# The Night Shift



## Jon M (Jun 1, 2015)

Notes from the Night​



Friday, May 29​ 

Little Debbie is 5'6", 260 pounds. When we enter her room at almost four in the morning, during second rounds, she is sideways in bed, head lolled off the mattress, eyes closed. The small box TV on the nearby dresser is on, some blue, delirious infomercial. As she breathes, her forehead gently grazes the edge of the bedside table where some old fruit, a soda, and a tiny bag of half-eaten chips lay. Below her left breast, in the folds of her gown, more broken chips. I pick out the shards one at a time and throw them in the waste bin. Bobbi goes around to the other side of the bed, rubs Little Debbie's shoulder until she opens her eyes at us, bewildered.

It always feels wrong turning on the bright lights, interrupting people's dream time. But we have to do wet checks. We can't have people sleeping in their own piss and shit.

Little Debbie has a catheter, but somehow her brief is still wet. She's the third person with this issue tonight, but the problem is not as mysterious or inexplicable as it sounds, considering how the night has been going so far, everything we've had to contend with. Bobbi's not even supposed to be here. She should be home, drunk or asleep. She already worked the 2-10, but at changeover, when the other night aide went AWOL, no call no show, and it became clear I'd be the only aide in the entire building, she chose to stay for a double. So we could lose our minds together.

I fetch a clean brief while Bobbi repositions the catheter tube so it isn't kinked or crushed under Little Debbie's thigh, so urine can actually flow into the bag. Bobbi starts hunting for the entry site, wondering aloud if maybe the tube is leaking from there, surprised at how hard it is to find in all the skin. I look on from Little Debbie's left elbow, temporarily stunned by the plump size of her mons. The thicket of pubic hair. The only thing we find with any certainty is buried in the folds of her perineum. A red grape, fallen from the bowl on the bedside table. Bobbi holds it up in the light for a moment, so I can see, then tosses it in the trash.


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## dale (Jun 1, 2015)

is this real? just wondering why you posted it in this section. i'm gonna assume it's real. great writing. are you in the medical field now?
shit like that has to rough to deal with, if you are.


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## Kevin (Jun 1, 2015)

Poor colon... why does no one like to use mr. colon?     : a red grape...   the realities of life require humor. Thanks for the read. Always interesting, the subject, and the writing.


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## escorial (Jun 1, 2015)

intense read that felt like a write in a journal on the nights events...


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## Jon M (Jun 1, 2015)

dale said:


> is this real? just wondering why you posted it in this section. i'm gonna assume it's real. great writing. are you in the medical field now?
> shit like that has to rough to deal with, if you are.


Yeah, real. I work as an aide in a nursing home. I just pick a moment from my shift and just write about it; an ongoing thing I've been doing on my blog, and will do here.

It is rough. The job. But mostly I feel for the people who wind up in homes, because unless it's a really good one, well staffed, the quality of care sucks. Not because of nursing staff, poor training, wrong people, or anything like that. But because the workload means limited time per resident. Like the night this vignette comes from; there were only two aides in the entire building, five halls, where normally there would be two per hall, ten total.



Kevin said:


> Poor colon... why does no one like to use mr. colon?     : a red grape...   the realities of life require humor. Thanks for the read.


I know; I thought about using one there. Felt too correct, I guess. Academic. 

Also, because I don't have a colon, either.



escorial said:


> intense read that felt like a write in a journal on the nights events...


Thanks for reading.


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## Bevo (Jun 1, 2015)

Interesting to read during breakfast 

This was a great view of your role and one that is hidden under this invisible blanket, most people have no idea of your important work. My sister in law managed a nursing home and a few friends are in the trade, thankless job at time but needed.

Great first person account!


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## Jon M (Jun 3, 2015)

Monday, June 1
​ 

The  night is gentle, and we spend the first hours of the shift roaming the  halls, lulled on by blinking call lights wherever they appear. The plan  is to start rounds at 1 AM, then again at 3, and 5. But for now the work  is light, and it is time for the building to sleep. 

Netta  is at the front desk, doing some early charting on the computer, when I  come out of C hall. The whites of her eyes flash toward me. It's our  first night working together, orientator and orientee, and so far it's  going well. We seem to get along. She has her own preferred way, and is  good at explaining her process, her own little tips from experience. But  as I head toward the bathroom lugging my backpack, I feel I should  explain this weird thing I'm about to do. "You know that guy who had the  bag," I say, referring to the resident whose colostomy bag we changed  an hour before. "Well, I have one, too. And sometimes I have to empty  it." I hold up my backpack, where my supplies are kept, and smirk.  Netta's eyes flash again. She nods slightly and says nothing, goes back  to charting. 

I  grab the key from the hook on the jamb and sheepishly slip away from  the awkward silence, into the bathroom. I put a glove on my working  hand, take the graduate from the bag and set it on the sink, always in  that order, then turn on the faucet. Emptying is the same humdrum  process as usual until I realize the closure strip on the end of the  bag, called a "Lock 'N Roll" strip, has separated from its adhesive  backing. I fiddle with it for a time, somewhat desperately, knowing if I  can't get the strip to stick again the drainable end won't close, and I  won't be able to work the remainder of the night without leaking shit  all over myself. I fold up the bag's end and tuck everything back into  my belt as best I can. It's not a permanent solution, but gives me  enough time to drive home for a replacement. If I had packed an  emergency kit like I'm supposed to, or even just a spare bag, I wouldn't  have to leave, but without either of those I have no choice. 

I  am flustered, and a little sweaty, when I exit the bathroom and see  Netta again. I fumble through all the things I want to say, to offer as  an explanation. Somehow I communicate that this has never happened  before, this issue with a bag not closing, and that I need to go home,  take an early lunch, but that I'll be back in time for first rounds, and  I'm really sorry.


