#i know medicine is a horrible field rn but like. i genuinely want to do it.

[sagxshi]

i fucking hate everything about applying for mcat fee assistance this shit fucking sucks fuck the aamc

[kyotocaitlyn]

Long Term Care: What Dementia Taught me about Life, Nursing, and Love

If some one had told me the day I graduated with my fancy bachelor’s degree in biology that I would spend over a year working in a long term care facility on a lock-down memory care unit, I would have shook my head and laughed at them.  Geriatric medicine was not something in my well-thought out life plan.  

No, my plan was to work as a medical scribe for a while and then apply for a physician’s assistant program.  When all that was over with, I’d finally be able to begin my career working in pediatric medicine, something that has been my dream for over ten years.  That was my life plan that I had designed and it seemed full-proof.  A program called PhysAssist Scribe was going to provide online training and after I had completed the online training, they were going to assist me in finding a scribe job near me.  I was already enrolled and thus my summer post college began.  Like most post-college plans, though, this plan fell through within a few weeks.  My typing speed was excellent, as was my ability to hear and understand what was begin said so I could scribe.  My down side was spelling.  I could not spell any of the medication names to save my life and it clogged up my overall time spent on a patient’s chart.  So, without any warning or indication from PhysAssist, I was let go from the program.

I was devastated.  I was that 22-year-old college graduate with a mostly useless degree living at home with my parents and little siblings with no plan and no job.  I felt hopeless and aimless as a nearly four-month long process of applying for entry level laboratory jobs began.  I was rejected from every job I applied to.  By the end of August and the pressure of having to pay for student loans loomed closer, I began to panic.  I had no idea what I was going to do.  There was one thing, though, that I had told my self I would never do.  I would never get my CNA and work in a nursing home.  I knew about the poor conditions, the back-breaking labor, the emotional turmoil, and the way people saw CNAs.  They saw them as nothing more than butt-wipers, not the essential back bone of modern health care.  I wanted nothing to do with that.  But there was a nursing home literally 5 minutes away from my house with a hiring sign up that whole summer.  As September inched closer and I got desperate, I knew I had no choice.  That nursing home offered in-house certification classes while working full time and I knew they would essentially hire me on the spot.  

So, I swallowed my pride and applied.  I got a call and a phone interview right away and soon, I was in orientation.  I was terrified.  I both knew what to expect and had no idea what to expect at the same time.  I was being thrown head-first into patient care in a field I never even wanted to be a part of.  I was surrounded by people of various walks of life in that class and always felt out of place because of my knowledge, my background, and my degree.  My bosses ranged from people with associates degrees to RNs, some of whom had little to no respect for me or what I was going to be doing for a living.  I had never felt more out of place in my life.  I wanted nothing more than to just quit and work in customer service or something but I knew better.  The patient care experience was going to be irreplaceable and help me get into whatever PA or nursing program I wanted to go to.  This was something I had to do and I knew that.  So I was going to tough it out for how ever long I needed to.

My first day of on the job training had me on the memory care unit.  That unit was small, only 20 residents, and was locked down meaning if the doors leading in or out of the unit were opened without the code, an alarm would sound.  The unit was designed specifically with dementia and Alzheimer’s in mind.  It gave them a safe place to wander (a common symptom of dementia), gave them a place for stimulation and activities, and a place for them to get the specialized care they need and deserve.  Those first few minutes on the unit were the scariest of my life.  I had never been personally touched by dementia so I genuinely had no idea what to expect.  I stood next to my trainer, watching quietly as these elder people wandered with walkers or wheelchairs around the unit, congregating in the TV area.  They looked at me from a distance, trying to size up this new person in their home.  Consistency is crucial for dementia and Alzheimer’s patients so throwing a new person into the mix can cause anxiety and behaviors.  But, as the night went on (I was on second shift until about August of this year), I slowly felt less scared.  The residents began talking to me and though sometimes it made little to no sense (word salading was common as was just talking nonsense or talking as if it was a totally different time or place) it made me feel better.  

