Tag Archives: empathy in long-term care

A Break before a Breakdown ; a moment to reflect


Alice
I get so tired sometimes. I want to shrink from this world that seems to subsist and thrive on anger, panic and fear. Has it always been this way and I’ve just been oblivious to the fever of it or is this some new beast fueled by everyone’s absolute certainty that they are right? The days of context and nuance seem to be gone for the moment and shades of grey no longer exist. Black or white. Right or wrong. Bottom line thinking for an end results world.
I am never very certain about very much. In my experience, that way lies madness. I have certain ethical guidelines and passions that anchor me and I try to keep my mind open to learning from others who have different points of view. Work has been vital for my sanity in this social climate where people seem to be filling some inner need by yelling at one another and coming up with shallow, half-hearted and blame-filled excuses to the deep and complex problems that our society is facing. I guess that’s easier and less satisfying than putting aside anger and wounded egos in order to come together and effectively work toward common solutions. We currently live in a world where everyone wants to be the boss but no one wants to lead.
Those of us who work in Long Term Care are no strangers to the damage such a management style causes. It’s flat out ineffective. The best supervisors are the ones who roll up their sleeves regardless of who is watching. If I only see you when state is in the building, I’m less likely to trust you around those in my care. I have more respect for an LPN who will help me calm a resident who is lashing out in fear than a career administrator with degrees on the wall who’s first solution is Ativan because she’s about to give a tour to a potential new client and wants the hall orderly. That is the difference between a leader and a boss. Because I find my own personal standards of quality care to be much higher than what is expected of us, I have no need for a boss. I learn from leaders, however, and that makes them as invaluable as they are rare.
I decided to step back from Facebook for a little while. Every other status I read is angry. Every article posted has completely different facts cherry picked to enrage or validate you depending on what side of the given position you take. They all agree that everything is the absolute worst. The only difference is who they believe is to blame…and all of that is crap. Cynical, self serving crap wrapped in a bow made of ego.
But, Alice! Aren’t you concerned about the state of affairs?! Of course I am, possibly shocked and appalled reader, but here’s the thing…this is NOWHERE NEAR as bad as it’s been. In my years in this field I’ve cared for people of color who actually lived through the civil rights era. I’ve cared for a Vietnam vet who lost his sight, and a WWII vet who lost his leg. I’ve cared for people who were children during the Great Depression and for people who lived through the Cold War. I’ve had women in my care who lived in a time when it was more socially acceptable to be an abused wife than a divorced woman. Collectively, we survived all of that. As a society, we have faced our worst behaviors and bit by bit we have grown from them; progressed step by painful step forward. I refuse to believe that this…this angry, entitled, backwards thinking reality we are all actively creating is going to stick. I have more faith in us than that.
Individuals are all more than one thing. Are my residents simply their Alzheimer’s disease? Or prostate cancer? Or schizophrenia? Are they not bigger than that? Am I not more than my political affiliation? Is it not beautiful that we are all people who bleed the same? It is a combination of different ideas and individual experiences that gives life it’s richness. When did we decide that we should only surround ourselves with those who look, think, believe and behave exactly like us? How can we possibly come up with and solutions to vastly complex issues without the benefit of diverse ideas and the freedom to dissent without fear?
So I would like to thank every single person who has ever been in my care for teaching me gratitude and perspective. Life is too short to waste on fear and anger over troubles that we create or stir up in our minds before they even occur. I would also like to thank you for living through adversity and sharing your stories so I know what courage looks like. I would like to thank my fellow caregivers who adapt to the reality on the floor rather than the one we are told to expect. We come together to make the most of what is rather than complain about what should be…ok to be fair sometimes we do both but for the most part we are about action. It is a diverse world on the floor, full of people from all walks of life with a variety of skills and reasons for being in this field. Despite what some may think, we cannot all be painted with one brush and for that I am incredibly thankful. This field has honed a strength in me that would not have developed otherwise and directed a passion for purpose toward a path where it would be put to good use. I get tired, but I’m one of the lucky ones. I get these reminders at least five nights a week. I can step back from the combative and fear filled world online and reorient myself to the world in which I live.