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## musichal (Jun 3, 2015)

I noticed you used 'shit' rather than 'chyme'.  What I wondered most about is why a facility would not have a closure - at least one of those plastic bag clamps often used.  Pilfering a cheap plastic clamp beats being short-handed, or even losing orientee time.

Also, I envy a health-care facility job where anyone is lulled by anything, much less by call lights.  I worked like a dog from 7p to 7a.

Don't mean to sound critical.  I am enjoying the read.  Netta should have fixed you up with a clamp, I most definitely would have done so.  Netta also should be checking those leaky caths.

Just the two of you, eh?  And almost you alone if Bobbie hadn't stayed.  That sounds more like my experience. (Retired RN)

And yeah, Nursing Homes do have quieter nights than the acute-care facilities in which I worked.  I should have read more closely at the first, but I'm with you now.


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## Loveabull (Jun 3, 2015)

"Jackie, Jackie oh he was a friend of mine..." Sorry too young for the reference look up The Commodores. I remember the midnight shift. By 4am you're almost hallucinating and then it gets better.


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## ppsage (Jun 4, 2015)

Hi Jon. Although you are apparently, for reasons I cannot begin to divine, not posting this for critique, I have to congratulate you on the characterizations you achieve. I find the subordination of the work setting to the realization of character, while so authentically detailing  mainly the former, brilliant and engaging. If there is a clause in your will, requiring the posthumous destruction of your journals, I urge you to retract it. pp


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## Jon M (Jun 4, 2015)

musichal said:


> I noticed you used 'shit' rather than 'chyme'.  What I wondered most about is why a facility would not have a closure - at least one of those plastic bag clamps often used.  Pilfering a cheap plastic clamp beats being short-handed, or even losing orientee time.
> 
> Also, I envy a health-care facility job where anyone is lulled by anything, much less by call lights.  I worked like a dog from 7p to 7a.
> 
> ...


I didn't think to ask about any plastic clamps. Doubt they have any, and if they did it seems like it would have been a hassle to scrounge one at that hour. It was just easier to go home and fetch a new bag, really. 



ppsage said:


> Hi Jon. Although you are apparently, for reasons I cannot begin to divine, not posting this for critique, I have to congratulate you on the characterizations you achieve. I find the subordination of the work setting to the realization of character, while so authentically detailing  mainly the former, brilliant and engaging. If there is a clause in your will, requiring the posthumous destruction of your journals, I urge you to retract it. pp


Just doing this to amuse myself, more or less. Haven't been writing much long-form, or any-form, fiction right now. Kinda in a painful growth period, feels like. Something transitional. Everything I do feels stagnant, so when I'm not disparaging myself over lack of productivity, or publishing nods, I've been reading more. 

Posthumous? Will? Buddy, I'm gonna live forever.


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## Jon M (Jun 4, 2015)

Tuesday, June 2
​ 

When  I return from lunch at two-thirty, the front desk is empty. Netta is  elsewhere in the building, helping a resident. Before I can go looking  for her, the night nurse, a black woman in her mid-fifties with a  scarlet tint to her permed hair, comes out of B hall and tries to get my  attention from across the living room with a series of tender, cooing,  "Yoo-hoos." After the second or third such call, I turn and find her in  the lowered light, amid shadows. She waves me over. 

We're  still so new to each other that even after several introductions we still forget each other's name.

She  explains that she needs help with a resident. I follow along behind  her, curious to know what's going on, getting only a vague response that  the man is awake and being a little difficult, resistant to cares. When  we get to the room, I recognize the man and his roommate from my first  day of orientation when they were introduced by name, and then simply as  "hospice." He is lying in bed in only a papery brief, arms and legs  kinked, the blanket and top sheet kicked down to a hard heap at the foot  of the mattress. Beneath him, all over the fitted sheet, there are  specks, smears, and whips of dry blood.  

Between  his slow, restless rolling side to side, he sees us, but there is a  distance in his eyes, a gloss of pain. I kneel at the side of the bed  and softly restrain his arms over his chest, keep him from falling to  the floor. The skin up and down his forearms and wrists is mottled and  bruised, the sores on his elbows bright red. 

For  a time I am left alone in the room while the nurse goes to her cart for  new bandages and some Ativan. The man rolls onto his left side, then  back to his right, on and on, ceaseless, with the sleepy insistence of the sea. I smooth my hand along his back, up and down his  shoulder blade, and whisper sounds more than words, things I won't  remember once this is all over, until the nurse comes back. I hold him  still while she tapes his elbows, puts an oral syringe into the corner of  his mouth, once, then twice, and tells him to swallow, swallow. 

We  roll up the stained sheet, bag it, and put down a clean one. Straighten  out the rest of his blankets and cover him. For a moment after turning  off the room lights we stand by in the darkness and watch. 

Still, now, his back toward us.


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## musichal (Jun 5, 2015)

I noticed you edited a little.  Don't know whether you care, but you do seem to be very detail-oriented, words spelled correctly, good grammar and so forth.  Third paragraph, a small typo, an errant "s" ending the phrase "resistant to care."  Look forward to more; you have a nice presentation for these vignettes.  Does the client above have periods of lucidity?


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## Jon M (Jun 5, 2015)

musichal said:


> Does the client above have periods of lucidity?


I learned tonight that he died, actually. Yesterday.


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## Jon M (Jun 6, 2015)

Thursday, June 4
​

When  the light for B shines, I walk out into the living room, the hexagonal  main hub, and peer down the hall to see which room is calling. The light  is down at the far end by the large black window, second to last room.  Only my third night in this facility and the building still seems  sprawling and labyrinth, the residents needy strangers, but I know this  particular room well. It's Margaret, and she has been "riding the  light," as Netta likes to say, since midnight. Sometimes she wants her  pain pill, her hydrocodone, but mostly the calls are about her bed pan.  Either she wants it, or wants the contents flushed and to sit on it  again.

