The Last Resort
By Ron Donoho
No emergency? The entrance sign at Edgemoor Geriatric Hospital belies the facts. The hospital is crumbling and way past due for replacement.
Administrator Florence McCarthy is a tireless booster, a boss who commands respect - and a woman who gets teary-eyed at the thought of Mother Teresa.
Patrick Shryack is an Edgemoor patient with AIDS. "I have syphilis of the brain," he specifies.
Ethel "Grandma" Ellard has one constant companion at Edgemoor: her bible.
Though clean and shiny, hallways have been cited as being too narrow.
Other adjectives used to describe Edgemoor include "outmoded, deteriorated, inadequate," even "dangerous."
"I came here half-dead. I was in a car accident, and there was a pipe stuck in my brain...I was very bitter and very cold...Now, I love it here. This is my home, and I want to live here until I die. This is like heaven on earth." - Nate Cohen, Edgemoor trauma patient
"I am dealing with pain on a 24-hour basis. It's a pain not like a toothache, more like sore muscles. I suffer from dementia." - Patrick Shryack, Edgemoor AIDS patient and prom king candidate
Supervisor Viola Ward cleans laundry with an old-fashioned wooden washboard.
Nate Cohen—whom you’ve met just seconds ago—wants a hug. Talk about a personality paradox: Serenity and hyperactivity inhabit his soul in equal parts. Vigorously explaining a plan for world peace, he rises deliberately from a wheelchair. "Hugs are the key," says the bald-pated, grinning man, whose glassy blue eyes match his sweatsuit ensemble.
Now he is embracing you chest to chest. His mouth is just inches from your ear. "When world leaders get together, they shouldn’t just shake hands," he insists. "They should hug. That’s how you get to be heart-to-heart with someone. And that’s how we can end wars and stop people from hurting each other."
You retreat a step. Nate is smiling broader than ever. Unexpectedly, he launches into "Ave Maria." After all, the talent show is coming up, and he has to practice.
After a few verses he lowers himself back into the chair. "Nate," says the doctor in the white coat, "tell us why you are here."
Yes, Nate, tell us why you are a patient in San Diego County–owned Edgemoor Geriatric Hospital. Explain what has brought you to the self-proclaimed Hospital of Last Resort here in Santee. Why does your soaring voice float here—among the aged, the AIDS patients and those with limbs seized by Huntington’s chorea?
"I came here half-dead," he explains, as if describing a trip to the supermarket. "I was in a car accident, and there was a pipe stuck in my brain." (You sneak a look. There, on the right side of his head, is the indentation and the scar tissue.) "I was unconscious when I got here. When I finally came to, my legs wouldn’t work. I lost all my faculties—I couldn’t even recognize my own brother. I was very bitter and very cold."
That was four years ago.
"Now, I love it here. The floors are shiny and bright. This is my home, and I want to live here until I die. This is like a heaven on earth."
Perception is relative, Nate. During the mid-1980s, Edgemoor was in a hell of a lot of trouble. It was fined by state licensing officials for serious operational lapses. The U.S. Justice Department stepped in after inspectors leveled claims of patient abuse, lack of supervision, inadequate care and lack of infection control.
In a 1989-90 San Diego County Grand Jury report, the Justice Department made it clear that future operational waivers for small bedrooms and narrow hallways in the facility would only be granted if there was "clear movement by the county toward reconstructing the hospital."
In essence, there has been no movement. Yet the facility remains open.
If you’re unfamiliar with the recent or past history of Edgemoor, then you’re in the majority. The hospital is an afterthought even to those who know of its existence. It’s not a popular cause to champion. Most patients here are on death’s front porch. The ones who can speak are apt to express very depressing thoughts—Nate Cohen notwithstanding.
Patrick Shryack is an Edgemoor patient with AIDS. "I have syphilis of the brain," he specifies. Gaunt and world-weary, he wears a sagging blue suit that imparts an innocent, almost childlike appearance. "I am dealing with pain on a 24-hour basis. It’s a pain not like a toothache, more like sore muscles. I suffer from dementia." Patrick, like Nate, speaks of the cold feelings the closeness to death brings. "Especially when you are alone or isolated, there is a coldness." He pauses to take a deep breath.
"As an AIDS patient, I sometimes was made to feel like dirt." Tears begin to roll down Patrick’s cheeks. "I have to say that here, I don’t feel like that. This place brings me warmth. I can feel the love."
