Category Archives: caregiver attitudes

Looking back and forward

May

Life is funny, sometimes. And it’s strange, always it is strange.
For almost three years, I have been writing for CNA Edge. Three years…it hardly seems possible. I must be getting older, because it feels like just yesterday that I was writing my very first post for this blog (Perception, now found in CNA Edge: Reflections from Year One).

But three years have passed, three wild and crazy years. Life marches on, bringing new responsibilities and opportunities. Just to be clear, I’m not leaving CNA Edge for good. I’m just stepping down to part-time contributor. Instead of once a week, I’ll be writing once a month. I’ve learned so much about the world and myself here on this blog; become a better writer and caregiver because of CNA Edge. Now it is time for me to take the lessons I’ve learned and apply them to new challenges.

Long-term care is a crazy corner of a strange world. We form deep bonds quickly with our residents and with our fellow caregivers. We have to: there’s too much work to do and too much stress to bear on our own. The relationships we form lighten the load, making it possible to bear. Not easy…but possible. Something we can struggle through, together.

The human cost of our long-term care system is something that is not counted enough. When it’s easy to justify making a profit off broken backs and burned-out hearts, you know there’s something screwy in the system. Something broken.
If I am proud of one thing I’ve accomplished in these last three years, I’m proud that I helped to empower other CNAs. My words and my stories touched people, helping them remember that they are not alone. Maybe I’ve helped to alter the perception of CNAs…that we aren’t poor, uneducated ass-wipers who can’t do any better than a crappy job. That many of us are intelligent, compassionate and hard-working people, just trying to do our best in a system that is set up against good care. We caregivers fight the clock every shift, just trying to give good care that we can be proud of…and trying to do it in five-minute windows. Drive by care, that’s what we’re forced to give. And it hurts us, to have to offer scraps and band-aids.
For so long, CNAs had no recourse but to swallow the hurt. Not anymore.
We’ve always had thoughts and feelings, voices and stories. Now, we have platforms to speak them from, safe spaces to tell our stories.
And CNA Edge has been so good to me, giving me that platform to write down and share my stories. Carving out time for good care is hard, but it’s easier now, knowing that change is possible. Knowing that there are those among management and policy-makers who do care, and try to implement lessons they’ve taken from my stories. Knowing that there are other CNAs who, like me, process feelings through writing stories.
I’m so grateful to CNA Edge, to Yang and Alice and the friendship we’ve forged here on the Internet.
Guys, you are the best and even though I’m stepping back, just know that I’m not leaving. I’ll still be here for you, even as I embrace new roles and opportunities.

To all my readers, thank you so much for all the likes, shares, comments and support. Your loyalty and support mean so much to me.

A Wide Movement

May

As I talk about CNA Edge more, there’s a question that keeps coming up: for whom am I writing? What is my target audience?

Whenever I’m asked, my initial reaction is always: “My audience is whoever reads it”.
But that’s a vague answer at best, and no answer at worst. There are some who tell me I should focus more on reaching policy-makers and people in positions of power. And I can follow their line of thinking and I agree with their points: there is a divide between direct care workers and those at the top. That divide hurts our residents, often badly. So yes, I would love to reach more policy-makers.
But not at the expense of also my reaching my fellow CNAs. To put it another way, I do not want to be the sole spokesperson for CNAs to policy-makers and administrators. 

Policies can change. Rules and regulations can be changed with administrations, and then swept away with the next changing wind of politics. I am not dismissing the importance of good policies and those who work so hard to affect change for long-term care. We need people fighting for good policies, and for responsible leadership. We also need people fighting to change the way CNAs think about themselves, to throw off the label of “nothing but an ass-wiper”. If I can do that, then I am not alone. One or even three CNAs speaking up can be ignored. We could even be silenced. How about one hundred CNAs? Or three hundred? How about a thousand, or a million?
That starts by letting CNAs everywhere know that they are not alone. Sometimes I think the worst affect of this broken system is that it makes people who work so closely with others feel utterly alone. We, who have the power to deeply impact the lives of our resident, are often made to feel helpless by all that we cannot change. We feel alone, helpless and burnt out. Silence and sullenness can and do follow.
But together and aloud…what can’t we achieve?
I do not ever want to talk over the heads of my fellow caregivers. I refuse to fall into the trap of thinking that I am somehow more than they are, or that they are something less than me. If I am intelligent, compassionate and eloquent, that does not make me unique among caregivers. Actually, I’d argue that makes me about average. If I stand out, it’s only because I speak out.