Over the course of my on the job training, I spent two more days on that unit and two in other sections of the building.  When I wasn’t on the dementia unit, I felt out of place and even sort of missed it down there.  Most people I worked with disliked the dementia unit.  They didn’t like all the behaviors, the combativeness, and felt like that unit was mostly “baby-sitting”.  A lot of my coworkers felt like because of their dementia, there was a barrier between themselves and the residents, a barrier that might even prevent forming real, genuine relationships. A lot of my coworkers also didn’t seem that concerned with forming relationships with the residents at all.  They showed up, barely did their job and left people soaked, and then left.  That attitude struck me as odd because in my mind, if you were going to be spending eight hours a day or more with those same residents for days on end, you should want to build a relationship with them.  It would make caring for them easier.  Despite all this, there was a thought in my mind that no matter how much I cared for or loved those residents, their dementia would make it nearly impossible for them to reciprocate.  That didn’t really matter to me, though, because each and every day I went in and loved on those people regardless.  Their ability to connect or understand or even know my name didn’t matter.  I loved them and planned on caring for them like they were members of my own family.

Over the course of many months, I began to learn things about those residents and began to notice how many “I love yous” we shared during a shift.  I never knew if they were genuine or just saying it because they felt like it was the right thing to say in that moment, but it always felt nice to hear.  I began advocating for my residents, suggesting new therapies and requesting more help each and every day I worked.  I would bug dietary when they neglected their jobs to the point that they hated seeing it was my unit calling.  I stood up to the other CNAs who belittled my unit, calling it nothing more than “babysitting”.  I would let people know how draining the unit could be, both physically and emotionally.  I would leave in tears many nights because I would get punched by someone who claimed to love me.  I would get yelled at, spit on, ridiculed, teased, and sexually touched by these people who told me they loved me just minutes before.  I knew it was their disease doing it, not them.  I knew they truly didn’t know what they were doing 90% of the time and probably really did care about me.  But the behaviors were hard to work with.  The yelling, the pinching, the hitting were hard to endure day in and day out.  But I did it.  I got bit.  I got felt up.  I got kicked in the shins.  I got my hair pulled.  I got kneed in the face.  I got my wrists squeezed and twisted.  I did it for months because all that bad stuff, while it was hard, never made the impact on my soul that the good stuff did.

The gentle hand holds.  The soft conversations as I got them ready for bed.  The laughs we shared when the residents would say something so goofy that I couldn’t help but laugh.  The hugs I got.  The compliments.  The words of encouragement that somehow despite the dementia they knew I needed to hear.  The way they would laugh during showers when I’d wash their feet because they’re ticklish.  The time spent sitting behind the nurses’ desk with Little Bean.  The time spent learning German so I could communicate better with my German-speaking resident.  The hours I spend coloring and handling soft toys.  The games of balloon toss.  All those good things left a bigger impact than all the nasty behaviors that the dementia was doing to them and me.  I was slowly learning how terrible dementia really was but how blessed I was to be working with them.  Dementia was horrible but these people were incredible.  I loved them all so much, even though I knew the dementia could make it hard for them to love me back.

During the summer, a resident that resembled my late grandma began actively dying.  She had had increased edema in both legs, weeping, a strange red blotchy rash that caused her no discomfort, and a low grade fever.  She had no real symptoms of anything outside of the edema that everyone assumed was from her CHF that was more or less not an issue.  The only other thing I was really worried about with her was that she had a decrease in appetite.  Whenever I’d bring these issues up to a nurse, they’d shrug it off because she was 98 and on hospice.  That response always made me clench my jaw, but I put up with the ignorance and kept bringing my concerns up.  When she started dying, I went to see her and her chin would quiver a little when I’d talk to her.  She passed peacefully with no pain, but I couldn’t shake the feeling that we could have done something more for her if someone had just listened to me and taken my concerns seriously.

