Category Archives: Guest contributor

“I’m Just Doin’ My Job”

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Minstrel

One of my all-time favorite movie lines was spoken by Paul Newman in Cool Hand Luke.  Luke, the non-conforming prisoner in a tough southern prison, refuses to accept the prison’s status quo.  His conduct is a cascade of rebelliousness, until finally the warden orders Luke to “the box.”  The box is a small tin-roofed building, the size of an outhouse, under the blazing sun in the middle of the hot, dry prison yard.  After Luke spends twenty-four punishing hours in the box, the guard releases him.  As he does he says, “Sorry Luke, I’m just doin’ my job.  Ya got to appreciate that.”  Luke replies,  “Nah, callin’ it your job don’t make it right, Boss.”   

Calling it our job doesn’t make things right.  Among the most pernicious problems in long-termcare homes is staffing shortages.  With a census of 25 to 35 residents or patients needing skilled nursing and/or dementia care, there might be only three to five aides scheduled to work a shift.  (Then there are the last-minute call-outs).  If the aide is lucky, very lucky, she may have only five or six persons to care for.  The more frequent reality is having seven to ten persons needing care.  Remember that cacophony of call bells that May wrote about?  Blame it on short-staffing.  And the resident pleading for you to take her to the toilet?  Oops, it’s already too late…  The resident teetering perilously as we rush to prevent a fall? … And the time you lifted a non-ambulatory person by yourself because there was no one around to help?  What about those wheelchair bound residents who haven’t been taken out to feel the fresh air in weeks?  The hits just keep on comin’.   And we keep right on keepin’ on, because it’s our job; right?   

No, it isn’t.  We simply can’t do our jobs as CNAs adequately when we’re so understaffed.  What most determines the quality of care is the staff-to-resident ratios (‘duh’).  I challenge anyone to find an aide who disagrees with this.   Yes, staff need to be trained in good care practices.  Yes, we need to have certain supplies available (soap, towels, functioning hospital beds, appealing food, etc.).  But the key to quality care, to person-centered care is PERSONS.  Staff.  

We continue to work in short-staffed conditions we know violate our residents’ right to good care.  (See medicare.gov for a description of rights of persons in nursing homes.)  If we ‘complain’ to management about short staffing (and that’s how it’s viewed, as a petty complaint), we’re told sweetly that the staffing levels meet the state requirements.  And that’s probably true, because industry lobbyists have made sure that state regulators don’t burden the long-term-care industry with costly staffing requirements.

We complain about these deplorable conditions all the time.  As CNAs we’re mandated reporters of abuse.  (I guess we’d better not think about that one too much!)  But we tolerate abuse that residents endure as a result of understaffing.  Abuse isn’t just about physical or sexual assault.  It’s also about neglect and emotional abuse.  If I neglect a call bell for so long that a resident is left to soil himself and remain in his soiled condition for hours, that is abuse.  If I say to a resident who asks to be taken to the toilet, “Janie, I just put a clean Depends on you; I can’t get you back into the Hoyer lift and take you to the toilet, you have a diaper on, you can use that,” that is abuse.  Abuse is ridiculing a resident who cries for her mother all afternoon; scolding a resident who spills her drink all over the floor; ignoring the call bell of a resident who constantly asks to be taken to the toilet minutes after the last toilet trip, because we know she ‘doesn’t really have to go.’  Well, she needs something and it’s our job as aides to find out what.  “But I don’t have time for all that.  I have seven other residents to get to.  I’m just doin’ my job.”  

So what can we do?  Unlike the workers of the 1920’s and ’30’s, we can’t go on strike to win better working conditions.  We’re caring for the sick and the frail, not assembling cars.  But if we can’t leave the floor for a sit-down strike, we can use our cell phones as weapons in the revolution for better care.  Call your county or state abuse hotline every time aides have more than six residents to care for on a shift.  (And don’t count the LPN or Medication Aide in your ratio if she isn’t providing care, even if management does.)  The state regulators aren’t always thrilled to receive reports of abuse because they are short-staffed too, and don’t have the means to investigate all complaints properly.  They don’t always to a good job, for the same reasons we don’t always: because they’re understaffed and a little intimidated by their bosses.  

Revolution isn’t about violence and nastiness. (Remember Gandhi and Mandela and Rosa Parks.)  It’s about patient persistence and never giving up as long as change is needed.  It means taking that first step.  Maybe our first step will be a phone call.  

