Category Archives: Caregiver self-image

What do you do for a Living?

 

Lynn

The other day I was in a resident’s room getting ready to administer a nebulizer treatment.  Her TV was turned to the Game Show Channel with “Family Feud” going on.   My fellow care givers can attest “Family Feud” is a staple in the LTC environment with Turner Classic Movies a close second.  You can’t walk down a hall without hearing at least 3 different versions of “Family Feud” blaring out of multiple residents’ rooms. 

It was the beginning of the show where the host, Steve Harvey, has each of the family members introduce themselves before they provide an answer to the question he is asking. I wasn’t paying much attention to the show as I am busy getting the treatment ready and assessing my resident’s shortness of breath.  I am vaguely aware of Steve Harvey talking to the first three family members.  I didn’t hear their names, what they did or the answers to the question.  The fourth family member made me stop and look at the TV screen.   I half heard Steve Harvey ask her, “What do you do for a living?”  It is difficult to explain the fullness of what happened next.

She said, “I am a CNA at a long term care facility.”  It wasn’t the words she spoke as much as her tone of voice that made me whip my head around to look at her.  I see and hear so many CNAs when asked what their occupation is a sort of apology tends to follow.  “I’m a CNA but I plan on (insert a perceived better career choice here)…” or “I work as a CNA while I figure out what I want to do.”  The body language that accompanies those statements relays uncertainty, self-consciousness, and/or humility.  

This woman on that game show was different.  Those brief seconds she was on the TV screen showed a confident woman who was proud of her career choice, proud to be a CNA.  Everything about her body language supported the self-assured tone of voice in which she spoke those words.   “I am a CNA at a long term care facility.” End of sentence.  The words “courageous”, “bold”, “empowering”, and “confident” all ran through my brain in those few precious seconds.  She offered no apologies or explanations.  She stood tall, looked Mr. Harvey in the eye and declared her right to be proud of herself, of her career and those in her care.  I am proud of her, too. 

CNAs, be proud of your career choice. Do not ever, not even once, apologize in any way for working as a CNA. Stop feeling like you have to rationalize being a CNA with sentences like “I’m a CNA but…” You don’t have to do that.  Part of changing the LTC environment and other health care settings involves how we speak about ourselves and each other. Talk about your job with pride, with confidence.  What CNAs do is challenging, emotionally rewarding and taxing, sometimes all in the same day.  Not everyone can do the work. It takes a special kind of talent and perseverance to be a CNA for 2 years, 5 years, 15 years.  The more each of you declare with confidence and pride in your voice, “I am a CNA” the more empowered you will become.  The more empowered you are, the more others will want to hear what you have to say. Be bold; declare with confidence your career choice just like that wonderful woman on a popular game show did.  Be confident in yourself. Be proud to be a CNA.  I am proud of you, too.

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.

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. 

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.

*

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.

*

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.

*

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

*

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.

*

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.

*

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.

*

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.

*

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.

*

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.

*

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.

*

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

*

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.

*

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.

*

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.

*

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

*

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.

*

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

*

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.

*

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.

*

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.

*

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

 

The Crucible

Sunflower  May

Sometimes I swear the nursing home is secretly a crucible—with myself as the bit of iron being refined and beaten into steel. Maybe I’ll come out of this stronger, or maybe I’ll shatter under pressure. Sometimes I wonder what is being purged from my being…I know something is gone from my soul, gone or altered so fundamentally that it might as well disappeared.
What is burning in that fire? Is it only weakness, my selfishness, naïveté and arrogance or am I also losing bits of my compassion, my patience, all the soft parts of me? I feel harder, more brittle. Anger comes quickly, if I let it. I’ve seen so much ugliness, so much injustice and been dismissed so many times; I’ve learned by example how you dull the voice of your conscience. I have an edge I never had before, a sharpness where I was once fluid. I am weary in a way I wasn’t before. Sometimes it feels as though my youth has been a sacrifice. I meant to lay it on the altar for God and the ones I care for, but those ruled by greed and apathy keep trying to snatch it away for themselves. I’m tired and never far from sorrow.
Sometimes I miss the person I was before. In my years as an aide, I’ve shed so much of my innocence. Also, the time and energy I give to my work have held back my own stories. Change may come to this broken system, but not soon enough to save me from the bitter taste of burnout. Some days I can’t help but resent that. I remember one time being so frustrated and raging to my mother about the unfairness of it all; I remember she told me being a CNA had changed me, that I had both lost and gained from the experience. I asked her to give me the bad.
I never asked her how it had made me better. It wasn’t what I needed at the time: I needed to feel the cold water of my own failings…needed to remember my own flawed nature, that I wasn’t perfect or passive.
And I needed to decide for myself what I had gained.