What we need now is change, both on a personal level and on a larger cultural one. Compassion, common sense, communication and critical thinking have got to be infused into this broken system. We have to have people dedicated to change on every rung of the ladder…including the one belonging to CNAs.
Just like a democracy cannot function without the active participation of ordinary citizens, neither can our long-term care system function without a principled and vocal base of direct care workers. CNAs who are willing and able to speak up for themselves and their residents.

Broken System vs Personal Responsiblity

Sunflower  May

In compliance with HIPAA, all resident names and identifying details have been altered or removed.

If there’s a story of my career in health care, it’s probably: Nothing happens the easy way, or when I have time to deal with it. Take right now, for instance.
Mr. K has a reputation for being a jokester; he loves to laugh and he loves to make others laugh. The aides are his best audience as we always appreciate a bit of levity. Unfortunately, Mr. K doesn’t so much speak as he does mumble. It’s hard to understand him…especially when he’s cracked up laughing at his own joke. I know from experience that if I keep just repeating that I can’t understand him, his joy will vanish like his independence. So, I lean down and put my face right next to his mouth, in order to catch the words of what I am assuming is a killer joke. When he repeats himself yet again, I don’t take in his words. I can’t; I’m a bit distracted.
His breath is so foul, it smells like something died in it.

I didn’t brush his teeth this morning. I haven’t brushed his teeth all week. As I gag, I ask myself “How did this happen?”

Oral care is often the last part of personal care to be done, and by the time I get to it, I’ve been in the room for fifteen minutes already and ten other call lights are going off. It seems like a quick task, so it’s easy to say “I’ll get to it in a moment,”…and then never actually find time for that moment. When you’re scrambling just to change your people, making the time to do oral care is hard. Adding another five minutes to each resident’s personal care time, when you have ten residents and you’re already running behind…yeah, that adds up quick. Sometimes it is literally a choice between brushing Mr. K’s teeth or changing Mrs. L’s brief before she soaks through her pants. In other words: when you only have ten minutes, what is the most effective way to use them? Most often, we choose the big problems to tackle, the things that have an immediate impact on our residents’ quality of life.
The other problem is that we get so used to dealing with emergencies, crunch-times and hard decisions. We get so used to cutting corners just to survive the day that we form habits around the emergencies. The little things that we had to drop during the crisis? We forget to pick them back up. We get used to not brushing teeth.

The problem of oral care is the problem of this broken system of long-term care, narrowed to razor-thin focus: too few aides taking care of too many residents. We have a system that punishes the aides who take the time to provide good care, and then punishes them again for providing mediocre care. And yet, for all that is true, Mr. K’s mouth still smells like something died in it. I am still his aide…do the flaws of the system really absolve me of my personal responsibility? Being a CNA is, in so many ways, to be forever caught in the moment of drowning: my best isn’t good enough and yet my best is always required.

I laugh, like I got the joke. “Good one, Mr. K! Tell you what, while you think of another one, I’m going to brush your teeth, ok?”

Hangman Holidays

Sunflower   May

In compliance with HIPAA, all resident names and identifying details have been altered or removed. 

Perhaps the strangest part of being a healthcare worker emerges around the holidays. A lot of my family and friends talk about how what they are going to do with their time off; I wonder if I’m going to get any time off or if I’ll have to work extra this year again. 

This is by no means exclusive to healthcare…but it often feels like it. The debate that rages around stores being open during holidays is always “Why do they need to be open? We can shop/go to the movies/eat out/do whatever another day!” You can’t really say that about healthcare. In fact, I’m pretty sure that if all nursing homes and hospitals closed on Christmas, society would come to screeching, screaming halt. No one would celebrate and many would die from lack of care. 

