Time In Shady Manor

By Donald Sheldon

This work of fiction deals with a topic that many people find difficult to think about. Until the most recent three or four generations, humans eagerly looked forward to moving though the stages of development from babyhood to adulthood, impatient to become the masters of their own destinies. The rites of passage were well known and embraced by most everyone in our western culture. Until the modern age of the twentieth century, the extended family still personally provided shelter and care for their elderly. But as society changed so did the attitudes toward the burden of caring for the elderly at home and the use of nursing homes as the final places for the elderly, chronically sick and disabled became common. The guilt associated with placing one's difficult to care for elderly and chronically ill loved ones became gradually diffused by the knowledge that they could receive better care and attention by skilled providers of medical and routine care. Unfortunately, to this day, guilt still plagues those of us who truly care about our loved ones who we have a difficult time physically and emotionally caring for at home. This can be made worse if our relationships with these loved ones never matured into healthy, loving separation where each respects the needs of the other.
As the use of nursing homes developed into a more specialized and widely accepted medical industry, the need for more regulatory oversight became needed to correct the failure by many nursing homes to protect their vulnerable residents. In spite of the ever increasing regulations of the 1970s '80s and '90s, there continued to be shoddily managed facilities whose lack of oversight and true concern for this most vulnerable population group led to neglect and abuse of sometimes a shocking nature. In spite of penalties including large fines and sometimes loss of Medicare and Medicaid certification and even the closure of the worst facilities, abuses still continued and continue to this day. This is a story which is in some ways heartwarming, and at the same time disturbing. Although any or all of the types of situations depicted in this work of fiction could have happened and have happened somewhere sometime, none of the companies, facilities people or events are real, and are a product of the author's imagination. I hope you enjoy this story and can relate to the fact that many well-meaning people who devote their lives to the caring of our vulnerable populations start out with good intentions and find themselves caught up in a web of opposing pressures that either lead them down the dark path of neglect and abuse or they remain true to their purpose and develop into even better human beings. And I also hope that you can relate to the leading character of in the story, who really thought he was planning out his life in a way that allowed for a comfortable retirement and exit strategy for this life. But in spite of anyone's plans and expectations, the unexpected things in life can lead one down a far different path.

• Language: English
• Publisher: BookBaby
• Release date: Jun 1, 2022
• ISBN: 9781667844411

Book preview

Chapter 1. Of Shady Manor and Jim Masters

Shady Manor Health & Rehab Center was a nursing home in central Bakersfield, California, owned by a national nursing home chain with regional divisions in the Pacific Northwest and California. The company was called Progressive Health and Rehab Centers of America, LLC. The states of Washington, Oregon and Idaho comprised the northwest division and there were fifteen skilled nursing facilities that Progressive owned. California had twenty of the facilities and was a division of its own, since California’s Title 22, containing the licensing laws governing nursing homes, was more stringent and complex compared with the other set of licensing rules found in the states of the Pacific Northwest. Although the company was based in Seattle, Washington, and had facilities only on the west coast from Washington through California, the owners of Progressive had big ambitions and their name reflected their much larger ambitions to become a national chain of nursing homes. Shady Manor Health and Rehab was a 99-bed facility, a size considered by nursing home chains in California to be the optimal size. Much smaller, and it would be hard to staff efficiently and economically, and much larger, it would have required much more effort and money to manage and have more opportunity for problems. Staffing ratios were not developed yet in the 1990’s and facilities were required to do a self-audit of nurses’ staffing to patient ratios two weeks prior to the annual state survey and report the numbers to Medicare. Many facilities increased their staffing ratios just before and during the annual state surveys so they would look good, but seldom met those ratios during the rest of the year.

