It was Minnie Rogers’ first week working at Paradise Acres Nursing Home.  She had only been a licensed practical nurse for a few months.  She received a lot of experience at her last job working at the local clinic, and she had liked that job.  While working Monday through Friday from eight until five might be an ideal job for some, the hours were a conflict for Minnie.  She wanted to get her RN degree, so she needed a job where she could work nights and weekends while going back to school during the week.

     A friend of hers told her about Paradise Acres—said it was the best nursing home around.  Her friend had said, “It doesn’t have that nursing home smell that most nursing homes have…you know how most nursing homes smell like urine and death?  This one isn’t like that.”

     So here she was, working twelve-hour, overnight shifts.  She found the night shift to be mostly peaceful once she finished the nightly med pass and everyone began to settle in for the evening.  Each night, after everyone had gone to bed, the certified nursing assistants would sneak off to who-knows where, and the few nurses on staff would be at the nurses’ station documenting vital signs and filling out useless quality assurance reports in triplicate.

     She found the QA reports useless since their purpose was to prevent a similar accident from happening again.  They apparently were not effective, because the same resident had fallen in the floor for the last ten days in a row, and no physician or facility administrator had taken action to try to prevent it from happening again.  As she filled out yet another QA report on the same resident, she noticed a black lady named Thelma Williams approaching the nurses’ station.

     Ms. Williams was a resident at Paradise Acres.  Minnie had a hard time remembering to call them “residents” and not patients.

The administrator of the facility told her during the new hire orientation, “This facility is these people’s homes.  Remember that!  They have rights.  How would you like it if someone just walked into your home without knocking first…or just started going through your stuff?  You would feel violated.  We have to make sure that we don’t violate these people’s rights.  Many of these people will never get to return to their homes, and we need to do our best to make them understand that this is their new home and help them adapt.”  Then, after the speech, they made the new employees watch a customer satisfaction video about a pickle.

     Minnie sensed Ms. Williams had stopped at the nurses’ station window and was staring at her.  Minnie glanced up, and, seeing two large eyes concentrated on her, she quickly looked back down to her paperwork.  She hoped the woman wouldn’t try to strike up a conversation.

“Excuse me, Ma’am!  Can you tell me why I’m here?”

     Minnie thought that, maybe if she just ignored her, she would go away.  She pretended not to hear her.  “She’s just another confused patient…er…resident,” she thought to herself.  The majority of the residents there were disoriented.  They either didn’t know their name, or what year it was, or where they were—sometimes all of the above.

     “Ma’am, can’t you hear me?  I know you’re not deaf!” the lady persisted.

     Minnie let out a sigh and looked up.  “Yes, Ma’am!  What can I do for you?”

     “Can you tell me why I’m here?  I don’t know why I’m here, or when I’m going home, or nothing.  They just brung me here and didn’t tell me nothing.”

     “You’re here so that we can help you,” Minnie explained.

     “Well, I know that!  I’m not stupid!” the woman said in an irate voice.  “I don’t know why nobody will help me!  I guess it’s because I’m black.”

     Minnie let out another sigh.  “Ma’am.  Your skin color has nothing to do with anything.  I am trying to help you.  Tell me what I can do for you.”

     “Tell me why I’m here!” the woman demanded again.

     “I just did, Ma’am.  You’re here so we can help you.”

     “But help me to do what?  Nobody’s told me nothing.”

     Minnie felt this was just another waste of her time—trying to explain something to someone who couldn’t comprehend what she was telling them, but Minnie explained it anyway.  “Well…you know…your daily chores.  We help you fix your food and take your medicine and get clean.”

     “I’m not stupid.  I know what you do here.  What I mean is, why am I here?  What’s wrong with me?”

     “Oh.  I’m sorry.  I didn’t understand what you meant.”  Once she realized what it was she was asking, Minnie suddenly felt silly that she couldn’t answer her.  “Well, I’m not sure.  I’ll tell you what…let me look at your chart.”

