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The Aide from Hell
(Note: The following is a composite sketch based on some of the more interesting behaviors of certain nursing aides who have taken care of me here at The Institution over the past three-plus years.
(Please note that this is not meant to damn the profession of nursing aides! On the contrary, I am well aware of how hard the work is: I saw it almost break my poor wife physically. Indeed, there are certain parts of the job that one must do with extra vigor and there is no getting around it. For example, a pair of pants cannot be put on a person who is flat on a bed except by jerking them on. (The obvious next question -- "Does one jerk them off at night?" -- I will not dignify with a response.)
(The problem with aides like Bertha is that they still employ violence and mayhem on tasks that can be done gently. That is, they lack finesse. They also lack common sense. And: they lack empathy for the person they are taking care of. That is, they seem to be merely going through the motions -- and doing a very bad job at it. A bewildered fellow resident here tells me he has been tempted (but didn't dare) to ask those sorts of aides: "What are you doing in this profession?!"
(Fortunately, there are a handful of nursing aides here who are wonderful at what they do and whose behavior is utterly foreign to that of Big Bertha. And no, they are no bigger and no stronger than Bertha is. But they understand how to do something right and they care enough to make it right. In short, they care about the residents. That's the difference.
(I would like to stress that the aide whom I call Big Bertha is a fictional concoction, a veritable witches brew consisting of the worst characteristics of all the nursing aides. Those aides form a spectrum from best to worst. At one end are the ones having none or at most one (and this humorous) Big Bertha-ism; while at the other end, I am sorry to say, is found that handful of aides that embody many if not all of her nefarious wiles.
(By the way: the sketch below is meant to be humorous at heart. (I know, any writer who feels he has to make such a statement has already failed at his task.) In no sense do I mean to imply that Big Bertha is being deliberately cruel. If I thought that was the case, I wouldn't be writing this; I would be lodging complaints with the Charge Nurse.)
What is the first thing one does on a given day if one is the resident of a nursing home and one is lucky? Why one awakens of course!
Yes, I awaken -- and to what? For just that first instant I can believe that I am healthy (as well as -- why not! -- wealthy and wise.) I am ready to stretch my arms and then eagerly hop out of bed to face the day.
But in the very next instant (there is no such thing mathematically speaking, but I'll ignore that) I know that I will not be doing any stretching of arms or hopping out of beds, for the very simple reason that I am effectively paralyzed from the neck down. I am stuck there in bed until someone comes in to get me up.
Do I need to detail the thoughts that come over such a person at such a time of day? Whether I need to or not, I'm not going to bother; the reader can use her/his imagination. Suffice it to say that this poor individual wishes for, hopes for, indeed craves at the very least a touch of human kindness.
As if in answer to a prayer, I hear the door open and the water in the sink turned on. I have learned that this is a double signal which indicates that I am now to be gotten up. In a moment I would hear another human voice speaking to me softly, sweetly, caressingly...
Instead, what I hear is one of the following:
"Let's get one thing straight right away: I'm the boss!"
or:
"Don't push your luck!"
or:
"We're short today, so I don't have time to fool around!"
It is Big Bertha herself. Over the course of my time here, I have sought with patience and diligence and even a little cunning to deconstruct those opening salvos for her, to help her get some perspective. So I would say things like:
"You know Bertha, proclaiming that you're the boss all the time makes us suspicious that you are attempting to mask a power deficiency with verbal bombast." Or,
"Although it's true that 'to push' is a transitive verb, you're probably not aware of the fact, ordained by master lexicographers, that 'luck' is absolutely never used as an object to that verb!" Or,
"I'm sorry that you have extra work to do today, but do you have to impose a guilt trip on me because of it?"
It is no use, she will get on my nerves right at the beginning of the day -- and I am suffering from a disease of the central nervous system!