To Change the Things that I Can


Alice
I could hear her shuffling down the hall again. She was having a restless night, up every two hours hoping that it was morning. She slept too much during the day and it’s thrown her for a loop. Mentally, she was in that grey in-between place. She is cognizant of the fact that her thoughts are becoming murkier. She is aware that chunks of time slip by unnoticed and she is sharp enough to realize that she is not as sharp as she once was. I can’t imagine anything scarier and yet she handles it with both wit and rueful acceptance. At least I’m not ready for the hole. At least I’m not locked in that cage you call a unit.
Truth be told, I was grateful for the interruption. It was an unusually quiet night and I was on one of the easier halls. At first, I was grateful for the break, having worked several nights straight on memory care. I knocked out the laundry and cleaned the floor’s kitchen. I even threw in first shift’s laundry just to keep busy. I had the time. Soon I had done all there was to do other than hall checks every two hours. In between, I decided to catch up on the news. That was a bad idea. I stumbled into the comments section under the articles. That was an even worse idea.
The whole world is yelling at one another. Honestly, it didn’t matter the topic of the article or what side of the argument the yelling people were on because they all sounded exactly the same. I read the term “butt-hurt” twenty-three times in the comment section. I COUNTED it! Do you know what that means (other than the fact that whatever drive that motivated me to count it in the first place may be somewhat warped)? It means that twenty-three fully functioning adults from both sides of a debate felt that a perfectly appropriate way to express an idea or debate a thought was to call another person butt-hurt. Or snowflake. Or fascist. Or stupid.
Suddenly I was hit with a wave of deep sadness. Because there is nothing I could do about all the anger, the racism, the dumbing down of our society to the point where name calling is the best we have to offer in terms of open discourse. I can’t convince a world of people thriving on panic and smugness that life isn’t anywhere near as terrifying as they think it is and we have faced much more difficult times as a society. Maybe it was the 3:00 AM blues. Maybe I was just tired but it put my head in a dark space.
Suddenly I was thinking about my residents from facilities in which I worked in the past who didn’t make it or were “evicted” when their funding ran out. I was thinking of people I knew who ended up in assisted living as a direct result of untreated addiction issues or undiagnosed mental health struggles. I was thinking of the client I had to walk away from in order to work here. Before I knew it I was entangled with a combination of genuine emotion mixed with misguided self-pity over how powerless I felt to do anything about any of it. When I was a kid playing make believe, I never imagined adulthood to be full of bullies anonymously screaming “butt-hurt” at each other as they angrily debated the presidency of the dude from the Apprentice. It just wasn’t a reality that I envisioned. I certainly didn’t think those in power would cut the funding for the most vulnerable. Would cut the regulations designed to protect them.
All of this was dancing an awful tango in my head when I heard the steady thump thump thump of her cane as she came down the hall. Relieved at the interruption to my traitorous mind, I jumped up to meet her. There she was, decked out in earrings, bangle bracelets glasses on her head and a velour track suit, the top of which she somehow managed to put on inside out and backwards. The laugh escaped me before I could stop it. Her face fell. She thought I was laughing at her.
“The damn top is tricky. It’s hard to get dressed in the dark.”, she said defensively. This. THIS I can do something about. As she continued to try to explain why she had a rough time putting her shirt on the right way, I quietly bent down and rolled up both legs of my scrubs. Her voice trailed off mid-excuse. Her eyes widened and a smile spread across her face as she stared at my ghostly legs. My left leg was clad in a striped knee sock pulled all the way up and covered in smiley faces. My right one had a black and white polka dot ankle sock. Her smile became a chortle that quickly grew into a belly laugh that filled me with joy for what I do and chased away the last of the cobwebs in my mind.
“Now THAT’S a damn shame!” She sputtered between laughs. I was howling right along with her. Whether it was luck or providence or procrastination of my own laundry that had my socks so completely mismatched, I don’t know. I only know that it saved that shift for both of us. It reminded her that she’s not alone and it reminded me that the little things over which I do have power are maybe not so little. You can’t put a price on a genuine laugh, after all. That is something and in that moment it made all the difference.

