Life on display

I discovered this week that life has a twisted sense of humor.

FIRST Life Ha Ha of the week
I know that girls are expensive but combine that with marginal insurance and with large deductibles and a birth can be crippling.

I am on the third of five monthly installments, each of which would buy a large, high end washer/dryer set for the home.... or living room sets.... or five big screen flat panel tv's..... or four months mortgage payments or or or or or.... She better be nice to me when I get old!!!

Second Life Ha Ha of the week
My six year old has her blood taken every six months and her blood work done and analysed. First, she was attended to by a drunk, blind, club footed stutterer who obviously had never drawn blood for anything other then personal recreation and the occasional late night motel room blood doping scheme. She came out of the appointment with a grey bruise the size of North Dakota (I checked on a map!)

The doctor called us frantically with the blood results. Something about her levels are all over the map and that one organ is, for all intensive purposes, no longer working and that another is working overtime because of it. She was put, immediately, on another daily medication and instructed that she will now be required to have her blood work drawn and analysed every three weeks!

Third Life Ha Ha of the week
My oldest son was playing basketball with his brother in the back yard last night and broke his ankle. He came down on his brother's foot and turned the ankle. He spent the rest of the evening in various hospital, doctor and x-ray rooms. He is now in a splint until the swelling recedes. The best part, life's most warped aspect of this break is that he, most likely, (the doctor on call is not sure yet) that he broke the growth plate in his foot. This means that we would need to take him to an orthopedic surgeon to either have it set and cast or for surgery.

And it is only Wednesday...........

Read more

Clinicals...... continued

The residents offered varying degrees of assistance with their showers. Many can’t assist with much and it is a matter of getting them undressed, into the shower chair and rolled into the shower. With gloves on, you start the water, which runs down a tube into a mobile shower nozzle. Testing for a comfortable temperature, you begin applying the water to the resident from shoulders and head to legs and feet. After they are wet, using a shampoo/body wash, you shampoo their hair and then begin soaping their body. Once this is done, you rinse them off. Then, from under the chair, through the hole in the chair, you provide pari-care. Once they are washed and rinsed, you provide towels to cover them as you begin patting them dry. I was usually quite wet by this point. Once they are dry, you wheel them back into the general shower area and get them dressed.

Some residents will wash certain areas themselves, which is a welcome relief. I was usually with Emily, the CNA and sometimes at least one other student. One woman, the retired RN, spent the entire shower chatting with me and telling me story after story about nursing experiences in the Shriners Hospital. While I squatted there talking to her, the other student did the majority of the shower. Her stories were great. She is really sharp.

This shower was on Tuesday. On Monday, I assisted the same woman to empty, clean and replace a colostomy bag. Her bag is attached to her small intestine which means that the stool will be in a much more liquid form. The large intestine absorbs much of the liquid back into your system. The doctors had removed her large intestine and had drawn the end of the small intestine right up through her stomach with the end sewn to her skin. The bag snaps on to a plastic ring. She didn’t want to have to pay for new bags every time one needed to be emptied so we would remove the bag full of liquid stool, empty it into the toilet, wash and dry the bag and replace it back onto her stomach. She would finally through it away when it became too stained.

The gentleman that we showered were, by in large, more feisty and angry then the women. One gentleman refused to get out of bed when we told him he needed his shower. When we reported his response to the nurse, she told us that he had already refused before and that we needed to get him up and in the shower. He was angry and somewhat combative. We got him into his wheel chair and started down the hall. He had a catheter through his stomach into his bladder. It ran through a tube, down under the chair into the bag behind the chair.

He gave us fits trying to get him to stand up against the wall bar so that we could undress him. I was on my knees, threading the catheter bag through his pants and briefs. There were three students and the CNA. I was the only male. I helped wash him and held the water. The three women were chatting it up as we worked and he kept telling them to stop yakking or to shut up. I found it to be humorous and couldn’t blame him. They were loud.

