food for thought

I haven’t been blogging too much lately. I decided to hop on and try again. I realize how much working in nursing homes makes one think about death and aging constantly. I see what happens to the body day in and day out. I try not to see it, but it registers daily. I tell myself I would be able to handle the physical declines as well as the people I see, but I am not sure in any ways. I catch myself getting annoyed at people upset over petty issues. Or what seems petty to me. For instance, the aide didn’t smile enough today or just the food is bad. So many times I want to say, “at least you are not blind, you have two legs, are not paralyzed or drooling and no one is changing your diapers.” I so want to say that one time. I have become so grateful and complain so much less the longer I do this. I protect my health with every decision I make from what I eat to trying to exercise. I get my mammograms. Yes, even get the poop shoot checked. I will do it all to prevent what I see happen to others. When I do feel upset over stupid little bothersome issues , I will remember the people who really know suffering. Sometimes, just shutting up, not bitching and being grateful for all you have are the best advice. 

Stress to the max

I decided to blog on a recent chat I had with several nurses and case managers at a hospital. I was actually a bit shocked at what I heard. After a run in I had with a family made me feel disheartened, I sat and listened to what I heard from the case managers who laughed somewhat at my upset. Apparently they deal with it daily. They told me stories of feeling physically threatened and even felt they had to protect their cars in the parking lot. I have heard several stories of where police had to be called to escort people out of the building for threats and harassment. I felt pretty sickened by it all. People angry at not getting the outcomes they desired. Being angry they were being transferred to nursing homes. The doctors hide as the staff gets abused. I swear everyday that if I ever get critically ill that I will not take it out on my caregivers. I hope I am better than other people in that way. So many really kind and quality people just wanting to help, getting totally exhausted by the anger of the sick and dying. I do not feel I am exaggerating at all. I really felt bad by the stories and helpless to be able to try to make them feel better. Its just part of the job for them, but it should not be. I always appreciate that administrator that will stand up to the angry families in defense of their staff. The ones who do not care about filling that one bed despite of the emotional toll on people working under them. I think I would be a terrible administrator as I would not allow staff to be abused by families even if it meant I lost money. I would probably ruin the place. Working in the medical field is a constant balance of trying to make everyone happy, realizing you will always fail. Cheers to all those who try as they will earn their wings in heaven

blame it on the xanax

Oh yes I did ! I totally snowed your mother because she was getting in my hair. I had to pass meds, answer the phone, type my notes and she was totally getting in the way. I slipped her a pill and it was good for a good few hours of quiet time. Sweet! I actually gave all my noisy residents a narcotic so I could sign out on time. I even give them one in case they act up. You never can be too prepared. Does this sound familiar? I swear it is what some families think and say to the nurses and I. I feel like saying, really? How could I sleep with myself at night if I prescribed medications that I felt would not really help someone, just to make our jobs easier? Mom is more confused, mom is sleepy, what did you give my mom because she is not herself. Its never that mom was up all night screaming and pacing and is tired now. Its not she has a infection of heart failure. No, its because we drugged her. I even had a family blame something in the metamucil that must have made their mother confused. . Today’s blog is about the constant assumption we all drug patients for our own needs, not the patient’s mental distress. Of course I am sure somewhere , sometime a a nurse or doctor gave a medication for unhealthy reasons, but why do families assume this to always be the case. Yes, not all staff wants to drug mom up. We actually really like her and want to make her feels better. By making her feel better this includes non medication approaches. I guess we will remain under the stigma of all things scary about nursing homes. Just saying.