     Minnie retrieved the large binder with Thelma Williams’ name on it and opened it to the front page.  The first sheet in each chart was referred to as the “face sheet,” and it had all of the resident’s pertinent information on it.  She was sure she was going to see that the resident had dementia, Alzheimer’s Disease, or Sundowner’s Syndrome, but to her surprise Ms. Williams’ diagnoses were all heart-related.  She had a history of heart disease, hardening of the arteries, congestive heart failure—it appeared she was there as a result of a recent heart attack, and she recently had a pace maker implanted.

     “It looks like you’re here because you’ve had some heart problems.  They just want us to keep an eye on you to make sure you don’t have any more heart complications.”

     “Well, who is ‘they?’”

     “Your doctors.”

     “Listen!  What I want to know is…didn’t somebody have to tell the doctors to put me here—somebody in my family?”

     “Oh.  I see what you’re saying.  Let me look in your chart and see who your emergency contact is.”

     Minnie looked at the first emergency contact listed.  It said Lorena Smith, and she was listed as a cousin.  Minnie found that strange, because the primary emergency contact was usually a spouse, son, daughter, and sometimes a grandchild, but not someone as distant as a cousin.  Minnie wondered if, perhaps, Ms. Williams did not have anyone close.

     “It says here that Lorena Smith is your primary contact.  I guess she is the one who brought you here.”

     “Lorena Smith?  She’s my cousin.  What gives her the right to put me here?”

     Minnie was stumped again.  “Well…um…I don’t know.  Did she take care of you before you came here?”

     “No.  I haven’t even seen her in years.”

     “Hmm…Well, I’m not sure then.”  Minnie desperately looked through the chart for something that might help satisfy Ms. Williams.  She looked to see who her secondary emergency contact was.  It was Robin Bates, and she was listed as a neighbor.  That confirmed it for Minnie.  She knew that Ms. Williams had no close family that was willing to take care of her.  She pretended to still be studying the chart, but she was really just trying to buy some time, because she did not know what answers she could give Ms. Williams that would make everything okay.  Finally, she looked up and said, “Ms. Williams, can I walk you to your bedroom?”

     “No.  I want to go to my house.  They brought me here, and I don’t want to be here.  I want to go home.”  Ms. Williams’ voice was beginning to break.

     Minnie got up from the nurses’ station and helped Ms. Williams to a nearby chair.  “Here…why don’t you sit here for a little while until you get ready to go to bed?”

     Ms. Williams seemed grateful.  “Thank you.  I just don’t know what gives people the right.  People just don’t care for their own people anymore.  They just get tired of them and put them away.  We don’t have no rights.”

     Minnie felt bad for Ms. Williams, but it was beyond her control.  All she had the power to do is try to help Ms. Williams be comfortable and help her adapt to her new home.

 

     As the weeks passed, Minnie noticed Ms. Williams was beginning to laugh with some of the other residents.  She was making jokes from time to time, and she was funny.

     However, when night fell and the other residents would go to bed, Ms. Williams’ mood would change.  She would become depressed and cry, going on for hours asking, “How could people put me in this place and leave me here?”

     Her doctor had written an order for a drug to be given for agitation, as needed.  At first, Minnie tried to give it to Ms. Williams only when she would wake up in the middle of the night and start walking the halls in a zombie-like manner talking of doom and gloom.  Minnie suggested in her nurse’s notes that Ms. Williams might be manic depressive.

     Eventually, Minnie recognized the pattern—Ms. Williams was going to wake up every night in the same manner and have to be given the drug anyway.  She notified the doctor, and he ordered it to be given along with her routine bedtime medications each evening.  She noticed Ms. Williams started sleeping better and staying asleep throughout the night.  After a few weeks, she noticed that Ms. Williams’ mood seemed to be getting better also.  She wasn’t sure if it was because they had finally found the right balance with her medication or if it was a result of her adjusting to her new environment.

 

     One night, when Minnie was returning to work, after having been off for a few days, Ms. Williams was complaining about weird ailments.  She was complaining, “It’s like I’m breathing smoke—like there’s smoke in the room.  I just can’t stand it.”

     The CNA kept telling her, “There’s no smoke in your room, now go to sleep!”

     Minnie wasn’t sure what to make of the strange symptoms, so she asked the CNA to get her vital signs.

