Patience

One of my favorite, and oldest, little old ladies died recently at the GreatRep (the dementia care facility that I still work part time at).

Patience was seriously a bad-ass. She was the oldest living person I've ever met, at several years past 100. She still walked, fed herself, and talked when she died. She was chronically cranky, hated to get up early in the mornings, so we always let her sleep in and woke her up after everyone else had eaten their breakfasts. She was known for her particular style of combativeness - Patience would grab your scrub top's neckline, haul you in, and scratch the bejesus out of you while she shrieked "ouch! Owww! Hurting me!!".

But that's not all Patience was, of course. She still had a great sense of humor, and often seemed aware that her increasing deafness was a good source of entertainment. One day, in the dining room, she incited a food fight with another resident, a man. When the med tech on duty approached her to redirect her, she said "Patience, you're such a rascal!" and Patience stared at her for a beat, then said "I'm such an asshole?!?" then laughed maniacally.

Patience would constantly sing in a low, grumbling monotone, similar to her speaking voice. Very old songs, like Springtime in the Rockies, or The Battle Hymn of the Republic. She'd also talk out loud, verbalizing her thoughts, which she may or may not have been aware she was doing. If you were walking by her and stopped to say hello, give her a kiss, or wave at her, she'd often mumble "that one smiled. That one smiled. That one was happy." in her repetitive, robotic voice.

My favorite ever moment with Patience was when I was trying to put her to bed one night. She was being very resistive to standing up, not wanting to leave her comfy couch in the living room and walk down to her room. Patience had never had children of her own, but was a devoted aunt whose nieces and nephews still visited her until the end of her life. So, trying a different approach, I said "Auntie Patience, I want to go to bed but I'm scared to walk there by myself. Will you take me?". She grudgingly pulled herself up with her walker and headed to her room with me. She used the bathroom, brushed her teeth, put on her nightgown, and then, to my surprise, plopped down on her coffee table! She leaned back, pointed at the bed, and said, in her deadpan way, "Go ahead. You sleep now, I'll watch you. You go to bed. I'm here." Just thinking about that is enough to make me cry.

It's not often that the staff at a nursing home really loves and adores a combative resident, but we all loved Patience. Who else would repeatedly strip in the common area, to the point we had to go plunk her in her room where the nudity was more appropriate? And then when we checked on her later, we found her wearing only panties and a bedsheet tied around her neck like Superman's cape, singing Take Me Out to the Ballgame!

So, Patience, you were a delight. I miss you already. And I know you would understand that it's with great affection that I share the following photo of what you reminded me of at the breakfast table every morning, since you never mellowed out enough to get your hair combed until you'd been up for a few hours.

Watch out for WOLFS

It's been another weird weekend over at the hospital, y'all. As I've probably mentioned on here before, weekends are the time when all my nice, normal, elective joint replacement patients are not there. So weekends are when I am either floated to another unit or I stay on my own unit but we get atypical patients there (OB-GYN issues, medical problems that don't involve bones, etc.)

Last night I got sent to another unit to do a one-on-one with a very large, schizophrenic patient with a history of methamphetamine use. I'll just let that sink in for a few minutes, shall I?

I spent 8 hours in a hospital room alone with someone who, on paper at least, I would normally sprint away from.

And boy, was it an unusual night.

As I soon discovered, my patient had quite a fascination with "wild animals". Since my patient was a little edgy, I took this person on about eighteen million walks around the floor to try to burn off some nervous energy, toting along the IV pole with us each time. On one of these jaunts, a framed poster of a baby animal that looked like some sort of canine caught my new friend's eye.

"Oh, is that a hyena? Look at him! He's so nice and symmetrical. I've never seen a hyena. One time I saw a wild animal that was like a bobcat or a wildcat or a mountain cat. I saw it walk by the window here too [note; we were NOT on a ground floor level]. One time I saw an Orca whale in a lake. They don't usually live in lakes, so I took a picture of it."

This proved to be a fruitful topic, so my patient thoughtfully provided me with more tidbits throughout the evening:
"If you were by the woods you might get picked off by a wild animal. Like some wolfs. Or mountain bobcats. You should really be careful. If a wild wolf comes out of the woods, you give it a cookie. If it takes the cookie, it'll just, like, go back into the woods. If it doesn't take the cookie, point to the lake. It'll go jump in the lake. I saw that happen but then the bobcat got eaten by an orca whale. In the lake. The whale just ate it all up. It was weird."

