on becoming a nursing assistant

The world is full of loss; bring, wind, my love,

         my home is where we make our meeting-place,

         and love whatever I shall touch and read

         within that face.

Lift, wind, my exile from my eyes;

         peace to look, life to listen and confess,

         freedom to find to find to find

         that nakedness.

—  Muriel Rukeyser, “Song”

The Backstory

Last year I watched nurses and CNAs (certified nursing assistants) care for my grandmother during her last few months of life. They were so kind, loving, and dedicated, I went home and started researching how to become a nurse. I read job descriptions and real-life experiences (thank you allnurses.com), and looked at 50+ nursing programs. I quickly realized there are a TON of different types of nurses (seriously, if you don’t believe me, look at this incomplete list on wikipedia) and quite a few ways to enter the profession. I began taking prerequisites at my local community college (chemistry, human anatomy and physiology 1 & 2, microbiology, statistics, human development, nutrition and genetics) and narrowed down my interests (women’s health, maternal child health, and public health).

I read some books:

Sunday Morning, Shamwana: A Midwife’s Letters from the Field by Linda Robinson
A Nurse’s Story by Tilda Shalof
The Making of a Nurse by Tilda Shalof
Birth Matters by Ina May Gaskin
Spiritual Midwifery by Ina May Gaskin
Gynocide edited by Maria Rosa Dalla Costa
Notes on Nursing: What It Is, and What It Is Not by Florence Nightingale
Chicken Soup for the Nurse’s Soul
Moral Ground: Ethical Action for a Planet in Peril by Kathleen Dean Moore and Michael P. Nelson

& some blogs

MSF Photo Bloga>
MSF Stories Blog
Stories of Conflict and War
Choléra, Choléra!
C’est déjà dimanche
Life Less Ordinary

I narrowed down potential specialties to: Family Nurse Practitioner, Psychiatric and Mental Health Nurse Practitioner, and Women’s Health Nurse Practitioner (WHNP) & Nurse-Midwife (CNM). Of course, I want to do them all! After some soul searching and a lot of reading, I  settled on FNP & CNM (more on why another time).

The Now

This fall I am applying to ABSN and Master’s programs. While I wait to hear back, I am becoming a certified nursing assistant (CNA) to get hands-on patient experience. I just finished my third week of training; my body is tired and my brain is on overdrive thinking of how things are and how they could and should be (and my heart hurts with the difference).

And I want to write about it! I need to write about it!

We have 50 hours of classroom/theory and 100+ clinical hours. While the days fly by, the weeks themselves go by slowly. Most days I am up around 5:45am, an hour before the sun comes up. I wake, slip into my scrubs, and shake my head at the girl who thought this was a good idea (me, four weeks ago). I tie my shoes, stuff food into my bag, make sure I have my name tag, and close the door. The sound of the lock clicking brings relief—I have made it out the door another day.

While the classroom time is beyond tedious, I leave clinicals feeling totally defeated. I don’t know it at the time, but the CNAs I am assigned to follow the first week are particularly rough with the residents. They give me the impression that this is just “the way it is” because they don’t have time to be more gentle. While nice enough to me, they can be rude, unconcerned with privacy, and rushed when providing care to the residents. My heart breaks a million times watching those who cannot speak or open their eyes moan and shake when my CNAs wipe their genital areas aggressively. I feel so small.

On my way home the first day, I call the nursing facility (chelseaseniorliving.com/locations/new-jersey/brick/) that took care of my grandmother in KY and practically cry with gratitude that they had been different. I thank the heavens that they really made my grandmother feel like family.

If this is what it means to be a nursing assistant, I don’t think I can do it.

I used to think a janitor who cleaned toilets had the worst job in the world, but instead of cleaning poop from cement bowls, I am scraping/scrubbing/carving/wiping poop off and out of body crevices of living human beings who jerk, yell, and sometimes fart in my face. When patients throw up, I move them to a safe place while they heave, and then check the color, consistency, and amount. Maybe I’ll get used to this, but right now it’s still pretty gross. The physical work is exhausting, that feeling of smallness is never far, and we are often beset with requests we cannot fulfill.

For example, here is a a conversation with someone who has had a lot of medication and is at the highest dosage the doctor will allow: “please, please just make the pain stop!”

“Would you like to be re-positioned?”

“No, no, don’t touch me! Don’t touch my bed, just DO SOMETHING or go get someone who knows what they are doing.”

Then, if I stand there a second too long trying to figure out how to relieve their pain:

“I said, GET OUT!!! AND DON’T EVER COME BACK!”

Men (and it usually is men) add on other sexist obscenities.

