Merry Christmas, Happy New Year and all that stuff.

I'm taking the rest of the year off. See you on the other side.

Overheard

"Gay? I'm not gay. If I was gay, I'd be all over you."

"You've been whoring around on me, haven't you."

"From now on, I'll let her walk out with her underwear hanging out for everyone to see."

Mind you, these are all from the mouths of sixty to eighty year old women. Wow.

When not to come to work

When you have a fever over 100 degrees.
When you are vomiting.
When you have diarrhea that's not controlled by Immodium.

At least that's what I've always thought.

So, let's talk about ringworm, then. It's contagious and we do a lot of handling of resident's, so should you work while you have it?

"Ringworm is contagious (spread to others) through direct contact with an infected person or animal. It can also be spread indirectly through contact with the clothes, combs, or brushes of others who have it. Once treatment has begun and the circular rash begins to shrink, the rash won't be contagious. Until then, however, a person with ringworm can spread it to others."
http://life.familyeducation.com/infections/medical-treatment/40545.html

I vote that you stay home until it starts to shrink. And make sure you take all your medication if you're taking an oral anti-fungal like Diflucan.

Agitation

The myriad of things that can cause a resident to become agitated boggles my mind. It can be something as simple as asking them if they're ready to go to dinner. Of course, we don't know what's going on inside their heads at that moment, so maybe just the interruption is enough to tip them over the edge.

There's only one proper response to a resident's agitation. "I'm sorry." Sometimes it calms them, sometimes it doesn't but there isn't any other real option. Step two is reporting any behaviors to the charge nurse. Making snotty comments back or being physically rough with the resident are not acceptable actions.

The hardest thing in the world is to control your reactions when people are rude or mean. I know I don't always succeed. Still, striving for the highest ideals will get you closer than lowering yourself to the other person's level.

A Nursing Assistant, but not "Just" a Nursing Assistant

The other day I referred to someone as "just" a CNA. I refer to myself as "just" a CNA a lot. Why do we demean ourselves like that? We're not "just" anything. We're waitresses and maids; we're movers (usually of people, but sometimes of furniture, too); we're bartenders and hairdressers (both for their physical and psychological functions); we're shower attendants and cheerleaders.

I think we allow ourselves to feel like "just" CNA's because that's what people perceive us as. "Are you a Nurse?" "No, I'm just a CNA." It's only lack of education that separates us from the Nurses. As with most jobs, our lack of education is more than made up for by our wealth of experience. We have a more complete physical and psychological profile of our resident's than their nurses and doctors could possibly have. The more education you have, the fewer puzzle pieces of the resident you have. As CNA's we get to work with the majority of the pieces.

I've been asked several times if I want to be an LPN. "Nope." In a long term care facility, it's the CNA's that get to do the hands-on work that I enjoy. The nurses are relegated to finger-sticks, breathing treatments, wound treatments and loads and loads of paperwork. They may be a "Nurse", but I'm doing the true nursing work. Maybe they're "just" nurses, after all.

O/T I've been remiss

...in updating this blog. Mostly because nothing new is happening. Life is moving along over the usual hills and gullies. I'm just holding on as best I can.

Today is my last day off before Christi gets here on the tenth. I'm trying to clean up the house (as much as you can when you have a home full of men and dogs). I also want to hit the grocery store. They're having a "ten pound meat sale" and I'd like to load up my deep freeze. When you have a relatively full freezer, grocery shopping on a weekly basis is much cheaper. Plus, you have something to fall back on during those weeks when cash is tight.

Brad's catching the "staff infection" that they've been passing around at work. Hopefully we can load him up with Vitamin C so he gets better quicker.

Patrick's been playing Rock Band 2 endlessly. He's making noises about wanting to buy a real drum kit and take lessons. I'll believe it when I see the kit set up in the middle of the already crowded living room. He'll probably try to put one of the love seats outside to accommodate it.

Our Christmas Party for work is the tenth. I'm looking forward to that. It's always fun to see your coworkers in a somewhat social situation.

And that's that. I've been thinking through some work related posts that I'd like to write, but none of them are coming together just now.

Management needs to work in the trenches

You know, it never hurts to take a step backward now and then and remember where you came from. I would love it if my DON would take a shift and work my primary hall with me. I expect I could learn somethings and she might remember what it's like to be in my world. At least for a little bit.

I like idiosyncrasies.

Aside from the care aspect, the thing I like most about this CNA work is the idiosyncrasies of the residents. Knowing that Mr. John likes his cranberry and apple juice mixed at snack time, or that Ms. Jane wants her blankets arranged just so and then just doing it without them having to tell me makes me feel good. I don't know if they notice, but I do. Plus, it enables me to get done faster so I can move on to the next job; never a bad thing.

Happy Thanksgiving!

Wishing everyone a delicious and safe holiday.

Tubes and Insulin

So, the next step for me would be to learn how to do tube feedings and medication through tubes and insulin. They were offering a class, but I think it's out in Weatherford and I don't really want to drive that far.

Having said that, there was some discussion from the nurses "not letting" us do their insulin. "Do you know how fast you can kill someone with insulin?" And all I'm thinking is, yes, but we wouldn't be handling the residents whose blood sugars fluctuate wildly. We'd be handling the ones who occasionally need a little boost of insulin to keep them in line. And surely we'd have the sense to get advice if we were concerned about how the resident had been eating that day or whatever. Also, I'm thinking that the Digoxin we give at noon and the blood pressure meds we give in the evening are just as dangerous.

I understand where they're coming from. Ultimately, the health of the residents falls on their shoulders. I'd just like to be given a little credit for being intelligent enough to ask for help before I overdosed a resident on insulin.

DNR v/s DNT

The "Do Not Resuscitate v/s Do Not Treat" debate came up again last night. The resident in question has been slowly declining over the time I've known them and last night sounded like they were filled with water. The nurse sent them to the ER.

They have pneumonia.

One of the nurses was talking about it. She said, "If their heart stops, I won't do anything. If they stop breathing, I won't do anything. If they sound like they're drowning, they're going to the ER."

Makes sense to me.

Death Cycles

That sounds like the name of a biker gang, but that's not what I intended.

We are decidedly in a death cycle right now. In the last few weeks, there have been five deaths that were directly or indirectly connected with me. Yes, I realize that I work in a nursing home, but one of the deaths was a 26 year old grandchild of one of my residents.

I'm hoping that this doesn't last very long. In my line of work 1.5 deaths each week can add up to a big hole in your heart before you can catch your breath.

On the bright side, death cycles are generally followed by birth cycles. Next thing we know, a bunch of babies will be brought in to the world. At least it gives you something to look forward to.

Death of a Volunteer

Caroline (and I'm embarrassed to say I never knew her last name) was a dedicated volunteer at our Nursing Center. She was friends with one of the ladies and she was in the facility nearly every day. She was always there to encourage the residents to come to the activities, she helped out with Bingo on Fridays and was there nearly every evening to pass out supper trays. Sometimes she was pushy and she could get on your nerves if you let her, but not even the paid help was as dedicated to the residents as she.

We lost Caroline to cancer last night. I guess God needed her more than we did. We sure are going to miss her.

There's a very fine line...

... between "honesty" and "occupational suicide".

Reporting a med error, correctly documenting when meds aren't given, correctly wasting a narcotic are all important and require honesty. Writing behavior comments on the back of a resident's MAR, writing on the back of the MAR that you "didn't have time" to take a blood pressure or pulse or give a medication, while "honest" almost guarantee that you'll get a hand-slap or worse depending on how management is feeling that day.

I'm for honesty. But if you "didn't have time" to do something, you should report it to your charge nurse so she can get you some help. If a resident is giving you a hard time, either wanting their meds early or refusing them, state the facts on the MAR and report it to your charge nurse. Last night I had a resident who didn't want to take their meds. The gal in Social Services was there and helped me talk the resident into it. Problem solved without writing inane statements on the back of the resident's MAR.

At some point, we have to decide if our words improve upon the silence. If they don't, we need to keep them to ourselves or rework the situation to make it work for ourselves and the residents. There aren't enough CNA's out there as it is. Committing occupational suicide through "honesty" is not an appropriate solution.

If working doubles triggers my migraines...

...I'm not going to volunteer for them any more.

Sunday I worked a double on the med cart. I had time to eat both lunch and supper, so low blood sugar was not a trigger, but the weather was lousy on Monday. Anyway, when I woke up Monday morning, Madame Migraine was there with her whips and chains. Nasty old hag.

Anyway, I'm scheduled for another double on Saturday. I'll know Sunday morning if this is going to be an issue or not. I think I'm more of a marathoner (working many days in a row without a day off) versus a sprinter (working doubles) anyway.

What do you say to that?

If a resident who is in extreme pain expresses a wish to end it all, how can you argue with that? Hell, I wish they'd either die or instantly get better, too. Watching someone suffer like that, even someone you don't know personally, is the most awful thing aside from experiencing the pain yourself.

So what did I say yesterday? "Oh," in a tone that meant, "You don't really want to do that." I didn't think it through, it just came out. And it wasn't the right thing to say. Now that I've had time to mull it over, I could have said somethings that were better than what I said.

