Category Archives: caregiver-resident relationship

Honorary Grandparents

 May

In compliance with HIPAA, all resident names and identifying details have been altered. Also, this story did not happen recently.

It’s always strange, coming back to work after extended time off. . .anything longer than a three day weekend. I always seem to think that I’ll lose some skills (or worse, speed) when I come back. I’m not sure where I acquired this idea, nor why I hold onto it.
On the one hand, nothing changes while you’re gone: there’s still too many residents and not enough aides. The work doesn’t change. On the other hand, a lot can change in almost a week. One resident can pass away, another could fall. Mr. J can change from being a standing lift to a hoyer. The residents with more advanced dementia can forget me entirely, others assume the worst from my absence.

Take Mrs. N for example. As soon as she opens her eyes and sees me standing by the foot of her bed, an expression of pure relief floods her face.
“May, you’re back! Did you decide not to abandon us after all?” she asks, grasping my hands as soon as I set her tray down at her beside table.
I’m still worn out from the week I’ve has, so I convey my confusion about her inquiry with an ineloquent but effective syllable: “Huh?”
“You left us,” she says reproachfully. “But I suppose I can forgive you as long as you don’t quit again and leave me.”
“Quit?” I repeat. This is the first I’ve heard about a change in my employment status. “Honey, I didn’t quit.”
“You were gone for so long! And you didn’t tell me goodbye, or say you wouldn’t be here for a while.”
“It wasn’t that long,” I protested.
“It was forever!” she insists, still clinging to my hand. “Well, if you didn’t quit, where did you go?”
I thought I’d be stronger…but then again, how would I know? I’ve never been in this position before. All I know is that now I’m crying again. Sometimes it feels like the tears will never stop, that the pain will never dull.
“I had to bury my grandmother,” I sob out; then Mrs. N pulls me down beside her and holds me until I stop crying.
“Sorry,” I sniffle.
She waves her hand at this, dismissing my embarrassment like so much nonsense. As she looks at me with sympathy, I can see a thought forming behind her eyes. It seems to grow until she can shape into words and says, in a soft, hesitant tone: “Can I be your grandmother now?”
And once again, I get choked up. I pride myself over my command of words, but none will come now and so I just nod my head vigorously, and grip her hands tightly.

The bonds that form between caregiver and resident are often deep. We see each other at our very best, at our worst and every mood in between; we pour so much of ourselves into each other. I am still a girl without a grandma, still hurting from that loss. But it helps, in a way I couldn’t have imagined, to have so many of my residents glad of my return, and willing to share in my grief.
I seem to have a lot of honorary grandparents.

Nursing-home-made

Sunflower May

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

It’s funny, how a person’s possessions can tell us so much about them. Most new residents come in with very little: just the clothes they wore in the hospital and maybe a small bag. Then, their families either start bringing in loads of stuff…or they don’t. I have seen rooms so crammed full of personal mementoes that it’s hard to care for the resident; so many clothes in the closet that the door won’t shut and every surface covered with knick-knacks.
I have also seen rooms bare weeks after the resident moved in, the only proof of occupation being the person in the bed. Only a few clothes, no knick-knacks…no decorations or pictures.

Mrs. L seems to be one of the latter category. After a week, she still only has the one bag that she had clutched so tightly on the first day, plus a couple outfits. They’re nice, but the kind of nice that has been worn for years and years. Her family comes often, but they seem more stressed each time and their visits get progressively shorter.
There’s always a learning curve, some time required to start feeling comfortable in the new environment…but Mrs. L doesn’t appear to be adjusting at all. She won’t leave the room, she hardly eats and from what I can tell, she seems to spend most of her days screaming into her phone and crying. I decide I can’t kept walking past such agony. We don’t know each other very well, but that’s about to change.
“Hey, can I sit down?” I ask, walking into her room and gesturing to the empty chair (provided by the facility) that sits by her bedside. She shrugs and I take that as permission. Good Lord, but it feels wonderful to get off my feet.
“I’m May, if I haven’t introduced myself before,” I add…although I’ve introduced every day this week. “Do you need anything?”
She shakes her head. I’m trying to decide between asking another question and telling a story about myself when she suddenly starts talking.
“You can’t help, nobody can help. Can you make me better? Can you tell the insurance company not to be assholes? Can you give my family a fortune so they won’t have to sell my house to afford ‘getting me the help I need’? Can you buy back everything of mine they had to sell, so I don’t have to look at bare walls while I wait to die?”

