University of New England

“The Creature that Lifts the Bed”: Steven Fosmire, '10

[Editor's Note: The following profile originally appeared in the September 2007 COMmunicator]

The nights were rarely silent, so Steven rarely slept. At the Maine Veterans’ Home in South Paris, darkness crept the hall with bells.

From other rooms leaked the too-loud laughter and blue conversation of television families; sterile companions who had never spent a moment in a nursing home and who would never come to visit. There were the regular soft knocks at the door, the cool swish of curtains drawn suddenly back, the gurgle and whinny of Steve’s Alzheimer’s roommate as nurses checked his midnight vitals. “Moron!” the man would yell, to no one in particular, “Moron!”

And every night there was the metallic grinding-creaking-crackling of the other man’s bed raised and lowered, the nurses concerned that if he fell, he wouldn’t fall far. To Steve, the sound seemed faintly feral. The creature that lifts the bed, he thought. It was a silly thought, a midnight thought, but in the unquiet darkness it somehow fit. And so did Steve.

Too Intriguing

The idea was too intriguing to overlook. “I met Dr. [Marilyn] Gugliucci at the faculty advisor dinner last fall during Orientation,” Steve recalls. “She talked about her geriatric research and how several students had lived for a couple of weeks in a nursing home. I thought, ‘Oooh, interesting,’ and filed it away.” The project, as near as he could tell, was a perfect fit.

A veteran himself, Steve was born in Utah but doesn’t remember the desert. His dad was Air Force, but Steve’s parents split when he was six weeks old and he didn’t meet his father until years later. Steve’s mom, overwhelmed but trying to cope, joined the Army and her parents offered to look after Steve for a little while, until she settled down. A little while turned into most of his life: “I definitely had a non-traditional upbringing,” Steve smiles, his voice tiny for such a bear of a man. “My grandparents raised me in Saratoga Springs, New York, and I consider that my home. My grandfather was a World War II, Korea, and Vietnam vet; he served in the Air Force for almost thirty years.”

Steve received his BS degree from Binghamton University before working at the Center for Functional Genomics as a research technician in charge of performing DNA sequencing and DNA synthesis. That egged him on to engage in pre-health studies, which then spurred him to pursue a Doctorate in Physical Therapy at Sage Graduate School in Troy, New York. To pay his way up the escalator of schools, Steve worked as an aircraft mechanic on LC-130s with the 109th Airlift Wing, Stratton Air National Guard Base, Scotia, New York, from February 1997 until September 2005.

“I have traveled from pole to pole on this wonderful planet with the 109th,” says Steve, “supporting the United States Antarctic Program’s research efforts via the National Science Foundation in Greenland and Antarctica.” He has stood at the actual geographic South Pole and visited CFS Alert in the Canadian Arctic, which is the northernmost permanently inhabited settlement. Currently, Steve is a 2nd Lieutenant in the United States Air Force Reserves’ Medical Corps, on a full, 4-year health professions scholarship at UNECOM.       

Final Billet

In front of the neatly kept Maine Veterans’ Home, flags sprout from the green island that lolls in the center of the entrance circle. American, of course, Maine State, and the melancholic POW/MIA flag that quietly demands its memories. On a brass plaque in the front lobby, a visitor reads, “Maine Veterans’ Home: A tribute to all veterans of this state. Dedicated by Gov. Angus King, Jr., Sept. 24, 1995.”

“When I checked in, we ran through a ton of paperwork with a social worker,” Steve says, “way more than you would think. It was daunting.” With the paperwork squared, Steve watched another worker catalogue his valuables – wedding ring, watch, movies, a laptop - the few personal things he decided he’d like to keep during two weeks as an embedded resident. The lobby had fake plants and lots of natural light. Bricks alternated with spic-and-span white walls.

After a nurse checked and documented his vitals, Steve was assigned a ward, a room, and a malady. The 90-bed Home is divided into three units: skilled nursing, residential living, and a dementia wing. “The residential side has more freedoms, even mountain bikes and scooters if the residents want to use them,” Steve explains. “I was assigned to the skilled care side, with lower functioning residents, including many in wheelchairs or with moderate Alzheimer’s. For many, it is their final billet, but they don’t act like they know they will die there.”

