Journal Entries

NaJoPoMo 2013 The Art of Death 14

Car Wash

I see my feet three times a week. These are shower days -- Tuesday, Thursday and Saturday for South Back, and Monday, Wednesday and Friday for South Front, a.k.a. Skilled hall. Well, yes, I can look down the length of the bed and there they are, and I also observe them resting on the foot supports of my scooter, but we are no longer intimate the way we used to be. There was a time when I hearkened to their every whisper, but that was when they took me everywhere I wanted to go. Now we are profoundly divorced. Their whispers go unheard.

But on those three days of the week, my feet and I get close. Not intimate. Our relationship, as I carry out the pedicure and exfoliating and so forth, is more like that between a dog and a professional groomer. I can't feel them but still feel responsible for them. In fact the more you think about it the more bizarre is paraplegia. But that, as Arlo Guthrie once said, isn't what I come to talk about.

Luz is my aide on the day shift. After breakfast she rounds up the shower chair and the hoyer lift (shown with another CNA, Linda, at http://www.lilatladera.com/h2g2/hoyer.jpg ) and we begin the process of getting me to the shower room. I crank my bed flat and Luz shakes out my sling, a length of heavy mesh fabric with six appendages, canvas hooks. She bodges it under me -- a maneuver we call the tuck and roll -- then hooks each appendage of the sling to a corresponding hook of the hoyer. At this point a second CNA will join us, the spotter. Then I get lifted and swung over to the shower chair, a throne-like assembly of mesh and PVC with two positions, straight up or leaning back. This is actually sort of fun, unless the battery pack runs down, in which case I get to dangle while one of the two aides jogs off to get a replacement. Low battery is a common occurrence because there are but two hoyer lifts in the facility, and they get quite a workout on shower days.

So now I'm in the shower chair. I grab my tote of soaps and such, Luz throws a sheet over me, and we're ready to go. The shower room is on the other side of the nurses' station, and Luz has to push me around, avoiding approximately seven wheelchaired people along the way; most are clustered there waiting their turn to be pulled into the shower. A couple, R and L, are just loose cannons. If Rita is there, I won't be allowed past her until we've held hands. She's a sweet old Navajo lady with colon cancer and failing kidneys and a wonderful smile; every time she passes my room she stops and waves until I wave back and say, "Ya'a ta hey, Rita!" (That's 'hello' in Navajo.) Then she nods and smiles and moves on, leaving me with a big smile of my own.

This is a Tristram Shandy of a shower -- I'm on the fifth paragraph and haven't even got into the room yet.

I don't know whether I mentioned that this building is about 35 or 40 years old, and what is most entertaining are the places where Original Design came up against Money and lost. You can't see these places, you can only experience them. During my first year here, I was showered on a gurney, not the chair -- you can see a corner of the gurney in the hoyer picture. That was what led to my calling it a car wash. Occasionally I would be parked outside the shower room to wait until one of the front stalls came free. There are clerestory windows in that wall, with vertical blinds, and right beneath the windows are fluorescent lights panelled with frosted plastic. Well, as I lie on the gurney I notice that big jagged holes have been punched into that frosted panelling so that the blind controls have somewhere to hang. Oops!

Still not in the shower room. Let's get on with it. The first time I was wheeled into the shower room, on the gurney, I saw clouds. One of the staff members had painted the ceiling throughout the room with fluffy white clouds. This delighted me and I was about to exclaim about it when wham! the gurney hit the wall. Seems Money took the shower room and made it a little smaller, and now the gurneys have a hard time getting around the corner into the front stalls unless the aides really jam them through. I'm happy to have graduated to the shower chair because I don't take up nearly as much room, and can slip through to my favorite stall, where I imagine the water pressure is a little stronger.

I spend an inordinate amount of time in the shower just enjoying the feel of hot water on skin. The shower aide usually attends to two or three of the older and frailer ladies before I need her help to wash my back and lower legs (leaning forward remains a dangerous thing for me to do). Then I get a couple of towels and a few minutes before Marta is back with a fresh nightgown and a modesty sheet. She usually hauls me back to my room and tells Luz that I'm ready to be put down again. So we repeat the process with the hoyer lift, and finally I'm sitting up in bed with my hair dryer, toothbrush and toothpaste and all that. And it's nearly 11 in the morning. My feet are waiting for me.

