I hopped out of my car, my heart filled with trepidation and joy, nervous but excited about starting my new job at the nursing home. My certification as a Geriatric Nursing Assistant was as new as the crisp white scrubs I wore.
I had volunteered to work 12 hour shifts -- 7 p.m. to 7 a.m. Would I be fast enough? Strong enough? Smart enough? Or would I be fired before I had a chance to get the hang of the job? A Geriatric Nursing Assistant (GNA) has to hit the ground running. If I didn't do the job well from the very beginning, I wouldn't make it.
Accidentally killing patients, or killing them through carelessness, was easy as pie. Keeping them alive was much more difficult.
Many elderly people can't swallow liquids. Instead, they suck the liquid into their lungs and get pneumonia. If we didn't squeeze every drop of water or mouth wash from the small oral care sponge used to clean out the mouth of such a patient, this simple procedure could turn us into benevolent killers.
People could be severely injured if we dropped them while transferring their still living, yet dead weight, from wheelchair to bed. If we didn't maintain a constant vigil, a patient might unbuckle the useless seat belt on her wheelchair, get up to walk on her own and come to a stop on the floor with a freshly broken hip.
How could we watch everyone all the time and still perform the patient care required of us?
The nursing home wasn't completely new to me. I had already worked there for several months as a Hospitality Aid, passing out snacks to the patients, filling water pitchers, emptying bins filled with soiled laundry.
But now I would actually be allowed to touch the patients. I would wash them and change them into hospital gowns before putting them to bed. Throughout the night I would make rounds every two hours -- changing diapers and rolling the patients from one side to the other in the losing battle to prevent ugly bed sores.
My main concern was speed. Geriatric Nursing Assistants have to work quickly. They are overloaded with patients. Nursing homes never have enough help. When I was a newspaper reporter, I could whip out an article in 20 minutes.
But could I wash a patient, dress him in a gown, brush his teeth and get him into bed in less than 20 minutes?
We really had only about ten minutes to spend on each patient so that everyone would be in bed by 10 p.m., when it was time to start first rounds.
I HAD to get up to speed. I HAD to work quickly and perform the tasks well.
I needed this job.
So I made myself walk briskly through the front door of the nursing home, pretending to be filled with confidence, pretending I knew what I was doing, and I took the elevator to the third floor, where I knew every patient.
I was assigned to West Hall that first night, the hall with the fewest patients because the area that would usually be occupied by four standard rooms and two bathrooms was instead filled with a Day Room. The Day Room had chairs, couches, tables, a television, and jigsaw puzzles. I never saw anyone use it.
Four GNAs were on duty. Three of us were responsible for the three halls filled with double rooms for the patients. The fourth GNA was a floater. She went from one hall to another, wherever she might be needed because where the fourth hall could have been, instead there was a large dining room.
In the center of the floor lay Command Central, the nurses' station. The RNs and LPNs spent their evenings passing out medicine and most of the rest of the night sitting at the nurses' station, filling out paperwork.
With a little help from Shayla, that night's floater, everyone on my hall was in bed by 10.
That was when the fun began.
I started rounds by entering the first room on my right. "Oh, help," the man in the bed closer to the window suddenly groaned. "I'm going to have diarrhea."
His name was John. He had a broken hip, and he couldn't walk to the toilet.
I looked in the bedside table for a fracture pan -- a smaller version of a bedpan used for patients with broken hips. The patient could roll onto his side then roll back down onto the fracture pan without lifting his hips for the more cumbersome bedpan.
No fracture pan in the bedside table. Bedpans and fracture pans were supposed to be standard equipment. Where was John's?
"I can't wait much longer," John cried. "I'm sick. I need to poooooop!"
I dashed to the bathroom. Surely a fracture pan would be close at hand.
No fracture pan in the bathroom.
"I have to get a pan for you, John," I called back as I scurried out the door, headed for the supply room that occupied a small space near the nurses' station.
Fracture pan. Pink. Handle on one end. Where was it?
In a box, on a shelf, almost out of reach. I grabbed the pan and wasted precious seconds following the instructions that had been drummed into me during my certification classes.
"Always remove the sticker from supplies and place the sticker in the charge book on the page with the patient's name," our instructor had said over and over. "If we don't charge the patients for supplies, it may save us 30 seconds at the time, but it hurts our paychecks in the long run if the patients aren't charged for every single item we take to their room, whether it's a toothbrush or a basin."
With the sticker in place in the charge book, I walked back to John's room as fast as I could go. We were not allowed to run because if patients saw us running, they might think there was an emergency and be frightened. Sudden scares could lead to heart attacks.
As I approached the room, I heard John's wails increasing. "Unnnnnnnnn . . . I can't hold it much long. Hurry! Hurry!"
"I"m hurrying, John," I assured him as I pulled on plastic gloves, removed the protective plastic from the fracture pan with my right hand, rolled John onto his side with my left hand, placed the pan under his butt, and rolled him onto his back, fracture pan firmly in place.
"Here it comes!" he cried, as if he were about to give birth to a giant poop baby.
John proceeded to poop as if he had never pooped before. I didn't know anyone could poop that much. He pushed out so much poop that it squeezed over the edges of the pan and onto John's hospital gown, onto the protective pad under his bottom that was supposed to protect the sheet, and then squished out from the pad to the sheet.
When John decided he was done, I rolled him over, removed the overflowing pan so I could rinse it out, and tallied in my mind what I would need from the large metal linen cart in the hall: a clean hospital gown, a fresh bed pad, clean fitted sheet, clean top sheet, washcloth, towel.
At that moment, an RN named Trish stuck her head in the door and saw the mess. She told me to leave all the soiled linens on the floor at the foot of the bed, which was against the rules. Soiled linens were to be placed in large plastic bags immediately and taken to the soiled utility room, where we would then use a large sink with a hose to rinse off as much poop as possible before placing the linens in yet another plastic bag and leaving them in the laundry bin.
"But, but," I tried to protest to Trish.
She cut me off. "You have more people who are sick."
To be continued, I hope.