For a simulated condition, Steve “contracted” pneumonia, which meant that he was at risk for aspiration. All-pureed foods and thickened liquids made for a safe but exquisitely unappetizing dining experience. Steve’s first pureed meal was roast beef and mashed potatoes. He smiles weakly. “It looked like something my cat threw up,” he offers finally. “I folded the mashed potatoes into it, emptied four pepper packets, and choked it down. The thickened water was even worse. It was like drinking gelatin, but thicker – it doesn’t quench your thirst. Thickened coffee is sick! The apple-sauce was ok.”

After several days of aspiration precautions, Steve was given a clean bill of health and placed on an unrestricted diet. “Normal food was great!” he says, “It was dining-hall quality.”  A maroon board with gold letters offered each day’s menu: Monday’s breakfast was cereal, French toast, sausage, and a melon cup. Dinner at 5:30 was chicken stew, a cinnamon roll, and mandarin oranges. Or a roast beef sandwich. Steve chose chicken.

To Better Understand

Few medical students would jump at the chance to live in a nursing home. Steve is that rare student. “I did it for two reasons,” he says quickly, his answers well thought-through. “I wanted to re-connect with my grandparents, and I thought it would be good to get insight from a professional perspective about what life is like for an older person. At some point, I’d like to work with veterans. And as my grandparents age, it seems harder to relate to them; I wanted insight into how to relate to folks their age.” 

“You would think that relating to older people would be common-sense,” Steve continues, “You listen to them respectfully and really try to hear what they say, just as you would with anyone else. But for some reason, many physicians have a hard time with that.” Miscommunication plays a significant role; some senior citizens tend to speak more slowly, can be hard-of-hearing, and sometimes process instructions with difficulty.

Doctors, Steve thinks, may easily tend to infantilize older patients, talking at them, or down to them, without understanding that they are real people with mental acuity. “I didn’t experience any of that at the Maine Veterans’ Home,” he says, “Everyone was very respectful.” But the danger of misjudging another person, without having walked a mile in their slippers, is real. “I wish every physician could spend some time as a ‘resident’ in a nursing home,” Steve says, “It is very educational.”

“The Greatest Generation”

Indeed. The showers were supervised – no exceptions. Steve wasn’t sure who was more embarrassed; himself, or the cute, red-headed CNA just out of high school. “What are my choices?” he stammered, before learning that he could take a whirlpool shower which covered everything awkward.

Some of the nurses were young and pretty – they were tan and smiled a lot. The older nurses were strong and heavy-set, veterans of a thousand bedside and dining room skirmishes that left them with whimsical smiles and an efficient manner. They were all the same to Dan. A salty-mouthed, wheelchair-bound Air Force veteran, he offered unprintable comments with equal ardor to any nurse in the room. “He chose the strong but pretty ones to help him,” Steve laughs, “and most of them would dish it right back.” 

“Sparky,” a retired naval electrician, was matter-of-fact when he first met Steve. “He didn’t ask why I was there or why I was so young,” Steve says, “he just asked what branch I had been in. I said ‘Air Force,’ and he groaned and said, ‘Aww, you damn fly-boys are everywhere around here!’ It was pretty cool to hang out with “The Greatest Generation” as if I were one of them.”

The Perfect Melding

Steve pursued osteopathic medicine at the behest of Tanya Hanke, a friend from Saratoga Springs who gained entrance to UNECOM in the class of 2008. “She was the first person to introduce me to the field of osteopathic medicine,” Steve recalls. “I felt that osteopathy was the perfect melding of everything I enjoyed about Physical Therapy, personal training, and medicine. UNECOM provides a strong foundation in osteopathy and what it means to be an osteopathic physician. The facilities are top notch. Wi-fi is everywhere on campus. The learning environment is team-driven. Everyone here works together very well; we all help each other out in many ways in order to level the playing field. Plus, the ocean is a few stone-throws away from campus. UNECOM and the ocean, two brilliant reasons to move to Maine!”