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Latest reply: Nov 14, 2013

NaJoPoMo 2013 The Art of Death 13

Residents' Council Meeting

Once a month, Ladera residents are invited to participate in a meeting. There is no formally appointed or elected Council; there is an elected chairman. however, a position which, as far as I can see, consistes of banging a gavel periodically while Kim, the head of Activities, runs through the agenda. Whoever attends meetings is ipso facto a member of the Residents' Council. All department heads attend, if they are available to do so, and this includes the chief administrator.

Meetings have a two-fold purpose: announcements are made, with supplementary explanations and answers to our questions, and we are given the opportunity to comment and complain.

We met this (Tuesday) afternoon in the main dining room, which abuts the kitchen. Several residents expressed apprehension as they arrived, as to whether there would still be bingo. They were reassured by staff and, at 2:30 the meeting was brought to order after a nudge to the chairman from Kim. There were perhaps 18 residents present.

Meetings always follow a certain format. Each department is named in turn, and residents are invited to offer compliments and then to express dissatisfactions. Inevitably, the following things happen:
smiley - spacesmiley - spacesmiley - space1. A resident will launch into a complaint about one department when we are talking about a different department.
smiley - spacesmiley - spacesmiley - space2. The lady with the orange perm will announce that the nurses are doing a grand job.
smiley - spacesmiley - spacesmiley - space3. Everybody piles on when it comes to dietary, and even after the meeting has moved on to other departments there are flashbacks.

Being subversive by nature, I have slightly modified how the compliments sections are handled. Although individual compliments are proffered, Marilyn (you haven't met her yet) and I now respond with "Yay administration! Yay maintenance!" and so forth. I complimented Natasha and Carol of the front desk for good-naturedly taking menu requests when I phone them from my room (that would be administration). And I all but burst into song when it came to dietary. Just that lunch we had had a generous cheese and bean burrito with a salad and cake for dessert, and Marilyn noted how much better the food was generally since Hermano's management had begun to be felt. The lady with the orange perm complained, as she always does, that the fresh fruit served for dessert was insufficiently ripe. The chairman complained as he always does that the cream of wheat was lumpy. [I'll be talking about food in a separate journal.]

But I have got ahead of myself. Point one was honored by a middle-aged man I haven't seen before. We were just discussing administration when he couldn't contain his indignation any longer. I'm not even sure what his point was because Kim asked him to wait until we got to Nursing or Therapy or whichever it was. And he subsided, but only briefly. We were on to Maintenance when he suddenly lost his temper and began speaking louder and louder, and then attempted to flounce out of the room only to be confounded by the doors which in the dining room are not wheelchair-friendy. Some staff fluttered after him and calmed him down, and the rest of us settled back into our routine.

Announcement: hot chocolate will only be served by special request at breakfast, due to its expense. That means residents can have it if they ask in advance, but it won't sit out in its own samovar any more.

Announcement: There will be a Christmas party as usual, but the charity that has previously provided presents can't come through this year. All its monies have already gone to families in need. The residents shrug, and someone calls out, "As long as we get turkey and cranberry jelly!" and we're back to talking about Dietary.

The meeting is adjourned at 3:30 and I roll out just in time to witness staff consternation in the skilled hall. A patient went AMA right at shift change. He and his clothes are gone. AMA stands for Against Medical Advice, and this seems to happen regularly; I've had two room mates go AWOL without being formally discharged. The DON is already on the phone to next of kin as I head for my room and my netbook. Can't wait to write about the day.

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Latest reply: Nov 13, 2013

NaJoPoMo 2013 The Art of Death 12

Activities Part 2

I have to give props to the smokers for attendance. Four times a day, patients, visitors and residents are permitted to smoke. Four times a day the smokers assemble in the courtyard, regardless of the weather, and wait for the CNA who has smoking duty to show up with the lighter. Obviously, there can be no naked flames in the rooms, since there are so many concentrators and portable oxygen units around the facility, so the "smoker," as the CNA with the duty is called, joins the addicts in the courtyard and lights all the cigarettes. There isn't much talking. I've been out there a few times when it's smoking time, and it is only barely a social occasion. The task is to consume at least two cigarettes before end of session. Even those on oxygen still participate (although the bottles remain in the day room.

