A Waste of Good Brain

Yesterday was our first real clinical day. For this quarter we're in a nursing home (I figure this is b/c we're less likely to kill people in a nursing home than if we were in an acute setting - i.e. an ER). Though at this point, working in a nursing home is not my first choice, I am grateful to be in a more relaxed setting. It makes it easier to focus on remembering what your supposed to be doing rather than launching us into the chaos & stress of imminent death.

So, clinical is good. We shadowed the CNAs today so we could get to know our residents and their needs. I helped with bathing, dressing, and feeding residents, took some vitals, listened to a woman's lungs who had COPD (Chronic Obstructive Pulmonary Disease). The base of her L lung had crackles on inspiration. 

I also got to talk to some of the residents for a while. The unit I'm in is for those residents who are further along with dementia (i.e. they need more assistance w/ADLs (Activities of Daily Living), their trains of thought and speech are a little more scattered, etc).  What is really amazing (and sad) is the number of these people who have so many accomplishments in their lives. Many of them were nurses, one was a pastor (and he repeats the word "church" all the time), one has a degree in Mechanical Engineering from Texas A&M, another went to Harvard, some others from UW MedSchool (one woman was I think one of the first three woman graduates from UW MedSchool), one woman was an army nurse in WWII in France, and she cared for both the French & US soldiers. She has a photo in her room with all her pins & badges around it, and she has so many! The CNA said she would have been one you would salute. It's

 really sad to see how many really good brains are just dissolving away here. All that knowledge and intellect is just disintegrating into disarray and nonsense.

Here's a little info about Dementia/Alzheimer's:

As people progress through Dementia (Alzheimer's is one of the most common forms of Dementia), their brain just deteriorates, particularly in the memory and language centers. As they get further along, they begin to stop talking. Finding the correct words becomes more difficult, so they get frustrated and just stop. Eventually, they only talk if they have something really important to say...so you'd better listen!  

                                      

P.S. Those holes/gaps in the brain are bad. No wonder people with dementia have trouble with memory & language...there are just chunks missing, like when you pick pieces out of a pie you're not supposed to eat. Well, I tried to Google for a pic of a pie that shows what I mean, but no real luck. Not b/c there aren't photos of partially eaten pies online...there are pages & pages. I mean, My goodness! Why the heck do people post photos of partially eaten pies?!?!?! That's just gross and bizarre if you ask me...so I found a lung cancer steak instead b/c it's just as gross...well maybe a litter nastier. Looks like a tasty steak (minus the tumor. I think that's a tumor. Anyway, it looks like it shouldn't be there.), but I'd rather not have that as my source of O2 exchange.

     

                       

Talking to some of the residents who are in further stages of dementia, it was actually rather difficult, not really because they were having trouble finding words, or because they don't make sense much of the time, but just because you don't really know how to respond. We're taught to just enter into the world of that person with dementia; don't contradict or correct what they say, but just go along with it. So, if a resident asks you if you voted for Nixon in the election on Tuesday, rather than correcting them and saying, "you mean Obama or McCain?", which will just confuse them because their memory doesn't support immediate events as well as long-past events, you just respond "oh, yes. I voted for Nixon." or whatever statement you think will best satisfy them and their question. But I feel like this is hard to do (at least for me anyway). It took me a while to be able go along with it. I found it difficult basically telling straight lies or not validating the truth. When I was talking to a woman yesterday, she asked me "are we all going to the picnic or are just you going?" And of course my immediate thought is "what picnic?" Then I had to quickly remember the condition of the person to whom I'm talking and come up with an anwser. However, the difficult part was that I found myself trying to give as truthful of an answer as possible. So I would say: "I don't think I'm going to the picnic." I don't really know why I didn't just say: "Yes, I'm going too.", because the probability is that she would have forgotten about the supposed picnic and been onto another topic with a minute or so, but it was just weird. It was that Lutheran guilt creeping up on me...thanks Dad.

Oooh, another thing. There was an event. One of the residents is always very concerned about people and wants to make sure no one is being harmed. During breakfast, he saw some of the CNAs helping feed the residents, and this set him off. He was convinced that we were hurting them, and proceeded to somewhat aggressively herd all the staff out of the dining room. He then barricaded the entry and would not allow anyone in or out. When one staff member said, "But Mrs. Jones needs to eat breakfast", he simply stated, "No. No one can come in or out." This went on for a while, until someone finally redirected him by suggesting that he go shave (which he had just finished doing, but he really likes to shave, so he went willingly and breakfast continued without further interruption).