You can stick a fork in me...

... I'm done.

I've accepted a job as a Medical Assistant.  Because I've tried to keep this blog positive, I won't go into all the gory details about why I am changing jobs.  Suffice it to say I have been unhappy for over a year and when this opportunity presented itself, I felt it was a sign that I should go.

I'm going to leave the blog up.  I think there's some good stuff and some funny stuff in here and someday I might want to read through it all again myself.

Thanks to those of you who have followed my blog and commented on my posts.  I have appreciated each and every one of you.

'Bye.

Proof

Proof that we never grow up:
"Is that cream style corn?" Mrs. A asked as she poked the vegetable with her fork.
"No, it's regular," I said as I uncovered her drinks and dessert.
She scooped up a few kernels, chewed them thoughtfully and then spit them out.
"Well, now it is," she said.

***

Proof that we can be happy anywhere:
The other day I walked by Mrs. B's room and heard a voice, but no one was in there.  Thinking the TV was on, I walked in to turn it off.  But it wasn't on.  So, I advanced further into the room and peeked into the bathroom.  There sat Mrs. B, on the toilet, singing away.  I decided to just slip out without letting her know I had heard her.

***

Proof that we still think we're funny:
"Do you got a dry pocket?" Mr. C asked me as he moved slowly from the dining room.
"Yes, do you need me to hold something for you?" I answered.
"No, I need to pee and I don't know if I'm gonna make it to the bathroom."

***

Proof that we always think we're a catch:
"Mr. D," I said, taking his hand. "This is the ladies hall.  If you go down there, they'll be yelling, 'There's a man out there!'"  I turned him around and headed him in the other direction.

"They might be yelling, 'Send another!'"

Restaurant-Style Dining Part Deux

A little while back I talked about how our facility was switching to "Restaurant-Style Dining".  Staff emotions were, and still are, mixed about it.  The residents were all for it.  Now that we've been doing it for several weeks, I wanted to let you know how it's going.

The residents really do like setting their own dining schedules and getting to choose what they want from more than two meals.  We still have most folks rushing to the dining room when the meal service begins, but a few are now wandering in later because they know the food will be fresh and hot no matter when they get there.  They also like having a choice of desserts, so on the nights when canned fruit cocktail is the "dessert of the day" they can get a fried pie or lava cake or ice cream instead.  (I mean, really, fruit for dessert needs to have a little sugar and a crust.  But I digress.)

In the beginning the biggest difficulty was figuring out how to deal with the residents who really didn't want to come to the dining room and the residents who needed to be fed.  We are still struggling with the assisted diners, but the residents who stay in their rooms are being handled by bringing their trays two at a time throughout the meal.  Ideally, the assisted diners would also be brought to the dining room two at a time, helped with their meal, and then brought back to their room.  Unfortunately, what's happening is that they are all being brought in at the same time and fed by one or two aides.  This seems to be related to staffing problems more than anything else.

All in all, it's going well.  The residents like it and the staff is adjusting.  I'm hoping that this is the first in a long line of "updates" that we'll be going through to make the nursing center more like home.

Phew! Made it.

I'm off for two days.  I'm hopeful that we'll get our ducks in a row and I won't be asked to put in any more extra time.  Even if they ask, they're on their own, I'm afraid.  Seven weeks of overtime is more than enough.  Sometimes the extra money is not worth the trade of my time off and the re-collection of my patience and sanity.

Where have I been?

Working.  A lot.  My last month or so looked like this:
Six days on.
One day off.
Thirteen days on.
Two days off.
Twelve days on.
Two off.

We've had people get fired, people quit and people quit before they could get fired.  The whole joint's in an uproar.

So, the blog had to rest so that I could try to keep the house clean (sort of) and squeeze in extra naps when I could.

I think I have one more twelve day stretch here and then things should smooth out and get back to normal for a while.  I'm going to start making myself notes again so I have something to say when I get back on a regular schedule.

Sorry for the dead space.  I'll inject some life in here soon.