I could have said, "I'll bet you do. It must be awful to hurt like you do." I could have said, "Healing is the hardest thing your body has to do. It will hurt but it will also eventually get better." I could have said, "Yes, I wish for that, too, sometimes. After I die, me and God are gonna have words and most of mine are going to start with 'f'."

If I could have one new talent, right now, it would be the ability to think quickly and SILENTLY before I spoke.

O/T Brad walked his first 5K.

Pet Helpers is an organization that helps pay to spay or neuter pets when their owners can't afford it. They had their first annual 5K race this year. They also had a 1K, a kiddie run, a dog costume contest and a best dog smooch contest.

Brad raised $59.50 for Pet Helpers. He crossed the finish line in just over 55 minutes. Went there, did that and got the t-shirt to prove it.

Next year, he'd like to run it. Possibly with one of our dogs.

CNA v/s CMA

Well, I've gotten to work the med cart for three nights in a row. I might get to work it tonight, too. And which job function do I like better?

CNA. Hands down.

What I'm hoping will happen is that I'll get a chance to do a couple days of each every week. I'm already getting more efficient at passing meds and as long as I keep my hand in that pie regularly, it shouldn't be a problem. But helping folks is what I really like to do and passing meds is just that: passing meds. Important, but lacking that "touchy-feely" that I like.

In any event, I have a job where I'm needed, whether it's passing pills or helping folks get ready to go to supper. The way the economy is, this is a very good thing.

More pain than you can know.

Sometimes people complain about the residents being "whiny" or "babies". I'll tell you what. The worst pain you've ever experienced doesn't come close to what some of these folks go through every day. All their pain meds do is dull the pain. It doesn't make it go away.

While I can understand being impatient, especially when the resident doesn't know what they want, we should never, ever pass judgement on them. If we're lucky, we'll never experience what they're going through. If we're unlucky, we'll end up in the same place and gain understanding that we wish we never had.

"Wake up! It's not your time to die!"

I guess I'm lucky that I lost my parents young and quickly. I went to bed and in the morning they were gone. The longer your parents are around, the harder it must be to lose them.

The resident being spoken to above can't hardly get out of bed. Rolling them over makes them cry. They're on heavy duty pain medication and have been under hospice care for months. And yet one of the children needs to try to fight off the Angel of Death anyway.

Brad says that if it were me lying in that bed, he'd do everything he could to keep me here. I told him that I loved him enough not to let him lie there and suffer any longer than God wanted him to. Death is not necessarily worse than life. We're just afraid of being left behind.

Old Man Winter...

...just crashed the party.

We knew it was coming. We would have known even if the weather folks hadn't told us. We were giving out PRN pain pills like they were candy.

Last night it was warm, not much breeze, just a nice evening. This morning, the wind is howling out of the north and I imagine it's COLD. (I haven't gone outdoors yet.) Hopefully, this will afford the folks some relief. Of course, the ones who hurt when it's cold out will still be hurting today.

"Cold" is relative. We've been enjoying days in the high 70's. Today it's not supposed to get to 60. Not cold for Chicago, but cold for Oklahoma.

This is a temporary win for the frosty dude. It's supposed to get back up to 70 in a couple days.

"Well, she wouldn't stop screaming."

And that, said in a very reasonable voice, was the explanation for why she slapped her. Of course, she was screaming because the "slapper" had a hold of her arm and wouldn't let go. So the "slappee" screamed and got it right in the kisser. And then she screamed again.

If the incident had happened in a vacuum, it would have been funny. My problem with it is that the other resident's who witnessed it were upset. The two residents involved will probably not remember it this morning. The other residents will and will probably still be talking about it at breakfast.

I asked the nurse if it constituted a trip to the psyche ward to level out the "slapper's" meds. Because it didn't escalate into an uncontrollable situation, they won't send her. Unfortunately, folks, this is what happens when your brain shrinks. And it will, just because it's part of the aging process. How much it shrinks depends on so many factors that there's no way to control all of them. Limit your alcohol consumption, exercise, eat your veggies, and hope for the best. And try not to scream in mixed company.

You can never get "too attached".

We lost a resident yesterday. One of the CNA's was crying and said, "I'm gonna have to quit this place one day. I get too attached."

"If you don't get attached, you can't do a good job," I told her.

I think that's true. In a nursing center, you are there to keep people as happy, comfortable and healthy as possible. But, let's face it, the bottom line is that the majority of people who are in a nursing home are there to wait to die. Once in a while we get someone in who just needs some rehab and then will go home, but not often. You can't be standoffish with these folks. Many of them want their hands held, want to get hugs and want the occasional smooch. Denying them that does nothing but make their "not so great" existence even more miserable. And you can't do those things if you're not "attached".

Don't even talk to me about spreading germs. Unless we put them all in solitary confinement, germs are going to be spread. Hugs and kisses aren't going to make one iota of difference except maybe to make them happier and that alone helps boost their immune systems.

In any event, I'm for being attached. So what if you cry when they are hurt, sick or pass on? We have emotions so we can express ourselves. No one wants to live a monotone life and no one wants to be around someone who does.

How many pills do you take?

Working the med cart for a day and a half has been a revelation. I have a couple residents who are on more than 15 different pills. Granted, two or three of them are vitamins, but... wow. Can you say over-medicated? Furthermore, the ones with the most pills don't seem to be functioning any better than the ones who only have a few. However, the amount of suffering they would go through to wean them off the pills might precipitate a stroke or heart-attack, so the doctor's are hesitant to make any changes. And I can't blame them. I wouldn't want to deal with an angry family, either.

The key, I think, is to be aware of this and control it while you're still relatively healthy. If you let the doctor's prescribe you a pill for every little thing, you're going to find yourself taking more pills than you know what to do with. No wonder folks get put in nursing homes because they can't remember to take their pills. If you had that many prescriptions, you couldn't remember when to take them all, either.

And should we talk about cost? I'll bet the street-value on some of these medications would be enough to fund a small family for six months. No wonder folks have to get government help to pay for their meds.

Ultimately, we're responsible for our health. Better living through chemistry is not the answer unless you have a money-tree out back somewhere. If you have a loved one who's on multiple medications, it wouldn't hurt to have their primary care doctor review their meds and slowly make changes to reduce the number of pills they're taking.

Bomb Threat

One of the other nursing centers in town got a bomb threat yesterday. I'm told that the local newspaper has the details, but I'm thinking I really don't want to know.

What I do know is this:

• Everyone is OK.
• The residents were successfully evacuated to the VFW building.
• There was no bomb.
• It happened as between third and first shift so third shift had to stay on duty until the drama was over.
• The son of a bitch who made the call needs to be lynched.

Seriously. What is the purpose of phoning in a bomb threat to a nursing center? The police think it's a disgruntled employee. This is one for the Karma book. Three times three.

I've been accused...

...of castrating one of my residents.

Yes, castrating. I know. I was stunned and amazed myself, but there it is. This was several days ago and I'm still laughing about it.

Now, had the gentleman cried out in pain, I wouldn't have laughed. But all that happened is that his "equipment" got tucked under his leg while we were helping him to bed. Apparently, this amounts to castration. I didn't know it was so easy to do and I'm not sure that it was information that I needed in the first place.

Good thing most of my residents are women.

It isn't the residents...

...that burn us out. It's our co-workers and managers.

Three things would make my job easier:

• Communication
• Communication
• Communication

If someone has to leave early, everyone on the floor should know about it. Then we can make sure the residents are taken care of. If only one or two people know, then when the shit hits the fan, we're all in a tizzy trying to clean it up and repair the damage.

I'll be the first to acknowledge that I'm not as flexible and forgiving as I could be. I figure if I can work all my shifts, so should everyone else. However, I realize that not everyone is made of the stuff I'm made of and everyone's home life is not as good as mine is currently. I need more patience, I guess.

But if you have to go home, at least let me know.

Flu Shot

I signed up for my first-ever flu shot yesterday. I figure that I don't want to be the one to infect the residents and I sure don't want to bring it home to my family.

One year, about eight years ago, we all got the flu. At that time, I was walking three miles a day most days of the week. After being down with the flu, it took me more than three months to build back up to those three miles. Brad and Patrick were even worse off than me. Right after they recovered, they came down with bronchitis that required antibiotics to cure. Granted, I am healthier and in better shape now than I was then, but I sure as hell don't want to go through that again.

Days off.

More than any job I've ever had, this one requires days off. When I hear about these aides that work 12, 15, 20 days in a row, I can't understand how they do it. The most I've done in a row was 10. It was incredibly hard and I was impressed that I made it through. To work more than that would have pushed me over the edge, probably into sickness.

I'm trying very hard not to catch the cold that's going around. I'm eating my fruits and veggies and taking vitamin C every day. Did I mention that the aide that worked the 20 days in a row has the cold?

There's nothing wrong with working an extra shift here and there to help out, but to work yourself into short-temper, injury, or illness isn't good for you, your family, your co-workers or your residents.

The weather, it is a-changing.