It will be okay

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Rose 

It seems like every other word out of my mouth tonight was an apology.  “I’m sorry I forgot your towels.”  “I’m sorry I forgot your coffee.”  “I’m sorry it took me so long.”  “I’m sorry, but it looks like I won’t be able to do your shower tonight.”  After two years of this, I finally felt like I was starting to get the hang of things.  But this particular hall was so busy that some things just slipped through the cracks.

              Every time I feel like I’ve finally got things figured out, it seems like the universe drops a load of crazy in my lap.  Or in this case, a week of crazy.  They just filled this rehab unit up after having it closed for a few weeks due to low census, and it seems like they managed to find every demanding, picky, or needy person in town and drop them on us all at once.  Everyone who works this unit knows that it’s crazy.  We’re struggling to get the bare minimum done, and it’s starting to show.  We’ve been asking for more help for days, but it’s not going to happen.

              It’s been a while since I’ve had an assignment this busy, and it was a rough day.  I forgot Mr. A’s towels and Mrs. B’s coffee.  Mr. C’s wife and daughter were sitting in the hall just before dinner, watching me run my legs off and making sympathetic comments about how I needed more help.  Mrs. D waited over two hours for me to be able to put her to bed, and I never did get the chance to give Mrs. E her shower.  As I’m driving home, I find myself running through the day in my head, trying to pinpoint what I could have done better.

              I want to tell them that I’m busy.  That there are too many people.  That I need more help.  But I try to avoid excuses, because they don’t really change anything.  For better or for worse, this is what I’m stuck with, so I’ll figure it out.

              In the end, Mr. A and Mrs. B got their towels and coffee.  Mr. C’s family went home and I was finally able to take care of him without someone breathing down my neck.  Mrs. D got into bed, and I told Mrs. E that maybe she can request a shower tomorrow or the day after if the staff has time.  The orientee from the other hall came over to help me for the last hour, and I finally got everyone into bed.  The charting wasn’t finished, and I clocked out late, but that’s okay.  It happens.  I’ll get to try again next time.

              The truth of the medical field is that it’s hard.  Some days it feels like I’ve been put through the wringer and dropped on a sinking ship with a teaspoon to bail myself out.  I can either sink or learn to swim very quickly.  But in the end, it’s worth it.  Because when I walk into a room, they smile.  They ask how my weekend off was, or how my classes are going.  I celebrate with them when they graduate from the wheelchair to the walker.  I give them a hug goodnight and tell them I’ll see them tomorrow.

              They need me.  It’s terrifying to realize that these people are totally dependent on me to care for them.  It’s a million times more terrifying for them.  There will be good days and bad days, but I’ll figure it out, because I have to.  It will still feel like things are falling down around me, but I’ll learn to be calmer and deal with it.

              When I first started as an aide, it was hard for me to accept the fact that I can’t do everything.  That some days I was only able to get the minimum done.  I thought that I was failing, and or that there was something I was doing wrong.  But eventually I realized that everyone else was in the same boat, and that we were all just doing our best within a tough system.  I learned to cope by focusing on the good parts of my day, not the bad.

              And there were good parts today.  I was able to share a joke with Mrs. F as I readjusted her pillows and gave her something to drink.  Mr. C told me that I must like my job because I’m always smiling.  I was able to teach the new girl a few tricks she didn’t know.  Several people asked me when I would be back.  If they want me back, I must be doing all right.  I’m driving home listening to a good CD, and I have the weekend off before my classes start.

              So I’ll go home, go to bed, and come back next week to start all over.  It will be crazy, and I’ll probably mess up a few times.  But I’ll survive in the end, and I’ll find a way to make someone smile.  Just as I told Mr. C, I really do like my job.  And it will be okay. 

The Magic of Music in the Chaos of Long Term Care

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Minstrel

Being a new CNA is challenging.  Yes, in training I learned how to make a hospital bed with a mannequin in it.  To wash my hands according to procedure.  To transfer fellow trainees with a gait belt.   But now I’m in the unit, needing to transfer a dear little wheelchair-bound lady who can no longer speak and who, while petite, is a dead weight when I try to lift her.  And she is contracted.  Her arms remain tight at her side as I try to undress her.  Who is more distressed, ‘Goldie’ or me?  

