Coming out of a daze with traces of static charge around me fading into the background, I looked around myself, feeling startled and puzzled. I didn’t recall the drive over to work today, yet here I was. Concern shot through me as I worried at this development. A quick glance at the time shown on my car dashboard showed 1:59 pm. This threw me into a minor panic as I was about to be late clocking in for my shift. This immediate concern of being late took precedence to my moment of forgetfulness.
Dashing out of my car and clicking the lock button, I rushed to the waiting automatic doors to the nursing home, feeling impatient at their brief delay to register my presence. Slipping through the barely opened doors, something continued to tickle the back of my mind, yet I couldn’t be bothered to think about it till I was clocked in and in the unit. Heaving a sigh of relief at the confirming beep which showed 2 pm exactly, I finished registering at the time clock. With little pause, I decided to try working out my brain fog after getting that day’s report.
Other than that initial rush, it felt like just another day of working on the wandering dementia unit. I mournfully glanced at my name badge as I keyed in the door code to the locked unit.
Andrew M.
Patient Care Tech
As a PCT, I should be working in the hospital itself, rather than with one of its affiliate nursing homes. Unfortunately, after my stunt in the PCCU 2 years ago, the management felt I would be better suited to working with the sometimes-erratic senior citizens, who were still very much mobile. I mean seriously, all I did was chase down a naked guy through two medical units trying to cover up his complete nudity with a blanket. Nobody got hurt and no medical equipment was destroyed. For goodness sakes, he wasn't even one of my patients!
Were it not for the decent pay raise I got out of that; I'd have thought my transfer was a demotion. Unfortunately, I realized how much they needed someone with my proactive inclinations to help out in this sanity forsaken unit. It was locked for a good reason!
I was grateful that the facility they transferred me to, did not have the normal telltale signs of a neglected nursing home. Prior to working at the hospital, I had visited several nursing facilities to apply for a position. A simple test that I had, was that as soon as I walked in, if I could easily smell the cloying odor of old urine, then I would walk right back out. Working uphill against a firmly set sub-par standard of care, was not of interest to me. I held great sympathy for the residents, but I could not put myself through that when I was but a small cog in the machine with little power to elicit change. I admired those that made the attempt and stood firm with their decision, but I needed to see that my actions made a notable impact in order to not fall into depression.
As Albert Einstein aptly said. “The definition of insanity is doing the same thing over and over and expecting different results.” It wasn’t fully relevant to my concerns. However, being a single caretaker of integrity, in a network of inefficient procedures and complacent bureaucracy, was not for me. Here, where my actions and care would cause a smile to bloom on a patients face, and not see its essence fade with the next shift, made working in this place worth it.
At this affiliate nursing home, I was always welcomed by white tile floors, a friendly receptionist, and fresh conditioned air. Admittedly as I had passed the front desk this time in my rush, I recalled that the receptionist appeared somewhat more lackluster than normal. All I got for my rushed greeting of “good afternoon” was a kind of quiet mumble. I would have stopped to ask what was wrong, but I was likely to upset my already impatient co-workers whose shift I was replacing. Entering the 5-digit code I heard the familiar beep before entering. Still though, I felt a little guilty for not taking the time to better communicate with the receptionist. I mentally promised myself that I’d get back to her during my first 15-minute break.
Stepping through the pass-coded door, I was about to turn to my right to greet the ending shift’s nurse when I was brought up short by an off feeling of wrongness which made me wrinkle my nose. Something in the air felt different this time, something vaguely sticky and off kilter from what I recalled as being normal. With a small shudder and a shake of my head, I brushed it off as a patient that recently had to be cleaned up after an accident of incontinence of their bowels. Either that, or maybe a resident had recently passed on. Seeking to get myself back into the upbeat and cheerful attitude that I knew the residents appreciated, I paused for a moment with my eyes closed to gather myself with a brief effort of reaching inside mentally. Just like did when listening to music, I reached into an intangible part myself and drew upon it. Warmth and chills cascaded over me, and the feeling of stickiness seemed to melt away, like a web touched with fire. *phew* With a sigh of relief I continued to the nurse’s station.