As we finished washing him, I was squatting down and washing his legs, on of the students began trying to shave him. The razor was cheap and disposable and he was not cooperating with her by flattening out his upper lip. When I finished his legs, they turned the shaving over to me. It was not the best job. I told him that were were not going to win any awards. The razor was difficult and dull. It was hard to shave the multiple days of growth, especially on his wrinkled neck. He seemed more cooperative or maybe more resigned with me and didn’t say much while I finished. He was not feeling well and kept spitting into a towel. Later that day, he threw up in the hall on the way to lunch. I was not with him at the time. Although in comparison to what I was doing at the time, I may have preferred the vomit.

We had a difficult time getting him dressed and back into his wheel chair. I dried his legs. The others dried his arms neck and torso. We then got his shirt back on and started the briefs, the pants and the socks and shoes all around his ankles and lower legs. I wheeled him back to the wall bar so that he could pull himself up to a standing position while we dried his bottom. We then pulled up the briefs and pants. He couldn’t hold himself up for long and began slumping back toward us while we were trying to pull up the pants. The CNA Emily and I used our bodies and knees to prop him up while we finished pulling up his clothes and slid the wheel chair under him. I was drenched and sweaty when I finished that shower.

For Tuesday breakfast and lunch, we were assigned to help feed the residents in the acute care unit. They were in a separate dining room in their unit. I helped a younger gentleman during breakfast. He spoke very little. He was a big cowboys fan. He had a cowboys shirt on and, having seen his room, I knew that it was decked floor to ceiling in cowboys gear.

Before his accident, he was an administrator in a Utah school district. He was one who liked to take care of his neighbors. He was shoveling off the porch of an elderly neighbor when he slipped, fell off the porch and broke his neck. His arms and hands were crooked, for lack of a better word, and his head lay at a tilt. He was on a soft diet which equated to French toast and cream of wheat with orange juice. Someone had already cut his French toast.

It was difficult to know what to feed him, how quickly he wanted it and in what order. I wanted to please him but didn’t have much feedback. He would try to point at things and would open his mouth when I offered him a bite of food. I tried to mix it up. We would often make eye contact and I would try to converse with him. I think that, with him and in general, I spoke too quickly. It was also hard to converse with him when it is just a one sided conversation.

I kept finding myself, without thinking, asking him questions or saying things that would normally elicit a response. It was a work in progress. At one point, he seemed to take a deep breath after I asked him about the french toast and he said, in his broken and slurred speech, that they made the best french toast in the world. I was thrilled. When he finished the meal, he, with a shaky knarled hand, reached over and, with a very firm grip, shook my hand and thanked me for helping him eat breakfast. I almost cried. How I take things for granted. He was grateful for my help feeding him.

Lunch allowed me to feed a much older gentleman. He may have been Italian. He didn’t speak, there were barely perceptible nods occasionally and he had an Italian name.
He ate slowly and chewed the food forever. He had shredded chicken and rice with gravy and pears with ice cream. He ate some of the chicken and rice before refusing the rest with slight shakes of his head. He was more than happy to finish the pears and the ice cream though. Oh, he also had orange juice. When he was finished, I wheeled him back to his room.

I didn’t know quite what to do with him. He wasn’t one of my residents and I was to return to the dining room so I put him in front of his tv and turned it on. It was some medical show about babies. I didn’t want to just leave him there but there wasn’t much else to do. We, as students, were not allowed to make any lifts or transfers by ourselves, so I could not put him back in bed. I asked him if the channel was ok and he gave a slight shrug. I told him that his CAN would be around to check on him and I reluctantly walked out.