Goldie, in her mid-90’s, is still a beautiful-looking woman with twinkly eyes and a smile that glows.  So as I work with her I sing “Glow little glow-worm glow and glimmer” to her.  (Are the Mills Brothers spinning in their graves?)  I’m not sure Goldie gets the words at this point, but I’m laughing as I sing and she laughs back.  She relaxes.  I open my arms wide to invite a hug and Goldie opens hers!  Now I can get her blouse off.   Mission Accomplished!  I don’t know what made me sing to Goldie that first time, except that she was such a sparkly person that being with her made me happy.   My singing is not a pretty sight.  But as one musician said to me, “They don’t care what you sound like if you love them.”    

Soon I was singing to all my residents as I did ADLs (Activities of Daily Living: bathing, dressing, toileting, eating).  Sometimes a resident would sing along.  Yes, this did mean that it took me longer than it took other aides.  One of my caregiver-mentors would say to me, “We don’t have time to talk to the residents.  We don’t have time to sing to them.”  But I persisted (quietly) and began to carry my IPOD nano and a small wireless speaker with me.  Now we had hundreds of songs, sung by the voices these residents might recognize: Frank Sinatra, Rosemary Clooney, The Mills Brothers, Judy Garland, etc. etc.  One morning as I brought residents to the dining room for breakfast I played Oh What a Beautiful Morning.  Soon the room was singing!  And smiling.  In time other aides began asking, “Do you have your music with you today?”   For one thing, I think they liked some of this old music.  And they saw that residents often became calmer and more cooperative when they felt ‘sunny.’  Music does that, connecting us to each other and to our memories.  

As my IPOD played the Marine Hymn or Anchors Aweigh, veterans walked to the dining room with new determination.  Accompanied by a waltz, a resident with unsteady legs could be coaxed to move more confidently.  Sometimes we can engage a resident with a song we know she enjoys, singing together as we walk to the toilet.  Because we’re in the midst of something pleasant, a resident might hardly notice that an ADL she usually resists is about to happen.

Some residents can no longer speak; they might no longer understand language.  The saddest reality is that some can no longer hear.  (Even then, rhythms might be felt.)  Not every musical event works every time with every resident.  Nevertheless, with many residents, music can be magical in its effect.   Music has a profound positive effect so often, that it seems crazy not to try it.  

When I am old and grey and full of sleep… (thank you Mr. Yeats), they can take my food, they can have even my books.  But I want my music.   

More on the Green House Model of Long Term Care

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Minstrel 

In a series of posts in 2015, CNA Edge offered a caregiver’s perspective of the Green House Project, an innovative alternative model for Long Term Care. In today’s post, caregiver and guest contributor Minstrel gives her take on the Green House Project after a visit to one of the homes.

Yang has written previously on the Green House Project.  Recently I also visited a Green House Project complex.  Today these embody the most promising ways of caring for those needing long-term skilled nursing care.  It’s a tremendous care model.  I do have several reservations.

First, this model depends on having a majority of residents with substantial nest eggs.  (At one home in New Jersey, I’m told this is about $350,000.)

Second, while Green House homes do pay their Shahbazim more than what they were previously earning, they are still not earning a living wage, and some work a second job to supplement income.  One of the Green House Project’s three philosophical underpinnings is staff empowerment.  Doesn’t staff empowerment need to include their economic empowerment?  I asked this question at a GHP seminar but didn’t get a satisfactory response.

Third, as aging impacts physical and mental health, some elders will develop dementia and some will need two-person assists for transfers. We may find that even a two-to ten ratio won’t sustain the quality of care as care needs increase.  The current staffing ratios, which seem ideal, may not be adequate.  Down the line there is likely to be a need for more staff at greater cost to the home; or, if staff isn’t increased to meet the greater needs, a diminution in care.

It’s hard to imagine how this model could be affordable on a large scale — and Dr. Bill’s vision is enormous — without a changed allocation of national resources.  In 2014 the US GDP was over $17 trillion. Green House nursing homes are an economic possibility, just not a political possibility yet.  Thus the current model of LTC homes seems likely to survive.  But the culture of care — for residents of LTC homes and also for their caregivers — must and can be improved radically.  This belief is at the heart of CNA Edge’s mission.

I am not an Angel

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Lynn

If someone calls me an “angel” one more time today, I think I’m going to puke all over their shoes.  Really, I mean it.  I am not a messenger of God dressed in a long white robe with wings.  I am a CNA: a certified nursing assistant, a trained professional.  I am a person who chose this career field.  I am a wife, a mother, a daughter, a sister, a neighbor, a voter and a human being.  I am not an angel.

