Still emotionally devastated by the circumstances surrounding my transition away from Homeland, it's time to do whatever needs to be done to heal myself and find a new income source. It's a position that's terrifying, and I'm grieving too, although over what I'm not exactly sure. I'm feeling that there's a well of grief, anger, and fear in my mind on the child level. I'm looking into the phenomenon of post-traumatic stress disorder as a possible explanation. Also I've had a sudden insight.
I attended the teaching campaign during the last two weekends, and whenever I was thinking or sharing about my relationship to children, however tangentially, I kept thinking/saying, "I don't do children." I have a spotty history of feeling traumatized and unsuccessful anytime I had the misfortune to be involved in children's classes. There is a lot of fear there. So I was also asking myself why. It popped into my head--"because I am one." For whatever reason, I realized that I have been emotionally operating on the level of a child. Hard to make good judgments, hard to make wise decisions, under that condition.
I can't fix this right away. But I have received a wonderful amount of support so far.
Also I have been able to reflect back to Miss Lisa her wonderful level of success, and many ways to be supportive of the children's classes occurred to me, which I shared with her yesterday. I have some ideas and resources which may prove helpful.
Although I look at it as the coward's role, I spent both weekends in prayer in support of the teaching. It has helped anesthetize my pain, stopped the whirling thoughts, and made me feel better. People also reported they could feel our prayers. So that has been a comfort.
As William Sears said, sometimes the best prayer is "HELP!"
Monday, October 25, 2010
Wednesday, October 20, 2010
All The Pillars of the Dwelling
We went to the celebration of the birth of the Bab, the forerunner to Baha'u'llah, yesterday evening. It was held in the community center at Salishan, the recently rebuilt, tremendously successful, and wonderfully diverse public housing development in Tacoma. For Baha'is who have been roaming the streets interested in conversing with people about spiritual community-building, it has been a mine rich in gems of inestimable value.
To gather jewels have I come to this world. If one speck of a jewel lie hid in a stone, and that stone be beyond the seven seas, until I have found and secured that jewel, my hand shall not stay from its rest.
~Baha'u'llah
As I drove up to the center and could see the action through the window, I was appalled. We were in trouble. Children were sprawled across the floor with crayons; some hugging books obtained from the library in the lobby. There were children climbing the curtains, dangling from the ceiling, hovering in the air, popping out from doorways. Dozens of them.
I could also see that they all, without exception, passionately adore and instantly obey Miss Lisa. She works at their school and lives in the neighborhood; now with the support of the Baha'i community she host children's classes and other core activities nearly every day in her home. These children were now here, attending the Baha'i holy day.
At the opening of the celebration, Lisa's son Liam enthusiastically recited a memorized prayer; he knows several. The children sang songs from their classes. We read Baha'i writings about the Bab, and Tim exquisitely told the tale of the Bab's first attendance at school at the age of five. [Tim has developed his storytelling skills to a wonderful degree.] Then children and youth vied with each other in lining up to sing more songs that they had learned.
Also, my favorite new star appeared, a youth I'll just call "Badi." I first saw Badi Saturday at the home which hosted the base for the neighborhood teaching activities. I came to hide there and say prayers while the brave miners went off, whistling, to dig up more gems. They returned with this youth they had scrounged up. He appeared positively glowing, dutifully phoned his mother, and wasted no time informing the participants [estimated lowest age about forty--sorry!] that it would be advantageous to have more youth out in the neighborhoods engaging people in conversations.
I believe Badi's primary interest is becoming involved as a "youth animator." [Most of the young participants of last night's holy day already seem pretty animated.] Anyway, Badi's glowing visage seemed like an outstanding expression of this verse:
For thus the Master of the house hath appeared within His home, and all the pillars of the dwelling are ashine with His light.
~Baha'u'llah
To gather jewels have I come to this world. If one speck of a jewel lie hid in a stone, and that stone be beyond the seven seas, until I have found and secured that jewel, my hand shall not stay from its rest.
~Baha'u'llah
As I drove up to the center and could see the action through the window, I was appalled. We were in trouble. Children were sprawled across the floor with crayons; some hugging books obtained from the library in the lobby. There were children climbing the curtains, dangling from the ceiling, hovering in the air, popping out from doorways. Dozens of them.