Empathy
When there are worlds and words swirling endlessly inside your head, it’s easy to get lost inside yourself, to distance yourself from other people. I was absorbed in myself and my stories, before caregiving forced me out of my head and into the stories of others. If you can put yourself in another person’s place and feel what they are feeling, it makes care go so much better–especially if there is a barrier of communication like aphasia. I am a better storyteller now for having learned to put aside my own perspective. My stories have a depth they did not before, back when I still thought I was the center of the universe.

Faith.
I used to be so afraid of my own mortality…terrified that one day I’d be gone from this world and would have done nothing to mark my existence. I was so scared to be forgotten, until I held the hand of a dying woman and recited the Lord’s Prayer with her. She took that fear with her when she left this world. I have a confidence I didn’t have been.

Strength.

Before I was a CNA, I thought strength meant stature and a rigidity of will. I thought only the unbreakable and the bold were strong. I didn’t realize that true strength…that’s resilience, to have your heart broken and your dreams shattered and then get right back up to go again. Until I was surrounded by fellow caregivers, I did not appreciate that strength is a dance between confidence and humility: a willingness to bend when necessary and wisdom to know when to stand your ground.

Purpose.
I’m the kind of person who needs a crusade, something bigger than myself to feel satisfied with my life. I’m not content to let injustice go unchallenged or to allow the dignity of a person to be disregarded, no matter how much they “contribute” to society or how much of an “inconvenience” meeting their needs causes. Whatever other heartaches and frustrations come with it, being a caregiver has certainly given me a crusade to fill a lifetime or more.

In the end, it’s heart-breaking, life-affirming trade. Everything I am, I became…or rather I am only who I became. What I lost I surrendered, and what I gained I was given. What I have retained, that I earned.

Bad Boss Part 1: “Work Harder”

Sunflower

May

Note: This, like most of my posts, does not tell the story of recent events. I try to chose stories that are a few months (or years) old, although I am usually inspired by recent events or conversations which remind me of the story in question. 

All I get is a whispered warning in the hall: “Watch out for so-and-so [a person of unspecified authority in the nursing home who shall henceforth be called VIP]. She’s on a bit of a power-trip today.”
“Great,” I sigh back. This bit of information has two possible meanings:

  1. The other aide is having a Bad Day, very possibly got talked to about some deficit of care and now thinks everyone’s out to get her or
  2. VIP is actually on a power-trip and I’m going to have to try to be invisible as in addition to being everywhere at once.

We’re already working short today, and seeing as how the next shift is also short, there’s a good possibility I’m going to either be asked or ordered to work a double shift. Again. I really don’t have the energy for any more drama, I really, really don’t.
“May!”
I swing around, startled and resist the impulse to shout: “Speak of the devil!” However applicable the phrase, I fear the wording would not go down well.
“I need to see you,” VIP says. She’s dressed to the nines today, I notice and mentally calculate the cost of her outfit and accessories to be roughly a month’s worth of my wages. With, you know, the usual amount of overtime thrown in.
“Okay,” I say, bracing myself for anything.
“May, I don’t want to hear anyone saying that we are ‘short-staffed’ today or any iteration of it,” she says. “We are not. We are still within acceptable and legal ratios.” Well, technically, in our state there’s no safe staffing requirements for direct care workers/CNAs…that might very well be legal, but it’s no help on the floor…no requirements that I can find, any way. She might as well say “It’s after breakfast” when asked for the time; it’s perfectly true and very little help in figuring out if you’ve missed your favorite show. “If I hear anyone saying ‘we are short today’, or any iteration thereof, or even a mention of how difficult it is today, I will be writing up that person. Understood?”
“What am I supposed to tell my residents when they ask why I’m taking so long to get to them?”
“You’re just going to have to do your best and not let them even notice,” she says. “We do not need to be adding to their burdens because you have a few extra people today. They shouldn’t even notice a difference, it’s only four people more per group. Understood?”
I nod. Well, I’ve only been forbidden to say a few phrases: how rough can it be?

