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.

Me + Med Cart = True Love

I fricking love my new job at my same facility. I have more independence and autonomy, which is AWESOME when my coworkers are being douchebags like they were today. I'm learning a lot and becoming more med-literate, which is helping as I do my nerdy stuff like look up decision making flowcharts related to different behaviors and how to manage them. Now I can look up "screaming" on www.alzbrain.org and am familiar with some of the medications they suggest.

Also, I'm good at getting all my residents to take their meds. Even the paranoid ones. And I'm starting to remember who takes what so if I see Sally Lou limping and say "Does your foot hurt?" and she says yes, I can remember whether I give her routine tylenol or not, and go run and get it right away. Or if I see Harry starting to get hinky and rearrange his furniture while wearing lots of layers, I can think "Do I give him behavioral meds? Yes! Now might be a good time for that!"

Now I'm feeling guilty that I said my coworkers were being douchebags. Really it was only 2 out of the 12 that I saw today. And it's the same 2 that are always like that. One is just honestly very dumb, and so it's really hard to communicate with her. Example: our facility has two wings, East and West. On East, most of the residents can walk, talk and feed themselves. On West, they don't. My dimbulb coworker has been there for probably 4 months and still cannot tell you which is which. Or where each resident's room is. These are things that normal people knew within 2 weeks of working there. Not the sharpest tool in the shed, that one!

So I love getting to wheel my cart around, popping pills, doing my paperwork and phone calls to family, and not having to chase down Dimbulb to help with a 2-person transfer or Lazy to watch the floor while I go give a shower.

Oh med cart, I love you so much!

Superstitions

The other night after work, I was telling Mr. Polly about my day and he said something like "and tomorrow they'll all try to escape" and without thinking about it, I reached over to knock on the coffee table. Because at work, whenever anyone says something jinxy (be it "Wow, what a quiet night" or "They're all so calm today!") we all immediately knock on wood.

I think this is common to all healthcare workers, in nursing homes or in hospitals. Lots of people are superstitious about death and ghosts as well. Since my buddy Darlene passed away, many of my coworkers have been extra worried about our other residents when they get wheezy or have an unresponsive episode, because they think death comes in threes.

We all metaphorically batten down the hatches whenever it's a full moon as well. Seriously, the weirdest stuff that my old folks have done has all been during the full moon. Walking around in the courtyard in the cold weather with no pants, shoes or underwear? Check. Falling asleep in someone else's bed and then insisting that yes, those dresses in the closet ARE yours and this IS your room (male resident)? Yep. All during the full moon. Eating fake plants, rearranging furniture in odd ways, hoarding all sorts of pillows under one's sweater? Those are everyday things.

Promotion

My facility is fairly small, as assisted living facilities go. We've got just under 70 residents, and usually have 1 charge nurse on shift supervising 6 caregivers/aides who take care of approximately 10 residents per shift. During regular working hours we also have the Director of Nursing and a med-tech.

All told, we've got maybe 2-3 different charge nurses for each shift, and they just take turns, and have 2 med techs. One does M-F, one does Sat-Sunday.

That doesn't leave a lot of wiggle room for call-outs, so sometimes our charge nurses end up having to work a double, and this last weekend our Director of Nursing (DON) had to come in and work a med tech shift, which she didn't like doing since she also had to come be the charge nurse simultaneously. Oops! That means she had to do all the routine med passes, PLUS all the treatements and assessments PLUS all the charting by herself. Ouch.

Med techs/med aides are a fairly new position that mainly work just in nursing homes and assisted living facilities. They can hand out routine meds to people who are able to actually take them independently - meaning that I could hand them a little med cup, say "here's your medicine" and they could then take those pills. If they had to have them crushed and in applesauce, or they weren't able to comprehend that they're taking medication, the nurse has to administer it to them.

Med techs have to be trained, need to have a basic understanding of pharmacology (how drugs interact, what they do, when to give them vs. when to hold them) and be responsible enough to handle narcotics honestly and chart appropriately.

Our DON decided we need another med tech because right now there is no backup if one of our two gets sick or goes on vacation.

Normally she would advertise within the facility to see who might like to apply for it, but this time, at our meeting, she apologized for not doing so but said that she had one person in mind for the job for a while now and was glad that this person accepted the position. She'll be training the new med tech starting this week. The new med tech is ... ME!