A couple weeks before that resident began dying, my Bean was moved to a different floor.  I shared my concerns about her moving to a crowded, over-stimulating floor with a member of nurse admin.  I told this nurse that I was worried that my anxious Little Bean would be stranded at the nurses’ desk in an unfamiliar floor with people everywhere, phones going off, and call lights buzzing and fall out of her wheel chair because she was unsupervised.  I told the nurse that I was terrified that one fall would be the one that killed her and I was brushed off.  I was told that I was favoring Bean over the community and that I should think better of the aides on other floors.  I visited that resident everyday she was up there until one night, the scenario I described happened.  Bean was stranded at the nurses’ desk late at night and fell, hitting her head.  She began to actively pass later that morning.  I was devastated.  I cried practically all shift when I found out that my Bean, the Bean whom I had shared so many moments with over the last year, was in pain and dying.  I went to see her that night, kneeling next to her bed and sobbing.  Then I noticed Bean was rolling toward me.  Her lips were moving like she wanted to say something to me, but couldn’t, and she squeezed my hand.  It was then that I realized that dementia didn’t prevent these people from loving.  No, it was a mutual relationship Bean and I shared.  I meant as much to her and she meant to me.  Little Bean loved me and I knew it then more than I had ever known it before.  Yes, dementia is an ugly terrible disease but when a person with dementia says they love you, they mean it.  They mean it with their entire being.  Yes, they might think you’re their mother, their sister, or their daughter, but they mean it when they say it.  They know you aren’t just some stranger.  They may not know your name, but they know you.  They trust you and they love you.  Believe me, they love you.

After little Bean passed, I began thinking about everything my residents have taught me and now that I have worked my last shift at that facility, a certain thing keeps creeping up in my head.  There’s a verse in the Bible about what love is and it’s all I can think about.  My residents have taught me so much about love and I didn’t even know it until one of them that I loved so dearly left this earth to go be with Jesus.  The verse is 1 Corinthians 13:4-7 and it reads, 

“Love is patient, love is kind. It does not envy, it does not boast, it is not proud.5 It does not dishonor others, it is not self-seeking, it is not easily angered, it keeps no record of wrongs.6 Love does not delight in evil but rejoices with the truth.7 It always protects, always trusts, always hopes, always perseveres.”

My residents taught me that love really is all of these things.  Love is patient.  Love is having to explain to a confused person why they cannot leave the locked unit 1,000 times a day and having to do it with a smile on your face each time.  Love is being able to patiently take the seemingly endless slaps and yelling, all while being friendly and professional.  Love is choosing to be patient, even when those behaviors seem unmanageable and you’re at your wits end.  Love is kind.  Love is showing unbelievable kindness to someone who was literally just beating up on you minutes before.  Love is just smiling and nodding when someone is being cruel to you, but you know it’s the dementia talking.  Love is choosing to be kind to someone who more than likely is not kind to you in that moment.  Love does not envy.  Love is knowing that while it’s okay to long for something more or something better, that there is no good in envying what others have.  Love does not boast.  Love is knowing that you are no better than anyone else.  Love is choosing to be humble.  Love does not dishonor others.  Love is choosing to be genuine and honest, even when it’s hard.  Love is not self-seeking.  Love seeks to build others up, not tear them down.  Love is knowing that you’ll get peed on or beat up on, but doing it because it is right and it is good.  Love is not easily angered.  Love is knowing how frustrating your job is, but never showing your frustration or even anger to the residents because you know they cannot help the way they are acting.  Love really does keep no records of wrongs.  When a resident does hit or yell or spill bodily fluids on you, you do not throw that in their face to use it against them.  Love is forgetting they were cruel, just as they did.  Love really does not delight in evil, but always does rejoice within the truth.  Love does not look to blame, shame, or condemn.  Rather, love builds up, love supports, and love tells the truth.  Love is celebrating the little victories, rather than loosing it over the things that goes wrong.  Love does protect.  Love is standing up for your residents, even though you know sometimes what you say goes in one ear and out the other.  Love is getting in between two angry, violent residents so they cannot hurt themselves, but can hurt you.  Love does trust.  Being loving builds trust, breaking down the barriers of dementia and Alzheimer’s.  When that resident loves you, they trust you and there’s nothing more important than that.  Love trusts that their cruelty comes from disease, not from the sake of being cruel.  Love does hope.  Love is hoping that tomorrow will be a better day.  Love is hoping that your hard work has given hope to a family that’s suffering through dementia as their family member is.  Love is hoping and yearning that one day, this world will be dementia free.  And love truly does always persevere.  Love is coming back, even when the bad days out weigh the good.  Love is working short staffed, getting flat-out ignored by those higher than you or even ridiculed by those higher than you, and encouraging the families that dementia is tormenting.  Love is coming back with a smile, not tucking your tail in between your legs and running.