After her 'friendly' salutation, Big Bertha proceeds to wash me. The face is first. Due to the forced air heat here, my face has a tendency to get dry and blotchy (in fact, I have some special cream to treat it with.) A good aide will dip a cloth in warm water, stretch it over her index finger, and then very carefully clean the 'sleep' from my eyes. Then she would very softly and gently clean the rest of my face.
So what does Big Bertha do? She takes a rough face cloth, wets it, and then proceeds to scrub the driest parts particularly hard -- as if she could by some miracle rub in moisture. The result, of course, is that my face is drier, redder, and more raw.
But that isn't the only way she rubs my face. For some reason, she is convinced that my eyes and my nose demand particular -- and aggressive -- attention. So she will stubbornly rub for a long period of time around each eye. What do I do while Bertha is attacking my eyes and coming within an angstrom of sticking her finger in one of them? I shut my eyes, like every normal human being with normal reactions. But Bertha does not like this: "Keep your eyes open, otherwise I cannot clean them!"
She also attacks both nostrils of my nose in the most aggressive example of nose picking I have ever experienced. To paraphrase the poet: "Something there is that doesn't love a nose." That 'something' is Big Bertha. And so repeatedly the finger in the wash cloth is thrust up my two nostrils in order to attempt to dislodge -- what exactly? I have no idea. I felt nothing up there such as an impediment to breathing or lonesome crust. But she will make my nose the perfect temple of physical purity, and it will stand as a shining example while the rest of me falls to pieces.
(My favorite Big Bertha story in relationship to my nose has to do with the time we were in the shower and she proceeded to vigorously scrub the insides of my nose with a wet soapy cloth. Not only did I have the cleanest nose on earth, I set a new personal record (17) for the number of sneezes in a row.)
And so the washing proceeds, each stage containing its own fractured and contradictory 'logic'. But there is an added twist: for whatever reason, she is attempting to do everything using just one hand. And so she washes each arm, and under each arm -- except, of course, one cannot lift an arm and at the same time wash under it with just one hand. So Bertha simulates washing under my arms. And then, when that is done, she applies the deodorant; or rather, she attempts to insinuate it under my arms (which are still lying against my side.)
The last things to be washed are my back and bottom. Now Bertha, like every other aide here, is a Certified Nursing Assistant, or CNA. You might assume, then, that she would have learned that there is an order in which you must perform certain tasks -- such as what order you wash a person's back and bottom. (In fact, you don't need a course to teach you something that is common sense.)
How dirty was my back before Bertha washed it? Well, it was against the back of my wheelchair during the day, and I had slept on my back at night. So I suppose that, at the most, there might be a lingering bit of perspiration on my back when I woke up in the morning. And after Bertha has finished with me? Then my back has been contaminated with a thin film of human excrement. Good job Bertha!
Once the washing is complete, it is time for Big Bertha to dress me. First the shirt: it is rolled up at the neck (good) and placed carefully around the top of my head (also good.) A decent aide would now carefully pull it down over my head. But with Big Bertha it is jerked down on my head, violently yanking my neck forward in a credible imitation of a whiplash (not so good.)
Once I am dressed, it is time for her to put the sling (they call it a 'saddle' here at the Institution) under me in order to use the lift to transfer me from bed to wheelchair. This is normally done as follows: 1) turn the resident on his/her side by pushing them away from you, then push the saddle under them; 2) come around to the other side of the bed, push the person onto their other side, and then pull the saddle underneath them.
But this is not exactly how Big Bertha does it. True, she will do the first half of this correctly by turning me over away from her and pushing the saddle under me. But then she will stay where she is, reach across me to grab my further arm, and then yank it violently to turn me on my other side. This gesture, which saves her from having to walk around the bed, runs the very real risk of pulling my arm right out of its socket.
The lift is now brought over and hooked up to the relevant parts of the saddle. But before she can transfer me from bad to wheelchair, Big Bertha must by a rule of the Institution find a 'standby' who can provide another pair of eyes to make sure there is no accident. She follows this rule about half the time; the other half she obeys it. Why? Does she care about the state of my health? Not at all! More often than not the other person is also from her home country; thus do the two of them chatter together in their patois while facing one another, thereby ensuring that there are no pairs of eyes watching me as I hover precariously six feet above the floor.
