl or playing a game of basketball. We all know Bernie’s had the elephant man treatment his entire life.

Then there’s a nursing report call on line one. Sounds like we’re getting another hip fracture admission. That’s the way it seems to go. We come in through the birth canal and we go out the head of the femur. And this one is no exception to the rule. The surgeon has her on non-weight bearing precautions which leads to immobilization which leads to pneumonia which leads to death. That’s why research clearly shows we should let everybody bear weight after hip fracture fixation, but nobody seems to care. Some docs just want to stay old school and keep killing people. Don’t stand on it, but we’ll let you sit on it. And we’ll put you on the bedpan even though biomechanical studies show that bedpans put twice the amount of force through the femur than normal walking. I have a saying, if you let the patient poop, you should let them walk. Words after my own heart, but nobody cares. Where’s the money in that? That’s all it comes down to.

I go down the hallway and find a nurse with the vitals machine. She’s got a patient whose resting blood pressure reads 220/99 mmHg with a resting heart rate of 140-something, well above the heart rate max. She jots it down and moves on to the next patient. “Hey, this guy’s gonna stroke out,” I say. “You’ve gotta call 911.” The man grips a spoon in his hand but he doesn’t even know what it is.

“That’s just normal for him,” says the nurse. “That’s normal for a lot of people.”

You’ve got to love a little old fashion aggressive ignorance. I try telling a few others including the charge nurse. Of course, I don’t even bother with the head nurse. Nobody seems to understand what the hell I’m talking about. I’d call 911 myself, but the administrator threatened to fire me last time that happened. They said I was practicing outside of my scope. He said, “I swear, outside of this facility I’d shoot you with hollow-tip bullets and you’d be done.”

Of course, I’ve looked at other jobs, but it’s the same aggressive ignorance wherever you go. At outpatient clinics they don’t even take blood pressures and they throw a fit if you bring up the thought of sending someone to the emergency room. And at the hospital in acute care, the only goal is to get people out the door as quick as possible. Forget treating the issue, show them how to roll out of the bed and out the door. That’s how you make more money. At least in the nursing home, all I have to truly worry about is the head nurse telling me that she shoulda been a stripper. “I’ll tell you one thing,” she says, “I’ve got the body.”

I take Bernie back to his room and walk down the hallway to the memory care unit. As I stand outside Benson's room, the dilemma gnaws at me. The administrator's latest demand to reinvigorate Benson's therapy sessions felt like a personal affront. For a moment, I grapple with the thought of treating a man who doesn’t need it. At 97, he walks about 3 miles a day. While on the other hand he presents a fall risk, he has never actually fallen. To mitigate this risk, he would need an intensity of therapy that his heart troubles couldn't withstand. So I would just be doing sham therapy.

Then I remember this guy the nurses killed a few months ago. They left a fall-risk patient alone in the shower. Predictably, he slipped, hit his head on a pipe, began seizing, and died. They manipulated paperwork to suggest the seizure caused the fall. The corruption ran deep. I blew several whistles and even filed an anonymous complaint with the state, but inspectors didn't show up, and even if they did, change seemed unlikely. State inspectors lacked diligence, and hope dwindled. That's the harsh truth.

As far as me and Benson go, it is what it is. I walk in and say hello. Mr. Benson gives me a salute every time he sees me.

“Hola, que pasa, senor?” he says. “I mean, how’s it going? God dammit, why is it so damn easy speaking Spanish?”

“Hey Mr. Benson, I’m going for a walk outside. You wanna come with me?”

“That’s fine,” he says.

He cinches up his belt and we get going. Benson starts rambling on in circles about his ranch near Fort Myers and his quarter horse named Tilley. He tells me her name three times in the course of two minutes. When he passes a nurse, he lets me know she’s his ex-wife. And the CNAs are just chambermaids whom he frequents. “And that’s my other girlfriend,” he says. “She’s always after my jockeys.” We keep walking past the nurse’s station and down the long hallway towards the gym. But we pass the gym and head down another long hallway. The whole time I keep telling myself I’m just showing this guy the way out the door so he can escape one of these days. When we get to the front door, I’ve got to punch in the code because Benson has a bracelet on his ankle which will trigger the alarms. The alarms shut off. We walk outside.

“If your shadow is shorter than you, you’re getting vitamin D from the Sun,” I say.

Benson stops on the sidewalk and looks down at his shadow. “There’s West,” he says, “then there’s North.” He looks down at his shadow again. “It’s 3:15,” he says.

I check my watch and he’s only off by 2 minutes, but hell, what if it’s my watch that’s off by 2 minutes? For a moment, it makes me wonder if there’s any actual hope with this guy, but no, it’s just dumb luck. After all, there’s no prosthetic for a broken mind.

“My mother and father took me out in the Everglades when I was a kid and they got tipsy and left me there, and when they came back, I was curled up with a mother cougar, and she was very defensive,” he says and laughs to himself. “And the story has been verified,” he says.

“I believe it,” I say.

“Since then, I've been recognized as Co-cowa-ca-chee, Chief of all Cherokee.”

“That means wildcat,” I say.

“That’s right,” he says, with a smile.

“Let me ask you something,” he says. “You ever ride horses?”

“I’ve busted a few broncos,” I say.

“Okay, how about you come down to Shell Creek Ranch sometime. That’s my ranch and I’ve got some fairly good quarter horses. It’s halfway past Star Route A and Fort Myers.”

“That sounds good, Mr. Benson, I’d love to, but these guys inside won’t let me.”

“Pardon my French,” says Mr. Benson, as he flies his middle finger. “Fuck those guys,” he says. “They can eat my dust or my bony butt crust.”

Of course Benson doesn’t think they’re nursing home employees. He thinks this is a military base and they’re trying to send him back to Vietnam. He’s always walking around looking for his flight gear and complaining that he has to go back to the jungle. I just let him roll with it, because I figure he’s not too far off. These gold-diggers are the same exact prototypes that sent him over there to Vietnam in the first place and now they’re just after his Medicare money.

It’s hard to believe I used to think that doctors controlled the devil and therapists governed god. What little did I know?

“Hey, Mr. Benson, tell me how you told the time with the Sun,” I ask.

“You’ve got a lot to learn,” he says and points out West across his shadow.