15 December 2013
Sunday morning
Today's continuing installment |
Here we are, the
last half of the weekend. The weekends are the worst. The higher
level administrators are not around so the low level folks end up
running the show. The problem is that the higher level administrators
are salaried, and so their work hours are 9 to5 on weekdays.
Technically they don't have to been here on the weekends – so they
aren't. I imagine like everyone else the weekends take on a semi
sacred flavor. The last thing anyone wants to do on THE WEEKEND
is show up at work. So they don't. Not everything we set up takes the
weekend off, keeping astronauts supported in space, for example. Its
hard to imagine, “Houston, we have a problem” and the weekend
crew are theonly ones around. “Ah yes, Apollo – can this wait
until Monday?”
Once, during the
week when I was having a particularly difficult time getting anyone
to respond to my calls using the call light, the Charge Nurse, upon
hearing my complaint said, Yes John, I understand. We were, all
fifteen of us, in a supervisory meeting, downstairs. And you know how
it works – when the cat is away, the mice will play.” I hate to
think that my care is being handled by the equivalent of small rodent
brains. I used to have pet mice as an early adolescent, mice do not
have a very wide ranging world view. The simile is not lost on me,
even though I realize that the Charge Nurse was using a figure of
speech. Sometimes we speak volumes in the innocence of
colloquialisms.
So weekends have
devolved into two day bridge events over less than ideal conditions.
Having experienced sever weekends in nursing care, you don't want to
experience such events. As the clock unwinds on late Friday I find
myself involuntarily bracig for the upcoming hours of sloppy
thinking,smaller than usual viewpoints and a sudden inability of the
CENA staff to understand anything beyond “gosh we are so over
whelmed” mentality.
About two weeks
ago the resident population was low, people don't tend to schedule
elective surgeries and such medical excursions during the holidays.
The population on the floor was thirty, which is below the capacity.
So,in order to keep costs low the number of CENAs scheduled to be on
duty was trimmed back, there were two CENAs for the whole floor,
according to the CENAs themselves. Responses to the call light
extended to twenty, thirty minutes. When the CENA appeared at the
door the seemed harried, usually in a voice whose qualities
reinforced this notion they would say something like we are swamped,
there are only two CENAs on the floor. Being an empathic sort I get
the message very clearly – these folks are feeling rushed and like
someone on an assembly line moving faster than the can keep up, they
are in the beginning phases of frustration. People get to the work
when they can, but it may take a while.
One thing that
makes this running-on-a-tight-margin operation difficult is that
communication is severly hampered. Unlike being in a hospital (as is
my experience), this place has only call lights. This entails a push
button at every bed that sets off a light at the nursing station and
an electronic beep that repeats incessantly until canceled. The beep
is obnoxious andloud enough to be heard the entire length of the
hallway. This is, I imagine, so that the call will be heard and
responded to. However human beings are more adaptive than this. A
constantly ringing call light can eventually be successfully ignored
if one tells them selves that they are busy with this resident,
someone else will have to get that call light, but there is no way of
knowing who that other responder might be. This system inadvertantly
shaped the behavior of the CENAs like Pavlov's dogs to not be
responsive. The other problem with the call light system is that no
one knows what the call light is for until someone physically walks
into the room and asks the resident what is needed. This touches on a
problem previously mentioned, that the tone of voice the inquiry is
spoken can imply lots of information. An exasperated sounding “what
do you want” gives more of the wrong message to the resident than
is ever intended, plus it takes up a lot of time on the part of the
CENA.
Whereas the
hospitals I have been in use an intercom system. When the resident
presses the call button a signal at the nurses station opens a
channel to someone manning the response board. A pleasant, unharried
voice responds inquiring how they could help. A vocal transmission is
elicited, the information is exchanged quickly, directly and without
undue wear on the CENA staff. If some equipment is needed to assist
the resident (like an easy stand) this can be collected on the first
trip to the resident without having to make a separate trip to
collect the equipment after finding the resident's request.I have
mentioned this before and it is usually brushed off with some
half-hearted reason as towhy it hasn'tbeen done before, too
expensive, or it breaks down or some other answer that tells more
about the speaker than anything else.
It is Sunday
morning and I am sitting in the same briefs I was put in after my
shower Friday morning. Not many people willingly wear the same
underwear three days in a row, except for here - on the weekends.
Things are looser on the weekends, the cat is away and everyone knows
that it is the weekend when they are working. I imagine the kick back
attitude that pervades the culture creeps in here. I hear the staff
as they compare notes with one another, “No I can't, thats my
weekend to work”, they know where in the week they are, and it
always means the weekend is different. Different rules, different
expectations.
Now the weekend
spent in the same undergarments may not be that earth shaking, other
people have managed this before, I'm sure. But I am operating under
different circumstances. I have Multiple Sclerosis and due to that
cannot stand or walk. I am basically disabled from the sternum down.
I can't roll over, if I am placed on a toilet when finished cannot
lift one cheek to clean myself, formant of the activities of daily
living I require help. I can use my hands but I am limited to the
position that I am in at the moment. Usually first thing in the
morning the CENA used to ask if I needed a bed bath before breakfast
was produced. That, however has gradually subsided over several weeks
until that is a rarity. I have asked to have a bed bath, which
includes a new brief, only to be told, “Later, we are extremely
busy now” (staffing remember?)Only problem is later never comes.