     Her blood pressure and pulse were elevated, and her O2 saturation was low.  Minnie went to look at Ms. Williams’ chart and immediately recalled that she had a pace maker and was there because she was recovering from a heart attack.

     She returned to Ms. Williams’ room and she had begun to complain of pain in her chest and down her left arm.  Minnie immediately recognized the classic symptoms and went to call Ms. Williams’ doctor.  He agreed that she should be sent to the emergency room immediately.

     The ambulance was contacted, and Minnie spent the next few minutes filling out EMS transfer forms and making copies of Ms. Williams’ folder.  The ambulance arrived just as Minnie finished getting all of her paperwork stapled together and, by the time she got a chance to head back to Ms. Williams’ room, she was already strapped to a stretcher and they were wheeling her out into the hall.  She could see Ms. Williams smile through the transparent oxygen mask which had been applied to her face.  It was muffled, but Minnie could hear her say, “Thank you for taking care of me.  I’ve been trying to get somebody to listen to me for two days, but they just kept ignoring me.”

     “It’s no problem, Miss Thelma.  I’m glad to help.  They’re going to take good care of you, so you don’t worry now.”

     Ms. Williams reached out and patted Minnie on the hand as they rolled her away.

 

     Minnie didn’t see Ms. Williams anymore that week.  She heard they admitted her into the hospital and that she had a heart attack a couple of days later while still in the hospital.

     She didn’t see Ms. Williams the next week either.

     By the time another week passed, Minnie had almost forgotten about Ms. Williams.  So many residents were admitted and discharged from the facility that it was hard to remember everyone who came and went.  She sat down during shift change to get shift report from the nurse coming off duty and was surprised to see Ms. Williams’ name was back on the census report.

     Minnie said, “Ms. Williams is back?”

     “Yeah,” the other nurse said apathetically.  “She’s a hand full.  I don’t know what her deal is.  She came back in three days ago, and nobody can make her happy.  She complains about everything!”

     Minnie said, “I never had any trouble with her.  I’ll see if I can cheer her up.”

     “Well, good luck with her,” the other know-it-all nurse replied.

     As soon as she finished getting shift report and had gone into the med room to perform inventory of the controlled narcotics in the drug cart, Minnie headed down the hall to see Ms. Williams.  She looked like she felt much better than she had the last time Minnie had seen her.

     “Hey, Miss Thelma!  I heard you had a rough time.”

      “Oh, child!  I did!  I’m so glad to see you!”

      “I’m glad to see you too…and that you’re all right!  I have to go, but I’ll be back around in a little while with your medicine.”

      Ms. Williams started laughing.  “You’re going to come in here with your needles and start sticking me, aren’t you?  You just want all of my blood.”

      Minnie knew Ms. Williams was referring to having her blood sugar checked and receiving her insulin shot.  The fact that she was laughing and joking about it was a good sign.  “Yes, Miss Thelma.  You know I have to do that to make sure your sugar isn’t too high.  We don’t want you to be too sweet.”

      Ms. Williams laughed, and Minnie went back out of the room to prepare for the nightly med pass.

 

     Several more weeks went by.  Ms. Williams had a few moody spells of depression, but other than that she was doing much better.

     Then, one night, while Minnie was administering medicine to one of the other residents, she heard shouting coming from down the hall

     One of the CNAs that worked the night shift was standing in the doorway to Ms. Williams’ room yelling at her and tugging on her arm, trying to pull her back into her room.  Minnie immediately went to see what was going on.

Neda, the CNA, had a reputation for being a grouchy, old sourpuss.  She screamed, “I can’t do anything with her.  She’s impossible!”

     Minnie calmly said, “Well, what’s the problem?”

     Ms. Williams said, “I was trying to go to the bathroom and change into my pajamas, and she come in here and started telling me I was taking too long and telling me what to do.”

     Neda began hollering back at Ms. Williams, “You’re a mean old lady!  You can’t take so long in the bathroom!  Your roommate needs to use the restroom too sometimes.”

     Minnie looked at her roommate, Ms. Dobson.

     Ms. Dobson looked like she wanted nothing to do with the conflict and said, “No.  I don’t mind.  I’m fine.  I don’t need to go to the bathroom right now.”