The reputation of nursing homes before 2008 was mostly based on community word of mouth. Family members would walk through a few of the nursing homes before deciding which one to try to get their loved one admitted to. Usually, the reputation of a facility was long established, partly on word of mouth and partly based on whether or not they had been in the news for horrible incidents or neglect. Things making the news in the seventies, eighties and nineties could include horrors such as large numbers of bedsores, maggots getting into sores and wounds or residents being restrained in bed or wheelchairs to prevent falls. Residents might catch themselves on fires while smoking or wander out of a facility just to be lost or fall down and injure themselves. Restraining residents in bed or in wheelchairs was common and was usually justified by the professed desire of the facilities to prevent falls and injuries but was more realistically because it was easier on the staff to manage the residents. During the late 1980’s and 90’s, the federal government started collecting more and more data to help improve the care of one of the most vulnerable populations in the country. It a combination of the data collected by the government as well as private studies that showed that the use of restraints actually caused more serious injuries and death than other measures used to keep residents mobile and healthy. Although falls and injuries might still occur, the more serious injuries and especially death might be avoided by other more humane and functional means. This set the stage for increased regulation of nursing homes to meet the federal standards. The state of California, being more progressive than most states, used Title 22 to regulate the nursing homes and referred to the title during state surveys which were done annually, or more often if indicated.

Nursing homes during the 1990’s became creative when trying to comply with the focus of reducing physical restraints but at the same time preventing falls. Chemical restraints, drugs that could cause lethargy and improved compliance, started to be used more but these had negative effects on residents’ health, and soon became a focus of the state and federal governments. A small industry grew up around devices being marketed to nursing home for use in reducing restraints. Residents could be seen wandering around in nursing homes in large, seated PVC walkers that could keep a person from falling to the floor, yet allowing them to walk around at will, or sit down. Wedged seat cushions for preventions of sliding and improved posture were used, wedges for beds, low beds a few inches off the floor, and alarms that alerted staff that a resident was trying to get up unattended were used. A company called Wander Guard developed a facility alarm system for the doors that picked up the signal of a wrist or ankle bracelet worn by wandering residents that went off when they came close to an exterior door. Systems like this were very expensive, but not as expensive as Class A citations by state surveys for non-compliance. Facilities experimented with visual deterrents to wandering by painting the floors with striped lines to look like cattle guards or the exit doorways camouflaged to look like a solid barrier. The use of physical therapy became more encouraged to get residents more mobile and then maintain the mobility through nursing programs such as walk to dine and use of restorative nursing aides who provided routing ambulation and exercises. Assessments by nursing and rehab on a quarterly basis helped identify resident changes of condition that might have been missed, and the facility could address the declines when found before they became permanent. Shady Manor found itself going through these kinds of changes during the events of this story. It was hard to stay on the right side of change, even if one tried hard.

When Shady Manor was purchased by Progressive back in 1990, it was actually a 112-bed facility. However, there were not enough rooms for offices, a conference room, storage, and other needed space so several of the rooms were converted into these much more needed spaces and the facility size reduced to a 99-bed facility. The building itself was an old building, approximately 60 years old. It had once been a large motor lodge back in the 1940s when folks would drive from Los Angeles to the Central Valley on the way to Northern California. It was located near the old highway 99 that ran through Bakersfield and by this time was known as Union Avenue. In those early days, people stayed in Bakersfield as their first stop after traveling the hazardous grapevine over the mountains between Los Angeles and the San Joaquin Valley on the way to the Bay Area. A sign along old highway 99 at the outskirts of Bakersfield said, Stay, Play, Sun, Fun. A local doctor and a businessman bought the old motor lodge in 1954 and converted it into a nursing home, calling it Shady Manor Nursing Home. Black and white pictures hung on the walls of the lobby and a couple of other main hallways in the building commemorating the old days of the automobile culture and pictures of the facility when it was a motel surrounded by palm trees.

A small new nursing home company took it over in 1969 and had thought of changing the name from Shady Manor to something more modern, but the original motel was called The Shady Palms Motor Lodge and because of the historical significance, and input from the local community at the time, the facility was renamed Shady Manor Convalescent Hospital. The facility had gradually developed a poor reputation and hadn't stayed up with the times when it was purchased by Progressive Health and Rehab Centers of America, LLC. Progressive spent a lot of hard work and money at first, improving the physical plant and educating the staff. The name was changed to Shady Manor Health and Rehab Center to update the image and the focus the company had on increasing their Medicare Part A component of patients that came from a hospital and could be partially or fully rehabilitated again. Progressive cleaned house and the newer employees were performing in a much better manner, closer to the current standards and healthcare practices. Still, some of the old laziness and shoddy practices remained embedded in the building and Shady Manor was occasionally in the local news for some incident or for having a citation by the California state Survey team for poor care compared with some of the other newer facilities in town.