The mind’s eye is an unpredictable thing. Who can say what causes certain images to be looped on our optic memory tapes and projected nightly on the backs of our eyelids? Edgemoor provides abundant fodder for such internal montages. Imagine The English Patient as directed by Tim Burton. It’s no wonder no one wants to give this place a second thought.
The hoary hospital dates back to 1923. That’s when the 375-acre Edgemoor Farm was purchased by San Diego County to provide housing for the poor in exchange for agricultural work. It was a proverbial "poor farm." Soon after it opened, 16 women from San Diego Hospital moved in to help care for the elderly.
Edgemoor gradually became a home for the aged and indigent. By 1955, farming activities had been phased out (though the dairy barn, which originally was a polo horse barn, still remains today—used for storage—and is registered as an historic site). The facility was then licensed as a public medical institution, and the current name was put into place. In 1960, Edgemoor became California’s first specialty geriatric hospital. Today, it is one of just two in the state.
Though "geriatric" remains in the name, not all patients are as old as feisty centenarian Ethel Ellard, who answers only when called Grandma. Of the 250 or so patients occupying the hospital’s 322 beds, most are between the ages of 35 and 55. They have had severe trauma, like Nate Cohen. They suffer from AIDS, like Patrick Shryack. Or they are tube-fed, incontinent, suffering from tuberculosis or Huntington’s disease (which attacks the central nervous system and is characterized by involuntary jerky movements) or are disabled by a variety of ailments that prey on mind and body.
A patient cannot be placed in Edgemoor unless he or she has been turned away at least 250 times by other caregiving facilities. This is according to Medi-Cal rules for acute-care hospitals. Sometimes, to comply with these regulations, a patron of someone who needs special care will call 10 hospitals for 25 consecutive days to amass the necessary rejections. How ironic that such effort must be exerted to get into a place called "decrepit" and "falling apart."
Other adjectives used to describe Edgemoor include "outmoded, deteriorated, inadequate," even "dangerous." That description comes from the "Facts and Findings" portion of a County Grand Jury report from 1992-93. Similar missives are issued every year. Here’s an excerpt from the ’92-93 report:
"Water and power utilities at Edgemoor are provided via outdated systems which do not lend themselves to modification; and such core problems as narrow hallways take away any consideration of upgrading the existing buildings. The toilet facilities are inadequate; water is not available in the rooms; oxygen cannot be administered in all patient rooms; and the rooms do not meet present-day spacing standards."
Nonetheless, the report concludes that "the rooms, halls and common areas were clean, as was patients’ bedding; there was no odor, and the staff maintains high standards of daily maintenance."
The 400 hospital employees—many of whom are government issued—seem to really care about their work. But Edgemoor staff and sympathizers are stuck in the dated groove of the same broken vinyl record. Their chorus: We need to build a new facility. We need air-conditioning; we need running water in rooms. We need to lend some dignity to the final days of fellow human beings.
Florence McCarthy says Newt Gingrich couldn’t believe the part about not having running water in rooms. The year was 1995. McCarthy, who has been Edgemoor’s head administrator since 1986, bent the ear of the Speaker of the House during a fund-raising mission to Washington. There was no scheduled appointment—McCarthy was dining at a D.C. rooftop restaurant when she spied Gingrich. She was at his side in seconds.
"I gave him my card and talked to him about Edgemoor for 17 minutes," she says. "He seemed interested and amazed." McCarthy says the Speaker noted he was coming to San Diego for the Republican National Convention. Unfortunately, the 1996 GOP wingding came and went without a visit to Edgemoor by Gingrich—or any member of his staff.
If McCarthy is fazed by snubs and setbacks, she doesn’t show it. Her ability to transcend obstacles likely stems from her childhood. She grew up as the next-to-youngest of nine children on a Chicago farm. When she was 3, little Flo accidentally pulled a scalding pot of oatmeal off the kitchen table. Her face and chest were severely burned. This—and another, unrelated traumatic experience—rendered her aphasic, unable to speak.
It wasn’t until age 7—aided by the love and coaxing of Chicago’s Sisters of Notre Dame at the Academy of Our Lady—that she began to talk. "It really wasn’t until 1990, when I took a speech class, that I’ve felt at all comfortable speaking to groups," says McCarthy. "But I do think that because of my early experience, I have an appreciation for the patients here at Edgemoor who can’t speak at all."
