Chapter 8/ 2007
“He is sovereign!”
My orientation at the hospice consists of tailing a Filipino nurse around the length and breadth of every inch of Los Angeles County in my 69 Chevy Malibu. Even though he has been to our cases numerous times, he manages to get lost traveling to each of them, way lost, miles away from our destination.
The price of gas goes up daily. No one I know quite understands the logic behind this. Like Pavlov’s dogs, we insert our credit and debit cards into greedy gas pumps and subtract money from our food budgets.
“Shouldn’t we be driving together?” I ask the nurse. “We can talk about the cases and you can tell me how things work.”
“I wouldn’t be getting milage money if we drove together.”
I think that is what he said.
“We could drive in your car, that would work,” I tell him.
Fingering the quarter size glass beads on his necklace, he does not answer. Or, maybe he does. He never speaks above a whisper. The patients can not hear him, I can not hear him, the low hum of his voice leaving me without a clue as to what the job entails. During my week with the whisperer, I spend seventy-five dollars on gas. After a week of an orientation I never heard, I am sent out on my own. The patient part of the gig I can do, always could, but the paperwork I can not get a handle on, being that it was never explained to me. Or, maybe it was and I just never heard it. I am working part-time and spending one hundred dollars a week on gas. Lucky.
My first patient has been transferred from a hospital in Simi Valley to a nursing home on Martin Luther King Boulevard, its location within spitting distance of the University of Southern California. In a coma, he is what we in hospice world call “actively dying.” I enter his room to find an overweight nurse’s aide in a purple midriff baring scrub outfit feeding him mashed potatoes. Nice touch, but he is lying flat in bed.
“Please stop that right now,” I tell her. “He can’t swallow. And if he could, you would need to elevate the head of his bed.”
“I was told to feed him and I am.”
I empty the food on my patient’s tray into the garbage can in the bathroom. I call his sister in Utah to tell her he has arrived safely, but that he will, at best, not last more than twenty-four hours.
“Could you do something for me?” she asks.
“Whisper in his ear that all is forgiven. Tell him I love him.”
I say the words into my patient’s ear. I cry. His unblinking eyes stare up at the cracks in the dirty ceiling. Like the sweet smelling air which floats over the pools of Bel Air, there is a fine blue mist in the room. I sit next to my patient and hold his hand. The patients on either side of us smile at me when I get up to use the bathroom.
“Where are you going for the rest of the day?” my dreadlock wearing Nurse Manager squawks over the walkie-talkie speaker of my agency issued cell.
“I’m staying here with him. He shouldn’t be alone.”
“You’ve done your job. Move on to your next patient. You’re not getting paid to see one patient a day.”
I cut off the walkie-talkie speaker.
It is President’s Day. Traffic is minimal in the City of the Angels, allowing me to visit my patient two more times before I go home for the day. He dies alone at four in the morning, surrounded on each side by sleeping roommates, their TVs blasting “Law and Order” reruns in a futile attempt to keep death out of their room.
Paperwork wise, I am not working out at the agency. I can never seem to get it straight. My inbox is stuffed to the max with forms I have spent hours conscientiously filling out, each wearing a different colored post-it note telling me to redo everything. Redo each headache inducing form. All are autographed with smiley faces by the dread or her co-conspirator, the gospel loving Nurse Manager.
To explain the clerical fiasco I find myself in, I set up a meeting with the two on a Monday morning at 9 AM.
“It’s your responsibility to ask questions if your knowledge base is lacking,” the gospel nurse says.
“I’ve asked…I asked. The guy never spoke above a whisper, I couldn’t make out a word he said.”
The dread traces the outline of the Seconal pill tattoo on her forearm with a bright blue Sharpie.
“You get too close to your patients,” the dread says. “How do you feel when you leave a patient’s home?”
“I’m not following you,” I answer.
“Do you feel like a friend? A nurse? A professional? Before you answer, center yourself and take a deep breath from your belly. Breathe out your answer.”
“What are you talking about? I just want to know how to do the paperwork.”
“You can’t be a patient’s friend and be a nurse at the same time,” the dread says.