Kindness Doesn’t Cost a Thing


Alice
In all my years in this field I have never had a person in my care who did not respond better when approached consistently with kindness. Never, not one single time. My most resistant residents have been more willing to be an active participant in their own care when they didn’t feel invisible. My most confused residents had less anxiety clouding their minds when I have been able to coax a laugh from them. Kindness doesn’t cost a thing. It takes no more time to be kind than it does to be resentful and impatient and it takes far less energy.
“You’re going to spoil them”.
“Now they’re going to expect that from everyone.”
“Don’t get that one going. She’ll talk your ear off if you let her”…To which I politely smile and go about doing my job exactly as I see fit. Treating my folks the way I’d want to be treated is not “spoiling” them. It’s being good at my job. I give my best effort regardless of what it causes other people to expect. Quite frankly, I don’t care if that raises the bar or not. My work ethic does not include doing less for those in my care so they don’t expect it from other workers. And I don’t mind having my ear talked off. Why should my night owls feel lonely? If they want to talk and I’m not in the middle of a task, I have no problem listening.
The idea that the people in our care are tasks to be minimized and tackled begrudgingly has to be changed. Not every caregiver treats the job with such apathy; not even most, but there are more than enough that do. Rightly or wrongly, the majority of hard working and dedicated caregivers are stigmatized by the behavior of those who are not right for this field.
We are the frontline of Long Term Care. We are the faces most seen. When something goes wrong, we are the easiest to blame. People see the bad behavior of the caregiver and not the broken system that spawned it.
There is grace, value and purpose in this field. We are needed and trusted by those in our care. There is something sacred about that. If the system has beaten you down to the point of resenting those in your care and basic human kindness is too much to ask, then maybe it’s time to consider another field. As workers we don’t like to feel disposable or invisible so why would we treat our residents as little more than a burden? We can do better. We HAVE to do better…any lasting change that matters will begin with those of us who work the floors. We are the closest to the residents and we have a deeper understanding of the world through their eyes. All improvement begins from within, though, and before we change the system we have to change our attitude toward those who live within it.

Contempt Prior to Investigation


Alice
As a caregiver, I cut my teeth on first shift memory care. For years that was my world. Fast paced, short staffed and unpredictable, first shift was nonstop action. I remember thinking it was ridiculous that there was a pay differential for third shift. After all, there work load was so much lighter than ours. It just didn’t seem fair. I thought along the same lines about private care. One client? How hard could it be? Why were they paid so much more than those of us in facilities? Their job was a cake walk in comparison. Of course, at the time I had no experience with private care or third shift but it seemed like common sense to me. I was wrong.
Contempt prior to investigation. My thinking at the time can best be described by that simple concept. And we are all guilty of that from time to time; Viewing people, events, and moments solely through the lens of our individual perception without the benefit of direct knowledge. If the past few years have taught me anything, it is that the remedy for such thinking is actual experience.
Private care was not easy street. In many ways, it was much more challenging for me than working in a facility. Sure, I occasionally lamented the pace and amount of work we had to accomplish on first shift in my facility, but truth be told, that is when I’m at my best. It was harder for me to pull back and refocus my energy than I expected. The hours were long and it was difficult for me to set work boundaries without the guidance of an agency. It could be very lonely and at times I felt very isolated. The flow of the shift was entirely based on other people’s moods and level of pain. There were also amazing aspects of private care. I loved the family. All of them. I loved the freedom of working independently and having the time to really get to know my client. I loved being involved in bringing holidays back into the house and making her laugh. I loved the deeper connections I was able to forge because my focus wasn’t split eight ways to Sunday. That also made it very hard to leave when a new opportunity arose. My two year journey into private care has enriched my experience in this field and added skills, abilities and insight into my work that I would not have gained had I not taken that path for a little while.
Though I’ve only just begun my jaunt into third shift, I’ve already made some realizations. I understand why they offer a shift differential now. It’s true that the work load is much lighter but that is all I was right about. When I worked first shift, I ran hard. I bled for the job, but when I clocked out for the day I was able to leave work at work. For the most part, anyway. Not so on third. So much of my time in the day is spent trying to effectively work sleep into my schedule so I can be awake and alert through my shift that even when I’m not at work, I’m thinking about work. Or thinking about sleep. And everything else has to be worked in between those two things. The extra money isn’t about what happens on the clock. It’s about the willingness to rearrange life off the clock in order to work when the worlds asleep. It’s about the toll that takes on your mind and body. Sad to say, I would not have connected the dots on that had I never taken this position.
So I am very glad my experience in this field has evolved and hope it will continue to do so. These experiences will remind me not to engage in the “shift wars”. We do not need to tear each other down, ESPECIALLY without having the first clue as to what it’s like from first hand experience. I consider it a lesson well learned.

