You can always tell when it’s coming.
Their breathing will become faint and irregular. They will phase in and out of consciousness. Their extremities will turn purple to the point that their skin changes color slightly, and their heart rate will waver back and forth. You know when its going to happen.
“I’ve seen way too many people die.”
Bobbie’s grandmother lived at home till the day she died at the age of 102.
Just this past November, Bobbie and her family all gathered at her grandmother’s home to be with her in her final moments. For Bobbie, this was not her first time experiencing death. She had known what to do many times in the past, but this time was different. This was the first time a family member neared their death.
Bobbie and her family took turns and different shifts to help care for their grandmother in her final days. Bobbie was the night shift.
Around 3 a.m. one pitch-black night is when Bobbie began to see the signs…
Her skin color changed, her breathing was queer, and a faint odor of death was being produced by the chemicals breaking down in her body. But Bobbie was prepared for this, she had seen way too many people die before to not be.
She woke her family and began comforting them with details, preparing them for what was about to unfold.
She tells the other family members, “this is going to happen, then this, then she’ll take a huge gasp, and then she’ll be gone.” Bobbie helps to ease her family during this difficult moment.
At about 5:00 a.m., “I knew it, she took that big gasp… and I said ‘It’s okay Grandma’…”
“And that was it.”
Death is the most inevitable thing in life, it is the only thing which is guaranteed. Throughout history, and even through to today, death is something that is greatly thought upon. It’s something about which I ponder, and I’m sure it’s something you have thought of as well.
What will happen when I die? Where do we go after?
They’re all valid and intriguing questions, one’s that we may never come to find out. And out of all of the possible “what if’s” someone can think of, there is one which stands out the most: Where do we go to die?
There are roughly 1.4 million American residents in the nation’s 15,600 nursing homes across the country today. With a growing population of elderly, this number is bound to get bigger. Many of these facilities, with names like Lodge, Manor and Plaza, can often put on the façade being exclusive and comfortable living spaces for the elderly, sick and dying. When in reality, they are all at their core the same.
These are places you go to die.
Between Alzheimer’s disease and dementia, blindness and loss of hearing, there are numerous reasons and diseases which cause people to end up in places such as these. Often times, their sicknesses are too much for a family to handle, and they have no other option but to send them to a nursing home. Many times, they don’t have any family to care for them at all.
These places are habitually one’s with sad, old and worn memories, carried by old and frail individuals who occupy the rooms and spaces up until their lives come to a close.
Between these individuals, their lives and illnesses, their impending deaths, their complicated histories and families, there is one individual at these nursing homes whose occupation is to manage and find balance to all of these heavy and daunting personal complications. There is only one kind of individual, who has the training, the empathy, and the expertise to guide someone through the final moments of their lives, and help them to not only do so peacefully, but do so with happiness and contentment with one’s life: and that is the job of a caretaker.
And Bobbie is one of them.
Bobbie began her career as a nurse’s aid at the age 18, working for six years at O’Brien healthcare and retirement home in a small town in Northeast Ohio. She’d been working on her prerequisites to become a nurse, but was finally able to get her clinicals done and earn her degree as a nurse by the time she was 25. Bobbie, who works as the supervising nurse for the retirement home’s mental support unit, remembers a time before that part of the building’s construction.
“I was kind of a shit-starter back then” Bobbie says, relating to her go-getter attitude. O’Brien supposedly had no full-time openings, “but they ended up caving in and giving me a spot.” Bobbie also tried her luck working at LifeCare for a short period of time. She enjoyed the position, but when the schedule became too complicated, she went back to where she knew it best. “So I cut ties there and stayed where I already had six years in.” Bobbie returned to the comfortable and consistent little retirement home in Ohio.
For the next few years Bobbie bounced back and forth between different units in O’Brien starting in 2003, working with different levels of residents along the way. She’s worked in units like hygiene and other, much less glamorous positions – “I’ve paid my dues!”
Bobbie started her career working the day shift, but switched to nightshift when she became pregnant. For a short while though, after her pregnancy, Bobbie left O’Brien and began working full time in Cleveland for a psychiatric facility which helped mentally ill criminals.