While Emily and another student were helping one of the residents in his bed, I struck up a conversation with his roommate. There are two residents to a room. He was in his wheel chair, had a prosthetic on his left leg below the knee and was waggling a long unlit cigarette between his fingers. He turned out to be a Redskins fan. My scrubs evoked a response and the beginning of a fun conversation. He was the former interstate truck driver. I talked to him about where he would drive and what he would carry. We talked football as well. As I left, I rubbed part of my scrubs on his tv table and told him that now he would have a little cowboys on his table and in his room. He knew that I was teasing and played with it. He told him not to make throw up or have to throw out the table. He said that if I was walking down the hall in my cowboys scrubs and felt some one spit on them, that to sure that it was him!

One of the final residents that I helped on the second day was a gentleman that I was asked to change. He was in his wheel chair in his room. He originally said that he though that he had already been changed but after a question or two decided that he probably hadn’t. The bed was raised so that he could stand up and put his hands down against it. I knelt down behind him, pulled his brief down around his knees and began wiping him. He then began to pee. I grabbed an adult pullup and reached up between his legs and placed it there so that it would catch the pee. He said “oops.” He said that he was “kind of a dribbler.” I then took additional wipes and, leaning around his legs, reached up and wiped down his front. He was starting to get a little shaky so I hurried and finished with a new brief and got him back into his chair.

I left at about 2:30 pm, took off my soggy shoes while starting the truck, and drove home in wet socks with the heater blowing at my feet.

Read more

Clinicals

Monday and Tuesday began at 4:40 AM as I pulled myself from bed, put on Dallas Cowboy scrubs and drove up to Woodland Park, a Nursing home in Salt Lake City Utah. I worked as a CNA student with one of the staff CNAs, assisting her with the residents from 6:30AM till 2:30PM.

I don't think that I would want to work as a CNA in a nursing home as a career but it was a fascinating experience.

The work evoked a number of feelings and emotions. There was a joy that came from getting to know these elderly individuals and working with them. I experienced things that made me uncomfortable. There were many smells that challenged the nose and the stomach to a mortal duel and that hung in the air like a curtain to get on your clothes, in your nose and hair. Finally, I felt a tremendous sadness for most of the residents there, helpless, lonely and with physical bodies that were quickly deteriorating.

There were people of all walks of life residing there. A woman who had graduated from BYU in Archeology, a woman who had been an RN for 40 years, an interstate truck driver, many mothers and grandmothers. They are all now residents and roommates, brought together like a cruel class reunion of humanity in a semi-circle labeled "North Hall".

Day one: I was apprehensive. I had no idea what to expect. I was nervous and embarrassed about being asked to change a soiled "brief" or to shower someone. It turned out that I got to do all of the above.

I arrived and met our clinical supervisor in the lobby. His name was Art, he was an RN and he worked for the school not the Nursing home. His job was to work as a liaison between the students and the Nursing home. He gave us a tour of the facility and then assigned us different departments. There was the Rehabilitation unit for residents recovering from one thing or another. These residents were expected to be there for no more than 60 days.

Down the hall from Rehabilitation were two extended care units. These units were contained in one long continuous hall forming a long oval like a zero. The main dining hall and activity area filled the inside the zero. The zero was essentially cut in half with sets of double doors into North Hall and South Hall. Residents of North and South hall were lifers. There was no expectation of any of these residents leaving here accept through the receipt of a certified invitation to the great BINGO game in the sky.

The final unit at Woodland Park is a more critical care unit called the MAC Unit or the Acute Care Unit. These patients were no longer able to feed themselves and were on much more specific and specialized diets. These residents included those on ventilators and tracheotomy tubes.

I was assigned North Hall. As I made my way to the nurses station in North Hall, one of the CNA's rushed by and called out that she would be willing to take two students. Her name was Emily. I jumped in with her and we were off. She was especially busy Monday morning because one of here coworkers had failed to show up for work and the remaining CNAs were given additional residents for the day.