I could also see that they all, without exception, passionately adore and instantly obey Miss Lisa. She works at their school and lives in the neighborhood; now with the support of the Baha'i community she host children's classes and other core activities nearly every day in her home. These children were now here, attending the Baha'i holy day.
At the opening of the celebration, Lisa's son Liam enthusiastically recited a memorized prayer; he knows several. The children sang songs from their classes. We read Baha'i writings about the Bab, and Tim exquisitely told the tale of the Bab's first attendance at school at the age of five. [Tim has developed his storytelling skills to a wonderful degree.] Then children and youth vied with each other in lining up to sing more songs that they had learned.
Also, my favorite new star appeared, a youth I'll just call "Badi." I first saw Badi Saturday at the home which hosted the base for the neighborhood teaching activities. I came to hide there and say prayers while the brave miners went off, whistling, to dig up more gems. They returned with this youth they had scrounged up. He appeared positively glowing, dutifully phoned his mother, and wasted no time informing the participants [estimated lowest age about forty--sorry!] that it would be advantageous to have more youth out in the neighborhoods engaging people in conversations.
I believe Badi's primary interest is becoming involved as a "youth animator." [Most of the young participants of last night's holy day already seem pretty animated.] Anyway, Badi's glowing visage seemed like an outstanding expression of this verse:
For thus the Master of the house hath appeared within His home, and all the pillars of the dwelling are ashine with His light.
~Baha'u'llah
Alive!
Transitioning out of my job at Homeland, I feel like the man, spat out from the maw of a monster as indigestible, who, though escaping with his life, experiences a sense of rejection.
As children when pretending, we used the expression, "Let's say." "Let's say we're starving in the wilderness, and . . ." Homeland would cast me as the monster. "Let's say Arlene is a monster."
My place at Homeland, my belonging there, is something I can no longer emotionally support. The income was terribly addictive, and there were aspects of the position that were tremendously enjoyable and fulfilling. I also learned a lot. There are staff members there of such a high caliber both personally and professionally that I will miss them terribly. Yesterday, after saying goodbye, I could not restrain my tears. I was embarrassed in front of all the staff taking their breaks, as I emptied my locker and removed my name from the door.
There is no individual at Homeland who worked harder than I did. I saw nurses blow off charting and a multitude of other tasks, just to clock out on time. I stayed until the work was done, no matter how late.
I have long felt, however, that my job would be perfect if the people would just go away. While I relished the challenge of meeting whatever comes up at any moment, there can be no break from it. Between my difficulty in focusing and my introversion, and the pressure of completing work and dealing with emergencies while frequently changing gears to meet people's needs, I rarely crossed the threshold at night except in a cloud of sadness, frustration, anger, and a profound need to be alone.
What I would have needed to continue, was support and validation from the Director of Nursing.
I think I reached a point where my chief fun at work, besides doing admissions, and the childlike entertainment I derive from peel-and-stick labels, was honing my deadpan humor. Nothing is more fun than cracking people up. I've had many shining moments there, but others not so shining. Eventually I became aware, from the hostility drifting down the hallway, that the DNS and I have irreconcilable differences.
Lately in my deep sense of isolation, as I strive to overcome my material roots, I have been yearning for some sign that I could feel for myself that I am loved by God. I think this is it. I have been pulled out of this field by God, uprooted like a beet, with my health and best interest at stake. I do not wish to drop in my tracks like L. [See previous post.]
For those who wish to know my next step, I will let you know when I know. I trust I will find a more suitable field. Inshallah.
As children when pretending, we used the expression, "Let's say." "Let's say we're starving in the wilderness, and . . ." Homeland would cast me as the monster. "Let's say Arlene is a monster."
My place at Homeland, my belonging there, is something I can no longer emotionally support. The income was terribly addictive, and there were aspects of the position that were tremendously enjoyable and fulfilling. I also learned a lot. There are staff members there of such a high caliber both personally and professionally that I will miss them terribly. Yesterday, after saying goodbye, I could not restrain my tears. I was embarrassed in front of all the staff taking their breaks, as I emptied my locker and removed my name from the door.