"Hey Courtney, how's the day going so far?" I asked her loquaciously with a hint of a smirk on my lips as she sat behind the counter, entering last minute details in her charting. Standing at about 5” 4’ with a lean body, her dyed blonde hair looked like it had lost a little of its bounce with the strain of the day, and a couple of spots dotted her pink scrubs with what I guessed to be the rejected remains of crushed medicine mixed with applesauce. She didn't look a day older than 35, but her worn blue eyes looked vaguely haunted, and I could see a hint of crow’s feet at the edges of her almond shaped eyes.
An equally dyed blonde eyebrow quirked at me before she paused in her work to respond. "Oh, the usual. Miss. Lenard refused to take her medicine again today and you know what that means."
*Groan* I most certainly did. Even with her medication, there was no guarantee that Miss. Lenard was not going to take a turn for the worst when the sun went down. It simply reduced the likelihood and intensity. At that moment, the aforementioned senior resident was happily hobbling about with the help of her cane. Her white hair was done up in a short cut perm style that the majority of the women in the nursing home sported. Dressed in her favorite trademark flowered shirt and pink pants, she was checking in on what the other 23 residents were doing with their time, while complimenting them on their work. Such a harmless looking old lady.
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'Sundowning.' Prior to having worked in the medical field I had never before heard that term. Even after hearing about it, I had first scoffed at the notion that the time of day could have THAT big of an impact on an individual’s personality or disposition. I had since then been well educated. Sundowning could be aptly described as a sometimes-radical change in personality and behavior from senior citizens, usually triggered about the time when the sun goes down. For the most part, the cases were mild and only made encouraging the residents to go to sleep a minor chore. It was the rare cases that were cause for concern. Drunken-like unstable swaying, belligerent refusal to accept any form of help (especially when they were on the verge of falling down), and a predilection to antagonizing others was at the other end of the dreaded sundowner spectrum.
Turning back to the nurse, I figured that I should arm myself with as much knowledge as I could before starting my shift. "Anything else you can tell me before I go relieve the other CNA?"
"Hmm, not that it matters but Mr. Smith just came back from a hospital check-up a few minutes ago.” My eyebrows creased in thought at her response. Since he had arrived on this unit about 1 year ago, not once that I could recall, had there been a family member or friend that came by to check up on him.
Usually, residents would only go for a check-up when the family had requested it, or if there was something abnormal that we couldn’t take care of. I paused to take a glance at him from across the room. Lounging in his normal place in the brown reclining chair he seemed just as sedentary and unresponsive as usual. From experience, he would eat when fed, walk when guided, and was overall very complacent with all other ADL’s (activities of daily living) that we guided him through. An overall very easy and passive resident to take care of.
She then continued. “Other than that, everything else has been nice and cal . . "
"No!" I almost screamed out the word, but it was a bit strangled since I was careful of not antagonizing the herd. My somewhat frantic expression was met with a wry smile on her face, which seemed to be gaining back its humor with the conclusion of the morning shift. 'Calm, peaceful, quiet,' or any variation of those words spelled trouble. Another “myth” that I had learned that just might hold more truth than fiction. I wasn't one to believe in superstition, but I did believe in an innate 6th sense that the senior residents possessed that would cause the metaphorical 'dust to hit the fan' when they heard someone say those words.
"Oh wait, I did just give some milk of magnesia to ummm . . . . .” She snapped her fingers, “Mrs. Jenkins about half an hour ago."
I felt a twisting in my gut that I'd likely have a case of explosive or runny diarrhea on my hands till Courtney mentioned the name. "Oh, thank goodness, Mrs. Jenkins isn't mine." I said with a relieved sigh. Although we CNA's (or in my case PCT) do help each other when things get rough, we still have a primary responsibility for our assigned residents.
