Tweet round-up

Real bloggers do this, sometimes, don't they? I think the Bloggess does. She calls it phoning it in. Anyway, here are some of my most recent tweets for those of you who don't have the pleasure of subscribing to my brilliance there.

• March 25th: I feel genuinely excited to be about to clean my bathroom with lemon comet while I listen to an EMT podcast. 30 isn't too different from 29.
• March 26th: PT [physical therapy]asked me to come help push a guy's leg and then when I did it went kablooey and sprayed blood. And I didn't faint!
• April 7th: My shift is half over and very boring, I'm watching an old man watch baseball.
• April 8th: My confused elderly patient told me our relationship won't work if I don't stop lying to him & pretending we're at the hospital.
• April 15th: Hospital riddle: you're working a double and get a 1:1 for a confused impulsive fall risk old man. What word do you least want to hear him say when you walk into the room? ...My real answer (and what he said) = Vietnam. Other contenders?
• April 27th: What should I watch on VHS, crossroads or 3 men and a baby?
• April 29th: I'm still sick. Wheen I finally get better I have a new life goal: pinup girl gator wrestling queen. Seriously, I like Louisiana, waterproof makeup, alligators and crocodiles in general and I could dust off the fisticuffs.
• today: OMG I just got to cut off a patient's undies for the first time: today is AWESOME!!

Oh, Gross! Again.

Now that I'm working in the hospital, I see waaaaaaaay more disgusting things than I did in assisted living. I won't say that hospital is definitely more disgusting than home care because sometimes people's homes are just beyond nasty. But assisted living tends to be pretty decent.

So now that I've been exposed to more things, I figured you all would be delighted to know what I find the most icky.

1. The Worst Smell Ever; when someone keeps vomiting blood and poo. It's just so, so bad. I mean it's three unpleasant things all mixed together. And it smells ungodly.

2. Trach suctioning. I know, not nice. It's necessary. Sometimes people need that tracheostomy (a hole at the base of their throat in front) to help them breathe. And sometimes that hole gets plugged up with mucous. And then that mucous must be suctioned out. And yep, it's exactly as oogy as it sounds. Especially if they're coughing and end up with puddles of phlegm pooling on their chest, which then also must be cleaned up.

3. Pulling out lines. This is more of an "I feel phantom pain imagining this" reaction on my part. The people who do this aren't with it enough to be as bothered by it as a normal, alert person would be. But the sight of someone ripping out their own IV, or (God help them) other lines or tubes just makes me shudder. Doesn't matter what the line is or what it's putting in or out of the body, the idea of them ripping out really grosses me out.

...and lastly, one that I'm surprised is not that bad to me? Wound packing and unpacking. When someone has MRSA or whatever and it eats a hole into them, that wound must then be frequently packed full of stringlike bandaging, then have that removed, and replaced with clean packing. It sounds awful, but it's actually pretty cool. It's what allows people to heal from the inside out, rather than the outside in. You wouldn't want your skin to close up over a big empty pocket in your body, because that wouldn't be structurally sound. So instead this way it heals properly. But it does look pretty weird.

A Butt-Sized Bra and other stuff

Things have been pretty busy over at the GreatRep, what with activities department people quitting by pulling the ever-popular no call/no show, and caregivers getting pregnant and then never staying through a shift. I laughed and laughed when one of my charge nurses got snippy about that, saying "I worked here throughout both of my pregnancies. I've vomited in almost every room in this building! She needs to get her butt in gear and work through it because this illness? Is SELF INFLICTED!"

So we're all pulling extra shifts down there to try to keep it running smoothly enough until we can get more staff hired. And I'm tired, but I still like my job.

Highlights of my week: I have this resident, Mildred, whose children do not speak to her. I don't know why, I assume she did something to them to make them dislike her back before the dementia, and she's certainly a handful now. I genuinely like Mildred and find her funny, which is lucky, because as one of the two Med Aides at my facility, it falls to us to help Mildred wash her panniculus daily. Panniculus is a fancy word for "apron fold" or, less politely "big belly that hangs down enough to make a crevice that gets ouchy unless kept clean and dry at all times". Mildred's Granddaughter is a huge pain, and refuses to get her Grandma any new clothing that is the correct size for Mildred and her panniculus to fit into. So I'm at Goodwill the other day, looking for scrubs (found a cute pink top, too!) and I see a GINORMOUS bra there. Big enough that I could almost fit my butt into one of the cups. Perfect for Mildred! So I spent the $2.99, bought it, embroidered her name onto it, and brought it into work. Then, not wanting the buttsized bra to fall victim to our industrial washing machines, I wrote the following note, complete with illustrations of the bra, and taped it into Mildred's closet:

