May 28, 2013

Lessons Learned on the Night Shift.

Photo: Tomasz Sienicki

“Our society must make it right and possible for old people not to fear the young or be deserted by them, for the test of a civilization is the way that it cares for its helpless members.”
~ Pearl S. Buck

To grow more mindful as a culture, we need to embrace our responsibility for our weakest members, in particular the youngest and the oldest, but also those who are disabled, sick, and otherwise disadvantaged.

Too often, these individuals are out of our view, existing only on the periphery, and they are all too easy to overlook. They are less invisible, however, if you know you are just like them, and that they are just like you, that we are all truly one and the same.

Today, I live in a pretty house in a lovely little neighborhood in Minneapolis full of mature trees and interesting University professors, gardens walks and block parties, activism and affluence.

On the outside, I blend in with these comfortable surroundings I’ve worked so long and hard to wiggle my way into. However, on the inside, I am vividly aware of how fine the line is between one kind of life and another, the line between lending a helping hand and needing one. That’s because I grew up poor, which is a relative term, I know. I always had a roof over my head, for instance, but it didn’t always have running water or lights depending on whether those bills got paid. My family also suffered many of the side effects of poverty, including extreme stress and social isolation, and eventually the “system” got involved and I ended up in foster care at age seventeen.

While I was in foster care, I enrolled in a certified nursing assistant program. Through that endeavor, I learned that the helplessness, isolation, and degradation I felt as an institutionalized child was unfortunately shared even more intensely by our society’s institutionalized elders.

My nursing assistant courses were held at night, in a large building on the edge of downtown St. Paul, Minnesota, not far from that city’s grand cathedral. It may or may not have been a community college. My friend and fellow foster teen—her name was, ironically it feels now, Joy—and I rode the bus together from our foster house near Lake Phalen.

Our foster care arrangement was a quirky and questionable set up for responsible, high-functioning teens whose families for whatever reason weren’t stable. It was called an Independent Living Situation. (You can’t make this up.) In this “situation,” the “parents” lived with their real children downstairs, while the “independent” foster teens (you had to be at least sixteen to live there) lived upstairs—boys on one side of the apartment, girls on the other. The girls’ bedroom overlooked the lake; the boys’ room overlooked the driveway. Each of us received a city bus pass and a weekly food credit to be used at a small, independently owned grocery store within walking distance.

Our entrance was located at the end of a long driveway, in the back of the house, through a door that led up a steep staircase. A buzzer alerted the “parents” to our comings and goings. Curfew was strict. If you arrived late, the door to the stairway was locked—and the police were called. No exceptions.

It was deep winter when Joy and I embarked on our adventure in nursing assistance.

The kind of chronically subzero winter we used to have in Minnesota back in olden times, before climate change. This was, in fact, 1986, the year that the city of St. Paul’s annual Winter Carnival’s Ice Palace was constructed on Lake Phalen; I remember walking across that frozen lake at night, on the way home from learning how to safely transfer an elderly person from bed to chair or from chair to bed or—even trickier—how to remove and replace a full set of wet bedsheets on a bed with an immobile elderly person still in it.

Of course, for our practice sessions, the sheets weren’t actually wet and there were no elderly people, just us, the students, mostly young and generally spry, pretending to be what we could barely yet imagine. After our long evenings spent awkwardly mastering transfers and other unfamiliar skills, Joy and I would shiver our way across that interminable expanse of snow-covered ice, our ungloved fingers frozen stiff around our red-tipped cigarettes, our feet numb inside of our cheap and inappropriate footwear, our path illumined by that incredible glowing palace, so magical and incongruent against the bitter darkness.

I cannot remember what compelled me to sign up with Joy for those night classes on top of everything else we were juggling at the time—like high school and the foster care system, for starters. We must have really, really wanted to be nursing assistants. Our end goal was to get hired in a nursing home.

The truth is, I did hold exceptionally fond memories of my earlier experience of volunteering in a nursing home, the lovely Sholom Home in St. Paul, where I read to residents and led bingo games and helped decorate for special events.

I also recollected warmly the time I had spent reading to an elderly neighbor, Charlotte, who was blind and had advertised for volunteer readers. I would walk to Charlotte’s small white house on autumn afternoons during my junior year of high school. Her house sat far back on a deep lot so thick with conifers it felt almost forested; the pine smell always filled me with equal parts hope and sadness. Once inside, I’d read to Charlotte—mostly from the Bible—as she rested in her sage green armchair. Charlotte was quick to correct me if my reading was too fast or too soft, but soon I knew how to use my voice just as she liked it.

