We had these two patients in the nursing home, Ethel Johnson and her sister Roberta Johnston. They were roommates and they were the cutest pair! Roberta, the eldest, taught me a few things.
I noticed one day that she kept spitting in a cup. It was nasty looking so I asked her what it was. She told me it was snuff, but I was thinking she would say chewing tobacco.
“You take a little dip, like this...” she said, pulling open her can of snuff, pinched a little between her fingers, and then put it in her cheek. “Then you just spit it out. You can’t swallow it or it will make you really sick.”
I looked over to Ethel to see if she were serious. Ethel promptly dipped from her own personal can of snuff and put it in her cheek as well. I guess that answered my question.
Roberta had also taught me that while Johnson was a popular name, Johnston was the upper crust of the Johnson pedigree. That being said, I was able to deduce that while Ethel Johnson had married a man of meager means, Roberta Johnston had married well.
The older sister was with us because she had crippling rheumatoid arthritis while Ethel, the younger, was with us because she had terminal breast cancer. It wasn’t terminal when she was first diagnosed, but she had refused treatments. When it had gotten so bad that surgery was the only hope, she refused that, too.
“I had a friend die from breast cancer,” Ethel explained. “She went through all that chemotherapy and even had a double breast removal. She still died anyway and I just soon not put myself through all of that.”
Try as we might, we could not get either sister to understand that each patient is an individual and each diagnosis affects people differently, too. There are different stages of certain diseases so her friend may have already been in the worst stage of cancer, but Ethel was in stage one. Still, they thanked us for our concern and went on with their own beliefs.
Although, Ethel had an order for Tylox (a morphine derivative), and it could be given every four hours, if she wanted it, she only took it at 8:00 every night. She didn’t want to become an addict. Roberta was the same with her Darvocet: she only wanted it at bedtime and one tablet in the morning to get her started for the day.
When Avis started working evening shift with us, we explained this to her, “Ethel gets a Tylox at bedtime, Roberta gets a Darvocet. That’s the only time they want it.”
Avis being a new nurse, fresh out of college, had her own way of doing things. We realized this one night when Ethel and Roberta chased her out of their room swinging their hard (HARD) specially made canes from sugar cane stalks, at the new nurse.
I was coming down the hall when I saw the sisters chasing her out of the room so I intervened. The problem was she tried to give the sisters Tylenol. They told her they wanted their pain medication and she refused to give it to them.
“Avis, we explained to you already, they get the Darvocet and Tylox at bedtime,” I reiterated. “It’s the only time they want it.”
“I don’t care,” she snapped. “I’m their nurse tonight, not you! We were taught you give the lesser pain med first and if that doesn’t work then you go back and give them the stronger one!”
“Why do you think that is?” I asked.
“It’s to cut down on drug addiction,” she answered, shocked that I did not seem to know that myself.
“Seriously?” I was even more shocked that she was worried about these two old women, who were in their late 80’s, becoming drug addicts. “Do they look to you like a couple of old bitties who will be going out on the street panhandling for money to pay for their drug fix?”
Avis wore a dumbfounded expression to my question while the sisters openly laughed in her face.
“Michelle, will you give us our pain medication, please?” Roberta asked of me sweetly.
“Certainly,” I answered and reached down to the narcotics drawer and pulled their two medications for them.
While signing the book for the narcotic administration and count, I explained to Avis, “If you want to be a good nurse, then know, it is only 25 % book sense and skill and 75% heart. Toss away what you learned in school and deal with each patient as an individual. Learn their needs, learn them as separate people. The truth is you can have all the book sense in the world, but if your heart is not in it, and you have no compassion at all, you’ll not be a good nurse.”
The following night, the same thing happened again and another nurse went through it all over again with Avis and the sisters as if I had not done it the night before. The day after that, the sisters went to the boss and told her what was happening. The boss made it clear to that dingbat nurse, if she pulled it a third night, she’d be out on her ass before the end of her shift. Avis got it after that.
We had a nurse that was an aggravating woman. At 64 years old, Betty thought she knew it all. She only worked part time and since she was elderly to us spring chickens, I was always patient with her even when she talked smack about me behind my back (she did that to everyone, though. I wasn’t a special case).
She was always quick to tell us that her son worked at the police station as a detective. Having cleared that up for any listener, she was always happy to come in and regale us with her own rendition of intimate details of a crime or ongoing case he was working.
She would tell everyone, “He called me tonight and told me all about...(Insert whatever news story was current at the time). He couldn’t wait to call and tell me what is going on.”
We ignored her. I don’t think any of us really believed he was busting a gut to call his mother and tell her personal details of a case he was working. We just let her have her say. It made her feel important so we let her be.
Whenever Betty needed a G-Tube (gastric) or NGT (nasogastric) inserted, I would go down and do it for her. The same with IV’s. Her hands were not steady enough to start the IV’s herself. I think she worked only to give herself something to do.
