02/26/2011 11:57 am ET Updated Nov 17, 2011

The Keeper of the Red Dot: Protecting the Elderly

Gladys, my mother-in-law, known to family and friends as "GladyO'," is having a near perfect day visit away from the nursing home. And although the dementia from which she suffers seems to visit more frequently as of late, it hasn't reared its ugly head today. Instead, I find myself dealing with another important medical issue: GladyO's persistent question about end of life.

"What's the red dot for?" GladyO' asks shyly, then leans back in her chair and rubs the tips of the arm rests, waiting to see if I'll confirm what she already knows. "This." She taps the red ink mark on the nursing home bracelet secured around her wrist.

In past visits, GladyO' has informed me that the red dot on her wristlet is the nursing home's code for the "do not resuscitate" a patient, and she believes the red dot represents what is actually known more commonly as a Directive -- the official document which allows a relative to instruct medical professionals and physicians to withhold life-sustaining procedures. GladyO' remembers that I'd witnessed the initial signing of her Directive papers years ago, after having a discussion with her during her admittance stage to the nursing home.

I want to tell GladyO' the red dot on her bracelet is an alert symbol to nursing staff for an Alzheimer's patient. But the day is such a pleasant visit and no matter how many times I've told her in past discussions that the red blot represents her Alzheimer's and is there for her protection, she'll insist differently and become argumentative.

Still, GladyO's comprehension of the red dot has become an uncomfortable reminder, a tangible congruence of family responsibility, difficult life decisions and its consequences. I glance away, remembering a recent conversation with my veterinarian about "disposable pets" and wince. I'm suddenly reminded of my senior dog's frail health and GladyO's juxtaposed query.

Just recently, I'd taken my dog to the vet to have her euthanized, but in the end, I had ignored the informal Directive my family and I had agreed upon. Instead, I'd brought her back home with a bag of meds that would prolong her life. My senior dog's red dot is there; just not visible to the naked eye. Still, I see it.

My mother-in-law leans toward me and whispers that she's found out what the red dot is for.

I look at GladyO', brush back a few scraggly bangs on her forehead and wait. She raises a finger, anxious to share her secret. GladyO' is old -- musty-old. She rocks compulsively and chain smokes the pack of cigarettes I've picked up for her for our special day visit. And even though she suffers from dementia and other health issues, I know GladyO's comprehension of the red dot is not going to be analogous to the dotted ads of a Target presale, which she enjoys.

I lean in closer to study the red dot, and I'm reminded of a frightening day three years ago and the almost fatal misstep caused by the nursing home's negligence in dispensing her drugs. An emergency room doctor had called me at 2:00 A.M. and advised me GladyO' was in critical condition, and he was confirming the red dot order and was proceeding. I'd bolted straight up from bed and quickly rescinded the Directive.

But now we have the ugly red dot again. It looks like an angry pulsing blister.

GladyO' nervously fidgets with her wristlet and says, "Yes, ma'am, that new nurse told me, and she said they won't save me. Won't let me live..."

Her voice trails away.

I look at her and see questions, fear and hope. She's watching me, her caregiver -- her trusted keeper, waiting for me to make the mark disappear.

I take her hand in mine and ask her what she would want.

Her rocking accelerates. The corners of her mouth contort and tighten as she struggles to answer. "I think I'd like to live," she says. "Yes," she proclaims. "Why, yes, I want to be rescued, live a long life. Wouldn't you?"

I hesitate. I silently wonder about my own red dot and its keeper. We all have a GladyO' red dot, I know. And I think about a close relative and how I was the keeper of their red dot. I think about the difficult decision I had to make years ago.

In my mind, GladyO's red dot grows bigger and brighter. I knit my brow, reach down and touch the cheap plastic band. I try to twist it around, out-of-sight. It won't budge. It's tight -- too damn tight.

I smile, tap the bracelet, then remark that it's too restrictive, that maybe it's time to remove it.

A smile ripples across age-creased lips, stretches and then settles comfortably into the corners of her mouth.

My throat tightens. I don't want to be the keeper of the red dot -- anyone's red dot.

But yet I do, and I also know that at any given time we can become a keeper of a loved one's red dot. More importantly, with this difficult responsibility comes additional duties and issues of critical importance to be the strongest advocate, eyes and voice for your loved one, and to improve the quality care of our seniors. Current national studies and news releases have repeatedly shown us that most nursing homes around the nation are not making the grade; they are failing and are providing seriously inadequate nursing care. Check in with your State Elder Care Division to become an advocate for a nursing home senior and to also find out if the nursing home you choose for a loved one has received a failing grade.

GladyO' Richardson
10/28/1932 - 10/10/2010
Cause of death: Lithium Toxicity