My patient had the flattest affect during all this, and consistently called wolves "wolfs" very clearly. I checked in with a nurse at one point to find out if perhaps this person was messing with me, and nope, the nurse said this patient was a bit of a 'frequent flyer' and advised me not to laugh at any advice or stories the patient told me.

We made it all through my shift just fine. Then tonight, in the cafeteria, I saw another CNA who works that unit. She said that my wild-animal-expert patient was pacing the floor, ranting, and attempting to get dressed in all sorts of things because the patient believed it was time to leave.

WHEW! I dodged a bullet there, didn't I? So glad I got floated last night instead of tonight!

Two Days Left

I've only got two regular days left at the GreatRep, and then my orientation at the hospital on Monday and Tuesday. I'm planning to still work one day a week at the GreatRep, because they'd like me to and I could use the extra income. Today I was looking at my residents and thinking about how much I'll miss some of them.

And then a call light went of because Mr.UberCombative (the one who Darth Vader choked a nurse) was attacking two CNA's with a full size floor lamp and they'd locked themselves in the bathroom to get away from him then hit the call light for rescue. And then while I helped the remaining CNA from that wing hunt down our charge nurse (he ended up grabbing the DON and the Administrator to deal with that fun situation) I found the charge nurse, who pulled me into another bathroom to help hold up a 103 year old woman while she digitally disimpacted her and avoided her resulting mule kicks as she screamed "That was HURT!" at us all. Poor baby, I bet it really, really did! She was waaaaaaay backed up.

And then I hustled my butt over to where I was originally supposed to be doing what I was originally supposed to be doing (helping the less able residents drink their ensures for snacktime).

Whew.

I don't expect the hospital to be a cakewalk. But I do expect to be assaulted a lot less regularly.

Cross your fingers for that, anyways!

A few minutes after all this, I saw our maintenance man walking down the hall, having confiscated said floor lamp. He looked PISSED. I wonder if he has a special room where all the furniture that's been used as weapons goes for "time out" the way I used to put toys that the kids were fighting over in "time out" for a while to let them all calm down?

Yeah Buddies!

I got my first Chem exam back, and scored an A-. I'm thrilled by this! The first two chapters, what the test was on, involved me relearning all the algebra I'd forgotten since high school. Plus all the regular chemistry topics we were all learning in the class.

Now that we're past that part, the following chapter on naming compounds, Lewis diagrams, and predicting molecular geometry are way, way easier.

Plus my lab partner is really nice; she's a CNA also, and works at a skilled nursing facility. We were swapping stories about the weird residents and the most horrifying post mortem cares we've done, and it's great because we're both 'returning students' (she's in her thirties) so we're both actually motivated to do well in the class because we've got other stuff to do besides goof off.

Work today was sucky.

One of the CNA's that's been at the GreatRep for a few years was fired this week for getting into altercation with a resident. WTF? I haven't heard any details, so I don't know if she just snapped, but the resident she was yelling at is very compliant and nonverbal, and never combative. Not like it's ever okay to really yell at someone you're supposed to be caring for, but if that person had, say, slapped you across the face with their wet brief and then spat on you, one might understand raising your voice a smidgen more than your heart tells you is right. But I can't imagine that anything like that had happened, given who was involved in this. Bizarre.

And yes, the brief-slapping thing is real and did really happen. Not to me, thank goodness. But the resident who did it is alive and kicking. And told me last week that she would like to "shoot [me] with a gun and make a beautiful mess out of [me]". I just sighed and rolled my eyes. That's her horrible, horrible baseline.

I cheer myself up by talking to the adorable little lady who asks for cocoa by calling it "kokomoko". So cute!

Simplicity of success

After 3 long shifts as a med tech at my facility, I went and worked my once-a-week evening shift caregiving, and for the first time, it felt like a relief. We've got multiple residents on a lot of medications right now, many of which would normally be PRN's and therefore not my department. However, one of the nurses wrote them in our book as nursing orders, so for the first time we're giving medications that absolutely must be given at a certain time and that is really stressful with this population. You just never know if or when these people are going to cooperate with you.

So anyway, we've still got the Darth Vader Choker running around. He's a reasonably nice guy a lot of the time, but when he gets combative, it's scary. He's a big man (and remember, he lifted one nurse clear up off the ground by choking her). During report today we were told to "keep a close eye on him" and perform "frequent checks" because he's been peeing everywhere. And housekeeping is getting mad because he peed on the drapes and it's expensive to clean them. I'll file that under "not urgent". If it's that expensive to clean the place when he pees all over stuff, how about NOT ADMITTING people that we KNOW ahead of time are going to freak out when toileted and have a pattern of voiding inappropriately? Duh.