I can’t. I can’t wave a magic wand and sort out the economy, endow her with the money she needs to have a good life even though she is now elderly and disabled.
The only magic I have at my disposal are my imagination and my hands. I stay for a few minutes, now holding her hand as she cries yet again, then I slide off the chair and leave the room.
It only takes a few words in the right ears. When I come back, I’m not alone and we aren’t empty-handed.
We disperse over the room, laying out our various offerings. The Laundry department brought up clothes that have been donated to the nursing (usually by families of resident who have passed away in our care); Activities gave several left-over decorations from the various Arts-and-Crafts over the years. Nursing gathered personal care items from the supply room and arranged them in her drawers. Staff from every department drew pictures and scribbled down nursing-home-made Get Well cards…but the best bit came from a fellow resident. She heard of my cheering-up campaign and told me to pick out the prettiest flowers from the bouquet she got for her birthday and give them to that “poor lady”.

Small acts of kindness in Long-Term Care are not whistling in the dark. With each act of compassion, we light a candle. True, it will take a lot more candles than I can personally light to lift the shadow of greed from our broken system…but that’s the funny thing about kindness. Even when it’s not enough to turn the tide, change the culture or right the wrongs of this world––it is still appreciated and it can still mean the world to that one person.

My hope is that, one day, we will have more to give than what we can scrape up. I hope that one day, compassion will be considered along with costs, that questions of ethics will be given equal standing with questions of economics. 

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?”

Break Interrupted

Sunflower  May

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

“I need a break!”
With these words, I sweep into the room, startling the occupants.
“So,” says Mrs. R, “go to your break room.”
“Can’t, they’ve already looked in there for me,” I sigh as I drop down on Mrs. R’s bed…it’s the one farthest from the door and it’s the empty one. For good measure, I pull the privacy curtain down to the foot of the bed and arrange my legs so that you can’t see tell-tale nursing shoes from the door. I don’t dare close the door: I wouldn’t be able to listen for call-lights and nothing screams “CNA in here!” louder than a closed door.
Mrs. E, the resident in the first bed, rolls back over and goes back to sleep. She’s always resting her eyes; meal times are her favorite nap times of all. Mrs. R, sitting up in her wheelchair, turns away from the window to look at me…apparently, I’m more interesting than the birds outside. “What do you mean, they looked in the break room for you?” she asks. “It is the law that you have two ten-minute breaks and, knowing you, you probably haven’t taken them already. Tell them to go away.”
I just stare at her. “How do you know that?”
“I listen,” she replies, a bit smugly. “You would have to be completely deaf not to learn every detail of the working conditions here. Someone is always complaining.”
“Um…sorry. I try not to complain in front of you guys––”
“Quit changing the subject. Why don’t you just tell them to go away and leave you alone on your break?”
“Because then they just say ‘Oh, when you’re done’. It’s not one of those things worth kicking up a fuss over. I’m sure if I went and complained to the DON, there’d be an in-service for everyone to sign…and nothing would change. Everyone would continue to interrupt my breaks for the stupidest crap.”
I sound bitter, I realize. The thing is, being fetched out of the break room during one of my few breathers never fails to irritate me. I only take my ten minute breaks when I’m about to snap, but today there is no escaping the madness. The straw that broke the camel’s back was when my nurse stormed into the break room right after I’d gone in, to tell me to get back out on the hall because “there are too many call lights for one person to keep up with”. I think she meant “one CNA” because she has said before that she is “above aide work” and I’ve never once seen her answer a call light.
The next chance I had to take a breather, I decided the break room was not a safe place to take it––so here I am, seeking refuge from the demands of my residents in the company of my residents. Funny how things work, sometimes.

