Last night was quite an interesting affair. Most likely it was one of my most difficult moments as a care manager, and therefore, I know I will remember the experience clearly. But I feel the need to write about it, in all its gory detail, so that I am able to ultimately remember the more pleasant aspects of it, and the essence of the encounter. Let me just say first, though, that since the initial essence that I sniffed was the very pungent aroma of diarrhea, it took me about 12 hours to distill that essence down to what it is; caring for another person in a compassionate and humane way.
One of my residents went in for gallbladder surgery a few months ago. After a few weeks of respite care in a skilled nursing facility, she returned to us, still fiery in personality, but now also with fiery hot bowels to match. Poor woman, I wouldn’t wish her experience on anyone, though doubtless, many of us will experience it at one point or another. Her bowels mellowed over time, but it is still not uncommon for her to have 1 or 2 episodes of incontinence per day. Last night, this resident was eagerly anticipating going out with her daughters (who had just arrived in town) for a steak dinner. She was ready to go nearly an hour before they arrived and waited patiently in the lobby for them in a bright pink sweater. When her daughters arrived, we puzzled over how to fit the wheelchair in the rental car trunk. While they knew she had been having bathroom issues, they still wanted to take her out to eat, which of course I understood. Who wants to be controlled by their bowels 24 hours a day, 7 days a week? Who was I to suggest denying her of such a pleasurable experience, possibly the only one in days?
2 hours later, as I was just finishing serving our other residents dinner in the dining room, the daughters returned, visibly shaken and distressed. They pulled me aside and told me that their mother had a terrible accident in the restaurant, just before leaving. I already knew what to expect but I still shuddered. I am embarrassed to say that after all my training, my 6 months of experience here, I momentarily froze. I’d like to think it was partly that I just felt so terrible for our poor resident, but I am honestly not sure what was going through my head in that moment. It didn’t take too long (thank goodness, Rachel) for me to finally spring into action. 15 towels, check. Rubber gloves and an extra pair in my apron, check. A big plastic bag for discarded and soiled items, check. Game face, ummmm…on? Then the sweetest angel descended on me, another care manager who had actually volunteered to come help me with my resident. Um, hello? Are you crazy, or just the most compassionate and lovely care manager that I have ever met? I have never before felt quite so grateful for working in a team that truly feels like one. I wanted to shower her in kisses, but I didn’t want to contaminate her with my clothes that already felt soiled by poo. The car was a mess, but we left that to the daughters as we carefully wrapped, wiped and winged our way through helping my resident first into her wheelchair and then up to her room and straight to the shower. The whole way up, she told us about how embarrassed she was. I held my breath in the elevator but I tried to focus on what she must be feeling at that moment, and my cheeks warmed at imagining what it would feel like if it was me in her predicament. Warm water on incontinence temporarily made matters worse, but soon we had our resident warm, dry, powdered and most importantly, clean in her pajamas and ready for bed. The whole incident took less than 30 minutes, but felt like eternity in the moment. There was so much running through my head. Why did I feel less competent to deal with the situation until I had another care manager to assist me? Why was I unable to focus entirely on my resident’s feelings until I actively forced myself to listen? It’s not like I never dealt with poop before. And we all do it! Why is it still so disgusting? Well, maybe I won’t argue that one… But, truly, if I am going to be a nurse practitioner, I am going to need to be able to spring into action much more quickly, no matter the scenario, no matter what I am faced with. Granted, I won’t be working in an emergency room (most likely) on a daily basis, but my patients will depend on my ability to listen reflect, react and respond quickly and accurately.
I did that here, I know I did, but my reflexes are still a little primitive. I hope that my resident feels like she received the care she deserved. I hope she is able to focus on the delicious steak dinner that she had with her beloved daughters, rather than the event that succeeded it. One thing I will always remember is how she looked up at us and said in her crackly voice, “I love you, I love you both.” I had never heard that from this resident in particular before, and while unnecessary recompense for my work, it felt good to hear. It is truly amazing to me to see how quickly she was able to rebound from feeling sorry for herself to feeling such immense gratitude for someone else. I know I can learn from her. When I left her in bed, she was smiling, incredibly. This is something that I think is what we all need to remember about growing old. It may not be easy, it is difficult to imagine doing it gracefully, but that is certainly what my residents have done. It is about taking life a moment at a time, not dwelling on the past or leaning too heavily toward the future. A moment at a time.