Today, the ebullient McCarthy is giving a walking tour of the hospital compound. Gregarious, spiritual and tireless, she interacts with staff and patients with engaging charm. Still, everyone calls her Mrs. McCarthy. There is no doubt who is in charge.
She visits with Patrick. And Nate. She discusses a recent field trip she and patients took to St. Jude Shrine of the West in East San Diego to see Mother Teresa (Nate, who is Jewish, now carries a rosary she blessed). Walking outside—Santee in the afternoon is an oven—McCarthy points out Viola Ward. Supervisor of laundry and linens, Ward is washing curtains in a basin of soapy water—using a wooden washboard. Laundry hangs from a nearby clothesline.
You check the date on your digital watch —yes, it’s still 1997. Could this be some kind of setup, a staged sympathy ploy? No U.S. hospital is forced to use old-fashioned washboards, right? But it’s no act. If McCarthy were staging this, she wouldn’t risk taking a reporter through one particular dining hall. "Some of our patients have antisocial behaviors," she warns.
One woman hunches over a green lunch tray. A bib is flecked with foodstuffs. She stops eating when visitors walk by. "MRS. McCARTHY!" the woman screams. The hospital’s administrator bends over and gently strokes the woman’s arm. "THEY’RE DOING THINGS TO ME!" McCarthy consoles her. Suddenly, the woman changes the subject. "WANT TO HEAR ME SING ‘AVE MARIA’?" She doesn’t wait for a response. The talent show is fast approaching, you will recall.
The tour winds into the Santa Maria building. This is where the most-dependent patients are housed. Many can only be fed through tubes. Men and women lie in beds in all manner of contorted positions. Here and there old, wood-framed TV sets flicker. Fans swivel atop dressers. Rooms seem devoid of emotion. Indeed, there’s no acknowledgment of new faces; no glimmer of personality. "Many of our patients are trapped inside their bodies," whispers McCarthy.
It will cost $20 million to build a new hospital, claims McCarthy. It needn’t be state-of-the-art, she says. "We don’t need a Cadillac; we just need a decent-running Ford." Edgemoor currently bears resemblance to a broken-down go-cart.
The hospital’s annual budget of about $19 million is covered primarily by outlays by Medi-Cal, from which it receives $221 per day/patient. According to County Supervisor Dianne Jacob, when costs are averaged out over the years, operation of Edgemoor is a break-even venture. "It fluctuates from year to year," she says. "There are some years that Edgemoor has contributed more than a million dollars to county coffers."
After a revenue-greater-than-expense situation in 1990, the County Board of Supervisors arranged for just over a million dollars to be returned to a construction fund for the hospital. Fund-raising officials associated with the Edgemoor Hospital Foundation wish that one-time practice could be restarted. Through interest and private donations, the construction fund stands today at around $2 million. Only $18 million to go. The clock is ticking.
That $18 million will have to come from private benefactors, says Jacob, because there are no funds available from the county. (Federal funding is also being sought.) Not that Jacob is unsympathetic to the cause. She praises McCarthy’s leadership, noting that the hospital "has done miracles with baling wire and chewing gum." Jacob offered that remark at the 1993 "Senior Prom." The prom is the social event of the year for Edgemoor patients; sadly, in ’93 the prom queen died two days before her coronation.
"I don’t know anyone who has gone out to see Edgemoor who doesn’t fall in love with the people there," says Jacob today. "But it’s a relatively unknown facility."
Stan Boney agrees. "Our job is to get support for something many people would like to hide in a corner," says Boney, a member of the hospital’s honorary advisory board and cofounder of Boney’s Marketplace. So fund-raising efforts—both public and private—slog along in relative obscurity.
In the meantime, Nate Cohen will continue his singing, his smiling and his quest for hugs. Around him, power generators break down, outdated transformers blow, and dairy-barns-turned-hospital-wards quietly crumble.
Nate will continue to roll his wheelchair into the cafeteria. He’ll gaze at the wall decorated by a giant, colorful mural. The painted landscape contains two figures: Merlin the magician and a pink fairy princess. Rendered between those two dreamy characters, shrouded in ethereal fog, is a brand-new hospital. If you’re not looking for it, it’s easy to miss. It’s not a drawing of a castle, mind you—just a respectable, decent-running facility.