I’m not a nurse, nor do I work in nursing now, though for a few years I worked as a certified nurses’ assistant (CNA) working the night shift (11PM-7AM) at a few different nursing facilities while attending colleges in Missouri. I’m in a different line of work now and hadn’t thought much about those days of late… until one of my regular visitors shared with me her experience with prematurely demented loved one. There are stories in life you don’t care to talk about for various reasons until you realize that when nobody talks about a problem, it doesn’t get fixed. Your story may not seem that consequential in the grand scheme of things, but every little difference does count even if it benefits only a slim percentage of the people who ever hear about it. So, here is one of my haunting memories of a nursing home resident, while I’m still young enough to remember him.
Delbert was a farmer before he came to live in the nursing home I worked at near Kansas City, Missouri. I bet he used to raise brilliantly happy crops because you really wouldn’t find anyone with a sunnier supposition. He almost always had a smile on his face, one that only grew wider the minute someone paid any attention to him. I could almost imagine the sunflowers turning to face him wherever he walked. By the time we met, however, Del was already suffering from dementia and aphasia, and his vocabulary consisted mostly of simple ‘yes’ and ‘no’ and a lot of unintelligible mumbling. He spent his days and nights there roaming the facility’s halls on his own, looking in on other patients without really socializing with anyone. He would stop by someone’s Geri chair to mumble and nod before moving on to someone or something else. I had a distinct feeling that he was living in an alternate reality in his own head, one in which his mumbling made sense and where the resident cats and flowers actually mumbled back to him.
Being both short and stocky-ish and prone to a laughing fit at every little thing in sight, we hit it off quite well and after a while Del took to following me around like a perpetually amused shadow as I worked. It was flattering but also endlessly exasperating. Having a shadow was harmless enough when I was only cleaning the floor or filling up water jars or doing laundry, but how was I supposed to change the lady-next-door’s incontinent pad in the middle of the night while Del was trying to break in through the door to render me his unwanted assistance?
We were getting on like that until one night when I came to work my usual shift and was briefed by the charge nurse that Del had fallen and broken his hips the day before. She was actually not sure if he had fallen and then broke the hips, or if his hips had broke, which then caused the fall. Either way, he was in a bad fix and was staying in the hospital after his hip surgery. That was our understanding until, of course, I came to work the next night, walked onto the floor to see the staff conferring at the nursing station mutely listening to a hoarse voice loudly moaning and groaning from the end of East Wing.
‘What the heck is going on? Who’s making all that noise?’ I asked. Big Tim, the senior CNA, looked at me and said just one word, ‘Del.’
WTF??? I raced down the hall after the moaning sound and found him alone in the previously empty last room down the hall. They had put him in isolation and there was even a red caution sticker on the door! Del had caught a nosocomial Clostridium difficile infection while in the hospital. Nobody at the nurses station knew what the exotic sounding disease was and was simply too scared to get near the dude. You’d have to have worked in nursing to understand, I suppose, but most nurses’ assistants aren’t all that knowledgeable about medicine and infectious diseases (though many of them like to sound like they do). But at any rate, everyone was panicking a bit and was treating this like a BSL-3 airborne disease. One of the CNA’s, the one that was actually assigned the East Wing that night, flat out refused to enter the room, telling others loudly that ‘they’ can’t pay me enough to make me risk my own life or health.’ Naturally, that put quite a damper to the others’ willingness to help. They just wouldn’t go in there without one of those containment suit (the space suit, so to speak) on. Imagine what sort of message that sent to Del and his neighbors!
As a college premed-chemistry freshman I was not familiar with C difficile, but I knew its nasty big brother Clostridium botulinum fairly well from my time hanging out at my oncologist mother’s hospital. The infectious disease fellow there always kept a jarful of M&M’s on his office desk, and delighted in showing me his latest exotic specimens on the slides as we munched on them together. (The M&M’s, not the specimen!). Botulism, thankfully, was a relatively rare disease even then, and the poor soul from whom that slide was originated got it from eating some fruits out of a dented can. You can call me weird, but I was one of those strange kids who knew how to fix, then Gram stain body fluids and tissues before I knew the intended use of a Trojan..
But, back to the main story! The causative agent of botulism is a major league nasty bacterium secreter of the botulinum toxin, better known as the active ingredient of Botox. Of course, the thing they use in Botox is extremely diluted… it has to be since botulinum neurotoxin is the most toxic biological substance on the planet. So even though I didn’t know about Clostridium difficile, I knew that since this was a Clostridium it was a spore-producing Gram-positive anaerobic bacillus; which meant that not only was the thing not an airborne bug, it actually could not live in the presence of oxygen. Later on I would look the thing up and found that it wasn’t even something a healthy person should even worry about in the first place. C diff is a normal flora in your colon, and only two specific strands of them produce toxin that would bother people with defective immune system. In Del’s case, it was causing problem because it had gotten into his bloodstream while his system was being overwhelmed with a traumatic injury. In other words, an opportunistic infection.