"Attention Caregivers! I got lucky and found a Mildred-Sized bra at the Goodwill. Let's only wash it on shower days so that the hooks can survive longer; I bet I won't find another one this big at Goodwill again. Thanks, Polly"

So hopefully it'll survive and Mildred will start being a little more ... contained. By her garments. Speaking of which, if anyone has maternity pants with those giant elastic waistbands, size 18-ish? Send 'em along. I'll embroider those with her name too, and then she'll be comfy and modest, both of which would be a welcome change to all of us over at the GreatRep.



Then the very very best part of my week was that the visiting wound care nurse came, and very enthusiastically showed me the pressure sore she's treating on another one of our residents, and the stuff she's using to treat it, and all sorts of awesomely disgusting and wonderful things! I told Mr. Polly about this, and his response was "There's such a thing as a wound care nurse? Why aren't you that? You would be in heaven. You should go be that." And he's right. I frickin' love that stuff. I googled the Tree Man (have you?) and am fascinated by burn treatments, weird rashes, deep pressure sores, etc. We don't get much of that at the GreatRep because really, there's no excuse for our residents to be developing pressure sores that get beyond a stage 2.

The wound care nurse was in for a lady whose pressure sore got deeper than we'd have ever let it get because she had MRSA. Not because we didn't position her correctly, or use cushions, or any of the other stuff we did. Just so you know.

So much as I'd like to see pressure ulcers that go down to the bone, and wound-vacs, and tunneling wounds... where I work isn't the place to get all that.

But I looooooooove when the wound care nurses come in!

Dementia Facility FAQ's: What family members are probably wondering.

We've had a few tours come through the GreatRep lately, as well as out-of-town family members come into town to see some of our residents. It's interesting to see how people react to the place their first time, and it made me think about what they're probably wondering but don't ask. So here's my version of what you might like to know about a dementia facility, and my answers:

1. Doesn't it bother them to know they're locked in here?
Surprisingly, no. None of my residents have ever said anything like that to me, and very few are aware that they cannot exit certain doors without setting off the alarms. We have secure courtyards they can go outside in, and we just redirect them away from the front door if they're up there fussing with the keypad (it requires a keycode to open it without setting off the alarm). People with dementia are very inwardly focused, for the most part, and get more so the more their disease progresses. So our little world inside the facility is usually big enough for them. It helps that it has a circular part of the floor plan which is good for walking/pacing.

2. Why are all those people dozing in chairs? Why aren't they awake?
The most common answer is that most of them don't sleep all through the night. I just worked my first overnight shift at the GreatRep and was very surprised at how often I was informing people that no, it's still the middle of the night, and helping them back to bed. I figure that even the ones who can't get up and talk probably spend a good portion of their time in bed awake too, so they just kind of doze off whenever they're tired. They're on more of a 24-hour schedule, like a newborn. And yes, if they're hungry or thirsty in the night, we give them snacks.

3. Why is that lady making that noise/yelling for help/hitting that chair?
I don't know. Sometimes repeating the same words or phrase over and over is soothing for people with dementia, it's called perseveration. Unfortunately, sometimes that phrase is something hard to listen to, such as "help me help me help me" or "hurry up hurry up" or a repetitive action, like banging on whatever is in front of them. We try to mitigate, redirect, and keep them occupied with other things but there's nothing we can really do to make someone stop doing a behavior like that.

4. What about privacy? Won't you sometimes be doing some things in front of other residents? We had a family member complain this week because the podiatrist was in to do foot care, and was set up in a room at the end of the hall which isn't closed off from the hall. They thought it was inappropriate to do foot care out in the open. The thing is, you have to consider the logistics; sometimes there isn't enough space in each person's room to set up a podiatry station. Also, see #1 about the inward focus. Very few of the residents pay too much attention to what the other residents are doing for any long span of time. Some have friendships and stick together, but then they don't mind if their friend is present while their feet are being worked on. We don't change their clothes or use the restroom in front of others, and if they're getting a brief change in bed, their roomate is asleep/cannot see over to their side of the room plus it's still quite dark.

