While My Little One Sleeps

As a DON in assisted living, I oversee the health needs of 85-plus people, most of whom are a pleasure to know, and I consider it an honor to be entrusted with their lives. Still, I never forget that I'm also a professional who must maintain an appropriate clinical objectivity, and for the most part I don't get too involved in a resident's personal life. There's an invisible wall I've spent years building that protects both of us, and it is strong after fifteen years as a nurse. Specialties Geriatric Article


While My Little One Sleeps

She lies in her narrow nursing-home bed with eyes closed and feet elevated on pillows, looking much like the little girl in the faded black-and-white photographs she showed me that first day in her new apartment. In her pink fleecy oversized pajamas with the white polka dots, she appears even more frail and childlike; and as I watch her sleep, I wish again with all my might that we had met sooner.......I'd been so close to solving the mystery that brought us together.

Until someone like Katie Wright* comes along and breaches that wall. Actually, she blew it to smithereens, and that's why I'm here tonight, standing in the doorway of her SNF room wondering whether to wake her and say hello, or just slip away and out of her life, as I probably should. She had a hemorrhagic stroke last week, and now she has to be hand-fed, turned and changed every 2 hours, and given her meds crushed in applesauce. She also has an alarm on her bed to alert staff to attempts to get up on her own, and she is on hospice. Her family has even begun already to move her belongings out of the apartment she occupied for such a short time, because her doctors have said she is no longer appropriate for assisted living.

I understand that. I've issued involuntary move-out notices before; when care needs become too complex to handle in our environment, the resident has to go to a facility where they can be managed.

That's what my logical mind says. I wish someone could explain it to my heart.

You see, we were so close to figuring out what was wrong with Katie. Up until last summer, she had been an independent 87-year-old retired professor from Australia who still drove, volunteered, and even took vacations on her own. Then she began to experience recurrent fainting spells that laid her out for hours if she didn't get into a reverse-Trendelenburg position quickly. She'd had syncopal episodes as a teenager which disappeared during her childbearing years, and they didn't interfere substantially with her life even when they reappeared in her 70s. But last September, she developed seizures and had several bad falls which landed her first in the hospital, then in a SNF for rehab so she could develop enough strength and balance to enable her to function in assisted living.

Katie was understandably disappointed at having to give up her home and her independence, but she was philosophical about it, and accepted her fate with as much grace as I've ever had the privilege to see. Professional distance went out the window as I fell head over heels in love with this tiny, dignified lady, who couldn't sit up longer than 20 minutes before she greyed out and needed to be put on the floor with her head down and her feet up. For all her physical difficulties, though, she has maintained a lively mind and an alert manner; she never forgets a name; and she's never, ever complained, not even the time her aide failed to answer her call light in time and she wound up hitting her head on the corner of a table as she slid to the floor.

In my own late middle age, I have found Katie to be a font of wisdom, even as she looked up to me for my medical knowledge. I already miss going in to check on her and being drawn into a lively and intelligent discussion about life, football, whatever's on the news....she'd even tackle politics and religion, although it's probably more fun because we agree on just about everything. And I guess I've been more to her than just a nurse, because when I was out sick for five days recently, her son called at 0800 on my first day back and begged me to go see her right away. "You bring so much light into her life," he told me on the phone. "She was worried about you, and she needs to know you're OK."

Funny, I thought it was the other way around.

Katie's condition continued to spiral downward. By Thanksgiving, the syncopal episodes were increasing in frequency; she began to vomit miserably after each meal; she couldn't take her pills without gagging. I didn't want to say anything, but I was reluctanly beginning to think it was time to consider hospice. Then one day after accompanying her to a doctor's appointment which turned to disaster---they'd kept her waiting too long, and when she headed for the floor they sent her to the ER---a friend of mine in Texas gave me some information on something I'd never heard of, a condition called Postural Orthostatic Tachycardia Syndrome. I researched it online and quickly found that the diagnosis fit Katie's symptoms to a "T". I was immediately excited, and shot a fax to the PCP for a neurology consult; what if all this was something that could be treated?

