Episode
3 - Working Trace
Standing in the recently reorganized living
room, Trace smiled as he surveyed his work. He had restored
the room to a rational condition and successfully minimized
its institutional features. The certified nursing assistants
had fallen behind in patient care, and with this morning ritual
completed, Trace had nothing more to do until the residents
were fed and dressed. Picking up the phone, Trace dialed Mare’s
number.
“Hello?”
“Hey, Mare. It’s Trace.”
“Hello there. How are ya?”
“Good, still thinking about placing that
ad.”
“Have you written it yet?” questioned
Mare.
“Yes,” answered Trace.
“Well, don’t keep me waiting; read
it to me.”
Trace paused a moment to suggest he was fishing
a piece of paper from his pocket: “NH: GWM, 26, 5’9”,
150, 30w, dk br, dk br. Nice prof masc guy seeks masc GWM for
friendship and fun. N2: theater, music, reading, hiking, running,
tennis, and coffee shops. LTR oriented. ”
“Nice. If you were a car, I’d drive
you away,“ quipped Mare.
“Cut it out,” retaliated Trace.
“But you’re not, so you’re
going to have to decode it for me. What the hell does all that
mean?”
“It’s easy. There’s a code
for doing this. My ad says I am from the New Haven area; that
I am a gay white male, who is 26 years old, 5 feet 9 inches
tall and weigh 150 pounds; that I have a thirty-inch waist and
dark brown hair and eyes. It says I am a nice professional masculine
guy, and I am seeking other masculine gay white men for friends
and fun and all those activities I listed. Lastly, it says I
am long term relationship oriented.”
“Why the hell don’t you just say
that for Christ’s sake.”
“Money! Larger ads cost more. Besides,
any guy reading this would know what it means. If not, they
print a key for it all.”
“What about your cock size, and who the
hell says you’re nice?”
“I thought about adding that, should
I?” questioned Trace.
“Shit, I was just kidding. What does
your cock size have to do with wanting dates or a long term
relationship?”
“Probably a lot,” answered Trace.
“You have a point there,” conceded
Mare. “Why are you restricting yourself to white men?”
“I’m not,” answered Trace
indignantly.
“Yes, you did; you did so. You said ‘seeks
GMW’—or whatever it is.”
“It’s G--W--M!” Trace corrected.
“Whatever,” yawned Mare.
“I guess I did. I don’t know why
I did that. Didn’t really think about it.”
“Well, it just seems a bit limiting.
You might want to think about it.”
“Yeah, I guess so,” sighed Trace.
“And what’s this about being long
term relationship oriented? You’ve never even been in
a short term relationship, and correct me if I’m wrong
but aren’t you pretty much just horny?”
Trace leaped to his own defense: “No,
I’m not just basically anything. I want both: sex and
a boyfriend.”
“Aren’t you a bit queeny to be
asking for a masculine boyfriend?” asked Mare pointedly.
“Oh, shit, you think so. I know I’m
not a jock, but I'm not a flamer,” replied Trace nervously.
“Well, hon, you do have your queeny side.”
“Do you think I shouldn’t have
described myself as masculine?” asked Trace nervously.
“I’m just giving you a hard time.
When I met you, I had no idea you were gay, which is completely
unusual since I grew up in San Francisco. You got right by me
on that one, but you were also covering it up a lot back then.”
“Should I not have said masculine?”
Trace uneasily repeated his question.
“Relax, you are not queeny. Hon, I’m
not saying you don’t have your queeny moments—cause
you definitely have those. Those I have seen, but you are not
a queen.”
“You sure?” Trace pushed for more
assurance.
“Think of Thomas. Now, that’s a
queeny queen; you don’t act anything like Thomas.”
“It’s all such crap. I never know
what people see or think about it—me--I mean. I just don’t
want to be with a guy who acts more like a girl than a guy.
If I wanted a girl, I’d date one.”
“You placed the ad already, didn’t
you?” accused Mare.
“What? No, I didn't”
“Yes, you did. Didn’t you?”
“Okay, I did. How’d you know?”
asked Trace.
“You asked me if I thought you shouldn’t
have said masculine. I was just waiting for you to admit it,
but as usual, you take your time in revealing some things.”
“I didn’t mean to keep it a secret.
I wanted your input, but I had it written, and I thought if
I didn’t just send it, I never would.”