So, nursing homes and hospitals must stay open during holidays, which means they must be staffed. Which means CNAs (among others) must give up their holidays to show up at work and care for their residents. 

The problem is, we want time off to celebrate with our families just as much as everyone else. There’s always an increased amount of grumbling during the holiday season as we try to squeeze family dinners into our few hours off,  have to wake the kids really early in order to them open presents on Christmas morning and miss our various religious services because of our hectic work schedule. There’s a bit of resentment that creeps in even the most dedicated hearts when we’re wearing scrubs while everyone else is dressing up. 

Scheduling around the holidays is like playing Hangman on steroids. It’s trying to guess who’s going to call in because she “deserves Christmas morning off”, who’s going to be cranky all day, who’s going to trade hours with whom. Some aides always seem to be able to get off, while other aides always seem to work every holiday. The reliable/really dedicated aides get called out like vowels during a game of Hangman, which creates its own kind of resentment when you’ve worked doubles on Thanksgiving, Christmas Eve, Christmas Day, New Year’s Eve and then you’re also asked to work New Year’s Day. 

It’s not all bad. I love being with my residents on holidays…just as long as I get a chance for me to celebrate as well. Really, it’s the usual short-staffed story, just exasperated because of all the holiday cheer and emphasis our culture puts on having time off and family get-togethers.

How do you all cope with the craziness of the holiday season at work?

Laughing together

 

Sunflower May

In compliance with HIPAA, all names and identifying details have been altered or removed to protect patient privacy.
It’s funny that we call the oncoming shift our “relief”. Funny and yet oh-so appropriate. Right now I am so relieved that I hug the poor woman as soon as I spot her on the hall.
“Oh, crap,” she gasps. “Let me go clock out if it’s that bad!”
“Some say the world will end in fire, some say in ice,” I tell her. “Clearly, they’ve never been to a nursing home or they would know it’s going to end in shit.”
We just look at each other and burst into laughter. It’s not quiet either, a soft chuckle and back work. It’s the kind of laughter that has us both leaning against the wall for support.
Just our luck, the strictest of the management team happens to walk down just then. She raises her eyebrows at our “lounging” posture and we push off the wall so fast I get a bit dizzy.
“What has you both so tickled?” she asks drily.
I glance over to my relief for some moral support, then grudgingly repeat the joke.
Our hard-ass, straight-laced management person doesn’t laugh. She doesn’t even smile, she just says in the same dry tone: “Clearly. What did they feed these people last night?”
“Corn,” I say promptly. “I felt a bit like a gold panner today.”
“Gross!” exclaim both the other CNA and office person.
“Not as gross as what else was in there,” I counter.
Then, all three of us are laughing, leaning against the wall for support.
<oOo>

Sometimes it easy to get lost in the trenches. We line up on opposite sides, slap labels over the other’s face.
Housekeeper.
Cook.
Administrator.
Supervisor.
First shift CNA.
Second shift CNA.
Third shift CNA.
New CNA.
Student.
Resident.
“Those” residents.
Labels are nifty little things, handles by which grab on to something. The trouble comes when we forget to look beyond the handle to see what it is we’ve actually picked up.
Another human being. A person who laughs and cries, the same as us. A person who laughs at your exhausted attempt at humor.
At its best, laughter is the best medicine. Laughter can connect us, transcend the labels and jump the lines.
It’s really hard to give good care all by yourself in this system. Having allies by your side, someone to lighten the load, relieve you and sometimes just not punish you for a moment’s breather…those things really go a long way. Those things are what allow me to survive long enough to have those personal moments with my residents that renew my passion for this field.

Empathy vs Apathy

Sunflower  May

In compliance with HIPAA, all names and identifying details have been altered or removed to protect patient privacy.

Can I ask you something?” a newbie CNA asks me…in that tone of voice that usually means “Trouble this way”. We’re assisting Mrs. A to eat her lunch, although “assist” doesn’t quite seem like the right word when all she can do on her own is open her mouth. 

“Um,” I say, “sure.”

