By Jenna Price
The phone buzzes at 4am. Could be a marketing call from a different time zone. Buzzes again.
My 94-year-old mother-in-law has broken her hip. Broken her hip just two days before she was set to return home after lengthy rehabilitation. She had a fracture in more or less the same place in August.
Only a third of elderly patients who suffer a fracture return to independent living.
She fell. This is what happens as you age, at least once a year after 65.
Leonard Cohen's death this month came after a fall – and it's quite shocking to me to read that of those older patients who suffer a fracture, only a third ever return to independent living. Fractures lead to a greater risk of death and disability – and you can see how the disability sets in. It gets so much for the frail to participate in really successful rehab.
The last 14 weeks have been a real education for me about how hospitals work, about how the health system operates. But they have also been an education for me in how people relate to each other.
Grandma's been a huge part of my life but not in the way that mothers-in-law are sometimes characterised. She is not overly critical of me and she doesn't take her darling son's side on every occasion, well, not on every occasion. She has always been interested in our children but hasn't condemned us for the choices we have made for them (of course, she would have been really thrilled if we had sent them to Catholic schools but, you know, she became used to our godless ways).
And, because my parents died at, more-or-less, the age I am now, she fulfilled for me a really important role in my life, a role model for ageing.
By the time my parents died, they'd already been unwell for years, a function of the kind of lives they had led after they found refuge in Australia. They worked around the clock and stressed around the clock. And I am now so sorry that I contributed to that in my youth.
But grandma, as my own children call her, was still a guide at art galleries in her 80s, still interested in the world around her, watched the news every night. On her 90th birthday, she was, in black and white, the well-groomed life-of-the-party when 90 of her closest friends and relatives came together to celebrate. She remembered everyone's birthdays, enjoyed lunches and coffees out with all of us.
Now she has had three fractures in four years and is a filament in the moving parts of the aged care system in Australia. At 94, she's a member of the silent generation. Made a lot of sacrifices, didn't ask much.
The health system is not even what it was four years ago. As Mary Batch writes in her research on the environment for nurses today: "The contemporary working environment is being rapidly reshaped by technological, industrial and political forces."
Even in that short time, the number of casual nursing staff who deal with patients like grandma has increased dramatically. Australia has the second highest rate of casualisation within the OECD. Casualisation can be an excellent solution for those who want very flexible working arrangements. But it can be a real struggle for patients when they deal with one nurse after another; and it can be a struggle for those casual nurses to be brought into what might be called the communication loop. How does this hospital deal with challenges, compared with other hospitals? What's the handover like, the moment when one shift tells the next shift what's been going on?
And it takes a certain kind of person to nurse the aged. Patience in spades. And as Mary Batch says, it can be even more demanding than working in acute care.
One evening, I arrived at one of the institutions where grandma has been admitted over the past three months as she moved from acute care to being on a normal ward to the rehab hospital.
It wasn't all that late, but late enough for the light to have died through the windows. And in nearly every room, lay someone who was calling out for help. I stood in the hallway for a moment, frozen. But it wasn't as if the nurses were ignoring the cries. There were just too many for them to deal with at any one time.
Batch says that's exactly the kind of behaviour which overstretched nurses can tend to normalise. That chorus of need is a constant humming in the background of a workplace which is now more dollar driven than ever. Batch is a researcher but she also works as a clinical charge nurse at the Royal Brisbane and Women's Hospital which she says is finally recovering from the cuts made during the Campbell Newman era, a one-term Liberal government which oversaw the kinds of changes to funding which didn't put patients or staff first.
Nurses have huge expectations placed on them by the community and they have some autonomy but the pressures on them make their working lives chaotic. And that's at a time when there is some move towards trying to cut penalty rates.
Of all the things I have learned over the time grandma has been in and out of hospital, the most important is this: If you can't speak for yourself, you must have an advocate of your own, at least one, three or four is better. People who know what your wishes are and can protect you as you move through the system.
It's pretty confronting to ask someone you love very much how they would like to be buried.
But it's better you ask them, in plenty of time, before a perfect stranger needs an answer to a question you can't possibly know and never thought to ask.
Twitter: @jennaprice