Mrs. R looks at me steadily for a minute while I swing my feet. “That nurse today is lazy,” she declares. “Next time, tell the person interrupting your break to go to hell.”
“Mrs. R!”
“Or, better still, tell them to take care of the crap themselves.”
“Do you really want the nurse you call ‘lazy-ass’ to be the one taking you to the bathroom?” I grin.
“Yes. Then I could fart in her face.”
It’s a good three minutes before I catch my breath enough to answer. Mrs. E grumbles about the noise and tries to burrow deeper into the covers.
“Oh, Mrs. R, never change,” I tell her, still giggling.
“I’m sure I’ll change a bit when I die,” she says. “Can you cuss in Heaven?”
I shrug. “I don’t know, Mrs. R. But I’ve got to get back work now. Thank you for the refreshing break!”
“No, you don’t,” she replies. “You have four more minutes. Sit your ass back down and tell me about what’s going on in your life. Then, you can take me to the toilet. I promise not to fart in your face.”

At the feet of the elders

Sunflower  May

I am upset. I am not having a good day. I can’t even remember what started it: something bad in my personal life that has snowballed, absorbing my every frustration about this broken system. There’s never a lack of frustration within Long-Term Care…which either makes it a great channel for all your passions, or the straw that breaks the camel’s back. Right now I am broken.
I’m behind, smashed straight into the grimy floor by all the work I’m expected to do. On top of that, everyone is call-light happy, wanting things done for them, needing to go to the bathroom for the seventh time this shift. I’m not able to get to the quiet ones for all the chaos and noise.
Mrs. K is the one I’m with right now. She’s a mess today, confused and not content with the answers I’m able to give her.
“Why am I here?” she asks me again. “I don’t need to pee!”
“I told you,” I say through tightly gritted teeth, “I haven’t been able to get to you all day. I need to check you before I go home.” It’s pretty obvious that I haven’t changed her all shift and that she’s going to need more than just checking.
The pants are wet. Wonderful. Just freaking great. The shoe laces have a knot and I can’t get them off. I can feel the tears welling up in my eyes and I can’t even wipe them away, not with my gloves on. Can you recall a tear through sheer force of will-power?
Nope, there it goes: straight down my cheek to splash against her leg. It’s like that tear broke the dam. Great sobs burst from me; I lay my head down on the closest thing and proceed to cry my heart out.
A soft hand runs through my hair, gently pushing it out of my face. I realize that I’m still kneeling in front of Mrs K, resting my head on her knee like a little child seeking comfort…comfort she is giving me.
“There, there,” she tells me, “you just let it out.
.

There’s many things they never tell you about Long-Term Care. They don’t tell you how painful it will be, how stress breaks your heart. But they also don’t tell you about this bit, the little shards of kindness and wisdom that can stab your soul. They don’t tell you about the renewing power of sharing grief. They don’t tell of how much wisdom you can gain by becoming so close to those who are near the end of life’s journey.
This is my peace, the balm of my soul. This is my joy and I will not let anything snatch it away, not this broken system, not fear and not burnout. She is losing her mind and I am breaking my heart…but this moment is ours. We’re here for each other.

 

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.

