13 min read · 2,482 words
The notice came while I was sorting Dad’s mail at my kitchen table. $390 a month for oxygen therapy. Sixteen hours a day. The amount was printed beside a little picture of a smiling older man, like that made it easier to look at.
I’d been at the facility that morning. Dad had stopped twice trying to finish one sentence.
The machine beside his bed was cold.
I didn’t know what that meant yet. I just put my hand on it because I’d been staring at the tubing and trying to figure out whether it was plugged in. The aide, June, was folding a towel near the closet. She said they checked Dad’s oxygen levels regularly and they were “within range.”
I’d heard that before. I’d accepted it before.
Dad’s name is Walter. He was seventy-eight then, and I’m his daughter, Elise. I live in a paper-mill town in Maine where the roads get named after families that stopped owning the land two generations ago. I’m not a nurse. I work in payroll at a plumbing supply place. I know how to match a charge to a date. That is about the whole of my medical training.
I took a picture of the machine’s hour meter. It read 112.
Dad had been in that room for nineteen months.
The thing I kept looking at was not the number. It was the dust around the plug.
Dad wasn’t always sick. He used to split his own firewood and keep a coffee can of screws sorted by size, even though he’d forget where he put the can. He had a laugh that came out before the joke did. After Mom died, he’d call me Sundays and ask whether I’d eaten anything besides toast. I’d say yes, even when the answer was toast.
Then he got short of breath. His doctor prescribed oxygen. The facility said it would be handled.
So I let them handle it.
That was the first thing I was ashamed of. Not the bill. The weeks I’d walked into Dad’s room, seen him sitting upright in the chair, and told myself the staff knew what they were doing. I’d touch the tubing sometimes. I’d ask if it was working. Someone would say yes, and I’d feel relieved enough to go home.
The bill kept coming. $390, month after month. I paid it because Dad’s pension covered most of his care and I covered the parts that didn’t. There wasn’t a dramatic family meeting about money. There was just me moving one payment around so another one would clear.
The notice that started this had a new line on it. “Oxygen therapy, sixteen hours daily.” I read it twice, then checked my picture again.
I called the billing office. A woman named Denise answered. I wrote her name down because I’ve learned to do that.
“His treatment’s documented,” she told me.
“I’m looking at the meter.”
“Those machines don’t always reflect the full care provided.”
“Then what does it reflect?”
She paused. “I can have the clinical director call you.”
I said fine. I was still trying to be polite. I thought maybe I’d misunderstood what the meter counted. That was a small, comforting thought. I held onto it longer than I should have.
I called the oxygen supplier next. I asked whether the hour meter was optional or if it could be reset. The man on the phone told me it was built into the unit and recorded the hours the machine ran. He said the number could be low if the unit had been replaced.
It had not been replaced. The serial number matched the delivery sheet from nineteen months earlier.
I didn’t tell the facility that part yet. I wanted to be sure before I accused anybody. Also, if I’m honest, I didn’t want to be the difficult daughter. I’d seen other families make scenes at the front desk. I judged them. Then I went home and spent half an hour deciding how to phrase a question so no one would think I was accusing them.
The next visit, I brought a notebook.
Dad was in his chair, wearing the brown cardigan with the loose button. I’d sewn it back on twice, badly. His breathing sounded like he’d just come in from shoveling, even though he’d only walked from the bathroom.
“Did they give you oxygen today?” I asked.
“They said I’m fine.”
“That’s not what I asked.”
He looked at the tubing. “Sometimes.”
I kept my voice even. “Does it run when you’re asleep?”
“Not always.”
I asked why. He shrugged. “It makes a noise.”
The machine did make a low rattly sound. I’d heard it the first time I visited. It was the kind of thing you stop noticing if you’re there long enough.
I checked the plug. It was in the wall. I pressed the power button. Nothing happened. The little screen stayed dark.
June came in carrying a tray. She set it down and looked at the machine.
“It’s been temperamental,” she said.
“Since when?”
“I can’t say. I’m not the maintenance person.”
I wrote that down, too. I could tell she didn’t like it. I also didn’t like myself for writing it while she was standing right there, but I did it anyway.
The clinical director, Mr. Pike, called two days later. He spoke in that careful voice people use when they want to sound helpful without giving anything away.
“Mr. Bell’s oxygen level is checked by staff,” he said.
“Is the concentrator working?”
“Our records show treatment was provided.”
“I have a meter reading.”
“I’d rather review it in person.”
So I drove back. I took the picture and the bill, and asked for the treatment chart. Mr. Pike met me in a small office with two chairs and a box of tissues nobody had opened. He showed me a page of numbers. There were entries in neat handwriting, sometimes at 8:00, sometimes at 8:15. The notes said “oxygen on” and “tolerating well.”
I asked who had made the entries.
“Several staff members,” he said.
“Can I see the names?”
“We don’t usually release staff records.”
I put the picture beside the page.
He leaned closer. “That unit may have been off for maintenance.”
“The meter says 112 hours since it was installed.”
“It doesn’t capture all oxygen therapy.”
“The supplier says it records machine run time.”
He looked at the paperwork for a few seconds. “I’ll have our nurse review this.”
I didn’t yell. I didn’t have to. My hand was tight around the paper, enough to bend the corner.
“Please do,” I said. “And send me the full record.”
He promised he would. I took the page he’d shown me and left with no answer.
