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 

14 December 2013

Satiddy

Being in two states at once

how to step over the threshold

Dead to the world

I woke for good this morning about six AM. I had been dreaming. It was one of those last dream cycle dreams where your unconscious has already spent the night going over events of the previous day, had given you all sorts of impossible tasks to complete many times over while you finally get an understanding of what ever you have been trying to work out, until the last segment of dreams.

Often these are fanciful, like having discovered the secret to levitation on a moderate scale. It occurs slowly and you only float inches above the ground. It takes along time to get there so you are not going to make any great escapes from bad guys or anything like that. Or dreaming of having learned how to move like kangaroos do with great leaping bounds, often twenty to thirty feet at a time. You try to tell everyone but no one is interested. In fact they act as if they can't see or hear you. Here you are, busting with this knowledge that could change humanity – and nobody seems capable of paying attention. One time I dreamt that I had created a beautiful series of photographs that depicted infinite wonders of the universe. In that way that one can learn more from a picture than any amount of words, the way an image slips right past the defenses and patterned way of prior understandings that dupe us into believing that we know when we really don't. Our prior knowledge that keeps us from understanding any further. It is often based on that which everyone in our culture knows and is propagated through words. I couldn't get anyone to look at the pictures, it was like they were all ignoring on purpose by some secret command.

In this way we as individuals are effectively kept within the range of the group as a whole. No cowboys here thank you, iconoclasts need not stick around, we know all we want to know, just keep on moving or be the same as the rest of us.. These dreams are not only highly visual but are accompanied by a felt sense that is stronger than any other type of dream. Much like the theater organist would play a score to accompany the old silent movies to enhance the mood being portrayed on the screen, this felt sense added a fuller dimension to the dream. So full, in fact, that it seemed there had been a reversal of parts to the dream, as if that theater organist had become somewhat overzealous and was making his part more present than the film images.

Puppy dreams

These end of sleep cycle dreams were mostly about the felt sensation than the images. In fact there are many times in the progression of these dreams where the feeling continues on and the images have temporarily ceased. Sometimes the images of the dream fitfully develop, as if the images were being made up to fit the feelings. It becomes very clear at this point that the feeling is the most important part, that the visuals are what we create to augment and shape the felt sensation.

This seems to run counter to the science we have all been subjected to, that we are visual beings, our brain uses most of its massive amount of neuronal capacity to process vision. Or that the brain cannot tell the difference between an imagined event and seeing the real activity. Athletes use this visualization technique all the time. We all do this all the time without realizing it. Our brain is encased inside of a dark cranium of bone with only sensual peepholes open to the outside. From these bits of information we construe the world in which we live, develop a pattern of understanding and expectations about that world, and then boldly strike out to be in this world of which we don't have any more sense of the realness of it than our capacity for confabulation and delusion can carry us onward. No wonder society changes, as Max Planck once said of science “One funeral at a time”. We are all blind. Some of us leap to the fore exclaiming that they have it sussed. The concept of memes comes into operation here as people don the mantle of scientific explorer and explainer, or moral interpreter, the image presented becomes more and more accepted until the cumulative weight overtakes even the strongest and most resilient. A culturally accepted understanding prevails which if we buy into we gain certain behavioral privileges. Like earning a driving license, graduating from an educational program, obtaining a job – which in turn bestows even more benefits.

The mass delusion is ubiquitous, rampant, and self perpetuating. It is everywhere and is relentless in the way that memes can do, like viruses they take over our body (through the mind) to ensure that the illusion is maintained. There is no mastermind behind this, no bad guy onto which we can lay blame for this condition. It is us. We have allowed ourselves to become infected with this malady. Some of us play the part of social administrators keeping everyone in line, others of us play the deviant finding ways to push the envelope of acceptance and yet remain within the fold.

If we try to confront this situation solely with the mind, we are only binding ourselves deeper into the morass. Sort of like trying to dug a hole in a large body of water using a shovel, the chore is going about the task using the wrong tools. So trusting on the mind and its ability to manipulate logic that we fail to recognize a solution even as it is knocking on our forehead. It is there but we don't see it.

Along comes Candace Pert and her research, very scientifically oriented, without flaw. 