Margaret  really likes her bed pan. She will lay on it long after the plastic has  left the back of her thighs red and creased, and if the aides allow, or  get distracted with another task and forget, she is happy to sleep on  it all night.

Sometimes  she pees, or forces out a palm-sized ball of stool, but often the basin  is dry. She wants the pan just to have it, and telling her no, she  can't have the pan right now or should wait a little longer, is always a  delicate tug-of-war. It is wrong to refuse her the pan if she really  needs it, but it's also bad seeing the dents in her skin after hours of  pressure and no relief.

This  time Margaret seems to be calling for some company. She is sprawled on  the mattress, legs crabbed open, crotch exposed where the gown has ridden  up, when I approach the side of the bed. Her eyes brighten and she  grins, and while I pull on my other glove she starts talking about the  bed pan. Just the word at first. I ask if she's all done. She nods,  still smiling.

Time  and old age have been very cruel to Margaret. She looks like road kill.  Her face is long, creased at the eyes and mouth, a thing dragged through  pain and disease, through almost seven decades of life. When she speaks  I can hear the country, gravel roads churning beneath tire tread, can  almost taste the dust inside of my mouth. And yet there is something  very sweet and child-like about Margaret, as though, despite everything,  she has never forgotten how to dream and play.

I  flush and rinse out the pan, set it on the floor in the bathroom. I  come back into the room to see about straightening and pulling her up in  bed so her legs aren't so bent. She raises her right hand over toward  me. _Look at what I made_, the gesture seems to say. Three of her fingers are caked with shit. 

"When'd you do that," I say. 

Margaret smiles. She doesn't know.

The  stool is very dry. Briefly, I wonder how many hours ago. Evening or  night shift. Someone else's or my fault. In truth it is no one's fault,  but a thing that happens. I reach for the wipes and spend several  minutes cleaning her fingers one by one, the nails where the feces looks  like trapped dirt.

I  rotate my wrist until she mimics with her own hand, side to side, palm  up palm down, and I can see she is clean. "There," I say. "Pretty hands  again. Pretty, princess hands."

Smile so wide, eyes so sweet. "Yeah," she drawls.

"Go to sleep now, sweetheart. I'll be back in a little while to check on you."


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## musichal (Jun 6, 2015)

Very descriptive.  I know her well.  Good job, both writing and care.  Yep, "riding the light."


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## Kevin (Jun 7, 2015)

> When she speaks  I can hear the country, gravel roads churning beneath tire tread, can  almost taste the dust inside of my mouth


.  This is really good. Excellent.


> I  rotate my wrist until she mimics with her own hand, side to side, palm  up palm down,


 this is somehow childlike, and this:





> Smile so wide, eyes so sweet. "Yeah," she drawls.
> 
> "Go to sleep now, sweetheart. I'll be back in a little while to check on you."


made me cry.


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## Jon M (Jun 15, 2015)

Saturday, June 6​
Smile at the ones still awake, television in their eyes, wishing they would abide, knowing pain has stripped them and that they will only fade, slide into sweaty, fitful sleep night after night; stand away in murmuring darkness for the ones already asleep, watching the work of their hearts, the rise and fall of their chests, sometimes a witness to things too big, too real for one person alone.


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## musichal (Jun 15, 2015)

deleted per OP request, with apologies


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## Jon M (Jun 23, 2015)

Sunday, June 21
​

I'm  out on the west side of the building, sitting, legs crossed, on a curb a  few feet from the basement door. Usually I'm out here around  five-thirty when the sky is just beginning to pink up. My face shining  with sweat by then, body wrung out and sticky under my scrub uniform as I  lug a couple of huge trash bags toward the dumpster. But tonight is a  little different. The sky is still dark, and if I crane my head way, way  back I can see the stale light from a few of the brightest stars  pushing through the city gloom. I've never come out here so early, just  to chill for a minute. I check my watch again. In another forty-five  minutes it will be two in the morning, and only time for lunch.

Maybe  I shouldn't be out here right now, resting my feet, letting some of the  anxiety from tonight's shift dissipate. The night is beautiful, though.  So wide open and charged it soon has you believing dreams are possible.  Watching the blank trees, the desolate, uphill street in front of the  facility, the apartments beyond, has allowed me to slow down a little,  get my head right. Last time I was on the edge I went all the way. I  never took a moment to cool down, find perspective. I just walked out of  my shift without a notice or parting shot to anyone. After crossing the  lot to my car, I remember gazing back at the building for a time, the  front door where a gaudy, green awning shaded the walkway. It was early  afternoon, the sun high overhead. A spring day so bright and clear it  felt like a revelation. I opened the driver's-side door, lingering for  what I was giving up, then only to savor the breeze moving through my  hair, the bliss of sweat cooling on my face.

Sneaking  over to the B hall exit, entering the door code with one eye on the  lookout, only worsened my guilt, but I told Paulette where I was going  and why. She nodded, smiled weakly in understanding.

It's  just us, tonight. The schedule says I'm on C hall, like most nights,  while Paulette works B. If that was our sole responsibility, it would be  a good night. Challenging, always challenging, because aide work is  hard and often thankless, but still somehow good. But on a night like  this, when there are only two aides in the entire facility, and the  usual night nurse has called in, and the nurse substituting is on the  eleventh hour of a double, nothing goes according to schedule, and few  things, if any, are good.