That night I couldn’t sleep. I kept adding it up. Sixteen hours a day for nineteen months was well over nine thousand hours. The meter said 112. Even if there had been days when Dad didn’t need it, even if the machine had been replaced and the records were wrong, something was badly off.
I called the supplier again and asked when the unit had been delivered. They sent me the delivery record. Same serial number. I called the doctor’s office and asked whether Dad’s prescription had changed. It hadn’t. I went through the bills and circled every month.
It became a stack of paper on my counter. The kind of stack I used to tell Dad to throw away.
At the facility, people started saying “we’re looking into it.” June stopped making small talk with me. Mr. Pike told me the chart entries could reflect checks, not necessarily the machine running. That was different from what the page said. I asked him to put that in writing.
He didn’t.
I asked the state ombudsman what to do. I’m not proud of how long I waited before calling. I think some part of me wanted this to be a faulty machine, one person forgetting to plug it in, something small enough to fix without changing what I thought about the people who cared for Dad.
The ombudsman told me to keep copies and not leave the original documents. So I did. I also asked Dad if he remembered anyone turning the machine on.
He said, “June tried.”
I looked at him. “Tried?”
“She’d put it on. I’d take it off.”
“Why?”
“It hurt my nose.”
He showed me the red place where the cannula had rubbed. It was a small mark. I’d seen it before and thought it was from sleeping on his pillow.
That didn’t explain the chart. Or the bill. Or why no one had told me he kept taking it off.
I called the facility again. This time I asked to speak with June. She didn’t come to the phone, but Mr. Pike did. I told him Dad said he took the cannula off.
“Patients can refuse treatment,” he said.
“Then why did you charge me for sixteen hours a day?”
“We’ll review the billing.”
“I need the full records. Not a page you picked out.”
He said he understood. He said he’d get back to me.
I thought the next step was a complaint. It was. But before I filed one, June called me from her own phone. I was standing in the grocery store parking lot with a bag of apples in the passenger seat.
“Can I talk to you for a minute?” she asked.
I didn’t say yes right away.
“I’m not trying to get you in trouble,” she said.
I was tired of hearing that from people who had already gotten me into trouble.
“What happened?”
There was a pause. “Your dad asked me not to tell you he wasn’t using it.”
I sat down in the car. “Why would he ask that?”
“He said you were paying too much already.”
I didn’t answer.
June said she’d tried to get him to wear the cannula. She’d adjusted it, asked maintenance about the machine, and reported the problem. The machine had been checked once, she said, but the record of that check wasn’t in the paperwork I’d seen.
“Why didn’t you tell me?” I asked.
“I should have.”
“You told me his levels were fine.”
“I checked them. They were okay when I checked.”
“That doesn’t mean the oxygen was working.”
“I know.”
I wanted to be furious at her. Some of me was. She’d let me leave those rooms thinking Dad was getting the treatment I was paying for. But her voice sounded worn out, and I could hear a cart rolling over a floor behind her.
“I can’t talk long,” she said. “I’m on break.”
“Did you know about the billing?”
“No. I don’t see bills.”
“Did you write those chart notes?”
“Some of them.”
I gripped the steering wheel. “Did you write ‘oxygen on’ when it wasn’t?”
“I wrote what I was told to write.”
That didn’t clear her. It didn’t tell me who’d told her. It was the first honest thing I’d heard, though.
I filed the complaint the next morning. I sent the meter photo, the supplier’s delivery record, and copies of every bill. I requested Dad’s full chart and asked the facility to stop billing the oxygen charge while the review was open.
They did.
The state investigator came out about three weeks later. By then, Dad had been moved to a working concentrator through his doctor’s office. A respiratory therapist showed me how to check the machine and what the numbers meant. Dad still didn’t like the tubing. We tried a softer one. He kept it on longer.
He began finishing his sentences.
Not all at once. Some days he still had to stop and catch his breath. But when I asked what he wanted for lunch, he could say “chicken soup, the one with rice,” without losing the last part. I noticed. I tried not to make a big deal of it because he hated being watched.
The facility eventually refunded five months of charges. They said they couldn’t confirm that every billed hour had been delivered. That was their phrase. I filed another complaint about the rest, but it took time and several calls. I kept records. I didn’t make it easy for them to forget me.
Mr. Pike said the staff charting had “not met expectations.” He wouldn’t tell me whether anybody had been disciplined. June was still there when I visited. She didn’t come into Dad’s room as often, but she still brought him the tea he liked, with the tea bag left in until it was almost too strong.
I was still mad at her. I was also grateful she’d called. Those feelings didn’t cancel each other out.
One afternoon, while I was helping Dad sort the drawer beside his bed, I found a folded piece of paper tucked under the spare socks. The paper was soft at the creases, like he’d opened it and closed it many times.
I thought it was one of his old lists. Then I saw June’s name.
Dad said, “That’s nothing.”
I opened it anyway. I know. He was tired, and I should’ve asked. I’ve never been good at leaving a closed thing closed.
It was a short note in Dad’s blocky handwriting. He’d written that he knew the machine wasn’t running, and that June had been trying to help him. He asked her not to tell me because I already had enough to pay for. Then he asked her to bring him a cup of tea when he was awake.
At the bottom, he’d added one more line.
“Please don’t let Elise blame you.”
I read it twice. Then I put it back under the socks, exactly where I’d found it.
Dad had been trying to protect June. June had been trying to protect me. And I’d spent weeks looking for someone to blame while the person who couldn’t breathe was still trying to make sure I didn’t add one more bill to my life.