Last night I worked the floor. It was nuts. We are noticeably heading into fall this week. Everyone was in pain, sick with a cold that's going around, or both. It was one of those nights where the call lights were on until we finally did last rounds. Phew.

Tonight, the rumor is that I get to work the med cart, but I'm not betting on anything.

To be or not to be...

...should be our choice.

One of our residents who has aphasia and a PEG tube, tries to pull the tube away from us when we are administering their medication. To me, this is them telling us that they are refusing their medication. If you have to have a CNA hold the resident's hands and basically force the medication on them, they are refusing. However, this resident does not have power of attorney over their health care any longer. What does this mean? Even though the resident wants to stop treatment, the grandchild, who has power of attorney, is going to keep this person alive until the bitter end.

To top this off, the nurse told me that even if the resident still retained legal control over their health care, we could not take this as a refusal because the resident has aphasia and can't "tell us" that they don't want their medication.

Let this be a lesson folks, make a will, make it early and make sure you are very specific about how you want to be handled in case you are incapacitated or else you might end up in a museum for live corpses.

Nothing funny happened last night...

...and nothing interesting. For once, it was what I'd consider a "normal" shift. We were only short one person in the Med room, we had enough nurses and enough CNA's. Everyone got taken care of and most of the shift went smoothly.

I have, however, started keeping a log of the shifts I'm working. Anything that does happen, I'm making notes of and writing it down in full when I get home. It takes extra time, but I think it will be of help to me in the long run. I know I should have started this earlier, but I just didn't see the benefit in it. The more responsibility I get (being in the med room) the more I feel like I might want something to use as back up in case something goes wrong. Plus, it makes a good mind dump after I get home, so I don't go to bed thinking about work.

He tried to bite me!

Last night when I was passing out snacks, I was chatting with some of the residents who were sitting out by the nurses station. At one point, one of them grabbed my hand. I didn't think anything of it because I hold hands with anyone who wants to (and probably some who don't). Pretty soon I noticed my hand being drawn closer to this person. When I looked down, the resident had his mouth open and was drawing my hand in for the chomp. When I squealed and pulled my hand away, you should have heard them all laughing.

The amount of joy that I get from hearing them laugh more than makes up for the bullshit I have to put up with from management.

Stress at the Rest Home?

Seems to me that Nursing Homes were once called Rest Homes. Maybe they still are. I'm pretty sure that anyone who has ever worked at one feels that this is a misnomer. There isn't anyone at a Rest Home who is actually resting.

My stress level has gone so high that my migraines are increasing and this morning my stomach is hurting so bad that I'm seriously thinking about going to the doctor to get something stronger than OTC meds for it.

Knowing what work is like, I'm going to try a few changes starting today to reduce my stress level:

• Taking two fifteen minute breaks and a thirty minute break is often impossible. (We were short again last night. I sat down for seven minutes all night.) What I'm going to try to do (which the smokers have perfected) is taking a five minute break once an hour. And I'm going to go somewhere peaceful to do it. Doesn't matter if it's the courtyard or the bathroom, I'm going to go.
• Drink more water and less coffee.
• Take fifteen minutes to eat either while everyone is at supper or after everyone is settled after supper.
• When I get stressed, I'm going to smile. They say they act of smiling actually does make you feel better.
• If I get a chance to take normal breaks, I'm taking them. Sitting on the hall watching for lights does not count as a normal break.
• I'm working on adjusting my diet anyway, so eating healthier at work is a good goal. Candy bars and pop are not good stress reducers. In fact, they just make more stress.

If any of this actually works, I'll let you know.

First race after a layoff.

OK, so I'm not a horse and two days can hardly be considered a layoff, but I know that tonight is going to be a challenge. You wouldn't think two days makes that big a difference, but it does. By the time ten o'clock rolls around, I'm going to feel like a wet dishrag with little pieces of food stuck in it. New shoes not withstanding.

On the other hand, after two days off, I miss work. I get a charge out of helping people even if I always feel like I'm not doing enough. Every once in a while, one of the nurses will tell me that a resident has said something nice about me and it makes me feel like I'm doing something right.

Vertically challenged again and other stuff.

Yes, we were short last night. And first shift had been short, too. When I came on shift, there were four call lights on down my hall and three of them were people needing to be cleaned up because they had had diarrhea. Not only did I get the short end of the stick, it was shitty, too. (Please wait while I laugh at my own joke.)

Anyway, to compound this, I had a migraine yesterday. It came complete with a visual aura before the pain hit. The last time I had a visual aura was before we left Illinois, so previous to October 2002. For some reason my migraines are increasing in both number and intensity. I'm not sure if I'm feeling more stress or if my hormones are out of whack. I'm fixing to make some adjustments in my diet in an effort to lose 17 more pounds by the end of the year. Hopefully the change in diet and the weight loss will bring the migraines back down to one or two a month instead of however many I've had in the last month. (It might be five.)

In any event, today is payday, so tomorrow I plan on buying a much needed pair of work shoes. The support hose I bought seem to be helping lessen the leg pain I feel at the end of the night. The addition of new shoes should make me even more comfortable. Then maybe working short-handed will hurt a little less.

Reporting back

The resident I dreamt about three days ago was still alive and kicking yesterday. However, we did lose a different resident on the morning I had the dream.

Of course, I didn't find this out until I had been at work nearly six hours yesterday. It's strange how you get isolated when you work on a hall and aren't aware of what is going on down the other halls unless someone has told you.

O/T Powerful Woman's Motto

My sister emailed this to me this morning.

Powerful Woman's Motto:

Live your life so that when your feet hit the floor in the morning, Satan shudders and says, "Oh, shit. She's awake."

Initially I laughed at the thought of "out-Sataning" Satan. But then I realized it could be taken another way. You can live your life so that you are blocking Satan's every move and making the world a better place.

Now, I don't believe in Satan (another discussion for another day) but it's making me think and that's never a bad thing.

Dreaming about work

I know that work is getting to me when I start dreaming about it. I'm also concerned because the dream involved one of the residents and I'm hoping that it's not a portent of death.

This morning, sometime between 7:30 and 8:00, I dreamt that one of the resident's came up behind me, touched my shoulder and walked past me, laughing. This resident is wheelchair bound, so them walking is odd in itself. Even odder is that the feeling of them touching my arm was so real it woke me up.

I have the night off tonight. I'll have to report back on their status the next time I work.

"They don't appreciate you, but we do."

The charge nurse told me this last night. "They" meant the nursing center's administration.

"I don't care about them. I only care what you think. And the residents. They seem to be happy, so..." was my answer.

I work for the residents. Granted, I wish I was faster and yet could still make everyone happy. Instead, I settle for doing right by the ones I can touch and hope that later I can make it up to the ones I don't get to quick enough the first time around. When I go into a resident's room and they say, "I'm so glad you're working here tonight," I know I'm doing OK.

How things change.

Funny how your perceptions change.

I used to try to grow my fingernails out. I'd file and paint and buy new products that came out to help them grow long and beautiful. I'd lament a broken nail and then have to cut all my nails back and start over.

Now, I get upset if they get too long and lament the fact that I have to keep cutting them.

First night passing meds

I did my first shift passing meds unsupervised last night. I did just fine, thank goodness. I did, however, smash my fingers in the narcotic lock box twice. As bad as it hurt, my fingers ought to be black and blue. I don't even have a red mark this morning.

I think I'm back on the floor tonight. I'm not planning on anything. I'll go in prepared for both jobs and just do whatever they tell me. No point in getting hung up on it because what will be will be.

Gratitude

I'm forty. I have little aches and pains and sometimes have to take a deep breath before standing up from a chair or getting out of the car because I get stiff if I sit for too long. I need new glasses (possibly bifocals OMG!). I have relatively frequent bouts of CRS (Can't Remember Shit).

But you know what else? I can walk and talk. I can read, type and diddle around on the Internet. I can write in this blog, write stories and write notes for myself so I can remember things. I can get up to go to the bathroom whenever I need to go and wipe my own behind when I'm done.

I'm grateful.

O/T Reprieve rescinded.

Patrick's best friend Andrew Haden left for Fort Hood yesterday. He'll be shipping to Iraq in the next 30 - 60 days. All prayers for his safe return are appreciated.

Glad that's over.

Six shifts in four days is officially too many for me.

Yesterday, I came in to work to find that I could not be in the med room, I had to work the floor. I don't have a problem with this, except that on Wednesday, our big medication order comes in and now I don't know how to deal with it. So, now I'm picking up yet another shift next Wednesday to learn how to do it. Also, the reasons that I could not work the med cart are as follows:

• They left a person on the schedule who has never once shown up to work.
• One person was out sick, but they didn't call in.
• One person's spouse was in the hospital, but they didn't call in.

I heard "no one told me anything" so many times yesterday, I thought I would lose my mind. Our communication is horrendous.

And they asked me to work this morning. It's 10:48 a.m. I am not at work. I told them I needed my two days off. They are working short this morning and I'm sorry about it, but there's nothing I can do. I need to have my recuperation time, or else I'll be calling in sick and becoming part of the problem.

