Wednesday, January 16, 2013

THE BIRTH OF A BEDSORE: PART TWO

To read the first part of The Birth of a Bedsore, click HERE.

As Vivie and I grew closer, I learned that the woman, Barbara, who put her to bed each night was not her daughter, as I had assumed. Vivie had been this family's landlady at one time. Their little girl, Megan, thought of  Vivie as her grandma. Barbara's husband also came to visit regularly.

These people were among the most faithful visitors in the building, and they weren't even related to Vivie by blood. They just loved her.

I did see Vivie with a visitor one other time. The first Christmas I worked at the nursing home, an unattractive burly biker-type guy came in with his equally unattractive wife. They were Vivie's son and daughter-in-law, and they were drunk. They brought beer along. Maybe they felt they needed it to get through the family reunion. When I stopped by Vivie's room that day to give her fresh water, it smelled like a brewery. She looked at the pair with absolute disgust; they didn't seem to notice. They had poured a cup of beer for Vivie, which she didn't touch. As soon as the pair left, I hurried to her room and asked if I should pour it out.

"Yes, y-yes, g-get rid of it,"  she stammered.

I did, and reported the incident to the charge nurse. She raised her eyebrows, but said nothing.

I never saw those visitors again.

After I earned my GNA license, I became responsible for the direct care of the patients; that is, my duties included keeping them clean and dry, and since I worked the night shift, turning them in bed regularly to avoid bedsores, more accurately known as decubitus ulcers. Elderly or bedridden people are prone to bedsores because they tend to spend many hours sitting or lying in the same position. The skin on which most of their weight rests gradually breaks down and opens up into a runny sore that grows deeper and deeper, sometimes going all the way to the bone in spite of treatment.

Vivie was on South Hall, so her care was usually in my jurisdiction. Now that I was no longer responsible for bringing her snacks or fresh water, I didn't see a lot of her because she didn't need much during the night. She could roll over in bed and pick up her water pitcher to get a drink if she needed one.

Occasionally Barbara would call Bernadette, a member of the activities staff, to tell her she couldn't come in that night to put Vivie to bed. Bernadette would make sure the word got out that I was needed. Vivie couldn't remember my name. She referred to me as "that girl."

"I-I want that girl to put me to bed," she'd splutter. Almost everyone knew she meant me. If I happened to be working on the second floor, someone would call for me or come down to tell me that Vivie had requested my services. I was glad to go -- glad to do what I could to make her happy.

I had already figured out that Vivie had some form of dementia, maybe Alzheimer's, since she couldn't remember names and had difficulty coming up with words. But when I started helping her change for bed, I learned she had only one breast. So I knew she had had cancer, or perhaps still had cancer. She also slept with supplemental oxygen running into her nose through a nasal cannula, so she may have had emphysema, too.

Strangely, we GNAs were given very little information about the care the patients needed. I never understood if the charge nurses felt they didn't have time to tell us about the patients, or if they thought we were too stupid to understand. I probed for information constantly. Sometimes I got answers to my questions -- sometimes not. Sometimes the nurses said they didn't know what a patient's condition was. They just followed orders for medications and passed them out.

So most of what I knew about the patients was conjecture based on long-term observance. That's why I didn't know much about Vivie's multiple illnesses.

But then she developed a problem that I saw from the moment of its inception.

35 comments:

  1. Yet another fascinating read. I wonder why they didn't give you information on the patients. With our Home Health Aides in Hospice, they always have at least the bare minimum about the patient's condition. I think the more info you have, the better you can do your job. But you managed to do a great job, anyway :)

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    1. I think we could have been more useful with more information. At times, we put patients' health at risk because we gave them things they weren't supposed to have.

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  2. These are fascinating and sometimes heartbreaking stories.

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    1. I hope I can also work in how much we laughed. Right now the sad stories are coming out.

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  3. It was short-sighted not to keep everyone who was responsible for providing patient care informed about their conditions, limitations, and needs. To do less than that makes it seem like the patients, as individuals, don't matter, if you know what I mean. You provided excellent care, based on your instincts, training, and good heart, but not telling you those things was denying you another valuable tool.

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    1. Sometimes a patient's abilities deteriorated and I didn't know about it. If I was on the second floor for a couple of months, then switched to third again, I might find that someone who had been able to stand could no longer do so. I often learned the hard way.