It's one of those places where one set of rules butts up (you should pardon the expression) against another set. Smoking may be bad for you, but abusing a patient by restricting their rights is worse and, at the moment, smoking still falls in the "rights" column.

Long-term residents are allowed off campus; patients on the skilled hall have to make special arrangements and get written permission from the DON (Director of Nursing), but all a resident has to do is sign out, just like a dorm. You don't have to wait for an organized activity. You can sign out, roll through the front door and right down the street to WalMart, if you have the courage to cross the street in front of the grills of those big American trucks.

Not many residents do; they prefer the safety of the courtyard and the day room.

When I was still on the skilled hall, one of the activities staff stopped by and persuaded me to come to the day room after lunch for a spa treatment. Activities are always announced over the P.A. system twice a day. The Bangladeshi staffer makes precise, formal announcements, but the other, the American one, has a verbal tic such that she always says, "Come on down!" Come on down for bingo at 2:30. Come on down for Mass at 10:30.

I went on down for the spa treatment, and was waved to a table, shortly after which the American brought me a basin of warm water and a towel. She instructed me to put my hands into the water, and then she covered the whole basin with a towel. And walked away. Punked! I looked around. Lots of residents were sitting with their hands stuck in water, no way to dry them off in order to use their wheelchairs to move.

Another resident rolled up and asked what was going on. On hearing it described, she was rather incredulous and wanted to know why. "It feels nice," was the answer. Well, everyone was polite except R the Alzheimer's patient, who immediately dried his hands on his pants and rolled away. I waited as long as politeness demanded before doing the same. There may have been skin treatments and massages later on, for all I know.

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Latest reply: Nov 12, 2013

NaJoPoMo 2013 The Art of Death 11

Activities 1

It was dangerous to get too close to my great-aunt Ethel Oberholtzer. Especially if there were no restraints. Mother took her to Sea World once, and as they sat on the bleachers the announcer exhorted the audience to introduce themselves to the person sitting next to them. Great-aunt Ethel's restraints flew right off and she turned to her neighbor. As mother recounted it to me, the conversation went something like this:
Hello!
Hello!
I'm Ethel Oberholtzer.
I --
I'm from Lansdale.
That's in Pennsylvania.
I have a son called Cresson.
My husband Henry is dead now but he was a salesman.
We're related to the Kriebels and the Benners and the Cassels.
They're from Lansdale too.
And so on until her victim fled. That was great-aunt Ethel. No restraints.

I have only met one woman like her so far. I don't know her name because it wasn't necessary; she wheeled up to me and sort of trapped me in a corner, uttered a big Hi! in broad New York City accent, complimented me on my hair, and then she was off. After about five minutes and the third stomach tumor recollection I found an excuse and moved off. She didn't mind, she and her bright red sequined vest and shiny black cowboy boots. She always smiles broadly when she sees me and calls out loudly, "Hiii!! Howaya?" Ya gotta like her.

That first encounter took place in the day room where it's OK to wheel up and introduce yourself to strangers, or start conversations with acquaintances. I don't spend a lot of time there because I'm not a cocktail party kind of person. Nor am I into bingo, Wii bowling, being read aloud to, or gathering in a circle to toss a ball back and forth. Or watching The Price Is Right communally while growly bear F keeps up a running commentary.

Activities! I'm talking about activities. Both secular and religious. Despite a rather limited budget the head of Activities tries to schedule one outing per month. It might be to WalMart or it might be to the Natural History museum. She schedules live music on weekends and special occasions -- country for the Anglos, ranchero for the elder Hispanics. The monthly birthday party. Garden club in the summer, teach-yourself ASL in the winter. It's eerily like an elementary school in many ways, even down to the decorating of bulletin boards and the twists of crepe paper that festoon the room on holidays.

I am not being the least bit condescending about this, even if none of it tempts me to participate. It's an important way of filling up the day for a lot of residents. Oh, I've been hailed by one volunteer or other when I'm on my way through the room, and invited to join in finding "how many words you can find in 'schoolteaching'." But my laptop and kindle are waiting for me, and I have things to do!

Very few of us do. J used to be my room mate until my air conditioning ways drove her out of my room and in with Bertha. I noticed that she had certain things to do at certain times -- the crossword puzzle from the newspaper, the rosary at 9:30, the coffee at 11, and always a novel at hand. Several residents have laptops, several more have ebook devices. The rest have... activities. They had jobs and social networks and stuff when they were independent, but somehow they left all that behind and brought little with them.