One particular night, I was having a rough go and I really didn’t want to be bothered. Like always, I knew she would come down to my floor to gossip and tell me all about the different staff members she knew something about. Since I didn’t feel like hearing it that night, I psyched her out.
When we heard the unmistakable sound of the doors down the back hall open, my CNA, Anne, said to me, “Here comes Betty.”
I quickly sat in a big wing back chair in the lobby in front of the nurse’s station and pretended to be asleep.
Betty came on the floor but didn’t speak. I knew she left when I heard the back hall doors open again. I peered through my eyelashes and saw my CNA’s, both of them, standing next to me, and staring at me.
“What are you doing?” Lavada asked as she laughed at me.
“Shh,” I answered, “I don’t want to listen to her complaints and gossip tonight. I have a headache.”
The doors opened again. “She’s coming back,” Anne stated in whispers and then they walked away.
I closed my eyes again and remained still until I heard Evelyn and Mae, the CNAs from the other wing, say, “I don’t believe it, Michelle is asleep!”
“Oh damn! I thought you were Betty coming back,” I exclaimed as I stood up. “What are you two doing down here?”
Mae answered while Evelyn laughed. “Betty came back and said you were asleep and we had to come see it for ourselves.”
“In the five years we’ve worked with you, we have never seen you fall asleep,” Evelyn explained, “So we came to see if it were true.”
Needless to say, Betty had made it a point to tell everyone she spoke to about it. Thankfully, no one believed it and figured out on their own that I was probably only pretending to sleep in order to avoid a conversation with her.
When I was in nursing school, we had an instructor that had a speech impediment. My heart went out to her as she tried to pronounce many of the difficult vocabulary words associated with medicine. I felt bad when the doctors at the hospital would yell at her.
I remember on one occasion where she was speaking with a surgeon and asked him about the ostomy he was going to perform later that day. She pronounced it as os-tee-o-tommy (os-toe-me is the correct pronunciation).
The doctor asked, “What the (blank) is an os-tee-o-tommy?”
A fellow student, recognizing the impediment as the problem, answered, “She means ostomy.”
At which time (using more explicits than I’m using in his quote), the doctor started screaming at her, “If you cannot pronounce the words correctly then what in the (blankety-blank-blank) are you doing teaching a class!”
She blamed me for that incident even though I was only a spectator and nothing more. Her pets often sat in the classroom during the mornings making fun of her behind her back and mocking her as we waited for class to begin.
She pulled me into the office before class one day and said she’d been sitting on the other side of the partition listening to me make jokes about her.
“I don’t sit near the partition,” I replied. “I sit in the middle row of the class, in the back. Your favorites sit there. You might want to talk to them about it.”
Because of her constant accusations towards me, by the end of the year, I didn’t feel so sorry for her anymore. She couldn’t fail me since I was a dean’s list student. Honestly, she couldn’t do anything to me but complain about me.
When I graduated and passed state board, I didn’t ask for a reference from her, either, as many of the other students had. I just went and got a job. A couple of years later I bumped into her, and of all places, at my job.
We had a patient, David, who had a tracheotomy (hole in his throat/neck so he could breathe). She pronounced it trach-otto-tommy. I was on my way into his room to do trach-care when she stopped me and asked if her students could observe me doing the treatment.
I almost laughed in her face. Instead, I said, “Sure. Come on, but first, let me go ask David if he is comfortable with having an audience.”
I practically ran into the room. I shut the door and ran to David’s bedside. “David! David, listen… my old nursing instructor wants to let the class watch me do trach-care on you. She used to be mean to me when I was in school and this is my chance to get some satisfaction so…when I bring the class in, I’m going to slap this shit on any ole way and then I’ll come back later and do it correctly. Don’t tell and just pretend I am doing it right.”
David nodded. Most times, he was expressionless because he was so depressed. However, when he nodded, I thought I saw a twinkle in his eye.
I stepped out to the hallway and waved the class inside. Very professionally, I began doing my care (incorrectly), explaining (with a crock-of-bull explanations) what I was doing and why. I had to give some rationale to my care. That crazy woman was agreeing with every piece of bull snot I was slinging.
David started laughing. It was the only time I had ever heard or seen him laugh. Every time David laughed he would spit mucous through his trach which he usually did not do during the treatment. It was like he was hocking up a loogie.
“Is that normal?” One student asked of the copious amounts of mucous coming out.
“Oh yes, that’s why we do the trach-care six times a day,” I answered with a straight face (in reality, we only did trach-care once a shift).
The instructor agreed with me and offered her own rationale as to why David was coughing up so much. At one point, David coughed and a loogie hit a student in the chest. I thought for sure he was going to lose it and not get it back either because he began laughing so hard that I almost started laughing, too.
In the midst of all this, the instructor was called away for a phone call and asked me if I would finish up. When she walked out of the room, I confessed to the students what my accomplice and I were up to and then I did the trach-care properly.
I realize that I was giving them misinformation so I was relieved that I was able to correct myself quickly once the teacher left to answer the phone. Otherwise, I was going to have to go to each student individually afterwards and tell him or her.