I  inhale as deep as my lungs allow, let my eyes slide shut. I'm tired  tonight, physically, mentally. But more than that I feel ground out,  extinguished, not unlike the crushed cigarette butts on the ground by my  shoes. For a time I let all the bad, bottled-up emotions come out, the  feelings of worthlessness and self-loathing that never really go away,  and sit with them. After awhile I get bored of the street, the sleeping  neighborhood. I drape my arms out over my knees, more fully into the  orange security light, and study the backs of my hands. The terrain of  knuckle and bone, those knotted spots in the veins where the valves are,  the scabbed scratches from my kitten at home, the faint rashes at the  base, by the wrist, from all the latex.

I  told Paulette I'd be ten minutes, but now outside, free, I can't seem  to let go. I find myself glancing at my watch about once every minute.  Below, ants wander the concrete near my shoes. Overhead, flies and moths  bang against glass in a light-drunken frenzy. After five minutes I  enter the door code and go inside what feels more and more like a meat  grinder. I return to the hub, the five halls and needy call lights, to  Paulette, my friend in the trenches, and what feels a little like war against burn out.


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## Jenwales (Jun 24, 2015)

That was great, is there more? This is something that will draw people in and maybe people like me who don't do this job can understand how hard it is for you. This could be the start of a novel or a short story. Or maybe you don't want that, it's good either way


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## Jon M (Jun 25, 2015)

Thanks. 

No grand aspirations for these. Writing them just so I can feel productive at the end of the day, and also to remember what it was like. Putting the experience into words makes it a little more ... magical, to me. Lush. 

And the job needs that kind of magic, again, for me. This is all just for me. Nice that other people enjoy; I appreciate it. But this is all basically a way of coping.


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## Jon M (Jun 28, 2015)

Saturday, June 27​

"Transfer of care. I know you know what I'm talking about."

"No. See. Don't tell me how to do my job."

"I get here and she's not in bed," I say, nodding toward Ms. Lilian's room, a short distance away. "It's almost eleven o'clock and she's still in her fucking wheelchair."

"And I told you: she literally just got here after ten. I dont know if you were late or not, but the aide was already gone. See. You keep waving me off like that, and it's really starting to make me mad."

"No. I was here at ten. I'm never late."

"Well, OK. But―"

"I technically can't even be late tonight. I'm not supposed to be here. I came to help out."

"And I thank you for coming in, like I said. But―"

"I was over on D getting report from another aide. And I get here and I don't know what's going on in this hall. I didn't get report. She's still up," I say, gesturing to Ms. Lilian's room again, "and she's never up. I work this hall all the time and she's fucking never up."

"The aide left at ten―"

"And that's what really pisses me off. You can't just leave. You can't just not give report."

"You could have come to me for report if you really needed to. Isn't that right?"

"No. What?"

"You could have come to me. I can also give report. Is that not right?"

I shook my head. Getting the aide's report from the hall nurse sounded ridiculous. "You got your own stuff to do."

"Is that not right?"

"I guess. Technically. Nurses are also supposed to answer call lights, too, but how often does that happen?"

"Oh I answer call lights."

"Look. Whatever. All I'm saying is―"

"I know what you're saying."


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## Jon M (Jul 10, 2015)

Thursday, July 2​

She doesn't open her eyes when I say her name. She doesn't watch while I take a brief from the dresser drawer, or lay the wipes on the mattress by her foot, or bring the trash bin to the side of the bed, within reach. When I roll her up on her left side, she doesn't help me, doesn't hold the rail firmly with her good hand. She hangs heavy and limp. The hair behind her head is crushed, black with sweat. I tuck part of the brief under her hip, roll her flat then up on her other side for the rest. Still her eyes are closed. She doesn't seem to hear her own name.

I finish cleaning her and stand away for a moment. I push the trash bin aside with my foot, set the wipes on top of the dresser where I can find them in a couple of hours, when I return to clean her again. Thinking the entire time, what to do, what to do.

Maybe the evening nurse gave her some heavy narcotics at bedtime, and now she's out cold. Maybe I haven't been at this facility long enough, don't know these people well enough, and this is all just how it goes. I say her name again, over and over like a lullaby, touch her shoulder in a weak attempt to rouse her. I rub my knuckles up and down the length of her sternum, and still she does not wake.

The next day, during a sunny, pre-Fourth of July cookout with family, I find myself thinking about it all. I'm about to mention it to Mom when she cuts me off.

"Got someone from your place last night."

"Really? Wow."

"Figured she was yours."

"Stroke? Whole left side gone?"

Mom nods.

I tell her all about it while my dad and oldest brother stand over by the grill, a few feet away, in their own conversation. How the woman's initial blood sugar had been forty-two. How it dropped to the upper twenties by the time she was on the gurney, twenty minutes later, and about to be wheeled out to the ambulance. _You gotta go,_ the nurse was saying from the foyer, ushering them out the front door. _You can't be hanging around here. You gotta go._

Mom happened to be working at the same hospital that night, and assisted on the call. The coincidence, that we were both involved in some way, makes me feel warm and woozy on the inside. Proud. I can't stop grinning.

"She was pretty much dead when we got her. If you hadn't found her when you did, she would've been gone in another couple hours."

"So is she all right? What'd you do for her up there?" I already have an idea, but am curious to know the specifics.

"D50. Ran it wide open. Why didn't the nurse just give a bag there? That's what none of us could understand."

I don't have an answer just then, but later it occurs to me that the nurse working that night was an LPN, not an RN, and so was unable to start the line herself. Probably she could have. IVs are not very hard to start. I was certified at one time, back in paramedic school, before dropping out of EMS altogether. The issue has to do with scope of practice, and for LPNs that sort of thing is beyond what they are legally allowed to do.