I talked with Katie and her family, cautiously optimistic that maybe, just maybe, we might be onto something. Diagnosing the condition wouldn't be easy; it wasn't the first thing that comes to mind, even among neurologists. It would take some experimentation with different meds and treatments, but even though we couldn't fix the problem, we might be able to help her get back into life again. The referral had been made, the appointment set for late January (the soonest we could get her in), when the medication aide walked into Katie's room with her pills early last Friday morning and found her on the floor by her bed, head leaning against the mattress. We called 911 because she was confused and we couldn't be sure she hadn't hit her head; her BP was in the toilet, her heart rate in the 120s.....all pretty much routine by now. So routine, in fact, that we expected her back by suppertime.

Now, a week later, I find myself a visitor in a place I don't want to see anyone in, and I'm cursing myself because this HURTS, damn it. I've been in healthcare for the better part of two decades; I know better than to let patients get under my skin like this. I should simply walk away before my heart winds up in tatters from loving this little woman so much and feeling like I've failed her when she needs me the most.

But even as I wipe my eyes and head to the car, I know I'll be back. Because my sadness and my pain aren't what's important now.....not while my "little one" sleeps, dreaming what I pray are dreams of her long-ago girlhood, when she used to run wild and free across the wide brown land of her birth.

Long Term Care Columnist / Guide

I'm a Registered Nurse and writer who, in better times, has enjoyed a busy and varied career which includes stints as a Med/Surg floor nurse, a director of nursing, a nurse consultant, and an assistant administrator. And when I'm not working as a nurse, I'm writing about nursing right here at allnurses.com and putting together the chapters for a future book about---what else?---nursing.

108 Articles   9,984 Posts

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Specializes in LTC.



352 Posts

Wow, what a great article. You put into words so well the things that many of us feel but can't articulate.

It's what keeps me going back day after day; the hard things, the things that hurt, it's all part of the connection that just happens sometimes doesn't it? The ones that get under your skin.... often I don't even know why it's that resident and not this one.

Sometimes it's almost a physical pain sending people to hospital, it's what I have to do at the time but I stand there watching them being loaded into the ambulance and I know in my heart that it's not the right thing, that it's a failure, that it would have been better to find the person gone rather than at the point where you have to 'do something'. Very hard.

I love how you even KNOW what the 'wide brown land' line means for Australians and that sentence is so powerful, I can see you standing at the door of the hospital room just watching, I've done it myself. I too hope that's exactly what she's dreaming of.


23 Posts

Wow! very touching and powerful.


18 Posts

Brought a tear to my eye. You're human and that is why it hurts. Thanks for sharing and for caring. It is easy to see how you impacted her life as well.

rn/writer, RN

17 Articles; 4,168 Posts

Marla, can we clone you and send you around to about 10,000 assisted living and skilled care facilities? Pretty please?

Now I just need to figure out how to type with tears in my eyes.

Thanks again, for choosing to feel the pain of caring instead of numbing out. We're all the better for your decision and your willingness to share it.

Long Term Care Columnist / Guide

VivaLasViejas, ASN, RN

108 Articles; 9,984 Posts

Specializes in LTC, assisted living, med-surg, psych.

Arrgh, that caring business........sometimes it really hits you in the solar plexus and leaves you gasping for breath.

Today, the most extraordinary thing happened at work. One of my med aides is a young single mom who acts about as tough as they come---when she's not dealing with the residents, almost every other sentence out of her face contains at least one profanity, and she's loud and angry and waaaay too old for her years. She goes through life with her head down and her fists up, just waiting for someone to hurt her so she can fight back. She is also one of the best resident advocates I've ever known and far too smart for what's happening to her.

She's been unusually quiet lately, which is an alarming change: we all know that if "Hallie" isn't talking, she's only about a step away from losing it. This morning I asked her if everything was okay; typically, she muttered "Not really" and went on about her business, and that---I thought---was that.