We went from room to room, rousing residents, changing their briefs and getting them dressed in wheel chairs for breakfast. There was not much time to spend with each resident initially, there was a schedule to keep. The residents reacted like any of us would. They were being suddenly awakened. Most are tired, sore, in wet briefs or just plain uncomfortable. They can’t move much and don’t feel well. I couldn’t blame them a bit if they wanted to more time to get going or more time to get their bearings. They were unceremoniously placed in their various types of chairs in the hall way where we would begin pushing them around to the main dining room.

They really are sweet people. All of them had specific tables and even more specifically, certain spots at these tables where they were to sit. There were people that worked the main dining area and took their “orders” but I was always flagged by multiple people to get this or that. That morning, two women had me cut their French toast. One woman wanted different syrup, two new small glasses, but not the Styrofoam glasses, the glass glasses, and a combination of cranberry juice and apple juice in one of the glasses. She then had me cut the French toast in pieces lengthwise, in pieces that were not too big but not too small and then open the new syrup and pour it on the cut pieces of French toast, but not too much and not too little.

One gentleman would have me get him his coffee. He was a happy man and would always say when something was done for him that “Boy there certainly is good service in this hotel!” I had the opportunity to help him quite a few times throughout my time there and I got to know him. He was, incidentally, known as quite a urinater. He was usually wet when we checked on him and he would frequently pee when we would turn him to his side while changing his brief. We would turn an adult pullup inside-out and tuck it around him, inside his brief, while changing him so that he wouldn’t pee on the sheet and his clothes. He had no legs below the knees and we would do a two person lift to transfer him to and from the bed and the wheel chair.

There was a lady who would stop me and tell me jokes like…. What did the monkey say after getting his tail stuck in the lawn mower? Well it won’t be long NOW!
I helped here find her clothing protector one day, not a BIB… the class instructors warned us, and helped her attach it around her neck for lunch.

We were assigned hall lunch tray duty on Monday. A large food container would be pushed down the hall and we would remove trays of food with slips of paper with the resident’s name, room number and dietary assignments. These were for the residents that either could not or refused to get out of bed and go to the dining room for meals. We would take the food in to them and help them get situated. This would mean that ten to thirty minutes later we would begin getting room light calls where the residents were finished and wanted the trays removed.

Room light calls were common and something that we, as students, could follow up on to help the residents with whatever they needed. There were call lights above each door and a central light board at the nurse’s station.

There was a little Asian woman who would slowly scoot backwards around the halls in her chair or sit in the doorway to her room taping a foot. I answered her call light one time. Through hand gestures and short bits of an Asian language, I determined that she needed to use her bathroom. I pushed the door open for her. She wheeled past me. I stepped inside and closed the door.

She rolled up to the hand rail next to the toilet and pulled herself to a standing position, she was all of 4 and one half feet tall. I, in what must have been an extremely slow and awkward process for her to instruct me on what she needed from me, helped her pull down her briefs and sit on the toilet. I then stepped out and gave her privacy. She was done 30 seconds later, indicated with another pull of the bathroom call light.

I knocked and stepped back into the bathroom. She, with some insistent pointing, explained that she needed a wipe from the package on a shelf. I gave her one and waited while she wiped herself and dropped it into the toilet. She then stood up with the help of the rail and I pulled up her brief and pants and then pushed her chair up behind her so that she could sit down. She would then navigate back out the door into the bedroom.

After this first bathroom trip with her, I must either have not have done too badly or she may just not have had much choice, she flagged me down two additional times to help her through the same process over the two days. I was also given the opportunity to assist in showering her.

Ohh the showers….., this was not something that I really got used to after only two days. I went home on both days with waterlogged shoes, although the scrubs seem to dry fairly quickly.

I helped shower at least four women and two or three men. There is something strange, eye-opening and depressing about an elderly person sitting slumped and naked in a shower chair, outwardly unfazed, unembarrassed or resigned to the lack of privacy or self sufficiency.

The shower chair is essentially a PVC pipe frame chair with a toilet seat and some thin textured rubber sheeting strung between the PVC in the back for a back rest.

CONTINUED ON ANOTHER POST

Read more