I'm Here for the Bath presents a look into the support of hospice patients and their families from the perspective of a hospice aide who provides hands-on bedside care. Hopefully, this look inside the world of hospice care might bring the topic of end-of-life care to the table in a way that inspires, supports, and informs anyone, particularly those facing such end-of-life issues.
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I'm Here for the Bath
By Peter Rolita
Balboa PressCopyright © 2015 Peter Rolita
All rights reserved.
MY FIRST DAY ON THE JOB
A certified home-health aide (CHHA) is similar to a certified nurse assistant (CNA) in a hospital or nursing home but with care being provided to patients in their homes. Both CHHAs and CNAs assist patients with activities of daily living (ADLs), such as bathing, dressing, and personal hygiene.
I earned both certifications at the same time but did not work in private homes at first. Instead I worked as a CNA in a nursing home for about two years. While there, I made friends with Lea, a coworker who was a licensed vocational nurse (LVN) who had a second job at a home-care agency. One day, Lea and I were on break, and she told me that her agency was looking for some guys to help out with some of the heavier patients; she encouraged me to check it out. I was not really looking to work more than I already had been, but I liked Lea and decided to call up to see what the job was about.
Knowing a current employee of theirs was a plus, and before I knew it, I was signed up, oriented, and equipped with supplies for my car and a name badge. I was ready to go! I was used to providing care to patients, but this new job had one big difference: I was on my own. There would be no nurse at the nurses station to call if needed or another aide to give reports to when I left for the day. At the time, working on my own seemed like nothing to worry about. The idea of being responsible for one patient at a time instead of eight on the day shift, sixteen on the evening shift, and thirty-two on the graveyard shift sounded unbelievably easy. The home-care agency provided a flexible patient load, and I had control over my schedule. I could set up visits with patients after my weekday shifts at the nursing home were over or on weekends.
I called my first patient and made a late-afternoon appointment to visit him after my shift; so far so good. I drove out to the home, and there were a lot of cars parked all around it. When I got out and opened my trunk to get my supplies, a group of people came out to meet me at the curb. I was not prepared to start yet and was making sure I had the care plan and the supplies I might need in my bag when one of the people, a woman, grabbed my arm and said, "You have to come now! I think Dad is dying!"
Her father had been identified to me as a hospice patient, terminally ill, a patient not to be resuscitated. This agency also took care of home-health patients and post-op or rehab clients who fell within my scope of practice but were not terminally ill. I was prepared to take care of this patient and felt that the family members were overly anxious and perhaps unclear about the status of their family member. I had been told that when a patient was "imminent," my visit might be canceled or a nurse might go with me. My care plan, or written report, stated that this patient was stable and that bath aides were scheduled for the patient's comfort. But things can change very quickly, something I was about to learn up close and personal.
I closed my trunk and went to meet my patient. I was ushered into a bedroom containing a hospital bed with a group of folding chairs around it. The room was full of people, and when I came in, they looked at my white scrubs and bag and rushed over to me and exclaimed, "Please, can you help him?"
I looked at the patient; he was unconscious and breathing rapidly and looked sweaty. I put my bag down and removed my gloves and hand wash from it. My hands were shaking, but I washed and put on my gloves before I approached the patient, as I had been taught. The patient was breathing only with the top of his chest — called agonal breathing — and was indeed sweaty. I felt his pulse, and it was racing — well, in excess of normal. I peeked under the covers, and his legs were a blotchy dark blue, a condition called mottling. This man was very close to dying. I had seen patients die before, but none who were had died with only me there to help.
I turned to the man's wife and asked her if everyone who wanted to see him had seen him. She gestured around her and looked at me with ancient eyes, eyes that said she was facing something big and hoped I could help her through it. She was unable to talk and had a tissue balled up in her fist and jammed against her mouth. I lowered the rail on the hospital bed and pulled up one of the folding chairs so she could sit with her husband. I took the patient's hand and put it in hers and said what I had been taught to say: "Tell him you love him. Tell him you're going to miss him. Tell him he was a good husband. And tell him it's okay to let go."
She balked at the last part but choked it out anyway. I went around to the other side of the bed to get a better look at the patient, and I noticed that his eyes had kind of filmed over and that his breathing was really slowing down. I thought to myself, This guy is going to die right now! Holy shit! The room got really quiet; my new patient was not breathing anymore. His wife was looking over his body at me. I had witnessed this huge moment in her life, and I did not even know her name.