I have a full set of emotions and thoughts that you, the family of the residents I care for, will never see or hear.  You will never hear the cuss words that run silently through my brain as I discover your delirious wife smearing her feces all over her bed, the floor, herself and anything else within arm’s reach.  Instead, I face the task at hand; cleaning up your wife and her room while calmly interacting with her.  You will never hear me sharply respond to your mother’s cruel, untrue words concerning my work methods.  Instead, I redirect the conversation in a quiet, soothing tone.  You will never see the frustration I feel showing on my face when your husband refuses to walk even though he is able to do so.  Instead, I continue to encourage him to keep trying. You will never notice as I slowly inhale and exhale to calm myself after your elderly father just threw his meal tray across the room because the cook accidently gave him juice instead of coffee.  You will never see the tears I cry while I apply ice to my bruised cheek after your aunt, in her dementia, punched me while I changed her urine soaked clothes.  You won’t know the feeling of disgust that runs through my body like an electric shock when your aged, confused uncle grabs my crotch while muttering sexually explicit phrases as I help him out of his bed and into his wheel chair.  No, you family members of the residents we CNAs care for will never really know these things.   You see us working and instead of respecting our professionalism you call us “angels.”

These are not the behaviors of angels; this is a professional CNA in action.  We are trained, licensed and trained some more to be CNAs.  We work very hard to help other people’s family members.  I would much rather hear someone exclaim with pride, “She is one hell of a CNA!” than call me “an angel” any day of the week.  I won’t even feel like puking because I’ll be too busy smiling.

Sunrise, Sunset

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Edison Terrell

I went in to my old work to volunteer with activities this afternoon before work. My last day at this place, but I’ll spare the choked-up emotion for later. Maybe cry into a cup of Americone Dream. Anyway one of our residents was sent to skilled a month ago after he broke his hip, and he looks so different since I saw him I didn’t even recognize him until he started grumbling angrily at the door to the living room. It was the pomp British voice, and the way he called the door a “f____ wanker” that clued me in.

The difference was, in a word, shocking. Disturbing, really. He was a lawyer in his past; not in the best of shape when he moved to Personal Care from Independent Living, but he was walking, talking, and speaking his mind confidently to us. Sometimes he didn’t make much sense, but I took it as part of his charm; the way he vigorously and skillfully defended his own nonsense perception was admirable in its own way, as well as frustrating. Today he’s wheelchair bound, kicking and pulling on already opened doors, grabbing feebly at the air, at the sleeves of his woolly sweater, even at his own hands, like they’re alien things at the ends of his arms. Mumbling incoherently the whole time. He grabbed at a cooler of ice at the nurse’s station and shook it violently until an exasperated aide came to steer him away, then scooted aimlessly around with his eyes barely open. He’s so delusional right now they may as well be closed.

Seeing him in that state shocked me further to the core than almost any other experience I’ve had on the job. He went from a gentlemanly annoyance to a maniacal monster in less than four weeks. The sharp decline is horrifying to see, a fate worse than death. It almost makes me not want to go back.

I know I can handle future residents like him thanks to this experience. Clinical and months of work have shown me that if the shock doesn’t kill you, it’s a recoverable one. There comes a time when you start to question how many more shocks you’re willing to take, though. You start to slowly turn a corner then, if you’re like me. I’m confident I could work almost any aspect of this job after a little adjustment, but is it worth it? Am I so needed that I should sacrifice my comfort and drive to come back and keep being horrified and saddened? Or do you just hold on the good and keep going?

Fran had a mini victory tonight when she was able to put both her arms in her shirtsleeves and take off her pants and briefs before sitting on the toilet without me urging her or showing her how. Little moments like that keep me here. Tomorrow she may be different. She might break her hip as soon as I leave the unit, and maybe an ambulance will zoom into the parking lot while I’m driving away around the other side. It’s pointless to ponder like that in this work, though. In that moment she was exemplary, and I was so proud of her.

