A few years ago I worked at a hospital as a constant observer.  It was a transitional job as I tried to figure out the next step of my life. What exactly is a constant observer?  one might reasonably ask.  A constant observer is basically a nurse’s aide who stays in one room to be with patients who might be a harm to themselves or others. Hospitals try very hard not to tie people down on their beds anymore.  There are a lot of reasons I might be assigned to a patient: dementia, adverse reaction to medication, brain injury, detoxing, or suicide watch, to name some.  I saw people at their most vulnerable state.  This is the fifth in what I plan to be a series of vignettes on my experiences in the hospital.

It’s possible to drink so much you turn your mind to mush.  I’ve seen it.

He went by the name Buzz. One nurse kept referring to him as Buzz Lightyear, even directly to him.  It was disrespectful, even if he was in the hospital for self-inflicted reasons.  Sometimes staff want to take it out on patients.  I found this especially true for detoxing patients—they wouldn’t treat them the same as other patients.  The first time I sat with him, it was only for about two hours or so.  Buzz was asleep, but not for long.  He wanted to wriggle out of bed, so I helped keep him from falling out.  His food arrived for dinner, but he could barely keep his eyes open to take a bite.  He was a leaning tower on the bed, and his speech was slurred and incoherent.

The next day I had him again. Unluckily for me, he was much livelier and intent on walking somewhere.  The Neuro Acute unit was small, with only eight rooms, most of them empty that day. We walked up and down the short hallway.  Each time we reached an end, he’d inevitably lurch toward it, despite my attempts to steer him away and my explanations that he had to stay.  At one end of the hallway were the double doors to the ICU.  Stopping him at that end wasn’t so bad – he seemed to understand my rationale that we couldn’t disturb other patients. But there was also the fire exit at that end.  No way.  Opening that door would set off an alarm and a world of trouble for me.  At the other end of the hallway were the double doors to the hallway and sweet freedom.  It was impossible to keep them closed for long as people come in and out of the unit all the time.  It was a lot harder to keep him from leaving the unit.  He wanted to get out.  He thought he was fine.

But he could barely stand on two feet without precariously leaning. I put a gait belt around his torso, just under his armpits, so I could hang onto something as he careened this way and that.    Meanwhile, his pants couldn’t find any place to cling on his skinny waist.  Again and again I tied them tight, again and again they fell down.  I was struggling to keep him from getting into trouble.  He wanted to go into the clean, empty rooms or behind the nurses’ station.  And I could barely keep him from falling over, but I couldn’t really stop him either. I kept hoping he would tire out and take a nap.  But he continued his exploration of the hallway, and I followed every step of the way.  I turned him around at both ends of the hallway, sometimes with a gentle nudge or a quick distraction.  I didn’t want to use force, but he was so insistent.  The gait belt was handy for holding him back, too, when he tried to make an exit.

I was about to break down after hours of this. The nurse aide marveled that I didn’t seem frustrated.  I was amazed that I had hid it so well.  We were down by the fire exit again, and he nearly pushed the door open, when a nurse and the aide came to my rescue, sending me off for my 15 minute afternoon break.  I went to the locker room, something I never did on my break, because I wanted to be absolutely alone.  I called my wife and started crying.  I was so overwhelmed with the responsibility of trying to keep this man safe even as he wanted to leave.  There was no way to reason with him.  When my 15 minutes were up, I said goodbye, wiped my tears away, and went back for more.

A few years ago I worked at a hospital as a constant observer.  It was a transitional job as I tried to figure out the next step of my life. What exactly is a constant observer?  one might reasonably ask.  A constant observer is basically a nurse’s aide who stays in one room to be with patients who might be a harm to themselves or others. Hospitals try very hard not to tie people down on their beds anymore.  There are a lot of reasons I might be assigned to a patient: dementia, adverse reaction to medication, brain injury, detoxing, or suicide watch, to name some.  I saw people at their most vulnerable state.  This is the fourth in what I plan to be a series of vignettes on my experiences in the hospital.