They got a pill for that?

Yesterday, I was looking for Mrs. A to administer her meds.  I saw the back of her wheelchair sticking out of Mrs. B's doorway, so I headed down the hall. When I arrived, I knocked on the door and then rubbed Mrs. A's shoulder so she would know I was there.  Then I held her pills in front of her.  With a big sigh, she took the cup from me.

"Now, you better take those, whether you want them or not," Mrs. B said, with a stern look in her eye as she struggled to keep her face straight.

"What are they?" Mrs. A. asked.

"Those are two purgative pills, now take them," Mrs. B answered for me.

Mrs. A laughed, put the pills in her mouth and accepted the glass of buttermilk from me.  After she swallowed, she shook her head, squealed and kicked one of her legs out in front of her.

"Well, I hope those pills fix that," Mrs. B commented, raising her eyebrows.

Update to End of Life Care

The Prevention Magazine article I referenced in my blog post was Safe Passage.  The doctor featured in the article was Dr. Ira Byock.

Thanks to my sister for getting this information for me.

Odd

The resident in the previous post who said "...I'm older than I thought I was", passed away two days later.

Makes me wonder if it's not how old you feel, but how old you think you are that matters.

Gems

Overheard...

"What year is this?"

"Two thousand and twelve."

"What?"

"Twenty twelve."

...

"Well, goddamnit, I'm older than I thought I was."

***

"Lookin' sharp," the aide said as he combed Mr. A's hair.

"Lookin' sharp?" Mr. A asked.

"Yes you are," the aide confirmed.

"Hey!" Mr. A called to his wife.  "Come and look at a good lookin' picture of your husband."

End of Life Care

In Prevention Magazine this month there was a very interesting article about a hospice doctor and what is involved in his end of life care for his patients.  Sadly, I threw the magazine away and I can't find the article online, but if you can get your hands on it, it's a good read.

In any event, one of my residents passed away today and it made me think about the article.  This resident's family chose to finally just let nature take its course.  Unfortunately, in my opinion, they did not put the resident on hospice care.  So, for the last three months or so, we have tried to feed this resident when they didn't want to eat, we have cajoled them into taking medications that they probably no longer needed and we did not make any changes to their pain medication routine that were worth mentioning.  We just continued on as if they were stable or improving instead of making allowances for the changes they were going through.

Sad.

The thing that really hit home for me was the paragraph where they said that pneumonia is one of the least painful ways to die but, because it's easily treated, we cure the patient.  This then forces them to continue to live in pain and subsequently die in a more painful manner.

Did I mention how many times my late resident was on antibiotics over the course of the last year?  It makes me wonder how much more pain and suffering we caused them by getting them better as opposed to just letting them go.

I realize that this is a very personal choice.  Maybe the resident would have wanted to live for as long as possible.  I have seen more than one resident with a DNR change their mind at the last minute and do whatever they could to stay alive, so it's not out of the question.  Still, I think the resident's Power of Attorney could have made better arrangements for them.  Hospice care with an aggressive pain relief program might have actually extended their life and certainly would have improved the quality of the days they had left.

The list of things I don't understand seems to grow longer by the day.

If you want to become invisible...

...all you have to do is lose your mind.

Currently, I'm working with a resident who went to the hospital as one person and came back as another.  Before they left, they were sociable, aware, and the village gossip.  If you wanted to know anything about anyone in the facility, staff or resident, this was the person you went to see.  You would routinely find their room occupied by other staff or other residents when you went in to care for them.

One day they found this resident unresponsive and sent them to the ER.  They stayed at the hospital overnight for observation.  And when they came back, something was obviously wrong.

Now the resident thinks their spouse is still alive and is looking all over the facility for them.  They wander the halls asking for help.  They cut holes in their catheter with fingernail clippers.  Any stories they tell you aren't reliable in the least.  Something in their head went "pop" and because they are nearly 100, there's no hope for repairing it without doing further damage.