Knowing even then that I would have had to stick a cut hand into a C diff infected body fluid without a glove on in order to catch the stuff, I pushed open the door and went in to see what was causing Del such misery. It was — a soul-chilling sight. Del was alone in the far bed (the one by the window), in hospital gown that was soaked through from his fevered sweat, body fluid leaking out of his foot-long surgical slash running along the left side of his hip — a slash that was only held semi-shut by a series of metal clips, and a generous amount of urine. He was in such severe pain that all he could do was to lay there micro-writhing (it probably hurt like heck for him to lay still and even more so when he did move) and moaning incoherently. I was aghast. How could they have shipped him out of the hospital in this condition? I cleaned him up, changed his soaked pad, and went up to the nursing station to see what the charge nurse was doing about it all.
To her credit, the charge nurse was ringing up everyone she could think of short of the mayor, but Del’s surgeon had apparently not prescribed him any painkiller stronger than Lortab before leaving town for a few days. The doctor who was his ‘cover’ was either off in a tunnel somewhere or just plain not answering his phone and pager. And without a doctor’s order the nurses couldn’t give the suffering patient any stronger medication! And so on it went, straight on until morning: the nursing staff went about our business as Del’s moans, groans and cries wreaked havoc on his neighbors’ already frazzled psyches (how would you like to be one of those poor souls laying helpless on your bed listening to that all night long while trying to ignore or suspend the thought that this could very well be you instead of that hunched over old man next door? Surrounded by medical staff in a medical facility, and yet benefiting almost nothing from it?). I could hear him half way up the West Wing (where I was assigned that night), and it would take a long while before the combination of Del’s moaning and the persistent sound of the call light (the alarm that goes on whenever a nursing patient needed assistance) worked its way out of my head.
Seven o’clock came and the day shift crew were now on the floor asking the same questions I did, but still finding no solution. My first class that day wasn’t until 10AM, so I clocked out, grabbed a bunch of alcohol swabs and went about disinfecting the railing around Del’s bed before settling down in the chair next to him for 45 minutes or so before I had to leave. He was running out of steam then with the moaning and the mini-writhing, though I don’t know if he was in any less pain. I had one of my chemistry textbooks with me and read a few pages of it aloud to us both. I’m sure he understood nothing of what I read, but hoped that hearing a familiar voice from nearby for a while was more comforting to him than annoying.
That became our little ritual for a couple of days (they managed to get a doctor on the phone to prescribe him something useful that first morning, much to the relief of everyone involved). Del never talked much, before and none at all during that period, though he was occasionally conscious and aware of what was going on. I think he was just too out of it to be social. Then I had two nights off and when I next came to work he had passed away earlier in the day, having never recovered from his injury and infection. I wouldn’t have imagined before, feeling relieved when someone I knew had died, but I was happy for him that his suffering had finally ended. It was a feeling shared by practically everyone in the facility… for various reasons.
Del’s family never came for him. Once his body and belongings were collected, his room was scrubbed clean and his chart was retired from the nursing station’s shelves. No trace of the gentle old ex-farmer remained where he haunted. Life went on as if he had never existed. I was in my twenties then, and as afflicted by the delusion of invincibility as most people my age was. The inconsequentiality of Del’s existence and demise bothered me. I wasn’t sure why until I landed helplessly in the hospital myself a few years down the road. While remaining detached is a great way of staying objective in the way one views things, sometimes it takes first hand experience to truly understand humanity in ways that reason alone can’t surmise.
I don’t think Del’s suffering had any purpose to it. Yes, I learned a great deal from him and his final days, but I doubt that it was because any deity had planned it that way. (If there was a deity who did, then it had earned my eternal indifference to it from this episode rather than any sort of admiration). I can at times be quite guilty of arrogance, but not to the point of thinking myself so worthwhile that an innocent man had to suffer that much just for me to learn any lesson in life… as if his well-being and ending peace meant nothing compared to mine. As far as I know he did things and lived his life as well as he knew how to, but in real life one just can’t count on getting the results one deserves; be it good or bad. One can only do what one can and hope for the best. Therein, I suppose, lies the fairest ‘truth’ I had learned yet — life is fairly unfair to all, and its perfection is only found in its every flaws.