     Neda continued to holler at Ms. Williams.  “I done told you!  Get in the bed!”  She grabbed the sheets on Ms. Williams’ bed and tugged them so hard that her pillow flew into the floor.  “I said get in the bed!  I’m not going to tell you again!”

     Ms. Williams said, “Good!  Don’t tell me again!  You’re not going to tell me what to do.  I’m not going to bed now!  Go on out of here and leave me alone!”

     Neda shouted, “You’re going to get in the bed!”  She grabbed Ms. Williams by the arm, attempting to wrangle her into the bed.

     Ms. Williams jerked free and immediately bent over beside her nightstand.  She opened the drawers and began rummaging through them.  She said, “Get out of here, or I’m going to shoot you!  Just wait until I find my gun!  I’m going to shoot you in the head!”

     Minnie stood watching the entire scene, trying to figure out how to diffuse the situation.  She knew Ms. Williams was stubborn and felt that she had to stay awake now, despite how tired she was.  Minnie understood Ms. Williams had a need to feel independent and that she still had some control of her life.  The more Neda antagonized her, the worse she was making matters.

     It was obvious that Neda was not well educated, and Minnie was starting to doubt if she even had any common sense.

     Finally, Minnie had enough and said to Neda, “Just go on and let me handle this.”

     Neda ignored Minnie’s orders kept provoking Ms. Williams.  “You’re mean!  You can’t just do whatever you want to do!  You live here now, and we’re in charge.”

     Ms. Williams continued to shuffle through the drawer—looking for her gun.  Minnie was beginning to get worried that she might actually have a gun in the drawer.  She said again to Neda, “You’re making things worse.  Just go on.  I’ve already given her a sleeping pill.  You’re getting her so upset that she’ll be up all night.  I’ve got it from here.”

     Neda still refused and shouted, “What’s the point?  You can’t reason with her!  She’s crazy!”

     Minnie was getting as mad as Ms. Williams now, but she still tried to stay calm—for Ms. Williams’ sake.  Minnie realized it was Neda who could not be reasoned with.

     “Neda!  I need you to leave right now!” Minnie said sternly.

     Neda gave Minnie a hateful look.  “You’re siding with her?”

     “I’m not crazy!” Ms. Williams interjected.

     “It’s not about siding with anyone,” Minnie explained to Neda.  “You two are having an argument, but only one of you is being unprofessional by doing so!”

     Neda looked at Minnie like she had punched her in the gut.  “Hmmph!” was the only thing she could say before turning her nose up and leaving the room.

     Ms. Williams was so upset, she was physically shaking.  She kept mumbling, “I’m not crazy!  That woman done come in here and started yelling at me!  She ain’t gonna tell me what to do.  What right does she have?  I’m not crazy!”

     Minnie felt bad for Ms. Williams.  She had not deserved being attacked like that.  Minnie was trying to figure out what she should do about it.   The administration had made them watch a video earlier in the week defining nursing home “abuse,” and Minnie was sure what she had just witnessed would be considered verbal and emotional abuse.  She dreaded having to fill out the paperwork—there would be an investigation by the administration.  Neda would probably end up being suspended or fired, but Minnie was so mad that she didn’t care what became of Neda.

Minnie encouraged Ms. Williams to get into the bed before her medicine kicked in, but Ms. Williams refused.  “I’m just too mad.  I couldn’t possibly sleep.”

     Minnie knew differently.  She knew that Ms. Williams would sleep—whenever she sat down and got still, she would sleep.  She would sleep, and there would be no getting her to her bed at that point.  Ms. Williams was pacing back and forth, and Minnie knew that convincing her to go to bed was useless.

     “Let’s go sit in the day room and watch television, Ms. Williams.”

     As they walked down the hallway together, Ms. Williams said, “I can’t stand it when people try to act like I’m a bad person or something.  I didn’t do nothing wrong.  That woman came into my room and started getting all in my face…then acted like I did something wrong.”

     “I know, Miss Thelma!  Don’t worry about it.  Nobody’s upset with you.  Don’t worry about what she thinks about you.  God knows you’re a good person.  Right?”

     “That’s right!” Ms. Williams said.

