Category Archives: humor

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?”

Laughing together

 

Sunflower May

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

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

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.

As Long As You Know

Sunflower

May
I must have the worst sense of timing in the universe…or the universe has the worst sense of timing around me. One of the two. Either way, I seem to be the common denominator. Perhaps this is a touch self-centered, but I am inclined to be in a melodramatic mood at the moment. My patience is leaving me, escaping with every sigh I’m trying to repress. Somewhere along the way in my years as a CNA, I’ve developed the habit of rubbing my temples when I’m trying not to show my exasperation. It’s a useful little gesture as it almost completely obscures my eyes…my eyes which have never learned how to lie. My eyes which show everything I am feeling.
Including my current desire to throw myself down and show Mrs. S that she’s not the only one who can pitch a world-class tantrum. I feel a sudden swell of sympathy with Mrs. S’s long-gone parents: she must have been a hellion of a toddler and my goodness can she ever yell. All that’s missing is a little leg-thrashing and pillow punching.
Her entire vocabulary has boiled down to a single proper word–no–and those meaningless syllables that kids use to mimic and taunt each other. In this particular instance, I seem to be the other kid. At least, in her head. I’m fairly certain I did not toss my head from side to side screaming “wah-wah-wah” in a high-pitched, shriek-y tone.
If that’s what I really sound like, I think tiredly, I’m taking a vow of silence right here and right now. Well, that’s something. I might not have any patience left, but my sarcasm has not yet deserted me. Good old sarcasm: it’s seen me through many of crisis. I need to think of some way to handle this, but I’m just too tired to think. Instead I sink down to the floor, rest my back against the wall and bury my face in my hands.
The jeering stops after a minute. I peek through my fingers to see Mrs. S peering at me. Silence–and then:
“Would you like me to kick you in the face?” she asks, quite calmly.
“Um,” I reply, “no. Not really, thanks.”
We just sit there, her on the bed, me on the floor, and stare at each other. I’m in rumpled scrubs, looking, I imagine, quite harassed; she’s in filthy clothes nobody’s been able to get her out of for two days, looking quite put-upon. The silence stretches on again as we continue to regard the other with exasperation.
“I’m not a child,” she says suddenly, fiercely, coherently.
“No,” I respond, “you’re not. You are, however, being rather mean to me.”
Her foot swings out towards me, I jump back on reflex–but she’s not trying to kick me. She’s giving me access to the shoe that needs to come off so I can change her clothes. “Well,” she says, for all the world like she hadn’t two minutes ago been reduced to words to one syllable, “just so long as you know I’m not a child.”
And just like that, I appear to have won the argument. She allows me to change her clothes and, for good measure, her brief. I’m stunned but still possessed of enough sense not to comment.

It’s not until later, after I’ve left the facility, that I’m able to think back to the start of the incident and realize what triggered it. I had tried to soften the explanation of why I had to change her clothes; I had tried to sugar-coat it, sweet-talk her. In short, she felt like I had been babying her and had responded in kind. It’s hard, when my instinct is to protect them, handle them gently…it’s hard to realize that sometimes brutal honesty is the appropriate approach.
I drive home, feeling a touch amused (I mean, what did she expect me to say: “yes please, kick me in the face”) and a touch sad for her. I decide to stick with amused. I don’t think Mrs. S would appreciate my pity.