“That one aide. Why is she like this? How do you get to point where you just don’t care? Why does she act like giving these people your very best is a waste of time?”

“Well,” I sigh. “There’s a lot of stress that goes with being a CNA, and a lot of the time you don’t seem to be making a difference…”

He picks up the spoon, loads it up with mashed potatoes and gently gives it to Mrs. A. “There,” he says, “I just made a hell of a lot of difference for her.”

I almost come out of my seat. “Promise me you’ll stick with this,” I say fervently. “You’re right. Every little bit we do makes the world of difference…but sometimes it’s hard to remember that when you’re frustrated, over-worked and, well, when nobody else sees the good you do. And for that one aide, well, sometimes it’s easier to shut off the part of you that can feel, to spare you from feeling despair. Some aides learn how not to care to survive this broken system ”

“You didn’t,” he says indignantly. “I won’t.”

“Remember that promise,” I say gently, “but also remember this: deciding to be a good aide is not a battle you will ever leave behind you. It’s a choice you will have to keep making every single shift, to do your best even when it seems pointless, to keep being kind even when your efforts seem as terminal as your resident.”

“Is that what makes a bad aide then?” He asks. “Deciding that your best isn’t required? Choosing apathy over empathy?”

∞oOo∞

What is the good of small acts of kindness done for a person who will shortly be dead? Isn’t it a waste of time and talent? Isn’t your struggle to be kind as terminal as the disease killing your resident? One day soon, your resident will lie cold in a bed and there will be nobody left to remember how you put off your break so you could fluff her pillow. Nobody saw you give a good bed bath to Mr. T instead of just running a wet wash cloth over him. So what’s the point of trying? Why put yourself through the agony of giving good care in a system that is not set up for small acts of compassion?

Nobody wants to admit to having these feelings. Who wants to stand up and proclaim to the world that you wonder if somebody’s grandparent was worth the effort?
So instead of acknowledging these doubts, you repress them. You decide that you’re going to be a good caregiver, not like those bad ones who seem to act only on your worst thoughts. So you take your doubts and you shove them down, bury them deep, you say that you’ll never be like those CNAs…but idealism and good intentions will only carry you so far. Eventually, you will reach the place where everything exists in extremes and to feel at all is to be in pain. In that place, it easier to just shut it off, to distance yourself from that which causes you pain.
In this case, what causes you pain is the same thing that causes you doubts.
How do you handle the stress of constantly never being good enough? When you are constantly given more work than you can do and when you see your residents suffering because of it…what can you do?
Becoming a jaded CNA is not a single decision you make; there’s no switch you flip between “good CNA” and “bad CNA”. It is instead a series of small compromises. It’s slowly learning how to shut off the connection between you and the resident, until that resident seems more like work than a person. It’s getting to the place where your worst thoughts are the only ones you can hear. That’s when you become the thing you swore to never be.
This is how you surrender your compassion…because it hurt too much to care. Empathy hurts and apathy is appealing.
So, to all new CNAs, don’t go in blind. Being a CNA is like holding your heart to a cheese-grater. To feel is to feel pain. You will doubt whether you’re actually doing any good, and any difference you make will seem to die with your resident.
When these doubts came, face them. Look them straight in the eye and do not despair.
Doubts do not define you; a feeling that came over you during the struggle does not make you a bad person. But a feeling you buried deep in the bedrock of your soul, left to fester until it poisoned all the feelings that came after it…that one might, in ways you never expected. Sometimes, they chain you in such a way that you will never get free. The only way to break the chains is to acknowledge that they are there.
Remember that empathy hurts, but apathy doesn’t…because apathy means you don’t feel anything. Not pain and not joy. You can’t have one without the other, not in life and especially not in Long-Term Care.

And most of all, do not forget the other person in the room. Never forget the silent observer to the tiny acts of compassion, to all the sacrifices and struggles to carve out room for good care.
Do not forget yourself. 

