Hello again. It seems he keyboard has been calling for a few weeks and today I finally - after days of rolling around the juices in my brain - I think I have finally figured out how to say something that has been on my mind for several months now.
This post is dedicated to all my friends in healthcare, the unsung heroes of everyday. Not just the days when we are all over the news during pandemics, but in those moments while we are getting spat at, and kicked by grannies and grampies, and cursed at, and denied breaks in the interest of capital gain. We are heroes on the days when we cry on the way to work and sit in our cars in the driveway blasting some song when we get home. We are heroes as we sit there in that driveway for 20 minutes because we need to shake off the energies of the shift and take off the mask we wear to hide our inner gangster in front of our charges. We are the heroes who showed up. We continue to show up. We are terribly insane, but I love us. Thank you.
I started my journey in health care a long-ass time ago. I won’t count the years. Too depressing. I had family in the nursing home business. I spent time on the weekends I visited my dad at the nursing homes he and my step mom worked at. I’ve always loved old folks. In my life, it has always been the grandmas and grandpas who gave me safety.
When my grandfather suffered a stroke, I was there in the trenches of my grandfather’s recovery with my grandmother. Back then, visiting nurses didn’t come by much. Maybe once a week, but it certainly was not enough to really support how difficult it was for my grandmother to care for him. Let’s just say it was not her jam.
For some reason after his stroke, I could always really get my grandpa to bathe. He hated bathing. He preferred to stay seated in his spot on the couch smoking his ciggies and reading the paper. He hated the bath and he hated that he had to be helped. For whatever reason, and I can’t to this day tell you why, he would allow me to lead him upstairs to the bathroom and cue him to shower. One day he was having a difficult time getting up the stairs. When we got there, I sat him on the commode and took off his socks to find that the back part of his heel was left behind. He had what I think now was a severe peripheral vascular ulcer that had completely necrosed and fell away. I was horrified, but I got him into the shower and ran downstairs with the sock in my hand and gave it to my grandmother, who threw up in the kitchen trash can before calling his doctor for guidance.
This was my introduction to being a caregiver. As time went on, grandpa had to undergo several surgeries which eventually led to them amputating his foot, then more of his leg as the stump refused to heal. I watched my grandmother gag through dressing changes and changing his diaper. He became bed bound and increasingly difficult to care for. He was always a quiet man, but he became withdrawn and depressed. Reading the paper to him would sometimes bring a faint smile. Aside from that, he slept or stared straightforward praying, I think, for God to take him. He had lost the ability to really communicate. There was no dignity left in his existence.
What appealed to me in my helping was the feeling of joy I got from being appreciated and praised. Grandma never insisted I do any of the care for him. It wasn’t at all like that. What I did for him, I did for her, to ease the distress in her eyes. We would sit in the same dining room as his hospital bed and play cards and drink coffee. I loved emulating her even then. She had made these adorable little cups in her ceramics class that had animals in the bottom of them. I liked the ones with the bugs. Somehow my grandma stumbled onto the fact that I was soothed by caffeine. My mom would have had a fit, but coffee and Cokes were our secret I suppose. My mom only bought diet caffeine free Coke… disgusting. Grandma knew if she gave me coffee we could have one conversation about one thing instead of ten random conversations at once. She was a genius. Even now when I sit down to write, a cup of coffee is a necessity to keep the thought bus on one cohesive road.
Caring became a source of dopamine in my little misunderstood adhd brain. I liked being helpful. It gave me a sense of purpose.
Grandpa passed away in October of 1988. I remember when the phone rang just knowing he had left us that day. My mom and I were sitting at the table eating when we got the call. I said to her, its grandpa, he’s gone. I remember the disturbed look on her face when I said it, and then I watched the sadness fall across her face at the confirmation. I wore a pretty maroon frock my best friend had passed on to me to his funeral. It’s one of those formative experiences that left a mark. I think most of us in caring professions had some type of experience like this.
Nursing became part of my identity. People praised me constantly for putting the needs of others ahead of my own. It’s a strange kind of reinforcement for those of us who grew up in traumatic circumstances. Becoming a caregiver gives you a sense of control, while also reinforcing those people-pleasing tendencies. We already have the masking skills needed to survive such an environment because most of us had years of practice at this at home before we ever even thought about a profession.
The sense of control I had in healthcare came to an abrupt halt during the pandemic. I almost shudder to go back to the place I was mentally at that time. The constant news on the lobby television at the nursing home, the hours and hours of listening to doom and gloom as covid ravaged the nation. I spent months in its shadow, waiting until it was our turn. I knew it would eventually be our turn. I looked around at the impossible regulations making it even more uncomfortable caring for residents in a long term facility. It was wholly and truly an undignified nightmare. All you could do was sit back and try every day to force people to comply with regulations that made no sense and hope that your turn would be delayed one more day.
Healthcare is already an thankless beast. Much like being a mother, we are often forced to deal with the unhinged emotions of people going through the worst times in their lives. We stand in the gap every day for people navigating the enormous costs of being sick and try to build a foundation of trust with our patients. I’m sorry to say, but the things that we have endured as a profession have certainly stifled our desire to go out there every day and be our best. I mean, I was heavily criticized by members of my own family simply for getting vaccinated. Something so deeply personal and central to my profession.