Small Gestures Go A Long Way

Sunflower  May

This would so much easier if there were tears, screaming or something. Hell, at this point I’d take a nightmare and violent confusion. I know how to soothe nightmares. I’m good at chasing the monsters away.
I’m not good at this.
I don’t know how to make this better, this lingering listlessness, the utter lack of energy and interest. It’s not like I’ve never seen this before: depression is wide-spread in the nursing homes. Depression is a hard thing to treat, harder still to manage in the time-crunch of Long-Term Care…the CNAs quite literally do not have the time or emotional energy to coax every one of our residents out of the deadened state of despair every time they fall into it. The sad truth is, when a resident refuses to get out of bed, that’s one less person you have to try to get back into bed later. It’s easy to let slide. It is, after all, the resident’s right to refuse. You can’t make them get up and coaxing takes time. Sometimes a lot of time. You say “I’ll get them next time,” and the next time things are so hectic that you don’t even remember your whispered promise. Eventually, you realize that you’ve let your depressed resident stay in bed for the tenth shift running…but by now it’s a habit, both for you and the resident.
I’ve seen it a hundred times, and I’ve had to turn away, had to prioritize my other residents who really wanted to get up and interact with the world over the one who continually refuses to leave their room…the one who just wants to sleep.
Not this time. I can’t make Mrs. N get up, but I can’t just leave her to wallow in her own regrets and despair.

“I’m not leaving you like this,” I say suddenly. “I’m not giving up on you, okay? I really don’t care if you appreciate it or not. I’m not giving up on you. Ok, then think, May. What helps alleviate depression?”
Sunlight.
I rush to the window and twitch the curtains open. Light floods the room, chasing away the shadows and warming the air. A thousand dust-motes swirl in the golden beams. Well, I feel better, at least…strange how quickly the sunshine can work on human physiology. Mrs. N stirs and mutters. One eye opens, just a tiny sliver and then it’s squeezed shut with a force that only a person can only manage when they’re awake.
Well, that’s sunlight. I can’t think of anything else to do and as much as I like to shut the door and say “I’m not leaving her alone,” I can’t abandon my other residents. Also, if I push too hard, I could unravel any progress I’ve made.
I lean over her and squeeze her limp hand. “I’ll be back,” I tell her.
It’s a busy day (as per normal), so it isn’t until a couple of hours later that I’m able to slip back into Mrs. N’s room to check on her. She’s still laying motionless in her bed, but she’s oriented to the window and her eyes are open. She’s staring out at the green grass, the trees and the flowers. As I watch, a tear slips down her face.
What’s it like for her? She knows that even if she musters the energy to get up, even if she goes outside, she can’t do anything help. She can’t run across the grass, she can’t reach up and touch the trees. She can’t pick the flowers.
Flowers.
I rush from the room, down the hall and out the front door. Thank God for landscaping, because I don’t have to search very long to find what I was looking for.
I head back inside, back to the room that remains gloomy, in spite of the warm sunlight still pouring through the window.
“Here,” I say loudly, ignoring the way she slams her eyes closed and pretends to sleep. I set the handful of flowers I picked down on her bedside. “These are for you.”
She’s so startled that she drops the act mid-snore. I hear a call-light go off down the hall and I reluctantly turn to leave.
“Hey, little girl.”
I turn back. Mrs. N is clutching all of my flowers in her hands.
“Bring me some more tomorrow?”
“Oh, you bet,” I agree softly.

Those of us with whole bodies and sound minds, I think we often forget to appreciate the simple things. Things like opening the curtains to let in light, going outside for a walk when we feel blue. The natural world is bound up tightly in our psyche…replaced by the sterile environment of a hospital-like nursing home, is it any wonder that depression abounds in nursing homes? We can’t give our residents back everything they’ve lost: their mobility, their independence, their careers and loved ones.
By contrast, it’s a simple thing to bring a bit of nature to those who cannot go out to nature…to open a curtain, hang up pictures of landscapes, take them outside for five minutes turn on the Nature Channel, or bring a handful of flowers to a depressed resident who won’t leave her room. But simple doesn’t mean insignificant and small gestures often mean the world to someone who has learned the hard way not to take anything for granted.