What I Can

 

 

Rose

 

Old People’s Home
– W.H. Aulden

All are limitory, but each has her own
nuance of damage. The elite can dress and decent themselves,
  are ambulant with a single stick, adroit
to read a book all through, or play the slow movements of
  easy sonatas. (Yet, perhaps their very
carnal freedom is their spirit’s bane: intelligent
  of what has happened and why, they are obnoxious
to a glum beyond tears.) Then come those on wheels, the average
  majority, who endure T.V. and, led by
lenient therapists, do community-singing, then
  the loners, muttering in Limbo, and last
the terminally incompetent, as improvident,
  unspeakable, impeccable as the plants
they parody. (Plants may sweat profusely but never
  sully themselves.) One tie, though, unites them: all
appeared when the world, though much was awry there, was more
  spacious, more comely to look at, it’s Old Ones
with an audience and secular station. Then a child,
  in dismay with Mamma, could refuge with Gran
to be revalued and told a story. As of now,
  we all know what to expect, but their generation
is the first to fade like this, not at home but assigned
  to a numbered frequent ward, stowed out of conscience
as unpopular luggage.

As I ride the subway
  to spend half-an-hour with one, I revisage
who she was in the pomp and sumpture of her hey-day,
  when week-end visits were a presumptive joy,
not a good work. Am I cold to wish for a speedy
  painless dormition, pray, as I know she prays,
that God or Nature will abrupt her earthly function?

The poem that Lynn shared in her post a couple of weeks ago inspired me to start looking at poetry again.  This one in particular really spoke to me today.  The lines of this poem match up with the faces in my head.  I think that’s why I like it so much.  It puts into words something that I’ve never been sure how to verbalize- how do I help people who’ve lost so much?  Each line brings to mind a resident to match it. 

Mrs. E- a stroke took her sight, and old age took her strength.  Every time I help her with a shower, she apologizes for taking up so much of my time.  Mrs. A doesn’t like my help- her mind is going, but while she still has her body she wants me to know it.  Whenever I forget, she’s quick to remind me, “I can do it.”

A resident whose name I can’t remember anymore.  “Would you like to go to Happy Hour?”  A blank stare at the wall- no.  “Would you like to watch some TV then?”  An eye roll and a shrug- yes.  I turn the TV on, and change it to the channel she asks for.  I’d like to stay and cheer her up.  But I have two call lights going off, and a shower to give before dinner.  The stare has been transferred from the wall to the TV.

Mrs. F.  I like to think that she and I have a bond- she might be losing most of her function, but her sense of humor is still intact.  After dinner she leaves to round the building in her wheelchair, and I let her go.  It’s better than keeping her cooped up on the hall with nothing to do. 

The geri-chair group on the Skilled unit.  After dinner, we group them around the TV until we can put them to bed.  Mrs. W sits and watches the TV, and next to her Mrs. K mutters nonsense, the same phrases repeated over and over.

Sometimes I find myself forgetting that they used to be different.  I’ve only known them like this, and in a way, I guess that makes it easier?  I don’t have to remember, to look at their faces and see what used to be.  But if I pay attention, I can see glimpses that still shine through.

Mr. J used to be a farmer and every once in a while he’ll tell me he can’t go to bed because he needs to check on the cows.  Mrs. F isn’t the person she used to be, but she absolutely lights up every Thursday evening when her grandson visits.  It’s the longest I’ve ever seen her sit in one place without getting bored.

Mrs. V used to let me practice my Spanish with her, before she stopped walking down to the dining room.  Mrs. M likes to chat about crime shows.  Mr. B likes to discuss logic and human nature. 

They’re still there.  Behind the eyes of each of my residents sits a person trying to hold onto what’s left of their life.  I find it hard to deal with, and I get to go home at the end of the shift.  They don’t.  If I’m burnt out, I can’t imagine how they must feel.

My favorite quote comes from the book Unwind by Neal Shusterman.  The book itself has nothing to do with long term care, but this one quote has always stuck with me- “Love the ones you can.  Pray for the rest.”  I’m trying to make this my work philosophy.  Each day, I am given a group of people to care for, and for that day, they are mine to love.  I can’t do everything.  I can’t make legs work or memories come back or pain go away.  But I can smile.  I can listen.  I can look and actually SEE.  I might not be able to do everything, I can do SOMETHING.  And then I can go home and pray about the rest of it. 