There is no individual at Homeland who worked harder than I did. I saw nurses blow off charting and a multitude of other tasks, just to clock out on time. I stayed until the work was done, no matter how late.
I have long felt, however, that my job would be perfect if the people would just go away. While I relished the challenge of meeting whatever comes up at any moment, there can be no break from it. Between my difficulty in focusing and my introversion, and the pressure of completing work and dealing with emergencies while frequently changing gears to meet people's needs, I rarely crossed the threshold at night except in a cloud of sadness, frustration, anger, and a profound need to be alone.
What I would have needed to continue, was support and validation from the Director of Nursing.
I think I reached a point where my chief fun at work, besides doing admissions, and the childlike entertainment I derive from peel-and-stick labels, was honing my deadpan humor. Nothing is more fun than cracking people up. I've had many shining moments there, but others not so shining. Eventually I became aware, from the hostility drifting down the hallway, that the DNS and I have irreconcilable differences.
Lately in my deep sense of isolation, as I strive to overcome my material roots, I have been yearning for some sign that I could feel for myself that I am loved by God. I think this is it. I have been pulled out of this field by God, uprooted like a beet, with my health and best interest at stake. I do not wish to drop in my tracks like L. [See previous post.]
For those who wish to know my next step, I will let you know when I know. I trust I will find a more suitable field. Inshallah.
Sunday, October 17, 2010
Purple Potato Salad
I took my daughter to the pumpkin farm Saturday, where we picked up the obligatory pumpkin, but also some giant apples, several jars of honey, and pickled green beans which we remember fondly as my sister in law makes them. Irresistible and addictive. When they sell blueberry, raspberry, and even pumpkin honey, I can't help wondering how they know which blossoms the bees frequented to collect their nectar. Do the farmers hold a little huddle with the bees and only send them to specific plants?
My focus on nutrition is usually on plants, and when I put them together, although I think plants are a wonderful example of organic unity in diversity, as almost any vegetable can get along with any other vegetable in harmony and unity--still, my dishes often have a face that only a mother could love. I had some beets and decided they would be lovely in a salad, and so would potatoes, and it all ended up as a delicious, funny-looking mess.
Purple Potato Salad
3-4 beets, cooked
4-5 red potatoes, cooked
half a yellow onion
three large garlic cloves, or to taste*
one large apple
5 or 6 pickled green beans
one can or [one pound cooked] black or kidney beans
fresh basil
3-4 tablespoons dried dill
a splash of seasoned rice vinegar
vegenaise to taste [vegenaise is the non-egg version of mayonnaise.]
*I tend to treat garlic as a vegetable, slicing it up and throwing the chunks into a soup or salad. Not every tongue is ready for this, however.
Cut up beets, potatoes, onions, apple, stir it all together and refrigerate.
My focus on nutrition is usually on plants, and when I put them together, although I think plants are a wonderful example of organic unity in diversity, as almost any vegetable can get along with any other vegetable in harmony and unity--still, my dishes often have a face that only a mother could love. I had some beets and decided they would be lovely in a salad, and so would potatoes, and it all ended up as a delicious, funny-looking mess.
Purple Potato Salad
3-4 beets, cooked
4-5 red potatoes, cooked
half a yellow onion
three large garlic cloves, or to taste*
one large apple
5 or 6 pickled green beans
one can or [one pound cooked] black or kidney beans
fresh basil
3-4 tablespoons dried dill
a splash of seasoned rice vinegar
vegenaise to taste [vegenaise is the non-egg version of mayonnaise.]
*I tend to treat garlic as a vegetable, slicing it up and throwing the chunks into a soup or salad. Not every tongue is ready for this, however.
Cut up beets, potatoes, onions, apple, stir it all together and refrigerate.
Sunday, October 10, 2010
Allegaters VERSUS Justice
There's allegaters at Homeland. Recently the faceless entity designed to torture skilled nursing facilities, called "The State," cracked down on phoning in to The State every thing that ever happened to anybody at the facility. Bruises, falls and complaints, mostly. Anyway, that's Homeland's interpretation of the rules.
Suddenly, karmaically, this situation has mysteriously attracted a multitude of complaints and accusations, which were rarely mentioned before. I think it's the scent of blood.
