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.
I’ve worked in nursing homes for almost twenty years. I’ve dealt with dementia, Alzheimer’s, Parkinson’s and so much more. I think it goes without saying that I’ve also dealt with death, however, my way of handling it was not like the others.
Impending death has distinct symptoms. The patients’ eyes will glaze over which is often referred to as, “the death gaze” and their breathing changes. Although the medical term is called rales, in laymen terms it’s called, “the death rattle.” Some patients even begin a molting process where there is no blood circulation. Usually it begins in the feet and their skin turns a pasty white.
The most phenomenal thing I’ve ever noticed was the distinct smell of death. Some of us could literally smell Death and his scent in the hallway days before someone took a turn for the worst. We may not have known who Death came to collect at the time, but we usually knew he was there.
Whenever I came on the floor and was told someone would most likely pass on my shift, I would go down to their room and have a talk with that person. I calmly explained to them my situation.
“I do not handle death very well,” I would explain. “Please wait until in the morning after I’ve gone.”
At first, the other nurses would laugh at me … at first. They quit laughing when they realized it worked with me. After witnessing this for a few years, some of the nurses referred to it as ‘the talk.’
My nursing assistants, who worked the graveyard shift with me, were the first to quit laughing. They would often instruct me, “Now go on down there and have ‘the talk,’ with Mrs. X so she doesn’t go on us,” (They hated post mortem care).
In all of the years that I worked in geriatrics and nursing homes, I have had maybe ten patients die on me. That is amazing if you consider the odds of people passing away and the number of patients that I’ve cared for in that twenty year span of geriatric care. That low number alone tells me my theory works. Since hearing is the last sense to leave us, I was sure they heard my pleas.
I recall one patient I went in and had ‘the talk’ with. She had been holding on for two days already. Even so, I was sure my chat with her would be just as effective as any other day.
“She’s just waiting for you,” Jennifer snickered as we counted on/off shift narcotics.
“We’ll see about that,” I responded and promptly went to the room. I said to the patient, “I know Margaret is your favorite nurse and you’d like to say goodbye to her. She works in the morning so please, just wait for her. She’ll be here at 7:00.
That talk was on a Friday night. Margaret didn’t come to work Saturday. I did it again, Saturday night and again, Margaret didn’t come to work on Sunday. I was nervous as I repeated my request that night and when Margaret didn’t come in on Monday, I decided to look at the schedule. She was off until Tuesday morning. She had a three-day weekend.
I went in to explain the situation. “I know I said for the last three nights that Margaret would be here in the morning and she didn’t show up. According to the schedule, she’s going to be here for sure this morning. I promise she will be here and on time. Just hold on.”
The patient had already been holding on a total of five days so, needless, to say, I was pleading with her. It didn’t work, though. Around 5:00 that morning, she decided she had waited long enough and it was time to leave us. When Margaret came in, I told her what happened.
“Well, she held on as long as she could,” Margret sympathized.
“I think she did it out of spite because she thought I was lying to her,” I admitted with a chuckle. “I didn’t mean to lie to her, though.”
I believe my worst experience was during the spring. The aides came to tell me that our newest patient had passed away in her sleep. It was a sudden thing, absent of all impending symptoms of death. Even his odor escaped us. She was just gone almost as fast as she came to us. As I went to call the doctor, I realized it was Mother’s Day.
I called the Assistant Director of Nurses and told her what happened. “Did you call the family?” Martha asked.
“No, and I won’t, either,” I responded.
“Why not?” she asked confused that I refused to make the call and notify the family of the death. “I know patients don’t usually die on you, Michelle, but come on! It’s part of the job. Why won’t you call her?”
“Because, it’s Mother’s Day and I will not call her daughter and tell her today that her mother has died. If you want to wait until tomorrow, fine. I’ll call her then, but it will not be today.”
Martha made the call. When Margaret came in that morning, I told her what had happened during our report.
“I just couldn’t call her on Mother’s Day and say ‘Your mom just died, Happy Mother’s Day!’ I just couldn’t do it,” I explained. “Not today of all days. You know what else? I can’t believe she died so suddenly, either.”
“It’s okay, Michelle,” Margaret said sympathetically as she patted my back. “You’ll have to forgive her. She didn’t know the rules or that she had to wait for ‘the talk’.”
Miss Dorothy Pearlman was a 38 year old single black female who came to us with stage IV pancreatic cancer. Sadly, she came to die, but in comfort. Her only living sibling, a sister, was unable to care for her during her debilitation and it was agreed between the two of them that Dorothy would stay with us for the 24 hour around-the-clock nursing care she needed.
Miss Pearlman was admitted to room 411, just outside the nurse’s station. We kept her close to us. Twice her PCA (Patient Controlled Analgesia) pump beeped loudly. The pump allowed her to medicate herself whenever needed. Both times, it blew her veins and caused her a lot of pain. After the last time, we made sure to monitor the pump closely to catch the infiltration before it started to hurt her.
Her favorite aide was April. Although April was not a very religious person, she would spend a lot of time with Dorothy talking about the Bible and praying with her. She catered to Dorothy like a mother hen so much that Dorothy used to tell April when she died she was going to come back and visit her.
“You know, Michelle,” April said to me one night, “I love Miss Dorothy, but if she ever did come back to visit me, I would turn as white as you!”
“I don’t think it would be to haunt you,” I offered with a laugh. “I’m sure it would be just to let you know that she is okay and is no longer suffering.”
As April left to make her rounds, she stated clearly, “She does not need to come back and tell me that. I’m sure God will take of her once she leaves this world.”
Dorothy only stayed with us for six weeks. We came into work one afternoon to find her room by the nurses’ station empty. She had passed away only hours before. Because of the cancer, it was very quick and sudden.