So, here's the bottom line: every time something happens that I think management needs to know about, I'm leaving a note. If they want to use them as kindling to set themselves on fire, that's fine with me. I think it's about time someone stopped bitching in the break room and started filling the suggestion box.

Well, that was quick and other stuff

I just noticed that this is my 101st post. Boy, those added up quick.

My elbow is feeling good today. The goal will be to not hurt it at work tonight.

And just a "heads up". On Monday and Tuesday I'm working doubles: 6-2 as CMA in training, 2-10 as CNA. Wednesday 2-10 I'm working as CMA in training and that's the day our big drug delivery comes in. Consequently, I may not blog again until Thursday or Friday after I've recovered.

Mechanical lifts are your friends.

I might have mentioned this before, but it bears repeating: Use the mechanical lifts.

One of our larger residents has been suffering a decline in strength. It used to be that I could help them on and off the toilet without a problem and putting them to bed was easily doable by two people. Not any more. The other night their legs gave out before we could get them on the bed. Fortunately, I'm pretty strong, so I was able to pull them over and get them on the bed. Unfortunately, I pulled the tendon by my elbow. The resident is fine and I'm OK, but I'm going to have to baby my elbow until it's fully healed. Not an easy thing to do as a CNA. I'm hoping that I'll get more CMA work than I previously thought.

94%

I passed my CMA test yesterday with a 94%. I wanted 100% but I missed two drug pass questions, one ethics question (because what is "ethical" and what is "right" are not always the same thing to me) and one safety question.

I get oriented on the med cart next week and then I'll be doing the cart a couple times on my own. Come October 1, I'll be a CMA/CNA and will probably be doing a little of both jobs for a while.

Love / Hate Relationships

I find it interesting how many of my residents have love/hate relationships with their roommates. Mostly the women. With the men, they just kind of tolerate each other or ignore each other altogether. But the girls. Oh boy.

Every time Resident A says anything, Resident B (on the other side of the curtain) makes a face and shakes her head at me. But when Resident A was in the hospital, Resident B asked about her constantly and was upset until she got back.

Resident C just moved in with Resident D. They are constantly telling me that the other one needs a sleeping pill. Resident C tried to tell me that Resident D needs "special services" which I interpreted as "mental hospital". But the other night, Resident D had kicked off her sheets and Resident C had to call me in to ask me if she was OK and if she was warm enough.

Is it just that they can't throw off that caregiver role or do they actually love each other? We may never know.

I guess I'm just lucky.

Over at Nursingassistants.net, there's been a lot of negative news lately: lack of funding, mistreatment of residents, lack of nursing home reform.

Granted, I've only been doing this for six months, so I'm not suffering from burnout. My facility is pretty nice compared to some that I've been to while growing up. I don't think of myself as working in an "institution" because I don't think it looks or feels like one. Since I've started there, there's been enough turn over that some of the CNA's who weren't doing a good job, weren't being kind, or weren't showing up for work have weeded themselves out. I'm hoping that the new folks coming in aren't more of the same, but I guess we'll have to wait and see on that.

My point is this: I became a CNA because I wanted to, because the one thing I've always been good at is helping people, and because my life path led me here, thank goodness.

Some days suck. Some days I can't do as good a job as I want to do because we're short-handed or the shift before was short and I'm playing clean-up. Still, all in all, I feel proud to be a CNA. I like my facility, my residents, and most of the staff. I know that on most days, my resident's are as well or better off when I leave than when I arrived.

Maybe I'm just lucky. If that's the case, I hope my luck continues on for the next 15 years or so.

From the mouths of Senior Citizens

One of our residents is out of it most of the time. They chatter and what they say goes together, but it's not relevant to the moment. They will recite prayers or talk about what their favorite foods are. You have to get their attention and ask them a direct question to get an answer and sometimes you have to ask them more than once to bring them back from wherever their mind has wandered.

On occasion, this resident will ask for something: pop, water, bananas. Or they'll tell you they want to get up or go to bed, but this is rare at best. The other day, however, the resident looked at one of our male aides and said, "You need a shave." And he did. I told him he'd better go shave because if the resident commented on it, it needed to be done. He promised the resident he'd shave before coming to work again.

I hope I never stop being amazed.

"Sometimes they think you're crazy...

...when you wet," she said to me.

"But you can't help it," I said.

"No. You can't."

"They should go to hell and mind their own business," I said.

She laughed. "Yeah. They should."

I'd like to know who made her feel bad about being incontinent. Don't they think she feels bad enough about it? Who wants to be wet all the time? Who wants to smell like urine until someone comes to clean them up? Who wants to have someone else clean them up?

This is another one of those Karma issues. I wonder if they'll remember how bad they made her feel when they're lying in their own urine, waiting to be cleaned up.

Slightly O/T-Be careful what you pet.

Apparently the charge nurse on third shift went out to have a smoke the other night. In our courtyard, we have some raised flower beds with a two foot brick wall around them. She was sitting on one, enjoying her cigarette when Bubba, the resident cat, came up to her. She reached down to pet him. Good thing she looked before she touched him. It wasn't Bubba. It was Pepe LePew. She said she froze in place and waited until he wandered off.

I don't know how it normally is, but all my experiences with skunks have been just like that. They don't seem to be afraid of humans. They aren't aggressive toward them, but it doesn't seem to bother them that we share space with them. I've even had them continue walking toward me after they've seen me instead of walking away. My understanding is that if they stamp their feet at you, you'd better head for the hills, though.

Best way to exit a room

Before you exit a resident's room, do the following:

• Take a deep breath
• Make sure their call light is easily reachable.
• Make sure their water/other drinks/snacks are easily reachable.
• Make sure their telephone is easily reachable.
• Take out any dirty clothes or trash.

Resident's can fall out of a bed trying to reach for things that are too far away or they can trip over a sock dropped on the floor. You would be amazed at how easily they can hurt themselves doing things that you do without thinking. Sitting up in bed is sometimes a huge challenge in itself. I think we all learn this stuff the hard way, but it would be better for all involved if we didn't.

Do Not Resuscitate v/s Do Not Treat

If you have a resident who is on a DNR (Do Not Resuscitate), does that mean that you do not treat them for infection or other illness? Or is it limited to life-saving measures? My understanding is that the whole point of my job is to keep my residents as happy, comfortable and healthy as possible. If I have a resident on a DNR, doesn't that mean that if their heart stops, we don't try to restart it? But if they have an ear infection, shouldn't we treat that so they aren't in pain?

I'm only thinking about this because some nurses seem to think that they shouldn't give antibiotics to a DNR. Sorry, I call bullshit. DNR doesn't mean that the resident has to suffer. DNR means that if they are crossing over, we don't try to stop them.

The Dying Patient's Bill of Last Rights

When I was in CNA class, the last chapter of the book was about dealing with the dying and recently deceased resident. I copied this: http://www.geocities.com/hotsprings/5120/bill.htm
verbatim into my notes. It made me think real hard about how it is to deal with someone who's dying and may or may not acknowledge the fact.

No excuses

It wasn't a full moon and the weather wasn't wild, but man, the residents were. One was convinced we were killing people, chopping them up and putting them in the freezer. One was in such pain that she was begging for help. One was taking swings at other residents. One was refusing to eat. One thought his roommate was going to kill him. One resident, who has aphasia, was trying to tell us something and we could not figure it out. Whoa. In addition to that, we were short handed so all we did was run around and put out fires. I was glad to get home.

The worst thing is trying to calm a resident who's convinced we're doing nefarious deeds behind closed doors. What do you say? They think you're lying when you tell them that you're not making hamburger out of people and serving it to them for lunch. What ended up happening is that the charge nurse called the doctor who allowed the resident to have a pill for agitation. Two hours later, the resident was in bed. I hope they slept through the night and are feeling better today.

It's like a domino effect. One falls, tipping the next one over until eventually they're all lying flat. I wonder if by medicating that resident we broke the chain. I hope so. We don't need two nights in a row like this.

O/T - Reprieve

Andrew is not leaving for Iraq until sometime after September 30. Not sure exactly what happened, but there it is. Maybe he'll get lucky and they'll decide not to send him at all. Will keep you updated.

Date set for CMA test.

I finally have my date set for my Certified Medication Aide test. September 2. I'd love to score 100% on it. I got a 96% on my CNA test. I've read my Medication Aide book and my notes over so many times that I feel like it's ingrained into my brain.

O/T - I can't believe I sang the whole thing.

Rock Band.

Patrick on Guitar, me singing.

Endless setlist.

58 songs. (I sang all but one.)

On Hard.

4 1/2 plus hours.

Finished at 1:00 a.m.

Only missed getting 25 stars.

We have Legendary Status now.

If you see me online, Fear Me.

Don't know if I can talk today because I haven't tried yet. I couldn't last night.

"I don't know why we don't lose weight."

Someone said this to me last night. With all the rain and the full moon and being short-staffed, we were running around like headless chickens.

My answer was "I have."

Fifteen pounds so far. Another fifteen and I'll be at my goal (which is still on the heavy side for my height, but I think I need a little extra weight to do this job. Being a CNA requires a power lifter's body, not a fitness model's.)

