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.

Not a 9/11 post

I don't have anything special to say about 9/11 except that death really really sucks. I feel terrible for people who lost their families on that day, just as I feel terrible for the resident at work who's slowly dying from a series of strokes. She had another one today, vomiting beforehand even though I'd given her an anti-nausea drug by mouth before dinner, and the nurse had given her an anti-nausea suppository after the first time she threw up. She vomited a few more times, and then there was that telltale lean, the inability to control half of her body. A different half than last time. And she was so baffled about what was happening to her, and how could she get to feel better, and there isn't any answer.

This woman is a sweet lady with a devoted family.

And it makes me sad, trying to brush her teeth after she vomits and she cannot control half of her mouth while I do it. And it makes me sad, listening to her struggle to slur out that yes, she wants her daughter to come see her now.

Maybe it's easier for religious people once someone is actually dead - they usually say they're "in a good place now". But I don't know if watching the slow, steady decline is easier with a God around or not. I don't know if anything could make that easier; it's just so, so sad sometimes. And sometimes it's not, and I can't make reason of why sometimes it really gets to me and sometimes it doesn't.

If I do end up getting that hospital job, I'll be hoping that having patients for such a short period of time makes it harder to get very attached to them. A lot of the people I take care of now, I've seen nearly every day for about a year now.

And just to top off my bad mood, I got bitten right before the end of my shift, trying to scoop some non-food stuff out of a resident's mouth that she was trying to eat. I knew (obviously) that it was likely I'd get bitten, but I didn't want her to choke or get sick from this. I really hate getting bitten.

So that's my important thoughts for the day: I hate death sometimes and I hate getting bitten all the time. My sympathies for all of you that are dealing with either one.

In over my head

This has been a tough, tough week over at the GreatRep. We got a new admit, and he arrived under less-than-ideal circumstances; his daughter, the primary caregiver, was out of town. His wife brought him in and dropped him off, not wanting to visit because he'd been hurting her whenever she tried to toilet him. He had orders for meds, but had been refusing all of them.

So he comes from living at home with his wife to us, a decent-sized facility (around 65-70 beds) where we expect him to take his meds, use the toilet, and not hit us.

None of that happened. We quickly realized, after he had one of our charge nurses pinned up against the wall, choking her and lifting her off her feet, that he was going to require at least 3 people to change him out of his soiled clothes when he was incontinent.



In a hospital setting, or a psych ward, when a patient does something like that, you can medicate that person by any means necessary. In our assisted living facility, they must agree to take their meds orally (unless they have an order indicating otherwise, which this guy does not).

Things seemed to be calming down a bit after that, and he even cooperated with care in the evening one time, after the nurses began putting his evening meds in his desserts so he would actually take them in.

Then, randomly, on day shift, he punched a female caregiver in the face, and then in the back of the head when she tried to run away. Knocked her down, cut up the inside of her mouth from her teeth. She didn't quite black out and yelled for help, dragging herself to the door. It was awful. If I were in charge, that would have been the point where I'd have sent this guy on his merry way to the hospital with police there to assist the medics during pickup.

Instead, they updated his care plan to require and assist of 2+ people with all care and implemented more behavioral meds.

I was livid.

We had a meeting, and the DON was able to state her case and change our minds, even mine. I swear that woman is tricky as all get out. Plus she personally had been doing his care all day long by herself and will continue to do so, which gained her a lot of respect from the rest of us.

She laid out a specific, comprehensive plan to help him acclimate to our setting, and promised that we are NOT expected to stay in a situation where he'll hurt us, and if that means something doesn't get done, then so be it. I also understand that a gero-psych eval is not out of the question if we're not able to resolve the combativeness in our setting. Okay. Stressful, scary, unfortunate, but okay.

Then the bad news kept coming; another new(ish) resident of ours, "Linda" has a husband who lives independently but within walking distance of our facility. And he's telling anyone who'll listen that his plan is to come to our facility, shoot his wife, and then shoot himself.

This is about the time when I seriously considered just getting up from this meeting and going home.

Apparently Mr. Murderer may or may not be hospitalized right now, but of course he can go home, and then to our place, at any time. The good news is, he can't figure out how to use the keycode to enter the building, even though from the outside, the code is posted right above the keypad. So that gives us a grace period in which to see that he's the one knocking on the door trying to get in and call 911. Unless another visitor is being helpful and just lets him in.

Working in dementia, there's a certain amount of "I'm tough" attitude that comes with the territory - we deal with people who get combative for no good reason. That's just how it is. And usually the benefits outweigh the occasional injuries.

But this week has been so screwed up I didn't want to go back to that place. I don't want to be punched and knocked out, or choked, or shot. And I feel about 88% sure that I won't be. Which isn't really sure enough to make me happy about going to work again on Friday. Ugh.

Zip It (day 3)

Day 3: What's something you think of all the time but never say?

I wish I were a mother. I know I will be some day, and I know I'll be good at it. The kids I nannied for four years are good kids, and they still like to talk to me on the phone, ask their parents to drive them to my town to visit me, and write me little letters. I know I have the patience to deal with children all day every day, and I enjoy being around them. I know I can teach them to be considerate and to love learning.

It can be hard working in a nursing home, because the staff is 90% female, and there's always someone pregnant working there. Right now there are three. It can be hard hearing the same questions over and over again - "You've been married for 6 years and no kids yet?" or "How old are you? 29? And no kids so far? Do you not like them?". It's really hard when there's someone like "Calliope" who has 3 children at home and just lost her job for showing up at work high on meth.

I haven't always known I wanted to get married, or work in any particular field, or be vegan, or any of the other things I do right now. But I've always known I wanted to be a mother.

And I think about it often.

PS New readers - I do intend to have children some day, but it's complicated because Mr. Polly has Cystic Fibrosis. Google it if you're curious, or visit www.cff.org for more information.