Dementia denial

I think we all know what this one means. I am writing from the perspective of working in the nursing homes. I know how hard it is for people not to want to accept someone has dementia, but it is a huge issue as a medical professional. I do not know any nurse or social worker who has not had lengthy conversations, lengthy, lengthy conversations, trying to convince a family that their loved one has dementia. Some families get it right away and are even trying to convince us they have dementia. Thats easy. At other times it goes miserably wrong. For example, I recently had a woman adamant her 90 yo mother had no memory problems. She made an excuse for every memory lapse I tried to show her do to convince her mother had memory issues. The list is long, “the medications made her confused, she couldn’t hear the question, I can’t even remember those words you gave her, this is a new environment, she remembers everything from when she was growing up,” I even have people get really mad at me for mentioning I had concerns of memory issue. I finally gave up and let her go to learn the long way, hoping her mother will not get injured as they overestimated her abilities to live alone. I have even had families say I overreacted when their parent drove through a closed metal gate into the side of a building. They still felt they could drive. I totally get not wanting to hear such a horrible diagnosis. Totally. But as a nursing home worker, you can easily get blamed for all things bad because of a persons dementia. Every call bell that their parent waited “four hours to get help” is obviously true. Children are going to think the parent is right as nursing homes do neglect people. It is not that someone is confused and has no time sense. I recently had a CNA thank me for helping her keep her job as a patient made a false allegation. As a physician, it is scary at times to order any medications to calm someone with dementia. The next thing I know I am getting blamed for causing dementia, the psychiatric medications I prescribed caused it. It really makes you nervous to try to help anyone. Of course not all families are trying to do everything to avoid the truth, but my blog is about the families that are angry and look at everything to blame, but the disease itself. Any thoughts on how to handle the situation, go for it.

Where do we go ?

I said we would discuss life after death as my good friend shelly brought it up. I think as health care workers we deal with this daily. We meet people and we never know how long we will have with them. I have spoken to so many people about death at this point and I will tell you what I have learned. Most people (not all) fear death and will do anything to avoid it including completely ineffective medical care. They will have medical care that causes complete physical suffering even though several medical people will tell them it will not help. As staff we watch them suffer but I do what I can to discuss death with them. The patients generally have no problems discussing death. Families will avoid the conversations and think talking about death means you have given up. Its a voodoo topic for many. Its looking at a reality no one wants to accept. I tell them what I have been told from people who have died and returned. They loved the experience and I have even met one woman who wanted to go back. She had died once and was really angry she had come back. I do not know how anyone else feels, but I have heard enough that I feel there is a place where we go and death is just the next beginning. Please share any interesting stories. I love to hear them.

cpr, no thanks

Ok, we need to get into a few more controversial subjects to make some conversation. Yes, CPR in the nursing homes. I pretty much can tell you all what I hear and do not feel people will be totally shocked. None of us wants to do CPR on an older person living in a home. One of my first experiences in cpr was on this elderly woman as a medical student. It was my turn to take a crack at it, if you must. Thats basically all I felt was cracking. Her rib cage was so frail I could hear her ribs breaking. As you guessed she did not survive. I read a lot about CPR and realized hardly anyone survives if they are over 80. Like less than 10 percent survive CPR. I have heard nurses they have some elderly suffering patients that families insist are a full codes. “we run slow to those codes”. I honestly think most are kidding with me, but really we all wonder why people with advanced dementia, no quality of life , multiple medical issues, that families insist they are a full code. So we are basically keeping people alive longer to continue to live in poor quality of life. I think this all goes back to having the letting go talk with families. I bring this topic up as for nurses and doctors it is a helpless feeling to have to keep trying to revive people who are dying of a terminal illness. We have to also include advanced dementiain the terminal diagnosis. I often think if this all happened a few hundred years ok, without all this crazy technology, people just did what came natural and died. Food for thought. 

Connecting families and staff

One of my goals with this blog will be to connect caregivers in nursing homes to family caregivers. Once the anger and lack of understanding between the two diminishes, then we will really be powerful. I added a link from Elaine Forgie who is successfully helping family caregivers. I want families to see how much staff struggles with same issues. Nursing homes face a great deal of prejudice and I think it taken out on staff. We all entered this field to help people. I am not sure we were all prepared to see the sad realities of sickness and dying, in addition to deal with the many emotions of families. We are fearful of lawsuits and Medicare audits to top it off. I hope we all can just eventually focus on what we want, to improve the lives of the elderly.