There is something about nature that speaks to our primal nature, that has the ability to soothe us even after we lose our words or our will. There’s something about natural light that makes us feel at home, something about flowers that delights us. These primal instincts are a caregiver’s best friend, if you learn how to harness them.

The Things They Never Tell You

Sunflower  May

Here’s something that’s not quite––or not at all––a newsflash: human beings are sexual creatures.
Here’s something that’s (an often quite hilarious) newsflash: old people are still sexual creatures.
They still notice and remark on certain aspects of life that maybe we young folk would prefer they do not. Occasionally, we young folk are the ones they are noticing and remarking about.

At times this attention is sweet, like the nine marriage proposals I’ve received in the course of my career–only three of which were delivered in a location other than the shower room.
Or the time I went to wake up a resident and was subjected to a long, loud verbal tirade about how I was thoroughly unpleasant person and he was his own boss. This tirade derailed the instant he opened his eyes…prompting him to interrupt himself with “My God, you’re beautiful!” From that moment on, he treated every word out of my mouth like Gospel truth, to be obeyed immediately. I admit it: I quite enjoyed being treated like the Queen of the Universe. Being told that I was beautiful enough to derail a full-fledged, would-make-a-toddler-jealous temper tantrum didn’t hurt my confidence any either.
Then there was the time that I noticed a resident’s pant leg needed adjusting. When I bent over in front of her to fix it, I ended up getting a reminder that not everybody born before the 1960’s necessarily conforms to the Norman Rockwell image of heterosexuality. I will say that of all the passes ever made at me, hers was tasteful–far more in the nature of a compliment on my, er, physique than objectifying my body for her viewing pleasure. That woman had game.

∞oOo∞

And then, of course, there’s the far less enjoyable kind of attention. This comes in many forms, from overhearing a group of male residents ranking the female employees by sexiness, to outright asking me to climb into bed with them. You’ve got the “handsy” old men, the incessant dirty jokes, the lewd comments, the creepy stares…and the list goes on. I’m sure every aide out there has had an experience of some kind or another of this nature.
There was a time when I cleaning up an extra large BM that was, in spite of my best efforts, just getting anywhere. I became distracted from the mess when I felt the resident’s hand on my leg, slowly creeping further up. When I told him to remove his hand, he just looked at me, smiled and said: “What, don’t you like it?”
“Are you going to take your hands off me?” I asked him calmly. “Or do I have to use my hands to get yours  off me?” To illustrate my point, I held up my gloved hand…which just happened to be dripping BM. To anyone who says that there’s nothing like cold water to curb a libido, I can only guess that you’ve tried using BM. I’ve never seen anyone back off quite so fast as he did, or stay backed off for quite as long. I hardly needed to report the incident to my supervisor, whose first comment was that I “had managed the situation rather handily“.

Of course, it’s not just the residents who put on such displays of sexism and lechery. I learned very quickly to wary of certain visitors. I’ve had a visitor try to get me in trouble with my boss because I told him to keep his hands to himself. He was always trying to touch the female aides, especially trying to put his hand on a shoulder or upper arm and “steer” us around by squeezing. I objected to being touched so frequently and familiarly without my consent, especially after I politely asked him to stop. Unfortunately for me, he was one of those men who have trouble to concept of “No Means No” and began complaining to my supervisors that I was “rude”, “mean” and “hateful”.
Unfortunately for him, I’m fairly eloquent with written words and not afraid to defend myself.