I am lost. They must be high. It is 9:20 AM. Thankfully, the gospel nurse is not proclaiming “He is sovereign!” as she does every hour or so into our staff meetings. To address my paperwork queries, and to, as she says “Teach you how to set professional boundaries,” the gospel nurse decides to send the dread out with me on a few visits. I will say one thing about about the dread, she does not whisper. She is very loud. Gratingly so. She can barley follow a Google map printout to Koreatown, let alone explain the complicated paperwork, most likely because she has no clue how to do it.
Despite her misdirection, the dread does give me props.
We have finished our visit with a VA patient I have spent weeks working with, sitting next to him and listening to his stories as the empty air of hot Los Angeles afternoons washes over us. He does not want to die alone in his apartment. I do not blame him. Watching the bone white light crawling through his half covered windows, my eyes take in the greasy dust covering every exposed surface in his apartment. In the long afternoons we spend together, I have leveled with my patient, telling him this outfit has nothing of substance to offer him outside of daily visits. And even those are not supposed to last more than an hour. He did two tours in Viet Nam, he gets it.
“I can breathe now,” he tells the dread.
He snaps his fingers to get the dread’s attention, her glassy eyes having been transfixed for the last few minutes by the contents of a large tattered cardboard box, its guts holding huge brown VA issued bottles of Vicodin, Morphine, Dilaudid and Xanax.
“I know how it’s going to end for me. Jake told me. When the time…when I can’t get around here anymore, I’m going to the VA place, you know, the hospice.”
In the grime of his kitchenette, I make my patient eggs and toast.
“That would mean you’d have to switch your hospice benefit from our agency to the VA,” the dread tells him. “Do you really want to go there? It’s like in the Valley.”
“Try eating some breakfast,” I tell him. “I’ll take care of the details when it’s time.”
The dread and I sit in my car. I ask her about paperwork.
“You’re a light in a very dark room,” she says. “A very bright light. Let’s go eat.”
“I promised my next patient’s husband I would visit before noon and change her dressing. She’s close to the end now.”
“You’re too serious…no fun…no fun. Why are all your cases are so close together? How do you pad your miles?”
I let the dread out at the curb in front of our office building on Olympic. She stumbles over the end of her purple feather boa. I laugh as she straightens up, my back pressing against the warm leather of my car seat, my lips smiling with the realization that people who are alternative and way cool employ their hipness to camouflage their misanthropy and meanness. The dread’s boa wraps around the metal handle of the thick glass door of the building’s lobby. People walk around her to enter. They use the opposing door to exit. No one looks at her. Feathers fly in the air as the dread tries to untangle her boa. I take off for the dressing change. I will fix a light lunch for my patient. We can sit and talk about how the Santa Anas whipped up again last night.
Another Nurse Manager sits me down and explains the paperwork. She speaks clearly, what she tells me is beyond simple once it is explained and put into context. In two hours, I get it. Overnight, I am the good nurse. My rapport with our patients is admired. My colleagues ask me to help them write care plans and Medicare re-certifications. I smile beatifically. I nod my head. I never for a second consider helping them. For months, as the dread and the gospel raked me over the coals for the pettiest of reasons, my colleagues giggled and averted their eyes as I floundered, my head pounding from what I could not fit into the tiny boxes on the reams of forms jammed into my briefcase. Lucky me, not one offered to bail me out.
For the first time in months, I can pay the rent, buy groceries. Gas goes up daily. The agency reimburses the staff at forty-nine cents a mile, which does not come close to the five hundred dollars I pay monthly for gas. In a staff meeting, the head honcho, an extremely skinny woman of indeterminable age who strides the office hallways on four inch spiked heels, recites a story about how the war in Iraq is costing so much she can not up our milage rate. I fail to make the connection. Neither do any of my backstabbing colleagues.
“He is sovereign!” screams the gospel nurse.
No one else speaks. I should pad my miles, but I don’t. Instead, I look forward to seeing my patients. I like sitting with them. And they with me. We are lucky that way.
The end of my stretch with the hospice begins on a Monday, when I enter a board and care set-up in Burbank. My patient was transferred there the day before from an assisted living facility. The whispering nurse told his family he needed caretakers twenty-four seven. He did not require any such thing, but luckily for his family, several of the whispering nurse’s friends were caretakers. Imagine that. They took every shift. At top dollar, off the books, under the table. The vampires drained the family of the money they had put aside for their father’s end of life care. Now, two years later, when he truly needs caretakers and not vamps who obsessively Purell their hands, all his family can afford is a board and care, which is really just a board, with minimal care.