 

Fran is Lonely

buddha

 

 

Edison Terrell

I went to sit with Fran for a while, because she’s been unhappy lately. I don’t use words like “declining” around her, but anyone can see she’s going downhill. She knows something is wrong, but can’t put her finger on it. She’s gotten more confused the past few months, a lot weaker, and she didn’t had much self-confidence when I started here; this new development has her putting the brakes on trying at anything, even putting on a shirt. She’ll just fumble with it, groping both arms through the head hole or let it sit on top of her and look pitiful, not making any attempt until you put your foot down.

Fran’s little apartment is divided into a cozy living room/kitchen, a slightly bigger bedroom and a tiny bathroom that barely fits us and her walker. No stove, but there’s a counter and cupboards and drawers with silverware and cups, and a little fridge like you’d see in a dorm room. Coming in through the front door—always unlocked and ajar, because she fears she’ll lose her key—the kitchen is to the right, next to Fran’s electric recliner, a nightstand with a lamp and across from there are two tiny rocking chairs that somehow support my weight, though the arms pinch my girth. A subtle reminder I need to get back on a diet. Or “change my lifestyle” as chronic fat people like me tend to put it. I knocked on the door as I came in, she said she was happy to see me, which I took to mean I could have a seat. I took the chair looking directly at her.

“How you doing, Fran?” I said loudly. She isn’t hard of hearing, but speaking loudly and slowly helps her understand what you’re saying. She talks lower and slower than she used to. Takes time to ruminate on her words. I try hard not to check my watch when I’m around her. She doesn’t get a lot of talking done because we’re all rushed, almost all the time.

“I’m lonely, but I don’t know why,” Fran said finally. “People come in and out, but it’s not the same.”

“Nobody talks to you?”

“Yeah, people talk, but it’s all the same thing. They all their own way of doing things. And they creep up on me with things to do. PT. What you do—not you, but you know. The others. They want me to go watch old movies.” Fran has a perpetually sour look on her face like she was sucking on lemons before you walked in. Her skin is dry all over, no matter how much moisturizer I put on it. The flaking whiteness all over her scalp, her cheeks, and on her chin only adds to the gruesome texture of her face with her mouthed pulled back dryly in a near permanent grimace that forcibly reminds me of a skull.

“You don’t like the old movies?” I ask loudly.

“I saw them all years ago and don’t want to look at them again. That’s us. Old people. Old movies. Old things. Remembering. The sum of our parts; old, old, old; us in a nutshell.”

“Oh,” I said lamely. “I’m sorry to hear that.”

Before I could offer up an alternative, Fran verbally reached into my guts and squeezed them, twisted them. “I’m not used to being dirty,” she moaned. “I’m used to being clean all the time, but they’re not cleaning me as much as I’d like. You’re one of the only ones who does.”

I didn’t know what to say. I started to speak, to tell her she needs to tell someone about this, but she rambled on. I’ve learned sometimes it’s best to just let people talk; they don’t necessarily want advice or solutions as much as someone to grieve to.

“I don’t know what to think or where to go or how to solve anything. I used to know. This is my walker,” she said, rattling its aluminum frame. “My pouch is on it, and those are my pads. But it doesn’t feel right. It doesn’t look like my walker. I wouldn’t know it was if you didn’t give it to me. And you have to take me all the way to the bathroom if I have to go. Nothing is normal anymore. And I don’t know how to get it back to normal.

“My bottom is sore. I shouldn’t say that in front of gentlemen.”

“I know I’m gonna fall. I don’t want to fall again. It’s really bad. It’s bad when that happens. No hospitals. That’s the worst. You don’t get to live in your apartment if you go there too much. All my friends are in Independent Living and I need help with everything. That’s not normal. None of this is normal.”

If I could find words, I don’t know what they’d be. All I could think to do was validate that it’s “normal” at this stage of her life, and some people are at different levels, or some crap I was taught in orientation or class. But I’m twenty-nine. What do I know about any of that? Anything I said would come off as hollow and unhelpful as telling a dying man to cheer up, it gets better. I let the silence stretch on painfully.

Fran croaked that she was thirsty. “There’s a can of ginger ale in the fridge. Take half and we can share it,” she said.

Her fridge was barren but for a few bottles of V8. “There’s only V8 in here, Fran. I’ll have to go and get you one from the kitchen.”

“Please make sure you come back,” she whined. She had turned around in her chair to look at me, fingering the big button on her pendant, not quite pressing it. “I don’t want to be lonely.”