As it turns out, the only thing worse than working short of staff is being forbidden to mention this factoid.
“May, I put on my call light half an hour ago, where have you been?”
“May, this person is soaked. Why haven’t you changed him?”
“May, why isn’t this person up for the meal? What do you mean, there’s nobody available to help you with the hoyer?”
“May, why can’t you help me right now?”
“Where the hell have you been, you lazy bitch? I’ve been waiting for my shower for an hour!”
It’s chaos. I rush through my shift, begging for understanding from my folks and unable to explain why it is taking me so long to get to them. Words have always been my best weapon and I suddenly feel shackled, having been forbidden to use my words to coax or cajole patience and empathy from my folks. And I really don’t think just coming out and saying “we’re short today” would be a great shock to the increasingly frustrated and soiled residents. They’re not stupid and (for the most part) they can still count. They can see how quickly I’m running between rooms, that I haven’t stopped for a break yet, that nobody has shown up to help me. Oh, trust me, they know and my refusal to admit the truth is making some of them angry.
They aren’t the only ones. I’ve always been emotional and today has strained my control. I’m running myself ragged, haven’t had a chance to stop and breathe and for my efforts I’ve been screamed at, insulted, cussed out all day. I can’t even blame them, sitting in soiled clothes for almost an hour while I try to take care of everyone who has put on their light first. In a rather disturbing turn of events, I’m apparently having the walking-talking kind of melt-down…perhaps because I don’t have time for the actual sit-down variety. That is to say, tears are leaking from my eyes, but I haven’t stopped working and, rather bewilderingly, I’m still speaking in a semi-normal voice. I’m rushing around, doing my work in fast-forward and all the while, my sweat and tears are mixing on my cheeks. This day can’t get much worse.
I really should know better by now.

I round the corner and VIP is waiting for me. “May,” she says without preamble, “what’s going on? Why is it such chaos today?”
“…” I stammer. What can I possibly say in explanation that won’t get me written up? “I can’t keep up when it’s just me on the hall, okay? There’s just too many of them and I can’t do everything at once. Which is when they want it.”
Her eyes flash…but I never actually used the words “We’re short-staffed today.” This feels so unfair. How can I explain myself after she tied up my words and laid threats against my job?
“May, these residents deserve to have a good day without having to deal with all of our troubles. They’ve earned your best, even under challenging circumstances, so calm down, put on your big girl boots, dig a little deeper and work harder.”
Work harder? What the freaking hell does she think I’ve been doing all this time, sitting on the bathroom floor and crying my heart out? I wish! Oh, how I wish. I’m about to say something that will get me written up for sure, when a call light goes off in the room behind me. Seizing upon this gift from the heavens, I blurt out “Excuse me,” and dart in the room before VIP can say anything else. The resident in the bed looks extremely grumpy.
“May, I asked to get up an hour ago.”
“I’m sorry,” I start to say, but she doesn’t let me finish.
“May,” she says in a very different tone, “are you okay? What’s wrong? Are there not enough of you girls to take care of us today?”
“I’m running behind, but I’ll be okay,” I reply, conscious of VIP on the other side of the door. It’d be just my luck today if she had her ear pressed against the door! My resident doesn’t look like she believes me. I can’t say I blame her: faced with the evidence in the mirror over her sink, I don’t believe myself.
“You’re not okay,” she says firmly, but kindly. “You need to take a break.”
“Don’t have time.”
“Did I ask for your opinion? Did I call for a vote? Now sit down and take a minute to pull yourself together. If anyone asks, we’ll say I had to shit really bad.” That sliver of concern, of human compassion breaks the last of my control and I start to sob in earnest, out loud and quite noisily. I sink down to the floor, half-hidden by her bed, bury my face in my arms and proceed to rage and storm at the injustice of it all.
Who the hell does she think…no, that’s not it. VIP isn’t wrong in what she said. She’s actually got a good point about what my folks deserve…but under these “challenging circumstances” I don’t know how to give them what they deserve. Does she think I want my folks to soil themselves? Does she think I like having my residents sit in their own urine for hours? Does she think I’m not trying my damnedest to push through these challenging circumstances?
She isn’t wrong. She’s got a good point…and yet, it’s hard to hear the words “Work harder” from someone who is calm and collected while I’m weeping silently and uncontrollably. It’s hard to accept criticism from someone who is wearing roughly a month’s worth of my wages on her person, when I’m decidedly not looking my best. I looked at her, then I looked at myself and all I saw were the differences that divided. And I hate that. I hate thinking in binary terms, us and them, the powerful and the powerless. I hate looking at her and seeing only the wealth she’s wearing, the power she holds over me. It shouldn’t be like this. We’re both persons. Everything I believe in says we are equals…but I’m so stressed I can’t even hear my own beliefs in my own head. I hate that the only words reverberating in my mind are those that scream: “She’s on a power-trip and I’m the pavement she’s pounding.” It comes down to trust and right now, I don’t trust VIP to have my back.
Okay, calm down. Breathe in, breathe out. I’m not thinking straight and it’s likely I’m misconstruing her motives or projecting my turmoil onto her. I can’t do that. She’s got a good point, the residents shouldn’t have to bear our burdens…it’s just her approach to the problem was a bit half-baked and she didn’t consider how an overwrought CNA might take her words or choice of expensive accessories.
Calm down. Pull yourself together, if not for her than for your residents.
Because if there’s one thing in this whole mess that I have reason to be upset over, it’s that between a staff member with [unspecified] authority and a resident, it shouldn’t have been the resident who made the sacrifice to give me the time I needed to pull myself together.
When my ten minutes of rage and tears are over, I rise and splash cold water on my face. My resident still looks concerned, but she allows me to get her up and together we leave the room. Back into the chaos, but this time, I am master of myself.

