Highs and Lows

My job is one where the highs are really high and lows are really low. I think this COVID-19 pandemic has exaggerated that even further. I am not great at keeping a journal so my social media takes that place. Last time I focused on the low because I didn't want to lose that. I didn't want to look back on this time and only have the mediums and highs. I wanted to remember that it was hard. Really hard.

To give some context to my job, my retirement community sits on about 3 acres of land and serves 260 residents ranging from independent all the way to those receiving around the clock care in our skilled nursing care center. For those who are interested, here is a virtual tour of the campus. There are 170 employees providing housekeeping, maintenance, dining, administrative support, activities, and a lot of nursing care. When I was in grad school I actually lived on this campus for two years while completing an internship so this place is special to me (Link to LA Times Article). You can also look back to posts from earlier years documenting my time as a resident. When I was an intern I remember thinking that I couldn't imagine what it would be like to be the executive director. I still sometimes can't believe that I ended up back here doing the job that I was sure I didn't want.

In my last post I talked about crying on the floor of the bathroom. That really did happen as did other similar moments. The good news is that it has been 11 days since I have cried like that. I think it was just a lot of pent up emotion that needed to come out. As the executive director, sometimes I feel like I am not allowed to be afraid or overwhelmed. Well maybe I'm allowed to feel it, but I definitely didn't allow myself to show it. Unfortunately, once I let that emotion out it all came tumbling out and the truth is it kind of felt good to finally admit those feelings to myself and also to others.

But not all tears shed have been sad ones. Throughout this ordeal there have been tears of relief and joy as well as tears because I was moved by the compassion and bravery of others. Here are a few stories that demonstrate the highs.

The Miracle of the PPE

The challenges of obtaining PPE in the long-term care are widely known and publicized. Fortunately I have been shielded from this somewhat by having a healthy emergency supply to begin with, living in a state that has done a great job mobilizing supplies, and also having the safety net of working for a larger organization where I am able to share resources and purchasing power. Nevertheless, when your orders are 6 weeks late with no real estimated fulfillment date you begin to worry if your reserves will last.

It was around that time that my church encouraged us to join with other faiths in a day of fasting for the relief from Coronavirus. I also chose to add to my prayers the much needed PPE. I knew God could answer my prayers, but I was not prepared for how quickly and abundantly He would do so. Within days my director of nursing was able to use connections to obtain 5000 surgical masks almost overnight. This alone would have been miracle enough for me, but on that same day the environmental services director came to me and said, "I hope you won't be mad. You weren't around to authorize this purchase but one of our vendors reached out to me about a new supply of masks. I ordered 3000 surgical masks and 1000 N95 masks. They arrived today." I was not mad. While he was explaining this to me he was interrupted by a phone call. When he hung up he said, "Shaun, apparently the county just dropped of a bunch of masks out front. I have to go bring them in."

The Helpers

There is a quote attributed to Mr. Rogers that floats around the internet that talks about looking for the helpers after tragedy and crisis. I have been witness to that.

After our first confirmed positive employee we gathered the Care Center team together to tell them. We also took that opportunity to remind them about our procedures for how we would deal with a suspected resident with COVID. We reviewed PPE usage and isolation procedures. We talked about their fears and let them ask all their questions. You could tell that they were a little shaken. This pandemic had taken a personal turn. The next day a nurse stopped me in the hall. "Shaun, I just want you to know that if we have a COVID resident, you can assign me to them. I volunteer." I still get emotional thinking of her bravery.

She is not the only helper. There is the activities director trying to find creative ways to engage residents. My favorite is doorway dance parties which is exactly what it sounds like with resident standing in their own doorway. There is the executive assistant who took it upon herself to handle the scheduling for this weekend because, "I don't want you to have to worry about this on your anniversary weekend." There is the marketing director whose office is next to mine who regularly brings me lunches and dinners to make sure I eat. There were the two corporate nurses who came when I didn't have anybody to work the night shift. These are salaried, administrative nurses. They came and worked the floor from midnight to 8am. They were there when I was trying to figure it out. One nurse looked me in the eyes and said, "You're not in this alone. We are here for you. We've got you." And then there is my boss who lets me call him 5-8 times per day to bounce ideas, to vent, and when I feel like I've run out of options. He never complains regardless of how late I call him, and he tells me that he will always have my back no matter what. "Whatever you need, Shaun. You know that."

