ANGELL OF MERCY: Tales from the nether world of long term care - Tapa blanda

The "nether world of long-term care" is the underbelly of our technically distinguished but humanistically challenged American health care system and the final stop on the way to dying and death for millions of our most frail and elderly citizens. Each of them has a story to tell, and this novel is a compilation of such stories as related by Rob Angell, a social worker with a deeply troubled past who is advocate and confidante of dozens of patients on the nursing home units of Mercy Meadows, an upscale Charlotte Methodist retirement community. These include Fred Walter, a retired, disabled, depressed, and bitter academic physician once renowned for broadcasting the stories of heroic pioneer physicians in rural upstate New York from his radio station at the university medical center in Schenectady. The two of them collaborate in recording Rob's stories in a series of tapes that accumulate in Fred's bedside table drawer. Upon being notified of Fred's unexpected death, in going through his belongings, Rick Nelson, his 2nd cousin and an academic geriatrician who regularly combines social visits to Mercy Meadows with teaching rounds there with medical students there under his charge at the university in Charlotte, discovers the tapes and listens to them one at a time over the next few months during sleepless nights at his Carolina Piedmont home. While generally charming, these are also somehow deeply disturbing stories of Piedmont citizens living their final days in the apparent luxury of Mercy Meadows but passing them in boredom, neglect, and misery before coming to "untimely" ends, which remain unexplained and uninvestigated in the quiet environment of long term care where death is the expected outcome. This leisurely listening exercise for Rick comes to a crashing end when he listens to the final tape, which is the frightened call of his cousin who comes to realize in his final moments that his own death his imminent.

I am a senior academic geriatric physician at the University of Washington and a recognized national leader in this still young and struggling field. Although widely published in the geriatric medical literature, as a novelist I am a novice. The genesis of this novel-in-stories has been my smoldering anger at the neglect and sometimes frank abuse suffered by our most frail, vulnerable, and failing elderly patients, who all too often languish in long term care institutions as they pass their final days in loneliness and helplessness but whose life stories provide the inspiration for my daily work. The opening chapters represent thinly-veiled biographical caricatures of my personal encounters with such care, specifically as received by my late mother and her 2nd cousin, a retired academic physician who in his fictitious role has recorded the stories of several residents of an upscale Southern nursing facility as told by his troubled social worker and which uniformly end in a death whose cause remains obscure. I live in Seattle with my wife of nearly half a century in the same urban neighborhood where we raised our 4 children in the 60s-early 80s and to which we returned in 1999 after 17 years at Johns Hopkins and Wake Forest.