My years of experience and education suddenly meant absolutely nothing and Fox News became the almighty God in terms of creating this climate of heavily misinformed people. The other news outlets just sought to throw gasoline on the fire with heavy criticism and vitriol. Our hospital rooms became political battlegrounds in ways that they never were before. Prior to covid, I can’t think of a single time a patient ever wanted to have political or even religious discourse with me, but now it happens weekly. I know full well that I’m but a pale little blue liberal dot on a very red landscape here in Texas. I keep my opinions to myself, especially at my job. The last thing I want you worried about during your stay are my political or spiritual opinions. They bear no weight on your recovery at all. When I am asked my opinions on things, I am very careful because I have learned, in many unpleasant ways, that certain subjects just cannot be discussed because you already know that a war of words would ensue.
Now I want you to think about how awful it is to feel so censored in an environment that thrives on practices that are evidence-based. We spend years training and learning all the ways that we study how effective our practices are and we thrive on data. It’s a serious mind fuck to find ourselves having to give service to people who think everything about what we do is bullshit. It creates this “why are they even here if they don’t want our advice” coupled with a “why am I even here if these doctors don’t want to listen to me?” atmosphere. Shots have been fired from both sides and everyone is mortally and morally wounded.
I am all about patients being informed on their disease processes and I love it when they do research and are open to the discussion of all the options. Unfortunately, what used to be a productive discussion turns into arguments. After a few years of this constant berating, we have all lost the ability to participate in the discourse. There is an apathy in the air that weighs down the spirit of why we all went into healthcare to begin with. There is also this horrific entanglement with what kind of care people can actually afford in terms in options. Skyrocketing costs of healthcare and complete lack of usable resources negatively impact the care we can give to people. In states that you cannot get the Medicaid expansion services, we are experiencing healthcare deserts, especially in Texas. Even breathing the words Medicaid expansion in soft, under the radar tones here in Texas will get you called a communist. Yet, there are so many people who could desperately use this help. Cancer patients for one.
It’s really interesting to me to be having this heartfelt conversations with folks in the throes of a cancer battle and listening to them rant to me about the lack of resources and then politically undress me for saying we really need to get the Medicaid expansion in this state. It isn’t even about red or blue politics at this point, but I’m well aware that Texas operates at a surplus in the budget, and we should be putting very single tax dollar back into the care of the people who keep the state functioning. But I digress….
During our covid outbreak I saw so many disgusting antics, both by the bean counters and the regulatory bodies that knocked what was left of my rose-colored glasses right off my face. I think growing up in this profession at a large teaching hospital I was insulated some from the very complicated matrix of healthcare billing and funding. There are parts of me that really wish I had no idea of the things I know now. I think if I never knew these things, I might actually be able to reconcile some of these complex feelings that I have surrounding both the pandemic and long-term care.
While we were fighting for our lives trying to get supplies to care for our residents, dealing with the complexities of staffing, and at the same time watching our residents die of loneliness and isolation - finances were the central part of the conversations. It really broke my heart daily. I remember having this one sweet resident whose dementia advanced quickly during the isolation period prior to our outbreak. She would wheel around the facility crying and crying. I would have to sit her in my office and just try my best to hold her hands while I was working and soothe her in any way possible. I couldn’t even tell her family because they couldn’t see her anyway and knowing that she was wandering the halls crying for them would have shattered them in ways that could never be mended. Imagine dealing with all of that while being asked to cut your staffing to accommodate for the rising cost of supplies, knowing that this very pro-life state you live in had not had a Medicaid rate increase in over 10 years. I found myself seeking grass roots campaigns and letter writing projects to make deals with super PAC devils to try and get more funding to offset the costs of care. The political grandstanding was woefully disgusting. Seeing our governor oppose funding opportunities because he didn’t like the hand he was receiving them from while his citizens died in droves was eye opening.
Me and my girls at that facility, we tended the garden the very best we could. What I want people to understand is that on its very best day, with all the staff allowed by a corporately dictated budget, long-term care is neglectful in some form or fashion. It is not ever going to be as good as caring for your loved ones at home. It’s impossible to maintain the routines you lovingly crafted that kept them sound. It’s impossible to do all of the little things we do for people we love with the ratios we were afforded and with the pay scale that was dictated and out of our local control. We did love those residents though, and did everything we could.
I watched CNA’s fight to get to work the covid unit so they could finally pay their bills without working copious amounts of overtime. They exposed themselves and threatened their own lives for the chance to earn more money, the money they should be paid every day anyway. Do you know that the average CNA in this part of the country makes between 10-15 dollars and hour? Our local McDonald’s starts their pay at 12.00 an hour with a sign on bonus. Breathe that in for a moment. To add insult to injury, the benefits provided by these companies are far below even sub-par, mostly unaffordable, and cover very little. So in short we had underpaid women risking their health and the health of their families to pay their bills and many of them didn’t even have insurance to care for themselves if they got sick.
