Number One

I had to try to find a way to let myself describe the residents (ladies) with whom I work, without violating any HIPA laws, so I came up with the wonderfully original (not) concept of numbers. There are 7 ladies living in the cottage in which I work.

One is an approximately 57 years old female whose sisters are her guardians. One lives in Louisville and enjoys talking to One and visits from time to time. The other lives in Florida and the last phone # we had for her has been disconnected. (That's better, though, than the gent from the other side of the cottage whom they took on a home visit to his family ... and no one was there, as in the place was deserted!) But I digress.

One has a g-tube, where nutritional 'fluids' are passed directly to her stomach, bypassing the troublesome throat area, as she has had a barium swallow and it has been determined that she has dysphasia. Dysphasia is a condition where a person does not swallow correctly and it messes up parts of your digestive tract. One gets several drip, or 'bolice', feedings during the day and nothing at night. One can be sneaky, reaching into her clothing to open one of the ports on the tube, which allows the contents of her stomach to flow back out...kind of like vomit but without the nasty taste. But the smell MORE than makes up for it. Additionally, the liquid is corrosive outside of the stomach, usually necessitating a bath to wash everything up again. On rare occasions, when One gets angry enough, she will pull out the tube intentionally, and then a trip to the hospital for reinsertion follows.

A last note on the tube thing...in our daily log, we are not allowed to say "Nurse hooking up One for her g-tube feeding," as someone felt this would be demeaning to One. So I write, "Nurse beginning One's afternoon enteral nourishment".

One also has a condition called PICA (pike-uh), which means she will try to eat things that are not really meant to be eaten - pieces of paper are her favorite targets, although they have from time to time found bits of string and crayons in her tube. I prefer to call One a "non-discriminate ingester" which means "she don't care what she eats". At least she has stopped digging and eating her own excrement. (There are several residents in the facility's other cottages that do.) Other people with PICA seem to prefer a certain type of object or material. There is one lady who is PICA for metal, so they removed cabinet knobs and things of that nature.

Aside from the fact that One gets nothing in her mouth other than the occasional breath strip, the worst thing someoe could do to her would be to make her sit still for more than 15 seconds at a time. I have seen her sit and transfer her possessions from one side of her body to the other for hours while on the couch. At other times, she will do that for a few moments, then get up, dance, shake her finger at a cottage mate, shake her butt at the television, go back to sit down and transfer things all over again. A few weeks ago, they took One to get her hair cut. Apparently it was on once they told her to sit still in the chair. One came home with bruises and scratches all over her body.

Let me clearly state that One was not abused here. She is PICA for her own hair and will frequently and without warning run her fingers through her hair, give it a tug and then place her fingers in her mouth. Once they had to take her to the dentist to get a hairball cut out from amongst her teeth, because it had become entangled so badly. As it was, because One did not sit still, she came home with what I call the 'concentration camp' haircut...extremely short and choppy. (This is in no way meant to minimalize anything experienced by anyone who has been in a concentration camp or held as a P.O.W.)

One gets up between 5 and 6:30 a.m., usually of her own volition. Her first bolice enteral nourishment session is at 7, so she has to be up and dressed by then. One and her staff person (she has her own staff, due to the PICA issue) are on the go, from one classroom or community experience to the next, one feeding to the next until at least 4 pm, as are all the ladies living there, rain or shine, sick or healthy.

This is one issue that is a real contention between home staff and administration/therapeutic professionals. If we (as "normal" people - whatever that means) are sick, we call in to work or have our parents call in to school to tell those institutions that we will will not be present on those days. Our people (as the home staff calls the residents - well, at least I do *lol*) do not have that luxury. Congested or not, irritable or not, One goes out each and every day - unless she is sufficiently injured or sick enough to warrant a trip to the hospital.

I will have to continue this another day. I've just seen the daily paper for our city, which mentions the facility at which I work...and I am angry. I am close to 'waxing lyrical' and writing a letter to the editor of the local paper.

Success - One Step at a Time

For the last 3.5 years, I've worked at a residential / treatment facility for adults with MR/DD (mental retardation and developmental disabilities). I do very hands-on work with the residents, everything from assisting them in learning new skills to bathing them (depending on their levels of ability).