Respect Your Elders

Sunflower May

At times, it’s really hard to be professional. No, strike that––sometimes it’s really hard to be nice. This is one of those times I really wish I could just open my mouth and…well.
Breathe. Breathe and move on. Do not respond. Do not reply. This is neither the place nor the time for such a discussion. You aren’t calm enough not to scream, so don’t say anything. Prove him wrong with your actions. I keep thinking these words until I wonder if they’ve been seared onto the inside of my eyelids from the sheer force of repetition. It’s hard because I have to be professional and they can be whatever they want to, even if that’s unkind.

All this started because Mrs. L’s husband had come over for a visit. And he is a man with Opinions. He’s not one to keep them to himself either…and I could perhaps forgive him his outspokenness if I wasn’t the target of his outrage. Or I should say, one of the targets. Today, Mr. L has Opinions about Millennials.
“Man, kid these days,” he rants to his wife, ignoring me as I labor to make her bed behind him. “What idiots. When we were kids, man, I tell you, nobody was so selfish. They just want everything handed to them. Afraid of hard work, that’s what they are.”
I’m putting the pillowcase on as he says these words and I am so tempted to…no. Absolutely not, May, that is utterly unacceptable behavior. You are not allowed to even think that. Never mind that I’ve been hard at work for five hours already today, with seven more to go. Never mind that I’m in overtime for the umpteenth week in a row. Never mind that I haven’t had a break or a breather since I clocked in. Never mind…
“What is this world coming to?” he muses. “These kids are crazy and they don’t know nothing. Everything wrong in this world is because of them, I think. When we were young, we were taught to respect our elders, but I wouldn’t trust a dog with these so-called Millennials. What a disgrace––”
I can’t take this anymore. I dart around Mr. and Mrs. L, leaving the bed half-made and escape into the hallway.
No, he didn’t trust a dog to a Millennial. It was his wife he entrusted to my care. Many of the CNAs and nurses I work with are among the Millennial generation and we are the front-line of Long-Term Care. We make up a large percentage direct care workers.
I lean back against the wall, fighting tears. They’re tears of rage, but I really can’t afford to shed them right now. I am the caregiver and this isn’t the time to be emotional.

One day, I might have Mr. L or someone like him as my resident. His dignity will be left in my care, to either affirm and defend, or ignore and abuse. I wonder if he realizes that, as he rants and raves about the sins of my generation.
When you are weak and helpless, crippled and confused, I will be there, I think. And when you are my resident, then maybe you will see. Maybe you won’t…but either way,
I will take damn good care of you, whether you want me to or not. I will be your advocate and I will be your caregiver. I will fight as hard for your dignity as I fight for the gentleman down the hall, who I absolutely adore. You cannot change my compassion and you cannot change my professionalism.

I am a caregiver. I am a Millennial. And I think I am calm enough to go back into that room to finish making the bed.
When I do, it’s to see the strangest scene. Mr and Mrs L are glaring at each other; he looks surprised and she looks angry. They break it off when they realize I’m back.
“Oh, hello, sweetie,” Mrs. L says to me. “Do you know, you are my favorite aide. I don’t know how you do all the work you do. Especially,” she adds with a pointed look at her husband, “since you’re so young.”

One Voice, One Vote: Why Bother?

Sunflower May

I hate election time. I’ve come to absolutely despise all the political ads, all the fear-based rhetoric and emotional responses that seem to wash away all traces of common sense from both sides of the political spectrum. Working in a nursing home, it’s hard to get away from the political reality: TVs blare from every room and, supported as the Long-Term Care system is by the political one, it’s hard to forget that election season and its results could/will have a direct impact on my work environment.
I just can’t get away from this election, not even while I am passing out lunch trays to my folks. As I enter Mr. U’s room, the first thing I see is his TV on, set on a news channel where they are, once again, talking about the election. And in the room itself, fat stacks of political ads litter the bedside table, leaving nowhere to set his tray. As I sift through faces and promises, trying to make enough room for his lunch, I have to wonder: how did my residents get on all these mailing lists?
I’m so sick of this election and I can hear that frustration seeping into my voice as I announce the presence of food to Mr. U.
“Thanks,” he replies, never moving his gaze from the TV. “Hey, little girl, are you voting on Election Day?”
I nod. Politics is always a dangerous subject, but this isn’t exactly politics, I guess.
He frowns and shifts around slightly in his wheelchair. “Are you going to vote?” he repeats, a bit louder this time, every word slow and distinct…for all the wold as I am the one with hearing loss. Apparently, he wants a real answer: the kind spoken out loud. Suddenly I am reminded of all our previous conversations, conversations that reveal his still-fierce passion for social justice. His face is lined, his skin wrinkled and his body weak…but his eyes still shine brightly, all the more intense for the rest that has been forced upon him.
“Yes,” I say. “As much as I grumble, I’m not sure it would be…appropriate for me to pass. I mean, there have been too many people who have fought, died and sacrificed for my freedom for me to just sit on my ass at home.”
“That’s right,” he says approvingly. “Ignore the noise, forget all these negative ads and remember: what is your right will always be your responsibility. I’m gonna kick your butt if I find out you didn’t vote, little girl!”

