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