Anyway, Mr. Vader has been on a streak of bad days lately. So when we spotted him dozing on a couch in the hallway after dinner, I suggested to the other aide who was assigned to him that we go try to put him to bed right away, before his meds wear off. We got a wheelchair, because he was all zonked. We gently woke him up, told him we would help him get to bed, and plopped him in the wheelchair.

Once we had him in his room, I started with "Let's take a look at your feet." because apparently that's how his daughter would start his care. He was a contractor for years and years, and for all I know, he thinks he did it today. So I acted as though he had. I said "We want to make sure you didn't step on any nails or anything. Construction sites can be tricky." he was awake now, and agreed. I took off his shoes and socks. I continued "All right, those look good, no problems there. I think we better check your knees too, make sure they didn't get roughed up at all. Can you stand up?" He could, with our help. He didn't even notice that we were taking his pants off to check his knees, was just glad that his knees were okay. We continued like this until he had everything off, used the restroom, washed himself up with a washcloth, brushed his teeth and laid down in bed wearing only a brief. It was amazing. Such a change from his other days. I think if he could be appropriately medicated, he could be compliant like this all the time - he was aware of what we were doing, was doing most of the work himself, and was pleasant to be around.

It was the most successful moment I've had with this guy since he moved in.

And after all the stress of the last few days, it was a really pleasant change - sometimes it's nice to go back to basics.

Not a 9/11 post

I don't have anything special to say about 9/11 except that death really really sucks. I feel terrible for people who lost their families on that day, just as I feel terrible for the resident at work who's slowly dying from a series of strokes. She had another one today, vomiting beforehand even though I'd given her an anti-nausea drug by mouth before dinner, and the nurse had given her an anti-nausea suppository after the first time she threw up. She vomited a few more times, and then there was that telltale lean, the inability to control half of her body. A different half than last time. And she was so baffled about what was happening to her, and how could she get to feel better, and there isn't any answer.

This woman is a sweet lady with a devoted family.

And it makes me sad, trying to brush her teeth after she vomits and she cannot control half of her mouth while I do it. And it makes me sad, listening to her struggle to slur out that yes, she wants her daughter to come see her now.

Maybe it's easier for religious people once someone is actually dead - they usually say they're "in a good place now". But I don't know if watching the slow, steady decline is easier with a God around or not. I don't know if anything could make that easier; it's just so, so sad sometimes. And sometimes it's not, and I can't make reason of why sometimes it really gets to me and sometimes it doesn't.

If I do end up getting that hospital job, I'll be hoping that having patients for such a short period of time makes it harder to get very attached to them. A lot of the people I take care of now, I've seen nearly every day for about a year now.

And just to top off my bad mood, I got bitten right before the end of my shift, trying to scoop some non-food stuff out of a resident's mouth that she was trying to eat. I knew (obviously) that it was likely I'd get bitten, but I didn't want her to choke or get sick from this. I really hate getting bitten.

So that's my important thoughts for the day: I hate death sometimes and I hate getting bitten all the time. My sympathies for all of you that are dealing with either one.

In over my head

This has been a tough, tough week over at the GreatRep. We got a new admit, and he arrived under less-than-ideal circumstances; his daughter, the primary caregiver, was out of town. His wife brought him in and dropped him off, not wanting to visit because he'd been hurting her whenever she tried to toilet him. He had orders for meds, but had been refusing all of them.

So he comes from living at home with his wife to us, a decent-sized facility (around 65-70 beds) where we expect him to take his meds, use the toilet, and not hit us.

None of that happened. We quickly realized, after he had one of our charge nurses pinned up against the wall, choking her and lifting her off her feet, that he was going to require at least 3 people to change him out of his soiled clothes when he was incontinent.



In a hospital setting, or a psych ward, when a patient does something like that, you can medicate that person by any means necessary. In our assisted living facility, they must agree to take their meds orally (unless they have an order indicating otherwise, which this guy does not).

Things seemed to be calming down a bit after that, and he even cooperated with care in the evening one time, after the nurses began putting his evening meds in his desserts so he would actually take them in.

Then, randomly, on day shift, he punched a female caregiver in the face, and then in the back of the head when she tried to run away. Knocked her down, cut up the inside of her mouth from her teeth. She didn't quite black out and yelled for help, dragging herself to the door. It was awful. If I were in charge, that would have been the point where I'd have sent this guy on his merry way to the hospital with police there to assist the medics during pickup.

