Tina Cassara passed away on June 17, 2024.

The arts community mourns with her family and friends, and especially her husband, artist/filmmaker Bruce Checefsky, who wrote about their struggles with her brain injury earlier in June.

 

Written by Bruce Checefsky

I never wanted to write this story. I never imagined that I would have to.

In February, I got a call from my wife as I was pulling up to the house. She fell down the stairs and was crying. I told her not to move and rushed in to find her sitting on the floor at the bottom of the stairs to our third floor. We live above a retail store in Tremont and have been there for over thirty years. Tears rolled down her face, and as I moved closer, she was holding her arm in what looked like a twisted, broken elbow. I wrapped a scarf around her neck and made a sling to support the weight of her arm, then moved her to the couch.

When she lay down, I felt a large bump on her head. She complained about a headache. I called EMS. An ambulance arrived a few minutes later and assessed the situation. I watched as one paramedic tended to my wife’s injury, and the other looked around the room suspiciously as if to determine whether she had been pushed down the stairs. I get it. They were doing their job, but the thought of it made my stomach turn. I asked if she could be taken to the Cleveland Clinic, where most of her doctors work, and they said flatly that she was going to Metro Hospital because the Clinic “did not like to take head trauma patients.”

The words “head trauma” made my legs shake. I knew her fall was serious, but I was not prepared for just how serious it would turn out. She was rushed to Metro Hospital, where they did a series of head scans and wrapped her elbow in a cast. A few hours later, a doctor came to our room to say she had a brain bleed, and that they would monitor her for the next 48 hours. The brain bleed turned out to not need surgery, they told me, because the bruise would eventually stop bleeding and the body would absorb the blood that had built up inside her head. She stayed in the ICU for four days, in the general hospital for a day or two, then transferred to a rehabilitation center down the street. Ten days later, fully recovered, according to her doctors, she returned home.

Less than a week later, my wife complained about a headache. I took her immediately to the Metro ER. She walked in on her own. That was the last time she ever stood up. Within three hours, neurosurgeons were performing surgery to stop a second brain bleed, far more serious this time and located in the parietal lobe, where the original bleed was near the front lobe. When she came out of surgery, she was bound to a hospital bed in five-point constraints, which means her hands and legs were strapped to the bed along with her midsection. She was out of it, but conscious. For the next three weeks, while in the ICU, she struggled to get free from the constraints, her eyes closed most of the time, wailing and crying. Nurses kept sedating her, telling me that she was suffering from delirium, and eventually would get better. “Delirium is a syndrome, not a disease,” they told me.

At the end of three weeks, ICU doctors had done all they could, I was told, and she was moved into the general hospital on the same floor but in a different hospital wing. She remained in five-point constraints for the next four weeks, with little to no improvement. Almost two months after her initial fall and ER visit, the nursing staff said they were discharging her. “Where do you want us to send her?”

I was shocked. She was in no condition to come home, on a feeding tube with intravenous fluids, strapped to the bed. After more than a dozen phone calls to friends and family, my doctors, and hers, I was trying to understand what was happening. She was transferred to a long-term acute care hospital (LTACH) in Cleveland. A day after she got there, her doctor told me that she had been heavily sedated, and he felt their facility had been tricked into believing my wife needed fewer restraints, a requirement for any LTACH that patients have no more than two constraints. She was placed in a room with four other patients, with one nurse and an aide, and monitored 24/7.

Keep in mind, I had visited my wife every day since her interment in the hospital, sometimes twice a day, to advocate for her care, which required my full attention. Our hospital system requires constant patient advocacy, without which patients are subjected to mistreatment and abuse. While at the LTACH, I received a phone call one evening saying that my wife had fallen out of bed. The nurse said she did not hit anything, and there were no injuries. I asked if she needed medical attention, and I was told no, “She is doing fine. Nothing happened.” When I got there the next morning, my wife had bruises on her lips and chin. I asked the nurse what had happened and where the bruises came from, and she leaned in, looked squarely at my wife’s face, and said, “I don’t see any bruises.”

I made every effort to move her out of the LTACH, and when I finally got her into a skilled nursing facility a week later, most would not take her because she was still on a feeding tube and needed round-the-clock attention to keep her from pulling out the tube in her stomach or falling out of bed. My wife told me that she had been physically abused and assaulted while at the LTACH. At this point, she would drift in and out of tiny one-word or two-word conversations. “They hit me in the face,” she said when I asked about the bruises. She said was physically abused at least four or five times more, maybe as many as ten.

I filed a police report the same night, called an attorney, and reported the abuse to the Ohio Department of Health. I had photographs of her bruises, taken two days later. When I showed the police, they were visibly upset. “No one should get hit like that,” said the officer taking my report. He vowed to investigate the following morning, which he did by gathering more information about the facility, staff, and director. I told him what I knew. The investigation is ongoing.

My wife was in hospice at a longer-term nursing care facility in Parma. Just the other day, they called to say she was being discharged. I repeat, my wife was in hospice, and they wanted to discharge her. I was floored again and asked why. They could not provide enough nursing support for her one-to-one care, they claimed, even though she was accepted under those conditions. They felt she would be more comfortable someplace else. It seems this decision based on money as her Medicare coverage was coming to an end. I told them that I would private pay, even though we cannot afford to do it, but I would cash in whatever 401k retirement we had to help my wife. Everything up to this point was driven by money, and the first question asked as I barreled down this horrific road was, How are you going to pay for it? Always asked by a midlevel administrator, dispassionately and unemotionally, they never look into your eyes.

Luckily, I was told by an insider at the skilled nursing facility that she could not be discharged unless I approved and selected the place where she would be taken. He suggested telling them to invoke the 30-day notice required by a faculty to transfer or discharge her, a legal requirement that states, before proposing a transfer or discharge, a facility must identify and try to meet the resident’s individual medical, nursing and psychosocial needs. I was never given a clear reason why she should be transferred. Tina died on June 17. The outpouring from the art community has been overwhelming. I am so grateful to be part of it.

I’m heartbroken and devastated by her death, and I am mad as hell. I have no more fight in me. Our healthcare system is shameful. What I have seen in the long-term care facilities and nursing homes will make anyone cry, and I did, and I will continue to cry for my wife, whom I loved with all of my heart.

Donations and contributions can be made for a scholarship/fellowship named in honor of Tina Cassara at Praxis Fiber Workshop in the Waterloo Arts District in Collinwood. For more information, contact Jessica Pinsky, executive director, at contact@praxisfiberworkshop.org, jessicapinsk@gmail.com, or call (216) 644-8661. Donations are also being accepted for her care and expenses.

 

Bruce Checefsky is a filmmaker and photographer, and published writer. He is the recipient of three Ohio Arts Council Individual Excellence Awards, a Creative Workforce Fellowship, and four CEC ArtsLink Fellowships.  

 

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