Jim Masters was 74 years old but his later years had been hard and time had not been kind to him. Jim lived alone in a double wide mobile home in a small central California town called Earlimart. It had not always been that way. Twenty-five years ago, Jim had a loving wife, Susan, a daughter, Mary, and her son Ben. Jim had a busy auto repair shop. His shop handled small and large repairs alike and Jim was good at finding unique auto parts and repairing almost any car, truck, or other piece of motorized equipment. In addition to the auto service and repair shop, Jim had started a towing and wrecking service since his three employees were also excellent mechanics and would be able to help him expand without neglecting one service for the other. Anyone looking at Jim Masters in those earlier years would have thought Jim was a fine example of the American Dream and would retire someday, respected by his neighbors and friends, in comfort and ease.

Jim was born at home in 1924 and grew up in a poor family of hard-working folk that had a small family farm in the southwest part of Oklahoma. The Dust Bowl caused the farm to dry up. There was no money to pay back the mortgage that Jim’s parents had taken out to cover supplies, equipment and overhead during the first few dry years. Jim's parents took Jim and his two siblings in the old Ford, packed and loaded in the trunk, tied on to the back, and sides and top with small possessions that they could attached to it and left the farm to its fate just before the bank foreclosed on it. In 1932 they moved Jim and his siblings to California to join the many others in the Dust Bowl stampede to the West. The land in the Central Valley of California was fertile and Jim's parents believed they could start their new life of plenty there.

The family settled in Earlimart, which was a small farming community in the Central Valley of California, about forty miles north of Bakersfield. Earlimart was founded in 1880 by the Sand Joaquin Valley Railroad which later became the Southern Pacific Railroad as a rail stop. It was named Alila or land of flowers. The town later changed its name to Earlimart in 1910. The farmers in that part of the valley grew a variety of melons that ripened early and could be brought to an early market which was shortened to Earlimart. When the Masters family arrived in Earlimart, the melons still grew well there but many other crops were being produced in this part of the San Joaquin Valley, such as grapes, tomatoes, hay, sugar beets, nuts, cotton, and other fruits and vegetables. Jim soon made new friends and adjusted to his new life in their small new home at the edge of town. It had five acres of land, large enough to grow a huge garden. They planted some fruit and nut trees and had most of the food they needed for the year. Jim’s father got a job on a nearby farm, and soon worked up to foreman because he had a lot of farming background and know how to supervise the fluctuation of migrant laborers from the parched states of Oklahoma, Kansas and Texas looking for work. Jim’s mother and father did things the old-fashioned way, and they preferred it that way. Jim, like his parents and grandparents, know how to work hard.

After he graduated from high school, which was more education than his parents had received, Jim enlisted in the Navy. World war II was at its peak and the armed services needed every able-bodied young man they could find. The Navy taught him even more discipline, and he applied his hard-working nature to his duties there and found it an exciting experience. On board Navy ships, Jim traveled the world and set foot in many ports. He learned diving skills and became an excellent diver. Jim was mechanically minded and was trained in large diesel engine repair, but also picked up knowledge of almost everything mechanical. Jim extended his years on the Navy past the required four years, and decided after a total of eight years, he had had enough of the Navy. He came back home and stayed with his parents for a couple of years, while he adjusted to civilian life again.