 

The Tough Talk


Alice

I had to have the big hard conversation. It is handsdown the most difficult part of being a caregiver for me. Long hours, short staffing, poor management, bodily fluids…even dealing with death itself is easier than telling someone that I am leaving them in order to embrace a better opportunity. I’ve done it before. You would think that having previous experience with such conversations would make it easier. You would think.
All of my reasons for making the change are valid ones. I gave notice. I’m even doing my best to find someone to fill my position, knowing full well that is not my responsibility. I have all the emotional support in the world from loved ones who know
how hard it is for me to change jobs. I know this is about taking the next step forward and not abandoning a client…but it still hurts. I still feel guilt and I don’t get to minimize the hurt my client is feeling in order to make myself feel better. As always, the woman who was once a client is now a friend and it is never easy to disapoint a friend.
Work boundaries have never been my strong suit. In caregiving, this is a double edge sword. On the one hand,it keeps me flexible and this is a field that demands flexibility. On the other hand, it takes a good kick in the ass and a shitstorm of chaotic emotions for me to move forward. And it’s not just my overblown sense of responsibility or protectiveness; it’s not just the underlying feeling that I am abandoning someone in need. It’s not just about them missing me…I will miss them. I always do. Letting go is also not my strong suit.
Tomorrow, I will go in for my usual twleve hour shift. I will not wallow in my fear or sadness. I will not be morose. I will let them be wherever they need to be emotionally. This may feel like walking on knives but no one can love every aspect of what they do. I will allow this to teach me. Maybe I will set better work boundaries in the future. Maybe I’ll learn how to let go of outcomes outside of my control. The one thing that I refuse to learn is how to not be so close to those in my care. This is hard. This SHOULD be hard. Just because this move is the right one for me does not mean it doesn’t negatively affect others. Just because it’s the right choice does not mean it should be easy. I take care of people for a living. Taking proactive steps forward does not mean minimizing the emotions that are derived from those actions. It means walking through them and using the experience to grow.

Uphill Battles


Alice
The alarm clock cut through my dreams, it’s deceptively cheery jingle jarring my consciousness awake. I groaned, fighting the urge to hit the snooze button just once more. I had to go in early. No more time to snooze.
As I ran about the apartment in my pre-work routine of craziness, grabbing coffee, hunting my keys and making sure that I was wearing the same shoes on my feet, I mentally reviewed the day ahead. It was going to be an uphill battle.
Uphill battles are nothing new to me in this field. Both my experience in facilities and in private care have come with their fair share of obstacles. Not being one to shy away from adversity, more often than not I relish the challenges. It’s when I begin to view life as NOTHING but uphill battles that the trouble begins.
As a caregiver, I deal with a lot of loss. We all do. Death is inevitably part of our job. I’ve learned to view it not as a tragic necessity but as an inevitable conclusion. There is joy and peace in knowing that I have a part in making the last chapter of someone’s life as pleasant as possible, making certain that those in my care never feel alone. It is why I do what I do and that part of the gig I consider sacred.
As a woman in recovery who volunteers at a behavioral health center, I deal with a lot of loss as well. That kind of loss is different somehow. That kind of loss comes with a sort of survivors guilt that makes me choke on my own powerlessness. Why do I get this when others don’t? What could I have said or done differently that may have prevented another’s death or insanity or consequences? The answer is nothing. I can’t force a moment of clarity on another person. I can only share my experience.
I tell you guys this because I know we all have our baggage and we work in a field that can skew our perspective. Because I have to be vigilant, I recognize that change as it’s happening. When I start obsessing over the two people I was unable to help rather than the ten that I was, I know I need to check myself.
I cashed in all my “give up” chips years ago. Now as long as there is a breath in me, I will…I MUST keep moving forward. There is so much I want to do in life; so many people I want to reach and help. My fellow caregivers, my residents, anyone and everyone who feels lost and alone…we all have those shared experiences. I was given a second chance. I do not have the luxury of wasting it.
As a caregiver, I have the privilege of seeing the face of courage every shift. People who have survived cataclysmic and life changing events. People living with dementia, addiction, AIDS, strokes, PTSD, cerebral palsy; people of all ages and I SEE them…the very essence of who they are as individuals shine through their disorders. Their personalities, sometimes difficult personalities, may have been informed by their challenges but they are not defined by them. They laugh and cry and occasionally rage but they face their uphill battles every single day. They have no choice. Neither do I.
My keys were in hand, the same shoes were on my feet, my lid was tightly on my coffee cup and I was ready to face the day. I took a deep breath as I opened the door into the bright sunshine and reminded myself that it was uphill battles that made me who I am today. For that I am incredibly grateful.