I space out for a time, once our conversation lulls, and watch the hamburgers and brats cooking on the grill. My dad and brother standing off, away from the spitting heat, beers in hand. The day is beautiful. The temperature a steady, sublime eighty degrees. The weather of a perfect memory. Sometimes the breeze, the boughs all around waving and murmuring. I close my eyes and listen to the sound.


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## Jon M (Jul 23, 2015)

Wednesday, July 22​
The hard overheads are on in 204, so I stop for a minute on my way to dump trash and soiled linen to see what is going on. The curtain in the middle of the room is drawn. On the other side, Deb is standing by Juanisha's bed, sort of squeezed in against the wall. Juanisha is rolled up on her right hip, sad-eyed and quiet as usual, her other hip bare where the gown has fallen open. I turn to leave, to give them some privacy, maybe, but Deb's voice calls me back into the room. She calls me sweetie, asks if I would bring over the wipes from the nearby dresser. When I edge around the foot of the bed and get a glimpse of her work, it dawns on me that she is cleaning the ulcer on Juanisha's lower back. The sacral ulcer that, up to now, I'd only read about when the halls were quiet, the hours long enough to skim the fat binders containing everyone's health record.

All I feel is intrigue, curiosity, when I see Juanisha's ulcer for the first time. Not shock or revulsion, no stab of horror, even though those responses would have been appropriate. The wound itself is deeply recessed, a sinkhole in her skin, reaching down to bone, about the width of my fist. Deb pulls a string of wipes from the pack and continues her work, cleaning a watery trail of blood from Juanisha's backside before it can stain the sheet. My childish curiosity must be apparent in my voice, in that I linger by the bedside, watching. I've never had a chance to really see what her ulcer looks like, I say finally.

"Is that a stage four?"

Deb shakes her head, no. The wound is so bad it's unclassifiable, she says.

Juanisha is grimacing, the tenderness of her face knotted in pain, when I glance up at her. Were it not for these occasional looks, I might never know of her pain. She doesn't make a sound.

There is something I have always liked about Juanisha. Often, unless I have to turn her, I only see her face. The rest of her body is covered with at least three fleece blankets her mother brings from home. But even when I first saw her, months ago, I sensed a deep, sublime beauty. That her youth was fierce, radiant. That even now, in her forties, she could model, have us all dreaming, had the lens in her left eye not clouded over so completely, and there was not always a film of saliva on her lips, stringing apart as she tries to speak. Could she still actually speak, a voice and words of her own, instead of the broken utterances, shapeless, rising whispers, left in the wake of her disease.

I help Deb however I can, bagging up bloody wipes, old, stained dressings, a streaked plastic tube that appears to be part of an irrigation kit. And when Deb asks me to hold up Juanisha's lower leg, where another sore has chewed her heel and left a hook of exposed bone, I do so silently, mindful of the pain I might be causing with so simple a movement. I look to Juanisha's face, her eyes, then back at the wound on her heel. Deb's gloved hands rising. The gleam of scissor blades. A flake of black skin cutting out, falling to white.


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## Jon M (Aug 17, 2015)

Sunday, August 16​Most of my co-workers are travellers from other states. The home brings them in through an agency, often at a higher hourly wage than the regular staff. Two of the aides, both very heavy, sweet black ladies, are from New York. Billy, the skinny man from Mississippi who usually works my hall, had just finished a stint in New Mexico before coming here. And Kim, the charge nurse who has a kind of hard knocks, ghetto savvy, a twisted sense of humor, is from Cleveland. Her contract ends soon, in September. From here she's going north, Great Falls, Montana, those wide open, desolate skies.

At work, things continue to slide. With all of these agency contracts ending, and the usual attrition with new aides quitting weeks, sometimes days, after discovering how hard and thankless the work is, how seedy and depressing the building is on the inside, the overall atmosphere has changed. It feels like the night shift is unraveling, threads going off in all these separate directions. Soon it will just be me and another guy, Franklin. And in two weeks, unless something changes, Frank will be on his own.

Friday, after my shift, I'd finally had enough. I told the scheduler and the Assistant Director that my status was changing to PRN. A soft quit, as I had begun to think of it. Staying on as an aide, my name still in black and white on paper, but just a ghost in the halls. A face and a smile and a soft voice that used to be here, here no longer. So as the months roll on and I move to another home, or maybe the Med/Surg floor in a hospital, I can claim the time as experience when negotiating a higher starting wage.

The smartest way I know of telling management they are all supreme failures when it comes to leading and motivating others, that they should all rot, the home so poorly run state should come in and shut everything down.

This morning, John, one of a group of new residents on my hall, is parked by the nurses' station. Ever since he began trembling a few years ago, it's been a slow but steady decline. He used to weld for a living. Now, because of Parkinson's, he can't walk. But he's still sharp, up there in his head, beneath his frazzled mane of gray hair.

Not even five yet, the lights in the halls still low and golden, but John's an early riser. This is his usual time. He's down there at the station gabbing with Billy, the young man from Mississippi. Talking shop, the many different places they've been, which is how they eventually get around to discussing Billy's work assignment here. When it's going to end. When the kid's going to be gone for good.

"This Saturday," says Billy. His voice is loud suddenly, triumphant. Even from down the hall, I can hear the size of his grin.

He's been here almost two months, slumming these halls four, five days a week. By now, there is no amount of money the home could offer to get him to extend his contract. No number high enough to whitewash the shit on these walls.

"Most people will fly, when they come out," he says to John.

"Not you?"

"Not me. I drive. More money that way."


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## Kepharel (Aug 18, 2015)

I pressed 'like' because there is no 'appreciate' button on here. There have been some high profile news stories over here in the UK that translate, resonate directly with this post and they are pretty grim.