For almost the next two years, Bobbie worked with various patients who were sent to this facility after being deemed mentally unfit for trial or jail. They were sent to places such as these until they were again mentally fit to do so.
Bobbie refers to this place, hypothetically, as prisoner purgatory: not quite in the official system, but still much more terrifying than the older residents of an average retirement home.
She dealt directly with people from jail, still in their orange uniforms and assigned flip-flops. Many were still handcuffed. During her time here she took care of murderers, rapists, pedophiles and all the like. The stakes were high but many of the people were in serious need of help. It was here that Bobbie began to learn some of the harshest lessons as a caretaker.
One day, Bobbie arrived at the facility to find out something horrible had happened. A therapist who had been working with one many of the patients at this facility, had went into a room to speak with a paranoid schizophrenic man the day before. This man mind you, had just come from prison.
Bobbie learned that during their conversation the therapist treated the man very poorly, insinuating wherever she could, the ways in which she was better or more adapted than the man she was speaking with.
Infuriated and unstable, the man grabbed her head and threw it with all his anger against the room’s wall. Bobbie wasn’t present, but returned to that room the next morning to find an oval-shaped dent still carved into the wall where her coworker’s head had been slammed. Bobbie quickly learned what will happen if you treat mentally ill people like this.
Bobbie thought to herself, especially after being at the psychiatric facility, that most of these people, who were in no doubt very bad people, didn’t come from the greatest of circumstances to begin with. Many of those who are now mentally unstable and violent, are so because of their often harsh upbringing. Bobbie learned from taking care of individuals like this. For the first time, Bobbie began to make the connection that people back at O’Brien’s deserved to be treated with the same caution and care too, many times for the same reasons.
But the pressures of the work environment began to mount at the psychiatric ward. Bobbie prepared to move on, and thought to herself, “I need a home, some place I can actually call home.”
Bobbie, as she always has, returned to her home at O’Brien after hearing of an opening for a supervising nurse position for hallway 900, the memory support unit. She took the position and has been there ever since.
This specialized unit is in the very back of the O’Brien retirement building. It is closed off by a set of large alarm doors which remain locked at the end of the residents’ hallway. This ensures theirs and others’ safety, as they are often more difficult to take care of due to their quickly deteriorating mental health.
There are 24 residents who live in late 90’s-styled nursing home. There are twelve rooms in total, two residents in each room, and a common area/cafeteria at the opposite end of the hallway from the doors. Large sets of windows are placed on both sides of the large common area room, letting the outside in from both angles.
Often, the weather influences the small group of slow moving residents; if it rains and is dreary outside, then the residents match it by being uniquely quite and calm. If it is bright and warm outside, they seem to always be more active, doing tasks like painting bird houses in the craft section or building large 1000-plus piece puzzles.
Throughout a normal day Bobbie often makes rounds of standing in front of a white rolling cart set up to the side against the square-long desk in the middle of the room, an area where the nurse’s computers, files, and copy machine sit. She stands with excellent posture, her pony tailed tied back as tight as her shoe laces, her gaze decisive and sure.
The common area is lit like that of a hospital, dull but with an iridescent glow, which fills the room. The cabinet that Bobbie is in front of, sticks out unbelievably compared to the rest of the room’s décor of bright and paisley colored and patterned furniture, carpet, and walls. It’s the only piece of equipment that doesn’t seem “home-y.” It’s solid white like Bobbie’s scrubs, clean of any markings or spills. There are at least ten or so drawers on one side, all with locked key holes.
Bobbie stands in front of the drawers scanning the room of elderly, who sit around the several tables and chairs about the room, as she flips through the set of keys she has in her hands. With no second thought, or look for that matter, Bobbie is able to navigate the drawers throughout different times of the day, and distribute medications correctly to each of the residents. “I don’t have to think about it any more, I know who needs what, when.” A talent which comes from years of experience.
“When you sit back and think about it, it’s a lot to be responsible for. You don’t think about it when you’re doing it but you kind of step back every once and a while, it’s like I look over all these people, and the staff, and any issues with family. Thank god it runs pretty smooth 99 percent of the time!”