His wife, Senta, is very supportive of Steve’s decision to pursue a career in medicine. She dropped him off at the Maine Veterans’ Home and came to visit like any other family member. Steve has appreciated her support, especially as he has jumped into leadership positions at the College. Those positions tend to chew up any time he has left after studies.

Steve has served as a Student Government representative and Parliamentarian, co-chaired the SGA legislative committee, organized UNECOM’s “Physicians’ Day at the Legislature” and “D.O. Day on the Hill” trips last spring, co-edited the Synapse yearbook, and served on the ethics and special events committees. He currently serves as SGA vice president, is co-president of the Wilderness Medicine Club and the Physical Medicine and Rehabilitation Club, volunteers at the Soup Kitchen, has been nominated to the Sigma Sigma Phi Honor Society, and works as a tour guide and student contact for prospective students to UNECOM. He also occasionally sleeps.

1970 and Winter

Steve had lunch in the dementia unit one day. “The lady sitting across from me thought that I was her son,” he says, “she was more willing to eat as the nurse fed her, because she wanted to impress her ‘son.’” One resident flung his tray and got milk on another resident’s head. “Some of the people in the dementia unit are not that old,” Steve says quietly, “they look normal. But to them, it may be 1970 and winter.”

The days could seem washed out. With little outside activity and nothing to be responsible for, there was rarely a sense of urgency. High points were predictable. “Residents look forward to family visits,” Steve says, “or outings into town. Family visits depended on the person – some families came once a week, some people came every day. One fellow always fell asleep at dinner or social events, but then his sister called and he was animated and alert. It’s like he came alive.” 

Other times were gray. “You kind of lose track of time,” Steve muses. “You live meal to meal or meal to activity. Evenings were tough. There weren’t many people around, since the older residents went to bed early. You lived in the present, day-to-day. People didn’t talk much about the past, and you didn’t think about the future. We talked about current events, or who had won bingo that day. Bingo is strangely cathartic.” Also a newcomer to cribbage, Steve suffered a string of humiliating losses, leaving him to shake his head and exclaim, “I’ve never seen so many cribbage boards – I lost every game but one!”

By 7pm his roommate was in bed and Steve walked the gleaming halls alone. A squat bookshelf in the social room hoarded several dozen titles. They ranged from War in the Pacific to James Herriot’s Dog Stories and Wuthering Heights. A partial row of encyclopedias struggled to stand at attention. The entertainment room had a large flat-screen TV, shelves of DVDs, a polished hardwood floor, pleasant secondary lighting, and reading tables with blue tablecloths, placemats, and vases with cut flowers.    

The History of Doughnuts

Some of the residents were good friends, taking every opportunity to spend time together and hang out. “It was almost like a dorm,” Steve chuckles, “where you would go to each other’s rooms to watch TV.” He played cards with several of the other vets, especially Roger St. Hilaire, a one-legged WWII veteran who was Steve’s best friend.

The two-dozen staff members did their best to keep things interesting. “We made doughnuts one day,” Steve says, “and they gave a history lesson about doughnut-making, and we shook sugar onto them. Every day after exercise, a staff member would read The Daily Chronicle, which was a blurb about current events. They also organized mini-bowling with bright plastic pins.” Steve had to bowl with his left hand and sit in a chair as a handicap.

“The staff was outstanding,” Steve says. “They were very friendly and professional. They knew everyone by name, and some had developed long-term friendships with a number of the residents.” He stops for a moment, brightens, and continues, “It’s amazing how much of an impact you can have on someone’s life just by being their friend. Learn how to respect someone by listening. Learn by doing it. I guarantee that if you do something like this, you will have more respect for your patients, your colleagues, and the nurses.”

Steve plans to go back to the Maine Veterans’ Home this fall, but this time he’ll be a visitor, not a resident. He’d like to go on Veterans’ Day and wear his uniform. He wants to see his friends, though there’s no guarantee they’ll all be around. And he has another motivation, too. Roger St. Hilaire, the WWII vet, was once a dance instructor. He promised that he would teach Steve and his wife to dance sometime.

Roger promised he would – if he can just find a prosthetic he can dance on.

- Steve Smith, RSAS