In The Beginning
BAPTISM BY FIRE
I started out at the VNA as per-dium, which meant that I saw patients on an as needed basis, I just wanted to get my feet wet, see what this job was really like. I soon realized that I really liked it and wanted a full time position, so I applied for one with the team that covered what is known as the “coastal” area, which was way down south where no one else wanted to go, but me. I got the position and soon found that I was working for one of the nicest people I have ever met; my manager was great, how lucky was I? To be in the area that I loved and doing what I loved and to have a great boss, I was living the good life!
I was on this good life kick for about three months when I admitted to service my first patient who wouldn’t listen to anything I was trying to teach her, three months, not bad huh? I’ll call this patient Betty. Betty was in her late seventies early eighties. She had Congestive heart Failure (CHF), among many other diagnoses. She of course lived alone and in a huge home. She would never answer the phone and rarely came to the door. She was going to be my first real challenge.
Betty was on diuretics (fluid pills) that would take the fluid from around her heart and flush it out her body through her kidneys….which meant she had to go to the bathroom more often than the average person, Betty hated taking those pills. “I have to pee all the time; I don’t want to take them anymore.” At first she told me she was forgetting to take them but I caught on real fast. I then set her up for what we call a “pre-fill,” I put all her medications in a prefill box that had the times and the days that they would have to be taken, thinking this would make it easier for Betty. Nope. She just would forget to take them or did she?
Whenever we do a prefill, we do it for three days only at first to see how a patient will do with them, well Betty didn’t take any of her meds and I taught her the consequences of not taking them and set her up for another three days. When I came back I checked the box, she still hadn’t taken any of the pill, this time she told me that she took them straight form the bottles and she didn’t like the prefill box.
I was very frustrated with Betty to say the least…I too was very naive, but I was really worried about her too. She didn’t have any neighbors that could help her, none of her family lived nearby either. I went to my manager, who had many more years in this job than I did, for advice and she shelled out these words of wisdom, “Marilyn sometimes we just have to let a patient fall before we can help them back up again.” I looked at her and said “what does that mean?’ she looked at me and again stated another cliché`, “you can lead a horse to water but you can’t make them drink.” “Oh…so what am I supposed to do? Let this women just fail because I can’t figure out what to do.” “Yes! You will learn that we can’t force anybody to do what they don’t want to do, we just have to be there to pick up the broken pieces.” “I see” I said with not an ounce of satisfaction. I will never forget these pearls of wisdom because she was absolutely right, I can’t force anyone to do what they didn’t want to do, I had no right to make this woman of sound mind take medicine that she didn’t want to. I had to go through this rite of passage whether I wanted to or not. You just can’t fix them all because that’s your plan.
I did not give up on Betty though; I came up with another idea. I would let her take her pills from the bottle if she promised to answer the door so we could visit, she agreed. So I put all the pills back in the bottles and I set it up so we would see her for the next three consecutive days, Friday thru Sunday. In fact my boss saw her on Sunday and reported that she was doing fine and taking her pills from the bottles and that we could skip a couple of days and I could see her on Wednesday.
Wednesday came and I was very busy, I went to see Betty in the late morning, I knocked on the door for more than five minutes, to no avail she did not answer. I then went from window to window and the back door banging on them all as I went and yelling “Come on Betty please answer the door.” After twenty minutes of bruising my knuckles and a couple of phone calls later I left thinking that she must still be asleep after all it was early. I decided to go down the street to visit another patient and I would come back to her. She really was putting a dent into my day.
I came back to Betty’s home about an hour later and there was a car in the driveway. “Good” I said to me “someone is here.” As I started to get out of the car these precious two elderly women came running over to my car and one of the ladies screams “come quick I think Betty is gone.” Gone? Where? I am thinking to myself. One grabs my hand and the other grabs my arm and pulls me towards the door. When we got to the bathroom, they sort of just threw me into the room. I just stared for a moment not believing what I was looking at. There was Betty sitting, slumped over on the toilet, head down and arms down at her sides with something dripping from her nose, frozen in midair. I will leave that up to your own imagination. “Is she gone” one of the ladies asked. I slowly moved towards her and I touch her shoulder and she fell to the floor. Not only was she gone but rigor had set in.