Jim completed his time in the Navy and returned home in 1948. He spent a few years working at farms around Earlimart, usually repairing tractors, pumps and other equipment, making enough money to help his aging parents keep their place going. Jim eventually had enough steady income from working on cars and trucks that he decided to advertise and turn it into a business. The effects of the war and action Jim has seen, caused him to take his time adjusting to normal life again and he didn't bother to date any girls or even think about getting married yet. He suffered from nightmares almost every night and felt jittery much of the day. He drank pots of coffee daily and tried hard to forget what he had experienced in the war. Eventually, he ran into his old high school sweetheart, Susan, who had lost her first husband in the war. Susan had not remarried or had any children yet and hadn’t planned on remarrying. But gradually Susan and Jim begin to date and soon their old relationship returned and they felt comfortable with each other again. They decided to get married and they decided to remain living in Jim's parents’ old home while Jim grew his auto and truck repair business and at the same time help his parents in their old age. Soon both of Jim’s parents had passed on and his brother and sister had moved out long ago and had their own families. Jim and Susan decided to remain in the Masters’ old home and after five years of marriage their daughter Mary was born. During this time Jim had begun working on his neighbors' cars and trucks in the old barn which was large enough to house his growing assortment of tools and equipment. Jim's reputation grew and he decided he better find a shop in town large enough so he could move his business there. He opened up Masters Auto and Truck Service & Repair in Earlimart in 1960. Jim and Susan Masters were able to purchase a new home in 1966 after selling Jim’s old family home and dividing the proceeds with Jim’s brother and sister. While the rest of the country was adjusting to the post World War II era changes such as the war in Vietnam, awareness of racial inequality, hippies and Rock and Roll, Jim was happily working in his auto shop, listening to Tammy Wynette, Hank Williams, Jr., Johnny Cash, and of course, Merle Haggard and Buck Owens of Bakersfield. His country western music station never was turned off in his shop. It kept him grounded in his heritage and he was proud of that. More than that, the music calmed the chaos in his mind that sometimes tried to take over.

Yes, Jim was doing well and it looked as if he would be one of the pillars of the community someday. The only weak spot for Jim, was his complete lack of business sense. In fact, Jim never could keep a dollar in his wallet more than an hour or two it seemed. Spending money was never a problem, and during those early years making money was not a problem either. The difficulty was, to expand into a towing and wrecking service, one had to have capital. And Jim had not bothered to save up any capital. He would have to take out a loan. Yes, that would be easy. He knew the banker well and had taken care of his automobiles for several years. All he needed to do was walk into the bank and ask for some money and he would get all the money he needed. After all, Jim owned a house and a business. He had dreams of expanding up and down the valley someday. The sky would be the limit! Jim and Susan Masters’ home looked nicer than the other homes along their street, with a fresh coat of paint and landscaped yard, but the home values in Earlimart were some of the lowest in California and he would have to take out a second mortgage in order to finance the extra equipment he would need for the towing business expansion. The space around his repair shop was limited to a small lot and he would need to purchase the empty lot next to his shop. Jim's wife Susan was against his ideas of expansion no matter how much he tried to make it sound appealing. She said she was happy with their life the way it was and was afraid to leverage their home for some unknown business venture. Jim had always had large dreams but lacked the ability or education to achieve them

Susan Masters and her daughter Mary were extremely close. Mary grew up too quickly, and since she was a beautiful teenage girl, she had lots of boyfriends. By the time she was 18, she was pregnant by her latest boyfriend who left her when he found out. Mary continued to live with her parents and became a full-fledged adult in a matter of a year with a new baby, named Ben, to take care of. Susan felt sorry for Mary and encouraged her to live at home so she could be with the new baby. Mary had barely finished high school and had no concept of what it was like to be responsible for a family, run a household, or a business. When her mother started complaining to her about her father's dream of expanding their business, Susan found Mary a comfort. She needed someone to confide in. Mary sided with her mother and told Susan that she should not agree to a second mortgage for a risky business expansion that could jeopardize everything.

Jim kept nagging at Susan about his plans and tried to convince her how much better business would be. They could soon buy a larger home, take vacations, and get a larger family car. Mary and Susan remained skeptical but Susan finally weakened after months of constant pressure from Jim. Triumphantly, Jim brought Susan to the local bank where they signed the paperwork for the second mortgage. Jim soon had a tow truck, various new pieces of equipment and a half acre lot at the edge of town where he could keep his equipment. He had the lot fenced and built a small two-room office with a bathroom and installed a swamp cooler. Susan reluctantly agreed to answer the phone and help manage the new towing business. Within a few more months Jim and his employees were towing more vehicles than they had time for. Jim wasn’t getting much sleep and Susan was wondering why in God’s name she had agreed to any of this. She and Jim were becoming irritated from stress and lack of sleep and were fighting with each often.

