The heart of a caregiver

I completed the classroom instruction portion of my nursing assistant course yesterday with a perfect score on my final exam. This morning at 0600, I reported for the first of my four required clinical sessions, an 8-hour shift at a local long-term care center.

After doing a mock skills exam in class yesterday and, ahem, not doing as well on it as I would have liked to, I was a little bit nervous today. When it comes to book learning, I can compete with just about anybody, but practical knowledge is a whole other thing. Would I be able to remember all the correct steps to each procedure, in the correct order? Real people with real care needs were waiting for me, depending on me to know what to do for them. I certainly didn’t want to let anybody down, let alone inadvertently harm anyone.

The college instructor supervising the day’s coterie of students in training at the center gave us a quick orientation, then sent each of us out on the floor with another certified nursing assistant (CNA) on the staff who acted as our mentor for the day.

The first order of business for my mentor was to get her assigned residents out of bed, to the toilet, dressed and groomed, and transported to the dining room for breakfast. With the exception of one woman I saw who walked unassisted, every single resident moved by wheelchair. So my job was to hustle these folks to the dining room, park them in their assigned places, assist them to put on their clothing protectors (big bibs) and fetch their drinks.

During breakfast, I got to do my first actual care task of the day, feeding a man with Parkinson’s whose arms twitched and waved constantly in his lap so that he was unable to hold a fork or spoon. His voice was soft and breathy, so I had to lean in close to hear what he said. He let me know the scrambled eggs were “all right” but needed ketchup, that the toast was “no good,” and that he really wanted brown sugar on his Cream of Wheat. “That’s the way I like it, too, and if I had some brown sugar, I’d give it to you,” I told him, “but all we have is white sugar.” So I sweetened it up for him with two packets of white sugar and he cleaned his plate. He was unable to smile at me and could barely speak, but he seemed pleased by the end of breakfast and I was simply beguiled by his entire manner.

My first impression of him and of all the residents I assisted is “damn, these people are charming.” When the nurse in charge asked me to take another resident from the dining room back to her room, I said to the resident, “okay, sweetie, I’ll take you back to your room now,” then caught myself as the nurse glanced up at me. We were told in class to address residents by their names or as sir/m’am, so I told the nurse, “I’m sorry, I know I’m not supposed to call her ‘sweetie.'” She smiled sympathetically. “It’s really hard not to,” she replied.

These folks really are charming: some are courtly and gracious, some are spunky and sassy, some can get cranky and mean, and some are so withdrawn or confused that they are barely there at all. But each is a person who is worthy of my respect. For most, the last horizon is very close now and the infirmities and indignities of old age have made this final leg of their journey very hard. Many are traveling alone and have only caregivers like me to help them along the way. One woman was sitting in her wheelchair in the hall in obvious distress, not able to tell us why. She said she was “ready to go,” and another CNA asked her where she wanted to go. Her immediate answer was “home.”

The residents who know where they are and why they are there all want to go home, I think—home to where they have good health and control over their lives and their faculties, and where they are surrounded by people who know and love them whom they know and love as well. Instead, they are cared for by an ever-rotating cast of strangers who have too much work to do and never enough time to get it all done.

For the residents, the days crawl by, with meal times the highlight and little else to look forward to. For the staff, the days are fevered sprints from room to room with seldom a moment’s rest to catch one’s breath. I have always known that nursing staff work really hard, but I have an entirely new respect for what they do. I also have a tremendous appreciation for my own good health and (relative) youth, both of which are, as for everyone, temporary.

I learned a lot today: How to use a Hoyer lift, how to change a diaper on an immobile adult (and clean the person up no matter what they did in it), and how to communicate with someone who can’t talk (hint: watch the eyes). I also learned that I do have the heart of a caregiver: somebody who really wants to give care for the sake of comforting another human being, even when that person cannot see or hear or acknowledge me. I looked the residents in the eye, called them by name, asked them how they were doing, patted their shoulders, made sure they were okay before I left them to move on to the next one. I didn’t do any of that to make them like me. I did it to let them know that I liked them.

The man with Parkinson’s is not my father, but he is somebody’s father. The woman who wants to go home is somebody’s mother. If those people were my parents or my grandparents or my own loved ones, I would want them to be treated with all the respect and courtesy in the world by their caregivers, so I tried to do that—both for them and for their families.


At the end of my shift, I debriefed with the instructor before heading home to take a long nap. She asked me how the day went, and I was suddenly overwhelmed by all that I had seen and done and felt in the past 8 hours. Finally I said, “it was exhausting and rewarding in equal measure.”

She regarded my solemnly for a long moment.

“That is correct,” she said finally.

And I started to cry.


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