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Saturday, September 17, 2011

The Sunshine

“Why are you working today?” Nurse Inez asked, with an expression of surprise on her face when she saw me.
“I just came in for a little while to finish some paperwork,” I said, reaching for a resident’s medical chart. 
I didn’t normally work on the weekends, but that morning I felt the impulse of going to the nursing home to complete a couple of social services assessments.
Once I was finished, I grabbed my purse to head back home. But the thought of Vivian, one of my new residents, popped up in my mind. 
I put my purse back in my desk drawer and decided to check on Vivian before leaving. 
It will take just a few minutes, I thought to myself. 
Vivian was in the hall, sitting in her wheelchair, observing people. 
“Hello Vivian.” I drew close to her, and kneeled to make eye contact. 
“Hi” Vivian flashed a wide smile. 
In her late eighties, Vivian had managed well living alone until recently when she had become weaker and more confused. Her dementia had rapidly progressed. It was uncertain whether Vivian would be able to go back to her home. 
But Vivian didn't seem concerned about that, or anything. She voiced no desires to return home, nor stay in the nursing home. Always smiling, she liked when staff stopped by and talked to her about the food, the birds in the aviary or the flowers and plants in the courtyard. Her memory was limited, and she seemed to prefer conversations over tangible things around her. 
I asked Vivian about the breakfast she had that morning. She couldn’t remember what she had, but she expressed she liked it and that she was still full. She turned her head to look at a glass door at the end of the hall. 
“It must be nice out there,” Vivian said, pointing out at the sunny view of a courtyard clearly visible through the glass panel.
“It’s nice, Vivian, but it’s very hot today.”
“I like the sunshine.” Vivian smiled. “The sun doesn’t bother me.”
My knees started to feel numb from kneeling, and I had not planned to stay much longer at the nursing home, but Vivian’s eyes fixed on the outdoor view made me change plans.
“Vivian, would you like to come with me to the sunroom?” I held Vivian’s hand. “There’s plenty of sunshine there, and a beautiful view of a pond and a garden.” 
“Yes, please!” Vivian’s voice sounded vibrant. 
I wheeled Vivian to the sunroom. The golden glow in the sunroom made it a welcoming place. It felt warm and inviting—almost brighter than usual, I thought. Or maybe it was Vivian’s beaming smile that made the place look more radiant. 

Vivian and I engaged in contemplation of the beauty of nature. We indulged in the serenity of the garden and the    birds graciously bathing in the pond.  
Why am I always rushing? Why is my mind often occupied on paperwork deadlines?, I pondered. 
Vivian and I went back to our chattering as the sunlight embraced us. She avidly talked about her gardening activities. The conversation brought her memories of her late husband. Vivian knew he had passed away a while ago, but at times, Vivian talked about him as if it was in the present—as if he was still alive.
“Oh, there you are!” A nurse had unexpectedly walked in the sunroom. “I have been looking for Vivian. It’s time for her treatment.”
I said good-bye to Vivian as she was leaving the sunroom with the nurse. Vivian’s joyful smile remained in my thoughts as I went back to my office. 
I left the facility with gleeful feelings. I had had a pleasant time with Vivian. 
That evening, I received a phone call from Vivian’s nurse. 
“Doris, I have sad news.”
My heart pounded. To my dismay, the nurse was the bearer of bad tidings. 
“What happened?” Those seconds seemed like an eternity.
“Vivian had a heart attack this afternoon.” 
“What?” I gasped in surprise. “How is she?”
“She was rushed to the hospital.” the nurse’s words were near mumbled. “But she died shortly after arriving to the ER.”
I never anticipated Vivian’s passing that particular day. Or that she was ready to meet the Lord—and her husband.
“It looks nice out there.”  Her words echoed in my mind.  Simple words. Or perhaps mysterious words. Who would know?

In my heart, I felt certain that Vivian had found the sunshine. The sunshine she was longing for. 

