Day 04: My Thoughts On Religion.

I wasn't raised with any particular religion, and now I consider myself an atheist.

If I were going to be a part of any organized religion, I think it would be Islam. I like the 5 pillars of that faith, and I like that their beliefs are their laws. It's consistent and thorough, so you know what is expected of you and I like that clarity. I don't think it's inherently misogynist any more than any other religion - I don't think any religion was founded with the intention to oppress anyone, because it's unimaginable that any God would want that.

I also think the daily calls to prayer are very appropriate and beautiful; if you have a faith, why wouldn't you want to set time aside every single day to tap into it?

The 5 Pillars of Islam (as understood by atheist Polly) are:

1. Faith. Specifically that "There is none worthy of worship except God and Muhammad is the messenger of God." Hard to be confused by that, right? So as long as you follow the teachings of Muhammad, you are living the way God intended.

2. Prayer. 5 times a day. Prayer isn't led by a priest, because there isn't that type of hierarchy in Islam. Prayer can be done alone or with others. When you pray, you're communing directly with God. If you believe in God, I bet that feels good, and it must be a refreshing and heartening pause throughout your day to tap into that. I'd imagine it would also keep you humble and keep you thinking about your priorities and your behavior throughout the day. If I were Muslim and prayed 5 times a day, I'd hope that after each one, I'd be mindful of whether or not I was acting and living the way God wanted me to.

3. Zakah. Charity. Not optional, this is an obligation for every Muslim. It doesn't have to be financial charity if you aren't able to do that, but it means that you have the responsibility of somehow helping your community. I think it would be great if all of us felt this; I know I could use a huge shove in that direction, because I get so busy in the day-to-day stuff that I don't think about it often. That's not good.

4. Fasting. During Ramadan, everyone fasts (unless they are very old, sick, etc.) Again, I think this would be a very useful tool for turning one's focus to God. It's choosing to do something uncomfortable, and remembering why you made that choice all day long. I wonder what that would feel like, and I like the idea of giving something up, not because God thinks it's bad for you but to show God that you're thinking about him/her.

5. Pilgramage. Going to Mecca. I honestly cannot imagine what this must be like, to be able to go somewhere that significant to you and to be surrounded by others that feel the same way. Maybe it's the closest thing to going to Heaven?

Anyway, it probably seems weird that I've thought about Islam that much. I don't know why, it's just the religion I've learned about that resonates with me the most. But I still don't believe in any God. That doesn't mean I don't try to be kind or compassionate, or that I don't respect other people's beliefs. I do. I just feel like, well, that's all a little over my head and I'm just here trying to do the best I can. If a God wants my attention, it can find me. I'll be hanging out trying to help people and have a good life myself.

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.

Day 02: Where You'd Like To Be In 10 Years.

In ten years, I'll be 38 years old.

I will be an RN and never ever going back to school again if I can help it. I don't know if I'll still want to work in geriatrics or not. Maybe I'll have had my fill of it by then. I'll be working in a facility I like, with a population that I love.

I hope to have had children by then. At least 2. Hopefully they'll be healthy and happy. I'm pretty sure I'll think they're the best kids in the world.

In ten years, my husband will be 41. I hope he'll be healthy and happy too, and that we'll laugh about how we used to marvel that people with Cystic Fibrosis could be fine and middle-aged. I think he'll be fine and middle-aged, and so will lots of other people with CF, by then. And it'll seem silly that 41 ever seemed "old" for someone with that disease.

We'll still have our Small Business, but it'll have grown a bit by then. We'll take days off and vacations, and I'll probably still go and clean the store after closing time a few times a month.

I'll still live in this town, because I LOVE this town and am never, ever leaving, ever again. I moved away once, and that turned out okay because I'm back now. But I won't move away again. This is my home.

It's not that big of a town. In ten years, I'll know 85% of the people that live here. I'll have my fingers in every metaphorical pie around here, and will make up more ridiculous small-town festivals and parades to fill in the gaps of when we're not having one. And since I'll know everyone, my festivals will happen easily. March of the Maracas and Mustaches? On it. Festival of Whole Grains? Sure. Book it for April. These really aren't that far-fetched if you're familiar with some of the real-life shenanigans this town puts on yearly. And I love that about it.

In 10 years, I'll be happy, just like I am now.

Day 01: Relationship.

I'm married, and very happily so. I met my husband a long time ago, way back when I was 19. We married when I was 23, which I was pretty surprised about, having never planned on getting married until I began dating him.

We laugh a lot. When we go to bed at the same time, we stay up too late talking and playing stupid games we make up on the spot, like "Holla Whatcha Call Me" (pretty self-explanatory) and other weird stuff, like the time I decided to tell him "The Scariest Story Ever Told" in a bad Russian accent (it was about a character named Black the Ukranian who was covered in fur like a monkey from hell). I wonder if our neighbors can hear us, and if they wish we'd just go to sleep for God's sake.

I still think my husband is very handsome. And he's still very tall. Even when we're old and he shrinks, he'll still be very tall. When you start out at 6'4" you can spare a little spinal compression.

Having been so young when I started dating him, we've really grown up together. Learned how to be responsible adults that show up for work on time and pay our bills on time. I've learned how to cook, though not 'till we'd already been married a while. But I'm good at it now! We've traveled together a little bit, but not that far away. When I was a nanny, the family I worked for took us both with them on their vacation to Whistler, BC, which was really fun. They have special trash cans there that are too confusing for bears to get into. Also, I taught my husband how to ride a bike.

When I was younger and my single female friends would ask me how to pick a guy, my basic advice was "Look around at everyone you know, and pick the guy that you think is too nice and funny and cute for you. Then ask him out. Or maneuver him into asking you out. Then try really hard to be good enough for him, and expect him to do the same for you. Then you'll be happy."

It worked for me!

Happy 9th anniversary this fall, Mr. Polly!




PS we both just figured out what we wanted to be when we grew up, like, a year ago. So don't stress about that either, people.

30 Days of Blog Topics

Just like Estelle Darling at www.brfirefly.blogspot.com I thought this 30 day blog challenge looked fun:



I'm not promising to cover all of these, but we'll see how it goes. It's always nice to have something besides work to write about. Especially since work has been kind of nuts lately; one of our residents just came back from the hospital after a stroke and is now a 2-3 person assist WITH a sit-to-stand (shudder). This is inconvenient, to say the least. Plus she's the first one to have actually broken my skin while being combative (with her fingernails). Thank God for coworkers and sanitizer. It's instinctual to get pissed when someone injures you, so I was very glad to be able to leave the room when that happened. Ugh.

Let's all cross our fingers that this week goes a little smoother!

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