#1 of 64

Sometimes I feel at a loss for what to post here - I can't always share what's happening at work, and I rarely share what's going on in my personal life. So I bust out the blog topic challenges!

And this one's a doozy - 64 topics. I'm not trying to do a new one daily, though. That would be insane, with how work and school is going this quarter. But I do plan to get through all of them!

So, Topic #1: Introduce yourself with a recent picture and 15 interesting facts

Sorry dudes, no pictures of me on here. That might mess with my whole anonymous vibe.

And 15 interesting facts about me...

1. I love ballet and do DVD's of it at home.

2. My Mam-Maw could really turn a phrase, and said that when she was younger, she wouldn't have touched my Pap-Paw "if he'd'a been on an ice cream stick". She later changed her mind and married him.

3. I can turn a phrase too. Especially when I blurt out things without thinking first. I referred to a winter hat with ear-covers as having "Fudd Flaps" which Mr. Polly was delighted by.

4. I want to like gardening, but I suspect I secretly hate it. That's so awful of me! Maybe I'd feel differently if I had a yard?

5. If I were a character in Alice in Wonderland, I would want to be the Caterpillar, but suspect I might end up being one of the cards.

6. I'm jealous of Bill Nighy's strut and swagger.

7. I call Bill Nighy's character in Pirates of the Carribean "Tentacle Bill".

8. I'm afraid of depths (like in the ocean) and of very large aquariums, but not for the same reasons.

9. When I'm tired, I develop a southern slurred speech pattern that my friend described as sounding like Adam Sandler in "The Waterboy". I haven't seen that movie but I'm pretty sure I ought to be insulted by that.

10. I get nervous and inappropriate around religious clergy of all stripes and am pretty sure I weirded out this chaplain intern that was at my hospital this week. And I outed myself as an atheist too. And I blushed so much that he either thinks I'm in love with him or I have rosacea.

11. Sometimes I'd rather change someone's diaper than have to talk to them. This is more about whether I'm feeling chatty and less about my love of diaper changing. Sometimes I really hate talking to people.

12. I loooooooooooooove Thumbelina, the world's smallest horse! I daydream about sewing us matching pajamas.

13. I interned at a couple of juvenile detention centers back in the day, which left me with a lasting fascination with prison culture.

14. I have a never-ending crush on John Goodman.

15. Little Women is probably my favorite book of all time. Or at least right up there. You can get me to cry by talking about Beth and Marmee pretty much any time.

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 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!

Oh, Gross!

When I tell people what I do for a living now, a lot of them get hung up on the fact that I wipe butts and change adult diapers. I get asked "Do you have a really strong stomach?" (answer: no) and "Is that the worst part?" (again: no). It's just like anything else; you get used to it. It's just another task that needs to be done, and it's one that has a pretty obvious correlation to whether my patient is comfortable and healthy or not. Would you be feeling good sitting in a soaking wet diaper? Would it be fun for you to no longer be able to get up and go to the bathroom when you need to? Of course not. So by handling those things promptly, I improve someone's quality of life instantly. Not bad, really.

Besides, I'm a blood phobic, so anything involving blood is approximately 8,000,000times worse in my mind than any poop, vomit or urine could be. Blood makes me faint, usually. I mean really faint. Out cold, hitting my head on the way down type of fainting. Yikes.

So you can imagine how anxious I was when one of my clients had to have his toenail removed recently. Completely gone. Double yikes.

He got home with a sheet of instructions that read "soak foot for 10 min daily, loosely apply bandaid, can use small amount of antiobiotic ointment if needed". Wow, thanks for the hints about what I'm going to see under the weird blue gauze you packed him in, doc. Scribbled on a prescription notepad was the additional "for first treatment, remove bandage first. If dressing sticks, use peroxide to loosen."

Oh. Okay. Bandage sticking to never before exposed skin?? That can't be fun.

I got my client settled, got all my supplies lined up, and gloved up. Oh my lord, how I love disposable gloves. I cannot imagine doing this job without them. The first nurses were SAINTS to do what they did, and to do it bare-handed.

I gently began removing the dressing from this poor man's foot, and blood really started flowing. Like dripping-onto-the-carpet flowing. Crap! I got that bandaging off as fast as I could and dunked his foot into the little basin of water, which immediately began looking as if a shark attack had taken place. My client was woozy at this point, and shut his eyes, claiming to be too much of a "sissy" to look. Me too, buddy. Me too.

Luckily the bleeding stopped after a few minutes in the water, and after a very messy dry-off, the beast was safely bandaged up again. Ew.

I left that apartment a little woozy myself, and vowing to inspect my own feet every night for the rest of my life so I never, EVER have to have that done on myself. But you know what? I did it! I dealt with a bleeding wound without fainting, vomiting, or freezing up. I'm awesome! I'm brave! I'm a nursing assistant rockstar!

I'd also still prefer a diaper to that, no contest. Especially one as aptly named as this ...



That's right, buddies, me and the disposable briefs? We'll prevail!