Thursday, July 29, 2010

I'm a "Fixer"

This is what I do. I fix things. If you're sick, hurt, scared, have to pee, I can fix it or find someone who can. I have a pill, a tactic, a technique or a minute to listen to you so you will be better off than you were when I first walked into the room.

So yesterday when I went to Sherman's funeral what did I have to fix it?

Not a darn thing.

There isn't a pill, tactic or technique that's going to make this grief go away. I even said to Vickie, "I would fix this if I could". And I can't. I'm helpless and I'm not happy about it.

All the hugs and sympathetic ears in the world aren't going to make this better any faster. And the more involved you were in his life, the longer it is going to take to get over it.

Oh, and for the record, funerals are supposed to give you a sense of closure. It didn't work for me. When I saw him lying there, it was like it wasn't him but a statue someone had carved and painted to look like him. His soul was missing and you could feel it's absence like it was a hole in the atmosphere.

I guess I should be glad I work in an environment that lends itself to my desire to fix things and allows me to be reasonably successful at it. If I had to walk around feeling helpless all the time, I'd probably lose my mind.

Monday, July 26, 2010

In Memoriam

One of my co-workers passed away yesterday.

Sherman had been a CNA for well over ten years when I first came to work. He and Vickie were responsible for most of my training. I wouldn't say he took me under his wing, but since I could keep up with him, I was able to learn a lot.

He taught me that the resident is the boss. He taught me that it was ok to be upset, but never to let a resident see it. He taught me that you need to sneak your breaks in when you can because you don't know if the night will allow you to get another one before the end of your shift.

Sherman could be a jerk. If his perception was that you were lazy or stupid, he'd work around you until you got the message and quit. He was responsible for "running off" his share of inferior nursing assistants.

That said, he never turned down a request for help. He was good to his residents. The highest compliment a resident could pay to another male CNA was "he's almost as good as Sherman".

Knowing you're in a better place isn't much comfort to me. I won't get to hear your stories or benefit from your experience any more. I won't get to laugh when you say something so off color that it makes everyone around you blush. I won't get to join in your frustration when things aren't going well or your joy when something actually goes right. I miss you already, Sherman. Rest in peace, man.

Thursday, July 22, 2010

The Roxanol Question

Yes, it's a two post day.

I accept the fact that the longer I am in the nursing center, the more people I take care of will pass away.

I accept the fact that my residents who are under hospice care are not going to get better and that their last few days may be fraught with pain and anxiety.

I accept the fact that medicating my residents to the full extent allowed by their doctor is part of the deal and that it may hasten the end for them.

So tell me why I have nurses who will not authorize the use of Roxanol to ease my dying resident's pain and anxiety?

The doctor's aren't stupid. They know what Roxanol is. They know that while it eases the resident's pain, it also slows down the breathing and heart rate and that this may push the resident over the edge into death. They know all this and yet they have still prescribed it.

Ya know why? Because the resident's condition warrants it.

Still the charge nurses don't want to authorize its use. The resident is in pain. We have this drug that will work almost immediately to ease the pain. But let's not use it. Let's use something else that takes longer and doesn't work as well because we don't want to be the one who authorized their last dose of anything, ever.

Not me. I say give it to them. By the time the doctor gives us a prescription for this stuff, the resident only has days to live. (Actually, I had one resident who used it long term, but that's been one out of well over one hundred residents that I've worked with.) Let's keep them comfortable. Reducing their suffering also reduces the family's suffering and anxiety. And if their life is shortened by a few hours or days, so be it. They weren't going to be up and dancing jigs in the hall anyway.

For me it never has been a question. Keep the resident comfortable by every means we have available. Anything else is unconscionable as far as I'm concerned.

Losing my sense of humor

Sometimes the stress level in the nursing center skyrockets. Yes, it's always high, but every so often we seem to go right off the top of the current charts.

We're there now.

No one seems to know why. It's not a full moon. The weather has been pretty good down here. The "pain index" according to has been a 3 or 4, which is low. We have a pretty good group of employees right now. At least they all seem to be coming in to work regularly and that had been a problem recently.

I don't know what the deal is, but everyone is losing their sense of humor.

For a long time, I would try to write down the funny things that my residents said, because someone says something funny every single day. I've forgotten to do that lately. I'm going to start up again. Sometimes that one laugh we get is all that gets us through the shift.

So, here's one from the other day:

Mrs. A has been one of our more animated residents lately. She has been yelling and talking a mile a minute for several days now. And loud. You can hear her clear to the ends of the hallways.

One of the Med Aides was outside her door trying to pull her pills. She kept yelling and trying to get them to come into her room. The Med Aide kept telling the resident they were going to be in with her in a moment, but she just kept going.

Finally, she tried another tactic. "Here, doggy, doggy, doggy." And then she started laughing. Actually, we all started laughing. Funny how the atmosphere changed immediately.

I really need to find my sense of humor again.

Wednesday, July 7, 2010

Sometimes I wonder...

...what on earth has happened on the previous shift, based on my resident's comments.

I had a resident tell me yesterday that they needed to talk to one of my cohorts from the morning crew and could I let them know.

I explained that I wouldn't see them before then, but that I would leave them a note.

The resident then proceeded to say how they wanted to apologize because they had made it hard on the CNA and they felt bad.

My response was along the lines of, "You can apologize if you want to, but you don't have to. We understand that this is a rough time in your life. We just want to get you well and get you out of this joint." (Yes, I often refer to the Nursing Center as "this joint". I know it's a prison reference. I was just trying to insert a little levity into a serious and painful conversation.)

Obviously, the resident got a negative vibe from that CNA, whether any words were exchanged or not.

I don't understand how we can profess to be "there for the residents" and then still manage to make them feel bad when they take up our time.

In any event, I think the resident felt better after that. I hope so, anyway.

Separate note: Inservice is today. Pray for me.

Tuesday, July 6, 2010

An Embarrassment of Riches

We actually had 7 CNA's scheduled last night. Granted, one was an orientee, but she was just new to the facility, not a new CNA.

I didn't know how to act.

I was still busy, but for a change I didn't feel overwhelmed. I was still smiling when I clocked out for the night. This doesn't happen very often anymore.

I know that the DON and ADON feel like they've exhausted their options for hiring. We live in Small Town, America and it's hard to even find enough people to work much less finding good ones. And out here, people don't want to drive to the next hamlet to work. They want to work close to home. But nights like last night are so great I wish we could hire ten more and just keep them around in case we need them.

Well, I enjoyed it anyway. As we know, tonight may be an embarrassment of a different kind.