5. Why are you feeding them? Why are they incontinent?It just happens that way; over time, almost everyone become incontinent to some extent, and eventually they stop feeding themselves. That's why they're getting 24-hour care now. We use mechanical lifts called sit-to-stands so that we can still give everyone the chance to use the toilet, and whether they void on it or not is up to them. That's what the briefs are for. I think this is probably one of the biggest reasons I'd have a hard time keeping someone at home and caring for them myself. Everyone incontinent really should be changed approximately every 2 hours. I couldn't do that at home. We've got a full staff and we all get to go home and sleep between shifts, which is why we're able to do our jobs well. Having worked in this field and seen how hard it is, I think I would be totally willing to put myself or a loved one in a good care facility; I just don't see how it'd be feasible to do otherwise.

The Opposite of the Tooth Fairy

One of the things I was really excited about when I got my job at the GreatRep was that (although I don't have health insurance) I get dental insurance! I used to love going to the dentist when I was a kid and never had a cavity.

So I happily made an appointment for the first time in 8 or 9 years. Woohoo, I thought! I'll get a cleaning and be on my way. Plus the dentist I picked is kind of gimmicky and they give you a paraffin wax hand treatment and free tooth whitening if you're a new patient with them. It'd be nice! Like going to get a haircut, right?

I was wrong. So wrong.

They did x-rays, and then said I had 5 cavities. Oh no. I got scared.

Then they said they could fix all 4 little ones right then and there, and I wouldn't even need to be numbed. I relaxed and thought okay, this must not be any big deal.

Then I found myself with my jaw jacked open wide by a plastic tubey mouthguard that was sucking up all my spit, fighting off panic as the dentist drilled into my teeth and it smelled like something was burning and my only means of communication was to raise one of my stupid flippered hands (still sandwiched into giant oven mitt thingies because of the stupid paraffin wax). Raise my left hand if I'm not okay? OW! I wanted to raise my left middle finger.

Anyway, I got the damn slippers off my hands so I could at least give a thumbs up or down, and got some numbing something to help me make it through the end of Fire And Brimstone In My Mouth.

My God, no wonder people hate going to the dentist! I never understood until now. But I have to go back 2 more times this month. And get the muscle inside my mouth (the one that's just below where a labret piercing would go) cut and cauterized. Oh shoot. This is not the way I remember trips to the dentist, people. Everyone now has my sympathy. Everyone with and without teeth, bless your hearts, every single one of you.

And here's a visual of the labret piercing. Not mine, I don't have one. All I have is an about-to-be-slaughtered muscle behind there. Crap.

Maybe I can give the dentist one. With a dull needle.

Vasovagal EXTRAVAGANZA!

We had a new nurse on 2nd shift tonight, so all us aides were trying really hard to be helpful, make sure she knew who each resident was so she wouldn't give them the wrong meds, tell her who to take seriously when they did/or said things and who to ignore and they'll stop.

But because she's new, she didn't know the difference between "Polly gently flagging down the charge nurse to come into a resident's room" and "Polly panicking and trying desperately to get your ass in here STAT but I can't leave this woman alone right now". So NewNurse wasn't as fast as I wanted. But it all turned out okay.

You see, there's a little thing called "vasovagal response" or, as you may learn to call it "fainting because you need to poop or are pooping".

This clip from Scrubs illustrates it very nicely:



Yep, it's a real thing. Pooping and fainting. What a combo.

There are a few of my old ladies that have this occasionally, but the one I was working on tonight had not ever done so since I've been working at the GreatRep. So you can see why I was alarmed when Nellie lay limp and unresponsive (but not dead! I checked that first!) in her wheelchair. I patted her hands with increasing force. Called her name with increasing volume. Patted her face. And then I brought out the big guns. Nellie HATES it when you touch her mouth or brush her teeth, and the absolute most annoying thing you can do to her is stick your fingers in her mouth. I popped on a glove and stuck a few in there, to and got no reaction, which is when I panicked and desperately waved NewNurse to come in NOW.

She also couldn't get Nellie to come to for a while, but after we both hollered and patted and pestered the hell out of her for a bit, Nellie cracked one eye open to glare at us, at which point I started breathing again. And got a whiff. And then a big, poo-shaped light bulb went off over my head. It spelled out VASOVAGAL in morse code. And Nellie woke up in time to have the biggest BM I've ever seen her have in my life. I mean softball sized, and round like one too.

Sheesh.

So my little poop-weasel is all right, and was back to normal within a few minutes of passing that beast.

And you know what? Seeing it didn't make me faint too. Whew!