Take Anna. She was, for a long time, quite a pain in the butt, because she would roll into my room with no invitation and start picking things up. Not just my room, but wherever her eye fell on something. She sees something and decides it's out of place and then, by Balthazar's Hammer, she won't be deterred, and she'll check back again and again until the memory wears out. She was born to keep house. Staff sometimes give her a pile of towels to fold; it makes her happy, satisfies a drive I recognize in myself to be productive. Where this compulsion to neaten becomes inconvenient or worse is when she finds some papers lying on someone's table and carries them off to the shredder box. Or when she starts pulling on catheters, not realizing what they're attached to.

When Anna tried to neaten me in my bed I appealed for help to the head nurse, who came up with a length of material with velcro at both ends that could be attached to my open door. No, I can't close my door; my room mate is a fall risk. The length of gauzy stuff had a big red STOP sign in the middle, which wasn't a lot of help with Anna because she speaks only Spanish. Of course the staff hated it, and then it got less and less sticky, and it all came to an end when Anna wheeled over, pulled the cloth down, folded it up and placed it on my room mate's table before wheeling out again. So there.

All activities but the ranchero (that's a peculiarly Mexican song form usually with a sort of polka rhythm) music take place in English, so Anna is one of the group kept at the nurses' station. She sits and watches, or dozes, or folds towels.

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Latest reply: Nov 11, 2013

NaJoPoMo 2013 The Art of Death 10

Silence

Until I was carted off to hospital, I lived in Lincoln, a state monument with a population of approximately 50 souls "downtown", perhaps another one hundred in the historic district, which runs for ten miles through the Bonito Valley. It is a place of great beauty and rural quiet, if you don't count the donkey. The quiet and the true dark nights are what drew me to New Mexico. In the Bonito Valley the stars glitter right down to the edge of the hills and if it weren't for the masses of crickets echoing off either side of the valley you could probably hear them.

I don't see moon or stars any more, and would be unimpressed if I were to look up from this street somewhere in Albuquerque. There are laws protecting the night sky in New Mexico, home of the Very Large Array (of telescopes), so all street lights are capped, but even so, a smudge of light obscures the stars along the rim of the sky.

One January morning in 2007 I awoke to heavy snow, and went outside with the cats to look around. The silence wasn't complete; snow makes a tiny noise as it hits on other snowflakes, and cats go galumph-galumph as they forge through chest-deep drifts. But we were all startled by a heavy whoosh whoosh whoosh -- the pinions of a pair of ravens flying west up the street, right over our heads.

I knew, once I was permanently sat down in the wheelchair, that I was going to have to give it up sooner than I wanted or had planned, but I was envisioning an Ali McGraw departure, an orderly disposal of chattels and finding of homes for cats. Full makeup and no pain. While I was trying to make plans for possessions and pets, I never gave a thought to the intangibles. Otherwise I would have thrown the clothing aside and stuffed my luggage with silence.

I ran my digital tape recorder a few weeks ago, in the morning, to try and capture the normal morning ambience, of several televisions set face to face and frosted with the sounds of patients, staff and machines. You can hear that recording here (autoplay is turned off):
http://www.lilatladera.com/h2g2/ladera105.html
Nobody else seems all that bothered. I guess it's because they're city dwellers. Down on the skilled hall they have television sets mounted on swing arms, with jacks for headsets, so it was always a lot quieter up there. And the only noise we had to deal with at night was an occasional disoriented patient. Here on South Back, either the family brings in a set or Ladera digs one up from their donated collection of cathode ray tube sets, and the hard-of-hearing play them at the volume you hear in that recording. This is the worst aspect of nursing home life for me, especially at night, especially now that I have a neighbor who stubbornly refuses to turn her box off, even at midnight. She gives as an excuse the fact that she's dying. Well, yeah!

I long for crickets, and instead I've got laugh tracks. Be warned: there are laugh tracks in hell, packets of high-volume artifice with the texture of an aural weetabix. To be in involuntary propinquity to an American sitcom is damnation without relief. I'm buying myself a noise-cancelling machine for Christmas.

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Latest reply: Nov 10, 2013


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