The place is a fortress. Iron bars and gates painted a bright white barricade every window and door. I ring the doorbell and pull out my paperwork. It takes a good ten minutes for a caretaker to make it to the front door, another five to locate the keys which unlock the door and the gate in front of it.
On that Monday, I walk in through the back door. Lucky me, somebody forgot to lock the place down. I live for unexpected entrances. A Filipino caretaker is shoveling pureed apples and pears into my patient’s mouth. Twenty years ago, my patient had a series of debilitating strokes. Eating is a slow and difficult process for him. The lumpy thick grey concoction is dribbling out of the sides of his mouth and pouring out of his nostrils on to the floor. The facility’s three caretakers are speaking Tagalog to their English speaking patients, who on a good day, when the television is not screaming Tagalog at them, are confused and disoriented.
I turn the incomprehensible saga of “Impostora” off. I sit the caretaker down.
“Let’s role play,” I tell him.
I place my hand on his forehead. My eyes on the blank television screen, I shovel food into his mouth, not giving him a chance to breathe or swallow. My acting classes have taught me well, I am the perfect mirror to reflect his actions on. He pushes my hand away after a few seconds.
“How you get in the place?” he asks.
“Ce n’est pas la question,” I say. “Laissez nous manger encore plus.”
“What you doing? Why you speaking language I do not know of?”
Pureed pears drip onto the caretaker’s lap.
“If I ever catch you pulling this crap again, I’ll have this place closed down. And I’ll put you on a plane back to Manila myself.”
That Wednesday, I tell the dread I am taking a week off at the end of the month to attend Teachers Training Academy. I have been hired by the Los Angeles Unified School District to be a substitute teacher in the fall.
“Don’t you like have to have a degree for that?” she asks.
She still smells like kitty litter.
“I have a B.A.”
“You have to be smart to be a teacher,” she says.
I’m getting out. She’s not.
“Breathe out from your belly and wish me luck,” I tell her.
An hour later, the dread and I are sequestered in a conference room for the weekly interdisciplinary meeting. No windows, fluorescent lights flash at a seizure inducing clip from above, the table we sit at is too big for the room. The overweight nurses experience great difficulty squeezing into their seats. Everyone, except me, is eating donuts. When I went in for my pre-employment physical for the school district, my blood pressure was elevated.
“Are you stressed?” my doctor asked me.
I laughed for a good five minutes, then proceeded to lose twelve pounds. Changed my diet, went to the same nutritionist Maria Bello swears by. No more soda, coffee or meat. I begin to eat unprocessed foods, fresh fruits and veggies. It’s expensive, very expensive, but in six weeks, I am thin, my blood pressure is normal. Glares are thrown my way when I push the donut box away. Two hours into a three hour meeting, I drink my protein shake and relate to my fellow captives in the strobe lit room the feeding scenario I witnessed Monday morning.
“Those workers are Third World people…mostly women. They do what they’re told,” a nurse sitting across from me says.
Her eyes flash daggers at me.
“The guy was pushing food into my patient’s mouth. He’ll probably develop aspiration pneumonia.”
The dread pulls on one of her dreads. It falls onto the table. Maybe she is on chemo.
“I promised him when he transferred there I would watch over him,” I say. “I told him nothing bad would happen to him.”
“Why do you make their lives so hard?” Dagger Eyes asks. “What pleasure does it give you?”
The mouths around the table bite into their donuts.
“What would you do if your father was treated that way?” I ask.
Trying to move her chair away from the table, Dagger Eyes does not answer. Being too heavy to accomplish it with one move, she uses both hands to push as hard as she can against the chipped formica. Unable to manage this simple maneuver, she picks up her fourth donut.
I read a flawlessly composed Medicare re-certification to my hostile audience as the lights pop intermittently, the deep spirituality of it all surely signaling to the gospel nurse to proclaim my sovereignty. Her mouth is wrapped around a cruller.