Candace Pert

Everything is according to standard operating procedure, and yet her discoveries immediately answered some physiological questions but also the implications could not be stopped there. Through her work we have been able to see that our bodies are a repository for our unconscious, that thought and electrochemical neural messages are not the only manner the body is able to move information. The body also can very quickly know what is going on at the other end by chemical messages alone, nerves are not involved. We often sense this as a felt sensation. This began an investigation into how our felt sensations were more than mere emotional enhancements, like spice is to food. Feelings are real conveyors of information, they are of value, they are trying to inform us of something. The old time worn idea that they are poor imitators of valuable data has now passed. But as Planck's comment mentioned above cites, don't expect any changes anytime soon.

So this morning I awoke with this very interesting dream, not only echoing with fecundity in my mind but I realize that I was dreaming lucidly before I awoke. The dream had a continued sense that transited from the sleeping state into the waking state. The transition was seamless in that was not interrupted as dreams usually seem to be, rather the dream took on the added component of an experience that spanned two different states of being. It lent itself to the knowing that we are awareness that can exist in many states. Our responses depend on which is the present state in which we place ourselves.

This leads to another understanding, that we can bring ourselves forth into another state , by bringing ourselves forward, to step over the threshold, and enter a different realm than one we are familiar with. It is possible to see this often when someone goes beyond what can be attributed to practice as in an athletic event or a series of patterned behaviors. This is not doing the same thing with renewed vigor, it is more like doing the same thing with a renewed self. A different self, much like the older self, the more familiar self, the one that we have become used to with the same old caveats, the fears, the sense of inadequacies, the hopes and dreams – all of the beliefs that we have saddled ourselves with that impede that actualizing of our own true sense. The self we know is often a shadow of our truer self, one which we know is inside of us but often very difficult to bring forth before others. So often we fail and present our smaller self, which can be detected – usually by felt means. Like the world presented in the Flammarion Woodcut, we find ourselves in it but we are vastly different.

Flammarion Woodcut

We know when we are showing forth in one realm or the other. Some of us even know what was holding us back, but to know alone is not enough. That feeling component enters into the mix.

When we are hitting that mark everything seems to be in an expanded state. We tend to know not where our physical boundaries end and find ourselves feeling "connected" with the rest of the world and everything in it.

During this dream I sometimes dreamt that I was interacting with my former wife and for some reason she was actually responding to loving inputs and little acts of adoration in a positive way. Then, like a radio that was failing to hold the station to which it was tuned, she was just off the mark. Acting calculating, judgmental, accusative and suspicious (which more and more grew to be her favored way of acting/being as time went on). Various vignettes of tender moments would pass by my awareness and she would be one sort or the other. The contrast was amazing. Throughout it all I can feel my sense of affection toward her and at the same time feel her response or lack thereof in return. Toward the end of the dream she was settling into being more and more as if she were operating from her head and not her heart, which is just the way the marriage ended up. I woke up with a strong sense of wanting to love and appreciate someone and there was this tremendous feeling of a void in return. That is very disorienting.

Normally it is said that when one gives out love, more returns. The caveat is, the other person has to be in the same relationship at the same level. Otherwise, love pours out and is met with a resounding silence of nothing.

This is how I started up my day and I have been astounded to note that the feeling I get from most of the CENAs that have interacted with me is one of conditional acceptance. There is no sense of love being returned. It would be quite strange except for the fact that this is, sadly, normal in my experience of this place.

I can't help wonder if my wanting to hold the staff in a sense of appreciation and acceptance might be more flavored by the "Stockholm affect" then real altruism? The conditions for Stockholm affect are certainly in place. I am, for all intents and purposes, dependent on the goodwill of the CENA staff to get various things that I need - in the sense of physical needs, food, clothing and shelter. It seems that they are steadfast against showing or allowing any form of altruistic acceptance. I wonder if there is a fear of not being "professional" and that they may find themselves under some kind of administrative reprimand or something. I am not talking about flirting here, or any other physical or lascivious behavior. I'm talking about simple accepting and allowing someone to be who they are. That seems to be next to impossible for just about everybody here.

I often feel like Gulliver in a land populated by merely the shadows of the people who actually could be here, if only they would let themselves.

And so goes another day of supine paradise.