∞oOo∞

As a CNA, I often feel powerless. I am at the bottom of the food chain: in a position to see many wrongs, but not in a position that makes it easy to correct those wrongs. There’s only so much I can do, and what is within my power often seems so small: nothing more than a trickle of water seeping between the stones of a dam. Why bother? Why keep speaking out, why keep writing and trying, breaking my heart as often as not? I am only one CNA, one American with one voice and one vote. What difference can I possibly make? How can my voice and my vote make any difference whatsoever?

The worst part about the systems and mindsets that make us feel powerless: they make us forget what little power we have. When we listen to the voices that whisper “Why bother?”, when we throw up our hands and walk away with our words all left unspoken, it is not one voice and one vote that has been silenced. It is nothing less than a victory for the systems and persons who would indeed make us powerless. Feeling powerless is the first step to actually becoming powerless. Perhaps it is not so much, this freedom of speech and this freedom to vote. Perhaps I am not so very important, but I am one of many.

Silence spreads like wildfire…but so does liberty. I am an American…I have the freedom to vote, to have my voice heard in the election of my leaders. No matter who is elected, I am not powerless. I will not be silenced or shackled, either because I am a woman or because I am “just” a CNA. My voice has weight and my opinion has value no matter my socioeconomic standing. I urge you, my fellow CNAs…do not be silent. Do not forget the power that has been bought for us by the sacrifices of those who have come before, and the sacrifices we ourselves have made. Always remember: what is our right is also our responsibility. We are not powerless and we will not be made to feel so anymore.
Go out and vote. Make your voice heard. Do not be swayed by fear or fancy rhetoric. Do your research and make up your own mind about which candidates you wish to be your leaders. And never, ever forget: no matter who wins this election, it does not absolve us of our responsibility to keep speaking out for those who cannot. What is our right will always be our responsibility…what wrongs we see, we must work to right. Vote for peace and prosperity, for compassion and communication, for empathy and intelligence. Vote for the whichever candidate you feel will be more willing to embrace the qualities we have learned to value most as caregivers of the elderly and disabled.

Do not surrender your ability to think for yourself to the politicians. Our freedom to vote is our birthright, so let it be your reason and not your fear that cast the ballot. Freedom…it’s far too precious to waste on an opinion that someone told you was the right thing.