Thursday afternoon, our well-known movie star patient dies after a long illness. The dread goes to his house to pronounce him dead and dispose of any remaining narcotics, of which I am certain she flushed down the toilet. The toilet of the graffiti blemished lunchbox she uses as a pocketbook. Odd how when my VA patient died, even though he was no longer on our service, she managed to go to his apartment to dispose of his narcotics. Word is the dread told the movie star’s family she does not like taking care of entitled rich people, how turned off she is by their rudeness and insensitivity. The movie star’s body is still warm when the dread says this, his family gathered around his deathbed, crying and holding hands, their hearts supporting the star’s wife, who was married to her man for over forty years. And he was not even gay.
That same afternoon, my board and care patient develops aspiration pneumonia. He takes to his own deathbed. The caretakers sit at his bedside where, like an endless loop of the execution of Daniel Pearl, they watch repeats of “Impostora” through the night and into the morning.
Friday morning, I come into the office early to pick up supplies. The dread’s door is closed. The staff walks around slowly. No one looks anyone in the eye. I load my trunk up with diapers, bedpans and urinals and drive to Burbank. I park and check my work text messages. The dread had been fired. I do not call her and wish her well. I wish only that she takes a shower and gets with the program. Or at least calm down her overactive MySpace page. Hell, she is only sixty.
I make it through the gates and the bars to my patient’s bedside. The caretaker turned off the television when he heard my heels tapping on the hardwood hallway floor. My patient is breathing at a rate of sixty a minute. Normal is sixteen. His skin is blue. His eyes dart up to the ceiling and then back to the wall in front of him. I take the remote out of the caretaker’s hand and turn on my patient’s favorite XM music channel. Big band music beats into our heads. I place drops of morphine and Ativan on the insides of his mouth. The rate of his respirations decrease.
“I’m sorry you were placed here,” I tell him. “I didn’t know…I didn’t know.”
He closes his eyes. I hold his hand.
Her black eyes spinning in their sockets, the facility’s administrator enters, sweating under her arms like a pig desperate for a trough. She was pretty when I first met her, this morning she has become butt-ugly beyond words.
“Why are you giving him those drugs?” she screams. “You kill him.”
“Let’s have this conversation in the hall,” I answer.
“You the terrible person…the terrible nurse. I do not respect you. You trying to kill the old man.”
“Let’s take it outside.”
My patient opens his eyes. He begins to cry. I squeeze his hand tighter. I leave. The administrator follows me, chanting that I am “the killer one,” followed by her accusations of my having abused her staff after I “broke” into the facility on Monday. You can hear her screeches in the hills of Pasadena.
“He’s dying,” I say. “You do understand that?”
She rants for a good five minutes about the quality of the diapers the agency supplies.
“No matter what you think of the diapers, he’s dying. He’s dying because one of your employees forced food into his mouth when he couldn’t swallow it.”
“You can’t go in his room,” she says. “You can’t touch him.”
“At this moment, I’m the one with the license and the training. If you block me from seeing my patient, you are breaking the law.”
I arrange for continuous nursing care until my patient dies. The administrator stands in front of my patient’s door. Her arms are folded. She stares at the floor. I sit quietly in the living room until the shift nurse arrives. I explain the situation to her. The administrator leaves. I go into my patient’s room to say good-bye. Breathing at a rate of twelve morphine induced breaths a minute, he is sleeping, smiling for the first time since he arrived at this gated palace of compassion. I kiss his forehead and leave. My patient dies the next morning before dawn.
The following Monday, I tell the hospice’s manager I am going to report the board and care for elder abuse.
“Do what you think is right,” she says.
“You with me on this?” I ask. “Can you give me the number for Adult Protective Services?”
She fingers a paperweight on her desk. In its center is a goldfish, whose eyes hold the same terrified look my patient’s did when he fought to breathe.
“I don’t know the number,” she says.
We both look out her window to the traffic on Olympic.
The next day, the gospel nurse cuts my time from three days a week to one. And the one is a maybe. The agency on Sunset offers me a case. Two ten hour shifts a week. An assisted living facility in Toluca Lake, where several of my hospice patients roomed, offers me a part-time job. A fifteen minute drive from my apartment, it pays top dollar. No more one hundred and twenty-five dollars a week for gas. I quit the hospice.
For a day–an entire twenty-four hours–I am weightless and free as the air in Los Angeles teases me with its touch.
I wake up in the morning to the odor of rank kitty litter.