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.

Simplicity of success

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

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

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

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

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

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

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?

Ongoing Grief

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

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

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

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

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

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

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

It just hurts so much.

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

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

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.

Day 03: My Views on Drugs and Alcohol.

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

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

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

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

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