11 December 2013

You can continue to turn the other cheek

but some fools refuse to notice there is something wrong,

Meanwhile, I'm running out of cheeks

Yesterday I found myself in a foul mood. Surprisingly I began the day in for good spirits. It was my shower day and I always look forward to those. However, after the shower things began to go downhill. Upon returning to my room to collect a few things to utilize during my foray in the wheelchair I discovered that while I was in the shower someone had been in my room (totally legitimate of course) but in the course of their being here attending to their chores some items on my tray tables were knocked off onto the floor. I could tell that they had been disturbed as they were not in the usual positions in which I leave them. Most distressing to me was that my iPhone was placed back in the container in which it was resting without most of the other stuff that also resides in a container and the phone was in a different position. Now I've been in this room several times in the past when various CENAs have moved the tray tables and the phone has gone to the floor before. One of the staff actually dropped her phone onto a hard surface floor once and the gorilla glass on the front actually cracked. She contacted Apple and they told her that the phones not meant to be dropped and they do not replace the glass. Her phone still works but there is a big spider crack on the front of the phone. I realized that these are somewhat robust items, but they are not really designed to make sudden stops upon hitting the floor.

Amongst the items I was retrieving was five dollars to give to the activities director, who usually makes a shopping trip for residents who are requesting certain items. The other thing that I was trying to retrieve was a dime to give to the bookkeeper.

Toward the end of October the bookkeeper approached me and indicated that the previous nursing home I had been to still feels they need to be paid six cents. Six cents!! that alone shows me what money grubber those folks were. They know that all of my worldly possessions have been dispersed due to Medicaid rules, and they are grasping for six cents?! I have been told by family members that the former nursing home has contacted them trying to get $7000 they think that I owe them. They are trying to get it from my brother or my father!

That nursing home made some sort of arrangement with the bookkeeper that they would retrieve their six cents after I had paid my next installment at this facility. So she indicated to me that if I didn't mind they would refrain from going into my bank account for the next month so that some buffer could be built and then they would retrieve both months in December. I was not pleased with this arrangement for a couple reasons. One, I had not been involved in the negotiations for this arrangement, but I was merely being told that somebody else had made this arrangement. Two, the other facility has shown themselves to be less than honorable on several occasions, which they don't seem to accept but rather look for other people to hang this problem on. After they decided I was not someone they wanted to keep in their facility (i.e. they could not squeeze any more money out of me) they finally arranged to have me transferred to this place. I find very little reason to trust these people. I do not like being made available for them to mistreat me one more time, yet again.

I have been haunting my bank account regularly to see if indeed this arranged payment has been affected as it was set up. Nothing has changed in over six weeks, and there is already has been the second installment deposited into my bank account. Yesterday I intended to give the bookkeeper a dime so that she could give the six cents to the other facility and we could be done with it. When I tried to do this she became very dismissive towards me and indicated that she could not do that, they had rules to follow. They may have rules but they have no sense of propriety, no sense about how to treat their residents. And this is not the first time I've dealt with this bookkeeper. She has the unnerving ability to talk like a young child in the way she pronounces words, and her choice of words is always very haughty and dismissive. I do not tolerate this kind of treatment very well. So already I was in a not good mood as I returned to my room for lunch.

I know not to expect any better from the kitchen staff, but lunch did not improve my attitude at all. Ever since the kitchen crew had been replaced by a different organization the quality of food here has changed quite a bit, in only very few cases for the better. Previously the meat here was all mystery meat. That is it was ground-up and formed into various shapes depending on what the meal was to be. The same type of meat was used for hamburgers, pressed into round patties, meatballs formed into round spheres, riblets, formed into faux rib bones and connective muscle tissue - much like McDonald's does. The only thing that made these various meat dishes different from one another was the kind of sauce that was drizzled over each entrée. Fine cooking technique at its best.

Yesterday, I was grumbling to the woman who was taking over the receptionist spot during her lunch hour, a rather large rotund woman who obviously likes her meals. I indicated it ever since the kitchen staff had changed affiliations that we no longer were served eggs in the morning that were prepared over easy. When they had a big meeting to inform us of this new kitchen regime several of us asked why the change in egg style, as we enjoyed our eggs this way. We were told that it was a state law, because it's easy to get food poisoning from undercooked eggs. This brings up two questions. Since bacteria are killed at 160°, and this is not enough to cook an egg yolk all the way into a hard state. Does this kitchen staff not have the equipment and/or ability to judge when 1 60° has been reached? Why, if people are so concerned about bacteria inside of an egg shell that was formed inside of the bird, obviously the bird must be sick or damaged before the egg was formed. Why is the state that looking to the egg producers for this supposed problem instead of harassing the public about their preferred eating style? Of course both answers were dismissed as ridiculous, as those in charge of the kitchen took the stance that is often taken here toward the residents. That is we know better, were in charge, will take care of you, now just run along and let us do our job.

