The Story of Anthony Carnavello and Alexia Eliopoulos

Alexia Eliopoulos, a physical therapist, has just begun working in a municipal nursing home. The facility has a reputation for maintaining high standards of care. When Alexia interviewed for the position, she made a thorough tour of the home and talked with several employees and residents. Everything seemed “in order,” and she took the job.

It is now near the end of her second week of work. Alexia goes to the nursing home office to read the personal record of a resident who may be transferred to another facility because of his apparently worsening mental status. She learns that Mr. Anthony Carnavello is 76 years old and has diabetes. Recently, his left leg was amputated because of complications from a fracture of his left femur sustained in an accident. According to the record, he fell in the corridor of the nursing home after tripping over a chair. Reportedly he is “confused” most of the time and is kept quite heavily sedated “to keep him from becoming violent.” He is almost blind as a result of diabetic retinopathy. No neurologist’s report is found in the record.

Alexia decides to introduce herself to Mr. Carnavello before she goes to lunch. When she finds Mr. Carnavello’s room, she is surprised to see a shriveled-up, frail little old man lying in bed staring at the ceiling. Alexia introduces herself and tells Mr. Carnavello that she will be coming back to treat him in the afternoon.

Mr. Carnavello squints in an effort to see Alexia. Abruptly he raises up on one elbow and says, “I’m so scared! They keep giving me shots and pills that make me crazy! Can you get them to stop?”

Just at that moment, a nurse comes into the room with a syringe on a tray. “Anthony!” she says in a firm, loud voice. “Turn over on your side, please. It’s time for your shot!”

Mr. Carnavello protests that the pills and shots are making him “crazy as a hoot owl.” But the nurse has exposed one loose-skinned buttock and is deftly injecting the solution before Mr. Carnavello succeeds in resisting. He tries to take a swipe at her, but she backs off quickly. She pats his bony hip, saying, “There now, you’re okay, Tony,” and leaves immediately. Mr. Carnavello lies back on the pillow and sighs. He grabs the rail, pulls himself up toward Alexia, and says, “See what I mean!” Alexia thinks that Mr. Carnavello seems to be in genuine anguish. She reaches out to pat his hand, but he pulls it away and falls back against the sheet.

Alexia is angry and confused. There is a gnawing feeling in her stomach that something is wrong in the way Mr. Carnavello is being treated. At lunch, she shares her concern with Annette Carroll, the nursing supervisor for the entire home. Annette is highly respected by residents and staff alike. Alexia tells Annette it seems that Mr. Carnavello is not being treated with the dignity that the residents deserve. She doubts that Mr. Carnavello is “violent” but cannot put her finger on why she felt so much anger at the nurse who efficiently and without undue harshness gave him the injection. Maybe it is because she believes the medication is being used to “dope” Mr. Carnavello unnecessarily. As she recounts what happened, she can feel a seething rage rising up in her. She decides, on the spot, that she will talk to the nursing home administrator and announces that intention to Annette.

Annette listens attentively. When Alexia pauses for a few disinterested bites of her sandwich, she says, “Alexia, you have been here only 2 weeks. I can understand your uneasiness at what you thought you saw happening. And maybe you are right—maybe Mr. Carnavello is not being treated with the respect he deserves. But remember, being new here, there is much that you don’t know. We are doing for him what we think is best, as well as trying to protect our staff from his dangerously aggressive behavior. He was worse before we started him on Haldol.”

Alexia does not feel any better after lunch. She would like to talk to someone and decides to call a social worker who works in another nursing home.