My residents have also taught me a lot about nursing.  They have taught me to value the input of CNAs as important and even life-saving because they are.  CNAs are the eyes and ears of a long-term care facility.  They see the same residents day and day out so when they come to you with concerns or changes in condition, you should not shrug them off.  You should not belittle them.  You should not ignore them because they are “just CNAs”.  They are coming to you because they care and they are concerned.  There is nothing more important than that.  It’s better to investigate and find nothing than to do nothing and have someone suffer.  My residents have taught me that health care is a team sport, not an individual one.  Everyone must work together for the benefit of patient, listening to one another and bouncing ideas off each other.  We should not look down on those with a narrower scope of practice or those with less experience.  Instead, we should treat them as the important members of the health care team that they are and respect them.  There is no room in true patient-focused health care for self importance.  Patient-focused health care should be loving and as I’ve seen, love truly doesn’t boast and is self sacrificing.

I’ve seen and learned a lot this last year.  Those residents are family to me and I owe them so much.  They taught me so much about how to not sweat the simple things, how to be more flexible, and how, ultimately, God is in control.  God put me on that dementia unit for a reason I didn’t understand until recently.  I needed to understand what I was getting myself into before I dove head-first into a career in health care.  I needed to suffer so I would come out on the other side as someone who understands the struggles of those I work with and for.  He put me there so I could learn how to be an advocate and how to love, even when it feels like the person may not love you back.  I’ve learned how to deal with death better and learned that it really is okay to cry as long as you know that dementia and old age is no longer destroying the person I loved.  They are restored in Christ if they knew him, that that is the greatest comfort at all.  For those reading who do not share my views, it has taught me that everyone takes comfort when a loved one passes because we know they are free from dementia which I have learned this year to be one of the worst diseases on this earth.  

I have learned so much and this post is already so long.  I cannot possibly talk about everything I have taken away from this experience in long term care so I’ll end with this; health care should always be about love.  If love is absent, true healing, encouragement, and peace cannot be achieved.  When I first started doing CNA work, I was told by some that I should avoid getting too attached to my residents.  I was told it would be too much and interfere with how I did my job; that when one died, I’d be too distraught to do my job if I got too attached.  That is the biggest lie you could tell someone getting into this field.  It’s good to get attached, so long as it’s professional and comes from a place of love and compassion.  Caring goes such a long way and growing attached is only natural if you are doing it right.  Health care becomes robotic if there is no love, and love can only take root if you are attached to the people you are trying to help.  Attachment comes in many forms, not always in forehead kisses or deep conversations.  Attachment can be simply holding someone’s hand in the ER or the back of an ambulance during an emergency when they’re alone and/or scared.  Attachment can be listening, just listening to the patient even when they don’t make sense.  Attachment can be an extension of love and compassion, something that should not be absent in healthy care.  Thank you to all of the residents I have cared for over the last year for loving me and teaching me so much about life and love.  Thank you to all the wonderful nurses who have helped show me that despite the terrible hours, hard work, and emotional stress that this job really is worth it in the end.  Thank you to the resident family members and the residents who have become like family to me.  You all mean so much to me and I cannot thank you enough. Thank you.