The Story of Thomas - Better Grab Your Kleenexes
Posted 04-25-2008 at 03:10 PM by totallyforgiven2
Updated 04-25-2008 at 04:28 PM by totallyforgiven2
Updated 04-25-2008 at 04:28 PM by totallyforgiven2
Thomas was an 83 year old individual, who looked like he was about 60. He was one of our behaviors, because if he didn’t want to do something, even when you ask him nicely, he would beat his head with both hands. Anyway, he did get esophageal cancer, by the time they found it, it was too far along. It could be challenging to get him to eat, you would almost have to trick him into eating, because it was hard for him to swallow. Because of this, they put him on a ground texture diet. I would fix him some toast, I would then spread his ground meat on it & call it ham salad & then tell him it was there when he was ready to eat, well, he would walk by & look over at it, and then go to restroom & then come back and look at it again, the next thing you know, he would sit down & eat the sandwich, when he ate most things he would actually gag on them, because of the phlegm , but when he would eat the sandwiches I made with toast, he could eat the whole thing & it didn’t bother him. I think it was probably because the toast help clear out some of the phlegm, therefore he wouldn’t get choked, sometimes it would be almost an hour, but he would eventually sit down and eat it, I was one of only 2-3 people who could get him to eat. If you complimented him on eating while he was eating, he realized that you were watching him & this would make him mad, and he would quit eating, so you always waited till he was done and then ask him how he liked it, and he was say good good.
One time he was going to have a cat scan & was suppose to drink this chalky stuff. Well, The LPN tried to get him to drink it, so he started hitting himself, so she ask me for assistance. I went in & ask him to drink it, and he started hitting himself again. So I started talking to him about things he likes, such as: going to a Pittsburgh Pirates ballgame, buying new clothes, going to visit his brother, etc. The LPN then handed him a cup of the stuff to drink, he then took the cup & started drinking it, she then game him 2 more cups of the stuff to drink, all the while, I kept talking to him, you see, he forgot that he was mad & didn’t want to drink it, because I got him relaxed and talking about things he liked. I also got him to get on the scales to get his weekly weight, which no one else had been able to do for a couple weeks. I also went with him, when he had to have some iron pumped into him, via an IV, I kept him relaxed & there was no self-abuse, even though he had to sit there for almost 2 hours.
Another time another one of my co-workers & I took him to another hospital to have a pet scan done. Anyway when we got done I ask the other staff member if they wanted to stop & get something to eat, if he wanted to, she said only if he wanted to, so I asked Thomas and he said no, but just as soon as we got on the interstate, Thomas, said “EAT, EAT”, he had a limited vocabulary, when he said that, I told the staff member, we would stop at the closest restaurant and get him something to eat(this was against policy – there is this policy that when an individual, who doesn’t like doctors will be pre-medicated, this helps them relax & be a little more cooperative, you are not allowed to let them eat or drink till you get back, and they are checked out by nursing), we could have gotten fired, but he was to the point that when he said eat eat, you got him something to eat(wasn’t ground texture, which was what he was suppose to have, so I told nursing when I got back that I did stop & get him something to eat. I said we watched him closely & if he would start having problems, I would have ask him to save the rest for later, but he ate that better than he had eaten a lot things in a while.
