Ruthie was left at the ward one early Saturday morning by her ailing parents. The other nurses shunned them for leaving her there, but it wasn’t their fault. What else were they to do? They were both old enough to be patients themselves. How could they be expected to care for a grown woman with such big needs.
They rang the buzzer and I could see their three forlorn faces in the oblong window. I unlocked the unit door.
“Good morning Ruthie. My name is Kate, I’m the unit nurse.”
Ruthie was my age. I couldn’t imagine my folks taking care of me for forty years. They would have dropped me off a long time ago. I didn’t give them the opportunity, though. I left when I was eighteen. I only really saw them on the obligatory holidays and I called during the long stretches in between.
Ruthie carried her own suitcase. I wonder where they told her she was going.
“I’ve heard a lot about you. Welcome,” I said in my gentlest voice. The sound of someone screaming echoed down the hallway, the smell of disinfectant and urine coming with it. Screaming and moaning were common around here, though, it wasn’t a reason for concern. Ruthie looked at me blankly. Her father greeted me, his voice shaky and fragile. Her mother’s eyes red-rimmed and glassy.
“Lets go put your bags down in your new room and take a tour. “ I led them to the second room on the left, close to the nurse station so I could keep an eye on her. They placed the bags on the linoleum floor. She would have a single room, at least for now. Once she was settled in she would get a roommate. I found the biggest source of stress on the unit was roommate issues. Arguments over the temperature of the room, how dark they liked it at bedtime, the uncontrollable babbling one of them inevitably would be cursed with.
Her parents exchanged glances, both on the verge of tears. I tried to keep it cheerful. Showing them the common area, filled with stained chairs and frayed furniture. A single television set hung from the wall, an older model with six channels. I explained our activity calendar, that afternoon would be crafts at noon and a movie tonight, Air Bud.
“Are you hungry? We have a wonderful chef here. Meals are served three times a day and we keep snacks here on the unit; Jello, crackers and peanut butter, pudding… You’re not diabetic are you?”
Ruthie blinked, her mother shook her head ‘no.’
“We have physical therapist that comes every day to see patients on an alternating basis. They bring bands, cycling gear, and different things to get your exercise in.” They didn’t look impressed, so I went on. “And if I have time I take patients outside, a few at a time, for some fresh air.” I had done this once in the three years I worked here. I would have liked to do it more but the fact was it just wasn’t safe, for any of us.
Ruthie’s parents looked like distressed parents dropping their toddler at daycare. I encouraged them to make a quick exit. They said goodbye and gave her a hug. Promising to check on her tomorrow. I hit the buzzer and they were gone.
Several hours later when I went to the cafeteria I saw them still sitting in the lobby, her mother sitting on a bench, her head in her hands. Her husband stood beside her, his hand on her shoulder. I wondered if I was loved and missed that much by anyone.
I encouraged Ruthie to unpack her things. I attempted to unzip it her suitcase but she snatched it away and glared at me. “Okay, I’m sorry. It was just an idea we don’t have to.” She scowled. “Well, I’ll be in the office. I’ll let you get used to it in here. If you need me I’ll be right up front.”
It was time for me to pass the noon medications. I began hauling the med cart up the hallway. Punching the passcode to open the drawers, checking the MAR and repeating my nursing school mantra, ‘right patient, right dose, right med, right time, right route.’ Right route. As in, don’t give an oral medication rectally. I paid special attention to that one, as I once put eardrops in a patient’s eye. “It burns!” He screamed. We flushed it and it was fine. As far as ‘right patient’ I had to check their armbands, most of the patients didn’t know their names or if they did they couldn’t tell me. Most of them needed the pills crushed and mixed with applesauce, as most patients had dysphagia. That’s why the food in wards is always mushy, like eating pudding three times a day.
I had lost most of my nursing skills since working here. You don’t use it, you lose it, sort of thing. I was more of a glorified babysitter than a nurse. The most common ailment here was a UTI or pneumonia, both cured with simple antibiotics.
I made my way down the hall, finding the various residents, handing them the little white cups with their Parkinson’s meds, memory pills and mood stabilizers. Most often I had to put the spoon into their mouths for them. Watching them gum the meds down. “Why is it so bitter” they’d ask, or “no I already took my meds today.” I would explain to them they took them three times a day, they never believed me but I was used to convincing them.
Ruthie refused all her meds, which was her right. I couldn’t force her. Ruthie had a form of dementia that affects young people. She was still in the early years of it, but she had a tough road ahead of her.