PS Next weekend is my last weekend of clinicals which means I'll have a real live day off on St. Patrick's day! I cannot wait!

The Fury of the Little Old Lady

What I love about the generation that's old right now is the deeply ingrained sense of politeness and good language they have. There are exceptions, of course, especially when someone has dementia, but in general? Even when they are LIVID they don't tend to use curse words, and their expressions are antiquated enough to be funny and charming unintentionally.

I don't think the baby boomers are going to be that way. They'll be dropping f-bombs and the like, not exclaiming "Like FUN you will!" indignantly. And that's a shame.

One of my residents at the dementia facility is a perfect example of this cute-when-angry quality. Marla is in her late 80's and on hospice, but only recently became incontinent at night. Up until recently, she'd just use her call light to get up and go to the toilet when she needed to. So Marla is very, very unused to being changed in the night. And during the day, she gets Ativan and all the usual meds that help people remain compliant. But they wear off at night, so Marla gets feisty around 11pm. This means my rounds usually go like this:

I tiptoe into Marla's room, turn on her bathroom light so I can see, and say gently,
"Hi Marla, I need to check your undies, M'am, you can keep sleeing if you like"
I pull back the covers as little as possible and pat her crotch with my gloved hand, to see if her brief is wet or dry. 90% of the time it's wet. Shoot. I get a new one out, wipes, pull the trash can over to me, and ready a new incontinent pad.
"Marla honey, you're wet. We need to get you dried off so you'll stay nice and warm. These panties are wet. I'm going to take them off now."
(Marla groggily bats my hands away)
"Marla, sweetheart, I know you're tired but you're all wet. I'm getting you dry. It'll just take a minute."
(Marla wakes up all the way now, and oooooooh, she's not happy!)
"What in the HELL are you doing? Get outta here! Can't you let a body sleep? Go away! Get OUT!"
"Marla, I know you're tired, but you wet the bed, hon, so I'm getting you clean and dry."
"I did NOT! I've never done that in my LIFE!"
"Well somehow your underwear and blanket got wet, so you need new ones. You can just close your eyes, I'll do all the work and then let you get back to sleep."
"You are SICK! You people are sick! Quit taking off my pants all the time! Sick!"
"I'm sorry, Marla, we're halfway done now. Wet ones are off, I need you to roll towards the wall so we can pull up the new ones. Okay, I'm going to clean you with a wet wipe, there we go, okay, now one more big roll back towards me. Good. All done, you can go back to sleep now, thank you."
"You're sick. Don't come back."
"We'll see. Good night Marla."

The best was the time I forgot to bring a new incontinent pad to put under her, and said "I've got to get you a blanket, I'll be right back." Marla was angry to the Nth degree, and spat out "I WON'T miss you!" I know I shouldn't have, but I had to laugh at that one! How can you get mad at someone who says that to express their fury? It's adorable.

I do have one new resident who swears when I change him at night, but again, I can't take it personally. Warren starts out sounding fierce, but then drifts off again, sliding into "word salad" toward the end. So his tirades come out like "No no no no no ass BITCH get away bitch ass bitch no no no you can't you can't no fat bitch ass fuh fuh fiddle faddle diddle daddle doodle draddle . . ." and then he's out again. Starts out offensive, ends up silly. Every time.

And like every facility, there's that delightful 30% or so of little old ladies who are just sweet as pie no matter what. I wake them, ask if they need to get up and go to the bathroom, check their briefs, and usually get a hug and a kiss before leaving their room. It's pretty amazing. I really appreciate them, because I know I wouldn't be that sweet if someone woke me up every few hours every night of my life. But they seem to understand that I'm there to help them, and they love me for it. It's pretty great.

I like my old people at night, whether they're NOT missing me or giving me kisses for offering to help them to the bathroom. But that's not going to stop me from trying to rock my interview for evening shift at the skilled nursing facility!

Night Shift Polly, reporting for duty

As you might have gathered from my lack of posting, I started my night shift job. And boy did it kick my ass. Because I still have my daytime homecare job. Oops. This has led to me pretty much looking and feeling like . . . well . . .

Hell.

I like the night shift job, though. It's definitely hard work, very physical, but by being there at night I can avoid any contact with management (often a plus at Assisted Living facilities where there's usually a conflict between nursing staff who want good care for residents and corporate management who want to cut costs). Also, I'm much more able to manage my own time - most of the residents are sleeping so while I must answer any call lights promptly, the rest of the timing is up to me.