“I’ll be back soon,” I said, stepping out. I had a feeling it was a bad thing to say, and was rewarded for it moments later when someone else hit their pendant. Duty called, and “soon” was almost twenty minutes. I got her ginger ale in the end even though she only vaguely remembered asking for it, and she gulped it down, burping, which she remarked was very unladylike with a little laugh.

Update: Fran moved out of her apartment in assisted living to skilled about two weeks later, skipping right past personal care. Did not pass Go, did not collect her $200. This place would have taken it anyway. She died less than a week after that. I hope she was surrounded by family when it happened. I hope she wasn’t alone. No one told me or I would have been there. She was a huge pain in the final months I knew her, a physical and emotional tax more than a person, but the last few days in her company humanized her again. I’m thankful for that.

I’m sure someone would remark at how wrong it was for losing sight of her humanity. I can only shrug at it, look away. I feel exactly what you’re feeling for me, but it was never a conscious choice… No, I can’t honestly say that. I saw it coming like I’ve seen it so many times before, the moment where acquaintanceship either becomes friendship or sours slowly while you watch in a mix of anxiety and anger. Anxiety because it means a dark spot on your day, anger that swallows you up, pulls you down. Anger at the resident for being such a fuss, so much a dependent pain in the most tender part of the gluteus. The tailbone area for me, that’s the most tender area. She was a pain in my tailbone.

It’s a blind corner that you take with faith or your eyes closed tight. Every time I meet a resident like her I shut my eyes and hope for the best. Sometimes I take a hit. Sometimes I meet residents who are demanding, heavy, angry or mean. And I’d fight against it. I can’t say I did my best because I know I could’ve done a lot better. I could have smiled, forgiven them, rather than taking their meanness into me and holding onto it, hurting myself with it. I guess the more often it happened, the less I fought it, until Fran the human being with wants and needs and a personality was shrunk down to Fran the confused, shrieking harpy who depended on me for everything. Fran, My Future Back Problem. It’s hard to shake off bitterness like that after it has seeped into your skin. I still had some love for her, though, for whatever insane reason I couldn’t put my finger. Maybe because she reminded me so much of myself. A hypochondriac, dependent, whiny, pitifully scared person facing what she’d feared she would face her whole life. Trying to save her from the fear that came on at night when she was all alone—the same kind that creeps up on me when all my distractions are gone—was like saving myself. Working with her put that fear, and all the dependence, the whininess that came with it front and center. It made me take a long hard look at myself. I didn’t like what I saw.

Fran was my zen teacher, in a way, and I hated her like one, for showing me all the ways I was coming up short. I’m only realizing it now as all the confused emotion and mixed up thoughts unwind, smooth out. She was probably one of my very best teachers. 

Anger Management

buddha

 

Edison Terrell

You’d think anger problems like mine have no place in this work, and you’d probably be right. But I care a lot about my people and try not to let it get to me. 

The problem with saying I have an anger issue is that it instantly identifies me as a terrible person. Pop culture, movies, games love to paint a person with anger problems as a psychopath in waiting, just holding it together long enough to explode in a hail of bullets and crazy when the final straw breaks his back. I have to admit, a small, insistent part of me worries that I could be that guy someday. It’s one of the reasons I refuse to own a firearm. Just in case I snap at some point, I’ll be a hell of a lot easier to take out when I start attacking people in an effeminate, fussy nerdy rage. Probably crying the whole time, too.

Seriously, even saying I have an anger problem forcefully conjures up images of the bad guys on crime dramas, the wife and child beaters, the people who pop out of their cars with a bat if someone accidentally scrapes their bumper. That’s what people tend to think when we think of anger issues. Unchecked, unbridled rage. And I’ll admit, there are brief moments at work where something will inordinately set me off; my vision will blur and narrow almost to pricks at the same time as the rage seems to overtake every other mental process. And it could be nothing at all that sets me off. It could be Fran being her normal difficult self, trying to run away with her brief around her ankles, balls of poop hanging from her knee-length pubic hair. It hurts when I pull them off, but she’s not hearing that it needs doing. She’s pissed. I’m pissed. My anger just keeps rising every step until I’m ready to jump out the window and hug the ground with my face thirty feet below… 

But you know what I do then? I back off. I herd Fran into a corner where I can trap her, yank up her brief, and let her be on her way for now. The poop balls are disgusting but not doing her any harm, and she’s too wild to listen. I want to kill someone, myself, but I have her sit down in her chair as gently as possible, directing her through gritted teeth, and I leave, go calm down in a corner. I can spare a few minutes to chill out. Let the anger run its course, boil itself away like an overheated pot of water left on the stove too long; it leaves me cold, ashamed in the end. I’ll take that over jailed or dead from leaping out the window, though. 

