SHIFTING AND ROTATING (Nursing Home Life, part 12)

Institutional life has a rhythm. You fall into the groove of it after a while. It picks you up and carries you along. There are things you like and things you don’t. After a while, there are things you take for granted. Twenty-one months after we moved into Laurier House, I find that my emotions twist and turn with unwavering fidelity. I love every third Saturday, when an omelet is served at lunch. I un-love (hate is such a strong word!) every third Wednesday because the dining room will surely serve up plates of cabbage and corned beef. I’ve learned to savour many new flavours over the years, but I don’t think I’ll live long enough to acquire a passion for corned beef. At Laurier House culinary variety pivots on a 21-day rotation. Twice a year they shake up the rotation. Through it all, the cabbage and corned beef has remained. Staffing also has a rhythm, less predictable on a small scale, more so for those of us who’ve been here a while. I’ve taken a particular liking to the evening shift every second month. To be clear, it’s one of four shifts of staff that meet David’s on a daily basis. There’s night, morning and afternoon in addition to evening. The rotations on the other three shifts work differently, though I’m not sure just how. For now, in the interest of simplicity, let’s stick with the one I’ve figured out. You might want to skip the next few lines if you don’t like numbers, or if shifting and rotating makes you dizzy. Laurier House has approximately 80 residents and is divided geographically into four sections. We are on first floor, east wing. Every two months the evening staff move to a different section. They rotate in this fashion until each team has served all four sections. Then they return, eight months after the last time they returned. We are currently experiencing our 11th version of this rotation so we are seeing some staff for the third time. Given that this is their third exposure, they should be able to use their previous experience to show them how to care for David. But wait! David changes a lot in the time it takes to complete a full rotation. Each time they rotate through, they see a different version. His needs are more specific and his ability to express them more limited. David was able to stand up the first time they helped him. He was still eating in the dining room on their second rotation. This time, they are bringing our supper and turning him in bed. Each shift rotation brings a cast of characters, some working full time, some part time and some casuals. New people keep popping through our door, wondering what to do. The process of retraining goes on for a while. I like the second month of every rotation because, by the time a month of trial and error has passed, the care-givers have figured out how to help David. The current crew is learning that David wants his heels on a pillow, his left elbow on a pillow and his head on two pillows. They know that his pills need to be crushed and he can no longer tolerate cranberry juice. They know how to brush his teeth without causing him to choke on the liquid. They know that the shirts he loved to wear at bedtime the last time they knew him have been replaced by hospital gowns. They learn by doing. On the first half of each rotation, David is an experimental phenomenon. On the second month of each rotation he is a person they know how to care for, someone familiar and special. Living an institutional life presents us with many opportunities to second guess. It’s easy to complain about things you can’t control. In general I try to avoid it. On the emotional roller-coaster I ride here at Laurier House I sometimes find it difficult to tell which issues should be addressed and which should be ignored. Take the cabbage and corned beef, for example. It’s presence on the menu affected us differently. David likes corned beef. This is his big chance to have it on a regular basis. You can bet I never cooked it for him. What kind of wife would I be if I asked to have it removed? But then there is the issue of staff rotation. My views on the subject are guided by emotion. I keep remembering the dislocation we felt during the first few weeks of our stay here, and how we began to feel more at home as care-givers came to understand David’s needs. I also recall my disappointed surprise when, without warning, a cast of untrained characters replaced the familiar ones and started the process of dislocation all over again. I hoped I would come to accept these changes as an institutional necessity, possibly an inconvenience. I had hoped I would get used to re-experiencing the feeling of being strangers here. But I never have. Home in this phase of our lives is a suite in long-term care, where we watch David’s health slide slowly with dozens of care-givers shifting and rotating around us. we have met many care-givers who are generally interested in doing the best work they can do. Familiarity with the best possible job appears to breed empathy, competence and loyalty. I feel sad that the system is so obviously organized to discourage familiarity because those who are familiar with David’s needs are so much more capable of making him happy. I appreciate the second month of every two, when familiarity on the evening shift takes the place of experimentation. I dream of a system that would value familiarity, a place where the staff wouldn’t rotate, where David would only be served by familiar staff on four shifts, maybe as few as three shifts! I like to think it could happen, and would happen if only the people who organize our systems understood how it feels to be helped so uncertainly so often by so many. But now, accepting things as they are, I care for my own mental health by making a point of noticing the day on which the reassigned care-givers cross the bridge from uncertainty to familiarity. “Will you be back tomorrow?” I ask them hopefully. In the up and down rhythm of institutional life, it’s a good day when they say they will.