My grandparents moved down to Florida in the early 70s, looking for the "good life" in their well-deserved retirement. Moving north of Miami, they lived in a sort of an early form of "gated community", a mobile home park for senior citizens. It was full of largely active people: there was a large outdoor pool, shuffleboard, billiards, card games a couple of nights a week, people out walking and cycling after dinner, etc. The development around the park was rampant, out-of-control sprawl, with Route 95 buzzing nearby, but the people in the park were really nice, the wildlife and landscaping were gorgeous, pets were allowed, and the opportunity to socialize was always there.
Visitors under 55 were allowed, and we took a lot of advantage of that provision; generally, mom would come with us, spend a few days with our grandparents, and then go to the Bahamas for a week or so while we (generally my brother M. and me, but sometimes just me) spent time with the grandparents. My grandparents were pretty popular folks, between my grandfather's handiness around the house and willingness to help others with small odd jobs and my grandmother's piano accompaniment of sing-alongs after card games and bingo. As much as my mom liked to razz on their bourgeois retirement existence (why would it be any different from other phases of their life? She didn't like any of them), they were having a good time.
This all worked out OK until my grandmother fell in the grocery store in 1989. She was in her mid-80s. There was some water on the floor, and she slipped and fell, breaking her ankle. She was sent to the hospital, where an awful secret she'd been keeping was discovered. My grandmother had a foot doctor and and eye doctor and a back doctor, etc., but she had no general internist (much less a geriatrics specialist, which by this point she really needed) to coordinate all her care. She was on several medications from these docs, some painkillers she'd apparently been on for a very long time due to pain from troublesome dental work, as well as sleeping pills which she'd been on long-term (despite the fact that they were the type that lose their efficacy after only short-term use). She was quite a toxic mess. But nobody knew the sum total of what meds she was on, other than her and her pharmacist (who should have been strung up for filling all these prescriptions, in my opinion).
When she was hospitalized, she was in a good deal of pain; besides the broken ankle, some previously undiagnosed osteoporosis was discovered: she had some small spinal fractures as well. They put her on pain meds for the fractures, which apparently clashed with what she was already taking. At the same time, since she didn't have her other meds with her, she was in effect rapidly detoxed from a series of powerful, apparently somewhat psychotropic medications. She had what can only be described as something like a "psychotic break"; she flipped out, stopped speaking, and barely recognized anyone. She allowed her sister to be in the room, and later my mother, but not my grandfather. She died a few weeks later, despite the fact that she'd had, up until that time, an apparently strong heart, lungs, etc. It was as if her mind just went out the window, suddenly and without warning or explanation.
The one group of people who might have benefited most from my mother's studies in public health (other than herself) were my grandparents. But it seemed that my mother never really reviewed their health status or care with them, despite her expertise. If she did, there certainly wasn't any movement towards a better standard of care for my grandmother, who normally listened to my mom pretty well. By the time my mom got to my grandmother's bedside, it was entirely too late. Nanna died, nominally, of a "broken ankle", but that was just the first domino that fell; in reality, she died of drug overuse and bad drug interactions. These events might have all have been averted if my mom, given her Master's degree in public health with a concentration in health care delivery systems and professed keen interest in "patient advocacy", had brought even a fraction of her skills to bear in the case of her own parents.
After my disappointment wore away in the years after my grandmother's death, I comforted myself with the thought that at the very least, my mother would be the last person to get hooked on pain medications, having taken my grandmother's case as a cautionary tale. I was wrong. Tragically, in this one aspect, she instead saw fit to imitate my grandmother --- and go her one better, even, by having just enough medical knowledge to be dangerous via her attempts to manage her own care, as opposed to letting an internist do that job.
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