agnes rocks

I was just reading a colleague's posting on nursing homes, and figured I'd add my two cents here. I dredged this posting up from the archives. . . I've worked in 4 different ASAs, and, I'm sorry to say, have found with few exceptions that care in nursing homes is substandard. Notice I did say "with few exceptions." But thank god some of the patients are able to maintain a bit of spunk, eh?

Note: All names and identifying features have been changed so I don't get sued.

I tried writing this blog last night when I got home from work, and kept falling asleep in front of the computer. . .I'd wake up just a little bit and notice weird words up on the screen scattered throughout my sentences. The words looked vaguely like "HEENT" and "NEUROS INTACT" and "MAEW" and "BILAT" and I started realizing that I've been writing so many charts that I'm now literally doing it in my sleep. But. . .again. . .I digress.
So, yesterday, our first call of the day is to a nursing home for a 90 year old patient with respiratory distress and an altered level of consciousness (LOC) with bouts of self-harm.

Huh?

We get to this place I'll call Hopeful Heights or Whispering Willows or Shady Pines or whatever stupid name I can come up with to hide the fact that this is a place where people come to die when their families can't or won't take care of them. This is the place where the male nurse resembles a serial killer or a child molester, take your pick, and the head nurse has track marks and a seriously high tattoo to teeth ratio. Hopeful Heights is not really a happy place. Did I mention it smells like poop?
I should mention that we do have a somewhat jaded view of some of the lesser quality nursing homes. We frequently get called to them in the middle of the night by alarmist nurses and CNAs who insist their patients are in a "coma" and we get there and scare them out of a nice sound sleep and everybody's pissed but the nurse, who claims she just "couldn't wake them up." (Geez, Nurse Ratched, why were you trying to wake them up in the middle of the night, anyway?) Either that or the patient has been sick for five days, complaining of nausea, hasn't eaten, raging fever, and when you get there you don't even ask if they've given anything for the nausea, because you'll get a blank stare, and nobody can tell you anything because "it's not my patient" or "we just had a shift change, so I wasn't here." It's load and go, and you try to figure out on the way why a patient has Tegretol and Ativan on their med list if they've never had a seizure.
Anyway, this little old lady is lying flat on her back under a thin sheet in a room so cold that I'm shivering. I can hear her chatting away with a companion at bedside, but as soon as she catches sight of me and the gurney, she clams up and goes "unconscious." Fairly convincingly, I might add. I say her name, introduce myself, let her know we're taking her to the hospital. Her eyes snap open-- there's a twinkle in there, but I'm not getting all of it just yet-- and she asks, "why?" And I say, "you've been sick." Her hand slowly raises from the bed and (I'm ashamed to say) my first thought is that this little old lady is going to hit me. . .but she points right at me and smiles a little bit and winks. . .and then boops me on the nose. Hmmm. All is not quite as it seems, methinks.
We get her packaged on the gurney, head elevated so she can breathe, under several blankets to warm her up a bit. We get her outside, she looks straight at me, smiles again, and says, "I hate that fucking Hopeful Heights."

Yes, she did too say that.

We go enroute code 1, turn up the heater, get an IV. I start a head to toe and when I check her pupil response I notice that twinkle. I shake my head and can't help but say, "Agnes, you're a rascal, aren't you? A real troublemaker." And she smiles hugely and points at me and says, "no, YOU are." And boops me on the nose again.

When I get old, I wanna be just like Agnes.