Once I am up in my chair, Big Bertha proceeds to brush my hair, shave me, and brush my teeth. This might seem to be to her credit, since a lot of aides do not bother to do some if not all of these things. But let us see what happens with Bertha.
It seems obvious how my hair should be brushed, since it is never really messed up: I part it on the right and brush it across. So what does Bertha do? She wets the brush and then brushes my hair straight back in 'Godfather' style. Needless to say, this does not correspond with the persona I wish to project!
How does a good aide shave me with my Norelco shaver? By pressing the shaver against my face and rubbing it with gentle circular motions. And how does Big Bertha shave me? She turns on my electric razor and then uses it to make short kamikaze-like stabs at my beard. This just serves to push the whiskers down and not cut them at all. But she is capable of variation: today she wetted my face with a soapy cloth (no doubt she trained with a straight razor), and then shaved me with the Norelco. As a result, I have nightmare visions of wet hairs rusting out my shaver heads.
I own a Sonicare electric toothbrush. It may be the finest toothbrush on the market. It vibrates at a zillion vibrations per second, and it is meant to be used passively -- that is, one guides it slowly along the gum line so that it can remove plaque and thereby improve the health of the gums as well as the teeth.
So how does Big Bertha use this marvel of dental technology? First of all, she puts a huge gop of toothpaste on the brush. Then she literally attacks the teeth and gums with the brush. She belongs to the jab and scrub school of dental hygiene, the harder the better. At the end of one of her sessions, I am left with bruised and battered gums -- that is, exactly the opposite of what I needed.
Sometimes Big Bertha will get perturbed about something: a resident must be gotten up earlier than she expected; she is missing a wash cloth (which she needs to rub my face raw) from her pile of linens; she forgot to bring my shampoo to my shower (so that she can scrub with her 2 inch nails and thereby scratch my skull); etc. (I was once 'waterboarded' by Bertha in the shower, but that's another story.) At such times, Bertha will make a funny little sound out of the side of her mouth. It is produced by sucking air into one side while opening that side. The result is somewhere between a squeak and a screech, similar to the sound made by undoing the fastener on plastic diapers; or that produced by the wet tires of a power wheelchair when it comes to a sudden stop on a highly polished floor. I had never heard this sound from a person until I came here to the Institution. And what she appears to be saying is basically "Damn -- just when everything was going so well!" Oh really? Maybe in her alternate universe...
She will also get perturbed if I try to suggest a different approach to a task or even a reminder of something that I suspect she might forget to do. A good aide will say something like "Oh thanks Ted -- I do forget things on occasion!" But Bertha becomes all huffy and defensive end chastises me with the words, "Don't you think I don't know my own job?!" (Well...) Of course, a few minutes later she will actually forget something or other -- and then I will be lacking something I needed that day because at that point I would not dare to remind her.
Big Bertha does not really have a good handle on the residents' declining skills. More than once she has accused me of things like not using my hand to help her turn me over, or not helping her lift my head -- neither thing of which I am still able to do. Finally one day in exasperation I replied, "Hello Bertha -- why do you think I'm here in this nursing home?!"
Sometimes I will ask her to do something for me, and I try to make my directions as clear as possible. Unfortunately, due to the fact that her first language isn't necessarily English, Bertha often misunderstands me -- and I do not mean misunderstands in a minor way. Rather, her misunderstandings are total, all-encompassing. Today, for example, I asked her to tilt me back in my wheelchair a little bit. Bertha responded to this rather simple and basic request by attempting to force the right wing of my headrest out away from me. I challenge anyone to find anything whatsoever in common between request and deed, the latter of which threatened to ruin a highly sensitive piece of electronic equipment.
At lunchtime I need to be fed. Now there are several nurses and aides here whose feeding skills are all that I could desire. They are patient and kind, and they allow me to eat at my own pace. So it is a distinct pleasure to be fed by one of these people.