He looked like a caged animal.  I went into his room in the morning, and he was there only in a diaper, a grown man probably in his 70s, a retired farmer, on his hands and knees on the bed, which was covered with a mesh enclosure to make sure he didn’t get out of bed during the night. I was supposed to wash him up and have him ready for the occupational therapist, who would help him get his clothes on.  I wasn’t used to washing up a moving target.  I asked the nurse aide to help me—she was a little put out I couldn’t do it by myself.  His diaper needed to be changed as well.  And the bed linens, but that could be taken care of when he got up.

I had been with him the entire previous weekend down on Neuro Acute.  He had fallen down the basement steps and hit his head, causing internal bleeding.  He had more tubes and lines when he was down there.  A central line, a feeding tube down the nose, telemetry leads, a catheter.  He picked at everything—it was a constant battle so he wouldn’t pull things out or off.  The tele- leads weren’t a big deal, just an annoyance, but the others were serious.  I couldn’t let him get a hand on them or it would be big trouble.  He grabbed all of them at one point or another.  I would grab his hand so he couldn’t continue pulling.  Then I had to pry his fingers off one at a time from the tube or line.  Sometimes he would try to roll over or get on all fours, which was a problem with so much attached to him.  I felt like I was wrestling him in order to keep him safe.

He looked like a writer I had known while I was in grad school.  In fact, the resemblance was rather unnerving.  It made me feel protective of him, that he was in my charge, that his care was my responsibility.  So that’s why it especially hurt when I got chewed out by a nurse down on Neuro for not alerting her right away when some machine started beeping.  Things were always beeping in his room: bed alarms, telemetry monitors, IV pumps.  I was still pretty new at the job and didn’t know what was a priority and when I should get the nurse right away.  This time it was a leak from his central line.  I put on the call light.  Eventually his nurse was able to come to the room and check, only to find that some med that he needed had leaked onto his chest.  The connection between the central line and IV pump had been tenuous.  Instead of putting on the call light, I should have found her immediately.  Now she couldn’t properly chart how much medicine he had received.  I had screwed up.

When he was upstairs later in Rehab—a halfway unit intended to transition patients out of the hospital and where I found him on all fours like a naked animal—he did manage to dislodge his feeding tube.  I couldn’t stop him in time.  It was the last evening I spent with him before he was transferred to a nursing home.  Earlier he had begun to smile and even make jokes.  He pretended that he was going to drop a cup, and then smiled broadly when I fell for it.  He still couldn’t talk, but I could see the pleasure he got from this normal human interaction.

Before he left for the nursing home, he curled up on a couch in his room (the couch was a pull out bed for guests).  Still tethered to an IV pump on a stand with wheels, he seemed like my sleeping child that I was watching over.  I put a blanket on him so he wouldn’t get chilled.  My shift was almost over.  I turned the lights off in the room.  It was already dark outside on a late November afternoon.  And we both waited to leave the hospital.

A few years ago I worked at a hospital as a constant observer.  It was a transitional job as I tried to figure out the next step of my life. What exactly is a constant observer?  one might reasonably ask.  A constant observer is basically a nurse’s aide who stays in one room to be with patients who might be a harm to themselves or others. Hospitals try very hard not to tie people down on their beds anymore.  There are a lot of reasons I might be assigned to a patient: dementia, adverse reaction to medication, brain injury, detoxing, or suicide watch, to name some.  I saw people at their most vulnerable state.  This is the third in what I plan to be a series of vignettes on my experiences in the hospital.

The moment I step into the room she’s in the middle of packing to leave. She’s already kicked her sister out that morning (after calling 911 twice). Her therapies for the day have been canceled. I convince her to take a walk with me around the unit, but when she gets back to the room she keeps packing. It’s not going to be an easy day.

She carries her bag out to the hall and looks for the exit in another patient room. She sets her bag down because it’s heavy with her hair products, magazines, and clothes. Her nurse manages to take her on another walk around the unit while holding her hand. Her nurse is very good with her and has a calming influence (and medication). When she comes back she takes a nap for a half hour (like I said, medication). When she wakes up she’s fairly calm and normal again for half an hour or so. Then she realizes her washer/dryer aren’t there, so they must have been stolen. Obviously I am involved in their disappearance.