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## Jon M (Sep 4, 2015)

Wednesday, August 19—Thursday, September 3
​

Been  in a good place these last few weeks. Around the same time I gave  notice that I'd be cutting my hours down to eight every two weeks, I  also interviewed with the Director of Nursing at a different long-term  care facility, farther west, in a nicer part of town. I floundered  through the essay questions, as usual, shifting in my seat, talking with  my hands probably more than anyone should. I left feeling good, good  enough. Thinking I had at least been honest, that my personality, for  better or worse, came through. That maybe, maybe I would get the job,  and if not, well, at least I tried.

Forty  five minutes after I left, a lady from Human Resources called back and  offered me the job. I'd only just walked through the front door and  stripped out of my interview clothes. The starting wage, according to  her, would be about two dollars more an hour than what I had previously  been earning. On the weekends, because of the shift differential, it  would jump to almost three dollars.

I  scribbled the details of the call, including the dates of orientation,  on the back of an old short story draft, smiling the entire time.

*
​
A  couple of days later, at eight-thirty in the morning, I'm in a cozy  little classroom in the basement of a nursing college, on my hands and  knees, doing chest compressions on a dummy. "Remember what I said about  running a marathon?" the instructor says as my group humps through the  fourth set of thirty compressions, glee in his voice.

Things have changed since I first learned CPR, in 2009. Instead of the ABCs—*A*irway, *B*reathing, *C*hest *C*ompressions—the  sequence is all mixed up, brings New York City vaguely to mind, streets  yellow with cabs. Now you should get the blood circulating as soon as  possible. Push hard and fast, hard and fast, one hundred compressions a  minute. Then open the airway and give a breath.

By  the fifth set of thirty compressions, my world has narrowed down to the  hairless, peach-colored expanse of my dummy's chest. The heel of my  interlocked hands on the nipple line, over the lower half of the  sternum. My posture forward, shoulders in line, a large portion of my  weight feeling like it is drilling down into the plastic torso with such  force that the dummy not only clicks, but clicks a second time and  wheezes. There is a thin gloss of sweat on my forehead. I'm tired, along  with the other people in my group. After just two minutes, some of  their arms hang limp as noodles.

"But  that first time," says our instructor before and after our hands-on  training. "You'll never forget it. I've been in about a hundred-fifty  codes and that first compression, when the ribs crack, mmm, there's  nothing like it."

*
​
The  CPR certification is for the Med Aide class I plan to take this  November. I'd set myself that goal very early on, in January, thinking  that additional skill would be a good way to end the year. I pictured  December, the world fallen to white, and wanted to be able to rest easy  then. To truly rest my mind, celebrate my accomplishments, and know, for  once, what it felt to be content.

It  was only a year ago that things were so different. I was in the  hospital months before my nurse aide training began, in the summer, and  again in the days leading up to my state exams. The morning of my  practicals, I was still in a bed on the Med/Surg floor. The insides of  both forearms bruised from past failed IV attempts, a catheter dangling  from the crook of my left elbow. I had my textbook and was studying  between bouts of nausea, and sometimes one of the nurse aides on the  floor, a wispy girl named Misti who I couldn't help crushing on, would  come in to quiz and sweetly give me grief about it all.

And  then on to September, a month-long window in which it felt like all I  ever did was stare out at the changing world through glass. Those early  morning drives to and from the surgeon's office in the days leading up  to my operation, watching the interstate blur from the passenger-side,  too sick to do anything else. Opening my eyes to pink, gold light, and  seeing Mom in the recliner by the bedside, looking back at me with a  soft stare, a smile that said, _We made it_. And all the days and  all the weeks and all the months in recovery, walking the leaf-strewn  streets of my neighborhood in a hoodie and sweatpants, breathing hard,  just trying to get stronger, to start over again.

Most  of this year I've spent in one home or another, weaving myself into the  lives of residents for months at a time. Learning the basics of the job  at first, how to simply fit in, then learning if this was the kind of  work I wanted to do for the rest of my life, if I could be happy, proud,  to be a nurse.

Funny  to think that my first job in a home was better than my second, that  the wage was higher, the work easier, but it was in that second job  where I thrived and learned to love this profession. Sometimes I think  about all of the people I have left behind. I wonder who could be dead,  who's still alive, who made it out. I can see the faces of my residents.  I know their names. Most of the time, that's good enough.


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## Jon M (Sep 15, 2015)

Monday, September 7​
Billy comes to the front desk where I'm lounging with my feet up, in the dark. I nod. Yes, a quiet night. A good night so far. Shoulda been here the other day, he says, grinning his lean Southern boy grin.

The story going around is that Jay's gone, but I'd already figured out that much. Around ten, I'd been walking the hall on a very brief round, poking my head into each room and saying hello to whoever was awake, goofing with Sarah, who is always awake and doesn't sleep until three or four in the morning. When I peeked into 402, Jay's side of the room was cleaned of all his clothes and personal items, the bed stripped down to the plastic maroon mattress and blue pillows.

"Jay go home?"

Shavon, the nurse for the evening, looked up from the computer screen, said yeah. About a minute later, she heard me fiddling around a short distance away and called me back. "I was thinking about what you said just now. No, Jay didn't go home. He passed a couple days ago."

Saturday, Shavon told me. Evening, Billy tells me now.

"How'd he go? From what," I wonder. Jay was often independent, able to move from the bed to the commode by himself. On a typical night, aside from checking in occasionally, I didn't do anything for him. He never used the call light.

He seemed healthy. I remember feeling shocked when I heard he was hospice.

"Dunno for sure," Billy says. "I'd have to go back and read the report."

We fall silent for a time, watch the last jokes from Jimmy Fallon's opening monologue. The dazzling lights of showbiz, a whole world away. A laughing audience somewhere off sceen, in a darkness like ours.

"He seized for about two hours," Billy adds.