Her experience may go undetected to the normal eye, as her confidence and sureness of her caregiving abilities seems to be more of a natural part of who Bobbie is, rather than something she is pretending to be. “We have a good thing going back there.”
Karen, another caretaker at O’Brien, just announced her retirement in early January, and with her announcement came cause for the group to celebrate, back in their small, quaint corner of the world. Bobbie and the other caretakers all get together over the following week, collecting decorations, to hang and place all around the room in order to give Karen the perfect surprise retirement party.
That evening, Bobbie and all the residents made their way to the party-ready common area, to surprise an unaware Karen. Once the party kicked off from Karen’s arrival, music began to play. They only had a small collection of CD’s but soon Elvis Presley and Sinatra began to play from the small grey CD player on the countertop in the kitchen. And to the surprise of Bobbie and the other caregivers, many of the residents who are often antsy and out of sorts every day, began to rise up out of their seats and put their all into dancing to the classic tunes.
You make me feel so spring has been sprung,
and EVERYTIME I SEE YOU GRIN,
I’m such a happy, individual…
They all sang along to Sinatra. The part of the brain which is effected by diseases as some people age, is not the same as the part of the brain which stores items like art and music. And although the entire room would probably fail a quiz on a recollection of the day’s events, or fail to identify the person they just spoke to less than five minutes ago, they could all sing along to each word of Sinatra.
Bobbie started to join along with the dancing and singing, grabbing one of the residents, Lou, to dance with. He twirls her around as an unexpected Bobbie laughs and sings along.
More, much more than this,
I did it my way.
The residents sang as if they were back in high school, going to their first school dance together, or rollerblading back at the rink. However, they now move at perhaps an eighth the speed that they once did, but this doesn’t stop them.
They were all able to recall moments like these and others, memories which were attached strongly to these songs from their youth. Of course Bobbie and the other caregivers were happy the occasion was so uplifting, and Karen was even happier about her special send off. However, this was not Bobbie’s first time experiencing a farewell at O’Brien.
Many nurses and aids around the world deal with the intense and destructive diseases and sicknesses that poison the elderly both physically and mentally near their deaths. Many, or nearly all, have experienced a patient passing at some point or another early in their career. For Bobbie, this was not the case. She didn’t experience death until after over a year of work.
When Bobbie was around the age of 20, something odd began to happen to one of her patients. Signs were beginning to show that she was nearing her death. Bobbie was trained for these moments and, realizing that it was finally happening, began to go to work within the confines of the small, two person living space. She goes through the careful routine of keeping the resident clean and turned, and cared for in these final, fragile moments. “It’s never good. It’s never happy.”
The resident’s husband, in the past, was always at the retirement home. He would eat lunch, help care for her, and keep her company as often as he could. Bobbie became close with her patient’s husband, as he was there visiting her constantly.
Night had come and Bobbie began to see all the signs she had been trained for, her breathing became irregular, her skin color began to change. Around 3:00 a.m., Bobbie grabbed all the tools necessary to assist in the resident’s imminent death. She was prepared with morphine for when the resident started to actively die. It puts them in comfort and helps them pass.
The lady’s husband however was at home, and Bobbie knew it would be nearly impossible for him to arrive before she passed. “We know these people are elderly themselves and they rely on other people bringing them in to visit. He knew she wasn’t well…”
Bobbie’s patient passed away right in front of her, she took a big gasp, and was gone. Bobbie remembers a single tear rolled down her cheek. She knew this was likely the cause of just some physiological thing, but was still taken aback by the experience. It bothers Bobbie to this day.
The resident’s husband never arrived in time.
A long time after seeing her first death, and Bobbie continued to persist and help those in need at O’Brien. She had now experienced many more deaths throughout her years. One day, like always, Bobbie noticed a resident of hers, June, began to not do so well. She was not actively dying but wasn’t coming around like she should of.
For a day or two, June’s family all came to visit her, hoping and praying for her good health. One day however, when Bobbie came in to work, June snapped out of it. She sat up in the bed and started talking with all of her family and the other nurses. It seemed like June was recovering promptly.
