Dementia Wins By A Landslide !

I worked in various nursing homes during the years I worked as an RN, starting in 1985.  I worked as a ‘floor’ nurse, charge nurse, supervisor, and administrative (desk) nurse.  Nursing homes really are quite delightful places to work, and while nursing home nurses are often looked down upon by hospital nurses (I’ve done that kind of nursing too), the skill set required is extensive.  They have to have a bit of knowledge about all medical specialties (except obstetrics, though one gentleman did scream that he was giving birth to a calf in an emergent situation…my guess is that most people in a 3-4 block area knew of his distress; his doc felt that Haldol was a good ‘post-partum’ drug… I don’t like Haldol for the elderly; it was designed for schizophrenics- but it did quiet him down).  There are the medical issues that put people in nursing homes to begin with, and then there are those folks with dementia who can be so totally heartbreaking to watch…or a source of some humor. If we didn’t chuckle, we’d weep.  The following are from some decades ago… some of the rules were a bit ‘different’ back then, though nobody ever did anything to make the situation worse.

One woman I remember was very distinguished in her outward appearance. She was always ‘put together’ in how she dressed and in her appropriate greetings of people she met in the halls, but had no clue about hygiene or changing her clothes regularly.  Usually the certified nursing assistants (CNAs) could get almost every resident into the shower without too much hassle, but this lady was persistent in her refusal.  Nursing home residents have the right to be sloppy…when they are coherent enough to know the risk/benefit of their decisions.  When a green cloud follows them, and people fall like dominoes in their wake, something has to be done.  That’s when the administrative nurses have to jump in and figure something out.

The first thing to do was notify the family and get their permission to bathe Mrs. Cloud, even if she refused. They were the legal guardians since she couldn’t make decisions, so that wasn’t hard- they were thankful we were looking out for her (they were also out of town, so couldn’t be ‘hands-on’). The next thing to do was to figure out a plan.  The assistant director of nurses (ADON) and I were the ones who somehow got blessed with this task assignment, and thought we had a pretty good idea of how to get the job done. We got Mrs. Cloud into her private room, and carried on some generic, though tangential conversations as we got her overcoat off, and then talked about getting her clothes washed (that was usually less threatening than actually talking about showers up front).  OY.  We got the coat. We were doing pretty well with the dress, but getting down to her slip, and undies, we noticed that she had about 4 pairs of caked-on pantyhose. Each of those pantyhose required getting Mrs. Cloud back on her bed, ‘scootching’ the hose down, and then removing them…. x 4. Between each ‘scootch’, she’d bolt up and try to run off, so we’d have to get her seated again, then lying back on the bed so we could continue ‘scootching’.   The ADON and I were sweating by the time that was over.  The slip, bra, and undies were a piece of cake after the pantyhose circus.

So, we get Mrs. Cloud into her shower- after all, if we’re going to clean her clothes, why not get a nice warm shower (sounded like a good line)… she wasn’t happy, but went for it. We had the towels and washcloths ready. But…. oops. I forgot the body wash.  The  poor ADON was left wrangling Mrs. Cloud in the shower as I sped out of the room to find body wash.  I found what we needed, and we finished the shower from hell with no casualties.  A few minutes later, I saw Mrs. Cloud in the hallway, all fresh and sans cloud-o-funk, and she greeted me as if she’d never seen me before- very polite with a superficial smile. She remembered nothing. Crickets.

I also worked ‘the floor’ at night for a while.  One night, another confused little lady was wandering in a sort of frenzy, and was visibly tired. She had a sleeping pill ordered, so I offered her one. She wouldn’t take it.  I opened up the capsule, and mixed it with a tablespoon of orange juice in a one ounce plastic ‘shot glass’ medicine cup. I offered her a little nightcap, and she was so happy to take it.  I had poured some plain orange juice to get rid of any funky taste in her mouth, and she looked at me- dead serious- and said “Oh, Honey- I can only have one”.  She traipsed off to bed and finally got some sleep.

