This entry was posted originally on August 10, 2008. I have put it here 'at the top' of my blog again because the story, told by Steve Shields, is so profound; because the story is so well-written; because the description of "traditional" nursing home care is so heart-breaking when viewed from the humanistic, holistic view of culture change; because the story has such a wonderful, inspiring ending for all of us in service to elders.
--- "In screaming, Lee Chung Hi had used her only tool for hanging on to herself…" ---
This blog entry is longer than most of mine. The sacredness, poignancy and deep symbolism of the story that I excerpt here, however, merits its telling. It's a story of a woman with courage, reaching out in the only way left to her, and of an exceptional leader who trusted his gut instincts about his nursing home which kept telling him: 'It can be better. We must make it better.'
The author of the events recounted in the story that follows is Steve Shields, CEO of Meadowlark Hills, a nursing home, in Manhattan, Kansas that Steve guided from "traditional" nursing home to "home", an ongoing journey. I know Steve. He is an effective, professional executive, a leader with qualities stretching across the four types of leadership: intellectual, reformist, revolutionary and charismatic. (For more information about these types of leadership, see Sister Joan Chittister's address at the 2007 LCWR Assembly when she was presented with the Outstanding Leadership award.) Steve's actions flow from a profound faith and contemplative spirit.
I direct you to the book, quoted here, (co-written with LaVrene Norton another faith-based driven advocate for our frail elders). In Pursuit Of The Sunbeam: A Practical Guide To Transformation From Institution To Household. Published by Action Pact Press, 2006.
FROM CHAPTER ONE: 'The Way It Is."
"She screamed for years but nobody ever really heard it until she stopped. It was a shrill, penetrating, constant and unsettling shriek; a noise not readily identified as human. Words were not part of it. She could not form them. Instead, it was the cry of a trapped and desperate animal hoping someone could hear and understand. The howl haunted the nursing home corridors like a shackled ghost intent on settling its business, belying that the source of the sound was less than five feet tall, not even 90 pounds and unable to walk.
Her Asian skin was healthy and beautiful. The Meadowlark Hill staff moistened it with lotion, turned her at night and positioned her at specified intervals. Lee Chung Hi lived year after year, perched in a reclining Geri-chair. It kept her safe and in place. Her graying black hair was brushed and shining. Vital signs were monitored with regularity and her care-plan was carefully executed. She was bathed on schedule at three 'clock on Tuesday and Friday afternoons. By all valued and applied measures in long-term care, she was well cared for. In the nursing notes, and in the minds of all who cared for her, the never-ending screams were the result of dementia . . . an illness of the mind, which surely must have caused her initial placement. But then nobody remembered for sure.
The other residents were routinely lined up outside the dining room to wait for lunch. Lee Chung Hi ate alone in her chair, parked in the corridor farthest from where people gathered. Nobody – residents, staff or visitor – wanted to be near her. Caregivers attended to her dutifully, yet her noise repelled them. She ate alone, sat alone and slept alone.
She became her noise in the eyes of everyone. But nobody could hear her screaming for what it truly was. It never occurred to us that we might be the cause of it – we, who carry out the biddings of a system lethal to the human spirit.
Years passed before we finally understood it. And not until we transformed Meadowlark Hills into a vibrant household community and witnessed Lee Chun Hi's parallel transformation did we realize how profoundly appropriate her screaming had been in response to the dehumanizing conditions in which she lived."
FROM CHAPTER SIX: "The Essential Elements of the Household Model"
"I rang the doorbell and Susan, a household employee, answered the door and welcomed me in. I saw a warmly furnished living room and an adjacent kitchen and dining room; all appointed like any other home in America. The residents, an average of sixteen per household, had moved in less than two weeks before.
The signs of home were already visible amid what previously had been public corridors, cramped bedrooms and large public gathering rooms. The institutional odor was gone. My stomach growled in response to the smells of breakfast floating from the household kitchen. The previous set of monotonous unit style chairs, tables and other office-like trappings had gone to the auction block to make way for more cozy furnishings.
People were visiting with one another and, in stark contrast to the dismal scene of slumping, slumbering elders once parked at the now-dismantled nurses' station, a more inspiring dance of life unfolded. My heart warmed with hope.
But all the blossoming signs of home faded into the background when my eyes found Lee Chung Hi, the lady who screams. She had abandoned her Geri-chair and was sitting comfortably at the dining table, just as my wife had sat at our kitchen table when I left home for work that morning.
It was the first time I had seen Lee Chung Hi when she wasn't screaming.
She was smiling. Her eyes locked with mine, conveying a warmth of well-being that sent me into a suspended sense of time and place. All I could see was her warm smile and radiating eyes of peace, and I felt myself walking toward her as if in slow motion.
I stopped near her table. With her hands at her side, she bowed her head slowly forward and then back up, all the while continuing her smile. This gesture of greeting and respect, practiced in her culture yet universally understood, enveloped my whole being. I found myself returning the gesture in full communion. I was able to return eye contact and nod in mutual affirmation before emotion overtook me.
Her years of screaming, contrasted with the moment we had just shared, represented to me everything we must leave behind and everything we must achieve. The glaring reality was that she hadn't screamed for years because she was sick, but because we were.
In screaming, Lee Chung Hi had used her only tool for hanging on to herself rather than giving in to vacant slumping. She was a fighter -- a screaming indictment of the traditional nursing home system and proof in the pudding that we can overcome; that we have a moral imperative to do so."