That's right, guys, Polly is going to learn a lot of new skills, be paid a little more, get to wear cute scrubs for the first time, and get more responsibility!

This is huge for me. I'm really excited, proud, and nervous.

Med Tech Polly, coming soon!

Death, Extended, and Death, Interrupted.

In the 3 or so months I've been working at the GreatRep, 4 of my residents have died. Since I'm pretty new there, I haven't had a chance to form the long-term bonds with them that some of my coworkers have, so it hasn't affected me as deeply as it has for some of them.

This most recent one, Mr. 4, was the hardest for me personally. Partly because he and his wife were new to our facility and got there around the same time as I did. Partly because he went from being fine, to having a major health event and being sent out to the hospital, to coming home to us already on comfort care and ready to die. His family was pretty amazing; one of their adult children spent the night in the room with the parents the entire time. Mrs.4 really appreciated that, and I think it eased a lot of the burden on her. Mr.4 hung on for several days despite being NPO (nothing by mouth, including food or water). We turned him every 2 hours, kept him clean and comfortable, and his family watched him go through the whole process. Not just their children, but nieces and nephews, aunts and uncles, the whole gang was there.

Providing care to someone who's dying takes on a whole new dimension when their family is there, watching you, sometimes crying, sometimes joking, just trying to maintain some kind of life during that limbo. It really drives home how your patient had a whole entire life and millions of experiences before this one, and it makes it sad that they have to end this way, with a slow dragging towards death.

Mr. 4 passed peacefully, and before he went I promised him we would take good care of his wife. It's hard to know what to say to someone who's just been widowed. Mrs. 4 knows what happened, her memory is still fairly intact. It's hard to force myself to reach out to her when I'm afraid that saying Mr. 4's name will make her sad. But she's already sad, and she knows we all cared for him before he went. So I keep making myself check in on her, ask how she's feeling, and so on.

I thought dealing with the dying people would be the hard part, but it's their families that I ultimately feel sad for.

So it made it all the sweeter when I went to Jimmy's wife's birthday party today and found out that she is no longer on hospice care! Mrs. Jimmy has held on so much longer and stronger than anyone anticipated, and I'm so glad that Jimmy won't have to face that loss in the immediate future after all. I got to tell him jokes and give him hugs and kisses and watch him hold his grandkids while his wife opened her gifts and ate her cake. Pretty nice to see death get interrupted.

(for newer readers, I wrote about Jimmy back when I first started this blog, here: http://scrubsandcrocs.blogspot.com/2010/07/authenticity.html ; I don't work at his facility or care for him through HomeCare anymore, but I'm in touch with his family so they invited me and my husband to the party today - yay!)

Antipsychotic Drugs and Chemical Restraints

At the GreatRep, and pretty much all long term care or memory care facilities, there is a Bill of Rights list for all the residents posted prominently around the building. One of these rights is "to be free of all restraints, including chemical restraints". Logical, right?

As an aide, I have very little to do with the residents' medications. I report symptoms to the charge nurse, who then decides what to do from there. A few of the residents are on frequent doses of the same medications for certain behaviors or symptoms and so we all know what they will probably get in response to our reports of their symptoms. Lillian has severe pain and it's very obvious when it's not being controlled well, so when she hurts we all know she needs her Morphine. LuLu repetitively hits herself, which lets us know it's time for more Haldol or Ativan for her.


A lot of science news articles state that the use of antipsychotic drugs for dementia is a bad practice. It's not intuitive, because if you look at the list of symptoms of say, schizophrenia:
"They include disorganized thought processes and disorganized behavior as well as delusions and hallucinations. The disorganized thought processes are seen primarily in speech such as rambling and 'word salad'. The patient may babble about various different topics one after another, which to the normal person, do not appear to be connected in any way. The phrase 'word salad' describes a patient’s incoherent speech, which lacks correct grammar and any obvious purpose. Disorganized behavior will be discussed in a following section. Hallucinations are false perceptions; patients believe they can hear voices others can’t and sometimes see or feel things others don’t. Delusions are misinterpretations of events and their purpose such as when patients believe the CIA is plotting against them or that their psychiatrist is involved in an assignation attempt against them. Schizophrenics cannot be reasoned with over their delusions; reasoning and discussion leads to the patient’s mistrust and anger." (1)

All of that is very typical of dementia patients as well. You'd think since the symptoms are so similar that the treatments can be as well. But apparently not, since the use of antipsychotics in dementia patients increases their death risk, for reasons unknown(2).

