I completed my round of clinicals on Friday night and was sent on my way by the college to sit for the state exams, obtain my license, and launch my new career as a Certified Nursing Assistant if I so desire.
I knew I wanted to take the CNA class so that I could be helpful to my parents as their healthcare needs evolve, but didn’t really know if I wanted to make a career change with it. I am an overeducated white-collar professional with decades of experience doing what I do best: writing, editing, photography, and other things related to communication. Becoming a caretaker would require a complete rebooting of my professional self-image, and I’m not sure I am ready to do that. But I figured once I’d completed the class and spent some time giving actual care to real people, that question would resolve itself.
At the center where I assisted, as I suspect is the case in most facilities of that type, there are basically four classes of residents:
- Those who are oriented, temporarily non-ambulatory (most likely rehabbing from an accident or stroke) and have a date circled on the calendar when they expect to be released from the facility. They require minimal assistance, depending on their injury, and will usually assist with every aspect of their care or do most things for themselves.
- Those who are oriented, permanently non-ambulatory, and unlikely to be going home. They participate in a wide variety of individual and group activities both inside and outside the facility. They require varying degrees of assistance, usually with toileting and bathing, but they can feed themselves and assist with their care by asking for what they need and giving appropriate feedback.
- Those who are not oriented most or all the time because of confusion or dementia, permanently non-ambulatory, and not going home. Most require total assistance with everything from getting out of bed (some with a hoist and sling) to dressing, toileting, bathing, feeding and every other thing they do. Some can communicate in a rudimentary fashion, while others can’t. These are the “heavy lifting” patients.
- Those who are not oriented at all because of Alzheimer’s disease or other permanent dementia. They may be completely ambulatory or confined to bed, might need feeding or toileting assistance or might not. The variety in their physical condition is considerable, but they have one thing in common: the lights are on but nobody is home. They don’t know their own names, let alone those of their caregivers, fellow residents or even family members. They can become aggressive and combative in an instant, particularly when they’re startled, and most exhibit the kinds of behaviors that in any other setting would be considered profoundly disturbing. They are, in my view, the most challenging type of resident to care for because they are so unpredictable.
Each of these types of residents requires a slightly different type of care, and I had the chance to work with each of them over four shifts. I saved the Alzheimer’s (or memory care) unit for my last shift because I had a feeling I would not be comfortable there. All the other aides and my fellow students told me the Alzheimer’s residents were real characters and it would be “so much fun” working with them, but for me it was exceptionally difficult.
For instance, I like to tease and make jokes, but these people are either rigidly literal or simply so confused that my every jest fell flat and oftentimes just irritated them. They started and screamed if I touched them without giving a warning first, they refused every offer of assistance and then yelled at me for ignoring them, and they would ask me the same non-sensical questions over and over until after a while I would walk right by them and avoid their eyes to keep from having to answer yet again. A single shift on that wing convinced me that memory care is not for me! I think I would do just fine working with any other population except that one. I admire and respect the people who provide memory care, but I just can’t do it.
At the end of the evening, I debriefed with my instructor once again and we filled out the paperwork to officially close out my obligations to the college. She gave me a folder of papers, along with two parting gifts: a new black pen (which one should always have on one’s person when working as a CNA) and a small tube of moisturizing cream (because hospital hand sanitizer dries out hands quickly and thoroughly).
Although I am still not certain what my next career move is going to be, I will say that I got a lot out of this experience that I will carry with me long after the hand cream is gone and the pen runs dry. For instance, I will always remember the man to whom I fed breakfast on my first day, the one with severe Parkinson’s who could only ever manage to say a word or two at a time with tremendous effort. I made a point of finding him before I left the building for the last time.
Squatting down beside his wheelchair so I could look up at his face, I told him, “Tonight’s my last night here and I won’t be coming back, but I wanted to tell you how happy I am to have met you.” He barely hesitated before saying softly but clearly, “I’m happy to have met you too.” I squeezed his hand and patted his shoulder and told him to take care, then swallowed the lump in my throat and walked away knowing I will never see him again. His parting words are the best gift I could have taken from this experience.
The gentleman with Parkinson’s passed away on March 14, 2014, at the age of 71.