Life is better when it has a purpose

Sunflower May

“I wish I could die.”
“Don’t say that!” These words are a knee-jerk reaction, an involuntary verbal response to the five words I dread most as a CNA.
“But it’s the truth,” Mrs. T replies. “I hate this…this shadow of a life that I am reduced to now. I hate being utterly useless, a drain on society and a burden for my family.”
“You aren’t useless,” I say, a bit savagely. I defend my residents’ humanity to the rest of the world, must I defend it to my residents themselves? “Really, you aren’t useless. Nobody is useless, not even people who are truly helpless…which you aren’t quite, my dear.”
But apparently, my words do not comfort Mrs. T. “Of course you don’t understand,” she sighs. “You’re young. You may have known doubt, uncertainty about what to do with your life…but feeling useless, having to sit in a wheelchair while you remember everything you used to with your time and talents…you don’t know what that feels like. I hope you never feel like you’ve outlived everything good about your life.”
I can’t help but remember all the times us CNAs have debated quality of life, wondering if our residents are truly happy with the little scraps of humanity we’re able to keep for them.
“I wish I lived in a state that has right to die laws,” Mrs T continues. “Oh, don’t screw up your face like that, little girl: I have the right to wish myself free from pain. I’m never getting better, so that means wishing myself dead! And if you really cared about me, you wouldn’t want me to have to linger like this, useless and in pain. Life is better when it has a purpose and I don’t have one anymore. You don’t know how much that hurts…even worse than the physical pain.”
That’s going to far for me: I would never dare tell somebody how they should feel, but I expect the favor to be returned. “What kind of caregiver would I be if I wished you gone? If I didn’t believe that your life right now has value? And you’re not useless: you make me smile. I love coming in your room and never knowing what the heck is gonna come out your mouth!” This current conversation being the exception, perhaps…
Mrs. T smiles a bit herself at that, a weak and rather watery smile, but the best one I’ve seen on her all day. “I’m sorry, but after a lifetime of doing real, tangible good for my community…making one person smile seems like such a small thing.”
“Excuse me,” I say frostily, “but my happiness is a huge thing…to me.”
That startles a laugh out of her. We laugh together, and if a few of the tears rolling down our checks are born of something besides mirth…well, who can blame us? I hate these conversations: there’s no right thing to say. If I agree with her, I’m saying that I think the world is better off without her—something I most vehemently do not believe.
If I disagree, I’m denying her the validity of her feelings of pain and grief for the life she can no longer live. And I’d be lying if I said that the thought of me being in her position doesn’t fill me with dread.
“Look,” I say eventually, “I can’t—I can’t pray for you to die. I just can’t. But I can…I can pray for you to find peace, in whatever form takes.”
“That’s a good prayer,” Mrs. T murmurs. “And, since I’m stuck here as our state does not have right-to-die laws…if my new purpose in life is to enrich your life, honey, you’d better make damn sure your life is good one. You make something of yourself, little girl, for my sake. Deal?”
Since becoming a CNA, my feelings about quality of life and the right to die have morphed dramatically. On the one hand, I’ve seen the beauty of life shining through the most debilitating circumstances. I’ve seen human dignity when society saw only brokenness.
On the other, I’ve seen pain needlessly prolonged because the family could not bring themselves to let go, long after the resident was ready to go. I’ve seen unbearable suffering dragged out, a natural death that stretched on for days and weeks. When the end finally came, there was no grief, only relief that the pain was over for everyone.

I suppose I wish for peace for all my residents, peace in their last years and in their final breaths. Peace, as I’ve learned, is not always the complete absence of pain, but at least I wish for my residents to meet their ends without agony or anguish.
Whatever else I may believe, that, as Mrs. T said, is a good prayer.

 

Selling lemons and changing briefs

Sunflower May

 

This is crazy.