Family

I am grateful for the group text messages of both my family as well as Whitney's family. When I am feel stressed I can reach out to both of my families and tell them what's going on. Somebody will inevitably respond which helps me feel less alone. They also do a good job of distracting me with photos of cute nieces and nephews and funny conversation.

Finally, I don't know how I could have gotten through this time without Whitney. My work consumes most of my time and nearly all of my emotional energy. Poor Whitney, when I am home I am still responding to emails and strategizing. Whatever conversation we are having will inevitably devolve into me talking about my work. It is all consuming. Instead of complaining about that she indulges me in it while still having an innate ability of being able to calm me down. She takes my harried thoughts and turns them in a more productive direction. "Did you have more you wanted to talk about that?" "Have you considered..." "Could you instead..." Her ability to do this was one of the reasons I fell in love with her. I always felt better after talking through a problem with her.

So yes, this is hard. But it's also really rewarding. I know I made a lot of my friends nervous for me with my last post. I was touched by how many people reached out to either me or Whitney. We're ok. I'm reminded of when I came up on that same nurse who volunteered to be the COVID nurse. I found her crying at the nurses station. When she saw me she quickly got up embarrassed and tried to hide her tears. I told her "When I had nurses calling off and I wasn't sure how I was going to cover things, you know what I did? I cried. I bawled. This is hard. It's ok to cry."

She started to laugh and pretty soon other nurses and CNAs joined in recounting their experiences reaching their own breaking points with this, and somehow this led to us all laughing about it. At the end of this one CNA summed it up best. "Yeah. Sometimes you just need to cry."

Waiting

Facebook has turned into somewhat of a journaling experience to a certain degree, but like all of social media it’s a curated and filtered view. I don’t talk about the things that scare me most here, and for the most part I’m posting in the moments when I feel like I have things somewhat under control for a brief moment. Today was a good day, but the reality is this is hard. The kind of hard where I have locked myself in the bathroom and sat on the floor and cried for twenty minutes. But then you get back up and go back at it because what else are you going to do?

As we’ve had a few more employees test positive I think, where did we go wrong? How did it get here? I second guess every decision that was made along the way. And yet I know other good places with far better administrators where it happened to them too.

I calm my mind through planning. As we wait for the results of the testing we plan for the worst. We don’t know when the results will finally come. We don’t know how many asymptomatic employees will have to be sent home and how many asymptomatic residents will need to be transferred to isolations units. My mantra with the team has become “Assume you have it, assume everybody else has it too, and act accordingly.” I found out my HR director has taken that advice to heart. “I hope you’re not offended. After you leave I Lysol the chair.” It doesn’t offend me. I’m just grateful she doesn’t Lysol me directly.

Fortunately, I work for a great company that has encouraged me to start overstaffing. Double the nurses. Extra CNAs every shift. That way when the results come we will hopefully have sufficient. Right now the team is loving the extra hands, but I warn them what the plan will be when we get the results. Some of the hands will most likely go home. Those who are left will have a hard job in front of them.

Then there is all the self monitoring. Do I have a fever or is it just hot in here? Is that the beginning of a sore throat or is my throat just dry because I have been wearing a mask for two hours and really need to drink something.

I will be relieved when I get my results back this week. I take my laptop home every night just in case I’m not allowed to go back because even if I’m not physically present it will be hard not to try to help even remotely.

I’m totally inconsistent at home, something that also gives me guilt. Sometimes I mask at home especially in those hours when my Claritin is wearing off. Other times it’s hard to say no when Caleb crawls into my lap. I miss them. As it is Whitney sleeps in the living room and I sleep back in the bedroom now just in case I have it. Social distancing from your spouse is no fun.

I think the hard part is knowing that even we get through this part of the process, it will not be over. New cases could still occur. Even after stay at home orders are lifted, I imagine we will still be tightly locked.

The good thing is I have a lot of support. There is the emotional support from friends and family. My leadership team has stepped up. I have coworkers who have proactively taken things off my plate. I also see a therapist because I hope to learn things that will help me help my employees, and also because it’s hard.

Why

Today I took my turn as the weekend manager on duty. Part of the duties includes a one hour shift at the gift shop after lunch where residents can purchase anything from stuffed animals and necklaces to paper towels and laundry soap. Mostly people come in to buy a small snack and to chat. One resident surprised me with this question. "So why did you want to work with old people anyway? So many of us are mean!" I laughed and said, "I like working with people in general. Besides, the nice ones make up for the mean ones."

