Where Is the Mango Princess? by Cathy Crimmins

Author:Cathy Crimmins [Crimmins, Cathy]
Language: eng
Format: epub
ISBN: 978-0-307-81619-1
Publisher: Knopf Doubleday Publishing Group
Published: 2012-01-24T16:00:00+00:00

7

Level 5—Confused, inappropriate but not agitated. The patient is confused and does not make sense in conversations but may be able to follow simple directions. Stressful situations may provoke some upset, but agitation is no longer a major problem. Patients may experience some frustration as elements of memory return.

—Rancho Los Amigos Hospital Scale

of Cognitive Functioning

By the end of the second week at Magee, Al is walking with a cane fairly proficiently, so naturally our HMO tries to deny him further benefits and throw him out of the hospital. They already tried last week, but they didn’t have a great excuse then, like Al’s returned mobility.

Lisa Gordon is very frustrated. She tells me she spends most of her day fighting with HMOs. One woman who has done better than Al cognitively still cannot swallow food. The HMO will not pay for her liquid food and feeding tube.

I’m shocked. What is her family supposed to do, chew up cheeseburgers and spit them down her throat as though she’s a baby bird?

Lisa says that Al might have been better off, in terms of benefits, if he hadn’t learned to walk again so quickly. Cognitive deficits are not really considered medical problems. “The HMO case managers are ignorant,” she says. “I spend most of my time educating them about the effects of brain injury, although they don’t care, since they don’t want to pay for the treatments anyway.”

Lisa tells me tons of horror stories, including the amazing fact that one of the area’s most prominent (and expensive) managed health care program pays no money for cognitive therapies at all.

Aetna Managed Care doesn’t care that Al is unable to find his way from his room to the cafeteria without written instructions in his pocket. To say nothing of the Goat Cheese Incident.

“I actually used the Goat Cheese Incident to illustrate how Alan needs more cognitive help,” Lisa tells me, and we both laugh.

When Alan had been at Magee about a week and a half, I brought dinner one night: gazpacho, bread, goat cheese, and a nice gourmet chicken salad. Goat cheese is one of Alan’s favorite things on earth, and that day I had gone to a gourmet shop to buy a very expensive, freshly made domestic type that comes in large square slabs. I placed the chunk of goat cheese on a plate and gave Alan his own plate and some bread. He looked at the cheese curiously. Then, childlike, with his hand made into a fist over his plastic fork, he pierced and lifted the entire one pound piece onto his plate. He then cut it into four pieces, stabbed a piece with the fork again, and quickly shoved it into his mouth.

“Al, there’s bread to go with that.”

“Huh?”

He turned back to his plate and continued shoveling the pound of cheese into his mouth. This was during a period when he would pick anything off his tray and eat it in any sequence. What was this big white thing? All he knew was that it was flat and on a plate and could be picked up with a fork, so that’s what he did.

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