By Kelly O’Brien, MD, FACP, CCHP
Posted on March 3, 2010 – I am so close to peeing on my toothbrush. I’m in the shower rinsing out hair color when I reach for my washcloth, but knock my toothbrush off the rail into the shower. Being a woman of a certain age, warm water makes me pee. In a rare show of sphincter domination, I’m queen of my castle and don’t urinate onto my toothbrush. The dual geriatric syndromes of gray hair and urge incontinence are conquered in a brief moment of elder triumph.
Aging in your own home is hard enough—how much more so in custody? In my many years of correctional care, I’ve noticed a recent trend in our metro area. There seems to be criminalization of senile behavior. We have an increasing number of nursing home residents coming through jail.
Take, for example, the case of Mr. O. At 65, posttraumatic brain injury and years of Old Crow, he’s been deemed nursing home material. He’s still physically fairly active though none too steady. His pimped out walker has wheels, a padded seat cushion and a basket for his oxygen tank. When he gets frustrated, he has the unfortunate response of hitting or kicking. Then, he’s sorry about it. While I can absolutely understand not wanting to be on the receiving end of these tantrums, it’s not actually criminal in nature.
Charges are pressed, however, and he’s transported to jail. There he promptly falls over and ends up in the locked unit of the city hospital. He goes from here to court, where it takes the judge four seconds to render a verdict of: Are you kidding me? Time served. Of course his nursing home bed is now filled, so he goes upstairs to a regular ward for placement and promptly hits a nurse. New charges are filed, bringing him back down to us.
Me: Mr. O., do you know why you’re here?
Mr. O: No. And I need to get out before my disability check arrives to my box and gets stolen.
Me: You hit someone.
Mr. O: Oh.
Now he looks very sad, as if he just remembered this rule.
Me: You can’t do that. People don’t like to get hit.
Mr. O: Looks sadder. Nods in agreement. I’m sorry. I forgot. Twinge of hope. Can I go now?
Back to court; back upstairs. And would believe it? He hits someone. At this point, I’m thinking these are the slowest nurses in the west, but our CNA, also a victim of Mr. O, assures me that he’s actually pretty fast and stronger than he looks. The cycle becomes so established that when detectives come to interview him on Friday about Wednesday’s assault, he’s in court for Monday’s charge. The upstairs staff is getting tired of this, and I am called to the office of the Very Important Physician.
Very Important Physician: We can’t have our staff getting assaulted. Keep him in your unit.
Average Staff Physician: It’s really the judge’s decision. We’re not allowed to keep him locked up if he’s actually out of custody.
The look on his face conveys this is somehow my fault, because it involved an inmate. I try again. Mr. O., if you promise not to hit anyone else, I promise to put my toothbrush in a safer place. He solemnly nods in agreement.
Only one of us even knows what I’m talking about, but both of us know things aren’t going to change. Aging is the one true thing people have in common, and some do it more gracefully than others.
Dr. O’Brien is an SCP member and Acting Chief, Division of Correctional Care at the Denver Health Medical Center. Readers may contact her at kelly.obrien@dhha.org.