<oOo>

I have been blessed: while I have had experiences with bad bosses (as detailed above), I’ve also had good bosses and, more frequently, decent bosses who were neither great nor terrible. It’s not all horror stories. It’s even mostly horror stories.

But what makes a bad boss? What combination of stresses and personal flaws combine to make a nightmare experience for those who work under these people? Sometimes it’s hard to remember, especially in the moment, that a bad boss is still just a person and not evil incarnate…a flawed human being, same as yourself. It just so happens that their flaws have the power to make your life a living hell while you labor under their authority.

Back to the Floor

May.                          Sunflower

It would appear as though my residents missed me.
To show how much they missed me (or perhaps to convince me never to go away again), they’ve apparently decided to throw a call-light party, complete with a few alarms…you know, just to complete the experience. The party entertainment seems to be in the form of the guest of honor, aka me, running around like a chicken with its head cut off. I’m running from room to room, sweat dripping off me and breathing hard; it’s been non-stop all day long–and the day is still young. This shift ain’t over yet and I already feel as though I need another vacation. No sooner do I answer one light than five more go off.
This is getting ridiculous.
I swing into the next room, turn off the call light and ask (in a slightly breathless voice): “Whatcha need? Are you ready to get up now?”
“No,” says Mrs. H. “Not ready to get up yet.”
“Okay then, ring again when you’re ready, good to see you and bye!”
“Stop!!” she shrieks. “Come back here!”
I stop as ordered, skidding forward just a bit from excessive momentum. Thankfully the door frame is there to help me redirect back into the room. “Yes?” I ask.
“Sit down,” she says, or rather, orders. “Sit down and tell me about your vacation. I haven’t seen you in a week!”
“That’s why you put on the call light?”
“Well, duh! I heard your voice out there and figured you were back. So sit down little girl and tell me all about your trip.”
I glance out in the hall. There’s only one other call light going off and I catch a glimpse of my hall partner heading towards it…so I close the door and sit down as requested/ordered. “It’ll have to be quick,” I tell Mrs. H. She nods and settles back against her pillows, eagerly awaiting my story.
I grin. Ah, yes. The best and worst of my job were waiting for me today: everything I can’t stand and everything I love both wrapped up in this one shift, my first back from vacation. Still, it’s good to be back.

If I had to pick one word to describe the Pioneer Network Conference, I would have to go with “thought-provoking”. (Then I’d have to argue that yes, that is one word thanks to the hyphen, thank you very much, Grammar hounds.)
Over the course of four days, I had so much information thrown at me, engaged in so many conversations, asked and answered so many questions…it was a lot.
I learned new things.
I received confirmation for ideas I’ve long held without any proof.
I heard things that made me change my mind on certain issues.
I listened to arguments for certain things that did not change my mind, but showed me how other people were convinced.
I walked away with a thousand ideas for change, and 30 or so blog post ideas.