We faced innumerable staffing challenges with the closing of schools, making it very difficult for people to work, and there was no child care available because day cares were closed too. We couldn't have make-shift daycare centers at the facilities because of the regulations. Staffing costs skyrocketed if we had to use agency and then the agency staff we did get were disengaged from our residents’ needs and making so much more money than our regular staff that they hated them and treated them poorly, and I do not blame them one bit.
When we couldn’t get people to work, they dropped the regulations regarding licensing CNAs and while that seemed to help a little it also exposed our residents to many people who were not properly trained caring for them. Sometimes we found some really great diamonds in the rough staffing wise, but mostly we had a lot of people come into the profession and leave as abruptly as they came because most people have no idea what it takes to work in a long-term care facility.
On top of staffing shortages, the constant fear made our residents angry and bored. The amount of complaints doubled, and so the state visits to investigate created more stress on staff already hanging by a thread. Families were constantly threatening us over things we could not control. Trust me, I would have thrown open the doors and let them all visit. I would have gladly taken the risk even if it shortened their lives so they would never have to experience seeing their loved ones through glass partitions and never being able to hold or simply touch them. We could not possibly staff ourselves in a way to comply with the ever-changing regulations and the state agencies seemed hell-bent on making our lives even more miserable than before.
Imagine having to try and figure out how to bathe our residents in full isolation gear, and do that for every resident on the hall, changing isolation gear between rooms on a hall with all total care patients without ever breaking isolation technique. Even seasoned and highly trained professionals make mistakes sometimes. Imaging having to scan into your job, being monitored for any illness and then being gaslit when they exhibit even one symptom because we have to tell them to stay home, but also not being able to refrain from conveying how fucked we are if they can’t come to work.
Imagine having to wear an N95 on your face all day long, then have to put that dirty ass mask in a paper bag to reuse again the next day because the price of them were gouged so much and the supply so little that we didn’t have enough to go around.
Imaging having to lead a bunch of CDC folks around your facility while they give you expensive and unreasonable suggestions that we could never do in a million years well enough to make a hill of beans difference in preventing the spread of the illness.
The stress was unimaginable.
On the heels of all of that came the knowledge that in a pandemic you are only privy to the data you have in front of you, which in real-time means that new patterns and information are changing minute to minute. None of the things we were going through were meant to cause us more harm than good. We could only operate with worst case scenario solutions. We couldn't stratify on real risk factors because we didn’t have all the information. I’m certain that the continued study of this data will be happening for many years to come. Like the Spanish flu pandemic, we will be learning from these experiences for a very long time. But the damage to the frontline healthcare workers cannot be undone. The mistrust the public has is not completely unwarranted, nor easily reversed.
I watched the same healthcare workers in my town who were deemed heroes turn to a target when covid landed at our home. The horrific messages and threats we experienced and constant bullying by the public nearly broke me because every single day we were doing just the very best that we could do with the resources we had available. The blame everyone had on each other and the guilt we all shared, it leaves a permanent mark.
I could go on and on about the many activities we had to do just to prove we were doing everything we could to prevent spread, including testing the whole staff and residents every single week, often multiple times a week or dealing with the fear or what would happen if we had a positive test.
Those days will be forever engraved on my heart. The faces of the precious lives we lost will always be a part of me.
I was so shut down that the idea of watching a Pixar movie because it might make me feel something sent me over the edge. I was afraid if the grief could find away to the surface, I would never be able to turn it off. It felt as though an ocean of tears was just waiting to be released on the next incoming wave and feared I would break. Every single second of my existence was dominated by that for almost two whole years. Even after the restrictions were lifted and we had lived through the worst, I could not get back to myself. I’m still, in fact, trying to get there. What’s sad to me is that this is just what was happening in the non-acute setting. I cannot imagine the amount of disassociation required to be an ICU nurse during that time. My situation was hard enough and I was only the director of nursing at a small town nursing home.
So what do we do now? How on Earth do we heal this divide? How do we heal the anger inside of us and reconcile our many separate experiences to find some common ground? I know for me I’m considering leaving the profession, and if I could crochet my way out of my career I surely would. The sad part is, I love what I do, but I can no longer sit back and idly take the large amount of vitriol and disrespect I experience from both my co-workers who are morally injured and the patients who no longer trust us. Maybe the world is this angry everywhere, I don’t know. Perhaps the joy of finishing a little doll to sell in my shop is a balm for the raw places on my heart. Every day I just hope I can find a pathway to make a difference for someone in that next 12-hour shift and walk away with my dignity intact. Every day we see impossible situations without a solution. We see overworked doctors missing crucial elements. I can’t imagine anyone even wanting to go into healthcare, and many who could don’t because the toxicity of it currently is so difficult to navigate. I pray that we can all find some peace and some answers for something that weighs so heavily on my heart on the daily. I personally think it will take time and a serious change of tone in the country to repair this divide. The question for me is how can I take care of myself well enough mentally to stay in the game while we wait.
In short, let us all find a way to be kind. Kindness and some pretty basic empathy would make such a difference. We are living in a time that our grandchildren will be reading about in the history books. I want the story to end well for all or our sakes.
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