“I understand. Well, good luck. Be sure
to let me know how it goes.”
“Yeah, I will. Still on the job prowl.”
“Oooo, job prowl, I like that,”
exclaimed Mare. “Yes, I’m heading out to the library
to do some research.”
As Mare spoke, Trace surveyed the unit through
its interior glass walls that allowed the public areas of the
unit to be seen with just a turn of the head. Trace could see
the CNA’s had begun randomly releasing patients into the
hallway as they worked to catch up before morning care ran seamlessly
into lunch and afternoon care. Trace watched three patients
as they self-directed to various activities, including furniture
moving, hamper emptying, and refreshment cart reordering. Realizing
he was needed on the floor, Trace gestured towards ending the
phone call: “Good luck with that, and you too, let me
know how it goes.”
“I will, honey.”
Trace became increasingly anxious as he watched
one patient toss soiled laundry on the floor and another patient
toss the refreshment cups into the laundry bin: “Okay,
the townsfolk are wandering aimlessly through the town square.
I better go redirect them.”
“Talk to you later, hon. I’m proud
of you for taking this step. It’s a brave thing to do.
I couldn’t do it.”
“Well, I’ll do it first and then
I’ll get you to do it,” offered Trace.
“Ah, we’ll see. Bye, love.”
“Bye.” Trace hung up the phone,
put on his clinical happy face, and walked out into the unit
floor with a smile that could rival a gymnast’s.
Positioning himself just outside the living
room door, Trace surveyed the unit and prioritized a to-do list.
Before him stood Unit 2A of the Alzheimer’s Care Center,
a thirty bed unit in a one hundred and twenty bed healthcare
facility designed to meet the needs of the Alzheimer’s
patient. Unit 1A was located directly beneath it and mirrored
the design of 2A except for the inclusion of a botanical atrium
in its center that provided a dramatic sense of space for the
first floor and required the center of the second floor to accommodate
the thirty foot tall ficus trees as they reached toward the
massive skylight that suffused both units with natural light.
This design brought a sense of the outdoors indoors, a rare
architectural design in New England, and was compensated for
on the second floor through the design of thick safety glass
walls that overlooked the atrium. This allowed the atrium’s
skylight and botanical life to serve both units. This see-through
design also allowed the staff to monitor all four hallways of
the unit’s diamond shaped panopticon with as few blind
spots as possible. Unlike similarly designed prisons, the goal
here was to allow the staff to visually identify a patient in
need of assistance as quickly as possible. Units 1 and 2A were
replicated by two sister units that were separated from them
by the locked no-man’s land hallway that connected each
unit to the rest of the building and served as a secondary safety
feature to guard against elopement.
The diamond shape of the unit was designed
to accommodate the wandering Alzheimer’s patient. The
wide hallways separated the patient rooms, situated along the
exterior walls, from the atrium glass wall and formed an uninterrupted
walking track that ran through all four legs of the unit. This
allowed the cognitively impaired patient to walk laps around
the locked unit without the frustration of walls or other barriers,
and, for this reason, the halls were largely empty. On a regular
basis, ambulatory patients could be seen meandering through
the halls seeking whatever, or whomever, they sought, until
they were so exhausted they needed to be redirected to a seated
position before they collapsed beneath their own fatigue.
Each corner of the diamond was utilized to
accommodate the unit’s functional needs. The unit was
entered from the locked reception area by keypad-controlled
doors, and these doors occupied one corner. This served as the
primary means of egress. A fire escape stairwell was situated
in the corner opposite the main entrance. Directly in front
of each of these doors, the atrium walls cut in at a ninety-degree
angle, allowing a triangle of floor space to open up. Here,
on both ends of the unit, a couch, two soft chairs, and end
tables were placed family style. The other two corners of the
unit were reserved for its community needs. In one corner was
a dining room filled with tables and chairs and a small locked
kitchen room that housed a sink, microwave, and cabinets. Directly
across from the dining room, a larger ninety-degree angle cut
into the atrium and provided space for the nurses’ station,
the back of which was adjacent to the atrium windows. The corner
opposite the dining room contained the recreational living room.
This room was furnished with tables, couches, chairs, bookcases,
and a television. Directly in front of this room, the atrium
cut in once again at a ninety-degree angle and provided floor
space for a round table that could accommodate six to eight
residents, depending on whether they were ambulatory or non-ambulatory.