Sadly, no one really knows how to deal with this.  Instead of gathering in the room for a good gossip, folks are avoiding it like the resident has MRSA.  Somehow, the resident still knows our names, but when they call for us, they don't know what they want, or they ask about their long-dead spouse, or they can't think of the word they need.  When we can't figure out how to help them, they get angry and tell us we don't care.

It's heartbreaking and frustrating.  I've worked with my share of residents with Alzheimer's Disease.  This is nothing like that.  This is like they've had a lobotomy.  It's impossible to find the person they used to be and impossible to relate to who they are now.

I know we need to learn to work with the "new normal".  It's just hard when the change is so sudden.

Whatever It Takes

(I found this in a pile of my writing.  If I posted this already, just disregard it.  I couldn't find it.)

Sometimes in the interest of keeping my residents happy, I do things that make zero sense to anyone but the resident.

***

Mrs. A rolled up to me in her wheelchair.
"Let me sign that myself," she said.
"Sign what, Mrs. A?" I asked.
"Sign that paper," she said, like I had any idea what she was talking about.
So, I pulled out a Post-It Note, put it on my clipboard, handed her a pen, and held the board so she could sign it.
"Well, that looks like crap," she said as she returned the pen to me.
"No.  I can read it.  That's all that matters," I told her.
"That's all that matters," she repeated as she rolled away.

***

"What can I do for you, Mrs. B?" I asked as I entered her room.
"I want to go to bed," she said.
"It's about supper time. How about we wait until after you eat?" I leaned over her chair and turned off the call light.
"No.  I want to go to bed now."
"Alright," I said and we got started.
By the time she was done washing up, changing into her pajamas, and brushing her dentures, she said, "I'm hungry."
I snorted.  I couldn't help it.  "Well, how do you feel about going to supper in your bathrobe?" I asked and held her teeth out to her.
She laughed.  "Won't be the worst thing they've seen down there.  Remember the time Mr. C took off his pants?"

***

"Here," Mrs. D said, handing me her slipper.
"Want me to put this on for you?" I asked, kneeling down.
"No.  It's for you," she said.
"But, it's your slipper."
"You keep it," she said.
"OK.  Thank you," I answered, smiling and walked to the clean linen room with her shoe.
Twenty minutes later I returned it to her room.

Ugh. Confession Time.

So, I got scratched, slapped, and bit the other day.  I accomplished my objective, but neither one of us was happy.

The confession is that, at the time, I wished they would have broken a tooth when they bit me.  Not because it would teach them a lesson, because at this stage of their disease-process, they aren't capable of learning.  Solely for revenge.

I can't be the only one who feels this way.  Still, it bothers me when I feel like I'm losing control.  Wishing punishment on someone is not the same as meting it out myself, but thoughts are things and can become actions.

I'm only human, but I expect to be better than that.

Baby Steps

"Culture Change" is one of those things that Administration has been talking about for well over a year, but we haven't seen anything change at all, much less the culture.  Finally, we have an ETA on our first step.  The first week of March, we are changing to restaurant style dining.

The residents got together and picked a name for the "restaurant".  We will have one CNA who will waitress during meals.  If the residents want to choose their meal, they have to come to the dining room, otherwise, they will get whatever the meal of the day is.  We're told that this will reduce the need for appetite stimulant medication and that folks will start gaining weight so we can discontinue the use of extra "shakes" or protein powders as they get back to "normal".  It will also eliminate the need to rush everyone to the dining room by 4:45, since they'll be able to eat when they want within the designated meal times.  It will also eliminate the snack cart except for the bedtime round because the resident will be able to go in and ask for a snack whenever the "diner" is open.

The other thing, which doesn't affect me since I work second shift, is that the residents don't have to be woken up in the morning and rushed down to breakfast.  They have until 1000 to eat.  No more of this "get your 5 residents up before you leave" for the third shift CNA's.  No more residents who can't get their appetites going in the morning.  They should all be able to get up and eat when they're hungry.

I'm sure we'll spend the month of March working the kinks out, but regardless, I'm excited.