Another night, I was doing my routine work on the 11-7 shift, and one of the CNAs comes flying up the hallway off  one of the ‘pods’ (a grouping of rooms), calling my name as if she’d just witnessed Jack the Ripper field dressing a dozen deer in the back room.   I immediately went racing down to meet her, and follow her to the room in ‘distress’.  I stopped cold when I saw the elderly gentleman (also confused as all get out) sitting completely naked, bolt upright in his bed, grinning from ear to ear with his sheets and blankets all over the place. He was ‘splashing’ the gel from his gel mattress (as much as someone can splash something with the consistency of applesauce).  He had managed to puncture the mattress (used to protect skin), and had that gunk all over the place. It was hysterical.  I didn’t want to laugh at him, but it was hard to maintain anybody’s dignity at that moment. He was having a ball !  We got him cleaned up, and my only comment to the CNA was the need to differentiate between something that is life-threatening and something that is an inconvenience, but essentially harmless.  We didn’t need blood curdling screams in the middle of the night for a little  gunk on the floor (well, OK, it was a lot of gunk).

We also had a  hoarder.  The facility towels and washcloths, junk- didn’t matter. And she was possessive.  Anybody who went to clear out the stuff for laundry to rewash had to have someone else ‘stand lookout’, or the poor ‘lone’ retriever would be yelled at for a good 3-5 mintues, until the hoarder forgot why she was mad. One afternoon, one of the activity aides found a family of mice (mama and babies….LOTS of babies) living in a leftover popcorn bag (from movie and popcorn day), and a cake in a plastic bakery container that was so old that nobody could figure out the original flavor and/or color.

One of my favorite little ladies was superficially appropriate, but 2-3 minutes into a conversation there was no doubt that some bulbs were dimming. She was generally cheerful, and had a buddy she hung out with. She also was not fond of showers or combing her hair (think Einstein plugged in to a household outlet), but would let me check her skin weekly (per required protocols everyone got weekly skin checks- head to toe). The CNAs and I got into a routine of doing the skin checks in the shower room, and since I needed to see ALL of her skin, she’d agree for the CNAs to ‘hold’ her clothing…funny how the shower would get turned on, and she’d get nice and clean- she was always very agreeable once she felt the warm water. One day before getting showered, she walked past one of the mirrors, and saw herself. She literally gasped loudly and stepped back from her own reflection… she looked at me and asked about a hairbrush.  At least she still knew it was her own reflection- some lost that.

Nursing homes get bad reputations, but there are so many nice ones. I had the chance to work at two that I really liked, each for about 2.5 years.  The residents become like extended family, and some of their families also became part of the daily routine.  I’ve worked with CNAs who have been at the same facility for over 30 years…when offered promotions, they refused, not wanting to leave ‘their’ people. ❤  I’m incredibly thankful for the coworkers and residents I met when I was working at those facilities. 🙂

September 11, 2001

My dad called me around 8:00 a.m. Central Daylight Savings Time to ask me if I had the TV on. “You won’t believe what they have done”.  They. THEY?. They… I was 5 days post-op from having scalp surgery and vein stripping on one leg, and was still a little out of sorts from the anesthesia and healing process from that.  I dragged myself out of bed and turned on the TV.

At first it was just too much to process. There was smoke coming from both of the World Trade Centers.  They.  It was incomprehensible that fighting a fire at that ‘altitude’ was going to work.  I was having trouble knowing what to think, what to do, what to feel… and I was a couple of thousands of miles away.  They were doing something to us in New York. I saw footage of thousands of people just looking up, their expressions a conglomeration of shock, disbelief, and horror.  How many people were in the Towers?  At that time, estimates were as high as 50,000 regular employees of the buildings and businesses in them. That number didn’t even register in my head.

I saw  replays of the second plane hit the other Tower.  The fireball.  The people who had to have died instantly and then the ones who were trapped filled my head.  The news kept showing people waving jackets and improvised ‘flags’. But they were too high.  When I saw footage of the second plane hit, I knew who they were.  Bin Laden was the one who had done other attacks, but nothing like this. His minions were attacking the United States.  Here.  I called my dad back to ask him if I should go get my car filled up with gas. I don’t know why that was important, but it seemed that everyone gets gas during an emergency.  Nobody knew all of the targets at that point, and I was in Texas. Lots of military bases in Texas.  For some reason gas seemed important. But I was immobilized by what I was seeing.

Another plane hit the Pentagon at 8:37 a.m. CDST. The Pentagon? How could anything get through the Pentagon?  More dead. More trapped. More hurting. Families watching, waiting… More fire.

I watched the South Tower implode at 8:59 a.m. CDST.  How could that happen?  It was a huge building full of people.  Full of people.  How many were trapped, but alert, as the floors started to fall out beneath their feet?  How many knew exactly what was happening as they fell 70-90 stories to their deaths?  How many were instantly incinerated when the planes hit?   How many really jumped?  Then the second tower went down. How many families were watching their loved ones die?  Were they alone? Was someone with them as they watched their lives change forever?