No fried eggs are presented unless in this overcooked state. Not only that, but whatever product they use to cook the eggs in to keep them from sticking to the cooking surface is a low quality oil that one gets sick of day after day. This makes it hard to eat the same politically correct eggs every day. This morning as the plate rested on my chest, it was not perfectly flat. While I was setting up my breakfast to eat, a slow stream of clear yellow fluid slowly oozed from beneath the eggs toward the low spot on my plate. I suddenly lost all interest in eating fried eggs this morning. I found myself missing greatly cooking in my own kitchen. It seems like a cruel fate to lose my ability to stand and walk, for this get to be treated as less than human, and the food is bad too.

This lends itself to another problem that I've had here. It is the wholesale reduction of anyone (read residents) to a very diminished intellectual state. Something which I find be thoroughly disgusting. I come from a long background based upon Maslow and the hierarchy of needs. There is more to people than just food, clothing and shelter, and being able to string plastic beads twice a week or play bingo does not account for enough beyond the food-clothing- shelter scenario. And yet I find that most of the upper administration here tends to believe this way and act this way toward all of the residents. I have mentioned this to a few people in that category and they don't seem to understand. In fact they almost take offense that anybody would find umbrage with the way they are treated.

I have been in nursing care for more than two years now, in two different organizations, nearly eleven months in this facility. It is one thing that this disease has taken my ability to stand or walk, even to wipe my ass after a bowel movement. But there is no reason on earth that my very humanity should be messed with. I find that the fact that many of the people here, and certainly the administration should fail to understand this is a great indictment on these people and the culture that allows this to exist or continue unchecked. Why should I be the one that has to constantly remind them that this is not the way to treat people? There are studies, for those who can't somehow manage to find this for themselves, that show time and again that when you consistently treat people this way it shortens lifespans and lengthens the time needed to heal from bodily wounds. So why is it that I'm here? Is it to earn disapproval from many in the administration and some CENAs because I know better and refuse to succumb to their uninformed treatment of residents? These may be the last years of my life. Do they really think that under these conditions is any way to spend them? Do they even think at all?  

5 December 2013

I wish that I could consider this as a type of retirement bliss

but who would tokerate this kind of treatment?

Here I am, again. Back for more. Yesterday was really crazy. I keep finding out more about how this facility works, I'm not impressed. Apparently the time around Thanksgiving until Christmas is a slow time for the nursing home/rehabilitation industry. People just are not scheduling elective surgeries and therefore there is not much need for the rehab that most nursing homes offer (like this one) during this time of the year.

Although the floor that I am on is designed to accommodate 40 people, most of them stacked like cord wood in a room (2 residents per room, very little privacy, providing unwanted and intimate information about the assigned roommate) this place shows in many ways how it is designed to work with people as objects rather than living breathing human beings. When there are 40 people on the floor there are four CENA staff assigned to help care for them. As the population drops from 40 the CENA staff is trimmed appropriately (whatever that may mean). Yesterday there were only 30 on this floor and so the intelligence that guides the administration of this place demanded that only two CENAs be shceduled.

Now to be fair, the staff Christmas party was shceduled for last night. So the administration was probably concidering not filling too many daily slots to allow the CENAs to be able to make the party. (Hint, most of the ones I spoke with had no wishes to attend)

Now, there are some individuals who come here and they are destined for only short-term rehabilitation, a matter of three or four weeks. Some of these individuals have never lived in a communal situation, military barracks, dormitories, or other groups living situations. Judging by the way they act, they are the center of their own universe. Think of it as someone living at the small end of the funnel, and everything else falls in towards where they inhabit. There is a man two doors down that insists the call light is not fast enough. Sometimes he doesn't even condescend to using the call light button. He just bangs on the table and calls out for the nurse in a demanding tone. On the occasions when the CENA staff does attend to his insistence on help, he asks them to do lightweight things that he could do himself, like fluff his pillow or turn down his sheet/blanket slightly. There are a few people that come through this place who are so demanding, most of us can hardly wait for them to rehabilitate enough to move on home.