The key is not taking in too many calories and getting exercise outside of work. This job will help you lose weight, but it won't do all the work for you.

Lucid conversations

It always makes me nervous when I start having lucid conversations with people who are normally wallowing in dementia. I worry that it might be a precursor to a change for the worse in their condition.

I had one of these conversations last night and I went ahead and reported it to the charge nurses. They told me the resident had been having chest pains the night before and that the last time they had the angina, two days later they were sent to the ER. Could be a connection... or it could just be the full moon.

Another entry to the "Things I have learned" list

Among the list of things I've learned at the nursing home, I'd have to put this one on the top of the list:

• Don't ever wish that a difficult resident would change.

Because the truth is that they will change, but it will not be for the better and likely it will be a precursor to their death. They may be easier to handle and less combative or they may not. In any event, wishing for that kind of change in another person is counter productive. Big changes in nursing home residents seem to lead to their ultimate demise. Wish for more patience and knowledge to deal with the devils you have rather than wishing for the devils that you don't.

O/T - Deployed to Iraq

Patrick's best friend, Andrew Haden, is being deployed to Iraq on Saturday with the National Guard.

Please send up prayers for his safe return next July or August.

Conversation overheard

"How're you doin'? You look good."

"Well, I had a bath today."

The pot calls the kettle black...

I had one more set of vital signs to record last night. It was one of our residents with dementia. There's a group of them that hang out together and rarely go to their rooms. I found the resident and two of the six sitting together by the nurse's station.

"Hi," I said. "Can I take your vital signs?"

"Well, sure," says Resident A.

"You can take mine, too," says Resident B.

"OK," I said. "I'll take Resident A's first so I can keep them straight."

"She's gonna keep us straight," says Resident A. "She's gonna make us walk the line."

"Resident A, are you teasing me?" I asked.

Resident B looks at me and says quietly, "No, she's not teasing you. She's just..." and shakes her head, tapping the side of it with her index finger.

New Recruit

At a meeting the other day, the facility administrator passed around a copy of an application we had received. The person was applying for a CMA position. They were willing to work "8 hours a day, 8 days a week" for a ridiculously low wage because they "didn't want to make too much money".

It was from a resident.

The two best parts of the story?

• The administrator initially gave them an application for a CNA instead of a CMA. After the resident filled it out, they realized it was the wrong form. So, they read the administrator the riot act. "How can you run this facility if you can't even read well enough to hand out the correct applications to people?"
• The reason for leaving their last job. "I had a stroke and lost my memory."

Priceless.

O/T - How do they know???

So, we get an extra paycheck this month. Well, I don't, but my husband does. And somehow the machinery in my life KNOWS THIS and takes advantage of it. Both my car and my washing machine need work. I TRY to be thankful about it and think, well, at least we can get one of them fixed this month, but all I really want to do is scream and pull all my hair out.

Sigh.

Back to CNA blogging tomorrow.

106 degrees in the shade

That's what it's supposed to be today. The nice thing about working second shift is that I'm in the air-conditioning during the hottest part of the day (about 5:00 pm).

On the other hand, some of the residents LOVE it. At least the ones without breathing problems. The one's with breathing problems stay in their rooms with the doors closed and the air conditioning full blast. The rest of them open their windows and let the heat in. For a little while, they're not cold. That is until it's time for supper and we have to go down "freezing alley" to get to the dining room. Traveling down the hallway always gives them the shivers.

Despite the heat, I have some residents who just can't get warm. One of the ladies had two sweatshirts on yesterday. Meanwhile, my hair was wet with sweat when I took it down after work last night. After a couple minutes, I had to go sit outside to wait for my ride because it was too cold to stay indoors.

Phew. Made it.

Well, I made it through the month of July with only four days off. I had two days off in a row and then was back at it yesterday.

Surprisingly, I'm not really sore this morning. Usually after a couple days off, that first night of work makes me all crunchy the next morning.

Bunches of stuff on my mind. I am going to make myself a list since I can't ever seem to remember any of it when I sit down to blog.

A few of them:
Do Not Resuscitate v/s Do Not Treat
The Dying Person's Bill of Rights
Some nurses need to take customer service training

Random thought to end this post:

Dear God,
I've been really good today. I haven't sworn, lost my temper, had a beer or eaten too much. But in a few minutes, I'm going to get out of bed and then I'm really gonna need your help.

"Smell the poot?"

I hope I never stop being amused and amazed by the words that come out of my resident's mouths.

Last night while I was cleaning up a resident, they broke wind. Now, I rarely if ever comment on this. Burps, yes; farts, no. But the resident asked me, "Smell the poot?" and I had to laugh.

Some people say we become more like children as we age. I'm not sure we ever really grow up.

Money for services rendered

My work involves many nasty little jobs that the average person would not want to be around for, much less actually do. Cleaning up urine, feces and vomit grosses most people out and it's embarrassing for the resident, too. However, I am getting paid and hourly wage to do it. I do it every day that I am on shift. Why residents offer me "tips" is beyond me. And I have one resident who won't take no for an answer.

So, my solution has been to inform this resident's family what's going on, advise my charge nurse and just take the money. Then, I put it back while the resident's in the bathroom or dining room or I hand it over to a family member if they come in that day. I don't have time to argue and if I don't take it, the resident is on the call-light every ten minutes until I do.

I have discovered that there's no explaining to some folks that I do this because I love it. I can guarantee you it's not about the money. If I wanted to make more money, the Flying J is hiring at $10.00 an hour and probably offering overtime at time and a half. When my resident's are warm, dry, comfortable and satisfied, it's worth a winning lottery ticket to me. Payment enough.

Ten in a row

This has been a wild month. I'm just past the middle of working ten days in a row. By the end of the month, between those 7 days of classes (eight hours a day) and work, I will have worked twenty-seven of the 31 days. One of my days off this month will be the thirty-first.

I'm not really complaining. The money has been helpful and that class will allow me to become a CMA come September, but I am tired and I think the early migraine this month is due to me pushing it too hard.

Next month, I'm not applying for any extra shifts. They'll have to call me in to get me to work. Fortunately, most of the extra shifts are on 6-2 and I can't work that shift without some serious finagling of my life and the purchase of a second vehicle. What I might be able to do is go in a couple hours early to help get folks back from lunch and settled for the afternoon. Frankly, it would work to my advantage because I'd know that everyone was clean and dry at the start of my shift.

O/T: Down with a migraine.

This one started yesterday morning. Next post from me may not be until Sunday or Monday.

Meeeeeeoooooow! Fffffft! Fffffffft!

Oh, Jealousy. That green-eyed monster will make a fool out of you every time.

"So, when was the last time you had two women fighting over you?" I had to ask. He just shrugged and said that they were both his friends and he didn't know why they were fighting.

Contrary to most of my experiences, this is funnier this morning than it was last night when it happened. Ever seen two senior citizen women bowing up at each other? It's a sight not to be missed.

We separated them before either one of them hurt themselves and got the "prize" back to his room without further incident.

I am never, ever bored at work. Tired, frustrated, hungry, but never bored.

What's in your pockets...

...besides lint, anyway?

I carry:

• A roll of little trash bags that I use for relining the resident's trash cans as well as carrying dirty clothes to the soiled linen room.
• Hand sanitizer that I try to remember to use every time I leave a resident's room.
• Notepad, pens (three or four).
• Wallet.
• Stuff to take care of me (any meds I might need, "feminine products", etc.")

This does not begin to fill all the pockets I have, surprisingly. I usually have one or two pockets that don't have anything in them at all. Except lint.

You can't tie 'em down.

Well, I could restrain them with all the little trash bags I carry in my pocket, but it wouldn't be socially acceptable.

What do you do with a demented, non-compliant resident? They're not supposed to lie on their back for any length of time, not supposed to try to walk on their own and yet I can't get them to lie on their side or stay in bed until they call me. They have an alarm, but by the time I get down the hall, they're off.

I'm pretty sure I'm working in a Nursing Center and not a prison, but sometimes it's hard not to feel like I'm their jailer.

"I just got a sideshow!"

We are decidedly feeling the effects of a full moon. Last night one of the residents thought it would be a good idea to walk down the hallway without any pants. At the time, I was in the room across the hall helping one of the other residents get ready for bed. I heard the flasher's door open and I knew what was probably going to happen, but I was in the middle of a transfer and it was not possible to leave the room.

I had two residents comment on it. One was a resident known for letting it all hang out. (The pot calling the kettle black, as it were.) The other resident had just gotten back from church. Living in a nursing center, you'd think that nothing would surprise them, but apparently this was an amazing event. What could I say? I apologized and explained that the flasher was confused.

I used to say that when I got old, I hoped my mind went before my body. I have decidedly changed my mind.

Remembering what to blog about

I'm going to have to start taking notes at work. Yesterday, on two different occasions I thought, "I need to put that in my blog."

Today, I can't think of what either situation was. Not even a guess.

Well, whatever they were, both were funny and added enjoyment to my day. I'm sorry I can't remember what they were to tell you so you could enjoy them, too.

On a separate note, tonight should be fun. The weather is edgy and we're dealing with the effect of the full-moon, too. I'd better bring a notebook so I can share.