Instead, they updated his care plan to require and assist of 2+ people with all care and implemented more behavioral meds.

I was livid.

We had a meeting, and the DON was able to state her case and change our minds, even mine. I swear that woman is tricky as all get out. Plus she personally had been doing his care all day long by herself and will continue to do so, which gained her a lot of respect from the rest of us.

She laid out a specific, comprehensive plan to help him acclimate to our setting, and promised that we are NOT expected to stay in a situation where he'll hurt us, and if that means something doesn't get done, then so be it. I also understand that a gero-psych eval is not out of the question if we're not able to resolve the combativeness in our setting. Okay. Stressful, scary, unfortunate, but okay.

Then the bad news kept coming; another new(ish) resident of ours, "Linda" has a husband who lives independently but within walking distance of our facility. And he's telling anyone who'll listen that his plan is to come to our facility, shoot his wife, and then shoot himself.

This is about the time when I seriously considered just getting up from this meeting and going home.

Apparently Mr. Murderer may or may not be hospitalized right now, but of course he can go home, and then to our place, at any time. The good news is, he can't figure out how to use the keycode to enter the building, even though from the outside, the code is posted right above the keypad. So that gives us a grace period in which to see that he's the one knocking on the door trying to get in and call 911. Unless another visitor is being helpful and just lets him in.

Working in dementia, there's a certain amount of "I'm tough" attitude that comes with the territory - we deal with people who get combative for no good reason. That's just how it is. And usually the benefits outweigh the occasional injuries.

But this week has been so screwed up I didn't want to go back to that place. I don't want to be punched and knocked out, or choked, or shot. And I feel about 88% sure that I won't be. Which isn't really sure enough to make me happy about going to work again on Friday. Ugh.

The Codger Whisperer

Just got home from my shift with the combative ex-alcoholic that lives at the CrapDorable facility that I used to work at and hated. Whew!

Let me tell you, walking into a place, saying "I'm here to pick up Mr. Codger for his doctor's appointment" and hearing "Ohhh, yeah, he's in a really bad mood. He was out here in the lobby but they took him back to his room to use the bathroom because he can't use the main one." (??) That's not how you want to greet any outside providers that come into your facility. If I hadn't known what I was getting into, I'd have been tempted to walk right back out.

The receptionist remembered me from my brief and hellish stint there months ago, and gave me her key so I could go find Mr. C myself. Which I did. Sitting in his wheelchair in his room with 2 aides trying to pee in a urinal & yelling at us all to get the hell out. I grabbed the paperwork I needed from his room and did so, waiting out in the hallway to work on it there. After his urination, Mr. C seemed in a better mood, and he and I sat in the lobby of the CrapDorable facility chatting while we waited for Dial-A-Lift to come pick us up (you know, those bus system buses that will take you door-to-door if you're disabled and have a wheelchair lift on them). Bus came, we went, he crabbed the whole way there. Arrived, read to him from a travel magazine in the lobby (his favorite topic) and got him all cheerful and pleasant for his appointment.

Then the doctor, who looked to be my age or younger, walked in. And told Mr. C he was there to consult on whether or not to remove his toe. OMG. They pulled out the offending toe, and I'm no expert but it looked like a good candidate for removal to me; lots of necrotic black flesh, and ooze, and bleeding. Yuck. Apparently Mr. C didn't have any pain from it though. Then came the awesome part, in which the doc said we needed to transfer Mr. C to the exam bench, Mr. C refused, the doc seemed completely unaware that his patient had dementia, and I pulled the MA and the MD out into the hall.

"Look, I just met this guy today, but I picked him up from a dementia care facility. He has dementia. He also gets physically and verbally combative. He is a 2-person transfer and can't walk or really bear weight. So we can transfer him if it's absolutely necessary, but he may not like it."

They came back in, we tried, Mr. C grabbed on to his wheelchair, refused, and started swearing at us all. At this point, I figured we were just going to have to do it anyway, but the MD backed down and said never mind, even though he was supposed to be examining the codger in other areas for cancer. Some people might consider follow up to a biopsy a little bit IMPORTANT.

Instead, he chickened out and said "Uh... well, we won't make any decisions about that surgery, and I'll have you come back in 3 weeks so we can take another look at that toe." and he and the MA rushed us out of there as fast as possible.

Sheesh. So the codger just spent a bunch of money for this appt. plus someone to shepherd him there and back, and all he got was a clean dressing for his horrible toe. Great.