We tell ourselves it’s not them talking, it’s their illness. Except sometimes I think it really is them.

That first week when I cuddle with Matt my mind returns to the residents I care for and I pull away. I think about the huge, hard, dark breast tumor I cleaned, the oozing pressure sores on otherwise wrinkled, but soft bottoms, the vaginas I spread wide to wipe. I remark to him that I have touched more vaginas and butts this week than I have in my entire life. The breast augmentation procedure is something some women go for after surgery.

I tell him I feel different. In some way, fundamentally different. Something in my core has shifted. Being responsible for strangers (and so many of them!) in such an intimate way has humbled me as a human—as an animal, really—in a way nothing else ever has.

Yesterday my partner-in-training and I were instructed to give a woman who does not speak a word of English a bed bath. She hadn’t opened her eyes all morning and did not respond at all when we tried to wake her. When I brought the warm wash cloth to her eyes, she flailed around and waved us off. We gently persisted, and the second time we tried (we are supposed to ask/try three times and if they say no each time, we leave them alone), she didn’t move. We thought she had fallen asleep.

I am steeped in rules of consent when it comes to sex (you know—it can still be considered rape if a person asks “do you want to?” so persistently the receiver feels like they have no choice but to give in and obviously, someone cannot consent if they are asleep) and so I try not to over think this bed bath. We take forever (which we can only do because we are students) and we are so careful to not wake her. We refill the water when it gets even a little cold. The bath takes more time than could ever be given if we were actually employed by the facility and responsible for multiple people waiting in their dirty briefs for us to come clean them. At the end, after we put on her socks and change the sheets, she says, clear as day, as if she had been awake the whole time, “Thank you.”

The words are like music to me after weeks of not hearing them—until now, most of my residents have been only semi-conscious.

Although she is not scheduled for a bath, the person next to her requests one (I think she heard how gentle we were) and we oblige. Although she also speaks very little English, she directs us around the room and tells us what she wants to wear. As we are taking off her diaper she tells us she has to poop. We don’t have any time to do anything except hold the diaper for her until she is done. Of course I am thinking, “I am holding a diaper, holding a diaper while someone poops!”
[aside]In the moment, I pretend my best friend is here with me, laughing at me from behind the curtain, and I laugh too (silently, of course).[/aside]

When we finish, she says, “Good job, girls.” Again and again.

“Good job, good job, good job. Good job.”

And then, “Good job, Julia.” I look down and see her reading my name tag.

I get teary. The “good job” alone is enough—that’s how desperate I am for some recognition and acknowledgment that I am doing the right thing and that my touch feels okay. And when she says my name, my heart jumps. This is the first time someone has said my name.

At home, I let all my complaints spill out, frustrated that with the exception of a few stories, complaining seems like all I can do. I expect better from myself! This is what I want to do with my life and all I can do is complain? This is so not okay!

I talk about the facilities—how sterile and hospital-like they are; the mountains of waste I create of latex gloves and soiled diapers and linens; the amount of water I use to properly clean my hands twenty+ times a day. The latex gloves, while important, feel like an emotional barrier as well as a physical one. I complain about our healthcare system and our busy lifestyles that leave no time for our elders. Seeing the odd family member visit brings such joy.

In one facility, a man who looks to be in his 60’s comes every day to sit with his mother and read and watch TV; another resident’s daughter faithfully brings lunch and her work to sit by her mother’s side.

They are present so often, they blend in. They belong.

One or two nursing assistants have even instructed me to give extra attention to residents whose family members check between their loved ones toes and behind their ears to make sure they are receiving quality care so that I don’t get in trouble. But I am determined to try to treat each resident like a grandmother, grandfather, or family member regardless of whether someone will be checking. You know, because I also believe that how you treat one person is how you treat the whole universe.

Many NAs call residents “Mama” and “Papa” or “Auntie” and “Uncle” even when there is no familial relation. I can see how this might be disconcerting to family members who might overhear, but the words usually make the elders relax. These names are used out of love and respect and I am trying to get used to saying them myself. Most residents only smile when talking about their grand-kids, and I appreciate when families put up photos with names and their relationships taped next to them so that we can ask about them.

My second week, I go in to check on my resident from the week before (that had been mine to focus on alone) and the cleaner is mopping the floor. I casually ask, “Where’s so-and-so?” and she tells me she went home. I say, “Oh, good” because she was just in here to recover from a fall. And then she points up to make it more clear, “No, that home.”

Compared to everyone else, my resident had seemed the most with it, the most okay. Without explicitly saying so, she made it clear she thought we were wasting our time taking her daily vitals since she wasn’t trying to get better, so why did it matter? But she also didn’t seem really sick. Whenever I had asked her to do anything, she would give a soft sigh and say, “Oh, all right.” But other than that, she seemed really well. Really.

