The staff began using a hoist to move David from bed to wheelchair, from wheelchair to toilet.  He hated it.  He’d always been afraid of heights, and being suspended terrified him.  His distress slammered me, though I trusted the nurses’ judgment.  I’d found transfers difficult and scary even months before, when David could bear his own weight more frequently.  Now weakness often made him less stable, and the toes on one foot had curled under. 

During the night, though, David had climbed out of bed.  Staff members always tried to watch and listen for signs that he was up, and someone would often sit with him until he got sleepy.  We all knew that he was likely to fall sooner or later, and he did.  He fell twice in one night.  He got out of bed to go to the sink, and a staff member helped him back into bed.  Then he got up again and returned to the sink, and this time he fell.  The index finger on his left hand swelled up.  It might be broken, it might not; the remedy, in either case, was a splint.

But David was left-handed, and a splint on his index finger made it difficult for him to grasp the finger foods that had become a main component of his meals.  The splint, ice, and propping his hand helped during the day; by night he was irritable and angry, clearly in pain, and pain hadn’t struck while the pharmacy was open.  Where were the pain meds that the hospice nurse had ordered in May?  Nowhere to be found.