     Minnie helped Ms. Williams down onto the leather couch.  “You look so tired, Miss Thelma.  Are you sure you won’t go to bed?”

     “I’m sure!  I’m just too mad to sleep!”

     “Okay then,” Minnie said.  She sat in a chair next to her and flipped past all of the infomercials until she found a late night sitcom rerun.  “This looks pretty funny.  You want to watch this?”

     “That’s fine,” Ms. Williams said.  “Thank you for being so good to me.  That woman just made me so mad.  What gives her the right?”

     “Nothing.  Some people are just unpleasant people.  You just have to ignore them.”  Minnie knew her words might as well be white noise, but she didn’t know what else to say.

     Ms. Williams had tears in her eyes.  “I just don’t know what to do anymore.  I don’t want to be here, but I ain’t got no home no more.   Sometimes I wish the good Lord would just go ahead and take me.  I just don’t want to live no more.”

     Minnie sat quietly and watched as Ms. Williams held her face in her hands and wept.  It broke her heart.  Minnie realized that sometimes there just aren’t any right words to say.

     She sat beside Ms. Williams for about twenty minutes, giving her time to calm down.  She didn’t really know how to best respond to Ms. Williams.  In nursing school they taught her to say something like, “You sound like you’re upset” and avoid ever giving any real advice—but Minnie always thought that seemed like a cop-out, to be stating the obvious when a resident was as upset as Ms. Williams was.  So she tried to just listen and hoped that allowing her to vent and express her feelings would suffice.

     Minnie tried to imagine what it would be like to be in Ms. Williams’ place.  If there was anything this job had taught her, so far, it was that she never wanted to end up in a nursing home when she is older.

     Once Ms. Williams had calmed down some, Minnie said, “I’m sorry I can’t stay here with you any longer, Ms. Themla, but I have to go finish my work.  Are you going to be ok?”

     “Yes.  Thank you for being so good to me,” she said again.

     “You’re welcome!”

     Minnie sat where she could watch Ms. Williams from the nurses’ station while she worked on her documentation and nurse’s notes.  In just a few minutes, she noticed that Ms. Williams had fallen asleep.

     A few more minutes passed, and Ms. Williams was beginning to slump over.  Another CNA named Susie walked past the day room and caught a glimpse of Ms. Williams in her peripheral vision.  She stopped in her tracks, did a double-take, then she cautiously approached Ms. Williams, asleep on the couch.

     Minnie watched to see what Susie would do next.

     Susie gently nudged her and said, “Ms. Williams?  Do you want to go to bed?”  There was no response, and Minnie knew that the drugs were doing their job.

     Susie looked around to see if anyone was looking, and Minnie quickly looked back down at her computer screen, pretending she had not seen anything.  Susie shook Ms. Williams a little harder.  “Ms. Williams?”  There was still no response.  Susie turned and walked away, and Minnie returned to her data entry.

     A moment later, Susie returned.  She was carrying a blanket into the day room.  She gently laid Ms. Williams down into a lying position on the couch and covered her with the blanket.  Susie looked around again to see if anyone was looking.  This time, instead of pretending not to see her, Minnie gave Susie an approving smile.  Susie returned the smile.

 

      At about four o’clock in the morning, when Minnie was finally caught up with her work and had a few minutes before the morning med pass, she went into the day room and patted Ms. Williams on the arm.  This time, Ms. Williams opened her eyes.  Minnie said, “Ms. Williams, why don’t you go to bed now.  You’ll sleep much better in your own bed than you will on this old couch.”

     “Ok.” Ms. Williams said groggily.

     Minnie helped her up and they slowly walked back down the hallway.  When they reached her room, Ms. Williams lied down in her bed and immediately resumed sleeping.

 

     The next night, as a result of being short staffed, Minnie was assigned to work on a different hall than she was used to, so she did not see Ms. Williams.  She looked for her, but figured she went to bed early since she probably hadn’t slept well on the couch the night before.

     When Minnie took her lunch break at around one o’clock in the morning, she went down the hall to Ms. Williams’ room and peeked inside.  Ms. Williams was asleep with a big smile on her face.  Minnie didn’t dare wake her.