Eating at work

My grandma was an RN. Her rule was: when you're at work, eat dessert first. Then, if you only have time to eat one thing off your plate, it's the thing with the most calories. She taught me this when I was about seven years old as we sat eating lunch at Andy's diner.

It seems funny to me that now that advice is still true and we haven't gotten any better staffed as an industry in all those years.

But anyway, I thought of this because last night I ate half my dinner while standing up and watching the clock. I think I downed it in less than 3 minutes. The other half of my dinner went back to the kitchen. Dessert was cookies and they were dipped in my Arnie Palmer and inhaled first. Then I ate the bread and chicken tenders and ran my tray to the dining room.

I wonder how many meals my grandma ate the same way as I ate mine last night?

Rambling, random thoughts

Oh, I got bunches 'o stuff on my mind tonight. Are you ready?

I am taking a class to get my CMA (Certified Medication Aide) license this week and the beginning of next week. I can't take my test until August 27, but the class will be out of the way.

So, since I love being a CNA so much, why am I going for my CMA?

Two reasons:
First, we need CMA's on my shift. So, I am filling a need.
Second, I am concerned that at the ripe old age of 40, my body may not be able to take the stress of being a CNA for very long. I don't want to get hurt so that I'm no use to anyone.

At my facility, the CMA's and LPN's are not afraid to do CNA work. I will still be able to help my residents, but I won't have to subject myself to the constant lifting. I think in the long run this will be best for me.

New subject. Sexual harassment.

One of our male CNA's was subjected to an almost hickey from an 89 year old woman last week. I'm not sure if I'm horrified or amused. I don't think he's sure either. One of our other male CNA's has been subjected to invitations to the bed of one of our severely demented residents. Apparently, he gets gibed about it all the time. I don't know if either one of them feels harassed or not but when I heard the stories (one from the horse's mouth, the other through the grapevine) I had to laugh. I, fortunately, work mostly with the ladies, and so far none of them has shown lesbian tendencies, so I'm all good.

New subject, again. Where do I go from here?

I am contracted to the nursing center until March of next year since they are paying for my CMA classes and tests. Currently, the plan is to work there for at least 4 more years. After that, I may consider getting my RMA (Registered Medical Assistant). This would allow me to work in a doctor's office. Half the coursework is medical, including phlebotomy (I vant to suck your blood), and half is billing and other computer work. At this point, I don't have any interest in being an LPN. I don't want to be in charge of anything. I've been in management and I don't like it. I just want to work and make suggestions for improvements.

One more subject, off topic. The weather this year.

Usually by this time, Oklahoma has gone from green to gold. Normally, we are very dry from May to October. Spring and Fall are our big growing seasons with a fair amount of rain. Winter and Summer are dry and dormant. Not this year. We've had rain at least every 10 days and it is as green as green can be out here. Unfortunately, this is encouraging the fleas and ticks also and my dogs are not happy. I will be buying some more flea/tick drops this weekend. We just did them three weeks ago, but they are scratching again and I am picking fleas off of me on a regular basis.

That's where I'm at. Where are you?

Short-handed is as short-handed does.

There's a very large difference between being short-handed with a crew that works well together and being short-handed with a crew that doesn't. If you're short-handed with a good bunch, things are tough, but you make it through without too many scratches. Working with folks who can't even be civil, much less work together, makes everyone, workers and residents alike, suffer more than necessary.

I say, why not just pitch in and go the extra mile? Someday it might be your fault that the crew is short. We'll forgive you more if you actually make your presence felt in a positive way on the days you do show up.

I hesitated for a moment...

... and then I said it anyway. I imagine I'll hear about my inappropriate choice of words today, but last night it was definitely the right thing to say.

I was doing rounds last night and settling folks down for sleep. One of my residents, who occasionally uses salty language, needed a full bed change due to spilled juice. They usually do, so this was no change from normal and I had already brought the clean linen with me. However, tonight they had also been incontinent of both urine and feces. When they realized it, they were very upset and proceeded to swear. I reassured them and proceeded to get them all cleaned up.

As I was gathering up the dirty linen bag and swapping out the trash bags, the resident said, "Ugh! There's a fly!"

As I shooed it away, I really did think about what I was about to say. I know the resident in the other bed could hear me, but I thought the one I was working on needed a little levity.

"Rude son of a bitch," I said.

"Yeah!" my resident said and started laughing.

Should I have said it? Nope. But I'm glad I did.

How quickly things change

I know that 48 hours can be long or short depending on what you're doing during that time. But, honestly, after 2 days off of work, I am amazed at how many things have changed. New admits, folks who have gone to the hospital or gone home, folks who have gone from sick to well or vice versa, folks who have passed on.

The essentials never change: still have to get them to and from meals, give baths and put folks to bed at the end of the night. But the dynamic of my nights change depending on who's there and how they're feeling. I may get baths done earlier if I don't have to spend 20 minutes convincing Ms. Ma'am that she needs a shower or it may take all night to get through 5 residents vital signs if I am taking care of someone who needs to go to the bathroom every 15 minutes. It's all about being flexible and not getting upset with myself if I don't get it all done.

Never a dull moment.

Unplanned hiatus

Sorry.

There are many things I enjoy about living in a rural setting. The amount of time it takes to get anything accomplished is not one of them.

Two and a half weeks ago we started having trouble with our Internet. We called the place who services our connection and was told he would "be out in the morning". Two weeks later, we called to find out where he was. He comes out, looks at it, says we need a new whatsit and that he'll "be right back". Two days later, we tracked him down and got a string of excuses including that the tower we feed off of suffered a lightning strike.

It's up today, but it's slow. I didn't see him come out, so I don't know if this is a result of him fixing it or if it's a fluke.

In any event, sorry about the hiatus. I'll be back on schedule tomorrow or the next day.

Lack of inhibitions

"Don't you laugh at my titties, 'cuz I ain't got none!"

My initial reaction to this was to reassure the resident that we would keep her covered while we changed her. But she was laughing, so maybe she was trying to be funny.

Amazing to me how they can just say the first thing that comes to their heads. No filter, at all. I'm not sure if I'm looking forward to that time of my life or not. Oh, how I would love to just let loose and say what I think. On the other hand, do they suffer from guilt knowing they've hurt another person's feelings? I don't need any more guilt, thank you very much.

I don't even know where to start

I think I might have PMS.

Assuming I make it to old age, I hope that my son lets me do what I want as long as I'm not endangering anyone else. So many of these kids want to control what their parents do. What is this? Revenge for when the kids were teenagers and their parents were trying to raise them right?

I have a resident whose daughter doesn't want her to smoke. I'm not allowed to take her out into the courtyard, because she might see someone smoking and want one. So yesterday, I take her outside out front and sit with her for 20 minutes, because I can't leave here there since it's not fenced in.

So, who drives up, but someone smoking a cigarette? Now she's thinking about wanting to smoke and I am probably going to get an earful from someone about it.

I say, let them smoke if they want to smoke. Jeez, at 85, don't you think they should be able to have a damn cigarette if they want one? Or a shot of whiskey? I'm not talking about anything illegal. I'm talking about enjoying what few years they have left.

Rawr!

Stories from other nurses

This is from the "you get as good as you give" file:

A CNA is in caring for a resident. Unfortunately, this resident is no longer able to communicate verbally, so does a lot of moaning. On this day, the resident is babbling so the CNA tells the charge nurse that the resident is "speaking in tongues". (Nice, huh?)

The CNA returns to the room to care for the resident and thinks they're going to be funny.

"Christ compels you," says the CNA.

The resident looks the CNA straight in the eye and says, "So, what?"

Scared the daylights out of the CNA. The only thing the CNA did right (in my opinion) was report the incident to the charge nurse.

This is another one of those things that was funny when I initially heard the story, but now that I've had time to think about it, it just seems stupid. On the other hand, I'll bet the resident's soul got some satisfaction from knowing that they got back at that CNA.

Stuff they don't teach you in school

Lessons learned:

• Be kind to everyone. You don't know if you'll ever get another chance to talk to them.
• Dementia makes every couple of minutes a new day for the sufferer.
• Good health is a gift we should always be thankful for while we have it.
• Beer works better than water for flushing out the beginnings of a bladder infection.
• Sometimes, no matter how efficient you are, you still can't get it all done.

Pedicure Party and other stuff

So, at 9:30 last night, I'm sitting on a resident's bed painting her toenails. It took all of 10 minutes, but she sure got a charge out of it.

I cajoled another resident into doing what I wanted by invoking her daughter.

"My daughter gets on my nerves!" she said.

The other CNA in the room said, "We'll keep that between me and you, OK?"

I remember thinking that my parents were constantly trying to keep me down and not let me be me. I imagine that's how this woman feels now about her daughter. Funny how we get to a certain point in our development and then start to shift backwards.

It also never fails to amaze me how passing gas is so amusing. I guess if you can't control it, you might as well laugh at it.

My brain is all over the place today. I'll try reining it in tomorrow. Maybe.

