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?

Eeek.

Sometimes I want to hate doctors for no reason. Sometimes I probably wouldn't hate them for whatever if I actually understood what their reasoning is for things. This is probably one of those times. There must be a perfectly good reason for requiring a clean-catch urine sample to diagnose a UTI even if the patient has had UTI's in the past and the care staff can easily recognize the signs. Even if the nurse could do a dip on a regular sample or send that out to the lab for verification.

(note: UTI = urinary tract infection; little old ladies get these a lot and they can cause pain, low-grade fever and increased confusion. They're fixable with antibiotics.)

But it seems stupid and mean to me, the lowly caregiver, that we have to hold still a really sweet lady with dementia, and the nurse has to put in a catheter for a few seconds so we can get that elusive clean-catch urine sample. We were all almost in tears at the end of it; I held one hand and food, a coworker held the other two, the nurse did the cath, and another caregiver held the light for the nurse so she could do it as fast and accurately as possible. Our poor resident was upset, we were upset, and I thought the Doctor Is Stupid. We got our resident cleaned up and into jammies and tucked into bed, and then she was okay.

I hope there's some good reason for this though. Or if not, that we don't have to do this to my poor resident again.

Who Manages Nurses? Nurses.

After pumping myself up, studying my nursing assistant flashcards, and getting all dressed up fancy-like, I got to my interview at the Skilled Nursing facility only to find that in fact, they don't even consider candidates who aren't certified. Crap.

Since the facility is affiliated with a hospital, and the hospital is part of a multi-state network, they do all their applications online and have outsourced recruitment to a different company. This means that even though I applied online like I was supposed to, did my phone interview with the recruiter and did it well, it was only today that I actually spoke to anyone who knows about nursing. A nurse, and a nurse manager at that.

Oh well.

This is why nurses manage nurses. You know on TV shows how the doctors are always bossing around the nurses, telling them to do this and that? And sometimes even firing them or threatening to? It doesn't really work that way. Doctors and nurses are paralell professions that work together, but do not supervise one another except to serve as checks and balances against one another. Doctors are responsible for the health of the patients and so are nurses. If one staff does something wrong, it's the other one's job to catch the error and correct it. Sure, doctors make more money and are often more respected, but doctors are not the ones who hire and fire nurses. Nurse managers are.

So what happened today was a good example of why nurses hire other nurses (or nursing assistants): it's a complicated little world, nursing is, with tons of niches and jobs to fill. And non-nurses don't always know or understand all the distinctions between the various certifications.

And in Long Term Care (nursing homes, assisted living facilities, and the like)? You almost never see a doctor on premesis. Sure they come and assess patients occasionally, but for the most part, nurses do that. Nurses fax doctors to get meds and treatments ordered, and then once they get what they asked for back, they administer the treatment or med.

Have you heard the expression "Doctors diagnose, Nurses heal"?

Today it should have been "Human Resources interviews, Nurses hire".

Oh well, I'll be back with certification in hand by January. By the end of this month I'll have worked enough overtime to pay for a private CNA course out of pocket so that I can be finished in just 3 weeks, take the state exam, and get myself certified. Hooray!