Lost in Translation


Alice

“She needs to do better about taking care of her gums. You need to help her with that. And make sure she uses an electric toothbrush.”…My growing anger at this woman, whom I had to assume had advanced degrees in order to be a dentist, drowned out the rest of what she said. I had spent the last half hour listening to her lecture my client through me, as if she was completely unaware that the woman was an adult with a fully functional mind of her own. Does this dentist think that because she is in a wheelchair, my client is incapable of following simple instructions?
First, I had to battle the rush of misplaced guilt. My client has a very lengthy oral care routine that she does twice a day. It is one of the tasks that brings her comfort. I assist her as needed, but I am a firm believer in fostering independence. Second, she HATES the electric toothbrush. Third, it would take more than mildly tender gums for me to rob a woman who is in her right mind of her dignity by insisting that I do for her what she is capable of accomplishing for herself. Fourth, if a professional in the medical field cannot direct their questions to their patient simply because she is in a wheelchair, then they need to go back to school and learn the basics of human decency. I caught a good case of the mads over that day. After an entire shift of inner fuming, I realized that my frustration served no purpose and I would have to get glad in the same pants I got mad in. So when I got home, I reflected on the experience.
I think what irritates me the most about it was that it was not a unique situation. It is as if a person reaches a certain age or level of disability and suddenly they speak a different language. Administrators from my work in the facilities would talk through the caregivers to the residents all the time. Doctors, family members, friends, all well meaning but cluelessly communicating AT those living with a disability or the elderly in our care without pausing to include them. How can you ever feel comfortable when almost everyone talks at or around you? How invisible and irrelevant would you feel? I would be constantly screaming inside.
I KNOW this. It’s not an awareness that I had to learn. For whatever reason, that part of the gig comes very naturally to me. For others, they gain it on the floor or through one on one care. I have yet to meet a caregiver that doesn’t on some level feel the frustration that comes from people not listening to the voices of those within their care; from the utter lack of understanding and misconceptions that those, and often those in authority, seem to have for those whose very lives are in their hands.
Getting angry is not the way to solve a problem. Becoming aware is the key. So I put aside my anger at the dentist and really thought about how that interaction played into the big picture. When I took into account that most people are well meaning and such thoughtlessness is not done with malice, my mind kept circling around the idea of a foreign language. They simply don’t speak the language of the elderly or the disabled. We do. If I accept that as fact, then the next logical step is to realize that one of the most important roles in our work is to be translators.
After you read this, close your eyes for a moment. Imagine the most painful moment of your life, your biggest fears or parts of yourself about which you may carry embarrassment or shame. Think about your deepest insecurities and the way you secretly fear people may think of you. We all have those dark places. I’m asking you to find yours for a moment and feel the emotions that come from that…now imagine if everyone was able to see all of those wounds all the time…imagine if some people ONLY saw those wounds. Now ask yourself, how would YOU want to be seen? How would you want to be treated? As caregivers, we see beneath the service. As translators, we must teach others how to do the same.

The Language of Caregiving


Alice
Ah the tricks of the trade. The little tips that I have picked up over the years in this field have made such a big difference. I can change a brief without taking off a client’s pants in no time flat; up through one pants leg, down and around the shoe and back up again. Whether it is selling the idea of a shower to a resistant client, coaxing and encouraging a resident to eat, or redirecting a person living with Alzheimer’s, somewhere along the way these little tasks have become muscle memory, as familiar and comfortable as my favorite well worn scrub top. I was reflecting on that recently, how what was once so foreign has become second nature to me and I realized that what I did was learn a language. There may be any number of dialects, but in the end it is in one tongue.
My ultimate goal, regardless of where I may work, is to meet the needs and improve the quality of life for those in my care. That is the overarching ideal for which we caregivers strive. It’s one simple concept but it is very individualized and it’s success is based on knowing our residents and growing our understanding of what makes them tick. It is the language of empathy.
My client was having a rough day. She slept well and all her pain pills from the night before are still there, so I know her pain level was not the trouble. Her blood sugar was normal. Still, her appetite was down, and she wasn’t interested in going out. She wasn’t engaged. After a year of working with her, I knew that she would open up if I could just make her laugh. She has a fantastic sense of humor and that is one of the most effective tools to open the doors to communication with this particular client.
This resident feels safe on the porch. This resident prefers showers in the afternoon. This client loves enthusiasm. This client takes a while to open up because the woman who cared for her for five years moved and she is feeling uncertain. It’s the language of knowing, the language of patience and perseverance and consistency. Because I’ve had to learn these traits in order to do my job effectively, I find that I am more capable of applying them into my daily life off the clock. Because I want to maintain my ability to grow as a person and learn from my work, I have to honestly take stock of myself on a regular basis. The language of caregiving is universal, challenging and transcendental. The skills I have learned on the floor have impacted my life, relationships with others, and perspective deeply. I truly hope that never changes because I find it valuable beyond measure.