At 9:03 a.m. CDST, the fourth plane went down in Pennsylvania, obliterating it.  The stories were scattered about what had happened, but word was that the passengers got control of the plane and crashed it themselves.  More lack of comprehension, and awe at their presence of mind in the middle of the crisis when I was dumbstruck many states away.  What had they felt? How had that group of people been on the same plane, and able to enact a plan to avoid more disaster and loss of life as they heard of what had happened in NYC and DC?  How had they been able to call loved ones ahead of time and get word about what was happening?  How were those loved ones when they heard news of that plane going down… Was someone with them to offer some token of support in a situation that defies the scope of ‘normal’ grief?

9:28 a.m. CDST- The North Tower falls.  The debris and aerosolized concrete  and building materials blanket the end of Manhattan, while the rest of the city has amazingly blue skies. The tops of the towers are both gone; the city is engulfed in particles of walls, papers, paint, office equipment…people.  The steel frames were bent and twisted when what little of what was left  materialized on the TV screen. It was still hard to really understand the magnitude of what had happened.  I was numb.

The next two weeks, I was off of work because of the surgery, and 24/7 for much of that time, the news channels were glued to the coverage; cable stations ceased programming. I was immersed in the news about the attacks continuously.  For some reason, I couldn’t turn the TV off.  I had to know what was going on. Were there more attacks?  Were we safe?  I’d see the shots of people putting up photos and descriptions of their missing loved ones on fences and walls near the Trade Center site.  They had to ‘know’, but also had to hang on to a bit of hope until there was none left to grasp.

Rescue workers were going through the wreckage of the Towers with buckets, pausing only occasionally when a body was found.  Everyone stopped working, paying their respects to the person coming out in a flag covered stretcher.  The NYFD carried out their priest on a chair. Dead.  Both the NYPD and NYFD lost SO many of their own.  How unfair that anybody die, but they died going in to help the others.  And the buildings caved in.  They didn’t have a chance up in those buildings or near the bottom where the twisted pieces fell.

Dogs wore special boots to keep from shredding their paws on the steel and glass.  They were there for survivors at first, and then those who were temporarily buried in that burning metal tomb.

In total, 2,606 people died in NYC, 125 at the Pentagon, and 40 in the plane crashed by heroes in a field in Pennsylvania.  The youngest to die was 2 1/2 years old.  Ninety countries lost citizens.  Nineteen highjackers also died, but I refuse to add them to the total victim count. In total, more than 2975 people were killed in the span of  102 minutes.  For what?  

In two days, it will be the 11th anniversary.  I still can’t see documentaries about that day without dissolving into tears, and I wasn’t even close to the situation.  This had no ‘borders’ or ‘city limits’. This was an attack on America, collateral damage in the form of foreign nationals- our friends- be damned.  It still makes no sense.  I still wonder how the people in NYC deal with their grief, and how the families of the victims are doing.  I wonder how those who inhaled that stuff  have fared; various illnesses have been reported- in those who were there to help.  My guess is that the actual number of victims is really unknown; the families and friends of those who actually died will never be the same. They are victims,too. And survivors.

September 11, 2001 showed the vulnerability of all of us.  While I’ve gone through a personal attack in my home, the magnitude of 9/11 isn’t something any of us could comprehend.  There are countries that go through terrorism regularly, but not us. Oklahoma City was the closest we got to knowing what that is like. Even the first WTC bombings didn’t come close to 9/11.

I changed that day.  The fact that life can be cut short in a nanosecond at the hands of lunatics was graphically shown for days on end.  For the first few weeks after I returned to work, I was overwhelmingly annoyed when my coworkers talked about everyday mundane ‘problems’ (matching shoes to a dress for some 3rd rate banquet? Puhleeze).  It took me a while to get out of those two weeks, and back into my regular life.

But I’m so insignificant in the grand scheme of things.  What about those families and friends, and now the survivors of those lost in the wars fought in response to 9/11.  In many ways it has been a world war.  I’ll never forget that day, and I hope those who were too young to remember it will grasp the magnitude of that day and learn from history.  I hope that we can regain some of our prior sense of safety without neglecting common sense.  It happened once… we can never guarantee it won’t happen again.  But we have to go on living if we are to really honor those who were lost.  Otherwise they win.