We then had a half hour to kill before our ride back to the CrapDorable, so I chatted and read to the codger until then. He freaking loved me. Just not anyone or anything else, today, unfortunately.

I brought him into the facility with an admonishment to behave ("I find it difficult when you aren't here, dear") and watch his language, and then set about coordinating his follow up appt. I told the homecare agency CareCo that I'm happy to take him BUT
1. He needs to be premedicated, because clearly dermatologists are afraid of pissy old men who swear at them. If he gets premedicated, he probably won't do that.
2. I want CareCo to call ahead to the doctor's appt. and make sure the physician understands what's happening and what needs to be done.

Jeez, people. How scary can one wheelchair bound old man be?

Um, what??

First, my favorite thing a resident said to me today:

I was at my cart getting meds out for the dinnertime pass when Wendy sidled up to me and quietly asked "So, have they reserved a rope and a tree for me yet?" I immediately burst out laughing and asked her where that question came from, to which she replied "I don't know, I just thought it up." and laughed as well.

Secondly, this is a note to myself:

Before accepting home care shifts, ASK A FEW QUESTIONS! I agreed to chaperon some dude to his doctor's appt via the local bus system's Dial-a-Lift on Monday. Then I got home and read the plan of care and ...
a) he lives at the CrapDorable place I used to work at briefly! Oh no. I hate that place. And the staff there, if they haven't all turned over by now, know it. So that's awkward.
b) his plan of care makes him sound like a freaking nightmare. Recovering alcoholic, combative toward staff at the crapdorable facility he lives at, multiple divorces ("DO NOT DISCUSS SPOUSES WITH CLIENT") and has threatened to kill his adult child and said child's spouse ("if this comes up, caregiver to redirect"). Oh my lord, this is going to be the longest few hours of my life.
c) he's wheelchair bound (hence the dial-a-lift) and apparently continent but is a 2 person transfer. So should he get the urge to go to the bathroom during the 4 or so hours I have him, I have to tell him ... what? "I hope you just have to pee, here's a big gulp cup you can use for a urinal." "Go ahead! All wheelchairs are destined to be pooped in anyway." "Let's see if I can get the nice receptionist to help me transfer you." Plus, given the quality of care at the crapdorable facility, chances that he'll be recently toileted and ready to go when I arrive are slim to none.

So, yeah. Polly, in the future, ask questions, you dumbass!

but yeah, I'm too broke right now to cancel this shift, so I'll just be crossing my fingers and counting my money in my head while I'm doing this terrible job

Ongoing Grief

A while ago, I wrote about a resident I nicknamed "ScaryLady" on this blog, because she used to beat up all of us caregivers every single night when we tried to put her to bed. I literally had bruises up and down my arms every day for about 2 months straight that were all from her. Now she's on a routine behavioral medication for the first time, and is doing much better. She cooperates with care more, which means she gets more care, rather than just the absolute necessities. I see a different side of her, and it's so nice.

Her daughter is pretty in denial about how far NotScaryAnymoreLady's disease has progressed. I wondered what she thought, hearing about how her Mom needed further medication in order to stop injuring her caregivers. I tried to put myself in her shoes and imagine what that would feel like, but all I got was awkwardness, and I felt self-conscious about my bruises when she was there to visit her Mother. I felt torn between wanting her to know where they came from and being embarrassed that I couldn't somehow stop the behaviors.

Today I felt like I got a bit of a taste of what it's like to have a family member that's acting out like that, and it really has made me sympathetic to my residents' families.

One of my residents is a man I've been taking care of for about 2 years at several of the last places I've worked at. His family moved him into the GreatRep partly because I started working there, and they have been very pleased with the way I've worked with him over time. There was a gap of several months where I didn't see him before he moved in, so my knowledge of him wasn't very up-to-date. I told my coworkers how nice he is, and easy going. And then he moved in, and he wasn't. He refused showers, did a lot of very annoying and rude things, and even sexually harrassed one of my coworkers. I felt terrible, having vouched for him like that, even though everyone reassured me that they understood it's just the disease. Dementia does that to people.

This last week has been hellish. My resident has been escalating in aggression, trying to take advantage sexually of other more impaired residents (like the nonverbal ladies who don't understand what's going on). And when we try to redirect him, he's been increasingly hostile to staff.