Monday, September 5, 2011

Clawed Heart

“We have a problem!” Sarah, a nurse assistant, exclaimed as she burst in my office.  

“A problem?”  I wasn’t surprised.  As the nursing home social worker, problems were my daily quest. “What is it?”

“Ms. Barnett has been stealing her roommate’s clothes.” Sarah’s face was distorted from obvious stress.

“What do you mean ‘stealing’?”

“Ms. Wilkinson complained that Ms. Barnett was wearing her sweater.  I peeked into Ms. Barnett’s drawer while I was helping her to get dressed, and saw more of her roommate’s clothes, but I didn't feel like saying anything.”  Sarah’s eyes sparkled with fear.  “Ms. Barnett has been in a bad mood lately.”

I frowned. I had known Ms. Barnett for being a private person, but I had never heard of her taking another resident’s belongings. 

I headed to her room.  Sarah had taken Ms. Wilkinson to one of the activities so I’d have some privacy when speaking with Ms. Barnett. 

“Ms. Barnett, I’d like to visit with you.”

“Go ahead.” Her voice was firm. She was sitting on the edge of the bed. 

I tried to break the ice with a casual conversation first, but she showed little interest in talking. Then I focused on the complaint I had to follow up.

“It appears that some of your roommate’s clothes have been mistakenly placed in your drawers.”  I was confident that the matter would be promptly resolved, and in a most polite way. “If you don’t mind, I would like you to help me go through your drawers and try to find Ms. Wilkinson’s clothes.” 

“Those are my clothes.” Her voice was tense. “You can look if you want!”

I started my search and soon spotted a gown labeled with Ms. Wilkinson's name. 

I retrieved the gown.  I was going through the second drawer when I found a pair of sweat pants with Ms. Wilkinson label.  As I was putting them aside, Ms. Barnett abruptly jumped up next to me. 
“These are mine!” she screamed and then pulled the pants from my hand.  I could sense her outrage.  Motionless and speechless I glanced at Ms Barnett.

Within seconds, she lifted up her hand, and as if a feline defending her territory, then bounced toward me, clawing her nails in my arm, as deep as her strength would allow her. 

I stepped back, borderline terrorized, with my gaze fixed on Ms. Barnett, my lips parted to speak, but my voice frozen in disbelief. 

“Oh my God, Ms. Barnett...” I managed to say, my voice  breaking.  I turned around to leave the room and noticed Sarah standing in the doorway.  She had witnessed the attack and called for help.  I headed to the nurse’s station to have someone assess and treat my wound. 

I was somewhat in shock for a while.  Until that day, I had never been physically assaulted by a resident, not even when I had been in the Dementia Unit.  Ms. Barnett wasn't known to have dementia.  She had never exhibited aggressive behaviors, or been seen taking things that belonged to other residents. 

Certainly, something was bothering her.

My arm hurt little compared to my worry about Ms. Barnett.  My mind drew blanks in trying to understand what was causing Ms. Barnett to act in the manner in which she did.  I had no answers.  I felt as if my heart, not my skin, had been clawed—clawed with the uncertainty of what had caused my resident to change.  That was not the Ms. Barnett I had known. 

Ms. Barnett was thoroughly assessed and tests were run. Her urinalysis test came back positive for a Urinary Track InfectionUTI.  I knew that a UTI could cause confusion and altered mental status in the elderly.  And Ms. Barnett’s case was now one clear example. 
I was relieved in having an explanation of Ms. Barnett’s behavior.  She would be fine after completing treatment. 

I followed up on Ms. Barnett through staff and reports, but I refrained from visiting her for a few days.

“Excuse me!”  A nurse assistant popped in my office. “I have a note for you.”  She handed me a piece of yellow lined paper, folded twice.

I unfolded it and read the hand-written note:

                                To Doris.

                                I’m sorry.  Please forgive me. 

                                                     Alice Barnett