 Later, as I concluded my final round for the day I ran into the daughter of a resident with whom I have had meetings off and on since I arrived here four months ago. Her mom's health has been declining, and our meetings have centered on how we could best meet her mom's needs. Finally, last week I had to tell her and her husband that the situation was such that we could no longer meet her mom's care needs in our assisted living and that we needed to transition her to our care center. Needless to say the conversation was emotional and difficult and was met with much resistance. It's never easy helping somebody realize that their loved one is probably not going to "bounce back" and that the decline is likely to continue. In many respects, that aspect of my job can be more difficult than dealing with cantankerous residents.

 Although I was receiving positive reports from my staff on this woman's mother, I was nervous as to how the daughter was perceiving the transition. After initial pleasantries, I turned the conversation to her mother. "I hear the first day was a little rough, as we would expect." She responded, "It was very rough as was the first night, but I think she's adjusting." To my surprise her voice suddenly shifted with excitement as she pulled our her cell phone. "I have to show you this! They're giving my mom physical therapy." She then proceeded to scroll through photos of her mom standing and taking a few steps. "She hasn't been able to do that for a while."

 It's hard to put into words why I love this job, but those pictures tell the story better than I can. The aging process can be full of so many indignities. Just this past Thursday I had a resident tell me, "Don't ever live to 95." It's unlikely that this family member's mother will ever be able to return to assisted living, but with the proper care we were able to restore a small part of independence to her. Even if the progress is small or temporary, that alone is worth all the mean residents combined.

No title

I discovered this snippet of a post that I wrote in March 2011 and saved as unpublished draft. I don't know what inspired this or even where I was going with it, but I like it. It was true three years ago, and it's true today.

I like my job. It's frustrating, challenging, and sometimes even exasperating. There are times that I have to close my office door and drop to my knees in prayer because I just don't what else to do. I'm yelled at, I'm hated, I'm sometimes even vilified. But sometimes I'm loved and somehow that's rewarding enough to go on.

Dementia

Every once in a while I will write a piece here for my blog and then save it as a draft for months, and this case years, before I rediscover it and finally decide to post it. This particular entry was written April 2011. 

Dementia is a subject that I don't think I've ever discussed on my blog. I probably have told a few amusing anecdotes from my experiences with residents with this condition, but I think I've shied away from talking about it outright. It's not really a pleasant topic. Even those who have it will try to pretend they don't. When told that they already did something they will often reply, "I did?...Oh...I think I remember that now." Nobody wants to admit that they're losing their mind. And out of politeness or maybe fear we try to pretend its not happening either.

Earlier this week a well meaning son of a current resident whose mother has short-term memory loss bought his mother a new laptop. She excitedly told anybody who would listen about this new acquisition. I cringe anytime a relative buys a new piece of technology for their family member. Selfishly I think of how this act of generosity will inconvenience me as I am left to explain over and over to them how to use it long after the family member has left. It seems like such a great idea for grandma to have 250 channels, but the reality is that it's just an overly complicated remote standing in her way of her watching Oprah and Judge Judy. But this story doesn't end that way. It's much more tragic than that.

The next day I was attending a meeting away from the community when I received a text message from the receptionist. "Are you coming back soon? Louise had her laptop stolen." When I returned I met with a distraught resident and her son. I don't think we'll ever know the real story. One of her versions (it keeps changing) is that she went to the bathroom to do her makeup, and when she came out it was gone. I have my suspicions that she might have carried it out and left it somewhere in a public place. I saw her with it outside at one point. No staff members were scheduled to go to her room that day, and nobody has seen it. I still hold on hope that it was left in the room of an equally confused resident who is still trying to figure out what it is. I listened as both son and mother went through all stages of grief in my office, and I assured them that we would have all the staff members keep an eye out for it.

Today my phone was ringing as I walked into my office in the morning.

"Hello, Shaun. Something awful has happened."
"Is this about your laptop?"
"Yes. How did you know?"
"You told me yesterday."
"What? It was missing yesterday!? What am I going to tell my son?"
"He already knows. You and he came to my office yesterday."
"I don't remember that."

And then this conversation takes a different turn than what usually happens. Unable to deny her fears she lets out a long stream of profanities followed by a fearful, "Shaun, I'm losing my mind. I don't remember that!"

It wasn't even 30 minutes later that Louise appears at my office door holding an empty laptop box.

"Shaun, something awful has happened!"'
"Yes. Your laptop is missing."
"How did you know?!"
"You called me this morning."

