Working the graveyard shift on a memory care unit…there really are no adequate words to describe the experience. In many ways, it’s the most challenging experience I’ve ever had in this field. I have twelve residents on my hall and on any given shift there are four to six that won’t sleep. It’s a crapshoot whether it will be an all night dance party full of fun or a nightmarish landscape over which I have little control. Mostly, it’s some combination of the two.
“I think I’m dead.”
“You’re not dead.”
“I might be.”
“ You’re not.”
“Ok. If you say so.”….I have that exchange at least once a week. This particular resident is very matter of fact about the whole idea that she might be a ghost, as if she finally figured out why her life has become so strange and unrecognizable. Death, however final, at least made some sense to her. The disease that has ravaged her mind and slowly robs her of who she once was makes no sense at all. She is still in there, though. Her caustic wit cuts through her mental fog; a beam that lights brief paths to moments of clarity in which who she is underneath the Alzheimer’s disease shines through. She loves music. All kinds of music and she loves to dance. She hates tuna fish. If she doesn’t trust you, she lets you know it. She doesn’t respond well to formality, preferring warmth to surface level pleasantries and when she laughs, it is full throated and from the soul rather than polite titters hidden modestly behind a handkerchief. This is a woman who does not bother with giggles. She laughs like she means it and I love that about her.
Those are the moments that I hold onto when the bad nights come; when my people wander in the darkest hours of the night, confused and afraid. When she is having a difficult night, she doesn’t sleep.
“I’m frightened!”, she tells me. Eight hours straight of I’m frightened. And when I’m on a round and out of her sight that fright turns to panic until I am finished helping another resident and she can lay eyes on me again. The best I can do to help her through those nights is to continuously remind her of who she is; that she hates tuna fish and loves music and loves to dance. That helps some, for a little while…but I have eleven other residents who also need me and when three or four of them are having a difficult night at the same time I feel like I’m drowning in my own powerlessness. I can’t cure dementia. I can’t bring back dead mothers or lost dogs from their childhood. In the light of day, with the activity and structure of the daily routines, redirecting is much easier. At three in the morning, it is much more difficult to escape the ghosts of the mind. That’s true for me, so I can’t imagine how hard it is for them.
When I first started on this hall, those shifts were so emotionally exhausting that by the time I punched out, I was feeling something very close to despair. I do not do despair very well. I haven’t for a very long time. Despair leads to giving up and that is quite simply not an option. Besides, those were only the shifts when it seemed that everyone was having a bad night at once and as painful as they were for me, it was exponentially worse for those in my care who were actually living through it.
So much of this field is trial and error. I decided to go back to my basics; ideas and tools I learned years ago when I worked in memory care on first shift. The hours are different and as are the mental state of those in my care but certain truths transcend from day to night. Consistency is always vital in memory care. If I say I’m going to do something, I follow through. I learned my residents, their patterns and preferences and the best night time bathroom times for each one individually and developed my routine. I keep it consistent but flexible. I work around them. If a lot of my folks are restless, I have a midnight snack party and play calming music. My night owls like Law and Order. It’s funny…the can’t follow the show but they seem to remember enjoying it and that’s enough. All of this has helped a great deal.
Of course there are still really tough shifts when events seem to snowball, but they are less frequent and I am better able to deal with them. One of my favorite aspects of my work is that in order to be most effective, I have to learn continuously. Anyone who says differently isn’t doing it right. I have been blessed with the support of those who love me most, both in and out of the field. It is impossible to give up when surrounded by people who believe in you. I walk in the footsteps of those caregivers who trudged the path before me and passed on what they know. At the end of the day, good or bad shift, daylight or in the still of the night, I love what we do. I love writing about what we do. I love that I see the value in what we do and I love those in our care for whom we do it.
I felt all my energy drain quickly as I punched out at the end of my shift. I was thoroughly enjoying my transfer back into facilities and I relished the challenge of working third shift as I do all new experiences in this field. Even so, there is a marked difference between my ability to push through my new hours on the clock and my hours off.
I’m on work mode when I clock in for the night. Everything falls away except my enthusiasm for this new opportunity and my desire to do the best job I possibly can. I’m not bothered by sleepiness and I have never been bored on the floor. Even at three in the morning, there is always something to do. I spend the periods of downtime getting to know the layout of the gigantic facility, acquainting myself to the residents who are night owls and occasionally getting some writing in. Clocking out is an entirely different story. Exhaustion that I didn’t feel on the clock falls upon me as I walk out after my shift, squinting my eyes against the harsh sunlight that slices sharply through the mental fog in which I am suddenly enveloped.