Try Again Tomorrow

photo
Alice

I can’t make her smile. I can’t lift her spirits. She is lost in her thoughts; memories of what was and dreams of what might have been. I can’t reach her there. I don’t have the map or know the road.
The days that she allows herself to travel in that mindscape are few and for that I am grateful. It’s not a happy place and it seems to rob the present moment of all joy and the future of all potential. She doesn’t see the Christmas tree. She doesn’t see the joy she brings to others. She doesn’t see the courage she inspires in me…on those days she only sees her disability.
I can’t make her smile. And I know that I have to be okay with that. I know that we are all entitled to a tough day. It’s my job to meet people where they are at, not to force them to where I want them to be. So I bite back the questions with no answers that I instinctively want to ask. Are you ok? What’s wrong? Can I fix it? I bite back the assurances that I can solve a problem of which I have no real understanding. I do not know what it’s like for her. Not really. I can walk in her shoes only to the extent that my imagination will let me. To pretend that I have any idea of the pain she walks through every day is to dishonor the strength and courage she has within her to face it. I bite back the shallow but well intentioned platitudes that do little but make a person feel guilty for feeling bad. Let’s look at the bright side is a frothy emotional appeal that lacks the depth to be of any real help. It is condescending and dismissive. I will not rob her of her need to genuinely feel whatever she may be feeling.
I can’t lift her spirits. Today, my high energy and enthusiasm are not assets. So I do my best to tone it down as I walk her through the activities of daily living. I let it be known that I am here if she wishes to talk and it’s perfectly alright if she doesn’t. I try to focus on the tasks at hand. Check her blood sugar. Apply lotion to her legs. Separate her laundry. Defrost some chicken for dinner. I do my best to not take her husband’s occasional criticisms to heart. No, I didn’t water the Christmas tree yet. I will get to it when I get to it. No, I do not want to discuss the president-elect. I don’t say any of this out loud. On most days, such things roll off my back with an inward chuckle, but not today. My emotions, held tightly in check while on the clock, are often entwined with those in my care. If she has a tough day, I have a tough day. It’s my biggest challenge in this field. It’s also my greatest motivation. I am attached. Most days, I’m very good at compartmentalizing. Sometimes, though, the feelings alter my perspective enough to turn the day grey.
I can’t lift her spirits. Days like this make me long for my days in a facility. In facilities, if I couldn’t cheer up one resident, I always knew that the odds were I’d be able to cheer another. There was no shortage of people to help or ways to help them. In private care, there is nowhere to go. No one else to help. The powerlessness really takes an emotional toll. I work very long shifts and after several hours, I begin to feel owned by my shortcomings. Without co-workers or other residents with whom to interact, my thoughts go into a self-serving shame spiral as I revisit every decision I’ve ever made since age six, because clearly, my inability to improve this ONE day for this ONE person means that I am an utter and complete failure at life, should just crawl into a vat of Ben and Jerry’s Cherry Garcia and hang it up. But then that still small voice within my heart cuts through the chaotic noise in my head. Alice, get a grip. This is not about you. And in that moment, I recognized that truth. Everything that I value about this gig goes beyond the physical assisting with the ADL’s. It’s my ability to be a companion. It’s the way I see and value the friendship of those in my care. I would gladly share their pain if it would make it easier for them and when I am unable to ease their burden, I feel that I’m falling short. Private care allows enough downtime for my mind to grab ahold of that self doubt and run with it. Especially when my client needs a day to quietly contemplate her situation.
I can’t make her smile. I do not feel great about it and that’s okay. How I feel is nowhere near as important as what I do. Today, my job is not to lift her spirits. It is to walk with her and be supportive through her sad day, just as those closest to me walk with me and are supportive of mine. A very wise person once told me that courage is not always a shout. Sometimes it’s the small voice whispering
“We will try again tomorrow.”…that much I can do.