So that he could save money, Jim bought a used tow truck which worked fine for the first year. Gradually the truck had more and more repairs and eventually the engine blew. Jim had to spend more money than he planned to on repairs and finally decided he needed to buy a new tow truck. Over Susan’s objections, Jim bought the new tow truck. That meant a high truck payment to add to the already high monthly business overhead. Jim and his crew spent more and more time working the towing business and the Automotive repair side of the business began to suffer. Mistakes were made and his clientele started taking their business elsewhere.

In 1975, when Mary was 24 and Ben was 6, Jim found himself alone at home. Susan had left him and took Mary and Ben with her. They got an apartment together while Susan was waiting for her divorce with Jim to go through. Jim didn’t want the divorce and tried to talk Susan out of it. Susan told him to get over it and Jim finally signed the papers. He still thought Susan would change her mind and come back to him. Divorce wasn’t that common and Jim ignored Susan’s requests until she finally hired a lawyer and he was presented with the paperwork to sign. Jim was angry and refused to sign them for as long as he could put it off, but finally he gave in. Since he had a business that seemed to be doing well, Jim gave Susan the house and he moved to the mobile office in the wrecking yard, thinking it would be only temporary.

After the divorce was finalized, Jim tried to keep the business going with the two employees he still had but it was hard to keep his heart in it. Susan had been the glue, keeping things running smoothly, answering the phone, keeping the schedules for both the auto repair business and wrecking business. Once she quit helping Jim with his businesses, things starting to become much more difficult. Jim moved the remaining furniture, personal items and a few small appliances that Susan had left him into a shed he had on the towing service lot. Jim continued to live in the small mobile office, letting his life slowly fall apart.

During the first few years after their divorce, Jim was quite angry with Susan, and when they did occasionally talk, it never ended well. Jim gradually quit calling her for any reason and Susan had no reason to call Jim. Within three or four years they didn't speak to one another at all. Jim was not happy with Mary and he blamed her for siding with Susan against him in their business disagreements and in their divorce. Mary called him once in a while to check on him but never would put Ben on the phone to speak with him. Jim would ask to talk to Ben but Mary told him that Ben didn't want to talk to him. Mary was angry with her father because she thought he had been too bullheaded and had ignored her mother's wishes. But Mary also was angry with Susan because Susan had become bitter and critical and expected a lot out of Mary in the way of emotional support. Within a few years what had once been a happy little family became four people that once loved each other and now tried not to even think about each other. Except for Mary and her son Ben who remained close.

Mary decided she needed to have her own life and gradually quit talking to both her parents. By the time Ben was a teenager, he hardly could remember Jim or Susan and had other things on his mind anyway. Mary still lived in Earlimart, about a mile away from Jim. Susan wanted to get as far away from both of them as possible and about five years after the divorce moved to Delano where she bought a small home and made some new friends. By this time, she rarely spoke to Jim, Mary, or Ben. Ben left Earlimart when he was eighteen and joined the air force because he had always wanted to be a pilot since he was a small boy. He and Mary kept in touch often by phone and Mary longed to see Ben more often. Mary had a lot of friends from school and others made along the way. She worked for an insurance firm in Earlimart as the receptionist, secretary and bookkeeper. The business was simple but thrived because the agent was a long term resident of the town from a well-known family and everyone knew him and his wife. Mary didn’t try to change her life much but there were times she wished she was far away from the quiet, lonely little life she lived.

Eventually Jim’s auto repair and towing businesses slowly ground to a sputtering halt. In the end, he sold the repair shop to a young man just back from his service in the army with a mechanical background. The towing business was practically non-existent by then and it wasn't worth anything, except for the lot, the small trailer that he still lived in, and a tow truck that still somewhat ran. Jim was able to sell them for whatever they were worth and had just enough that he could buy a very used single wide mobile home in a mobile home park in Earlimart. The mobile home wasn't in very good shape but it was a roof over his head and it was the best he could do.