To be clear, it seems like Doctors are warning against antipsychotics to control behavior that is merely "annoying" for caregivers such as wandering, agitation, uncooperativenesss, etc. For behavior that is truly dangerous for the patients or everyone around them (self-injury, extreme combativeness that can physically injure both caregivers and the patient, etc) I think it can still be merited.

Which is why when I read articles like this one, "Alzheimer's Therapy Focuses on Care: Giving Alzheimer's Patients their Way, Even Chocolate"(3) part of me gets really frustrated. It seems like outsiders and the media tend to think that some of the interventions we routinely do on our patients are for our own convenience, and therefore wrong. I loved that it explained about emotional states lasting longer than the patient's ability to recall or explain the reason for the emotion; however I would have liked to have seen a few more realistic examples of how this can be implemented. Things like when one of my widowed residents becomes anxious, thinking her husband is injured and missing, it's more productive to let her talk about that briefly, then steer the topic to her children, who are all alive and well. She calms down and gets happier as she tells us about what they were like when they were little, and shows us the quilt her daughter made her. That way, when the conversation ends, it ends on a happier note, which is more likely to stop her anxiety cycle about her husband. And of course there are the more conventional redirections like trying to get her involved in an activity or focused on something else.

I just hate the idea that we're somehow failing LuLu because sometimes medication is the only way to get her to stop hitting herself. You can redirect her, feed her, hold her hands gently, all sorts of things, but if she's in that mood she will not be deterred and it's not safe for her.

Patients have the right to refuse care, for example. But an incontinent person who refuses to be changed for 8+ hours isn't making a reasonable choice and is endangering themselves by hugely increasing their risk for a pressure ulcer. So sometimes we just have to force someone to let us perform very basic hygeine on them. And it sucks. And sometimes the only way to do that without anyone ending up seriously hurt is to premedicate them, and sometimes even that doesn't work. I wish there were a magic wand to make combative people cooperate when you're trying to help them.

But for all the caregivers and family members who read that article, I want to tell them that baby dolls and chocolate are a part of the answer, and can be good tools, but we need more solutions. And that even as a profession, caregiving is rarely "convenient"; that's not why we do this work. So please give your facility the benefit of the doubt and ask first before assuming they're chemically restraining people for no good reason. It's a last resort, but sometimes it's the only way.

And I don't know if it really belongs on any patient's Bill of Rights. Because the truth is, they do have the right not to be restrained unless they're hurting themselves or others and nothing else will stop them.


1. About schizophrenia http://healthpsych.psy.vanderbilt.edu/AntiPsychoticMeds.htm
2. Antipsychotics and death risk increase http://www.webmd.com/alzheimers/news/20080616/antipsychotics-for-dementia-up-death-risk
3. Giving Alzheimer's Patients Their Way http://www.nytimes.com/2011/01/01/health/01care.html?_r=2&pagewanted=1

What a Winkle

I absolutely love the weird conversations I have with my dementia residents, and there's one that pretty much always takes the cake. "Cookie" hallucinates and can be very difficult to deal with, but she's often very focused on wanting to see a doctor and wanting every person she sees to be a healthcare professional. So I usually address her as Ms. Oven instead of Cookie, and emphasize that I'm a nursing assistant rather than a caregiver in order to get her cooperation. I once had to wrestle a wet incontinence brief away from Cookie, who gave it up only when I told her I needed the sample for the Doctor. Gross.

Anyway, over the weeks, Cookie has come up with some good ones; telling me the Borg are trying to get her when I go to wake her up in the morning, hitting on the life-size dancing Santa that we had up at Christmas, telling my female coworker what a "gorgeous guy" she is.

The other day I went to get Cookie up out of her armchair to go use the bathroom, and she had a little stuffed animal sitting on her walker. "Look at my Baby!" she said, as I approached her, "Isn't he cute? What should I name him?"

Her stuffed animal was a little moose, so I said "How about Bullwinkle?"

Cookie blinked at me for a long moment, then said "He's from . . . where? He's a Winkle, you say? Is he a Winkle?"

I answered "I think he might be, what do you think?"

"Yes, probably. A Winkle."

Oh, Cookie!

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!