Homeland is turning into a police state. Anytime one of our residents, who all have at least some amount of short term memory loss, God bless 'em, opens their mouths and mentions that they thought it took too long for staff to answer their call lights, or they thought the staff performed a transfer wrong, or forgot a medication, bam, there went four hours of somebody's time filling out investigational paperwork and calling The State. And worst of all, an accusation is treated as fact.
Mrs. O'Hunnie couldn't remember two hours later getting her inhaler, but twelve hours later she can still remember that the nurse supposedly forgot it. Mr. Dunnfore claims that someone assisted him to stand by the bedside commode using the walker, but the nurse just walked off and left him there instead of completing the transfer to the commode.
I've noticed that the personnel hearing these allegations are usually the contracted therapy staff, and I've come to the conclusion that the next time one of them comes trotting up to the nurses station to mention one of these allegations I'm going to point to the paperwork and say, "Go ahead, there's the investigation form."
The Forms: the first page of which I am quoting an excerpt is cribbed from the incident report form, so most of it doesn't apply. It is an "Occurrence Report Checklist:
X Check off all items completed.
X All questions on the occurrence report must be answered.
X Review the resident's care plan--was care provided according to plan of care?
X Caregiver/Witness Report MUST be completed at the time of occurrence by the person reporting the occurrence AND the person assigned to care for the resident . . . etc etc etc. REMINDER: Washington State requires (RCW 74.34.035(3) you to notify the DSHS Hotline 91-800-562-6078), if the occurrence involves Abuse/Neglect, Abandonment, Mistreatment, or Misappropriation. Facility Protocol requires you to notify the DNS and/or Administrator of any occurrences of Abuse/Neglect, Abandonment, Mistreatment or Misappropriation.
State Hotline Notified? _____No ______Yes, Date/Time:_________.
LN is responsible to complete the following for all ALLEGATIONS OF Abuse/Neglect, Abandonment or Mistreatment:
X Intervene, immediately, and provide safety for the resident(s)
X Remove perpetrator immediately (employee, visitor, family, another resident, etc.)
X Initiate the Occurrence Report, obtain witness statements from all staff on duty
X Notify the DNS &/or Administrator: Date/Time:_________
X Notify Tacoma Police: Date/Time:_______________ (non-emergent Phone Number 253-798-4721)
X Notify Physician:________ Date/Time:___________
X Notify POA/Responsible Party: Who:__________ Date/Time:__________
X If appropriate, arrange for immediate transport to hospital/ER for evaluation
X Complete occurrence report, initiate alert monitoring/charting."
I will stipulate that we care about our residents, they are in our care and vulnerable, and that all the staff must do the utmost to keep them safe and secure and healthy. That is our goal. However, the process involved in dealing with these issues leaves something to be desired.
I'll spare the reader the rest of the extensive paperwork, except for the "CONCLUSION" section. I ask you to remember that nothing that someone claims to have occurred is actually proven to have occurred. Here is the dictionary definition of the word "allegation":
"The act of alleging; also, something alleged; an assertion made by a party in a legal proceeding, which he undertakes to prove; an averment; sometimes, a mere assertion without proof."
Listen to the language of this portion of the form:
Who was involved in the allegation?
What was the allegation?
When did the allegation occur?
[When was the complaint voiced, or when did the supposed event happen?]
Where did the allegation take place?
[Where was the complaint voiced, or where did the supposed event happen?]
Why did the allegation happen?
[Why was the complaint voiced, or why did the supposed event happen? Which, as you can see, the form assumes actually happened.]
How did the allegation occur?
CAUSE/REASONABLE CAUSE of the allegation was:___________.
Okay, the dictionary does say that an allegation could be "something alleged." I have issues with language that uses the fact of someone saying something interchangeably with the idea an event actually occurred. As soon as the questionaire is asking the staff to say when the "allegation" occurred, where it took place, why it happened, and how the allegation occurred, and what was the cause of the allegation, a line has been crossed. The language of the form is now assuming that an actual event took place. Guilty until proven innocent.
I have major issues with that.
"The best beloved of all things in My sight is justice."
~Baha'u'llah
Suddenly, karmaically, this situation has mysteriously attracted a multitude of complaints and accusations, which were rarely mentioned before. I think it's the scent of blood.