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## Jon M (Feb 13, 2016)

Tuesday, February 9​
Mary doesn't fight much anymore during cares. She used to clutch fistfuls of her gown while I tried to clear it away and unstrap her diaper, used to grab and squeeze my forearms with a sleepy, unfocused determination. "Stop it," she would cry during pericare, "O, stop it, stop it." I kept her door open at night so I could look in from the hall. She was often restless, a fall risk, and would sprawl herself sideways in bed, or off onto the floor. Some mornings I would endure her slaps, her grappling hands, stiff, locked limbs, and dress her before the day shift arrived, only to find her naked, sweater and pants under the sheet, ten minutes later. She was hospice then, too, had been for a month or two, but with her energy it hardly seemed like it.

We are in the east wing nurses' station, the lull following first rounds, when all of this comes up. Mary's swift decline. Karen, the new nurse who I've been avoiding most of the night, asks about a few residents on my hall, including Mary. We are cordial in conversation, professionals at least. I tell her what I know, that among other things, Mary's respirations seemed fast.

"Eighteen isn't fast," Karen says. She sits hunched before a computer, eyes never straying from the monitor. Her shape is like an engorged tick's, fat torso, short limbs. "Unless it's fast for her," she adds, when I don't respond.

Later in the night, as we're all rounding again, Dawn wanders over from 300 to visit Mary. I stop charting for a moment and follow her into the room. Abruptly, it feels like we are paying our respects to the dead. Dawn whimpers a little at the sight of Mary asleep on her side, reaches over the bed rail to brush her cheek. At one point she leans in and kisses Mary's forehead, a soft peck above the temple.

I like Dawn. Even though I find myself talking shit about her with Shay sometimes, that we think she's slow, not assertive enough with difficult residents, and a little melodramatic, I still think she's a good aide. Better than me in some ways. She is just different than Shay and I, not so hardened. She wears her heart out in the open, takes the work home, lets all of the terrible things inside where they chew her up. I can hear the frustration and anger in her voice when she says 'hospice,' as if she means to indict hospice nurses everywhere. It's because of hospice, she seems to be saying, that most of the light and life is suddenly gone from Mary's eyes. They have the woman snowed on so many drugs, morphine and Ativan and others, that she only sleeps now.

Mary acknowledges us, but only barely. Her eyes creak open at the overhead light, whites lined with red. Dawn and I leave, back to our rounds, but a half-hour later I return to Mary's room to clean and change her diaper again. The bony rise of her right hip. The long sweep, line of shadow, between her quadricep and hamstring. Maybe this is what Shay means by 'actively dying,' maybe this wasting, thinning away, is what it looks like. When I am finished, I smooth her gown, position her sagging arms across her chest, replace the fleece blankets. I watch quietly, remote in hand, as the bed lowers to the floor. Just a habit now, a precaution I took that probably doesn't need to be taken anymore. Not thinking or feeling much, just an observer, a witness. So this is what it comes to, I say inside.

At first I don't really want to. I think about doing it, crossing the line, but after so many nights in long-term care I am not sentimental about this kind of thing, dying and death. Learning that someone has passed who I've cared for doesn't really affect me. Most of the time I feel nothing. But I think about what Dawn had done earlier, I recall a saying I've heard occasionally, that you practice the care you aspire to give, and eventually reach in. I run my fingers down the side of Mary's forehead, smoothing the hairs down like in the memories I have of my mother doing the same to me. Her touch had felt special, untrapped, a summery breeze. I wonder how this compares, how mine feels to Mary now, what it stirs or if nothing at all, if the gesture goes unnoticed.


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## dale (Feb 13, 2016)

beautiful.


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## ppsage (Feb 13, 2016)

Just a note to let you know that I'm still reading, that I still think they're good writing from a good writer and that I still wonder what sort of work they could eventually become. In appreciation, pp.


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## Jon M (Feb 14, 2016)

Thanks for the kind words, dale, sage. I appreciate it very much.

Just a little update: this woman died two days ago.


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## Jon M (Feb 16, 2016)

Friday, February 12​
The first night of my usual four day stretch. Shay and I, our nurse Barb, are just settling in for the night ahead, doing some early charting before midnight rounds. I’ve been gone for three days, and they’re updating me on all that has happened around here. For a time, Shay and Barb go back and forth about some nurse who is flaming out, will soon be quitting. She worked evenings on 100, the second-hardest hall in the building behind 500 where Shay and I spend most of our time.

“Is it Gayle?” Shay asks.

My memory is sometimes as poor as my vision, so I don’t remember names, or most information conveyed through sound, very well. Only now, after five months, am I mostly successful in identifying the other nursing staff. And I’m not alone in this, apparently.

“She’s blond,” Barb offers.

“Cos there’s two blondes who just started, and they kinda look the same,” says Shay. “Was her hair curly or straight?”

“Why’s she quitting,” I wonder.

Same reason anyone in long-term care quits. “She’s done with the bullshit,” says Barb.

Eventually the conversation circles back to an ealier event Shay had told me about yesterday, the nurse who used to work here, lost her license, and recently committed suicide. Shay was frustrated that I couldn’t recall the woman’s name or face. “How can you not remember? I pointed her out to you,” she said at the time, exasperated.

Her name was Heather Kearington. According to Barb, Heather was fired for falsifying documentation. She had charted Accu-Checks for several residents in her care and did not actually do them. Worse, she still gave insulin to some of these people. On many occasions she was late with medications, or did not provide them at all. She was discovered after a resident approached a different nurse in the hall nearby, asking if it was time for his blood sugar to be checked.

The story seems too incredible to believe, how a nurse could be so reckless. In all, Heather had twenty-two medication errors. Soon after she lost her license, she killed herself.

