Friday, April 3, 2009

An Honest Day's Labor

Today I did real work.

I did exactly what I went to nursing school for: taking care of people. Lately, I’ve been feeling more like a facilitator than a nurse. Sometimes I am the “resource nurse” which simply means for 2 extra bucks an hour I oversee the care of about 20 patients and make sure nothing Bad happens. Juggling five balls in the air while typing on the computer and talking on the phone. I’m also in charge of making sure we meet the budget and don’t have too many staff members working if our patient census is low. Just looking at the description of it makes me want to simultaneously yawn and scream with boredom. Most days, when I am working as a bedside nurse I am in charge of five patients, their medications and their treatments; making sure the doctor’s orders are carried out; following up on lab and test results; following up on status changes. Referring to myself as a bedside nurse is laughable. Lots of computer time. A few months ago I guaged how much time I spent each shift charting at the computer and it was six hours. I spent a total of six hours documenting what I had done for the patient in twelve hours. But really, I had only worked with the patients for six hours. That’s terribly sad, isn’t it? I’m supposed to be a nurse not an administrative assistant. Oldest Friend tells me frequently: “you do real work, so few people can say that about their work life. “ Her words make me feel like a fraud because most days my work is rushed and I’m always always on a strict time based schedule. It’s rare--with administrative duties--I have time to do hands on work delegated to the nurse’s aid (aside from toileting and walks to the bathroom).

Today I worked as an aide on our unit. This sort of work is often thankless and always hard but I relished the difficulty. I had ten patients in varying degrees of healing and illness; a mixed bag of elderly, psychotic, young, brain injured and two living beyond the odds of survival. I have mentioned beforeI find the aid’s duties meditative and calming. My only time limits are making sure I complete blood sugars, vital signs and meals at the ordered times. Usually, everything I do is time sensitive. Without all of the charting, I eased through my day; no need to rush down the hall nor was I interrupted six times an hour with phone calls or requests for help or opinions or complaints. I worked my way down the hall; helping each of the patients with their baths or showers. Bathing someone is particularly intimate and I, being very shy about my own body, try to ease my own tension by talking to the patients’ about their lives.

Three of my patients were six to eight short years away from the century mark and each one of them had a unique story to tell. One grew up on a ranch and has entertained me for years with stories about the horses her father raised; another lived on a reservation and her grandparents had walked the trail of tears; and another was a hairdresser during the 1930’s. She explained the big Marcel wave device while I washed her body. I was rapt. Her memory was absolutely razor sharp and she could recall yesterday as well as an afternoon in 1930. This patient is particularly special to me because a few years ago I was privileged to help ease one of her beloved family members towards death. Attending someone at death is even more intimate than seeing to their most private bodily functions.

I’m sure the other nurses thought I was an extremely inefficient aid and out of my element because it took me at least 45 minutes to wash each of my bedridden patients. But one of these baths went quickly because she doesn’t speak. Diagnosed with schizoid-affective disorder for many years and living on her own until a month ago something snapped in her mind and she just sort of left this plain of existence and lives somewhere deep inside her own psyche.

She has been with us for a few weeks and slowly coming out of her catatonic place. She will follow you with her eyes and answer yes and no questions. It has been necessary for us to do everything for her because she wouldn’t move or couldn’t move. She doesn’t resist these ministrations; she is placid but she does look at us with huge round eyes and it is hard to interpret if she is frightened or confused. Today, her face was more relaxed and she did speak the word yes rather nod her head. Thankfully, the staff keeps her television off so her room has a monastic silence to it and only the ambient sounds from the hallway filter in. Usually mute patients make me feel a helpless and out of control but I feel a great sense of peace when I am in her room.

At lunch, I sat next to her bed, explaining to her what was on her tray and arranged bites. Her catatonic state is so extensive it is necessary for us to not only feed her but to cue her to chew and swallow. I had a container of high protein shake in my hand and she reached out for it. Deliberately. This woman has not spoken anything beyond one word and has not moved on her own for weeks. Finally, she made a need known. She was thirsty. I smiled at her and handed her the container and she drank deep droughts without being reminded to swallow. I looked at the spoon I was about to place on her tongue and returned it to the plate. Making eye contact with her, I asked: “Would you like to do this yourself?” She didn’t nod or speak but looked at the spoon for a few seconds, contemplating it, sussing out exactly what it was for and then she grasped it with a fist, like a toddler, raised it to her mouth and tentatively fed herself a few bites before she drifted away again.

I’m glad she drifted away because it would have embarrassed me if she had seen me wipe tears from my cheeks as I gave her those last few bites.

At last, an honest day's labor.

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