Homeland is turning into a police state. Anytime one of our residents, who all have at least some amount of short term memory loss, God bless 'em, opens their mouths and mentions that they thought it took too long for staff to answer their call lights, or they thought the staff performed a transfer wrong, or forgot a medication, bam, there went four hours of somebody's time filling out investigational paperwork and calling The State. And worst of all, an accusation is treated as fact.
Mrs. O'Hunnie couldn't remember two hours later getting her inhaler, but twelve hours later she can still remember that the nurse supposedly forgot it. Mr. Dunnfore claims that someone assisted him to stand by the bedside commode using the walker, but the nurse just walked off and left him there instead of completing the transfer to the commode.
I've noticed that the personnel hearing these allegations are usually the contracted therapy staff, and I've come to the conclusion that the next time one of them comes trotting up to the nurses station to mention one of these allegations I'm going to point to the paperwork and say, "Go ahead, there's the investigation form."
The Forms: the first page of which I am quoting an excerpt is cribbed from the incident report form, so most of it doesn't apply. It is an "Occurrence Report Checklist:
X Check off all items completed.
X All questions on the occurrence report must be answered.
X Review the resident's care plan--was care provided according to plan of care?
X Caregiver/Witness Report MUST be completed at the time of occurrence by the person reporting the occurrence AND the person assigned to care for the resident . . . etc etc etc. REMINDER: Washington State requires (RCW 74.34.035(3) you to notify the DSHS Hotline 91-800-562-6078), if the occurrence involves Abuse/Neglect, Abandonment, Mistreatment, or Misappropriation. Facility Protocol requires you to notify the DNS and/or Administrator of any occurrences of Abuse/Neglect, Abandonment, Mistreatment or Misappropriation.
State Hotline Notified? _____No ______Yes, Date/Time:_________.
LN is responsible to complete the following for all ALLEGATIONS OF Abuse/Neglect, Abandonment or Mistreatment:
X Intervene, immediately, and provide safety for the resident(s)
X Remove perpetrator immediately (employee, visitor, family, another resident, etc.)
X Initiate the Occurrence Report, obtain witness statements from all staff on duty
X Notify the DNS &/or Administrator: Date/Time:_________
X Notify Tacoma Police: Date/Time:_______________ (non-emergent Phone Number 253-798-4721)
X Notify Physician:________ Date/Time:___________
X Notify POA/Responsible Party: Who:__________ Date/Time:__________
X If appropriate, arrange for immediate transport to hospital/ER for evaluation
X Complete occurrence report, initiate alert monitoring/charting."
I will stipulate that we care about our residents, they are in our care and vulnerable, and that all the staff must do the utmost to keep them safe and secure and healthy. That is our goal. However, the process involved in dealing with these issues leaves something to be desired.
I'll spare the reader the rest of the extensive paperwork, except for the "CONCLUSION" section. I ask you to remember that nothing that someone claims to have occurred is actually proven to have occurred. Here is the dictionary definition of the word "allegation":
"The act of alleging; also, something alleged; an assertion made by a party in a legal proceeding, which he undertakes to prove; an averment; sometimes, a mere assertion without proof."
Listen to the language of this portion of the form:
Who was involved in the allegation?
What was the allegation?
When did the allegation occur?
[When was the complaint voiced, or when did the supposed event happen?]
Where did the allegation take place?
[Where was the complaint voiced, or where did the supposed event happen?]
Why did the allegation happen?
[Why was the complaint voiced, or why did the supposed event happen? Which, as you can see, the form assumes actually happened.]
How did the allegation occur?
CAUSE/REASONABLE CAUSE of the allegation was:___________.
Okay, the dictionary does say that an allegation could be "something alleged." I have issues with language that uses the fact of someone saying something interchangeably with the idea an event actually occurred. As soon as the questionaire is asking the staff to say when the "allegation" occurred, where it took place, why it happened, and how the allegation occurred, and what was the cause of the allegation, a line has been crossed. The language of the form is now assuming that an actual event took place. Guilty until proven innocent.
I have major issues with that.
"The best beloved of all things in My sight is justice."
~Baha'u'llah
Sunday, October 3, 2010
A Messenger of Joy
It is an honor to be of service to patients and their families, especially in supporting them while the person passes on to the next world.