This time instead of expletives, she merely looks up at me with a look of confusion, fear, and panic which all culminates into a tearful question, "What is happening to me?" Her eyes pleading for answer, I decide to go with the direct approach. "Well...Louise...you have some trouble with short term memory." It's a horrible feeling when you realize that you have just made somebody confront their own dementia. Part of you wonders if it was the right thing to do. The other part takes comfort that given time they will forget and ease their way back into blissful ignorance. We go through what ends up being a loop.

"How am I going to tell my son?"
"He already knows?"
"How do you know?"
"You and he came to my office yesterday."
"It was missing yesterday? I thought we bought it yesterday."
"No. It was Wednesday. I remember you showed it to me out front by the gazebo."
"I showed it to you?"
"Yes. It's a pretty blue laptop."
"It was blue? Well that was my favorite color.Oh my son works so hard for his money. I don't think I'll tell him. I'll just buy a new one. How much does one cost?"
"About $300, but your son already knows."
"He does?"

The loop continues for several minutes as I contemplate how to break it. Finally she does by telling me how much she hates it here and that she's going to move. I don't fight it. I've learned. There's no sense arguing with somebody who won't remember. She leaves.

20 minutes later she's back with the same box.

"Shaun. Something awful has happened!"

It's frustrating. For me it's a repeat, but for her it's fresh every time. It's hard to be as present to her emotions the 3rd time as you were the 1st time, but I try to remember that every time is her first. There are times where this can work to your advantage. It reminds me of a story of my brother and sister-in-law. When they found out they were expecting their first child they called everybody on their list to let them know the good news. They had so much fun rejoicing with friends and family at this new that they were somewhat disappointed when they came to the end of their list. Excitedly they called Auntie Annie who had dementia who was just as excited and surprised as she was the first time. Unfortunately with Louise, each time she goes through this loop she grieves at the loss of her laptop, she frets at the prospect of telling her son, and she fears as she realizes she is losing her memory.

Louise and I repeat these conversations in brief 2 more times as I pass her in the hallway. In a public space she is quicker to confabulate to cover her loss. "Oh. I did tell you.? That's right. I remember." But a short while later she is in my office for a 4th time holding onto that same box with that same statement of "Something awful has happened." In some ways it feels like the movie Groundhog Day where Bill Murray is stuck repeating the same day over and over until he gets it just right. With each loop I learn how to maneuver the conversation. We start to breeze through the loop. "Your son knows. He was here yesterday. A laptop is about $300. We'll be on the lookout. I'll let you know if we find anything. Would you like a hug?" In our 3rd loop of that conversation I'm struck with the answer. I find that key that will let me out of my loop. "Louise, do you mind if I hold onto your box so that I can show it to the other staff members to help them identify it?" I quickly hide it under my desk. I am free.

An hour later Louise shows up again, but this time it's not about the laptop. "Shaun, I love it here. I can't stand my roommate, but I love it here." See. Don't argue with somebody who won't remember anyway.

UPDATE: About six months later we found her laptop. Afraid that somebody would steal it she hid it from would be thieves, and ultimately herself, at the bottom of her underwear drawer. 

Today could have been a hard day. I mean the really hard kind of day where you sit down and reconsider your career choices. I had one of those moments today at work that made me feel like I was kicked in the stomach. Although few witnessed the blow, just as soon as it was over there was no time to recover as people were there waiting for my attention. First it was a resident looking for an answer to a question followed by an employee who innocently asked, "do you have time?". And there was me standing there with a forced smile trying to pretend that I didn't just have the wind knocked out of me. Nothing to see here. Everything is ok.

But it's hard to maintain a facade like that for too long, especially with a blow that hard. So I snuck off to my office hoping for a moment to myself to process what had happened. As I sat there thinking about the nursing home licensing exam that I am poised to take next month, and reminding myself why I started on this path and where I was going, an employee who had seen the whole thing quietly appeared at the door. "Did you want me to have [the new employee] come in now?" In all the commotion I had completely forgotten that I was training a new employee that day. When I said that I needed a moment, she said, "I saw your face which is why I came in. I know your head is spinning right now, and you need a distraction. I remembered that [the new employee] was here for training, and maybe that would help pull you out of your thoughts."

I told her that I would be ok. Three years ago when I first came to work there, an experience like that would have ruined the whole day, but now with more time under my belt I knew that this would pass and I would be ok. I explained that I loved what I did, but it sometimes had challenging experiences, and I needed to recover for a moment from this one. I went on to tell her about a conversation I had with my roommate not too long ago. After a long day I said to him, "Sometimes I wonder what it would be like to have a regular 9-5 job where I went to work, came home, and didn't have to think about it until the next day." He responded, "You'd get bored." He was right.