This morning at breakfast, I was giving meds to someone who was sitting at the table with that guy, and the guy suddenly looked at me, looked at my chest, and asked me if I was wearing a bra. Ugh. I said "That's not an appropriate question and we aren't going to talk about this subject". He started challenging me "Why not? Are you? I bet you are." I restated that this was NOT OKAY and he needed to stop talking to me that way. And then he asked me if I wanted to fight. And I said no. And then he stood up and told me he was going to punch me. Instinct kicked in and I said authoritatively "No, you are NOT." He sat back down, and I ignored him and finished up my task.

This is a guy that I used to think of as like a second Grandpa. I know his entire extended family, went to his wife's most recent birthday party, and have babysat his great grandkids. And he wanted to punch me in the face, and would likely have sexually assaulted me if circumstances allowed it.

It just hurts so much.

Now there isn't much to be done about him right now. He needs medication changes, and until they can happen, he must have a family member supervising him in our facility at all times. For the safety of our residents and our staff. And me. I think the fact that he did that to me really shocked his family and they're being very helpful.

But I think I got a taste of how awful it is to have your loved one scaring people, scaring you. And it's so bad. I feel so terrible for the family members. Alzheimer's is a really mean disease at times.

In Which I Get Judgemental

You know those things you think about people but you aren't supposed to say because it's mean/prejudiced/snotty etc.? That's what this is about.

I recently trained a new employee at the GreatRep, who seemed nice. She's CNA certified but hasn't worked as one before. However she was working as a caregiver at a group home for developmentally disabled adults. Lower volume/patient load than what we do at the GreatRep, but same basic principles plus she's been through the CNA course so she should already know the essentials from that. Seems like a reasonably good hire, is polite, reads and writes English well.

The first red flag for me was when she mentioned something about her home life; that she had been traveling around the world or something for a few years (the first few years of her son's life) and then finally came back because she fell in love with her high school non-sweetheart, and now they're engaged and living with her son's Father. Huh. I generally think one needs a pretty good reason not to be around for their child's first few years of life, and wanderlust doesn't really count in my book.

The second one was that she was complaining about her job at the group home and how the stress of combative residents there was triggering her PTSD (acquired when she was younger, not through serving in the armed forces but ostensibly by having an effed up childhood). Uh-oh. Our residents get combative, and even though they're mostly old ladies, they can be a little scary at times. Would this be a good fit for her?

Answer: nope. Apparently even though she quit her job at the group home and now only works part-time at the GreatRep, she was STILL calling off frequently, wanting to go home early, etc. That's such BULL! Our jobs are hard but do-able when we're fully staffed. Leaving your coworkers short-staffed for no good reason is totally rude and shady.

Then the other night she insisted she had such a bad back injury that she had to go home. Seriously? Even though you were sitting there talking to me like everything was fine and bustling around preparing your dinner? I don't buy it. I think that this girl has a crazy family and that made her crazy, and then she hasn't bucked up and gotten un-crazy. Which sucks, because she's a parent now. And instead of growing up and holding down a job, she is hoping to get disability or something after working part time for a few weeks. Ugh.

I know it's not kind to assume people are going to suck if they tell you they had a bad childhood or whatever, but here's the thing: if they've gotten over it enough to function well? They won't tell you right away. They'll be aware that doing so is inappropriate. People can come from chaos and turn out wonderfully, but those are the people you're surprised to find out were raised so horribly. The ones where you go "Oh, that all makes sense" are the ones who need to get their butts into therapy and figure their crap out.

Or at least not come work with me. Sheesh.

Day 03: My Views on Drugs and Alcohol.

I just worked a 12 hour day, so this will be short and not-so-sweet:

Drugs: YES. Halidol, Ativan, Antipsychotics, and anything that makes those combative residents stop BITING me (yes that really happened tonight).

Illegal Drugs: No thanks. I'll stick to my ibuprofen.

Alcohol: Rarely. I went through a phase when I was younger when I used to binge drink, which was not the greatest plan. Now I almost never drink at all, and stick to just one or two. Mr. Polly says I have the tolerance of an 11 year old.

True story: Just now I was telling Mr. what I'm writing about and now he's going to get us some Riesling. Because I ache from head to toe and because I got BITTEN BY A GROWN WOMAN! I think a glass of wine and some Jeopardy or Smallville sounds like a good way to end my day.