To an experienced and organized nurse, having a death on ones shift is an event one can be well prepared for. Experience tells us, for example, that it is an advantage to have a mortuary previously selected, because a newly-bereaved family member can find choosing one at the last minute too overwhelming. So as nurses we have learned things which make everything go more smoothly.
So, even though I sometimes say [to myself or staff], "Don't die on my shift," it's not too difficult an event to deal with. At the previous nursing facility where I worked, a woman was on hospice, had some falls during her stay, and as she was currently dying [hospice folks sometimes use the word "transitioning"-- I don't know why], had sublingual atropine drops to help control oral secretions. The family in California phoned that evening to see how she was, and instructed me to tell her to "hold on until the weekend," as that was when they planned to visit. She did not hold on, but had a couple of atropine drops, a harmless dosage, and quietly passed on.
The family freaked out, questioned the atropine drops [as a different dose and route can be used as a potent medication for cardiac events]; brought up her history of falls; demanded a head-to-toe x-ray and a full autopsy. Guilt. The assigned physician phoned the family and sorted them out. Things can be a little rough.
So. At Homeland yesterday, "Mr. Scot" transitioned away from us into another realm. I had a particular affinity to Mr. Scot, as he was two years older than me but wasting away from cancer mets to the brain when he was admitted to Homeland from Harborview on Hospice care. Over the last two months or so, he lost a significant amount of weight, lost the ability to swallow, developed an open area on his behind which was unavoidable due to his lack of ability to take in nutrition and his cachexic [skeletal] condition. We managed his pain with morphine, which was appropriate.
At last he was failing, and died just before I came on shift yesterday. He had a non-related friend assigned durable power of attorney for medical and financial affairs, and a selected mortuary. The day shift nurse was from agency but had seemingly done everything she should: notified Hospice and the MD, and placed a "STOP" sign on the door to warn people not to enter. She had been unable to contact the POA, who came into the facility to see him just after change of shift and was informed of his passing. She asked us to delay phoning the mortuary until 5 PM due to expecting a friend of his from out of town who might wish to pay her last respects.
About an hour later, this friend arrived harried and breathless after battling traffic for two hours on the way down and getting lost trying to find the facility. She asked for Mr. Scot at the front desk [the agency nurse had forgotten to notify the receptionist] and breezed past the nurses station and the STOP sign, into his room, and right back out again, crying that he wasn't breathing. She was horribly shook up. We took her into the nurses station and sat her down, gave her tissues and water, and did what they teach in school as "therapeutic communication", i.e. listening to the person until they feel better. When she was ready to go I gave her a hug and directed her to the nearest Starbucks and some restaurants near I-5.
At five PM I phoned the mortuary, who let me know that a power of attorney appointment ends with the death of the patient, and asked if we had listed any next of kin. I gave the number for the POA, the number for the ex-spouse, and was asked if there were adult children. I said, names were listed but not numbers, and I had no idea of their ages. [This is often why people assign POA's: there are no viable next of kin.] The director said he would look into it and call me back. I pointed out that a significant period of time had passed and asked how soon they could pick up the remains. He stated that there was a law that he had up to twenty-four hours to collect the remains. I said that I could guarantee this gentleman was not going to remain in my facility for any twenty-four hours. We were at an impasse.
I was whining about this to another nurse and she explained that a durable power of attorney means that the relationship continues after the patient is deceased. So I called the mortuary with this information. Over the next two hours I phoned the mortuary three times, speaking to the receptionist, to find out whether or not they would accept this patient. Finally I phoned the Hospice to explain the problem. I was talking with the social worker when the mortuary called and said they had spoken with the POA and would be on their way ASAP.
Meanwhile the CNA's discovered that the day nurse had forgotten to remove his Foley catheter. I had just finished with this task and was emerging from the room when the two morticians arrived, status-post teenagers in suits. They were courteous to me, I think because they saw me with a garbage bag in my hands and thought I was a flunky. They were quite rude to the other nurse, eye-rolling, probably thinking that she was the head honcho. Mr. Scot exited the facility 8 1/2 hours after his passing.
Anyway, I imagine Mr. Scot got a kick out of the whole thing.
"Death is a messenger of joy."