Teresa had found a suicide note on her Facebook page, afterward. Shay and I spend a couple minutes searching for Heather Kearington on my phone, with no luck. We go through the search history on Teresa’s phone until the right person comes up, but by now the note is gone. Shay swipes through the photos on her page. “Here she is,” she says, handing the phone back to me. “She’s the one on the right. Her.”

In the photo are two women side by side, drinks in hand. They appear to be at an outdoor party, someone’s back yard. Shorts and t-shirts, the cool after the sun has gone down. Both seem to be in their early forties, Heather Kearington a little more run down in the eyes, face. Short and pudgy, hunchbacked, a helmet of frizzy brown hair. Smiles for the camera, both women ghosted white by the flash.


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## Jon M (Mar 16, 2016)

Friday, March 4
​
Shoulda been out of here in sixteen  days anyway. Going to do x-rays. Why’d you take my earrings out? You can  take them if you want. Hard on the head.

//

Where do you hurt? 

Only in the heart. Margo? Margo come on.  Watch what happens. I need different pants on to go to the hospital.  Don’t you ever have him around my body again. Dr. Sleavers? Dr.  Sleavers? Dr. Sleavers? You worked hard to get my back this far. I wanna  be over here, doctor. 

Red? 

I don’t care what color, just so I can walk. 

//

Margo get out of here as fast as you can.  I will. Get me out of here. Margo? Margo? I don’t want to be a cripple.  Brown cow. Mom help me. I knew I shoulda done it before. Everybody’s  hands off me.

//

I can’t stay. Not you. Back me up,  doctor. Don’t ever let some other doctor come in. In the other room  downstairs. He threw my back out. I’m suing. I should be dead so I can  sue. Ok. Can you bring him back to me? I want all the colors, Margo.  Twenty-four. All twenty-four. I don’t want that bastard touching them.  He’s a doctor who don’t know shit. 

//

In the rocking chair. No more. Why is he  in here. Mom? That lady laughing. Can’t stand that laughing. Dear god.  Dear god. Dear god. Dear god. Help me through this. We’re going down the  hole. Do the step ladders for me.



Tuesday, March 1​
A shuffle of papers, taps on the desk  as edges are aligned, corners squared. The final touches on report, one  nurse finishing her work for the night while the other just begins. And  there I am in between, the middle chair, the blue space their arms  bridge from time to time, staring over the top of the monitor at the  hall reaching down into shadow and pools of soft, old light. 

100 hall,  my hall for the next six or so hours. 

Another shuffle of paperwork, more taps  on the desk. Amy passes some lab forms, a code status sheet, across to  Gigi. I steal a look at the hurried handwriting to see what it all  means, with no luck. All I know for sure is that the papers are part of  Claire’s file. That is enough for my interest to wane.

Three months after she accused me of  abuse, of roughing her up one night during cares, and a tiny part of me  still isn’t over it. 

“So they finally made her a DNR,” Gigi says, reviewing Claire’s paperwork. “Thank God.” 

I don’t let on that I feel the same.  After a minute, Gigi lays the papers aside and returns to her newspaper,  the Oscars recap splashed across the front page of the entertainment  section.                     



Saturday, February 13​
It’s just habit now  that I walk softly, the weight on my heels rolling smoothly forward  onto the rest of my feet. Night time in a nursing home is a slower pace,  and moving quietly, through varying degrees of darkness, is its own  kind of serenity. It is one of the few things I enjoy about my work  anymore, those rare occasions when I spend time thinking about the  things that I enjoy. 

But Carl  doesn’t seem to agree, doesn’t appreciate my silent, sudden appearance  at his bedside, or when I pull the cord on the light and shock him  awake. He stutters a little, lays his forearm across his eyes to block  the intense light. What the hell are you doing, he says. 

The truth is, most nights I find myself wondering the same thing.

 “I’ll. Christ. Some of you people,” Carl says. “I’ll tell you what. Thinking you can sneak up on people at night.” 

I feign ignorance, pretend with a sort of  practiced apathy that I had no idea he was in here sleeping, or that it  is first rounds, or the middle of the night. I say hi, casually explain  what I’m about to do while unfolding a new diaper and laying it on the  bed beside his pillow, where it can be easily reached. 

Carl withdraws his forearm, cools down  once he realizes who he’s talking to. I’m not the lanky Sudanese man who  gets him dressed and in his wheelchair in the mornings, and I’m not  Shay, who is stout, built like a linebacker, and sassy enough to dish  his attitude back to him. If anything I probably remind Carl of his son,  supposedly a mechanic, his own shop out west. Often during cares, Carl  assures me that his son is knowledgeable, trustworthy in a world where  so few are anymore. It begins to sound like a sales pitch, the longer it  goes on. “The best deal in town,” he often finishes with, his way of  adding that last coat of shine. 

“But I heard you coming,” Carl says now. I  pull back his blankets, unstrap his diaper as he continues. “I was  trained for that very thing, to listen. How. Trained to listen for  people’s walk.” 

“They train for _that_?” 

“O yeah. ’49 and ’50. Back then the infantry trained for all kinds of things. Yeah I heard you coming.” 

“What company were you in,” I ask, reaching for more wipes from the package. “Is that the right word, company?” 

“Four-hundred fifty-first battalion,”  Carl says. I get the feeling, listening to him, that it’s just numbers.  Another story about the glory days plucked from somewhere behind that  large forehead of his. “We were good,” he adds, once I finish with his  new diaper, am about to pull the cord on the light again, to shut it  off. “Some of the best.” 

“I’ll bet.” The room dark again, silent but for a lone creak from the bed frame, and, maybe, my footsteps. “Goodnight, Carl.” 

Another creak. “Yeah. Goodnight.”


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