O2 Sat

I made use of the O2 sat machine last night. One of my residents was acting very out of character (trying to get out of her chair and talking to herself). She kept taking her cannula out, so I thought maybe she wasn't getting enough oxygen. After reporting to the charge nurse, I went and tested her.

99%. That was not the problem. And her blood sugar was fine, too.

Wanna know what it was? Double whammy: wild storms all around us and two days out from the full moon. I tried looking at it scientifically, but that obviously wasn't the right angle. We're coming up on the Solstice, too. Maybe it was a triple whammy.

Man, I can not wait to get to work tonight.

Yoga after work.

I've been (sporadically) doing a little yoga after work before going to bed: http://exercise.about.com/library/blmorningyoga.htm

I didn't do it last night. We had been short-staffed, I didn't even have time to take a lunch, and I was worn out. So, I just got in my jammies and went to bed.

Bad, bad idea.

This morning I feel like a bunch of rocks and nerve endings being jostled around in a leather bag.

Anyway, this is a nice, short little routine. Honestly, I don't do the last two moves. I don't have room to do the spine twist in my tiny little bedroom and the last time I did the corpse pose, I fell asleep on the floor. But, I believe it has helped me get up relatively pain-free on the mornings when I have done it the night before.

Your life can change in one second.

Yesterday afternoon I was called in to work on my day off. Two of our CNA's got in a wreck while driving in to work. Fortunately, the injuries were minimal and only one will miss a few days of work to recuperate an injured shoulder.

Now, everything changes, for them and us. They have to struggle around getting to and from work and we have to fill in the hole made by the absent employee.

Here's the ironic thing: They were broadsided by a woman who was elderly and (as admitted by her children) probably shouldn't be driving any longer. It would be even more ironic if she ended up staying with us.

Ultimately, it makes me think that there's no point in worrying about tomorrow. You only have this minute. Live in it. The previous minute is gone forever and you may not get to experience the next one.

"Drinking, smoking, thinking...

trying to free my mind." Wasting Time, Kid Rock

Based on my limited experience, folks in health care seem to do more than their share of drinking and smoking. Of the CNA's that I regularly work with, I'm the only one who doesn't smoke. And drinking stories abound, especially after payday.

It is a stressful job, no doubt about it. The chance for physical injury is far higher than it would be if we worked sitting behind a desk. (Unless you call getting fat and out of shape a physical injury.) Like any "customer service" job, you have to take flak from both the customers and the bosses. But the ratio of smokers to non smokers in the rest of the world is not 7:1 like it is amongst my peers.

I'm not holding myself above the rest. I do my share of drinking. It just seems to me that if our job is caring for people, we ought to care for ourselves. While someone will replace us if we can't work anymore because we've smoked and drank ourselves into oblivion, the level of care diminishes while the newbies get their feet wet.

Bizarro Day

It was not a full moon last night, but you'd have thought it was if you'd worked with me.

Whoa.

We had snarly cat fights between bed-ridden roommates, residents, who wouldn't say "shit" if they had a mouthful, dropping f-bombs and people asking for pain medication all over the place.

When it gets like that, it makes me wonder if they put something in the water. Or maybe the solution would be to put something in the water.

Words to live by

Speak only if it improves upon the silence.

Before saying anything, consider this: Is it kind? Is it necessary? Is it true?

I'm paraphrasing, because I can't remember the exact quotes, but the first is attributed to Gandhi, the second to the first Buddha.

Is it necessary to tell a person they they are on the "Do Not Rehire" list? Is it necessary to discuss how much money you make? Is it necessary to talk about bonuses that you choose to give one shift over another?

When we communicate, it should be with the intent to help and inform. The paragraph above lists things that do not need to be communicated. While they may be informative, they're certainly not helpful.

Here's a couple more words to live by:

"Do unto others as you would have them do unto you." Jesus
"Harm none." from the Wiccan Rede.

Actually, that last one covers it all.

Health Advice for Nursing-Type Folks

It amazes me that there is almost no information on the Web about healthy living for nursing-type folks. I'd love to see information about how to eat during a shift without resorting to the pop and candy machine. I'd like a list of herbal supplements that help with energy and immune system issues. I'd like to see suggested exercises that offset the bending and lifting we do. Funny how there's nothing out there about how the person in health care can care for their own health.

I guess all this stuff is really common sense. I could do the research myself if I broke it down into smaller subjects (eating when there's no time to sit down, herbals supplements for energy and immune function, exercises to offset bending and lifting), but I think it'd be nice to see it all in one place.

Maybe I'll start collecting information and do an occasional post that has real information. You know, just to offset the posts about farting and other lovely body functions.

Oh, What a Night!

Wow. That's all I can really say. I never sat down once last night. There were tornado watches and no electricity for the last 4 hours of my shift. What a nightmare. Everything takes twice as long when you're working by flashlight. I couldn't even punch out last night. Rumor was that there were 30 power lines down in the area. Everyone had their hands full dealing with Mother Nature.

I hope all is back to normal today.

Hey Doctors! Pay attention to real life.

Without an "order" we can't even give a patient a cough drop. You'd be stunned and amazed at how many residents catch a cold who can't get any relief because there's not an order for cold medication.

EVERYONE GETS COLDS.

There's one making the rounds at the nursing home now. I've got it, several residents have it and the staff is passing it around, too. All orders for nursing home residents should include medication that can be taken in case of: head/chest colds, nausea/vomiting, indigestion, diarrhea and constipation. Sometimes, a couple doses of cough medicine is all a person needs to get through a cold. It shouldn't require a call or a trip to the doctor to get something that they could pick up at Wal-Mart if they were able to go themselves.

I hope when I get old, I have a doctor with a little foresight. I also hope my doctor will prescribe Jack Daniels when I need it. We have some residents with an order for medicinal alcohol. I need to find out who their physicians are. Someday, this could become very important.

Floater

I hate that word. I don't mind being the float aide, because it means I get to help everyone, not just one set of folks. I like having my finger in all the pies. However, it also brings to mind gassy poop and I just don't want to be associated with that visual, thanks.

On staying healthy... or not.

On a busy day, I'll bet I clean my hands 5-10 times an hour. Either by washing with soap and water or using hand sanitizer. The other two things I need to do to keep from catching colds from my residents (and yes, I have one now) are to stop breathing and stop touching my face.

Since breathing is necessary if I'm going to continue to help folks today, I need to learn not to touch my face. I worked with a girl years and years ago who said that she stopped touching her face and her complexion cleared up and she thought it had been a couple years since she'd had a cold. Sounds wonderful, but we touch our faces all the time. To rub our eyes or noses, to cover a cough or sneeze (actually, I use the crook of my arm for this now, but still) to cover a yawn, to rub a headache. And every time we do it, we expose ourselves to other people's little nasties.

I have tried to stop touching my face. I truly have. But usually by the time I realize what I'm doing, I'm in mid-rub. And then, it's too late, so I might as well just keep doing it, right?

Yeah, right. That's the same logic that gets us in trouble with food, alcohol and other things that are not good for us.

Down with a migraine...

... I expect to be back at it tomorrow.

Gotta keep moving and learning new things

If there's one thing I'm taking away from working at the nursing home it's this: Keep moving and learning.

I have residents who can't stand up straight. Not because of debilitating illness or injury, but because one day, something hurt and they stopped doing the thing that hurt. Then, one day, another activity hurt, so they stopped doing that, too. Pretty soon, the things they didn't do anymore outnumbered the things they did do. Now, they sit in chairs until someone can help them to the bathroom and they cry because it hurts to move from the wheelchair to the toilet.

Recent research indicates that learning new things prevents Alzheimer's Disease. Whether it's true or not, it never hurts to gain knowledge. Educating yourself may help your brain stay young just as exercising helps your body stay young.

Keep in mind, I'm not talking about folks who've had cancer or a stroke or a broken hip. I'm talking about folks who just let themselves decline until they have limited themselves to recliners, wheelchairs and crying because they hurt so bad all the time.

We're off to see the Wizard

Last night one of the ladies with dementia had fallen asleep in the dining room. This isn't unusual for her. One of the other residents (who also had dementia) convinced her to go to her room. Also not unusual. I saw them at the end of the hall and as the sleepy woman was having trouble walking, I went to help. I held one hand and the other resident held the other and we started walking. Then the sleepy one's roommate came and held the other residents hand.

The Wizard of Oz suddenly popped into my head.

I didn't start skipping, but I'm not sure which character I was, either.

The Devil and the Deep Blue Sea

As a general rule, I let my residents do what they feel is best for them. If it's not hurting them or anyone else (including me) I let them have their head. However, I've had several situations where the choice has been causing them pain or getting hurt myself. I'm sorry to say I had to choose causing them pain.

The goal is to let the resident do as much as they can themselves. This means getting up from their chairs with just enough help to keep them safe. I'm willing to do it in several small, slow steps and to ease them down gently into their new space, whether this is the bed, the toilet or wherever else they want to plant their fannies. But when they stop midway between the Scylla and Charybdis, I'm going to move them as quickly as possible.

