THOSE WHO COULD NOT SPEAK: VADA

Before the nursing home occupied the fairly attractive and modern facility in which I worked, it was in an old house. Donna, the night supervisor, said she missed the house -- that she felt they were more of a family there. A couple of GNAs who had worked for the nursing home for years agreed with her. The house was more homey, they said, which, of  course, made sense.

A few of the patients had been in the nursing home long enough that they had also lived in the house. One of them was Vada. Donna told me that when they were in the house, Vada walked and used the toilet. She lived in the home because she was indigent, had no family of which we were aware, and was incapable of living on her own. I surmised she was developmentally disabled and had long been institutionalized by state authorities. Donna told me that Vada's abilities had always been limited to simple sentences, coloring with crayons, and joining in on games such as bingo. When I knew Vada, though, she was in a wheelchair and she didn't talk at all. The only sound she made was a strange chortling noise that we thought was laughter.

Gradually, however, a couple of the other GNAs and I figured out she made the noise when she was afraid. We learned this when Faith tipped Zelda's wheelchair backwards a bit and discovered she made the sound. We laughed, thinking we laughed with her because she enjoyed the surprise.

But then we realized from her expression that Vada wasn't happy and enjoying the experience. She was just plain scared. After that, I heard Vada make the noise at the flash of a camera or when we transferred her from her wheelchair to her bed and sometimes didn't make it. Occasionally, patients struggled while we moved them. If we couldn't get them on the bed or the toilet because they clung to us wildly or wiggled like toddlers, we lowered them to the floor as gently as possible and sought reinforcements to pick up the patient from the floor and get her where she needed to go.

Vada frequently ended up being lowered to the floor because of her struggling and because she was 200 pounds of dead weight. She couldn't support herself at all.

Vada, like Ronnie, shocked me one Saturday night. I got off the elevator on the third floor to start my shift. Vada sat directly in front of the elevator.

"Girl, will you put me to bed?" she shouted.

All the staff members within hearing distance were amazed to hear Vada speak, and in a complete sentence. We figured Vada REALLY wanted to go to bed.

I hugged her and said, "Of course I'll put you to bed. Just let me take off my jacket."

And I kept my promise.

Vada's condition gradually deteriorated during the months I knew her. She went from using the toilet (with our help, of course) to total incontinence. She lost the ability to swallow food and was put on a diet of pureed mush with "drinks" that had corn starch added to thicken them so she wouldn't suck liquids into her lungs and get pneumonia.

And her sometimes frustrating, but amusing, antics came to an end. One night she had taken the toothbrushes from every bathroom on South Hall and put them in a vase to create a multi-colored bouquet. On another occasion, she took a woman's glasses and dentures -- just before the patient's family appeared for a visit. They were quite irate when they found Mom without glasses and teeth. We scoured the third floor for the specs and the choppers and were very relieved to find them in the drawer of Vada's bedside table.

Angry family members were no fun. Although they often had good reasons to be angry, sometimes the incident that upset them was beyond our control. For example, almost all the patients wanted to go to bed right after supper. We could not put 65 or 70 patients to bed at the same time. When families came in and saw that Dad had fallen on the floor trying to put himself to bed because we ignored him (they thought), they became very angry.

As Vada's health deteriorated, she became one of the patients who really needed to go to bed as soon as possible after dinner. Many evenings, Vada's head drooped and she dozed in her wheelchair while she waited for bed.

One night, she cried, apparently from exhaustion. Zelda, who usually insisted on being put to bed right after dinner -- and got her way -- demanded that I "put that poor soul to bed right now." It was the first glimmer I had of Zelda's capacity to empathize with others.

Then one night when I came to work early -- before dinner -- I found Vada in bed, sound asleep. The day staff had put her there for a nap because she had fallen asleep in her wheelchair. I couldn't wake her by saying her name. I pinched her hand gently and she made absolutely no movement or sound. The Director of Nursing, Lynn, was assisting with patient care. Frightened, I asked her to check Vada.

She did and said she was sure Vada would be all right. "Vada had some medicine today that made her sleepy," Lynn explained. "She should sleep it off and be all right in the morning."

I didn't know what the medicine was for, but it didn't seem to help. Vada slept more and more and was quite obviously moving toward the end of her life.

Then early one morning I went to change Vada's diaper before I left for the day. I found Vada awake and waiting for me with eager eyes.

"I NEED TO SHIT!" she shouted.

"I'll get you a bedpan," I told her.

I rolled Vada onto her side, put her on the pink plastic bedpan, raised the head of the  bed some, and Vada let out a mighty groan as she released a large solid ball of poop. It must have been a while since the poor woman had pooped, and I bet it was painful.

It turned out to be Vada's final poop and last words.

I went home after cleaning her bottom. I had the next two days off.

When I returned to work, Vada was gone. She had died in her sleep. Every trace of her had disappeared, as if she never existed.