30 Days of Blog Topics

Just like Estelle Darling at www.brfirefly.blogspot.com I thought this 30 day blog challenge looked fun:



I'm not promising to cover all of these, but we'll see how it goes. It's always nice to have something besides work to write about. Especially since work has been kind of nuts lately; one of our residents just came back from the hospital after a stroke and is now a 2-3 person assist WITH a sit-to-stand (shudder). This is inconvenient, to say the least. Plus she's the first one to have actually broken my skin while being combative (with her fingernails). Thank God for coworkers and sanitizer. It's instinctual to get pissed when someone injures you, so I was very glad to be able to leave the room when that happened. Ugh.

Let's all cross our fingers that this week goes a little smoother!

Bathing the Reluctant: a How-To.

It's my first day off (finally!) after being on for 6 days in a row, so I'm predictably spending the day at home. On the couch, in the bed, or the bathtub. I plan to do laundry and roast some vegetables later, but that's about as enthusiastic as I'll get today. I'm Tired with a capital T.

So when I got a call from the HomeCare agency this afternoon (I'm still "on call" with them, though I've yet to actually go and work a shift for them since switching from regular employee to on-call) I screened it. And then was pleasantly surprised when it was a voicemail from the office staff saying that my former client Gary has recently begun refusing to bathe for his caregiver, the one that took over for me when I left. She wanted to know if I'd be willing for Gary's new caregiver to call me and talk it over with me to see if I could help. Sure!

So now I'm feeling like a (tired) Shower Expert. And wanting to share my super-important knowledge with the world. So if you've ever wondered "how the hell am I going to get that cranky old coot to take a shower?", this one's for you.

Step 1: Assess the need/reluctance:
Lots of elderly people don't like to bathe. They truly don't need to as often (2x a week is just fine - they have thin skin and tend to perspire less than younger folks, and dry out easily if you wash them too frequently). They hate being cold, don't want to get naked in front of anyone, are afraid of falling on a wet, slippery floor, and may have medical equipment (indwelling catheters, ostomy bags) that make showering a hassle. No wonder they say no when you ask them to go hop in. So think about it first; do they actually need one? If yes, do you need to shampoo their hair as well, or can you give them a shower cap and just wash their body, and shampoo their hair in a sink later? Figure out the bare minimum of what needs to happen today, so you know what you're willing to negotiate down to.

Step 2: Prepare.
Before you even mention the word shower to them, go get it set up. Heat up the bathroom so it's uncomfortably hot for you. Make sure their shower chair/stool is in there, as is their shampoo and everything else. Bring more towels than you think you'll need. If possible, put bathmats down from the toilet to the shower. Bring in the clothes you'll be dressing them in afterward.

Step 3: Approach.
Hopefully you already have gotten to know whoever it is you're trying to bathe, so you know what approach works for them. Some people hate surprises, so you really need to tell them ahead of time where you're going. Pitch it in a positive way, with a smile and enthusiasm, "Hey Betty! Guess what? Since today is your shower day, I went and got your bathroom all nice and warm for you, and pulled out that lavender soap you like! C'mon, let me show you what I did!". Others, it's a mistake to mention the word shower until they're already in the bathroom. I have several residents like this. For them, I just say "Let's go use the restroom" and walk them in there. Once they're seated on the toilet, I go ahead and remove their briefs, pants, shoes and socks (this is where the bathmats come in; no bare feet on cold floors). Then and only then do I say, "Okay, Bill, we've already got you halfway ready, which is great! Today is your shower day, so I've got the warm water running, and if you just walk along these mats to the shower, I'll help you get settled in and get all warmed up in there."

Step 4: Overcome resistance.
Once you've pitched the idea, you'll probably get some resistance. Common ones, and responses to them are things like

"I don't need a shower, I just took one"
"It's hard work being beautiful, isn't it?"
or "Time flies, doesn't it? Today is Tuesday, so it's been about a week since last time. It's going to feel so good to get that warm water on, isn't it?"

"Why are you in such a hurry to get me wet?"
"We're not in any hurry. But I want your skin to be clean and healthy, so we need to get you washed up for that to happen."

"I don't want to get in there! I don't want to get wet!"
"I know you don't always like it, but I set everything up really nicely for you today. I think you'll enjoy it. Give me 2 minutes to try it out, and if you don't like it, I'll help you get out and get dressed."

"I don't want my hair wet!"
"Okay, here's a shower cap"
or if that's not an option "Here's a dry cloth to hold over your eyes. I'll aim the water so it stays off your face."

If your patient has advanced dementia and can't really talk or be reasoned with, still set it up nicely, talk them through it in a positive way. They're likely to get combative when you start to undress them, so it might be best to get a buddy to come and help you get through that part as quickly as possible so they don't get any more riled up than they have to. It's fine to leave on socks, for example, if they really won't give them up. They'll want them off later once they're wet.