Lunch was served to the residents in the common room, meatloaf and mashed potatoes with mixed fruit. Who decided fruit was a dessert? Especially the canned fruit, tiny cubes all tasting the same. The food actually wasn’t bad though, whenever a patient died I would eat their meal. My father used to say I was like a seagull at the dump on a Saturday, because I ate anything. He loved to tease me, my mother wasn’t one for joking however. She never quite approved of my lifestyle, single and not looking. But I was happy to support myself and do as I pleased. I didn’t need to settle down, to allow someone to take care of me, which is what my mother wanted most.
After I passed the trays I found Ruthie had dragged her chair out of her room to the locked doors and was sitting there. Waiting. It wasn’t exactly allowed, moving furniture around, I had to keep some semblance of order on the unit but I gave her a pass this time. I offered her a tray but she didn’t even look at it or me. Just gazing out the oblong window. She wouldn’t eat for three days.
As Ruthie sat there Derek continued his pacing past her. Derek was a young man, in his forties as well, who had severe PTSD and head trauma. He towered over me and had vacant, black eyes. One day he came into the office asking to go outside for a cigarette. I told him he knew he wasn’t allowed to leave without a chaperone. So he cornered me and got me in a headlock. Luckily I could reach the emergency button under the desk. If I was somewhere else I don’t know what would have happened. The supervisor ran to the unit and pried his arms off. And he continued pacing, like a caged animal, as if nothing had happened. That was the thing with head trauma.
His wife visited him every afternoon. He had been there longer than me. She never considered divorcing him though, she came most afternoons and they sat in the common area, holding hands watching television. He paced the halls and she would pace with him. She always bought him new clothes, she wrote his name on the tags, as if we’d think any of the elderly would be wearing Harley t-shirts or Adidas warm-up pants. He had three children who came on weekends, all of them in high school. He showed little interest in them or his wife, but they were committed to him.
As I passed the five p.m. medications Ruthie still sat by the door. Waiting. Her parents called for an update. “Oh, she’s ok, doing as expected, it will take some time, but she will come around,” I told them sounding hopeful. Her mother, sniffling, thanked me and hung up.
That evening I gave report to the oncoming nurse, telling her to pay special attention to Ruthie. “Yeah sure Kate, whatever you say,” she said rolling her eyes. She smelled of cigarettes and stale alcohol. As I walked off the unit I looked back through the window. I saw Ruthie sitting, watching me leave. I prayed she had a decent night. Though I knew, she probably wouldn’t.
The next morning I got to the unit, Nancy was leaning back in her chair, her arms crossed over her chest, her eyes closed. I don’t know how she slept on the unit. Besides being against the rules, it was incredibly unsafe. I wouldn’t trust these patients like that.
After doing narcotic count, Nancy left and I went to check on Ruthie. Nancy said she went to bed around two a.m. Ruthie was laying on top of her made bed with her shoes still on. It would have broken my heart if I hadn’t seen it so many times before. And the fact she went to bed at all, was progress. I unlaced her shoes and placed them on the floor.
Her parents called shortly after shift change and I updated them. It sounded as if Ruthie had gotten more rest than they did. As I finished passing the breakfast trays I saw Ruthie shuffling out of her room, heading for the chair by the door again. I looked at her feet, the source of the shuffling sound, she was wearing tissue boxes on both feet, the rectangle kind not the square kind. I went to her room and retrieved her shoes. I kneeled down in front of her and attempted to show her her correct shoes. She watched me but didn’t move. When I reached for her foot, she yanked it away as if stepping on a bee. “Ok it’s alright, you can keep those on,” I said putting my hands in the defensive position.
Just then one of her neighbors, Roger, came down the hall pushing his walker, the tennis balls on the bottom squeaking. His head in constant motion, as if continuously agreeing. His fragile metacarpals pushed the walker, their steep peaks and valleys looking more like talons than hands. Oatmeal and syrup dripped down his shirt, a side effect of continuously trembling hands.
“Ha, what the hell are on her feet? What is she retarded or something,” Roger asked. He had dementia and Parkinson’s, which made him walk slumped to the right. His joints twisted and contorted, it was a very painful condition. He also had a urine stain down the front of his khaki pants, incontinence was another side effect.
“Roger that’s not nice, please help Ruthie feel welcome here. You were the same way when you got here last year,” I told him. He looked at me as if he didn’t know what I was talking about. He probably didn’t. Roger was one of the sickest people on the unit, but his stubborn heart wouldn’t give in. A Veteran, Roger liked talking about the war. He even had a Veteran license plate on his walker that read "This is how I roll." The day prior at craft time he drew a werewolf in fatigues smoking a joint. It was actually pretty good, I hung it in the office.