I think about the time I bathed her, totally unaware I would be one of the last to do so. Again, I feel different. Something inside me changing. With her passing, my frustrations from the first week before become clearer: the work we do MATTERS.

Dying matters.

And my resident’s last days were spent in a sterile room on a mattress covered in plastic, with thin, cheap towels, with drafts smelling of urine and feces, stuck listening to the groans of those around her. And before you ask, yes, I am working at a “good” (4-star) facility.

On every level—the waste, the emotional and physical exhaustion of the caregivers, the resident’s unmet needs—I think about how this is all so very unsustainable.

In our discussions, my love (tries to) encourage me by pointing out that I am “seeing a part of the world most never see—old people, many on medicare, put out of sight until they die—and that by experiencing this, I will have greater understanding when approaching the complex issues in our world and how it all relates.”

Honestly, one could say that for just about any difficult experience.

All of my talk about poop makes Matt think about Zizek’s book the Parallax View where the only way to the world of the Other is through the shit exit.

In The Parallax View, Zizek writes,

…Nemo escapes by being thrown into the wash basin hole [the toilet]… The hole in the wash basin thus functions as a secret passage way between the two totally disparate universes.. This is true multiculturalism, this acknowledgement that the only way to pass to the Other’s world is through what, in our world, appears as the shit exit, as the hole into the dark domain, excluded from our everyday reality, into which excrements disappear.

I see many connections, but maybe I am just desperate to find them. Nursing facilities… where old people go to die… an exit from normal every day life… where shit and body functions determine the rhythm of the day.

Here is the Finding Nemo Dentist Scene. If it doesn’t show up below, go watch it, I’ll wait.

I am not Nemo, I am the dentist. Actually, I think I am the little girl tapping the fish tank and then screaming WAKE UP, WHY ARE YOU SLEEPING?! Either way, my part is more adequately described by Zizek as:

… [Remember] when the father dentist catches the small Nemo into his net, he thinks he saved Nemo, from certain death, failing to perceive that what made Nemo so terrified that he appeared on the brink of death was his own presence… However, the wager of the notion of Truth is that this obscene-unnameable link, secret channel, between worlds is not enough: there is a genuine “universal” Truth that cuts across the multitude of worlds.

I am not sure about what this wager of the notion of truth stuff is, or the universal truth, but a quick google search brings up an article he wrote on Egypt in which he talks about “the eternal idea of freedom, justice and dignity” and maybe this is what he means by a universal truth? That the world of the Other is just an illusion to begin with? Now I just feel like I’m pulling at straws.

Capitalism

If you know me, you know I am quick to blame problems on our current economic system (and for good reason!). Capitalism, the way it is practiced in the US, is a system that only values what can be bought and sold and forces us to ignore the eternal things (relationships, hope, love) that have always been with humans and always will. When people cannot contribute economically to the system, they are quite literally, locked up and put away. Capitalism also makes aging appear as if it is a choice, one that can be avoided if one spends enough money on expensive skin creams and plastic surgery. Capitalism also thrives on polished, controlled, products—it doesn’t like messy. During childbirth, women are subjected to unnecessary surgeries and medicine because it gives control back to the doctors and, well, it makes more money. Getting older and dying is no different. Dying is especially messy and it seems we’ll do whatever we can to control it whether the person dying wants it or not.

This all results in a culture where we live as if we are able to exist beyond death, as if we are exceptional, as if we are never going to die. We like to keep death out of sight and out of mind (and as a result, aging as well) because it not only makes us uncomfortable and sad, but it shakes our understanding of the choices we make every day. Thinking about getting old and dying could easily paralyze us.

We need to change (of course, always, nothing new here).

We can start small by just acknowledging that we are all going to die and that we live on a planet with finite resources. Then, we can acknowledge that what we are doing, the way we are living, is not working. And then, we change.

We change everything.

So dramatic, right? I think you’d agree with me if you saw what I saw this past month: the pain, the loneliness, the bed sores, the restraints, and the unconsciousness.

I think one of the hardest parts about being alive is looking at a terrible situation (whether it be relating to human rights, education, poverty, war, pollution, or life in a nursing facility) and knowing how much better it could be. The worst part for me is feeling how powerless I am as one person in this huge world to change it for anyone else.

Of course, this is both the worst and the best part about being alive, it is the ache that moves me to action, and it hurts enough when on the outside world just living, but while watching people die… well… it is something else entirely.

 

OMG and it’s my birthday soon!!!!!!

My mantra right now: I want to see you be brave.

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