Nor should you come to the conclusion that it’s only the men who make unwanted sexual advances upon staff. While I have noticed that some of the female residents do as well, they are far fewer…in no small part, I think, to the cultural conditioning that encouraged men to be aggressive and women to be passive. Also, there’s the same mentality at work that leads some of our residents to treat their caregivers as “the help”, instead of a skilled worker. When you’re perceived as standing a rung below them on the social ladder, many people feel as though they’ve been given a pass to act as they want to, without regard to your feelings.
But it exists still, with or without the spotlight. All the crap women have deal with in our still amazingly sexist culture, with a side of proximity. There is, shall we say, an intimacy of the caregiver-resident relationship that often exasperates the “normal” harassment. Personal space boundaries are in a constant state of flux in Long-Term Care. You’re often operating in what Edward T. Hall, the cultural anthropologist who pioneered the field of proxemics, called “intimate distance” (6-18 inches between you and the other person). This close proximity influences the dynamics between you and the resident, especially if that resident has dementia. They either react with hostility, “What is this stranger doing in my personal space?” or an assumption of familiarity, “She’s right next to me, so we must be close.” Or “She’s leaning over me, so she must be open to my attentions”. Inhibitions are lowered or forgotten, causing many people with dementia to act without the social filter. Is it any wonder then, when they make a move and react with confusion when they are shut down?
Of course, empathy in this situation is a tricky thing. No matter how well you’ve managed to put yourself in the resident’s shoes, how much you understand the factors that lead them to act as they do––you cannot deny the validity of your emotions. Sexual harassment is a demeaning experience, even if the perpetrator is your resident. We can’t just shrug it off and say, “Oh, well, it’s not worth the fuss,”. If we aren’t taught–or don’t learn–how to shut down such advances with compassion and firmness, we only encourage more of the same behavior, making life harder for ourselves and all our residents.

Either way, it’s one of the things they never tell you about. It’s one of the areas that we are, for the most part, told to report to our supervisors and then left to figure out on our own. How do you deal with the handsy residents, the lewd comments and other objectifying behaviors without demeaning the resident who is exhibiting the behavior? It’s one of those ethical obstacle-courses we deal with every day.

The Wit and Wisdom of Edison Terrell

 

buddha

 

 

Edison Terrell

Caregiver, author, and occasional contributor to this blog, Edison Terrell offers a unique perspective on caregiving and life. He is currently working on a collection of caregiver related stories and musings titled I Take My Pills with Ice Cream. Edison is a frequent poster on CNA related social media and with his blessing we are sharing a sample of his recent offerings.

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Telling people to leave work at work is stupid and futile advice in Healthcare, but it’s telling that the advice is most often given by those who have bare minimal to zero patient interaction.

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I realize now that the greatest obstacle to compassion is compartmentalization. It’s snuffed out like a candle the moment a person’s humanity is boiled away to simplified descriptors. Compassion can’t survive the process of a human being turned into a list of qualities.

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Some days my motto is “Finish strong!” Most days it’s just “Finish.”

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I think we may have lost sight of the fact that trust and scrutiny aren’t mutually exclusive. When I put on my scrubs, I expect my quality of work to be under examination, always. I expect that my team’s work is at least up to par, and that we navigate our sometimes ethically muddy road as best we can. I have a duty to my clients, my patients, my residents. Because the nature of my job gives me power over them, and power to make decisions for some of them when needed, such as when they’re extremely aggressive or can’t do things themselves. I think that with power over people comes not just a responsibility from within to do your best, but from without to analyze your behavior–in all reasonable terms–that it’s truly satisfactory. I wouldn’t wish anyone to fully trust anyone in my position to the point they turn a blind eye to what one, a few, or many are doing to bend the rules to breaking.

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Even people like me who claim to want to observe the truth as it is in all its harshness and starkness at all times, hate learning the truth and living it. It’s far easier to say “l want the truth” than it is to hear it, and most if not all people–including me–who want the truth won’t hear it the first time or even the first several times. Maybe not the first hundred times.

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Sometimes my compassion overflows to the point everything drops away and it’s just me and the person in need of me… Most times I’m groggy and hate being awake before noon.

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I think to myself “I’m not as nice as I think I am,” and feel good with that assessment, like I’ve gotten to the heart of it: I’ve pulled back the layers of ego and exposed the shit heel underneath. But it occurs to me that by doing just that I’m letting myself off the hook. I might even be using it unconsciously as a shield. So maybe framing my thoughts in different terms will help me. I can be nicer to people. They deserve my kindness and don’t deserve my meanness; I will be nicer to people.

