This is one of those seemingly emo, somber entries. Sorry in advance.
I had quite possibly the most traumatic weekend in the history of my working for [the senior services co. I work for which shall remain unnamed to prevent them suing me for defamation of character, lol]. I’ve been working for this company in this position long enough that they can throw just about anything my way; crabby, uncooperative generally difficult clients, confused clients, clients with a bit of dementia.. I can deal with all that, have before, no biggie (exclusions: SEVERE dementia or alzheimer’s and near-death or severely debilitated clients.. that’s nursing’s job).
So I filled in on two shifts this weekend on a client whose power of attorney (also her financial planner) had called [my company] requesting we start services as soon as possible. His client was not functioning by herself and as a result, not eating correctly.. or really at all. The caregiver on shift’s job (in this case, my job) was to make her meals and make sure she ate while I was on shift.
It’s important to note here that NORMALLY, before *any* non-management caregiver goes in to care for a client, a member of management (usually the marketing manager) goes in and does an assessment on the client to determine their needs, disabilities, mental state, etc. This is done by conducting an interivew with them. It’s very similar to what happens in the nursing field, but less medical. NORMALLY, this is what happens. But I assume the client’s power of attorney wanted us to start IMMEDIATELY, because the office asked me to go in even before Joan had even spoken to the client.. we’re going to call her Mrs. B.
So no assessment had been done, and when I got in, I found (and/or deducted) that my poor little client was:
- malnourished. She hadn’t eaten a single thing in several days. I later learned that several days prior the front desk had not received her usual call down to order dinner, so a few staff went in, found her on the floor and I assume, got her back into bed. No further action was taken. By my guess, no one seemed to know she was unable to function by herself. So as a result by the time I got there, she was weak, disoriented and depressed.
- did I mention depressed? Not only had she NOT eaten, she also did not *want* to eat. She has no family aside from a few nieces who periodically call to check in on her (leading me to wonder why her sisters or in-laws haven’t checked in on her) and her financial planner who also acts as her power of attorney and is a good friend of hers. So completely alone in a dark apartment with little food in it, she slowly became more and more depressed and her nutrition dwindled to nothing. Then she fell, hit her head and lay on the floor until found by the facility staff. This, I suspect sent her over the edge of ability to function and she lay in bed disoriented, depressed and slowly starving to death. She repeatedly expressed her frustration that there wasn’t a “magic button to press” when “you’re done”. She has no desire to eat and would prefer to waste away.
- dehydrated. I wasn’t able to get more than a bagel (and a small one at that) with butter on it into her the entire two days I was there. She never once perked up except at the prospect of ice-cold bottled water, which she drank by the half-bottle at a time as if she’d just crawled in from California on her knees in July. She complained constantly of her tongue sticking to the roof of her mouth. I saw her go to the bathroom once in two days, and that was with my full assistance.
All these things aside, it was my task over those two shifts to make her meals. I’m sure the management was unaware of her complete inability to function and lack of motivation to do it. So after two very stressful, slightly traumatic days, I couldn’t get her to eat more than that measly bagel. Have I failed in my mission? Yes. Was it nearly impossible for an unskilled caregiver in the first place? I suspect so. But that doesn’t stop me from feeling horribly guilty, as I know there’s little anyone but a skilled med staff can do for her.. and the last thing she wants is to be checked into the hospital, hooked up to an IV and feeding tubes and brought back from near oblivion. Mrs. B is wasting away and wishing it on herself as fast as it can happen.
So I told the office this morning I couldn’t do it again this coming weekend. It was too traumatic for me and quite frankly, this woman is beyond my care. I’m not a skilled nurse or a therapist. I can’t bring her out of her depression or help her to function again. Which brings me to the point:
At what point do we fight for our patients, and at what point do we allow to happen what is inevitable? At what point do we stop fighting with Mrs B. about eating and surviving and allow her to do what she wishes she could do and die? Do we dismiss her wish to die as mere depression and convince ourselves that she can be saved? Or does she actually, depression notwithstanding, realize that she has lived as long as she wishes to, and is now ready to go where everyone eventually does? What is the right thing to do here? Send more caregivers in to make her a meal, try to convince her to eat it? Or simply sit with her, bring her water when she asks for it, leave her alone when she asks, and keep her company as her body shuts down? Which is better? Do we make our medical goals a priority over her personal ones?
I don’t know. I do know that I got a little older this weekend. A little, tiny bit of me dried up, flaked off and blew away and I’ve learned something important this weekend. Not everyone dies a graceful, peaceful death surrounded by loved ones. Some of us die alone and miserable, unable to find one single reason to get out of bed in the morning, enjoy what life we have left in us. That is indescribably sad to me.
I decided that I can’t care for this client and won’t work another shift with her. Because I can’t help, can’t improve on the situation and would only succeed in adding more anxiety to life, on top of studying for exams, clinicals, care plans, keeping healthy patients healthy… etcetera. Real life is stressful enough. And I don’t think that’s selfish of me. A person wants to die. Forcing her to live would prolong an end to a life she doesn’t enjoy and seemingly hasn’t for years. I think THAT is selfish. But that’s a moral standpoint and other people will have different views on that.
I woke up today and was really, really glad to be alive, healthy, well muscled, well nourished. It was a beautiful 90 degrees out at 3:00 pm in the sun with a breeze. I’m sorry it had to take one sickly, diminishing old woman to get me realize that.
-j