During night shift, my work falls into 3 main categories:
1. Toileting and changing people, which is physically difficult and the hardest part of my job.
2. Cleaning and doing laundry, which I actually like doing.
3. Keeping an eye on the wanderers and trying to re-orient them and put them back to bed if possible (this is the dementia facility, remember?), which is the funniest part of my job by far.

The dementia facility is divided into two wings, each with 3 halls in them, and 8 rooms per hall. Some rooms are doubles, some are singles, and the whole facility isn't full right now. On night shift, each wing has one aide (me and this douchey guy that I'm so glad I don't have to actually see during work) and then there's a med tech there to give pain pills if needed, and cover our breaks, and clean the main areas of the building.

That means I'm responsible for about 30 residents during my shift, which sounds like a lot but in general is doable.

I arrive at 10pm and do quick rounds with evening staff, so that they can update me on all the residents, and if they didn't do their jobs, I have the chance to bully them into doing it before they can go home. More on that part later.

After they go, I read the shift reports, sign any care plan updates, and start my own rounds, changing and toileting everyone who needs it. This can take anywhere from 45 minutes to about 2 hours, depending on what state they're all in. Trying to change a fully grown person's diaper in bed when they are stiff and/or resisting isn't easy, and most of the residents have pull-up type briefs instead of side-tab, so there's a lot of rolling side-to-side involved. And frequently changing the waterproof pads underneath them. And occasionally, a full bedding change. Sheesh.

I do 3 rounds per shift, typically at 10:30pm, 2am, and 5am. In between rounds I do the laundry (sheets, towels, resident clothes), mop the dining room, fold the dining room linens and bibs, and answer call bells. It's enough to keep me pretty busy. If there's a really calm night, I may have the chance to sit and read for 15 minutes here and there, but mainly I'm up and moving the whole time. Which is good for keeping me awake all night long!

Ironically, as soon as I'd accepted the job at the dementia facility, the skilled nursing facility I've wanted to work at for MONTHS called me for an interview! I'm still not certified, or even in the course to get certified, but they have one wing I'm qualified for. So I go interview there tomorrow, and if they offer me the job I'll come up with a pro/con list between the skilled facility and the dementia facility to help me decide. I'll feel kind of stupid if I end up only working at the dementia one for 3 weeks, but like I've said before, there's massive turnover in this field so it's not like nurse managers are unused to it.

Wish me luck at my interview tomorrow!

Crossing the line

The other day, in between shifts, I stopped at a fast food restaurant for a rice and bean burrito. Tasty! Since the home I was headed to doesn't have any toilets without "hats" in them to collect urine, I figured I'd better use the bathroom there. I walked in and was hit with that cloying, suffocating smell, and instead of thinking "Oh gross, jeez!" like a normal person, I thought "Oh! It smells just like Mrs. So-and-So's bathroom! Does someone in here have an ostomy bag?". Then I saw that one of the stalls had an out of order sign on it and probably something ungodly was in there.

That's when I knew I'd crossed the line and would never have a normal sense of what is and isn't disgusting again. I think it's inevitable when you spend your days toileting, changing, bathing and all around dealing with sick and elderly people.

It takes something really beyond the pale to get to me anymore, and if something does manage to grab my attention through sheer revulsion on my part, it's probably making me laugh at the same time.

So in no particular order, here's the short list of things I still get grossed out by. It's not for the squeamish!

1. Changing a brief or doing peri-care on a male who has a "#3" in there. If you're not familiar with this term, use your imagination. It's not a #1 or #2, although the presence of either or both of these increases the horror exponentially. Nope, a #3 is the other thing that can exit the urethra. Yep. Ew.

2. Poop on the shower floor. Something about the wet plopping sound and the way the steam just turns it into a vaporizer of fecality that will have you longing for Vicks or anything strong and mentholated to coat your nasal passages in. And the cleanup is a real bastard.

3. The smell of old, stale urine, especially if the urinator has a UTI or has been drinking alcohol. You wouldn't think it could possibly smell as strongly as poop, but it sure can.

4. The smell of blood mixed with any of the preceding three ickies. Adding in the smell of blood to any of those is the only thing that currently makes me gag and dry heave immediately.

What about you all, which of these is the grossest to you? If anyone says "none" and means it, you deserve a bronzed section of intestine to show what a strong stomach you have.

See, it stuff like this that makes healthcare workers into a subculture. No one else wants to hear about this junk, let alone thinks it's as funny as we do!