Unfortunately, neither reading to Charlotte nor playing bingo at the Sholom Home prepared me for what I experienced when I finally got hired to work the night shift as a certified nursing assistant at a St. Paul nursing home that looked not unlike a white brick castle, but that felt not unlike a lonely and surreal prison and smelled like something fierce and indescribable.

Especially bizarre was the basement, a maze of long snaking concrete tunnels where we employees could find locker rooms and vending machines for soda and snacks, and where the laundry room pumped out clean linens and towels and, I suppose, residents’ clothes 24 hours a day. Upstairs were the resident rooms and the dining hall. Feeding was a task we learned in our program, but the practice didn’t at all equate with actually feeding an older person. I was consistently too impatient, too fast with the spoon.

More natural to me were tasks such as bathing—though make no mistake, that was not easy!—and combing and braiding the women’s hair. I was fairly skillful at changing their clothes, intrigued as I was by how their soft, drooping flesh hung from their protruding bones, which seemed simultaneously sturdy and frail. These women were not shy about their bodies, not the least bit modest about what one referred to as the “feminine juices.” I was 17 and naïve. I had never really spent time—not ever—around older people. The women drew me to them as if I knew them in a way I cannot explain, as if I could see in them a familiar place from another life. In this way, they both comforted and unnerved me.

The men upstairs were another story. I remember changing their catheter bags and emptying the urine-filled containers, trying so hard in utter vain to keep the urine from splashing on my white canvas shoes.

The constant sexual banter, harmless as it was—and it was harmless, I knew even then—grew tiresome. The men did not draw me in the way the women did, but nor did they similarly unnerve me.

What did unnerve me, enough to scare me away from my brief foray in nursing assistance altogether, was neither the women nor the men, but John. John, like me, was a nursing assistant. But unlike me, John worked mostly on the third floor, reserved for the very impaired residents. Most (or maybe all, it’s hard to remember) were bedridden and demented. John claimed to prefer the third floor, but I only visited it to make necessary deliveries—laundry or other supplies. Behind its locked door was a constant and harrowing wailing that cut through me and hurt my bones. I was perfectly glad to stay mostly downstairs.

One night, though, perhaps due to a staffing shortage, I was assigned to partner with John on the third floor. That was the shift during which I learned a method of transfer Joy and I never learned in those night classes.

As much as I didn’t like the third floor, I also didn’t care much for John. He made me nervous. He was a good ten years older than I was, I’d guess. Between his age and his experience, John was obviously my superior on the shift. In addition to this legitimate authority, John  also had the kind of sharp, forceful alpha male demeanor that expects to take charge regardless of whether it’s warranted. On that particular night shift, John gave the orders and I took them. Our dynamic was as straightforward as can be.

At some point during that long night, John and I had to change a bed for a resident, a frail old woman.

I can picture her still, her tangled gray hair, her thin gown, her wild gray hair. I wish I remembered why we were changing the bed—that is, was it just a routine task, dictated by the clock, or did she scream for it (and if she had, how would I know, because there was so much screaming all through that endless night on the third floor?). I took my place beside John as he grasped the woman’s body. She was a good bit larger than I was. She moaned unhappily as John took hold of her, and I rushed to untuck the sheets and roll them toward her, as I’d been taught. What I expected was that John would gently prop the woman on her side while I rolled up the bedding, and then he would gently guide her body the other way so that I could remove the wet sheets entirely and begin anew with fresh ones. But that’s not what happened.

Instead, John lifted the woman into the air like a weightless bird, her arms flailing like useless wings. Then he set her  bony body on top of the dresser across from the bed. She screamed and I gasped as John pulled the sheets from my hands and stripped the bed in seconds.

“But wait,” I stammered. “You’re not supposed to… we should … I can… she doesn’t want to be on the dresser!” I pointed this out ridiculously; my words were futile. John laughed darkly. “She doesn’t know the difference, believe me.”

I didn’t press. I couldn’t, because there, at 17, in my urine-stained shoes, standing on the third floor of that not-castle of a nursing home, such a long bus ride away  from my lonely foster house, in that chilly room with the wailing woman and with John, I was too afraid to say more, even though her helplessness was so visceral to me I could barely breathe.

I couldn’t lift the woman from the dresser back to the bed, either. I wasn’t strong enough to take the risk of dropping her onto the hard tile floor. All I could do was change the bed as fast as I could so that John could put her back into it, then stay by her side, holding her hand, until her wailing slowly subsided. And I could tell her story weeks later when I met with my supervisor to resign from the night shift, even knowing it probably wouldn’t make much difference.

Most of all, I could keep her in my heart through the decades, willfully remembering the enormity of her helplessness and pain in order to search harder and longer for the same enormity of softness and generosity inside myself.


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Ed: Kate Bartolotta

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