Step 5: Bathe.
Do whatever it is you promised to do. If you promised not to wet someone's hair, don't surprise them by suddenly hosing down their head. That's not nice. Get them settled on the shower chair, check the water temperature on your inner arm (above your gloves). Chances are, most elderly people will want their shower cooler than you'd take yours. Approximately body temperature. Have them check the temp with their hand first. If they're not able to do that and give you feedback, start at their feet and move up slowly, so they get a chance to acclimate before feeling the temperature on their chest or back. Have them help and participate as much as possible, even if that's only to hold a washcloth to (hopefully) stop them from punching you. Keep talking through what you're doing in a gentle voice "Okay, Sally, here's some warm water for your back. Now I'm going to wash your back with this cloth, and then we'll rinse off all the bubbles. Good! Next let's do your chest" etc. If they're freaking out, do it as fast as possible, and concentrate on armpits and pericare.

Step 6: Finish.
As soon as you turn that water off, cover them in towels as much as is possible. If they walk, put down a dry towel on top of the (closed) toilet lid and help them walk over to it and sit down. If they don't, wrap up their shoulders and back, drape one over their lap, and keep one to start drying their arms and legs. Get them dry, lotioned and dressed as quickly as you can. Usually once they realize you're putting clothes on and not off, they'll relax and help more.

Pat yourself on the back, wipe the sweat off your face, pick up the zillions of wet towels, and spray down that shower with bleach. You did it!

...And then I come home crying

Even good jobs can give you bad days. Very, very bad days.

My current facility (the GreatRep) is divided loosely into two wings, East and West. Residents can circulate freely from one wing to the other, but the West Wing is more acute, and is where anyone who needs mechanical lifts to be moved, or consistently must be fed at meals lives. As you can imagine, the more demented people get, the more likely they are to be combative. And there is one little stretch of the West Wing that we may as well nickname Witch Wing or something else that rhymes with it, because there are 4 women there that will slap, spit, scratch and pull the hair of anyone who dares to try to toilet, feed, or bathe them.

I have no idea why the administrators decided that some lucky soul would get ALL of these women at once (plus a couple of pleasant residents) and put them all on one run.

So when I went to sign in and saw my name written next to the dreaded West 1 run, I got nervous.

The morning started out well enough that I was lulled into a false sense of security. Madge simply curled into the fetal position and refused to unclench the entire time I dressed her (while she lay in bed) and put her into her wheelchair, and cleaned her face and inserted her dentures. Lillian tried to slap me while I toileted and dressed her, but she was too tired for much and was easy to dodge. The others mostly cooperated.

Then it came time for the after-lunch rush to get EVERYONE out of the dining room, toileted or changed, into bed or a regular chair (no wheelchairs) and into clean clothes if they got food all over them. This didn't go as smoothly. Lillian grabbed a huge chunk of my hair and yanked, yelling "you said mashed potatoes! YOU SAID MASHED POTATOES! YOU SAID THAT!" and kicking me as I put clean pants on her. She also managed to slap me across the face while I tried to stand her up from the toilet. Madge was no longer content to curl into the fetal position and instead lost her damn mind when I had to pull down her pants to check if she needed a new disposable brief. Lots of kicking, plus another slap for good measure. Thanks, Madge.

I held it together, finished doing what I had to do, charted, and drove home. Walked in the door of my apartment and burst into tears like the giant baby I felt like being all day.

Days like that make me grateful for two things:
1. I will only have West Run 1 occasionally, and I'll know what to expect next time.
2. I'm married.

How horrible would it be to have a day from hell like that and then come home to a completely empty apartment? I couldn't handle it. I know lots of people like to live alone, but I will always want a roomate, a child, a family member, a spouse, or even a pet around when I have the worst day of my life like that.

As it was, I burst into tears, changed my clothes entirely (I was covered in pureed food after trying to clean the witches of West 1 after lunch) and got into bed. My husband fixed me up with ibuprofen, an ace bandage, a bowl of cereal and soymilk, and an episode or 3 of Jeopardy.

I survived, but I sure as hell didn't do it alone!

Oh, another thing I'm grateful for? They make halidol in cream form. That way when someone is totally freaking out, if they have orders for it, the nurse can rub some cream on them to get them to calm down. If I ever meet the person who figured that one out (and had the common sense to know that pills and injections are a Bad Plan for anyone who needs the halidol that badly) I owe them a medal or a plaque.