Things moved along on their own after that. The family all gathered around the bedside. There were lots of tears, and someone started to read from the Bible. I realized I was shaking, so I put my hands behind my back and stepped out of the crowd and retreated to my supplies bag for my phone list to call the office. I asked for the phone and called in. I got the receptionist, and I told her that my patient did not appear to be breathing and that someone needed to come out and take over. The receptionist told me that Marie, the RN, was scheduled to see the patient today; she was, in fact, on her way and would be there in a few minutes. I knew that postmortem care — cleaning and dressing the body as the family wished — could be part of my duties and might be needed, but I was unsure how to go about it with the mob scene at the bedside, so I decided to wait for Marie.
The doorbell rang, and a cheery voice said, "Hi! How is everything? Is Peter here?" And then — "Let me just go right in, then." In came a woman with short dark hair. She was carrying a bag and wore a name tag like mine. She walked right up to me and introduced herself and said, "Nice to meet you. Some first day for you, all right." Marie put her bag down next to mine, went over to the bedside, and examined the patient. Then she turned to the wife and in the most tender voice said, "Maria, he has died. What can I do for you right now?"
After speaking with the family for a few minutes, Marie came over to me and said, "I don't want to call the mortuary just yet. We like to clean up our patients and dress them before we do that. Let me clear the room out, and you and I will take care of him, okay?"
Marie went over to Maria and told her, "Peter and I are going to take care of Manuel and get him ready to go to the funeral home." Marie explained what we were going to do and that when we were done, they could all come back in and stay with Manuel until the funeral-home employees arrived. Marie ushered the family out and closed the door. Turning to me, she said, "Ready?"
I said yes, and we cleaned and dressed Manuel and put a clean sheet over him. We folded his hands neatly and adjusted the hospital bed to its lowest position. Then Marie opened a window, turned off a couple of lights, and turned up the radio that was playing some soft music. She made a nice lineup of chairs for the family while I cleared away the supplies we had used. She and I went into the bathroom, removed our gloves, and cleaned up. Then she opened the bedroom door and went out into the living room, coming back in with her arm around the new widow. The rest of the family trailed in behind them. Marie told them that there was no hurry. They could stay with Manuel as long as they wanted, and when they were ready for the funeral home to come, they could just let her know.
More people arrived, and the bedroom filled up. People brought Manuel's grandchildren in for their first look at death. It was overwhelming for me, and I grabbed my bag and slipped out the door and beat it for my car. "Hey, Pete," I heard. I turned to see Marie jogging after me. "You did really good in there. Glad to have you on board."
"Nice to meet you. I quit!" I said and meant it. My first home visit had given me a big gulp of real life, and I wasn't sure I could choke that kind of stuff down on a regular basis.
"Don't do that," Marie said. "People need us to be there when someone dies, to steer them around the curves. Sometimes we are right there when somebody dies, but I believe we are only there when we are supposed to be. Listen, honey — I've been doing this a long time, and I think it was no accident that you were here today. And you can't deny that having your first patient die on your first home visit has to be some kind of sign from God, to say the least. I have a good feeling about you. I think you were cut out for this kind of work. Listen — give it a week. If you still can't cut it, then go ahead and give it up. But I think you will stay with us."
Marie later told me that she was trying not to laugh at me for saying I was quitting. She said she could tell a lifer when she saw one. As it turns out, Marie was right.CHAPTER 2
THE TREE FOR ALL SEASONS
I began to feel comfortable with my new role of home health aide and started to accept new cases when I had room for them after work or on weekends if I wanted to make some extra money. One of my patients was a man who had a terminal heart condition. He was living with his latest wife; they had been together for twelve years and were very happy. They both had a few children each, and the Mrs. had a couple of ex-husbands around as well. My patient had been a rambler and had not parented or partnered well in his earlier forays into fatherhood and matrimony. He had a spiritual awakening during the course of his final decline and went to great lengths to get forgiveness or make his peace with people from his past, including his ex-wives and children. It was my privilege to witness much of this process and to see his estranged ex-wives gather around his bedside and support his current wife during his final days. Many of his children also were reunited with him, and he got to meet grandchildren that he had not known of. It was a wonderful thing for me to witness. I got to see how forgiveness works and how love is really all we are talking about in hospice care.