Yesterday was one of those days. My understanding was there only 30 people on this floor so only two CENA staff were scheduled. This is woefully inadequate. Shortly after lunch I felt the internal movement indicating there was a bowel about to make itself present. Knowing the drill, I pressed the call light and waited for one of the CENAs is to come by, to whom I would indicate that I felt a bowel movement impending. Upon which the CWNA would leave to fetch the lift-stand which is used to help get me out of bed and position me over the commode. It only took her 10 minutes to respond (about normal), I indicated my need and she informed me that she would go get the lift-stand. She left at 1:25 PM, I never saw her again. Knowing that the shift changes at 2 o'clock. I believe we had enough time to locate the machinery, extricate me from bed, position me over the commode, do my business, and be returned to bed in about 10 to 15 minutes.

I was quite puzzled, not to mention very uncomfortable, when half an hour after she left I still had no CENA in appearance. I ring the call light again and another CENA appeared wearing her jacket indicating that she was ready to leave as her shift was nearly done. I indicated my condition and that I had been attended to but not finalized, half an hour earlier. I got a partial answer when this individual left as well. After another 20 minutes I got my cell phone and called the front desk and asked to be run up to the third floor nursing station, whereupon I indicated to the nurse who answered my predicament. She indicated that they were very short staffed but she would have someone come by shortly.

While I'm waiting for someone, anyone to come by driving a lift-stand, I'm trying to picture how it is that whoever administers this place figures because there are less bodies in the facility, that those who are here suddenly don't have physical needs or bodily functions that need to be attended to. This just boggles my mind.

It only makes sense if you watch the staff and administration here in action, most of whom are women. And I am constantly reminded of watching the little girls in my third grade class during recess. They had an activity that they all performed in unison out on the playground. The school was situated where there were large oak trees, and appropriately there were many leaves on the ground during the fall. The girls would all race outside to "play house". For this activity they all assumed certain familial positions, father, mother, little brother, and little sister ( for some reason it made sense they all chose siblings who were younger) it always boggled me to watch these young ladies assume roles that anyone would find in a house, and yet they all knew the roles. To my mind they seemed extremely bossy and spent a lot of their time trying to direct their peers in the roles that they had been given. It also seemed quite interesting that they always insist on going through the open space that was designated as the doorway between rooms or into the house. Although the leaves were only pushed into a long snaking pile 8 to 10 inches tall, no one dared to ever step over the leaf row for the sake of expeditiousness. The girls never did that at all. Some of the boys would step over their leaf piles and the girls treated them as if they were ghosts passing through the walls, screaminf and berating them. There was something about the bossiness and the common belief that they all held that they knew best about this whole situation. It was just a game. It was just a bunch of leaves push together into an arranged format. And yet these individuals acted and believed as if the very structure of the world hung on what they did.

For some strange reason I'm reminded of that when I see the individuals, (mostly women) who run this facility. I have found that other than polite “hello” chit chat, there is no talking to them. They do not want to know what you have to say or see or feel. Don't approach them with your version of a problem, they can't hear it and they won't tolerate it. It's sad. But that's what I have to work with.

After an hour and a half of discomfort yesterday, I finally was helped with two CENA staff that had come on for the second shift (with whom I have never had any problems). It is sad that residents of this facility have to put up with this sort of physical discomfort just in attending to what are their usual daily bodily functions. I haven't done anything wrong. I have not been convicted of any crime to be treated like this. And yet I know that state prisoners are afforded better care than this.

Now, I have mentioned some of the kitchen proclivities in the past. To some it may sound like complaining, however I used to be a good cook and had a kitchen that had all the right tools. Yesterday at lunch the kitchen sent up another mound of instant mashed potatoes (which I normally do not eat, on general principles - potato flakes in a box are not a real food source, besides they taste like cardboard box), some steamed cauliflower, and two hot dogs (euphemistically referred to as tube steakes). What was interesting is that the kitchen set up this fine culinary repast with no condiments. No mustard, no ketchup. There was however, packets of salt and pepper. Now, I have yet to find a hot dog that needs extra salt. I found this to be somewhat insulting. Fortunately, I had a few packets of mustard and ketchup that I had saved from other meals, just for occasions like this. For the evening meal this same kitchen sent up a wonderful stuffed pepper, with another helping of the ubiquitous white stuff (instant mashed potatoes). And for this entrée they figured that nobody needed utensils. Luckily I had the presence of mind to save a spoon from one my previous meals. With that I eat the stuffed green pepper and my salad. When the CNEA of the evening came by to retrieve my plate, I indicated that it was a fine meal, however, next time I would appreciate some utensils with which to eat it.

She was aghast, I was once again bemused. What better addition to insult the residents here who have gone through a day of reduced staffing?

More later, now I have to recover.