Better grab your Kleenexes, this next part is hard for me, & will probably make you teary eyed. Anyway, they did put a shunt in his esophagus, but it collapsed, so he basically wasn’t able to eat much, because the cancer was where the esophagus hooks to the stomach. By then Hospice was in control, which was good, because, as you know, states like to control things & where I work is a state run facility, anyway, they told my employer what drugs to give him & how often & they had to do it the hospice way. Anyway, he got so sick, in such a short time, he went from being pretty independent, as independent as you can be,
, to total care in less than 2-3 weeks. When hospice took over, they told us he had 6-8 weeks, he lasted 6 weeks. From when they found the cancer, to when hospice took over, was only about 2 months. You can have up to 8 individuals per one staff, the really bad behaviors can be on a one-to-one, or if they are deathly ill, he was a one-to-one, so we would take turns of taking care of him. To try and make a long story short, I was with him his last day. I was taking care of him, & he was to the point that we knew it was just a matter of days, anyway, even though he looked like he was sleeping he would make small gestures, when I was talking to him, I was talking to him about his family, going to see the Pittsburgh Pirates, etc etc. Hospice came in every day to take his vitals, along with our nursing staff doing them, also to check & see if there was anything we needed too! Anyway, the hospice nurse came in and try to take his vitals, she tried like 10 times, but couldn’t because he was breathing shallow and heart beating slow. While she was doing her paper work, I went back to talking to him, rubbing his forehead, head, stomach, etc and she said do you hear those small sounds, I said yes, I ask if they were moanings because he was in pain, she said no, that is his way of communicating to you and his way of confirming that he is enjoying your voice and love for him and the human touch. I stepped over by her and I told her, I wasn’t sure if he could hear me, but I would rather talk to him for hours on end and him not hear anything, then not talk to him, and him hear everything going on. She said there needs to be more people like me(not telling you to brag, but just telling you what she said), that are not afraid to touch them and willing to talk to them and show feelings. He was on mega doses of high powered pain killers, most were not for pain, because he truly wasn’t in much pain, but were given to him, to keep his heart from racing. He had 3 different pain patches and also given a shot of morphine every hour his last day. When nursing came in, they would have to check respirations, they had to be at least 24, or they could not given them to him. I thought, geez, he is dying, what does it matter, but then if they do go against the rules and give it to him and it killed him, it would be murder. Hospice was having trouble getting his vital signs. Anyway, nursing came in around 2 and took his respirations and she said he definitely has 7, possible 10. Because she wasn’t our regular RN, she went and got another nurse and had her check and she came up with the same thing, even though she did not know what the first one came up with. So they said, at this point we can not give him anymore, but that if he showed signs of pain, we can give him some Tylenol. So they left and I went back to talking to him, and rubbing his head and about 10 minutes after they left, he took a deep breath and that was it, there was another staff member who was in the cottage also, with another individual who is one-to-one, for behavioral issues, I ask him to come in, I said I think Thomas has left us, about the time he got there, Thomas sighed, I said never mind, he must just be breathing even slower, but then he didn’t do anything else, by then the other 2 staff members had returned, from some of the programming and came over and ask what was wrong, I said I think Thomas has left us. She said but Thomas said he would be here when I got back, I said, that he had just left us when you came through the door, I told them, I did not want to wait to long, but didn’t want to call nursing too quick either, if it was a false alarm they wouldn’t be mad, but didn’t want to bother them, if he wasn’t dead, if you know what I mean, so after a couple minutes, I said I am going to call nursing, so I got on the radio and ask for nursing to come back to the cottage, they checked and said, he was gone. Under normal circumstances we would do a code 345 and state what building and cottage, this means there is a medical emergency, all available medical staff and available regular staff should report to that cottage, that way the regular staff can move the other individuals to another area, if need be. Once hospice took over and by the choice of his family, he was a DNR. There were 3 nurses that came back to the cottage, they knew when I came over the radio, that it was the end. So they called the unofficial time of death and ask if that is what we had, we said yes, so then they paged the doctor and he made the official call. You know, I know that I will be experiencing this a lot because we do have an aging population, but I am glad my first one, went as peaceful as he could, he could have been gasping for air and been a big struggle, but he went as peaceful as he could. I am not telling this next to brag, but to share how we need to be there for people. Anyway, I think the reason he went so peacefully, was because I was talking to him about things he likes, about his family, kept calling him my buddy, kept telling him that I loved him(this was a no no, also, because we are told during training, that we are not to become attached to them), you know, when the end is near, forget those rules and treat them the way they deserve, treat them like family, and I think, because I was showing feelings and concern, and rubbing his head and arms, etc, he was so relaxed that he was at peace and just basically went to a permanent sleep.