~Baha'u'llah
To an experienced and organized nurse, having a death on ones shift is an event one can be well prepared for. Experience tells us, for example, that it is an advantage to have a mortuary previously selected, because a newly-bereaved family member can find choosing one at the last minute too overwhelming. So as nurses we have learned things which make everything go more smoothly.
So, even though I sometimes say [to myself or staff], "Don't die on my shift," it's not too difficult an event to deal with. At the previous nursing facility where I worked, a woman was on hospice, had some falls during her stay, and as she was currently dying [hospice folks sometimes use the word "transitioning"-- I don't know why], had sublingual atropine drops to help control oral secretions. The family in California phoned that evening to see how she was, and instructed me to tell her to "hold on until the weekend," as that was when they planned to visit. She did not hold on, but had a couple of atropine drops, a harmless dosage, and quietly passed on.
The family freaked out, questioned the atropine drops [as a different dose and route can be used as a potent medication for cardiac events]; brought up her history of falls; demanded a head-to-toe x-ray and a full autopsy. Guilt. The assigned physician phoned the family and sorted them out. Things can be a little rough.
So. At Homeland yesterday, "Mr. Scot" transitioned away from us into another realm. I had a particular affinity to Mr. Scot, as he was two years older than me but wasting away from cancer mets to the brain when he was admitted to Homeland from Harborview on Hospice care. Over the last two months or so, he lost a significant amount of weight, lost the ability to swallow, developed an open area on his behind which was unavoidable due to his lack of ability to take in nutrition and his cachexic [skeletal] condition. We managed his pain with morphine, which was appropriate.
At last he was failing, and died just before I came on shift yesterday. He had a non-related friend assigned durable power of attorney for medical and financial affairs, and a selected mortuary. The day shift nurse was from agency but had seemingly done everything she should: notified Hospice and the MD, and placed a "STOP" sign on the door to warn people not to enter. She had been unable to contact the POA, who came into the facility to see him just after change of shift and was informed of his passing. She asked us to delay phoning the mortuary until 5 PM due to expecting a friend of his from out of town who might wish to pay her last respects.
About an hour later, this friend arrived harried and breathless after battling traffic for two hours on the way down and getting lost trying to find the facility. She asked for Mr. Scot at the front desk [the agency nurse had forgotten to notify the receptionist] and breezed past the nurses station and the STOP sign, into his room, and right back out again, crying that he wasn't breathing. She was horribly shook up. We took her into the nurses station and sat her down, gave her tissues and water, and did what they teach in school as "therapeutic communication", i.e. listening to the person until they feel better. When she was ready to go I gave her a hug and directed her to the nearest Starbucks and some restaurants near I-5.
At five PM I phoned the mortuary, who let me know that a power of attorney appointment ends with the death of the patient, and asked if we had listed any next of kin. I gave the number for the POA, the number for the ex-spouse, and was asked if there were adult children. I said, names were listed but not numbers, and I had no idea of their ages. [This is often why people assign POA's: there are no viable next of kin.] The director said he would look into it and call me back. I pointed out that a significant period of time had passed and asked how soon they could pick up the remains. He stated that there was a law that he had up to twenty-four hours to collect the remains. I said that I could guarantee this gentleman was not going to remain in my facility for any twenty-four hours. We were at an impasse.
I was whining about this to another nurse and she explained that a durable power of attorney means that the relationship continues after the patient is deceased. So I called the mortuary with this information. Over the next two hours I phoned the mortuary three times, speaking to the receptionist, to find out whether or not they would accept this patient. Finally I phoned the Hospice to explain the problem. I was talking with the social worker when the mortuary called and said they had spoken with the POA and would be on their way ASAP.
Meanwhile the CNA's discovered that the day nurse had forgotten to remove his Foley catheter. I had just finished with this task and was emerging from the room when the two morticians arrived, status-post teenagers in suits. They were courteous to me, I think because they saw me with a garbage bag in my hands and thought I was a flunky. They were quite rude to the other nurse, eye-rolling, probably thinking that she was the head honcho. Mr. Scot exited the facility 8 1/2 hours after his passing.
Anyway, I imagine Mr. Scot got a kick out of the whole thing.
"Death is a messenger of joy."
~Baha'u'llah
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