Why do I do enjoy this job so much when it has the power to drain me so much emotionally and physically? The answer is simple. Because it gives me more than it takes from me. There is no way I could continue if it didn't. I told this concerned employee that I would be fine. I would just have to spend more time with the residents over the next couple of days to bring me back up to where I needed to be and remind me why I do this. I've learned that my job satisfaction is directly proportional to how much time I'm spending with them.

Eventually I did call in the new employee. We spent the day talking about policies and procedures, core values, resident rights, and all the other things the law requires the I teach the employees including showing him the dreaded sexual harassment video. And it was fun. I decided to take a different approach. Instead of just sharing information, I focused on preparing him to love the residents. As we talked about each point, I shared with him stories about the residents he was going to serve. As we did our safety walk through of the building I made sure we stopped to meet each resident. "This is [resident]. Sometime when you get a chance ask him to show you his hot rod magazines, especially the one where his car was featured." "[Different Resident], this is [new employee]. [Resident] is a musician. Plays clarinet and piano." I wanted to make sure that he knew that these residents were more than just clients to be served. They were people with rich lives and rich histories.

My day ended with that same resident who came to ask me a question in the morning. Sensing that I was stressed she offered to come back later, and true to her word she did. I answered her question, and then we just sat and talked. We talked about her life, her difficulty accepting her declining physical capabilities. We talked about her neighbors including the difficult ones. As we talked I realized that I loved all my residents. The last three years I have spent more time with the staff and residents of Bethany Towers than anybody else which kind of makes us family, and you don't just walk away from your family because you had a bad day.

Being there for vs. Being with

I haven't posted here in forever. It's not that I don't have stories. They're just different. With my last job as Director of Resident Services, everything I did was with the residents. I spent very little time in my office or out in the community without interacting directly with a resident or family member. I sometimes feel like with my new job...I guess it's really not that new; I've been doing it for over two years now. At any rate, with this job I can easily get lost in budget reports, staffing issues, capital improvements, and all the other administrative tasks that cross my desk each day. To make matters worse, the work is never done. There is always something else that I should be doing. All too often, I am so busy getting things done for the residents that I forget to be there with them.

Tonight I was having one of those moments. It was 7:30pm on a Friday night, and I was still at work trying to get things done that had been on my to-do list all week--things that for whatever reason I felt could not wait another week. Contact vendors for pricing on new towels and pillow cases. Check. Finalize dining services department weekly schedule. Check. Write letter of recommendation for student intern. Check. In the middle of all this the receptionist called me to let me know that the phone was not working in the apartment of the resident who moved in today. "Did somebody check to make sure it is plugged in?" "Yes" "And it was working earlier, right?" "Yes, but now it won't dial out and you can't call it either." I hung up with a promise that I would check it on my way out.

I quickly wrapped up my work and headed up to this resident's room. He was in bed asleep already and did not hear my knocking or me calling his name as I entered his room. Normally I wouldn't have entered, but our phones are part of our emergency response system. Deciding that this couldn't wait I tried calling his name a few more times and then quietly went about my work of checking his phone. I was somewhat embarrassed when he suddenly woke up and found me next to his bed.

"I'm so sorry to disturb you. I'm here to check on your phone."
"Bless you for coming."

There was nothing obvious to indicate what was wrong with the phone, but on a whim I unplugged it from the wall and plugged it back in again. The lights flashed, and everything was up and working again. We had a brief conversation wherein I asked if he had everything he needed and whether or not the staff was taking care of him. As I turned to leave I said, "Well welcome home. I'm glad you're here." To my surprise he teared up. I got nervous thinking that perhaps I had upset him. I looked around his room. It was bare except for two items of furniture which he had insisted were the only things he needed, a bed and a nightstand. His furniture from his home won't arrive until next week. I added, "At least I hope you will feel at home here." Through his tears he said, "I do. I really do. I've always liked this place. I used to come and visit my friend here years ago. I'm 92, and now I just want to live out the rest of my life in peace here." He thanked me again for coming.

Budget reports. Worth it. Dealing with the constant changes in the kitchen staff's schedule. Worth it. Making sure they have enough clean towels. Worth it. And if that student intern gets to go on to grad school in gerontology so that she can eventually have moments like this one, staying late to do her letter of recommendation will have been worth it too.