After he moved into the mobile home, Jim managed to get odd jobs working on cars, truck, motors of all types making enough money to pay for his meager needs. He had nothing left over for maintenance and repairs over the years and the mobile home gradually fell into disrepair. By the time Jim was seventy, his small Social Security income was not really enough to do more than cover his food, utilities, mobile lot rent, insurance and other necessities. Jim had signed up with Medicare when he turned sixty-five but the small monthly premium was hard to pay for and he signed up for MediCal also. By the mid 1980’s HMOs were fairly new but a person from Bakersfield Family Medical Center came to Earlimart and held a meeting at a local recreation hall to explain how joining with them would allow patients to have medical coverage by one of the HMOs they represented for no deductibles and no copay. They had testimonials from patients, and glowing reports of the expertise of their medical doctors and clinics. They said they contracted with most of the hospitals and several of the best nursing homes in the area. It sounded too good to be true, but Jim was curious and went and listened. He found himself signing up with BFMC after the meeting because he couldn't pass up an opportunity to drop his monthly Medicare premium.

Eventually Jim wasn’t physically able to keep the odd jobs up anymore. The arthritis in his major joints that had been aggravated by his long years of manual labor, along with a family history of osteoarthritis, resulted in Jim barely getting up and down on a ladder to check his mobile home roof or crawling under his own car to change the oil. He didn’t drive much anymore since there was nowhere to go except to the store. By cutting his medical premium, he knew he would be better off. Jim didn't care if his choices in medical care would be severely limited by his changing to this plan. All he could think of was saving money which he badly needed. And Jim hadn't been to a doctor in years and as far as he knew, had no significant health issues. Just arthritis, which he really didn't want to believe he had anyway.

Jim was required to go get a medical examination from a doctor at BFMC as a part of his signing up process. He hadn't been to a doctor in 20 years and dreaded this, but decided he better do it before the HMO dumped him. Jim soon found himself at the BFMC outpatient clinic for a doctor's visit. When his new doctor completed the examination, he told Jim that he had high cholesterol, hypertension, was anemic and had COPD from smoking so many years. The doctor told him to quit smoking, take several medications and to eat more healthily. He told him to come back in 30 days to do another set of labs because he didn't like how high the blood pressure was and wanted to keep an eye on the rest of his health. Jim put the date in his calendar but in the end, he didn't go to the appointment. One doctor's visit was enough for a few years! And he couldn't quit smoking, that was out of the question!

It was a long, cold, and wet winter. Jim's arthritis became almost unbearable. One dark early spring morning after a night of rain, Jim forced his aching body out of bed and when he got into the kitchen stepped in a puddle of water. He looked up and there was a drip coming from the center of the mobile home near the ceiling peak and near where the heating stove duct vented through the ceiling. Water was dripping steadily down onto the floor. Damn it all, said Jim under his breath. I didn't need this on top of everything else! Jim made his coffee and drank it, smoked a couple of cigarettes and looked outside.

The rain had stopped. He didn't want to have to call a repair person, and he didn't have money to pay someone to fix his roof anyhow. He decided to get the ladder out of the shed and stand it up at the edge of the mobile home and get up on top to see where the leak was and what he could do to fix it himself. He had some roof patching material in a five-gallon pail in the shed that he had used before and it worked quite well for a couple of years. He was sure he could do the same thing now. Jim painfully got himself up the ladder to the edge of the roof and crawled onto it. He carefully walked across the roof of the mobile home which didn't have a very steep pitch. Sure enough, the drip was coming from the vent pipe for the stove that somebody had installed in the mobile home in its early days and probably didn’t seal the flashing well enough. The pipe went up through the roof and he thought the flashing was probably coming apart. He looked at it and sure enough, he could see that it was loose and the original adhesive had cracked and was no longer waterproof.

That should be easy to fix, thought Jim. He carefully worked his way back down the roof and as he started to step onto the top ladder rung his other foot slipped on the slick wet roof and Jim landed on the top rung and then second rung and then slid down the ladder and landed on the ground with a thud. Somehow his left leg twisted before he fell off the ladder and he felt a sharp excruciating pain in his left hip as he hit the ground.