With nothing more to be gained from the nurse, I went to the previous shift CNA to get information on the residents. I learned nothing new from our exchange that I couldn't have already guessed from looking around the room, except that she wasn't able to get all her baths and showers done. That was to be expected and acceptable, since they had 2 of the 3 meals during their shift from 6 am - 2 pm, while mine was from 2pm - 10 pm. It was frequently much easier to do showers and baths after dinner, and lay them right down to bed afterwards.
After the CNA left and I had taken over the shift, I went about collecting the vitals involving blood pressure, temperature, heart rate, and breathing respirations from each of my elderly residents. For half of the shift, things went by as per normal routine all the way up to dinner time. The other two CNA's and I had already put away dinner's meal trays and were selectively drawing the happily distracted residents away, to give them showers and then lay them down to bed.
Like magic, as the sun began to dip below the horizon, Miss. Lenard started getting Very fidgety. I quickly ran to intercept her blooming transformation. "Miss Lenard, it looks like it's time to lay down for the night, doesn't it?" I commented in a gentle and cheerful voice. The majority of the other residents were either being distracted by what was on TV or they were folding up baby clothing at the now clean meal tables (they seemed to enjoy doing that kind of thing).
Turning every which way till she could look out the window to the outdoor patio, she saw the last of the sun slip below into the night. "Yes," she replied a little shakily. "It does seem so. Let's get moving on then." *Phew* The relief I felt inside since she wasn't resisting this time was palpable as the other two CNA's, had paused in their work ready to dash to my aid. Miss. Lenard had certainly made a name for herself.
Resting her arthritic and age spot riddled hand on my arm, she happily allowed me to guide her towards her assigned room. Along the way though, as we began to pass the mumbling Mr. Smith who was sitting in his regular plush chair, she paused for a moment. I patiently waited for her to give her routine compliment to Mr. Smith as he continued to rock back and forth mumbling to himself, as he was completely oblivious to the world. I became shocked as she more firmly clutched at my arm to steady herself before raising her cane to whack the poor man in the thigh. "You there!" She cried out. "What do you think you are doing?!"
My eyebrows climbed as I observed the incredulous situation, before falling in resignation with a sigh, knowing that I should have expected something like this to happen. "Miss Lenard, let's not bother Mr. Smith since he isn't doing anything wrong." I said with a resignation in my voice. “He’s likely already had a rough day since he just got back from his hospital assessment.”
For a brief moment, a small part of me considered the possibility of justifying and blaming any upcoming bruising from that cane strike on the hospital, seeing as he already had bruising around his veins from their phlebotomy work. Unfortunately, I knew already that my conscience would not allow me the easy way out. Sleepless nights filled with guilt would be the least of my worries were I to give into that dark thought. Any kind of physical altercation no matter the injury resulted in more paperwork. This was going to be another report that I would have to corroborate with the nurse.
On the unit we had gotten used to the bald head and curled back of Mr. Smith that usually dwelled in one of the two brown plush chairs by the exit to the enclosed patio. At meal times he had to have the food pressed against his lips to get him to eat. Never at any time had I seen his eyes center on anyone or anything as he always stared off into the distance with a glazed look.
Turning back to her I watched her eyes narrow as she gazed more intently at the poor man. 'Awe Hell, she's not going to let this go.' I thought to myself.
"You think I don't see what's happening to you?!" She enquired loudly. Letting go of my arm to grip the armrest of the chair Mr. Smith was in, she got down right into his face. "It starts right in the eyes, doesn't it?!"
Trying to diffuse the situation, I carefully placed my left arm around her shoulders to gently lead her away. In the process of moving her, I couldn't help but look into Mr. Smith's eyes as well. . . .
. . . .
. . . .
Chills rushed down my spine and I took an involuntary step back as my mind tried to understand what I was seeing. A curse unspoken hung on the air that I refrained from uttering, fearful that saying something might make what I was seeing become real.
Although I didn't make it a habit to study every resident’s eyes in depth, I sure didn't shy from making eye contact when talking to them. I could say with absolute certainty, that Mr. Smith's eyes did NOT look like this the last time I spoke with him.