I began visiting him in late January, at which point he had been moved into the living room in his hospital bed so he could have visitors and be included in the comings and goings of his busy household. Standing in the corner was a large, very pretty artificial Christmas tree without ornaments. It was one of those things that had been left undone during this family's complex and emotional journey. I offered to take the tree down and carry it out to the garage, but my patient said he was in no hurry to see the end of his last Christmas tree, so there it remained.
One day in early February, as I was giving him his bath, he saw a little valentine heart in my smock pocket. It was a little red heart on a pipe cleaner with gold string announcing "Happy Valentine's Day." He asked me about it, and I told him I had gone to a grocery store that had been giving out little valentine trinkets to people with their purchases. He liked the valentine and asked me if he could have it to give his wife, joking, "I don't get out much to shop these days." I happily agreed, and he put it on his bedside table to give to her when she came back from the store.
Upon my next visit, I noticed the red heart prominently displayed on the bare Christmas tree in the corner. My patient's wife said she did not want to misplace the heart and thought that the tree was a good place to put it. Later in my visit, she came back into the room with a couple of yellow fuzzy chicks and put them on the tree with the red heart and said, "We can have a Valentine's Day tree if we want to. Who says we can't?" Over the next few weeks, friends and family and the nurses, social worker, and chaplain from my work all brought over little Valentine's Day trinkets for the tree, and it became a beautiful love tree to celebrate Valentine's Day. The tree became a kind of project for everyone who visited the patient.
The next holiday was Saint Patrick's Day, and the tree was re-decorated with four-leaf clovers, leprechauns, and shamrocks galore. With each passing holiday, the tree was transformed into a display representing that holiday. Before the patient died in late September, the tree was replete with pumpkins, ghouls, and candy for Halloween. Decorating that tree was truly a joy for everyone and provided a wonderful memory for the patient's family and for all of us in hospice who got to share in the tree for all seasons.CHAPTER 3
THE CHRISTMAS BATH
This is a story that may seem like a miracle to some, a confirmation of faith to others, and maybe even a lie to others. Please know that this really happened, and take from it what you want.
On Christmas Eve I was seeing home-care patients after my nursing-home job and went to my last visit of the day; I found my way to a big old house on a large lot in an old part of town. I knocked on the door and was admitted into a home filled with the smells of Christmas and the joyful sounds of people loving and sharing the holiday with one another. In the large living room, with a large, fully trimmed tree, my last visit of the day was lying in his hospital bed. I put down my bag and approached to introduce myself and get an idea of what my job was, how long it would take, and how hard it was going to be. I found a very large man moaning and turning his head from side to side and opening and closing his hands, which were tied to the rails. His feet were also tied, and a Posey vest held him to the bed by his upper torso as well. (For those of you who came into the health-care field after this kind of restraint was no longer legal, let me clarify that this was decades ago, folks.) The man looked very strong, and I knew how hard it was going to be to untie him and bathe him one limb at a time and dress him and change the bed.
I put my bag down and got my gloves and went to find a bathroom to wash up when a small woman came out of the kitchen and asked me if there was anything I needed and if she could help me in any way. I asked her if the patient had been given all the medication he was supposed to have, and she told me he had pain medicine that they almost never gave him and bowel meds that he got regularly, but other than that, he didn't take anything. I asked her how they changed him when he needed it. She looked puzzled for a minute, and then her face lit up, and she said, "Just a minute, honey; I'll be right back." She went off into the kitchen. As the door opened and closed behind her, I could clearly see and feel the lights, smells, and laughter and love of their Christmas celebration. Then in a few minutes she came out of the kitchen with a group of six or seven people close behind her walking single file with big smiles and quiet attitudes. She told me, "Honey, you get yourself ready to begin, and when you're ready, just let us know." I thought they were going to help me hold the patient while I did my work, and I was grateful and relieved as I prepared the supplies I needed to care for their family member.
When I was ready, I said, "Well, I guess we can get started now."
The woman said, "No, honey, it's just going to be you doing the bath, but us here and God are going to help out a little."