One time he was going to have a cat scan & was suppose to drink this chalky stuff. Well, The LPN tried to get him to drink it, so he started hitting himself, so she ask me for assistance. I went in & ask him to drink it, and he started hitting himself again. So I started talking to him about things he likes, such as: going to a Pittsburgh Pirates ballgame, buying new clothes, going to visit his brother, etc. The LPN then handed him a cup of the stuff to drink, he then took the cup & started drinking it, she then game him 2 more cups of the stuff to drink, all the while, I kept talking to him, you see, he forgot that he was mad & didn’t want to drink it, because I got him relaxed and talking about things he liked. I also got him to get on the scales to get his weekly weight, which no one else had been able to do for a couple weeks. I also went with him, when he had to have some iron pumped into him, via an IV, I kept him relaxed & there was no self-abuse, even though he had to sit there for almost 2 hours.
Another time another one of my co-workers & I took him to another hospital to have a pet scan done. Anyway when we got done I ask the other staff member if they wanted to stop & get something to eat, if he wanted to, she said only if he wanted to, so I asked Thomas and he said no, but just as soon as we got on the interstate, Thomas, said “EAT, EAT”, he had a limited vocabulary, when he said that, I told the staff member, we would stop at the closest restaurant and get him something to eat(this was against policy – there is this policy that when an individual, who doesn’t like doctors will be pre-medicated, this helps them relax & be a little more cooperative, you are not allowed to let them eat or drink till you get back, and they are checked out by nursing), we could have gotten fired, but he was to the point that when he said eat eat, you got him something to eat(wasn’t ground texture, which was what he was suppose to have, so I told nursing when I got back that I did stop & get him something to eat. I said we watched him closely & if he would start having problems, I would have ask him to save the rest for later, but he ate that better than he had eaten a lot things in a while.
Better grab your Kleenexes, this next part is hard for me, & will probably make you teary eyed. Anyway, they did put a shunt in his esophagus, but it collapsed, so he basically wasn’t able to eat much, because the cancer was where the esophagus hooks to the stomach. By then Hospice was in control, which was good, because, as you know, states like to control things & where I work is a state run facility, anyway, they told my employer what drugs to give him & how often & they had to do it the hospice way. Anyway, he got so sick, in such a short time, he went from being pretty independent, as independent as you can be,
, to total care in less than 2-3 weeks. When hospice took over, they told us he had 6-8 weeks, he lasted 6 weeks. From when they found the cancer, to when hospice took over, was only about 2 months. You can have up to 8 individuals per one staff, the really bad behaviors can be on a one-to-one, or if they are deathly ill, he was a one-to-one, so we would take turns of taking care of him. To try and make a long story short, I was with him his last day. I was taking care of him, & he was to the point that we knew it was just a matter of days, anyway, even though he looked like he was sleeping he would make small gestures, when I was talking to him, I was talking to him about his family, going to see the Pittsburgh Pirates, etc etc. Hospice came in every day to take his vitals, along with our nursing staff doing them, also to check & see if there was anything we needed too! Anyway, the hospice nurse came in and try to take his vitals, she tried like 10 times, but couldn’t because he was breathing shallow and heart beating slow. While she was doing her paper work, I went back to talking to him, rubbing his forehead, head, stomach, etc and she said do you hear those small sounds, I said yes, I ask if they were moanings because he was in pain, she said no, that is his way of communicating to you and his way of confirming that he is enjoying your voice and love for him and the human touch. I stepped over by her and I told her, I wasn’t sure if he could hear me, but I would rather talk to him for hours on end and him not hear anything, then not talk to him, and him hear everything going on. She said there needs to be more people like me(not telling you to brag, but just telling you what she said), that are not afraid to touch them and willing to talk to them and show feelings. He was on mega doses of high powered pain killers, most were not for pain, because he truly wasn’t in much pain, but were given to him, to keep his heart from racing. He had 3 different pain patches and also given a shot of morphine every hour his last