It’s one of those times when nothing I do works. This woman is not going to let me change her brief.
I’ve already left the room and come back three times: the re-approach technique isn’t working. She may not remember who she is or where she is, but when it comes to how many times I’ve been in her room…good Lord, but this woman has a fantastic memory!
I place her hand on the opposite bed-rail and try to roll her over again.
“No! No! No!” she screams, letting go of the bed-rail and pushing against me with all of her frail but frightened might. “Oh, stop, please stop! Mother!”
And now she’s crying again.
My feet hurt. My head hurts. It’s been a long day: this shift just will not end and this woman just will not be changed.
“Please, Mrs. E,” I beg her again, “just roll to the right–just a little bit! One roll. One roll, that’s all I need! I can get this brief out from underneath of you and put the new one in just one roll. And, um, maybe the sheets too. Possibly. Please?”
Mrs. E just buries her face in her hands and cries harder. There’s a certain smell when a brief has been left on too long, when it is soaked beyond capacity to absorb anymore: I catch that scent now, wafting up at me every time she moves. There’s a brown ring on the pad too, further evidence of her refusal to let anybody change her all shift.
I’ve stood here for fifteen minutes, alternately pleading, begging, reasoning, ordering and bribing: nothing is working. She’s not my resident. I could just walk away, tell my newbie coworker that “Yep, she’s refusing care all right, can’t do anything with her”.
Or I could go get help and we could change her in spite of her refusals. This is one of the blurry lines between right to refuse and being mentally incompetent.
I groan and lean against the bed rail. I’m too tired for ethical quandaries right now. I’ve been working for fifteen hours now and I’m dead tired. I swear I can feel my patience wearing thin, like the belt in a car about to snap and bring the whole engine to a crashing halt. In this case, my ability to be a caregiver is what’s in danger…I want to scream, cry, run away and make this woman let me take care of her.
Instead of doing any of those wonderfully tempting things, I move the bed-rail closest to me and, taking care to land on the clean sheets, collapse beside her on the bed.
It feels good to sit down, to not be on my feet. I feel like all my bones have turned to liquid within me and all my muscles have turned to jello.
Mrs. E jumps slightly and hiccups, my sudden movement startling her out of her tears. I stare back at her, blinking away my own tears. The silence holds for a long, long moment.
“You see this thing,” she says suddenly, catching ahold of the call-light and swing it around in a lazy little arc that brings it close to my face. “I told my father, I said, I don’t know what you want me to do with this…thing. It’s just stupid, is all and I said, well, I said I’m not doing it. And he said, well, what am I supposed to do with it? What am I supposed to do with thing, huh? What’s it for?” She holds it out for me.
On a sudden inspiration, I lean forward. “Hello?” I say into it, pitching my voice as though it were being filtered through a microphone.
For the space of three heartbeats, Mrs. E just stares at me. Then she throws her back and laughs, great big chuckles that shake the whole bed. “You’re a nut!” she gasps out, shaking her head.
“That’s me,” I agree, “the biggest nut you’ve ever seen. A cracked nut, too.”
“A cracked nut,” she repeats. “You’re silly.” But she’s smiling now and not crying.
“I am so silly that I want to get this pad out from underneath you,” I continue. “Do you think you could roll for me so I can get it out?”
“No,” she says firmly. “I’m not doing that.”
Damn.
“Why?”
“Because I’m not. My father said, now he said, we’ve got to sell these lemons and I said, now who wants to buy lemons? That’s just stupid. But he, he wanted to sell them and I thought, he’s nuts. He’s crazy.”
“He sounds crazy,” I say, wondering how the hell we got to selling lemons. “Hey, how many lemons do we have to sell?”
“Lots and lots.”
“Tell you what, I think I can sell your lemons for you–there’s a baker who wants to trade me lemons for cookies…she’s, um, making lemon meringue pie or something. But I need your help with something, ok? My wallet fell under your sheets and I need to get it out or my father is going to be very upset with me.”
“We can’t have that,” Mrs. E says, shaking her head in solidarity with me over unreasonable fathers who expect us to sell lemons and not lose wallets in other people’s sheets. Then, without warning, she grips the bed-rail tightly in her left hand, braces her right hand on my thigh and lifts her bottom off the bed.
There are times to provide meticulous peri-care and times to hurry it the hell up. This most certainly falls into the latter category. Her bottom is hardly in the air for twenty seconds, but I somehow manage to whisk out the old brief and pad and replace them with a clean set. It’s hardly the best brief placement I’ve ever done, but at least it’s not saturated with six hours of urine.
“Did you say cookies?” Mrs. E asks as her bottom thumps back on the bed.
“Sure did,” I smile at her, “but first, can you give me a hug?”
“Oh, honey,” she laughs, but she rolls towards me and crushes me against her. “You’re so silly,” she tells me.
“Guilty as charged,” I gasp, using my free hand to wiggle the brief into a better position.

It’s serious work we do, as CNAs, but sometimes serious just doesn’t get the job done.
We cannot always bring our confused residents back into what we call the “real world” so must be willing to lay aside our pride and look silly for a good cause. I have often found that a person’s sense of humor is the very last thing to go.