We Heart Volunteers

We get a fair amount of volunteerism at the GreatRep. There are people that bring in dogs to visit with the residents, people that come read aloud to everyone, people that do crafts, people that put on musical performances. You'd think that all our volunteers would be pretty normal, but they're not. They're often just as weird as the rest of us in there (staff and residents both). There's the guy that comes to sing and play guitar almost every week, who's incredibly tone-deaf. There are people whose ideas of "activities" are so half-baked that I really worry they're going to get scared and leave. There are people who set off the exit alarm every. single. time. they come and go.

My favorite are the well-meaning oddballs. We've gotten lots of them lately, it being holiday season and all.

Yesterday was extra awesome because the musical volunteer of the day looked a lot like If Wayne Newton Dressed Like Merle Haggard. He had a special synthesizer-thingie that made his backup music, and a microphone and everything. He set up in the dining room, so we brought anyone who was willing in to listen to him while we passed out snack.

First of all, you've gotta have balls to show up and sing to a room full of people with dementia; they're not your typical audience and they won't be shy to let you know if they dislike what you're doing. And if they do like it, they may not show that at all. So I give the guy credit for that, plus he really did have a very nice voice. He sang Christmas songs for the most part, and did it well.

The part that really made him the December Standout in my book is that he'd stop between songs to do a little patter as if this were a nightclub. So after a rousing rendition of Rudolph, here's what we were treated to:

"So a few years back, my wife and I were driving home from cutting our Christmas tree and she looks out the window and sees some reindeer in the field we're passing by. She's shocked because she didn't know that reindeer were a real animal! So we pull over, and walk around the truck, and go up to the fence and look at the reindeer. About now I decide it's time to play a little joke on my wife. So I says to her 'Honey, what you might also not know about reindeer is that if you talk to 'em, they'll talk back to you.' She looks at me skeptically, but I'm insisting here, 'No baby, really, go up to one, and say niff and it'll say niff right back to you!' She told me I was full of it. So I tells her again 'Just say niff niff to them, it'll work! They'll say niff back to you.' "

(he went on like that for a while repeating "niff" a few more times to make sure we all knew he was trying to get his wife to say "niff" to the reindeer)

"I said really, I know it's strange, but you just go right up to them and say niff..."

which is when LeeLee (resident) decided she's heard "niff" enough times and interjected "What the hell is that?" which then made me laugh hard and silently.

Her reaction was way funnier than the climax to his story, which was that he came around the side of the truck and heard his wife whispering niff to the reindeer to see if it was true, and he laughed at her.

LeeLee knows what's up. "Niff"??? Really. What the hell IS that?

Odds & Ends

I finished up my evening shift training this week, and it's official: I like 2nd shift better. Not having to wake up at 5am is a big plus, as is only having one meal (dinner) during the shift. The sundowning residents are a drawback. The biggest reason is the coworkers, though. The eve shift coworkers are much more laid back and helpful - day shift coworkers have (99% of the time) been helpful with me (probably because I'm new) but with one another? Not always. Plus one showed up with a disgusting infected finger and was about to go out on the floor to work until we all basically tackled her and got the charge nurse to look at it and send her to a clinic STAT. Ew. No common sense on that coworker, that's for sure.

Tip for the common sense impaired: if any part of your body is swollen and infected, and especially if it's leaking pus, GO HOME AND GO TO THE DOCTOR. Infection can spread to your bloodstream and kill you.

Moving on.

Funniest conversation I had with a resident this week:

Lady (freshly out of the shower, seated safely on dry chair & towel): Can you dry my back?

Me: Sure, here we go.

Coworker pops in, hands me a med cup full of ointment: This is her ointment from the nurse, can you put it on when you do her pericare?

Me: Sure, where?

Coworker: (makes incomprehensible hand gestures)

Me: Bottom or vagina?

Coworker: vagina.

Me: okay thanks.

Lady: Are you gonna put that on my vagina?

Me: Yes Ma'm, I am.

Lady: Do you know what you're doing?

Me: Yes Ma'm, I have my gloves on so I won't give you any germs, and I do know how to do this.

Lady: Well... all right then. Wait a minute. Are you married? (giving me the suspicious stink-eye)

Me (heroically not laughing): Yes Ms. Smith, I'm married. I promise this will not be a personal thrill for me, I just want you to stay healthy, and this is my job. Okay?

Lady (relived): Oh all right then.