Ruthie didn’t have any physical problems. Which felt like a cruel punishment, the people whose minds were gone being physically fine, and vice versa.
Ruthie spent most of the day in the chair again. Breaking only to use the bathroom, which was located in the hall, a group toilet. The only patient who had her own bathroom was Barbara, who happened to be the administrator’s mother.
Barbara was quite something. Beautiful, she still slept in her curlers. She would emerge in the morning in perfectly pressed blouses and slacks that her son brought her from the cleaners. She wore pearls and a gold watch. Her white hair was always perfectly pinned up. Although there was a patch in the back of her head that revealed an old pressure ulcer. Which had been healed and reinjured several times. Some times she would stay in bed for days at a time. Refusing to get up or even change position. Today was a good day though. Her cataracts had turned her eyes so opaque you couldn’t tell what color they even were. I only knew from the pictures in her room that they were a grayish blue.
She was also the only one on the unit who wore make-up, although sometimes she didn’t wear it correctly. Once she emerged with her lipstick on her eyebrows, two thick red lines over her pale eyes.
One time Barbara came up to me in the office with both her fists extended. She held them out as if for me to pick one. I picked one and she opened it, her pearl earring. Then she held out her other fist, I picked it. She opened and it was a small piece of stool. I asked Barbara what happened to her other earring as I washed her hands “I swallowed it,” she said plainly and walked out of the office.
Her room was filled with photos of her life, her wedding day, her children and grandchildren. There were photos of her riding horseback and playing the violin. She even had pictures of her pet bird, Tootie. She smiled whenever she talked about Tootie. Her memories were clearest of him, some days she didn’t know her own children, but she always remembered Tootie. Remembered or not, her son was a faithful visitor.
I set a lunch tray on a table in front of Ruthie. She looked at it and then up at me. Her parents called to check on her but I told them it would be best for them not to visit for a few days, not to give Ruthie false hope she would be leaving and then we’d have to restart the process all over again. If I hadn’t done this so many times I might consider myself cruel, but I knew it was the best way. Like dropping a toddler off at daycare with a simple ‘Bye, see you later.’ And walking away while the child wailed. Or so I’ve heard my sisters say. I never had or wanted children. Mom would be happy if I married off so she could stop worrying about me. She made me feel selfish for living the way I wanted, as if inconveniencing her. I told her she didn’t need to worry about me and she would say ‘Ha well you just wouldn’t understand you don’t have a child.’ When would that end? As if I couldn’t fully understand anything having not had a child.
Last time I saw Mom she held me at arms length, stepping back looking me over. Her perfectly pressed business blouse tucked into her pencil skirt, she lifted a piece of my hair up in her hands. “Really Kate, these split ends, it’s time a trim.“ When I would roll my eyes she would follow it up with “Oh darling, I’m just kidding,” then she’d laugh and pull me into an embrace, digging her blood red nails into my back.
At dinner time Ruthie roamed. Progress. I set her dinner tray up next to Helen. Helen was the most rambunctious patient on the unit, unable to care for herself due to morbid obesity and multiple co- morbidities. Diabetes had taken her foot. “Have you seen my foot anywhere?” She loved to ask visitors to freak them out. She was the ruler of the day room. She told dirty jokes and gambled. Of course no one had money, but to her candy was as good as any monetary compensation. The residents would bring any snack they had stashed in their rooms as Helen hustled them, which wasn’t hard to do. She would throw her head back laughing when she won a hand, exposing her four broken teeth. Her lips stretched over her toothless gums, she had dentures but she always lost them. I’d found them in the laundry, in her bed, and most often, under her, leaving her own bite mark on her ass. Her voice was gritty like sandpaper. She would pinch the staffs’ butts when they walked by. She would eye the male residents and look at me and raise her eyebrows. “I’m gonna get me some of that,“ she’d announce. Helen had pictures of all her five husbands in frames in her room. She never had children though “I was never blessed.” But she lovingly recalled all her husbands. All five now deceased.
Ruthie sat next to Helen. “Who the hell are you?” Helen asked. “Helen, be nice,” I reminded her. Helen looked Ruthie up and down. “Hey, you gonna eat that?” Helen asked gesturing to Ruthie’s pudding. Ruthie didn’t answer but slid her pudding towards Helen. And so was the beginning of a beautiful friendship.
That night Ruthie slept in her own bed. And I called my mother.