Many people have asked why I do this sort of work when I have a degree in finance (I can hear my mother in the background saying, "Did you tell them it was 'magna cum laude'?") For one thing it is one of the better paying jobs in the area (Kentucky) that doesn't involve wearing a suit. I hate suits. I hate working with "the suits". And this job is, bar NONE, the most intrinsically rewarding job I've ever had. Few things can beat you walking in a room and having someone call out in utter glee, "AWWW...LUCY COME BACK!"

I actually created this blog a couple of days ago. But this is my first post...and I needed NaBloPoMo to get me motivated! Well...thank goodness they were there and you'uns come on over and join the fun! (I used to say 'y'all' a lot but 'you'uns' is to Kentucky what 'y'all' is to Texas.)

Since the NaBloPoMo theme for the month is "Routine" I will speak to that today.

I leave home about 1:30 pm local time and drive the 4.8 miles to the facility at which I work, trying to avoid the square downtown, where it is h-e-double-toothpicks to make a left turn. Ten minutes later I arrive and struggle to find a parking place, like several hundred other co-workers. I join some of my shift and house-mates at one of the gazebos, which are the approved smoking areas on site. (I started smoking about 6 months after taking the job.)

We used to be able to clock in in my "home" there, along with the workers in two other homes. Now, all six homes in my area (there are 18 homes in all) clock in at the same location, which naturally is the farthest away from my home. We clock in and walk back to the home, where we receive "shift communication" from 1st shift, learning what has happened during the day (dr. visits, illnesses, trips and other things of note).

There is an extensive "Enrichment Center" (aka classroom) system at the facility. For about the past month, I have been sent nearly every day to the swimming pool to help with transporting residents and getting them changed into their swimsuits. All the ladies that swim in the 3:00 class are in wheelchairs, and it is like a sauna. During our recent heat wave, it got hard for me to breathe, and I took the extraordinary step of talking to my shift supervisor, home manager and human resources about getting some relief. That worked for about 2 weeks, now I'm back going to the pool every day. I know the residents enjoy the pool and don't mind doing my share, but they need to rotate people from the cottages that help out...at least at the pool.

At 4:00 pm the last clients (residents) go home and I return to the cottage. All the ladies that come home are toileted and the ones who eat are given a snack. Three of the ladies have g-tubes, which means fluids are passed directly to their stomachs through a tube that has been surgically implanted in their bodies. Staff breaks are started at this time and are usually over by 5pm, when the first supper arrives.

Most homes have all the people on one side eating at the same time, but we have one lady who gets her supper at 5:00, because although she can feed herself, she is quite slow. The other three who eat get their suppers at 6:00 pm.

I think for the purposes of this blog and so I don't run astray of any "privacy" issues, I will refer to "my ladies" by the numbers One - Seven.

After the ladies' suppers, staff suppers start and there is usually an activity on the facility (a dance, a movie, etc) to take what residents we can, depending on the number of staff we have. As my ladies are mostly in wheelchairs and the two who walk need their own staff due to unsteady gait, we can never take everyone...and this is a source of frustration to all concerned.

Then there is the bathing. The ladies in wheelchairs get bathed in a special pedestal bathtub, that raises and lowers. They are assisted or lifted onto a "lift" for transportation to the tub. Since five people use the same tub, we clean and sanitize the tub between each bath. So each 'bath cycle' takes about 30 minutes. If there are any bruises or scratches on the residents, we report them to the nurse to see if medical are aware of them, and if not, we have to do an "incident report".

Meds are passed starting at 8:00 pm. Two of the ladies with the g-tubes are hooked up for an overnight 'enteral nourishment' (the term "tube feeding" is considered "demeaning" and we are actually not allowed to use it in our log). Most of the ladies go to bed soon after their baths (and always at least 1/2 hour after getting their meds, and most of them are asleep by 8:30 or 9:00 even if they are not in their beds.

After 9:00 we do dishes (if they are not already done), take out the laundry and the trash, vacuum the main living area and hallway and start our last round of breaks. At 10:30 pm we do a "bed check" to make sure everyone is clean, dry and otherwise doing ok. Third shift comes in at 10:45 pm and we do shift communication with them, do another cottage check (you'd be amazed how many ladies "go"...or "go again" in those 15 minutes!), heave a sigh of relief and run out the door to sneak in a cigarette before clocking out.

That's my basic work-day.