I swear, I never know what these people are going to come up with. And what was up with my coworker's crazy gestures? I'm going to do that to her next time I see her. In no world is what she did a gesture for vagina. Maybe "pick up a lobster this way" or "the elves heads are shaped this way" but not "vagina not hiney".

Coolest medical phenomenon I saw this week: Raynaud's phenomenon. It's not harmful or painful or anything, just a startling color change in extremeties when someone is exposed to temperature change. Such as getting out of a warm shower. One of my resident's fingers looked a lot like this photo from wikipedia (the bananafingers not the blue ones). Charge nurse checked and confirmed that was all it was, and they were back to normal very quickly. I'd heard about Raynaud's on a podcast but hadn't seen it in person before, so that was cool.


Other than that, I'm doing my state-required training for the last 3 days of the week, so that'll be boring but maybe useful, and definitely not too tough. Which is good since I burned up my throat with an unfortunate burrito-from-taco-truck choice yesterday and it's still sore, so it's nice not to have to speak EXTRA LOUD for anyone for a bit. Sidenote - wish I could handle spicy food better.

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.

Lanie

Lanie is a very determined, frequently confused lady who lives at the facility I work at. Up until recently, Lanie lived in our locked memory care unit. This is something that most bigger places offer, because think about it: people with memory loss tend to wander, but don't have the skills they need to keep safe while they wander around. They might be trying to get back to a house they lived in 40 years ago, and not realize that they need to watch out for cars when they're trying to cross the street. So a locked unit may sound harsher than it really is. At my facility, it's not even physically locked; you enter a key code to enter or exit. If you fail to enter it right, it sets off an alarm and one of the aides from that unit comes to see what's up. If you're an old person escaping, they talk you into coming back. If you're a new employee that forgot to enter the code, they laugh and turn off the alarm. Even if you did the same thing earlier that day. Oops.

But back to Lanie. Lanie is a skinny little old lady who walks with a walker and whose apartment is sparsely decorated. It features Jesus and Baby Dolls prominently. Lanie is generally content to just sit in her living room, looking out the window, or maybe flipping through a magazine or catalogue. When it's time to eat, one of us gets her and walks her to the dining room, seats her, and orders whatever we discussed with her earlier, since she'll blank out when it's time to tell the server what she wants.

Occasionally, Lanie gets hungry a little earlier than normal and stalks the halls crankily, complaining about how they moved the elevator again and she can't find the dining room in a crazy place like this.

One of my job duties is to take turns with the other aides passing out evening snacks for the diabetics after the nurse has done blood sugars and insulin injections. This keeps anyone from bottoming out overnight (hopefully) and is usually a pretty fun little chore, especially if I've managed to snag anything unusual from the kitchen to make it more exciting. The night they gave us Activia instead of Yoplait yogurt was a big one, let me tell you! Although we staff were all a little worried we'd be up to our elbows in poop the next morning.

Lately, the last few times I've been wheeling that snack cart up and down the hallways around 8pm, Lanie has popped out of her room looking for all the world like a geriatric CIA agent in some combination of a nightie and another garment. One night she had jeans aka "dungarees" on under her nightgown. My favorite was when she had on her pink trench coat over it, collar popped and chin low.



Lanie summons me with a loud "PSSST!" on these occasions, gesturing impatiently for me to come huddle in her doorway with her. I abandon my snack cart mid-pass, and walk over quickly to her. What Lanie has to say on these occasions is usually some variation on how "That room is a mess and I'm LOCKED IN there, and I can't get it straightened out!" Never mind that she's out in the hallway and therefore not locked in anywhere. Lanie's got something in mind and she wants it done now.

I usually start troubleshooting with "Do you need to go to the bathroom?" followed by closing her blinds (always a big relief) and pulling back her covers (usually gets me a "THAT's the stuff! Good girl!"). If Lanie is still feeling locked in, I check to make sure things aren't in unusual places. The other night, she'd partially disassembled her air conditioner. Not because she was too hot or too cold, just to unlock herself, you see. So I put it back together, which earned me a hug and the privilege of hanging up her pink trench coat.

I don't know much about Lanie or what she did with her life, but I like to imagine that maybe she was a great chess player, a spy, or someone who worked underground in tunnels. She's got a low-pitched gravelly voice and intense eyes. I can see her formulating strategies and melting around corners and into shadows. Lanie may just be getting unlocked in her apartment now, but I bet she could crack safes before. Maybe that's why Lanie's not in the memory care unit anymore; those doors couldn't hold her.