 

     Minnie was not scheduled to work again until the next weekend.  When she arrived at work and was receiving shift report, the dayshift nurse said, “Mrs. Dawson did good today.  Ms. Edmonson refused her lunch and all of her medications today.  Mrs. McDougal was her usual confused self today.  We have a new resident in 37-B.  She’s here recovering from a hip fracture and has a wedge that has to stay between her legs.  Her family…”

     Minnie interrupted.  “37-B?  Wait…what happened to Ms. Williams?”

     “Oh.  She expired Tuesday morning.”

     Minnie thought the term sounded so cold.  In the nursing home, residents don’t die—they “expire,” as if they’re a piece of three-month old processed meat found in the back of the refrigerator.

     “Oh no!  What happened?” Minnie asked.

     “The doctor said it was probably a massive heart attack.  The CNAs said they had walked past her room about an hour before they found her, and she seemed fine and even waved at them.  Then, when they were doing their morning rounds, she was just dead.  They said she was already cold when they found her, so they didn’t try to revive her…but she was a DNR anyway.”  The nurse continued with the shift report, “Mr. Roberts, in 38-A, is on antibiotics for a UTI.  Mr. Jones is still complaining about…”

     Minnie tried to pay attention as the nurse finished giving shift report, but she couldn’t help but think how easy it was for those who work in nursing homes—who deal with sickness, dying and death on a daily basis—to become complacent.  She wondered if it was a way of coping so they could continue to deal with death, and over time they just aren’t affected by it any more.

     Later in the shift, Minnie asked another nurse on duty, “So what happened to Ms. Williams, you think?  Did they have a funeral for her?”

     The other nurse looked at her with wide eyes.  “What?  Did she die?”

     “Yeah.”

     “Oh.  I hadn’t even heard.  You know they put Mr. Dobson on Hospice.  He probably won’t make it through the night.”

      Another nurse said, “Oh no!  I hope he waits until day shift to kick it.  I don’t want him dying on me.  Last week I got off thirty minutes late when Mrs. Thurman died.”

     “I know what you mean.  The other day I had one die on me and I didn’t think I’d ever get out of here.  They’re family was being all dramatic…”

     Minnie stepped away from the conversation and decided to walk down her assigned hallway to check on her residents, but she really needed to get off by herself and think.

     Usually, the halls would be filled with the sounds of residents who were restless—a moan here, someone hacking there.  However, tonight the hallways were unusually quiet.  Minnie felt a strange sense of peacefulness as she walked past the room that used to be occupied by Ms. Williams.  She had a lot of thoughts running through her head.

     Two years ago, when she made the decision to become a nurse, it had been because she wanted to help people.  Then, by the time she finished nursing school, she was just trying not to mess up.

     Now that she was working and was becoming confident in her nursing abilities, there were so many assignments and duties that had to be finished each shift that she just wanted everyone to go away and leave her alone so she could finish her work.

     The conversation she had just heard at the nurses’ station made her realize that she, like many others, had lost sight of why people go into the nursing field to begin with.  Two weeks ago, she would have been as apathetic as the other two nurses had been.  She was wondering if, in two more weeks, she would be that way again.

     She started back up the hall towards the nurses’ station when she heard a woman say, “Nurse!  Can you come here for a moment?”

      Minnie entered the room where the voice had come from to see a small, pale woman.  “What can I do for you?”

     “Could you get me some ice and some water?  I’ve been trying to get someone to get me some all night, but nobody has brought me any.”

     Minnie’s first reflexive response was, “Ok.  I’ll tell your CNA.  That’s their job.”

     She turned to walk away and suddenly stopped in her tracks.  She turned back around and picked up the empty pitcher from the resident’s bedside table and gave her a friendly smile.  “You know what?  I’ll just go ahead and get you some.  I’ll be right back.”

     When Minnie turned to leave, the lady said, “Thank you.  I really appreciate you taking the time to help a person in need.”

     Minnie smiled.  “That’s why I’m here!”  For the first time she realized—nurse or not—that’s why we’re all here.  As she left the room, she thought about how so many residents in the nursing home just want someone to say a kind word to them or take a minute to listen to them, just like Ms. Williams.

 

 

Ain't Got No Home

by Jeffrey S. Holland