When Big Bertha is assigned to feed me during lunch, her behavior takes one of three forms. Either:
She will have a very detailed, intimate chat -- in English or a foreign tongue -- with the aide across the table, treating me as an occasional unwelcome distraction along the lines of a pesky fly when I have the impertinence to plaintively suggest, "May I have some rice please?" Or:
She will attempt to feed me as quickly as possible with the largest possible bites, this being called the "shovel-it-all-in" method. The idea is for Big Bertha to finish with me as quickly as possible, so that she might do -- what exactly? I haven't the foggiest idea, although I can guess. The problem with this 'method' is that most of the residents here, due to the nature of their disease, have a real problem with swallowing under even the most favorable of circumstances. If we are forced to hurry and swallow before the food is well chewed and coated with a thick saliva, it may get stuck in our throats; or worse, ingested into our lungs, where it will cause pneumonia and probable death. So I am thinking seriously of having Big Bertha indicted on charges of attempted manslaughter. Or:
She will feed me in a most desultory way while eagerly craning her neck to see what is going on in the rest of the dining hall, the implication being: "Anything else that is happening in this room must be more interesting than feeding this loser!"
During the course of a day, I may have the need of someone to do something extra for me -- pick up something I've dropped, put my headphones on me, or whatever. There are some aides who will always help me (one of them will spontaneously shave me if she thinks I need it), but Big Bertha is not among them. She may be sitting at the nurses station looking at a catalog, but if I ask her for help she will reply indignantly, "I can't be bothered with that now -- I have residents to attend to!" and then wander off as if she were going to actually help someone. Has Big Bertha ever done anything extra for me? Never!
At times, Big Bertha will work on the evening shift; so she will be feeding residents their dinner and then putting them to bed.
As soon as the sun goes down, Big Bertha seems to become a different person. Now she is quiet, subdued; but at the same time wary, stealthy -- and hardly less dangerous. Of course, the evening is a miniature reverse of the day, in that I must be gotten onto my bed and undressed. And so I am filled with fear anew when I realize that my arm can be torn from its socket quite as easily when a shirt sleeve is wrenched off my elbow in slow motion; or that I can be practically hanged by the neck until dead when my shirt is forced off over my head; or that a saddle, made of stiff abrasive nylon, might scratch my skin in 'Indian-burn' fashion when it is violently ripped out from under me.
But there is another characteristic of Bertha in the evening that I can only term bizarre or even eerie. A few of the aides hum or even sing softly as they take care of me, and I find this comforting, a sign that the aide is happy in her work. Bertha, however, neither sings nor hums; rather, she talks to herself. Or, perhaps more accurately, she holds a furious rapid-fire whispered 'conversation' with a veritable host of beings. Have these beings invaded her head and taken it over? I have no idea. But it is unnerving to think that an aide whom one fears might accidentally do one physical damage may actually be certifiably insane!
Bertha has at least one more trick in her bag at night. After cleaning me up from a bowel movement and without changing her latex gloves, she will put one hand under the nape of my neck to lift up my head, and then turn my pillow with the other hand. Thus am I fated to sleep in that slightly disgusting 'situation' for the night. Pleasant dreams!
In short, in the evening I would describe her as "slow-as-molasses, ever-dangerous, and possibly-wacko." That's Big Bertha in a nutshell.
(25 September 2008)
Postscript: I could not stop where I did above and feel that I have given a fair and balanced view of Big Bertha. Surely she has some positive traits that cry out to be recognized. I am happy to report that I have found one:
Once in awhile when an aide leans across me and brings her arm near my face, I sniff at it. After all, she does so much for my personal hygiene that I thought I might return the favor and at least look into hers.
What did I find out? That all the aides smell like they have been scrubbed clean with fresh soap and water. And this includes Big Bertha.
There you have it: she may visit violence and mayhem on me on a regular basis; but no one can say that Big Bertha is not clean!
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