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  4. Keep us hanging, Janie. Feeling sad for Vivie.

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    1. I'm sorry, but the story has a sad ending.

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  5. This is really an amazing story. That people like you and Barbara and her family are so selflessly good to people like Vivie give me great cheer.

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    1. Barbara was selfless, without a doubt. The only reason she came in was her love for Vivie. I loved the patients, but I wouldn't have been there if I hadn't needed the paycheck.

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  6. Surely you should have had a lot more information! I am glad she had you though :)

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    1. Most of the information we got was through word of mouth. One GNA would get a little information about a patient and would pass it on. We did know, however, who was supposed to be on oxygen. It was obvious because of the oxygen hooked up next to the person's bed. We could also easily see when someone was fed through a tube.

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  7. This actually explains a lot and I wonder if this is a prcitice that many institiutions have. Not telling the staff what is wrong with the patients that is. I had a nurse almost kll me one time by putting a bag of of glucose on my IV pole all weekend. The dr thought people were sneaking food in or that I wasn't taking my insulin. She got fired. Now I wonder if she just wasn't informed. Sad.

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    1. The nurse also might have been given an incorrect order or an order written in such poor handwriting that she couldn't read it. I imagine she thought she was doing what she was supposed to do.

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  8. This is an enlightening look at the system of care for the elderly. Most of us try and avoid this world.

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    1. I want to avoid this world in the future. My kids have strict instructions to kill me rather than put me in a nursing home.

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  9. How did they expect you to give people proper care without even basic information? That's very hard for me to understand!!

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    1. I never understood it either. That's why I drove the nurses nuts with all my questions.

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  10. How strange that her son brought beer with him! I enjoy reading this.

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    1. I think he brought it because he was a jerk and he knew she disapproved of the beer and of him, in general. These people did not look like the type to be related to a nice little lady who was always sweet and never cursed or gave us a hard time.

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  11. That seems crazy that you wouldn't be given that information.

    What a wonderful, genuinely loving and kind person you are to have her request you specifically.

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    1. I was also a pushover and everybody knew it.

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  12. Were the patients ever served any alcohol? Wondering for myself in the future...

    Kidding. You know, a nightcap or something?

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    1. Sorry, no alcohol. I think a lot of them would have been happier if they could have kicked back with a martini after dinner. One woman's family sneaked in vodka for her, and she was already on very strong painkillers. Dealing with her was miserable.

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  13. My MIL is technically an alcoholic, I guess. Her late husband would never let her drink. She had this home health aide who would give her a sherry in a coffee cup in the evenings. That's really all she needed to keep her happy. She doesn't get her sherry at her assisted living.

    I've seen ads for places around here that show an elderly man or woman with a wine glass in their hand. Just curious.

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    1. Some of the fancy expensive assisted living places might serve wine or a cocktail -- I don't know. Nursing homes definitely don't serve alcohol, but a lot of the patients would be less crabby if they had a drink during the evening.

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  14. Poor Vivie having such a son and daughter in-law and also having so many medical problems but as for the nurses not sharing with about patients problems I don't get that the more you know the better you could care for someone.............I guess me and mum would be considered faithfull visitors since we go every week to see my nan

    Now sorry to sound sound thick but what does GNA stand for.......

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    1. You're not thick. GNA = Geriatric Nursing Assistant
      Some states use certified nursing assistants in their nursing homes and don't even have the GNA. Maryland offered an extra test to achieve the GNA level. At the nursing home where I worked CNAs had to pass the GNA test within three months to keep their jobs.

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  15. This is a really amazing story. You are an amazing person.

    www.modernworld4.blogspot.com

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    1. I'm not amazing, but the world is. Thank you.

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  16. I love reading these posts. My dad is in a rest home and now I see things from others' point of view. I hope there is someone like you in his life!!

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    1. I'm willing to bet your dad has some good people in his life. Nursing homes usually have a couple of bad people, but most of the workers try hard.

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  17. I love reading your posts. My dad is in a nursing home and you are helping me see things from the other side. I hope there is someone like you in his life! You are a special person!!

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  18. I have seen a lot; but never drunks visiting someone in the hospital. How unwonderful.

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    1. I was grateful they didn't come back. Vivie didn't seem pleased by their visit.

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