The day before she had blown up at me when she couldn’t find her appointment book. I had tried to explain that her sister was holding on to it while she was in the hospital and had called many of her clients to let them know of the situation. She was in the hospital because of a brain aneurysm. She accused her sister of trying to ruin her business, and then she said I had taken her sister’s side and that I should just stay out of her family business. She had trusted me, and she thought I was couth. The nurse was able to calm her down, and later in the day I came back in the room and she had totally forgotten the incident.

Whenever she wasn’t mad at me, she treated me like a confidante. She would complain to me and talk bad about anyone after they left the room. While the nurse or aide was in the room, she would act relatively nice and compliant, but as soon as they left the room she would launch into them. Everyone was bitchy, or would cut your throat, or was snotty. I wondered what she said about me when I wasn’t in the room.

Later that day, right before I was off for the night, she looked for her cigarettes. I tried to explain that she didn’t have any because there was no smoking allowed in the hospital, but she said they had been in the drawer and now they weren’t so I must have stolen them and thrown them away. She walked out of her room and then right back in, but when she came back she wouldn’t look at me. She faced the other direction, towards her bed and the window, with her arms crossed. The night shift came in while this was going on. I slunk out of the room, escaping her silent accusations.

So now we’re back together again, and she’s upset about the missing washer and dryer. She goes to the bathroom, and when I ask if she’s okay in there (she could be unsteady at times) she comments that she can’t even go to the bathroom without a guard. Then she storms out in the hall and one of the aides asks where she’s going. The aide offers to show her the washing machine on the unit. This doesn’t satisfy her She wants hers, so she’d rather leave the hospital.

The aide turns off the WanderGuard alarm as we leave the unit (the woman had on a tracking anklet since a previous escape attempt). We try to direct her back around to the unit, but instead the woman bolts right towards the elevators. She hits the down button but then looks towards the windows at the winter landscape (a feint, I later realize). The aide goes back to get help. I stay, hoping I can delay her from getting any farther, but then the elevator door opens. I don’t want her to get to it in time, but she reaches a hand in just before it closes. I try to steady her/restrain her, but she shrugs me off and then glares at me because I was touching her. She tells me not to do it again. She’s seething with fury at me.

Once in the elevator she hits the ground floor button, and I keep hitting the open door button. It starts beeping loudly, so I let it go. We travel down, and I worry how I am going to stop her from going out the front door. It’s zero degrees outside with a wind chill even lower. I’m in a near panic about what to do. When we get to the ground floor she tells me she’ll yell if I touch her. I keep thinking about how to delay her or call security. I somehow manage to divert her to the information desk. She wants to complain about her treatment, but she has to wait because there is someone ahead of her. Then she sees her niece’s boyfriend and I see the niece and I motion almost frantically for her to come over. I’m so relieved that she happens to be there at that moment. She talks to her aunt, soothing her, and leads her back to the elevator.

Back on the unit, her nurse talks to her as well. I stay away for an hour. I sit in the nurses’ station and try to soothe my nerves. I’m tense and almost shaking. I go back to her room as her dinner arrives. She’s completely forgotten the incident and isn’t mad at me or anything. She falls asleep soon after dinner and sleeps nearly the whole night through. I find out later she does get up in the night for 40 minutes or so and apparently thinks the sink in her room is an oven and tries to light the gas burner.

Coda: The next day we watch a marathon of “What Not to Wear” on TLC together.

A few years ago I worked at a hospital as a constant observer.  It was a transitional job as I tried to figure out the next step of my life.What exactly is a constant observer?  one might reasonably ask.  A constant observer is basically a nurse’s aide who stays in one room to be with patients who might be a harm to themselves or others. Hospitals try very hard not to tie people down on their beds anymore.  There are a lot of reasons I might be assigned to a patient: dementia, adverse reaction to medication, brain injury, detoxing, or suicide watch, to name some.  I saw people at their most vulnerable state. This is the second in what I plan to be a series of vignettes on my experiences in the hospital.

The call light was on. Normally I was assigned to one room to care for a patient who might be a harm to themselves. But now I was on a wing of an understaffed department, assisting where I could. I ducked into the room to see how I could be of use.

“Hi, my name is Andy, and I’m one of the nurse aides on this floor. How can I help you?”