I turned to these two shaking women and asked who they were, “we’re Betty’s sisters, oh, my is she really gone?” I looked at Betty curled up on the floor and then at these two ladies, “yes I’m sorry she is gone.” All of a sudden one of them starts screaming, “Oh my God, oh my God, I just had two stents put in and I am having chest pain!” I was thrown back into reality when I heard this, I helped her to the living room and told her that I was going to call 911 for her and she agreed.
I called 911 and explained to them the situation and the dispatcher just says “you’re kidding right?” “No! please send me some help” On the way” he states. The next thing I hear is the fire engines ambulance and the police cars pulling into the driveway. The EMT’s headed towards the living room when they saw me, passing the body on the bathroom floor. Half of them came to me and the other half went to the bathroom to see Betty.
“What’s going on,” one of them said to me as they began to dig out their equipment for assessment. “Well you saw Betty as you passed the bathroom and these are her sisters and one of them states she just had stents place and is now having chest pain.” They all just looked at me; I saw the sympathy in their eyes, but I also saw that they wanted to laugh at the same time. Two EMT’s started to assess Betty’s sister as the police and firemen went into the bathroom to check out Betty again.
All kinds of details were running through my head, “shit they didn’t teach this in orientation, what the hell will I do next.” Call my manager that’s what I am going to do she will help me through this. I excused myself form the scene ad went into the Kitchen to make a phone call to the office, I needed my boss and I needed her now. She was not there; she just stepped out for a moment. “What’s up?” My unit coordinator says to me. I gave her a brief description of what was going on and the first thing she says is “Oh God let me get someone to help you.” Soon I found myself speaking with one of the managers from another team and I explain to her what’s going on and she says “you are kidding right?” as she starts to laugh, “no I am not” I must of yelled or something like that because she stopped laughing and asked “What can I do for you, are you okay?” I asked her what do I do now. She states that the fire department will pronounce Betty but I would have to call the Doctor, he will call the state examiner and the examiner will call the funeral home.
It all sounded so simple, right after all the fire department was on the scene. When I went back into the living room they were getting ready to pull out. “She doesn’t want to go to the ER, against medical advice” the EMT says, they then pronounce Betty and leave.
I informed the sisters of what we had to do, they were both crying at this point, I felt so bad, but I just wanted to get out of that house. I called the Doctor and told him what happen and he told me he would call the state medical examiner. It didn’t take long for the examiner to call me back to tell me that he has waived his exam and the funeral home would be there soon. I was very grateful for that too be happening. Then as I was getting off the phone with him, the same sister clutches at her chest and yells “Oh God I am having more chest pain. “This just isn’t my day” I thought to myself. I called back the manager and asked what to do and she says to me “well Marilyn, let’s take care of the living first” she laughed at me and all I could say was “not funny”
I had to call the fire department back again and ask them to come back, when they returned they told the sister that she would have to go with them now because it was their second trip. I advised her to go and take care of herself there was nothing here left for her to do, In fact I told both of them to go. The funeral home showed up moment later. It was the end of a very long day.
I went back to the office to write my charts and reports, this time my manager was there and she wanted to know everything, I sat in her office for a while telling her the story, leaving no details out. I asked her “do you think I could of done anything differently to change the circumstances of today?” “No, no one could have changed it or even predicted it. Marilyn you will learn that no matter what you do, you can’t change fate and you can’t change people.” She said this so eloquently that I knew I would never forget it. We had a good laugh believe it or not and she referred to the entire experience as “baptism by fire” and she says to me as I was about to leave her office, “By the way was she wearing a blue bathrobe?, that’s what she was wearing on Sunday I would hate to think I was the last to see her.” We both chuckled as I lied to her, “No she wasn’t wearing a blue bathrobe.”