About an hour later she knocked on my door and laid two pieces of lined paper on my desk. "This is to give you a little idea of what's going on with me," she said, and walked back out. I proceeded to read what she'd written, and was THUNDERSTRUCK. Not only did she pour out her heart to me in the letter, it showed a degree of writing talent---and amazing insight---that I've never seen in someone her age. She painted such an achingly vivid portrait of a young woman who is desperate to know that she's worthy of being loved, and who feels she doesn't deserve to be happy, that I broke down and bawled right there at my desk. My heart literally hurt for the unwanted and broken little girl she carried inside her......probably because she spoke to the unwanted and broken little girl I once was.

Then I was like, "Dear Lord, how can I help her?" I'm still blown away by the fact that she turned to me, of all people; I'd figured out she wasn't as hard-edged as she seemed within the first five minutes after I met her, and I have always been impressed by her work ethic and her integrity. But I am her supervisor, after all, and I'm old enough to be her mother and THEN some.

I didn't know what I was going to say when I asked her to step outside with me for a quick smoke (of course, I don't indulge in the habit myself, but I hang out around the ash can because that's where I find out everything I never hear in report). She was facing away from me, but I could see she was smiling a little as I gathered her into my arms and said, "If the situation ever called for a loud, smart, profane, hard-working woman, I'd pick you every time." Then we had a laugh, and some tears, and some more hugs before I asked her how I could help. She admitted she didn't know, but she was so obviously relieved at having unloaded her sadness that she even perked up and smiled a little more.

I have no idea where this is going, of course. All I know is that I am so honored, and so astonished, by Hallie's trust that I pray for the wisdom to know what to say, and most importantly, when to shut up and just be her friend.

Specializes in Correctional, QA, Geriatrics.

All I know is that no matter how deeply it cuts to feel for another, to truly see into their essence and embrace it that price is worth all the joy that comes from connecting with each other. So many people spend their lives encased in a shell of seclusion and exclusion and yearn for that connection. As nurses we can be privileged at times to break through that shell and connect. That is a joyous thing even when the seasoning of tears flavors it. It makes us better people no matter how it stings and burns our hearts and souls.

Thank you Marla for once again reminding us that barriers are sometimes meant to be breached in order to heal both others and ourselves.

Specializes in ED/ICU/TELEMETRY/LTC.

Dang it, and I just typed on the topic of how "hard heated I was." Maybe not so much.

I can only offer you comfort in the words of my mother:

"All that you can do, is all that you can do."


31 Posts

Ms. Marla, you made me cry:( I can totally relate to your post...It was so beautiful, and explained exactly how it is when something bad happens to a geriatrics patient that we grow attached to. My friend was taken away early because of Alzheimers...It was so painful watching her day after day decline and slip away from me....I lost her long before she died...that was one of the most painful moments:(

Such a beautiful, touching, relatable post!!! Thank you


36 Posts


viva means life,

each time you write , u simply bring life into this forum, and most especially our hearts. i for one couldnt help been teary after a while reading ur post. "it touched me" its just to say the least. thank you soo much for writing so beautifully each time, sometimes i just wish i knew you personally.

thank you for conveying the words of our hearts even when we dint know how to pen it down, for letting the world know that most times our patients mean so so so much to us. i love u n GODbless


14 Posts

I loved your story, right now I am going to school to only be an LPN and hopefully on to my RN, I'm 45 so I am starting a little bit late.

Your story touched my heart because my instructor keeps telling me I will eventually not be so kind to people, that it will be just a job and I will lose my compassion.

You have given me hope that I won't lose any of those things. I do realize that we have to be cautious of our feelings and emotions but after my geriatric rotation I'm not so sure. So many of those people touched my heart in so many ways. It's funny that as you clean up dirty diapers and wipe noses they almost feel like your children.

I often stand back and just watch the residents and wonder what their life was like before they came to the nursing home and I remember to be thankful for each day that I have, that I can walk out of there, drive myself home and take care of myself, because I know so many of them wish they still had that freedom and dignity.

Thank you again for sharing such a beautiful story and for giving me hope....................

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