Firstly let me thank you for providing a place to share, read and discuss issues that only other nurses can really understand, it lessens the isolation one can feel when everyone else around them works in different industries and can't full appreciate what it's like to give oneself so much to a role so vital to helping others.
That said, i too suffered the loss of a very special lady at a long term facility i had been sent to often over these last few months as an agency LPN. This facility has a wonderful array of cultural mixes, particularly from European origin, so each shift I'd exult in saying hello and how are you in many languages which helped boost the therapeutic relationship and encourage confidence and trust with resident's families.
This particular lady i had bargained with unsuccessfully for many weeks in trying to give her medications, we tried everything from crushing ones that could be, treating them like gifts, even clinking the small medicine cups when it came to taking liquid aperiants as i hoped by sculling my water, this would also encourage her to scull her med. It didn't help that she had a long history of schizophrenia and dementia which made cognition very hard to stabilize. I'd all but given up hope this lady would ever take her meds on time, her behavior also used to offset others nearby causing me to make return trips after the 1700 med pass to try to encourage ingestion after the drama of dinner, family/visitors and a massive med trolley had gone.
After many weeks of trying, she eventually seemed to warm up to me, it was then i realized, i was simply unfamiliar to her, that was all. A completely legitimate and substantial reason not to take a wad of pills from someone you weren't orientated to. This was obvious when another carer could be seen joking with a very formal Italian man who at times broke into a smile when she would joke with him...she had been working there for many years. That simple logic helped me when it came to encouraging this lady to take her pills, instead of getting worked up at her lag time and informing the charge nurse that i would have to return and re-encourage her to take her pills before psychosis took hold, i would approach this lady very gently, pat her hand or shoulder, kneel down to her level and talk very softly and gently. She would begin talking to me in her broken sometimes unrecognizable sentences but the core message of 'hi hun, how are you''I'm well darling, how are you' i feel would essentially be said. I felt i connected with her even without using proper English, enough for her to take her pills in a very calm, peaceful manner that would result in her symptoms being kept under control and her being calm enough to eat dinner, co-operate with hygiene and get proper sleep.
A few weeks ago however on an ordinary shift at the facility, the charge nurse went to her area to attend to a wound dressing on another client when she noticed a small raised red area on the lady's left arm. Unable to tell us if she was in pain and not making much sense as usual, the charge RN gave her prn analgesia and informed me that we would continue to monitor her over the shift. The lump swelled to a mass and right before clock off the RN stayed back to call a locum to discuss non emergency transport to the nearest hospital for an X ray. I returned a few days later with the lady wearing a tubi-grip (open sock type bandage that exerts pressure to reduce swelling) and stronger analgesic in her MAR prescribed by her doctor. The lady seemed calm and i made an effort to keep patting her shoulder and non affected hand to let her know we were there and cared. Later that shift an emergency in service on Elder Abuse was called and rumors spread like a wildfire through the halls that our lady in hall 3's arm was a result of rough play :angryfire. This immediately infuriated me, i could not imagine anyone taking advantage and being rough with this already vulnerable defenseless old lady. Although i had seen her yell and at times scream at the carers when they had tried to bring her to the toilet or help her prepare for bed, most of them made sure she was safe and warm and at times left her to the night staff when this lady just refused all care, i.e. it was never forced as it should never be.
Three weeks later i arrived back at the facility for a shift only to be told during handover that this lady had died the night before. Shocked i carried on my duties, stealing chances to further find out what had happened. The RN told me this lady had refused all her meds as she still sometimes did, and further refused all care. Attempts had been made to encourage ambulation with her 4 wheel frame but again, this lady simply refused. Instead, she started walking either freely (alarming to hear with high falls risk clients) or using furniture. Her last shuffle saw her using an over bed tray (i.e. those sided U desks that can be wheeled in over hospital beds) until the trolley lost balance, toppled and sent her head first onto the floor. Whether she died from cranial or sub-dural injuries, i wasn't told. There was huge emphasis on how hard staff tried to get her to use her walking aide when she wanted to ambulate and i do believe this, but this lady being her, only for the short time i knew her and with evidence and having witnessed stubborn independence most elderly prefer, nothing could have stopped her from wanting to get up and walk around by herself.
it could be the small success in getting this lady to finally become familiar with me enough to take her meds for me before she died, or that i did feel some calm connection with her enough to see through her diagnosis and see a very sweet lady trapped by her symptoms, or how sad i felt when her funeral arrangements were carried out by a local charity as i was told family members were either unknown or unreachable. Apparently only 4 staff attended who confirmed that they had felt like family to this woman and would missed just as much.
Since learning of her death and circumstances surrounding, i have decided to take 2 weeks off, entertaining the idea of travel or distracting myself with other short courses. Part of me feels that i have lost someone too, although having only known her for a short time, another still feels enraged that Elder Abuse could have contributed to her initial injuries perhaps having compromised her health leading to her decline, another feels frozen in fear that one day, that lady could be me, unable to speak for myself, without any family to deliver my eulogy (r.ships with my family are strained, but that's another story) and left to the faith that others would take my best interests to heart (despite clearly some of whom have not in this case).
Thanks again for the chance to vent here, i know i need to find other ways of coping, or find a way to release how i feel about this all. It is a comfort to know caring enough is a good thing, but maybe the lines of definition need to be redrawn. I'm open to suggestions.