The RGH Compromise

Walter gave himself a few extra minutes to enjoy the purring coming from his orange tabby, comfortably curled in the crook of his arm. As he stroked her chin, he enjoyed the feel of her soft fur between the fingers of his calloused hands. He had nothing special planned for the day and it wasn't essential to get up right away, he could spend some time being lazy, much like his cat. Eventually, however, the smell of coffee beans being ground up in the fancy machine in his kitchen forced him out of bed.

He did his first set of 15 pull-ups for the day, as much for the cameras he suspected may be hidden around his home as for his own well-being. Then he took a quick shower and did two more sets, much to the chagrin of the three impatient cats demanding their breakfast.

After serving the cans of disgusting slop his cats loved so much, Walter poured himself a cup of perfectly brewed java. For someone who tended to steer clear of machinery with lots of buttons, he had to admit, the state-of-the-art coffee maker pumped out a fine cup of dark roast. He was also starting to like the fact that he could program the thing from his phone when he was out, so that a cup could be waiting for him when he got home.

He pulled back the curtains to the windows of his small yard so he could eavesdrop in on the chatty little birds feasting on the special blend of seeds Walter had mixed himself. He opened the window a crack and threw out a few handfuls of peanuts to the squirrels that his Homeowners Association manual specifically forbade feeding. So yes, you could say that Walter was something of a criminal.

Another sign that might make you suspect Walter had a dangerous past was the ankle monitor affixed to his leg. But like his squirrel feedings, it was an indicator of something more benign. Walter’s device was the Med Cuff Monitor, billed as a miraculous life saver by the RGH Corporation who had unveiled it. It was only three inches wide and made of a soft material that could dispense micro doses of almost any medicine painlessly, right through the skin. By constantly monitoring blood chemistry, it was able to administer exactly the right amount of medication at exactly the right time. It was helpful for Walter, who sometimes had an issue of making his pill regimen a part of his daily routine. The device did many other amazing things as well, while taking up only a small part of Walter’s bodily real estate. It kept track of heart rhythms, oxygen saturation, and blood pressure. If Walter went online, he would be able to see charts of his sleep patterns and respiratory rates.

After doing five sets of 50 push-ups, Walter went out for his daily run. If he had downloaded the RGH app onto his phone he would be have been able to watch, in real time, when his body stopped using glycogen stores for energy and started burning fat to fuel his minimum 5, usually 8, often 15 mile, cardio tour around his neighborhood. He could also note his hydration levels. But Walter wanted nothing to do with any of that. The device was intrusive enough.

On his monthly visits to swap out his unit with a refill, Walter did his best to hide his conflict with this new accoutrement but he wasn’t fooling anyone. Thankfully, his MD dismissed Walters concerns as just another case of ‘that generation’s’ tech suspiciousness and unfamiliarity. Walter could try to explain it to him but he doubted he would listen or fully understand. More importantly, Walter always had to worry that the issues he had would come off as fearful conspiracy theory and Walter knew that he had to keep such utterances to a minimum.

 Walter didn’t deny that the thing was helpful. Not needing to worry about his beta blockers and B12 did make his life easier. He hated the device not for what it did, but for what it represented, at least in his case. The device wasn’t so much a medical monitoring tool as it was a compromise that had been in his ‘best interest’, and not for medical reasons.

Three years earlier Walter had collapsed while out on his run. It had been a particularly hot day and running in hot weather is something Walter normally relished. Though it was later blamed on a medication error, when he got to the hospital the staff chastised him for his decision to even leave the house. Someone had notified his children, who he was estranged from, and they joined in the chorus with the medical staff in berating the foolishness of an 81-year-old man running.

“So dangerous,”

“Too many risks,”

“Why would an elderly man exert himself needlessly?”

Of course, had Walter been a younger man, no one would have questioned his dedication to fitness. Because a large number of older people succumb to what has become an almost expected physical and mental deterioration, it was easy to lump Walter into a pool of degenerative stereotypes. The fact that he did everything in his power to keep deterioration at bay went largely ignored and even served to steer him into the ‘crazy old man’ category. His fitness plan was ‘obsessive’, his vegan diet ‘extreme’, the supplements he took were ‘snake oil’. Had he been younger none of those things would have been used as red flag for possible psychiatric or neurological evaluation. But when they’re combined with a warning from family members who are ‘concerned’ you need to start watching your back before they put you in a home.