Jane, the 7-3 nurse, complained, “I’ve been hearing Miss Pearlman’s PCA pump beep all morning. I forget she’s gone until I go to check on her.”
At the time, I neglected to tell April any of that even when April said, “As sad as it is, I’m glad she’s gone. She was hurting so bad these last few days.”
Instead, the prankster in me took over. When April was down the hall, I’d run into the room and turn on the call light to room 411 and then run off and be somewhere else before April could get to the room.
“Michelle, I know that’s you,” she declared after the third time.
I was coming out of the bathroom. “It isn’t me,” I lied innocently enough. “How can I have done it and be in the bathroom at the same time?”
“It can’t be Miss Dorothy. Do you think she really did come back to see me?” April asked a little unsure.
I shrugged. “Maybe she did? I have heard the PCA pump beep a couple of times (and I had) and, of course, the call light keeps going off so, who knows.”
“Yeah, but I still kind of think that’s you.”
Just before our shift ended, my staff and I were sitting at the nurses’ station waiting for the 11-7 shift to come on and take over when the call light to room 411 came on all by itself. We were all sitting there together when it happened. April turned to look at me and then turned three shades lighter in the face.
I must have been wearing the same look of surprise because she said, “It was you earlier, wasn’t it?”
With a nervous laugh, I admitted that earlier it was me, but we could all plainly see, it wasn’t me that time.
The following day, the nurse reported that the light buzzed the entire night and the call light stayed lit over the door. Maintenance couldn’t find any logical reason, especially since it had been unplugged and the cord removed from the room earlier that morning.
Was it Dorothy or just a coincidence and how did I manage to turn the light on if it maintenance had already disconnected it? I guess we’ll never really know.
When I was in nursing school, we had an instructor, Ms. Gordon, whom I felt was pretty naïve. She lived with a doctor and apparently, he did nothing to wisen her up. She claimed they were together romantically. I wasn’t so sure. I know I was young and dumb but she was just plain dumb.
We were sitting in class one day and she began talking about men in regards to the size of their penis. I laid my pen down and listened to her chatter away.
“If men have big feet and hands, they will have a large penis,” she stated as fact.
Who was I to argue, I had only been with one man.
Someone snickered and Ms. Gordon responded adamantly, “It’s almost impossible to have large hands and feet and be small down there. He would be ill proportioned.”
I thought to myself, Dr. Johnson must have a small pee-pee then. He was after all, a small man in stature.
Several weeks later, she was talking about men waking up in the morning 'aroused'. She sat twirling her hair and said, “You know why they do that don’t you?”
I raised my hand and answered, “Because they have to pee.”
“No, it’s because they have been having those wild dreams of a sexual nature,” she answered.
I slightly turned my head and looked out of the corner of my eye at my fellow classmate, Nancy Jones. Nancy let out a blurb of laughter and then composed herself. “Are you sure it isn’t because they have to pee,” I said again.
The teacher rolled her eyes and laughed a little. “Yes, I’m sure, Michelle. I live with a doctor and we laugh about his crazy dreams all the time.”
Surely, she must be joking, I thought. “So when my little brother was six months old and he would get little woodies whenever he had to pee, are you saying he was just really having dreams of porking the little 4 month old cutie next door?”
She rolled her eyes a second time. I glanced at Nancy again who, while smiling and a slight shake of her head, put her finger to her lips and motioned for me to not say anything else.
The next morning I pounced on my husband who groaned and said, “Stop, I have to pee!”
“That’s not what I hear,” I said laughing and then explained what my nursing instructor had said.
Not long after, she was talking again about things she apparently knew nothing about. She had my undivided attention. This time, Ms. Gordon was talking about condoms. She said, “In order for a condom to be effective, it has to have holes in it.”
Without looking at Nancy, I blurted out, “What!”
Startled, she turned to me and said, “Think, Michelle, how else is the fluid supposed to drain out? The condom acts as a net and catches the sperm while draining away the secretions that keep the sperm alive.”
“You can’t be serious,” I insisted.
“Now this, I know something about,” she said shaking her finger at me. “I bought a box of them the one night and we (her and Dr. Johnson) couldn’t use them because every one of them was intact without holes so we cannot have sex until I took the box back to the pharmacy and got a new one.”
From my right, Nancy asked, “Why not just use a needle and pop holes in them?”
Was I mistaken or did Nancy sound like she was about to start laughing?
“I didn’t think about that,” Ms. Gordon said in deep thought. “Dr. Johnson told me to take them back and just explain to the pharmacist they were defective and to get a new box.”
“How old are you,” I asked my instructor unexpectedly.
She looked at me strangely and answered, “I’m 36, why?”
“Tell the truth,” I said sitting up straight, “Have you ever had sex before?”
Nancy laughed so hard. She stood up and waved her hand at me, “Stop, please.” To the teacher she said, “I need to go to the bathroom; I have to pee.”
While we were out in the break area I asked Nancy “Was she serious? Is she really that stupid?”
Nancy just laughed. Finally, she pulled herself together and said, “You know she and Dr. Johnson split up, don’t you?” After confirming I didn’t, Nancy explained, “Dr. Johnson is really good friends with my neighbors and he told them he told her he was relocating and moving out of town. He didn’t think she should come with him.”
“Where did he move to?” I was intrigued.
“To Hemingway, about thirty miles away,” she laughed and headed toward the classroom. “He told my neighbors he had to get away from her.”
“Can you blame him?” I muttered as I took my seat.
After that, I only paid attention to her if she were discussing nursing because that she was very good at. Anytime she talked about men or relationships, I totally ignored her.