It was rather odd, sitting shoulder-to-shoulder with administrators, DONs, ombudsmen, policy makers, and other people whose spheres of influence are much larger than my own. It was odd, noticing that we took notes at the same time during a session. I guess I had rather expected to feel small, sitting with the movers and shakers, but I didn’t. Different, maybe, but not smaller. Perhaps that was the best part of the conference: hearing other people’s perspectives and actually listening. Having other people listen to my perspective.
My sphere of influence might be comparatively small, but it does have the advantage of being personal. I can’t change whole long term care facilities, or alter policies or build new facilities based on new models of care…but I can adjust my own personal style of caregiving to better suit the needs of my folks. I can take the big picture things I’ve learned and use them to make the day-to-day lives of my residents better. I can use what I’ve learned to stretch my own assumptions and perspective, use them to formulate and articulate new blog posts.
It might only make a difference to a few people, but it will make a world of difference to those few…and that’s totally worth it for me.

In the end, it’s the people who are important. The system should serve the people, not steam-roll them into molds with labels slapped on top. For me, the system will only be fixed when it empowers people to do and be their best whatever their role, whether it be resident, CNA, DON, RN, administrator or policy makers. For me, the best system is the one that encourages connections between people, no matter their social status or job title.
Systems break down, technology becomes outdated, but those personal connections?
That’s always been the thing at the heart of caregiving. It’s certainly why I do what I do.

Alice in Wonderland

The thoughts flit through my mind at a dizzying pace, a kaleidoscope of colors and frenzied impressions that dance around the idea of what could be and what already is. We are in New Orleans. The Big Easy. A city that has no shortage of whimsy and magic in its own right but to be here to present to the world our writing? To be given a platform in which we can shout our truths in the hopes of reaching others on our path to deep, meaningful and lasting change?…that’s surreal.
It wasn’t an accident that I chose “Alice” for my pseudonym. As a child, Alice in Wonderland was my least favorite fairytale. It made no sense. I much preferred Robin Hood. Now THAT was a story I could sink my teeth into. So, it came as a quite a surprise to me that after a great amount of life experience, I awoke one day in my mid thirties only to realize that my LIFE was wonderland and I am indeed Alice.
Call it fate, providence or synchronicity, I never believed it was an accident that I crossed paths with Yang and May. The odds of meeting two like minded caregivers across the country with such an amazing talent for writing and dedication to expressing truth and impacting change would be slim in any case, but the fact that we have worked together fluidly for two years without meeting one another until this week? The fact that our different styles and voices flow together in a way that is harmonious rather than clashing? The odds of us being offered such an opportunity by the Pioneer Network to speak out and reach others? No. That is more than coincidental.
Sir Arthur Conan Doyle said that if you eliminate the impossible, whatever remains, however improbable, must be the truth. The truth, as I see it, is this: We are on a path that is uniquely suited to us. We have not only the opportunity but the obligation to follow through to wherever this journey may lead and in doing so, we will impact the lives of the most vulnerable among us for the better. We will impact our OWN lives for the better and what we learn on the way will forever enrich us in ways that we cannot imagine. This I know to be true.
Lasting change may not happen on my timeframe but it does happen. I cannot properly express how grateful I am to the Pioneer Network, everyone involved and all who attended, for seeing in us the message that fits so perfectly with their vision or Yang and May for being such a vital part of my life or how much hope our collaboration has brought me these past two years. I only know that the three of us will continue to speak our truths, shouting it when necessary and as much as we can, be the voice for those locked in this deeply flawed system. We will never give up. Of that, I am absolutely certain.
As I sit outside, watching this whimsical city in all its wonders, I feel bittersweet about leaving in the morning. This conference has been the biggest and most fulfilling achievement of my life and it’s sad that it’s almost over. But in my heart of hearts I know it is but the first step of a journey that is sure to be a thousand miles and I am so excited to be a part of whatever comes next. In the meantime, we will continue to write and remind you, our readers…our friends, that each and every one of you matter and each and every one of you can and do make a difference. So don’t ever let the world convince you otherwise. Shine on, my friends!