Walter had first learned about guardianship and how some family members abuse the right to power of attorney at a meeting at the VA center. He immediately hired a legal team and consulted with representatives from his city’s Department of the Aged. He created an iron clad will giving his entire estate to a sanctuary he had contracted with to take care of his pets when he died. He had named his chess partner as his designated proxy in case he was incapacitated. And yet his children were constantly in his background warning doctors and city agencies about their poor, misguided father who was obviously showing signs of cognitive decline.

His two children had wanted no part of Walter for much of his life. The ex-wife turned them against him when they were young and they only contacted him when they needed money. For a time, Walter was happy to assist them, hoping with each check he mailed that it would inspire a thank-you call, but it never did. He paid for three cars that his son crashed and a wedding for his daughter that never happened. He wrote tuition checks for a university that his daughter stopped attending after the first month and got a refund for. His second wife sent numerous savings bonds and gifts to his grandson only to be labeled a "whore" at her funeral by his parents, who only attended long enough to make that announcement. The cycle of hope followed by disappointment that was Walter’s relationship with his son and daughter resembled the sleep charts on his RGH patient profile.

He spent many years of his life with his children completely absent and not by his choice but now, suddenly, they were worried about him and desperate for control of the estate. He knew they were behind a constant barrage of wellness checks from civil agencies. They were, somehow, always contacted when Walter was in the hospital. After one too many doctors entertained phone calls from his children, he started calling his lawyer to protect his privacy. Walter’s mental stability was never questioned by anyone else, ever. The use of the term ‘family’ gets you a lot of clout, however, in legal and medical circles. The hostility he held toward the children who ‘loved him and were only trying to help’ suggested instability to more than one solicitous social worker. Somehow his kids had been able to get access to far too much of Walter’s life and records by making the case that they were ‘family looking out’.

Walter and his children knew that if enough instances were documented it could make a case for guardianship simple in a sympathetic legal system. Every aspect of an elderly person’s personality could be scrutinized. There are thousands of regular, everyday decisions and issues that younger people do or engage in that could be viewed, by the right person, as something needing care and correction for someone over a certain arbitrary age marker. Walter’s love of solitude could be construed as ‘isolation’, his affinity for three (three!) cats was referred to as ‘animal hoarding’ by his children, his violation of the terms of his Home Owners Association manual made him a ‘hazard’. Walter’s children suddenly wanted only the best care for him now, with the implication being that this care is best served in assisted living. They still never called or even sent a card on his birthday but they wanted to advocate for the allocation of his resources now. His children would graciously sell his home and assets on his behalf, and use any leftover funds as a fee for their services in order to keep the estate away from governmental taxes.

Walter liked his simple life that sought to minimize many of the bells and whistles, beeps and alerts, of modern society. He could sit for hours watching the wildlife that he encouraged into his yard. He enjoyed the solitude of reading a book, made of paper, with just his felines nearby. He played chess in the park on Saturdays and had friends through his veteran’s group when he wanted to be social. He went to museums and cultural events. He shopped at the farmers market on weekends and like to cook his own meals. He wanted nothing to threaten his comfortable, satisfying life. He would fight like hell with anyone who tried to infringe on his autonomy.

Which is why when the RGH medical device was strongly recommended for him Walter felt somewhat defeated by accepting it. He was ok with taking his medicine. He didn’t need a device hooked up to his ankle to do it. But if he didn’t accept, it could be one more thing added to the cognitive decline list being compiled about him. If he did accept, he worried his kids would find a way to access the charts and information he was generating online and use it against him in some way. His RGH device constantly reminded him that his lifestyle was always being threatened.

Walter didn’t want to be constantly looking over his shoulder for people trying to take away his freedom. He didn’t want to constantly have to prove his competence. For a man just trying to live a simple life with familiar routines, things had become so complicated.

*This story highlights a medical ethics issue that I've dealt with many times over the years as a medical caregiver. Please make yourselves familiar with the guardianship laws in your area, not just for your family but for yourself.*