The appropriateness of black humor

Sunflower

May

It’s suddenly become very quiet in here. Laughter dies away, awkward silence chasing away the echoes. The new aide stands there, fuming and furious.
“I don’t know what you all think is so funny,” she snaps. Her anger is pitched much higher than our mirth and I wince. “Show some respect, would you? It’s not appropriate–”
“To laugh?” I ask. “To enjoy the memories of the woman we’ve all cared for? Mrs. Z was a hilarious lady and how is it not appropriate to laugh at her final joke?” Other aides around the table nod in agreement.
Taken slightly aback, the new aide blinks rapidly and tries a different approach. I’ll give her points for courage: she is most definitely not afraid to speak her mind. “You’re laughing about a dead woman. What if her family hears you?”
She’s once again interrupted, but this time it isn’t by me. The break-room door opens and in steps Mrs. Z’s daughter, as if summoned by our words. Her eyes are red, her cheeks stained with tears…and she looks blazingly angry.
Aw, hell. A part of me wonders why a family member is in the staff break-room, our safe haven from the floor–but that question is almost completely drowned by sheer panic. It’s not that I’m ashamed of what I said, it’s just that I chose the place I said it with great care..all for nothing now. Any doubt that the daughter heard our conversation is quickly laid to rest.
“What final joke?”
I seem to be voted spokesperson by the entire break-room. Well, I suppose I was the one telling the story…”Her dentures wouldn’t stay in. When I was getting her cleaned up, they kept, um, popping out whenever I’d turn my back. She always hated those dentures,” I add wistfully. Mrs Z used to spit them out any chance she’d get and I swear she would aim for me half the time.
Mrs. Z’s daughter doesn’t laugh.
She smiles. It’s kind of weak and watery, but there’s no doubt it’s genuine; the anger fades from her face. A couple rough swallows later, she speaks again.
“Sounds like Mom. Feisty to the last,” she sighs. “Did you get them to stay in? I didn’t even notice.”
A collective sigh seems to go around the break-room. Everyone looks relieved, except the new aide who mostly looks confused.
“No,” says another aide, setting down her sandwich and speaking for the first time, “she sure couldn’t. May is stubborn, but she’s no match for your mom.”
“Nobody was,” the daughter agrees. “Um, I’m just here to, um…” Her throat seems to close around her words and she just waves a hand clutched around a somewhat squished Danish. Someone must have pointed her to the break-room as having the closest microwave.
Someone stands and takes the Danish from her, popping it in the microwave. Not another word is spoken until the microwave beeps and the Danish is returned to her.
At the door, the daughter pauses. For the first time, she looks directly at the new aide who was scolding me. “Thank you for thinking of my feelings,” she says, “but Mom always preferred her jokes to be laughed at. Said it made her feel useful, to make you guys’ day a bit brighter, like she wasn’t helpless after all. I’m glad…she was able to one last time.”
The door shuts and a different silence falls on us. Most of us are furiously blinking back tears.
Finally, the aide with the sandwich turns to the new girl. “Your problem,” she says, waving the sandwich around to punctuate her words, “is that you still think grief only wears a sad face. Everybody knows May loved that lady and the only thing she’s guilty of is terrible timing. Don’t get bent out of shape and don’t tell me how to grieve my resident.”

One the most shocking things coming into long term care (or indeed any part of the medical profession) is the humor. It’s so markedly different from anything else in the outside world.
It’s often seen as calloused, disrespectful and symptomatic of a lack of compassion. While that might be the case some of the time, I’d submit that it is not the case as often as you’d think.
Humor is how we cope. It’s how we deal with what we have to see. It’s just that what we see is wildly outside the norm of American culture that our humor falls outside the normal bounds. We see bodily fluids, crumbling minds, lots of shit and death…and so our jokes reflect that.
That being said, there is a time and a place for CNA humor and in front of grieving families isn’t it. I’m just grateful the daughter understood the substance of my story and didn’t stop at the unusual surface.

It’s the thought that counts…

Sunflower
May

“When someone asks me what I did today, I think I’ll skip this part,” I annouce. I’m a bit upside down, so it comes out slightly muffled.
Mr. G grins.
It’s not really his fault; it’s also definitely not mine. The people to blame is outside the shower room, blissfully making his bed. They have no idea that I’m down on my knees and twisted so that I can reach under the shower chair. Even though I had a stroke of common sense and turned off the water, the floor is still sopping wet and therefore so am I.
It’s not helping my attitude.
“They were trying to help you,” Mr. G reminds me. He sounds like he’s enjoying this far too much. He’s right, I know. The two new aides that I’m working with tonight decided to show initiative: while I was finishing up my first shower, they got Mr. G ready and up in the shower chair. When I opened the shower door to let my other shower go out, I was surprised to see Mr. G waiting for me, already in the shower chair. Beside him was Newbie #1 with a big grin on her face.
I almost cried. Now that’s what I call team work.
Then I started giving him the shower.
I almost cried. Now that’s what I call a problem.

The Problem of course being that the geniuses out there forgot to remove the brief before they transferred him into the shower chair. They unfastened it, tucked it even, and then apparently forgot about it–because the brief is still there, hidden from view until I squatted down to scrub his bottom. The shower pads for the hoyer lift have a hole in them so…well, so that the resident’s bottom is exposed so you can clean it. Same principal goes for the shower chair. Two holes that line up so you can scrub the bottom. But when I squatted down, I didn’t see a bare bottom. I saw a brief so completely saturated that it was beginning to burst and shed crystals all over the shower room floor…crystals that had previously been bits of fluff and filler bounded to urine and soapy water.
Mr. G, a former member of the U.S. Armed Forces, gasped at my choice of words to describe the situation.