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On the seventh day, the LTC administrator allowed her employees a 5-minute break, realizing for one sane moment she wasn’t actually God in human form. Four minutes into the break she angrily cracked the whip with a “Get back to work, slackers!” because she remembered she was actually the devil’s.

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It’s not the thought or feeling that creates the mood, but my belief and investment in it. A passing cloud is only a passing cloud, no matter how dark or fearsome.

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My client got the news that he would never walk again today. First time I’ve heard those words in real life and they struck so hard I felt them, too. This is a guy who never gives up, no matter the difficulty or how much of a pain in the ass he is. The droop in his shoulders were like a wall coming down.

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Who gets a cold in August? Healthcare people, that’s who.

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I got a call today about a potential new client from a home care agency that found me on Care. They were desperate to get someone but couldn’t match my minimum pay requirement because they “only charge the client a few dollars more an hour.” Bullshit, they bill Medicare at least $45/hour. She said she could give me 10 an hour, so I lied and said I was making 20 at my current job. She said the most she could maybe do is eleven. I waited her out. “Twelve,” she says, clearly getting annoyed. “That’s the best I can do, I don’t pay anyone that much.” I said I’d meet her Friday

That’s how my daddy taught me. Lie like a dog, cuz nobody’s first offer is gonna be what you deserve. 12 isn’t what I deserve, but it’s closer than 10. Whether I take the job or not is no consequence, the most and truly only important thing when dealing with these types is squeezing them for as much as possible.

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Every aide and PT in this place is in awe that I can work with my client almost every day. They say “How do you do it? He’s so aggravating!” And I reply “I do it so I can leave my wife something behind when he finally drives me to murder-suicide.” We both laugh at that, but I’m not sure I’m not serious.

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I think if I could ask the heart the value of this kindness or that kindness, big and small, the heart would answer that they have equal value. The ego calculates the weight of goodness but the heart perceives a million dollar donation the same way it does a few pennies.

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There’s a vast gulf between a simple job and an easy one.

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Gotta say, for a guy who recently learned he may never walk again, my client has been killing it in the gym. Privately to himself, and occasionally out loud at the end of his sessions as he collapses in his chair sweating from exertion, he tells me in a hoarse voice “I can’t believe what she said. What a discouraging notion.” But he still puts his feet on the modified exercise bike, still glances at the bars now and then from his position on the mat, and unfailingly puts everything into the workout, no matter how banal or degrading it might make him feel. This guy pushes all my buttons every day but I can’t help grudgingly admiring the guy and raving about his determination. I hope he keeps it up to the end and I get to witness one of those miracles I only see on television.

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I’m more make-believe than solid on closer inspection.

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I find sad/sappy music is the best for my drive to work. I tried my workout playlist a few times to psyche myself up but it just made me more tired. Downbeat stuff, though, paradoxically lifts my spirits. Maybe misery really does love company.

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I have this prank I do at work where I sign up for tons of doubles and extra days and shit and this one part of my brain is like “Dude, what are you doing we’re gonna have no time off!” and I’m like “Lol don’t worry about it, bro, I’m pulling a prank. I’m not actually gonna do any of these shifts.” But then the day of the shift rolls around and I realize I’m broke and need my job more than I need to sleep and I go in anyway and it turns out I was pranking myself the whole time.

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Changes that threaten me, when looked at a little more deeply, don’t actually affect me at all. Just the ideas that I hold to be me. What I want. Everything that bothers me only does so because it conflicts with an idea of the way things ought to be. But me, the closer and harder I look for me, the less I seem to exist as I believe I am. Fear is the glue that holds this false identity together, and when that fear loses its grip, so do I, and I disappear in the best way.

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Every day is another priceless lesson in patience and compassion, and I mean that sincerely.