Jan. 7, 2019

Roberta, Ethel, & Avis

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.

Ugh!

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.