There are people who would try to make me feel like a dirt bag monster for having a problem like this. They’d say I have no place here, I’m a danger to my residents and staff. I promise you, though, as long as I have my wits, the only danger I present is to the Popsicles in the freezer and the Fig Newtons in the cookie jar. If that’s not enough, I don’t know what will be. You have to understand that we’re all one bad crossed wire away from turning into gibbering idiots, or aberrations. We love to say CNAs are angels, and to a point I agree; we can be wonderfully, beautifully humanitarian. We put our health on the line for vulnerable strangers every day, some who won’t live to see tomorrow and some who will never be aware of our presence in this stage of their lives. But you can’t ignore the darker side of your humanity for the bright angelic within.

All of us have fatal flaws. Maybe you care just way too much, to the point that everything breaks you like china. Maybe you don’t work well with certain types of other aides. Maybe you have a tendency to gossip a lot, and tend to unwittingly wreak havoc among staff. Me, I have an anger problem. I have an ugly, horrible issue that I deal with every single day. A thing I’m deathly afraid of anyone in this business seeing. And it has been seen. I’ve walked out of rooms, shaking with fury, on the edge of tears I’ve beat myself down so hard for being so mad, uncaring that other aides get to bear witness to this side of me. Most days I’m relaxed, joking, the life of the party for some of my residents. Every now and then, though, and it might be something stupid, it might be something totally unknown to me, I’ll get very, very angry, and have to walk away from my job for a while to reassess. I need those breaks to examine my rage to try and peek at its source. It might have nothing at all to do with the person who seemed to piss me off, that’s the unnerving thing. But it’s something I have to do. That’s how I deal with my fury.

 If you take anything from this, please let it be that people like me aren’t lost causes on our own. We think of rage issues and that’s what comes to mind. The irredeemable, the awful. Psychopaths, rapists, wife beaters. That one kid who went crazy and stuck a TV remote in his butt when his dad shut off his WoW account. If I need to walk away from something it’s not because I’m going to actually harm the resident. I’d never do that; I have too much empathy for them, too much love, or else I wouldn’t be in this work. It’s because I’m so mad at myself, so guilty, that I need a minute to calibrate my emotions. The only thing in danger is my perpetually rock-bottom self-esteem. 

 But I can’t tell this to my boss, or my coworkers, without fear that I’ll be put on some kind of watch, at the very least. And hell, maybe I’d do that too, if I were them. Part of the reason I take it so hard is purely because a part of me that logic can’t reach believes all the awful stuff people think about rage issues. I’ve been dealing with it for years with my zen practice, meditation, mindfulness, but part of me still thinks I’m a ticking time bomb just waiting to go off… no matter how many times I’ve proven the opposite. It plain sucks to live like this, it really does. I feel trapped by my anger and by my worries of what people will think if I come out about having it… 

The Connection of Strangers

We are pleased to welcome guest contributor Greg Zinner. While Greg is not a caregiver by trade, this post shows how the caregiver-resident relationship can create valued connections beyond the home. Greg is the author of the running blog Mystical Miles.

My friend who is a CNA often shares about the importance of her elderly residents having contact with the outside world.

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I’m a lifelong runner who participates yearly in fifteen to twenty races and other running based events. Through my friendship, residents of one particular long term care facility get to share in my triumphs and travails out on the asphalt and trails. I’m told on days I race they will eagerly await the results. Or voice concerns such as “it’s too hot for him to be running!”. Or ask questions like “what will he eat and drink during a thirty mile race?”. Or… is “your friend crazy?”

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But overall perhaps they can relate. They can relate to someone who is kind of at the margins in what society considers its norms. They can relate to what it’s like to struggle, to be in pain, and to want to give up some days.

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The photo below (editor: due to HIPAA concerns, displayed in segments through the post) was sent to me after I completed a rugged fifty mile trail race in the Appalachian Mountains in southwestern Virginia. I almost wept with joy when I saw, as did my friends who traveled and raced with me. For I felt like my running was a part of something much, much bigger than aid stations and finish lines. I got to bring a little joy hopefully to some wonderful people hundreds of miles away. Perhaps making their day just a little bit brighter.

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