Well... OK, Then...

Sometimes there's just no appropriate response...

"So, the other day, I'm sitting on the commode," Mrs. A began and bent over in her wheelchair, resting her elbow on her knee and her chin on her fist.  "You know, like you do.  And I looked up and he's sitting in the doorway, staring at me.  I wanted to get up and slap the back of his head off."

"Well, I'll bet you did," I answered, struggling to delete the image of Mrs. A making good on her threat.

"He belongs to someone.  He's always clean and dressed nice.  Why don't they keep him at home?"

"I just don't know, Mrs. A."

(Full disclosure:  "He" is not, in fact, a male.  "He" is a boxy woman with very short hair.  She probably looks like a man if your vision is not what it used to be.  And, since there are no locks on the doors, some of the wanderers do get into places they shouldn't.  Someday, I'd like to work in a facility that has a separate wing for the residents affected by dementia.)

Wanna be a hero?

Learn how to program a television remote.

I'm not kidding.  I have ladies who wait for me to come to work to fix their remotes when they stop working.  You'd think I was Wonder Woman.

Kainolophobia

"Ugh.  It's pill time," Mrs. A groaned as I pulled up to her door with the medication cart.

"Yes, it's pill time," I said.  "Ya know, you're supposed to do a cheer when you see me coming."  I proceeded to demonstrate a very small cheer, bouncing on my toes and waving my arms.

"I can't do that.  Once I started shaking, I might never stop."

Welcome to Hell (Slightly O/T)

I'm starting to question the existence of Hell as a place we go to for punishment after death.  I think we're already there.  Before you roll your eyes because yet another person is questioning their faith, hear me out.

What could be more horrible than waking up one day unable to walk or speak or eat?  What could be more upsetting than thinking your spouse is still alive and then finding out they're dead - and have been for years?  How much more awful can anything be than watching yourself slowly lose your motor functions, so that people have to feed you and clean you up after you've soiled yourself like a baby?  What about being constantly put in a wheelchair when you know damn well you could walk just fine, if they'd let you?

I'm sure you can think of your own horror stories.

Here's the second part of my argument:  I've had a couple of dreams about people who probably should have gone to Hell, but obviously hadn't.  Both had broken at least one - probably more than I knew about - of the Ten Commandments.  Both had delved into at least one of the Seven Deadly Sins.  In both cases, they were dressed in white and were not afraid.  One was confused, but probably because he had not expected to die.  The other was smiling and walking purposefully away.  In both cases, if they were heading for Hell, would they not have been kicking and screaming and begging for another chance?

The first part of my argument is rock solid.  You can't disagree with any of that.  You could roll your eyes at the dream part as if it were some New Age mumbo-jumbo. Let me throw into the ring that I don't recall my dreams very often and that when they jar me awake, I believe that's a sign that I should pay attention.  Also, the first dream was about friend.  I would expect to dream about him after he died.  The second was about a man I had medicated at work but I did not know him personally.  There was no reason for him to show himself to me unless I was supposed to learn something from it.  My last argument is that there are many stories in many religions about the gods contacting their people in dreams.

I've been trying to make sense of this since I had the second dream, about a month ago.  This is the only conclusion that makes any sense to me.  Until I have solid proof to the contrary, this is my Truth.

Just This Once

"Uh oh," said my charge nurse as she hustled past me down the hall.

When I looked her direction, I saw Mrs. A tottering down the hall, no walker, no wheelchair, no nothing.

I locked my cart and rushed for Mrs. A's room and located her wheelchair.

"Where's your wheelchair?" Nurse B asked Mrs. A as she took her arm.

"I didn't know I needed one," Mrs. A said.

"Well, here it is," I said from behind her.  "We forgot to tell you."  Nurse B and I shared a smile.

"Oh, that's OK," Mrs. A said as she sat down.  "We'll just let it go."

Happy New Year!!

Whatever you do today, you'll do all year.  Kiss your family, clean your house, and work if you have the opportunity.