I’m completely soaked by the time I finish cleaning up the floor: what little of me didn’t get wet from the floor was taken care of by the sweat that’s pouring off me.
“They were trying to help,” Mr. G repeats. He’s said it a lot.
“I’m not going to yell at them,” I sigh.
“You better not. At least they did something without being asked, even if they did it…er…”
“Half-assed?” I suggest.
“Just remember,” he tells me, ignoring the lame pun, “that experience only comes from making mistakes and cleaning up messes.”
“Or making a mistake that somebody else has to clean up,” I mutter, but I know he’s right. what is a mess in the shower room compared to an aide with initiative? That quality is more precious than gold and I’d be a fool to squash it. If I yell, the lesson they’ll probably learn is Don’t help May. “All right. I won’t fuss. I am going to have to give your back half a bed bath, though. It’s…not what you’d call clean.”
“You think?”

I push him back into his room and pull the call light. While I’m waiting, I assemble the supplies for a bed bath. It isn’t long before both Newbies arrive with the hoyer.
“Er…May, why do you have all that?” they ask. “And why are you sopping wet?”
I glance at Mr. G before I turn back to them with a blazing smile. “Thank you two so much for getting him ready for me. That was really very kind. If I could offer a tip, you may want to double check that you removed the brief next time. Apparently, it makes an ungodly mess. But on the other hand, the shower room needed to be deep-cleaned and I think we can check that off the list now. Seriously though, I really appreciate your help with him.”

No team is perfect and mistakes happen. Sometimes you’re the one making the mistake and sometimes you’re the one cleaning it up. Either way, a little grace and kindness go a long way.
And everything’s better with a dash of humor.

Fourteen Truths

Alice

Alice

 

Alice

 

 

 

  1. There is ALWAYS a solution. It’s simple mathematics. There are no problems without solutions. We may not know the solution right away. We might not like the solution. But knowing one exists brings some peace to the workplace.
  2. Wet sneakers suck.
  3. Friendship is vital to the quality of my life. My friends, co-workers and residents alike, make impossible work days possible.
  4. We are our own knights in shining armor. Management is unlikely to come fix issues on the floor that they do not understand. We need to be the leaders. They can keep the title.
  5. There is a difference between convenience and necessity. Life goes much smoother when I don’t confuse the two. It is this bit of insight that has taught me how to process and prioritize in a moment’s notice.
  6. They more effort I put into a day, the greater the sense of accomplishment I get at the end of it. It’s matched only by the sense of relief that I pushed through with my somewhat questionable sanity intact.
  7. Sometimes you have to make peace with the mundane. Thorough documentation may be repetitive but it’s so very important.
  8. A sense of humor can save your life. It can definitely save your sanity. Embrace absurdity! There is plenty of it to go around.
  9. Icy-hot is the greatest stuff ever invented.
  10. Don’t take it personally. We don’t pick our residents. Not every resident is going to love you. That’s not their job. It’s our job to care for them regardless of their personal feelings about us.
  11. Set boundaries, communicate, and negotiate! These are the magic words for me, not only at work but in life. Boundary setting has been a skill that I’ve had to learn. As caregivers, we are often thrown into situations which require us to be the solution. It becomes a habit, but we are not and should not try to be the solution to all problems. Sometime “no” is a complete sentence. Negotiation shows a willingness to be flexible. Life on the floor is that tricky dance between consistency and flexibility. A persnickety resident adamantly refuses a shower in the morning? Usually, I can convince them to take one after lunch. It gives them a little bit of control. It gives them an option. There is no overestimating the value of open communication, especially with my co-workers. If we are to work as a team rather that at odds, it’s important to be open, honest, and direct. It is equally important to be willing to receive what they have to say to you. Ideally, we are all working towards the same goal; quality care for our residents. I have found conversation and direction from one caregiver to another is far more effective than going to the office every five minutes in the hopes that they will solve a problem that they do not understand.
  12. More will be revealed. The tough times pass just as quickly as the good times and they have much more to teach us.
  13. We can never give up if we hope to convince our residents that their life still has value and is absolutely worth the fight. In a very real way, we are their most important advocate because we know them best. It is at the heart of what we do. We owe it to them to make sure that we are heard, and in doing so, THEY will be heard.

 14…..did I mention wet sneakers suck?