day. When nursing came in, they would have to check respirations, they had to be at least 24, or they could not given them to him. I thought, geez, he is dying, what does it matter, but then if they do go against the rules and give it to him and it killed him, it would be murder. Hospice was having trouble getting his vital signs. Anyway, nursing came in around 2 and took his respirations and she said he definitely has 7, possible 10. Because she wasn’t our regular RN, she went and got another nurse and had her check and she came up with the same thing, even though she did not know what the first one came up with. So they said, at this point we can not give him anymore, but that if he showed signs of pain, we can give him some Tylenol. So they left and I went back to talking to him, and rubbing his head and about 10 minutes after they left, he took a deep breath and that was it, there was another staff member who was in the cottage also, with another individual who is one-to-one, for behavioral issues, I ask him to come in, I said I think Thomas has left us, about the time he got there, Thomas sighed, I said never mind, he must just be breathing even slower, but then he didn’t do anything else, by then the other 2 staff members had returned, from some of the programming and came over and ask what was wrong, I said I think Thomas has left us. She said but Thomas said he would be here when I got back, I said, that he had just left us when you came through the door, I told them, I did not want to wait to long, but didn’t want to call nursing too quick either, if it was a false alarm they wouldn’t be mad, but didn’t want to bother them, if he wasn’t dead, if you know what I mean, so after a couple minutes, I said I am going to call nursing, so I got on the radio and ask for nursing to come back to the cottage, they checked and said, he was gone. Under normal circumstances we would do a code 345 and state what building and cottage, this means there is a medical emergency, all available medical staff and available regular staff should report to that cottage, that way the regular staff can move the other individuals to another area, if need be. Once hospice took over and by the choice of his family, he was a DNR. There were 3 nurses that came back to the cottage, they knew when I came over the radio, that it was the end. So they called the unofficial time of death and ask if that is what we had, we said yes, so then they paged the doctor and he made the official call. You know, I know that I will be experiencing this a lot because we do have an aging population, but I am glad my first one, went as peaceful as he could, he could have been gasping for air and been a big struggle, but he went as peaceful as he could. I am not telling this next to brag, but to share how we need to be there for people. Anyway, I think the reason he went so peacefully, was because I was talking to him about things he likes, about his family, kept calling him my buddy, kept telling him that I loved him(this was a no no, also, because we are told during training, that we are not to become attached to them), you know, when the end is near, forget those rules and treat them the way they deserve, treat them like family, and I think, because I was showing feelings and concern, and rubbing his head and arms, etc, he was so relaxed that he was at peace and just basically went to a permanent sleep.
Total Comments 2
Comments
 |  What an inspiring writing, Rick. You filled my heart and soul with what you wrote. As I've come to know you over the past couple years I know the compassion and genuine caring you give to your clients, but I also know how much those entrusted to our care give back to us if we take the time and allow them in their way to do so. I pray for you and the struggles with your health, and also that God keeps you in position to minister to those that many feel are lost. NOT...just differently abled. God bless. |
Posted 05-11-2008 at 03:24 PM by singpraiz4hym  |
| |  Thank you for the compliments, Shell. Even knowing these individuals are mentally retarded and face other challenges, I get into my job so much that I tend to catch myself, actually forgetting they are mentally retarded, I am sure this is God working in my life and also working through me, to bless these special individuals that God has placed in my care. I just wish you all could meet these individuals in person. There are a few in another cottage(cottages are like big apartments), that I started out in, I transferred to a different cottage, but in the same building, anyway when I see these individuals, they want me to come back. One is verbal and can actually tell you, the other grabs my arm and wants tries to drag me back into his cottage. They do become like family. |
| Posted 05-11-2008 at 04:19 PM by totallyforgiven2 |
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