She looked surprised and frustrated (and maybe annoyed) to see me. Her nurse, a woman (the nurses are almost all women, that goes for nurse aides, too), had been in the room less than five minutes ago. The patient had just come out of surgery about a half hour ago. She looked to be in her mid-40s. The bed was uncomfortable. The instructions were for her to lie on her back, completely straight, for four hours and not to bend her leg. Her nurse had set the blood pressure cuff to measure her systolic and diastolic every fifteen minutes per usual post-op procedure. She had a peripheral IV of saline.

“How am I supposed to go to the bathroom?” A reasonable question.

A man at the bedside (her husband? her brother?) chimed in, “She’s not supposed to get up because of the surgery.”

“Oh, well, then you’ll have to use a bedpan. I’ll get one.” No one likes to use a bedpan.

I brought back a pan and a towel from the service center. I was trying to be a professional. Most of my experience with assisting toileting involved helping people who were out of it or elderly. She looked disapprovingly at me. I could tell she did not want me to help her pee. I didn’t really want to help her pee. But everyone else was busy. I didn’t want to have to ask anyone else to come to the room after I had answered the call light. I shifted my weight from one leg to the other. “Would you prefer that a woman assist you?”

“Yes.” She nodded.

The man looked at me as if I hadn’t even been an option.

A few years ago I worked at a hospital as a constant observer.  It was a transitional job as I tried to figure out the next step of my life. What exactly is a constant observer?  one might reasonably ask.  A constant observer is basically a nurse’s aide who stays in one room to be with patients who might be a harm to themselves or others. Hospitals try very hard not to tie people down on their beds anymore.  There are a lot of reasons I might be assigned to a patient: dementia, adverse reaction to medication, brain injury, detoxing, or suicide watch, to name some.  I saw people at their most vulnerable state.  This is the first in what I plan to be a series of vignettes on my experiences in the hospital.

He couldn’t get comfortable on the bed.  And no wonder—his wife had told the nursing staff (and me) that normally at home he would sleep on a recliner for a few hours, get up to go to the bathroom, then lie down on another recliner.  She said he could only sleep for a few hours at a time, suffering as he did from restlessness and frequent urges to urinate.  I considered what this information meant for my evening. He had a catheter in place, so the urinating itself wouldn’t be a problem, but sometimes people still feel the urge to urinate.  I’d also found that it’s hard to explain a catheter to someone who is already confused.  I frequently would say “I know it feels like you have to go to the bathroom, but you have a tube that drains your bladder.  It’s doing the work for you.”  Sometimes I would show them the catheter bag filled with urine if I thought it would help them understand.  With one guy I had to explain the catheter more than two dozen times in a day—he’d forget within five minutes what I had said.  So the nurse brought a recliner—broken, but it was the only one on the unit—in an attempt to simulate the patient’s home environment.  I put a garbage can under the foot rest to steady the chair.  It wanted to lurch forward.  He was cold so we put a few blankets on him.  With that, he and his family accepted our illusion of home.  But soon enough, after his visitors left, they put him back in the bed so they could put the bed alarm on.  The alarm would let the nursing staff know if he tried to get out of bed, permitting them to dispatch me a few doors down to watch another patient.  A short time later they asked me to return to his room because he was yelling and cursing.  When I sat down next to the bed, he thought I was his wife there to comfort him.  The lights were low and he was confused because of… I don’t even know.  Old age?  Alzheimer’s?  A stroke?  It was the middle of the night?  He told me that he loved me so much.  I grabbed his hand, thinking that might comfort him.  He wanted to be comforted, so he was playing out the script of comfort.  I didn’t want to break out of my role and shatter the scene.  But then he started kissing my hand.  Now I felt really uncomfortable.  He was a total stranger, and he was kissing my hand.  Also, it didn’t seem right, posing as his wife, letting him believe she was there.  Still, I didn’t move at first because I was frozen.  But the moments passed, and I still couldn’t yank my hand away.  He was alone and disoriented in a place that was not his home, and I wanted him to be able to feel some comfort right then.  I also hated the thought of facing his embarrassment if I made him realize his mistake.  And I really didn’t want him to get upset again.  I told him to relax and go back to sleep.  I tucked him in, and then I withdrew back into the shadows of the room, thinking about how I had stumbled into misplaced intimacy.