Why won’t my car start?! Oh. Because I’m trying to put the key fob into an ignition switch that doesn’t exist. What day is it?! Come on Alice, you can do this. Two days ago, you were volunteering at the behavioral health center. You do that Saturday’s. That makes today Monday. Monday…what am I supposed to do Monday’s? Should I sleep now or push through until this afternoon and sleep then? Or maybe I’ll sleep a few hours now and a few hours later?…I have never thought so much about sleep in my life. It’s not rocket science. I should be able to figure this out!
And difficulty with sleep and keeping track of the days was just the start. My emotions off the clock have been haywire. Like the worst case of PMS ever. One minute I’m fine and the next I am completely convinced that I am ill suited to handle even the most basic life events. When should I eat? Brush my teeth? Shower?…it’s topsy turvy world! And then there’s the anxiety and disorientation that comes from waking up at four in the afternoon to start your day. While I wouldn’t go so far as to call it a panic attack, those first few moments of wakefulness haven’t been so pleasant.
After I finished my first week, it
occurred to me that those living with dementia or Alzheimer’s exist in a much more severe and progressive version of this state of vagueness. That awareness stopped me in my tracks and I was filled once again with admiration at the strength and courage it takes for them to walk through each day. I know it even if they don’t. So I decided to employ what I like to call the three “C”‘s on myself much the same way I do when I work on the memory care unit. Consistency- decide on a sleep schedule and stick with it. Schedule outside events and social interactions around it. I’m still working on that one but I feel good just having that plan in place. Calm- recognize that my change in sleep patterns is going to have an emotional and physiological impact on me. Realize that feelings are not facts and this will improve with time. Compassion- go easy on myself. Practice self care and if occasionally I have to have an off the clock melt down, allow it to happen rather than repress it.
It is getting better. I am actually adjusting faster than I expected. My head feels less muddy day by day and there is something special about working when the world is asleep. Third shift has challenges that I didn’t expect and it isn’t the cakewalk I believed it to be when I was working first shift for all those years. But I really like it. In time, I think I will love it. And I am already learning from it.
Most workplaces want their employees to leave their personal drama at home and come to work with a positive mindset. This is especially true of a CNA. We are reminded frequently to “leave your baggage at the door and smile as you enter.” I have always taken a small measure of pride in how efficient I can be at packing my emotional “bags” and leaving them to wait until the end of my shift like suitcases piled up on a hotel bellhop’s trolley.
Suitcases are all zippers, straps and heavy nylon materials these days. I remember when suitcases were made of a hard substance and had snapping locks that required both hands to open or close them simultaneously. If such a suitcase had too many items stuffed in it, the thing would spring open letting loose all of its contents for everyone to see.
My mother-in-law passed away about 6 weeks ago unexpectedly. She was like another mother to me and I love her fiercely. Due to a series of uncontrollable circumstances, I couldn’t go to her funeral. I find myself grieving every day since. Some days are harder than others but like the good CNA I am, I pack the grief neatly in my suitcase and leave it waiting for me in the parking lot while I tend to my elderly residents.
One of the residents I care for regularly has severe Alzheimer’s. She doesn’t know who her children are when they visit, most days she can’t remember how to walk and she can no longer chew or swallow food. The other day the gnawing pain of my mom-in-law’s death was eating away at my spirit. Ruth (not her real name) was sitting in her wheel chair quietly humming and watching me finish up some paperwork while the other residents were at supper. After I finished my work, I knelt down next to her so we were at eye level. I asked “How are you, Ruth?”
“I’m fine. You are sad,” she replied.
I didn’t know what to say back to her. My mind was racing, trying to think of something that would have meaning to her and I settled on the truth. I said, “Yes, I am sad.”
“Because I miss my mommy.”
“She died.” Ruth said as a matter of fact, nodding her head knowingly.
Ruth stretched out her hands and gently started to stroke my hair while tears started welling up in my eyes.
She stared intently into my eyes and with her hands still stroking my hair whispered ever so softly, “you are loved”.
The tears ran freely down my cheeks and I found myself resting my head in her lap while she continued gently stroking my hair and whispering “you are loved” over and over. My suitcase packed with grief and regret unwillingly sprang open for Ruth to see and she responded with love. While I cried she comforted me in a way only a mom knows how.
I’m not sure how long we stayed like that, only a few minutes probably. Time seemed to suspend itself for us. I felt loved and cared for in that small moment. I will never forget what happened between us while Ruth’s mind already has let it go. I like to think her spirit remembers when we quietly folded my grief with love and repacked it in my suitcase minus a few tears allowing it to close even if for just a little while.