Jim was stunned for a minute or so and lay there breathing hard and not quite sure what had happened. He pulled himself together and started to move his head, his arms and then his feet and legs. When he tried to move his left leg there was an agonizing pain in his left hip region. He screamed out with pain and could hardly breathe. He lay there for what seemed hours until a passing neighbor saw him lying on the ground at the foot of the ladder. She called 911 and within a few minutes the ambulance came noisily up the street, its siren screaming loudly. Jim tried to object to them taking him to the hospital but he had no choice. They went into his mobile home and got his wallet and keys, locked up the place, and hustled him off to Memorial Hospital in Bakersfield.

The next couple of days were a blur for Jim. Between the pain pills and the surgery to repair his broken left hip, Jim didn't remember much. He did remember when the physical therapist came to the room and told him it was time to try to get up and start walking. Jim knew he couldn't even sit up, much less stand up and it hurt to even move his left toes much less his whole leg. When the physical therapist tried to move his leg and help him move a little in the bed Jim yelled and cursed and tried to hit the therapist. Send me home! I'll get well on my own! said Jim angrily.

After about five days of poor progress in physical therapy and at the same time attempting to stabilize his medical condition, Jim's HMO representative told him it was time to move to a nursing home. Hell no, I won’t go! said Jim, I'm not going to any nursing home. Over my dead body! The HMO nurse said unsympathetically, Well, it could very well be your dead body if you go home from here. You're in no shape to go, and we would be in trouble if we sent you home like this. We have a nice nursing home lined up for you. It's called Shady Manor. You'll be well taken care of there, and if you work with therapy and do what you're told, you will go home in no time. And with that she walked out of the room leaving Jim cussing and stewing in his bed. Jim would have gotten up and walked out of there if he could have. But he couldn't get up by himself and he couldn't walk. And so, he just laid there and yelled and cussed and waited for the fate that was surely coming to him against his will.

It had been about 2:30 in the afternoon when the BFMC nurse coordinator left Jim fuming in his bed, thinking of all the dreadful things he would likely endure at this Shady Manor where he was being forced to go. He assumed that it would be the next day before he would be taken to Shady Manor, but about 4:30 in the afternoon, in walked the EMTs from a local ambulance company to take him away. Jim yelled at them and told them to get out. He hadn’t even had his dinner yet. The young EMTs ignored him completely and started telling him what they were going to do and proceeded to do it. Jim thought about trying to hit them, but the young man was about 6’2 and weighed at least 250 lb. and looked like a weightlifter. The girl was smaller but looked like she could throw him across the room if she wanted to. Jim just shut up and let them do what they wanted since he didn’t have the strength to fight them and the pain in his left hip would have been too severe. Soon they had him bundled up on the gurney and rolled him out of the hospital and onto the ambulance transport van. They bumped their way several blocks across town and arrived at Shady man Manor about 5:00 PM. They loaded him quickly out of the ambulance and every bump and jerk and rolling motion sent shockwaves of pain in and out of the freshly broken right hip. Jim was cussing up a storm but the EMTs just ignored him. They wheeled him in the back door of the facility and up the hall and stopped at the nurses’ station where a nurse looked up from her work and said, Let’s see, Mr. Masters is in room 39. Jim found himself inside a room with another bed in it, occupied by a very elderly looking gentleman who was asleep in the bed, snoring loudly. It took about five minutes for the EMTs to slide him across into his new bed and with voices far too cheerful given the circumstances, said as they walked out of his room, Goodbye Mr. Masters, and Have a good day, Mr. Masters!"