Used to be throughout the shift I could repeat the request, but
lately I am visited so little by the CENA staff that (weekends
especially) I see them only twice per shift. And even then they are
busy.
This week the
results are the same but the reasons given are different. Last night
the shift nurse told me that she was late bringing my three PM
medication at nine thirty PM because they are swamped. Five new
admissions in one day, so much paperwork, they have even called in
extra CENAs, there were five working at that time. The vocal tone
factor comes into play loudly here. And still I am pretty much left
alone.
Some of the staff
have told me, “John, you are too easy. You need to press the call
light more often.” Wow, thanks for your fix on
the situation. I never thought of pressing the call light to get
help, what a great idea. Meanwhile I press the call button when
needed, wait twenty minutes, on average, to get the same vocal
exasperation expressed to me about how rough it is being a CENA these
days.
The administration
ought to don a CENA uniform and just spend some time on the floor.
They don't have to be undercover or anything clandestine, just be
here. Oh, their presence may cause the staff to be on their best
behavior, but is that so bad? They might find out how things really
go during the week.
The progression of
events this weekend was; Friday morning I receive my shower. I start
off clean and dressed in clean clothes and a new brief. The rest of
the day nothing special. Thursday morning the CENA assigned to me
steps in the room shortly after six AM, greets me pleasantly and
drops of the daily bath linen for later. I never see her the rest of
the day. Next CENA visitor is a person whom I have known since I have
been here, she comes across as Eeyore, always depressed, mopey in
presentation with a wiff of waiting for Prince
Charming to appear
in a sort of demandingly expecting sort of way. She never uses words
that could be used against her, she is very careful that way, but the
mood says it all. I'm glad to see her too.She arrives at
approximately noon bearing the lunch offering – nothing to write
home about. I never see her again.
The next in the
line of CENAs parading through my room was a male who usually works
the second floor. We share some personal tales about the joys of
winter camping and backpacking. He had just returned my neighbor to
his room in his wheelchair, when he stopped in to check on me. He was
surprised to find my lunch tray still waiting in my room at three
PM, I had finished the meal two and a half hours earlier and he was
mildly intrigued that the empty tray was still here. I told him about
my request for a new brief and the pattern of ignoring my being here
as much as possible. His helpful advice was to use the call light to
get the help I may need. Notice how quickly the weight for the
situation was deftly shifted from any impetus to help, even if taking
my message to another CENA, on to me. He leaves taking the now long
forgotten lunch tray with him.
Following his
helpful advice I press the call light after he leaves. The CENA who
apparently is assigned to my care appears several minutes later to
find what I require. I tell her I would like to have my briefs
changed. She tells me that she will be back in a moment. I don't see
her again. Dinner is delivered by a different CENA around six PM.
By eight-thirty my
dinner empty dinner tray is still here. I can't clear the extra items
from my bed because the tray is taking up the space I use to move
these items from sharing my bed with me. My briefs are now soaked
from two days of use, I have difficulty moving the bed coverings to
access my briefs to use the urinal when my bladder signals that it
needs attention. I was disgusted with the lack of follow through
from the CENA staff, the usual weekend slovenly follow through and
that I was now sitting in soaked briefs for several hours now. My
dinner tray was still here taking up space so that I couldn't set
myself up to take better care of myself, so I stuffed a terrycloth
shirt protector (bib) from the now long past dinner, into my briefs
to help soak up some of the urine to be met through the night. Being
too sleepy to stay awake, I put my CPAP mask on and let the bed down
to go to sleep.
Next thing I know
is that the second shift nurse is calling to wake me up to administer
my three PM medications, as noted before, at nine thirty PM. The
tardy dinner tray had been removed, the urinals deftly placed fully
out of reach. I explained to the nurse that I was not happy as I had
not been able to achieve a brief change over the entire weekend. It
was she who said that they were swamped with too many intakes, that
they had five CENAs on the floor, she would have two of “the girls”
come down to attend to me when they are finished where they are.
After she left I cleared the bed, now that then tray table was clear.
I put the CPAP mask away so it wouldn't be in the way when “the
girls” came to clean me up. I put aside my iPod and got ready for
the expected to be helpful CENAs. By ten minutes to ten (the shift
ends at ten) I realized that if they hadn't arrived yet, “the
girls”weren't going to show up.
I reassembled the
sleeping paraphernalia (CPAP mask, iPod and ear buds, made sure the
extra absorbing clothing was secure in my briefs) and waited for
sleep to arrive. Off and on throughout the night I awakened just
enough to observe the strange sensation as my bladder was full and
the trickle of relief in my pants. Through out the night I slept well
but uneasy as bodily functions continued unabated regardless of the
needs and perceptionsof the CENAs.
It is quarter
passed ten as I write, the CENA who delivered breakfast got an earful
of how I was not happy regarding the same briefs issue and that I
wanted a bed bath. She was polite and appropriate, she listened and
said she was sorry, that she would tell the CENA who was assigned to
me. Breakfast has been eaten, as much as I could tolerate, the tray
has been removed by yet another (different) CENA, and I am still
sitting in the same soiled brief from Friday.
Its another
weekend and everything is normal according to the way things work
around here.
As the old post
cards used to say, Having fun, wish you were here.
Self Portrait |