In the end, they (the students) enjoyed what I did and even thanked me for getting back at her. Quite a few stated they could not wait for the opportunity themselves to do the same in the future.
As for David, well…he would often smile whenever I came in the room after that day. I’m guessing it was because of that particular memory of me incorporating him into my practical joke.
A Common Routine
We had a married couple that lived in the nursing home. They shared a room together, had been married for many, many years and even had several children and grandchildren who visited them frequently. From the viewpoint of an old geriatric nurse, that is one of the best things to see, lots of family visiting the residents.
The couple’s name was Graham. I cannot remember the father’s name, but the mother was Ruth. If memory serves, there wasn’t anything really wrong with the husband; he was just there because Ruth was ailing in health. She required around the clock nursing care.
Ruth had a pattern. All of the kids and grandkids would come by daily to visit or maybe take Mom and Dad off for a little while. About once a month, they would slack off and start missing a day here and there. It was during this time that Ruth would become ‘sicker’ than usual. She would call them on the phone, gasping for air more than she needed to be and convince them she was going to be dying in the next day or two.
As a result, the family would all rush back in to visit. Many would come to the desk and ask if we would go down to their room and check Ruth’s vital signs, check her oxygen levels, her machine and do all the ins and outs we needed to do in order to provide both patient, and family, comfort in that everything was as it should be.
It was a cycle: Family in – Family out – Ruth gets sick – Family in, again. And so the routine went for a couple of years. We all knew it, even the family did.
The family was so familiar with this routine that one afternoon, one of the daughters stopped at the desk as I was getting ready to leave the floor to clock out. It was 5-til-3 and I was dead tired, no pun intended.
“Do you think Mama is going to die?” she asked. I was so tired. I just kind of looked at her like really? She chuckled a little and then elaborated, “I know she isn’t going to this minute and I know she does this all the time, too, with calling the family in. She’s been doing it for years, even before we brought them to the nursing home. I’m just concerned because, well, she’s not getting any younger and she does look a little piqued.”
“She’s going to be just fine,” I assured her. “She is not any worse than yesterday.”
I got to the clock right at 3:00 and as I was punching out, I heard the PA system announce they needed the nurse to come to Ruth’s room. I didn’t give it a second thought until I came in the next day. As I was walking in the door, the PA system called my name and asked me to report to the nursing office.
I stepped inside and the Director of Nurses handed me some paperwork (unrelated to Ruth Graham – it was something I needed filled out).
As I was attending to the documents, she said to me, “Did you know Ruth Graham died?”
“Yeah, she died right at 3:00 on the nose yesterday. You were probably clocking out when she died,” my boss replied.
“How? What happened?” I asked still recovering from the shock.
With a shrug she answered, “I don’t know. They said she was sitting on the edge of the bed talking to her daughter and right in mid-sentence she just keeled over dead as a door nail.”
We’re taught in nursing school not to make pie crust promises (easily made/easily broken). For instance, we do not tell patients they will be cured of cancer or some other ailment because, in fact, there is no way of knowing for sure. Having said that, I’ve always kept that in mind when handling family members.
I was rather taken off guard one afternoon when a woman approached me and asked about one of my patients, Minnie Atkinson. “I’m her daughter, Linda,” she explained, “I’d like to know how my mother is doing.”
At the time, I had been working there almost five years and I had never, not once, ever seen this woman before much less even heard of her visiting Minnie. I pulled Minnie’s chart and glanced over it before returning to the front desk and answering.
“She’s doing well,” I answered honestly. “There hasn’t been much change.”
“Is she going to die?” Linda asked.
“We’re planning a trip to Ireland,” the daughter explained. “We wanted to be sure she isn’t going to die while we’re gone.”
I was so shocked. I stammered a minute and then answered, “I don’t know. I mean, we’re all going to die at some point, but as far as saying she’s going to die today … I don’t think so. Only God knows that plan.”
“Well, we’re going to be gone for a month and it costs a lot of money; too much money to fly over there and then to have to turn around and fly back because she died.” Linda stated quite coarsely.
I silently thought of ugly names to call her and then said, “Go ahead and enjoy Ireland. We’ll take care of Minnie.”
Before leaving, Linda came back to me and asked for a phone book. While looking up funeral homes, she asked which funeral home did the nursing home most commonly call. I told her it was Goldfinch and then watched as she called them to make last minute arrangements for her mother, in the event she died before they returned from overseas.
The next day, the boss called me into the nursing office. The Director of Nurses asked, “Did you tell Minnie Atkinson’s daughter that Minnie was going to die and had her call Goldfinch to make final arrangements?”
“That depends,” I answered shocked and aggravated at the lie. “Do you seriously think I have taken a complete leave of my senses?”
My boss chuckled and then said, “Linda said they were going to cancel their trip to Ireland because you told her Minnie was going to die and even told them to find a funeral home before they left.”
Fortunately for me, my boss knew this woman and was aware of how she would twist things around. Sad to say, Minnie passed away about a year later, but at least Linda got to go to Ireland first.