By this time Jim was in severe pain, his left hip throbbing and burning and if he tried to move, he had sharp jabs of knife-like pain. In spite of the pain, he was very hungry. He didn't like what the hospital had given him at lunch time so he didn't eat much, assuming he would make up for it with dinner. He had requested a hamburger and fries for dinner as well as some ice cream for dessert and some canned peaches on the side. These were some of his favorite things to eat and he had been looking forward to it. He had no idea that he wouldn't be there for dinner. Just then, a young girl and a uniform walked in with a tray of food and over to his roommate’s bed and put it on the table. Wake up, wake up Fred. It’s time to eat, she said as she walked out of the room, Jim yelled, Hey there missy, where's my food? I'm starving! What is your name sir? asked the girl. Damn it, I'm Jim Masters. I've been laying here waiting for something to eat and nobody is paying any attention to me. What kind of a place is this that you let an old starving man lie in his bed without anything to eat? Just a minute, Mr. Masters, she said. I’ll go and check to see if they have a tray for you yet. With that, she left the room quickly before Jim had a chance to tell her that it better be a big hamburger, a large helping of fries, some canned peaches, and chocolate ice cream for dessert. Jim swore under his breath. Already this place was off to a bad start. He remembered that the EMTs had left his call light beside him on the bed. He grabbed it and pushed on the button. He could hear a buzzing sound going on and off up the hall but that was it. He laid there and waited. Nothing happened. He yelled out Hey! Somebody, come here! Help! But there was no reply. He looked over at the bed across the room from him. Fred whatever- his- name was lay there still snoring. Apparently, he wasn't hungry and didn't want to eat. Jim thought about trying to get off the bed and going over there and eating the food himself, but the slightest movement sent more pain into the left hip. Jim lay there getting angrier and angrier by the minute. Damn this place, damn the nurses and doctors, damn it all, Jim grumbles loudly. Fred didn’t seem to hear him and didn’t move. Eventually a nurse came in and told him there would be food soon. She asked him a lot of questions and put some marks on the papers on the clipboard she carried. She asked him how much pain he was in on a scale of one to ten. Twenty! yelled Jim. Damn it, give me some pain medicine! I can't stand this any longer!

Chapter 2. Main Players Converge

Jennifer Brown had just turned 25, but was tired, and was feeling more like 35. After high school graduation from Bakersfield High School, she decided to take a break from her education, mostly because she did not have the money for the tuition and books at Bakersfield Community College, and because she was tired of being in school after twelve years. Her boyfriend of the past seven years, Levi, had been her classmate from high school. Levi had gotten a decent paying job in the oilfields doing manual labor and had been promoted with a raise. He was excited to be making more money than he ever had in his life, and didn’t mind the long, hard hours in the hot Central California sun. He bought a new truck, new clothes, and a new motorcycle for off-road riding on weekends. He had smoked cigarettes daily while in school and smoked joints with friends often and these habits had not changed at all. He always drank to excess on Friday and Saturday nights as well as in the daytime when out riding in the mountains with his friends. Jennifer had tried to convince him of the dangers of these excesses, but he just laughed her off, and told her to stop bugging him so much. If she didn’t like it, she could find someone else! He secretly thought to himself that Jennifer would never find someone as good for her as he himself was! Jennifer finally gave up saying anything to him about the smoking, drinking, and dangerous motorcycle riding and decided to settle for him. She tried a couple of fast-food jobs, and a job as a small café waitress, but the money was not enough to live on her own, and she remained living at home with her parents since they tolerated it for now. Jennifer’s father, Mark, was a sales rep for a business supplying oilfield drilling equipment, and had started out like Levi, working on oil leases, then on drilling equipment and now in sales for a drilling equipment company. Mark suffered a work-related injury when a piece of the drilling rig came loose and fell on his left foot, crushing it to pieces. After long months after major reconstruction surgery, physical therapy, and slow return to an abnormal gait with a limp, Mark was not able to return to his old job due to the loss of strength and function. He was given job retraining by the California Employment Development Department and landed a job in sales, working for a company that sold oilfield drilling equipment and parts.

Jennifer’s mother, Ruth, was an LVN at a weight loss clinic in Bakersfield and to maintain a trim figure, she had resorted to various diets, weight loss pills and recently had added bulimia to the list. She was tired all the time and complained that the people coming to the clinic were not really interested in losing weight but wanted a quick cure without any real effort. Ruth was caring and kind to Jennifer but didn’t spend much effort in motherly advice for the future, in relationships or in love. Ruth and Mark got along OK, but didn’t have a very dynamic relationship, one that provided a solid foundation that Jennifer could lean on and have nurturing from. Mark and Ruth had tried to have more children after Jennifer was born, but were not successful, so they tried foster parenting for a while, but gave up on that due to several bad experiences. The foster children were each from horrible backgrounds of trauma, drugs