The perfect world

Sunflower

May

It’s almost funny, how what people assume are the worst parts about my job actually aren’t. In some cases, such as this, it’s close to my favorite. I finish getting Mrs. L settled. She’s in so much pain that it takes me a long time to find a position she can relax in. Her body is so stiff, it’s almost a minor miracle when her arm straightens enough for her hand to grip mine.
“Thank you. I love you…but…”

The world is full of “I love you”s, and they are recorded, celebrated, memorialized. “I love you”: three of the most powerful words in any language. It’s a complete, perfect sentence: subject, verb, object. It’s a sentence that we are taught to say and react to…what we aren’t taught as often is how to react when that complete, perfect sentence continues with a qualifier.
“I love you but”.
I love you but I wish we had never met. I love you but I would never have chosen to be your friend. I’m glad you’re here but I wish I wasn’t.

I squeeze her hand carefully: not so hard that it causes her pain, not so lightly that she can’t feel it.
“It’s okay. I wish you weren’t here either…but, since you are, I’m glad I’m here as well.”
I’ve become used to this role, being the friend that nobody wants to have. Or rather, being the friend that nobody wants to have to need. After all, in the perfect world, there would be need for me. No one would lose their minds to disease, bodies would remain hale and trustworthy until death came to them peacefully. That’s not the world I live and work in. Bodies break, minds shatter; people lose themselves to disease and injury. Death walks hand-in-hand with pain.
And I’m here, in this imperfect world, just trying to make their hard way a little easier, trying to gather up as much peace for them as I can. When death comes for them, I’m there too: there to hold their hand while they struggle, there to fold their hands after they’ve gone.
I wouldn’t wish me on my worst enemy. Or rather, I wouldn’t wish the need for me on my worst enemy. And yet, I’ve become comfortable with this role: the friend you never wanted and the friend you cling to the hardest. When the need is great, so is the love.

It’s funny, how people assume the hardest parts of my job are also my least favorite. They aren’t. They are the reason I do it.

The Faces of Respect

Sunflower

May

“Just try to get along,” my supervisor says with a sigh.
I manage a half-nod that says both “You’ve got to be kidding me” and “I’ll try”–and further manages to say both at once.
“Get along”? I don’t want to “get along”. I want to wring her scrawny neck. Why do I have to waste energy playing nice while she’s so…so…disrespectful?

I’m not literally cornered, I know. There’s nothing blocking my exit from the room; I can leave at any time. Mrs. J’s daughter is ranting and raving about something, I’m not even sure what anymore. She started with the state of a shirt and sort of escalated from there to what can only be called an interesting interpretation of my character, work ethic and moral integrity. Snide, I decide, is what she’s being: very, very snide. And rude. And unpleasant. And disrespectful.

Oh good lord. That is perhaps not very original as phrases go, but truth be told, I have no need to exert myself. Mrs. G has already provided me with plenty of labels to slap on her: among the most applicable, I think, are “drama queen” and “so damned particular”.
“I know what you think of me, I know you think I’m worthless and needy and a drama queen wasting your time being so damned particular…”
Really, she’s spent 15 minutes yelling at me and another 15 explaining why she has not, in fact been yelling at me. This in spite of the evidence of my ears. Does she think I’m stupid or suffering short term memory loss? Well, everybody needs a hobby. Although, she’s no amateur at being disrespectful.

This is CNA week, and this year the theme is “I Choose Respect”. When I saw these words, I confess to being a bit puzzled. Respect I got, but choosing respect? All the stories that pop readily in my head seem to suggest that encouraging respect in others might be a better use of energy. Some days it’s hard to believe just how much disrespect is thrown our way.
But choosing respect? What does that look like? What, exactly, are we respecting?

Respect, I think, is a lot like trust…it is the assumption that you are dealing with a human being like yourself, under stress, prone to mistakes and still capable of goodness, like yourself. Respect is, in short, recognizing the worth of another person.
Not always easy, in a job when you so frequently see the worst in people.
The resident yelling before us: human.
The coworker scowling beside us: human.
The supervisor preaching behind us: human.
The corporate boss ignoring us: human.
Even at their worst, when all we want to see is the label, an attitude of respect demands that we remember the person underneath.

Choosing respect is not easy…lashing out is. Saying everything we feel in a heated moment is easy; maintaining control over ourselves and our emotions is not, especially when it feels like we’re the only ones doing it. When it feels like nobody will see or care about how we didn’t loose our tempers. But we don’t strive to be better so others will praise us…we strive to be better so that we can bear the flawed people who look back us from the mirrors.

In each situation that slams into me, I shall try to take a breath and not become the mirror image of the weakness before me. I shall be firm, decisive and nobody’s doormat…but I shall not be disrespectful. I am the professional, after all.