After a few years in this business, we all learn that patient-care supplies are hard to find (and even harder to get administration to pay for), but one thing we never run out of is bad-patient war stories.
Like everyone else, I've got my share of them, although I like to think that my repertoire of good-patient stories is much longer, to say nothing of more enjoyable. I have this strange habit of investing time in my more "challenging" patients right at the beginning of our relationship, which builds trust and saves us both much anxiety and grief later on when things are busier. It also works on almost everyone but the truly miserable and the pathologically angry, and I have met only a handful of these in the entire course of my career.
Unfortunately for everyone who works at the Grace L. Ferguson Airline, Storm Door, and Nursing Home Company, Wilma Bennett's* personality contained both of those characteristics. An eighty-three-year-old widow whose voice still carried the drawl of her native Oklahoma six decades after moving to the West Coast, she was, quite simply, a terrorist in an elderly woman's body: a twisted soul who ate nurses for breakfast and snacked on CNAs between meals, who was just as likely to punch you in the face as look at you, who cussed a blue streak and called the staff names that would make a repo man blush. She enjoyed nothing more than playing staff members against each other, unless it was playing the moderately demented residents against each other and egging on the fights that ensued. And of course, everyone hated her and was ignoring her on purpose, and if you didn't believe it......just ask her!
She'd put on her call light Q 5 minutes and then refuse care "because it took you too (blank) long to get your lazy butts in here". She had 30+ different skin tears on her hands and arms from picking at the parchment skin covering them, and one of her favorite tricks was to pull off the bandages right at dinner time or shift change, then scream at the nurses because we didn't have time to change them then. She weighed over 200 lbs. and was dependent for toileting and incontinence care, but insisted that only one CNA each shift be permitted to work with her, even after the DNS himself told her she had to have two because it wasn't fair to expect the aides to risk a back injury this way. She didn't care; she just wanted what she wanted when she wanted it, and if she didn't get it, she'd hit, kick, scream, curse, spit, and play mind games.
All of this would have been forgivable had Wilma suffered from dementia, as did the majority of our skilled-nursing patients to some degree. But no, she was as sharp upstairs as the average person half her age. She was just meaner than a snake and madder than a wet cat, although at what, we had no idea.
Shortly after her admission, the staff began calling her Mrs. Meanjeans.
I was new to the facility, and not a big fan of subacute units in general as I feel they're too much like the hospital---the patients are very nearly as sick, they take as many meds, and they need as much monitoring---only without the benefit of hospital staffing and resources. So I wasn't looking forward to working on this unit anyway, but I needed the money.....and I figured I could win over Mrs. Meanjeans with the tried-and-true "kill-'em-with-kindness" routine I'd used so successfully in the vast majority of 'difficult' cases.
I figured wrong. She yelled at me just like she did everyone else, accused me of 'neglecting' her, and griped about everything I did, from re-bandaging her fingers multiple times per shift (after she yanked the dressings off) to giving her nighttime pills at 2202 instead of 2200 on the dot. She didn't care that I had twenty other people who needed me, or that shipping the CABG patient back to the hospital for chest pain was a bigger priority than fussing with her pillows for the 900th time that night. While I knew better than to take any of her abuse to heart, it stung to hear "You don't give a damn about me, nobody in this place does" when I'd bent over backward to accommodate her needs (and more than a few of her wishes) at the cost of my lunch or break, or simply time spent with a more appreciative patient.
One night, she pulled this stunt as I was just about ready to explode from the tension of a tough shift during which I'd gotten two admissions, both at dinnertime, and one of whom I promptly had to send back to the hospital when she suffered a massive stroke right before the horrified eyes of her two daughters. I'd also suffered a reaming from another unhappy patient's grandson, who had demanded to know why I didn't just hop over to Walgreens to get some pain medicine instead of waiting for delivery from our 'house' pharmacy: "What kind of place are you running here, lady?!" the kid screamed at me. "Why don't you get off that fat orifice of yours and go get Grampa his pills?"
So when Mrs. Meanjeans started in on me about my many sins of omission that evening, I lost it. I actually yelled back at her. I didn't curse or call her names, of course, but I'd had enough of being bullied for one night, and I let her know it.
"Wilma, I wasn't put here on this planet to be at your beck and call," I spat. "I have bent over backwards to help you and make your stay as comfortable as I can, but I have 20 other people to take care of and sometimes you're NOT number one on my list. You are going to have to understand that, and no, I am not gonna put new bandages on you when I just changed them two hours ago. Quit pulling them off just to annoy me!" And I literally turned on my heel and walked out.
Later, I felt bad about what I'd said, but not bad enough to apologize, and certainly not bad enough to report my outburst to management. I figured that she'd take care of that for me anyway. However, I noticed over the days and weeks that followed that Mrs. Meanjeans tended to be just a wee bit less bombastic with her negative commentary when I was on duty than when another nurse worked that unit and I was on the long-term floor. I also noticed that when the CNAs came to me to blow off steam about her, and then I went in to listen to her side of the story, that she was somewhat less hostile once she'd gotten it off her chest. And one night as I was leaving her room after one such discussion, I even heard her say, ever-so-faintly, "Thank you".
After that, working with her was, comparatively, a piece of cake. On one noc shift, she threw all of the CNAs out of her room while she was on the bedpan, refusing to let them change her or even take the bedpan out from under her, even though she and her bedding were soaked. She demanded to see the nurse; when I showed up, I gave her a chance to choose two of the four CNAs who were on with me that night. I didn't care which two, but she would have two aides working with her, that was non-negotiable. (We needed to cover ourselves.....too many careers have been ruined by false accusations, and Mrs. Meanjeans was such a catastrophe begging to happen.) Once that was made clear to her---and yes, having three people in the room at one time probably helped to persuade her---she stopped fighting it, picked her two aides and even became almost......well........pleasant.
It turned out to be short-lived, but only because she was transferred to another facility a few days after this. During what turned out to be my last evening with her on the unit, she was actually HUMAN for the very first time.....she ate in the dining room, fully dressed and even wearing a flower in her hair. She didn't yell, didn't curse, didn't even use the call light more than a few times. I found myself spending more time with her that evening than usual; this was a restrained, even polite Wilma that we'd never seen before, and when the shift was over, I went in to say good-bye to her and wish her well at her new place. I even reached inside to find the words to say that I truly hoped life would treat her better there, and that she'd finally be able to go back to her home one day soon.
She was sitting there in her wheelchair, drawing pretty, intricate designs with colored markers on a pad of unlined paper, and when she looked up at me, her eyes were wet. Then she said something I'll never forget: "Thank you, Marla. You're a good girl, and you've taken good care of me, even if hardly anyone else did. Come here---I want to give you a kiss and a hug."
Thunderstruck, I bent down to receive the affectionate gestures. She had never called me by name before.
"I love you, honey," said Mrs. Meanjeans.
"I love you too, Wilma," I said, meaning it.
The next afternoon, I came on to find her bed empty, the tension which had gripped the entire building gone, and CNAs and nurses alike doing the happy dance. Two of them ran up to me excitedly to announce the news, then added, "You'll never guess what she said when she left---she told us to give you another kiss and a hug, and to tell you again that she loves you."
Good-bye, Mrs. Not-So-Meanjeans. Wherever you've gone, I hope you'll get good care, and maybe even find a little peace and joy in life someday.......but just in case you don't, your bed in 10-A will be waiting. :redpinkhe
*Names changed for HIPAA purposes