The daughter, seeing her mother’s obvious and drastic change in attitude and health, asked Bobbie if she thought it would be OK if she went home and showered, to which Bobbie replied of course. “Go home and get showered and come back,” Bobbie told her. Not ten minutes after the daughter left, the resident died. How else was Bobbie supposed to know?
“You’ll have residents that are dying and they’ll have a room full of family and they hang on till the last one from California flies in and they pass. Or, they wait until everybody leaves the room, they’ve all been there a week, and everyone leaves and then they die.”
“It’s their call”
Bobbie points out Fiona, a petite black woman, who’s eyes are drawn in to the black and white John Wayne movie playing on the flat screen across the room. The screen is hoisted above a dirty fish tank, containing only one goldfish which moves about the murky water. The tank sits next to a billboard with photos and facts of all the residents living in Hallway 900 labeled with the title, “Welcome to our Family.”
“Fiona used to be the head supervisor of Oberlin College’s cafeterias,” Bobbie says.
The residents will normally receive their meals on large carts about six foot high with rows for trays to slide on and off of. On each tray there are always various items from what food the kitchen is serving that day, to other special orders or amounts given as medically needed.
Fiona rises out of her seat, bracing herself with the edge of the table. As she does, she forgets where she’s at and begins to help collect the dishes and stack them back onto the carts.
“It’s a funny thing, she’s always trying to wash the dishes in the kitchen,” Bobbie said. She will walk straight up to others still eating their meal, and yell at them to finish in order to collect their dishes.
Where most caretakers would become irritated by a resident doing this, Bobbie goes along with it, helping to at least mitigate Fiona’s yelling, but still actively motivating her to continue helping them collect and stack the dishes. Bobbie just wants each person to be happy.
Today, Bobbie has a large family, with three sons of her own, brothers, and nephews and nieces. There has been a lot of new life surrounding her, ever since the passing of her grandmother.
She has admitted she doesn’t desire to move up at all in the caretaking industry, as she now seems content to simply watch her children grow, and be with them. She hasn’t taken many vacations during her time as a caretaker, and always feels a bit guilty when she isn’t with her residents. She has always had a second home at O’Brien.
This past Easter however, Bobbie went on a rare vacation with her husband and boys. They traveled to Texas to visit her brother and nephews. For her career, Bobbie is tasked with one of the most difficult jobs of taking care of the elderly, and has seen death up close and personal. And although one would assume at this point Bobbie fears nothing in this world, she admits she is terrified of flying. “I can just never get used to it!” But Bobbie had more pressing matters than her fear of flying. Her brother had just had a baby girl, and Bobbie still had yet to meet her for the first time.
“We got in at night, and she was a little sick, so I didn’t get to meet her till the following morning.” But sure enough, the next day, when little Findlay was feeling better and was awake, Bobbie was finally able to hold her baby niece. “She has just the bluest eyes,” Bobbie huffs in adoration. Its moments like these, which Bobbie really appreciates. After experiencing death so often, its revitalizing to reacquaint one’s self, with where life all begins.
After being a caretaker for so long, Bobbie has learned the ugly truths to many of the residents’ apparent family issues, and often times rather rough pasts. She empathizes with those she takes care of, realizing that there’s no sense in someone living a tough life, only to end up in a place where people treat them badly when they’re most vulnerable, regardless of what their sins were during their lifetimes.
“It isn’t for everybody,” it takes great patience. A lot of people are too controlling, and too non-empathetic. “You have to be calm, and treat them like human beings, like any other person.” Sometimes you’ll hear nurses say to the residents in memory care, “what are you doing?” and, “where are you going?” and its puzzling, “they don’t even know where they’re going, how’re they supposed to know?”
At it’s core, retirement and nursing homes are places where people go to die. Bobbie herself has seen far too many people die during her career and lifetime. But Bobbie’s view is everything but that.
She engages the residents more, and allows them to be themselves and be happy, rather than be sheltered and aggressively micro-managed during one’s dying days. Bobbie is the driving force of these crippled and forgotten people, to live their last days to the fullest they can. Under Bobbie’s personal care, rather than dying, all of the residents will learn to live.
ImJesseo 