The woman and the other people took positions all around the bed and then turned their backs to it and stepped away two or three paces to give me room and the patient some privacy. Then the most amazing thing happened. Swaying back and forth, they began to hum, low and strong, the same notes at the same time. I thought, Okay, here we go with another learning experience, but little did I know that I would be moved and thrilled in such a way that this bath would carry me through the rest of the holidays. It continues to give me peace and joy whenever I think of it.
As they swayed and hummed, the patient relaxed and settled down into the bed, and after a few minutes the woman said to me, "Okay, honey, you can untie him now." I was amazed and skeptical.
I doubted this woman, and the fear of trying to restrain my patient from running outside or some such event flashed through my mind. I hesitated, unwilling to unleash this person and perhaps cause him harm. The woman said softly, "Go ahead, honey. God has him, so you can take care of him. Now get to it."
Excerpted from I'm Here for the Bath by Peter Rolita. Copyright © 2015 Peter Rolita. Excerpted by permission of Balboa Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Chapter 1. My First Day on the Job, 1,
Chapter 2. The Tree for All Seasons, 6,
Chapter 3. The Christmas Bath, 8,
Chapter 4. The Shotgun Permanent, 11,
Chapter 5. The Lovesick Rabbit, 14,
Chapter 6. The Cold Snake, 17,
Chapter 7. The Stable Snake, 20,
Chapter 8. Bread-Eating Deer, 23,
Chapter 9. A Boot for a Bear, 27,
Chapter 10. The Dog and the Water Heater, 30,
Chapter 11. Three Visits, 34,
Chapter 12. Three More Visits, 39,
Chapter 13. The Cattle Drive, 48,
Chapter 14. Beating the Odds, 54,
Chapter 15. Beating the Odds Again, 60,
Chapter 16. The Bishop and the Crown Victoria, 66,
Chapter 17. The Man of Many Wives, 71,
Chapter 18. Waiting for the Bather, 80,
Chapter 19. Singing in the Rain, 83,
Chapter 20. The Well-Endowed Man, 85,
Chapter 21. The Outspoken Woman, 96,
Chapter 22. The Midnight Golfer, 109,
Chapter 23. Welcome to Lunch!, 114,
Chapter 24. A Quiet Good-Bye, 117,
Chapter 25. Blackberry Cake, 122,
Chapter 26. The Drug Raid, 125,
Chapter 27. Telling the Daughter, 130,
Chapter 28. The Pickle Jar and the Milk Can, 136,
Chapter 29. Baby-Blue Continental, 143,
Chapter 30. The Old Dog and the Rainy Day, 147,
Chapter 31. Apple Cake, 150,
Chapter 32. Nudist Camp, 158,
Chapter 33. The Sleeping Couple with the Big Dog, 161,
Chapter 34. The Faraway Sister, 165,
Chapter 35. Evening Serenade, 169,
Chapter 36. Twin Brothers, 172,
Chapter 37. Homer the Footstool, 177,
Chapter 38. The Seven Dogs, 183,
Chapter 39. The Llama Scare, 188,
Chapter 40. The Naked Man in the Window, 190,
Chapter 41. The Jealous Husband, 194,
Chapter 42. True Love, 198,
Chapter 43. The Recliner Ballroom Dancers, 205,
Chapter 44. The Dementia Prophecy, 209,
Chapter 45. The Christmas Ornament, 212,
Chapter 46. Welcome to Lunch, 214,
Chapter 47. The Hungry Cat, 217,
Chapter 48. The Bat-Eating Dachshund, 221,
Chapter 49. The Dog Mariam Could Not Give Away, 225,
Chapter 50. Twenty-Nine Days, 232,
Chapter 51. Doing for Ruby, 240,
Chapter 52. The Fancy Bridgework, 248,
Chapter 53. Registered Nurses, 253,
Chapter 54. The Brigadier General, 261,
Chapter 55. Persimmon Cookies, 265,
Chapter 56. The Mustache, 268,
Author Note, 273,
Most Helpful Customer Reviews
Written with great compassion and care, "I'm here for the Bath" illustrates the best practices in contemporary hospice care. While fully protecting their privacy, the author shares the heart-warming stories and many of the lessons he learned from 56 patients he cared for at the end of their lives. Told with exceptional insight, tender and loving humor, this is the go to book for caregivers, patients, and medical professionals.