I had to muscle a resident last night because they did just that. They stopped and I was stuck between them, the bed and the recliner. Either they were going to fall or I was going to get hurt trying to hold them up. So, I got them seated on the bed and rolled over onto their side (which is how they like to sleep) while listening to them scream. Ugh. If you've ever had to do that, you know it makes you angry. At them and at yourself. After I got them settled, I apologized and explained why I had done it, but I know it didn't comfort them much. And my voice was sharper than normal, I know. My only comfort is that they likely forgot it as soon as the pain subsided. They were sleeping quietly when I left, so I believe all was well.

I accept the fact that I'm going to be sore after work. But if I get seriously hurt, who will care for them? Given the choice between hurting them or hurting me, it's going to be them. And it's a crappy choice to have to make.

"A horse crawled up my butt...

...and pooped!"

I'm not sure if the resident was proud or distressed about this. I'm voting for proud. It was "an extra large" after all.

(We have to record the size of resident bm's at the end of shift.)

Searching for Bobby Fischer

There's an old movie called Searching for Bobby Fischer about a chess champ. Honestly, I don't know if I've ever watched the movie, but I've been told about it. In one scene, Bobby tells his opponent that he's going to lose and offers to let him concede the match very early in the game. Apparently, Bobby could "see" enough logical moves ahead in the game to know the outcome before even his opponent did. I'm finding that being a CNA requires this kind of mind.

The ability to anticipate the next move and be prepared with a response is a great thing. How many times have I gone into a resident's room, only to find that I don't have the supplies I need to get the job done? I'll bet it's been a thousand just since February. How many times have I found myself rushing around trying to accomplish a task by a certain time? At least five-hundred. Last night, I was thinking that if I could anticipate the next "logical move" then I could be prepared and therefore, efficient and timely.

This morning, of course, I realized that I'm not dealing with chess, which has order and method. I'm dealing with people who sometimes think it makes perfect sense to dance down the hall with no pants on. On the other hand, I could (and should) take a moment to gather my supplies before I start a task, if it's not an emergency situation. I should also take time to plan my day as far as I can, so I'm not rushing around at the end of a deadline. If doing this makes even one task go smoother, it would be worth the minute it would take to think it through.

Privacy Policy

We went over our privacy policy at work at the last In Service. I guess this is a good place to say that I don't divulge personal information about any of our residents. My stories are composites of things that have happened to me at work.

In real life, the incidents are more watered down. Kind of like the difference between sap and maple syrup.

OT Drink Recipe

My time off was fruitful, if only because we made this yummy drink:

ION-P

2 oz. Bacardi Select
2 oz. Bacardi Light
3 oz. Cruzan Mango Rum
1.5 c. Hawaiian Punch
Blend for several seconds until frothy.
Pour over ice in 3-16 oz party cups.
Top with
Seven Up
and a shot of
Bacardi 151.
Makes 3 servings.

Sounds like it would taste terrible, but you can't taste the alcohol. Kind of the same idea as Long Island Iced Tea.

Now it's back to work.

Few days off

I've got company coming in to town. I plan on being too busy to blog for the next few days. Of course, since that's the plan, something else entirely will happen. At least I'm looking forward, right?

In any event, I imagine I'll have something to say when my schedule gets back to normal.

"Thank you...

...for taking good care of my boyfriend."

This is the kind of thing that does your heart good. The even cuter part of it is that this is one resident talking about another. She eats her meals in his room because he can't often go down to the dining room. When they play bingo, she picks prizes that she can give to him as gifts. When he's cranky and yells at her, she just leaves quietly and comes back when he's on a more even keel.

She said this to me last night as I was rushing between halls.

"Oh, he deserves it," I said while hugging her.

"Yes, he does."

Humor

One of the things I discovered right away is that folks with dementia have almost no sense of humor. I say "almost" because every once in a while it will shine out through the darkness.



One night I caught a resident mimicking of one of the nurses. Funny in itself. Even funnier that that other two girls with her caught it and giggled.



I also have a resident who's been refusing to go to bed before the end of my shift. I can persuade her to let me help her into her pajamas, but she'll have no part in going to bed. Her roommate tries to mother her constantly. Last night the roommate said "You cannot make a habit of this!" The resident caught my eye and busted out the biggest grin. Ha! Oh, yes she can. And will.



On the other hand, you can't tease them. Either they don't hear you or they don't get it if they do. Better to let them take the lead and then just laugh in response. Of course, you'd better be sure they're teasing you and not being serious. Sometimes what sounds funny is not a joke to them at all.



Every day, I smile big at least once. Sometimes it's accompanied by a shake of the head, but it's a smile nonetheless.

Happy Mother's Day

OK, so I'm a day late. I'm guessing no one reads this every day anyhow.

I was thinking that even if you've never had children, if you are in the field of nursing, you're a mother at heart. The desire to nurture and comfort seems very motherly to me. And really, what else are we doing as CNA's or LPN's or RN's? Well, the LPN's and RN's are mothering and doing loads of paperwork, but still...

Oh, bother.

I can't decide on a subject. Should I talk about DNR orders? How hard that must be for a person to sign that paper that says "just let me pass on". Should I talk about how I might react the first time I find a resident unresponsive? I've touched dead bodies before, but they've all been relatives. Or maybe I should talk about getting training to become a CMA. Why would I want to? Is there a good reason not to go for it?

It's windy here today and all my brainwaves are scattered everywhere like garbage when the lid of the can blows off. Maybe tomorrow I'll gather my thoughts and try again.

The chair-sitting ghost appears again...

A couple nights ago, one of the residents asked who was sitting in their geri-chair. No one. Well, no one that we could see with our eyes, anyway.

I'm not sure if I'd want to be so "open" that I could sense the spirits wandering around my workplace. I'll bet the joint is overflowing with them. It does make me wonder what conditions change that make it possible for me to catch a glimpse of them.

Everybody talks about the weather...

but no one ever does anything about it.

I don't know who said that. Maybe one of y'all does.

In any event, we've been waiting for the spring storms to start. In March and April, the weather seems to set up one or two counties east of us, so that the storms miss us, but we still get the swings in barometric pressure. For the last two or three days, the weatherman has been telling us that it was going to storm, but we didn't get anything but clouds and a swinging barometer. Do you know what that does to folks with dementia and arthritis? Wrecks them. The poor residents have been far more confused than usual and taking every tablet and capsule of p.r.n. pain medication that they can get their hands on.

This morning at 3:30, I saw the lightning. If I hadn't been suffering with a migraine myself (somehow my hormonal cycles always line up with the screwy weather), I'd have done a jig. And according to the radar, we're in for hours and hours of it. Good. So today will suck, but tomorrow everyone should be back within normal range. Hopefully this will include myself.

Thoughts and words are things, too.

You really do have to be careful what you say. An offhand comment can come true faster than you can blink.

Last week we had a resident who insisted on walking around when they really aren't able to do so without help. We spent several discussions last week talking about how they were going to break a leg or something before it was all over. Now they're in surgery after taking a bad fall.

Now, you may say that we were just predicting the obvious. Still, I wonder if our talk calls things into being that might not have been created otherwise.

Body function alert!

It's really funny how excited my residents get over their bowel movements. They're so proud that it cracks me up.

Comments made to me:

"Well, would you look at that!"

"It's just a little dumplin'."

"I haven't had a bowel movements like that since I don't know when!"

"Hers was so big this morning they had to bring us a plunger!"

I'm not sure if I'm looking forward to the day when something as simple as a normal body function brings me such joy or not.

Strange experience.

I suppose everyone that works where people have died has a ghost story. I imagine that I'll have more the longer I work in the Nursing Center. But, yesterday was the first time I experienced anything strange.

We were using a lift to transfer a resident from her G-chair to the bed. The roommates wheelchair was sitting facing the shelf that holds the television. As we were working, out of the corner of my eye it looked like a man was sitting in the chair with his head turned and looking right at me. Of course, when I looked full on, the chair was empty.

The odd thing was that just a week or more ago, in another room on the same hall, one of the other aides told me that she thought someone was sitting in the wheelchair in his room as she walked past the door. When she backed up to see who it was, there was no one there.

Power of suggestion? I was not actively thinking about it at the time that I was moving my resident. It could have been my subconcious mind working, but why in a different room? Wouldn't I have gotten that impression in the same room as she had?

Off-Topic: The swallows are back

Last year, a pair of swallows had built a nest right above my kitchen window. The babies grew up and the nest blew down over the winter.

Yesterday, we saw another pair (or the same one?) building another nest above the kitchen window again in a different spot. Just another sign that summer is nearly upon us.

Another CNA poster

Check out Holly's blog for more CNA goodness:
http://darndesthings.blogspot.com/

Dementia = No acceptance of change

Not that you didn't already know this: Folks with dementia cannot bear even the smallest change. A change of room, even on the same hallway, sends them for a loop. And not a good one. Not only will they need to be constantly shown where their new space is, they'll refuse to take their medicine which makes them even more confused. Even if the room has the same set up as the old room, they won't be able to find the restroom. Need I say more? All the sympathy and kindness in the world is not going to make this better. What little stability they had has been taken away. At this point, I don't know if moving them back to their old room will make a change for the better or not. If I were a scientist, this would be interesting. As a caregiver, it's distressing as hell.