A circular opening in the center of the table provided room
for a staff member and a chair, and from this position, Trace
often ran programs with clients and the CNA’s worked with
patients who required various degrees of assistance with eating.
The two first floor units were reserved for
patients in the early stages of the disease. These patients
were more communicative, oriented, and ambulatory; therefore,
they required less assistance with their activities of daily
living. The second floor units were reserved for patients in
the later stages of the disease, and Unit 2A was occupied mostly
by patients in the last stage of the disease. Of the thirty
patients on 2A, twenty-one were in a persistent vegetative state.
These clients were no longer able to make self understood, and
they were unable to assist in their activities of daily living,
secondary to diminished cognitive, gross, and fine motor skills.
These patients often wandered around the unit or were restrained
to moveable chairs. In some cases, these patients could safely
be placed in a wheelchair, which was most desirable, so they
could maintain some degree of autonomous mobility. Wheelchair
bound patients may or may not be restrained dependent upon their
safety awareness and needs. In other cases, more elaborate arrangements
needed to be made, and these included the use of Geri or recliner
chairs, depending on the client’s safety needs. A Geri
chair is a larger padded version of a wheelchair that allowed
the patient to sit upright and usually included a safety tray
as a restraint. A recliner chair was more thickly padded and
was used primarily with patients in a persistent vegetative
state who were unable to sit upright. It provided the comfort
and safety of a bed but allowed for mobility. Nine patients
on 2A did not require chairs, but they were severely impaired
regarding cognition, and often, they were not oriented to time,
place, or person, and very often, they suffered from aphasia,
the partial or total loss of the ability to use or understand
language. Out of the thirty patients on 2A, one was able to
engage in conversation, albeit a confused, repetitive conversation
filled with non-sequitars. This was the population for Unit
2A, and Trace, as the Therapeutic Recreation Director was charged
with meeting their social, recreational, cognitive, physical,
and spiritual needs.
Surveying the unit, Trace grew uneasy with
its chaos. He knew the late start to the day would throw everyone
off, and if the patients’ energy was not redirected soon,
it would be difficult to settle them down to lunch. Rallying
himself, Trace whispered his mantra under his breath: It’s
realignment time.
Walking through the hallways, Trace moved the
public furniture into a functional and aesthetically pleasing
position. Then, finding the client, Sally, who was emptying
the laundry basket, he redirected her to a seated position,
withdrew a pack of playing cards from his work cart, and interested
her in sorting the cards by color into two piles on the coffee
table. Returning the soiled linens from the floor to the laundry
basket, Trace next retrieved the patient who was upending the
refreshment cart. Dee Dee smiled as he offered assistance and
released a series of confabulated “ya-ya-ya’s”
as Trace offered to wheel her over to Sally, so she could assist
with card sorting. Dee Dee enjoyed watching the activity of
others, and Trace knew she would be content watching Sally.
Positioning Dee Dee next to Sally, it did not take long for
Dee Dee to set her sights on Sally’s activity and to start
offering confabulated “ya-ya’s” in support.
Sally did not acknowledge Dee Dee presence, but Dee Dee did
not notice, and she was content to watch Sally, who was now
sorting the cards arbitrarily into the two piles. Trace reminded
himself, the redirection of energy was his goal, not the production
of an activity that accorded to his sense of reality.
Noting the time on his watch, Trace lowered
himself before a nearby wheelchair that contained the bound
and bent over finger sucking Lavinia and waited for her to focus
her eyes on him. Trace knew the moment she saw him, for she
smiled every time she looked at someone she liked. Once she
did so, Trace offered her a warm smile and sked if she would
like to watch Mass in the living room. Despite her inability
to respond, Trace knew from his experience with Lavinia’s
psychological-social assessment and through his conversations
with her family that this was an activity she would enjoy, and
if she could, she would answer affirmatively. Trace slipped
a piece of gum from his pocket and offered it to Lavinia, who
eagerly accepted it as a replacement for her fingers. He then
withdrew a facecloth from his pocket and dried her fingers.
Having checked that her feet and hands were safely clear of
the wheelchair's wheels, Trace unlocked the chair, announced
they were moving and rolled Lavinia toward the living room.
Along the way, he coaxed the furniture moving Helga to join
them. Helga smiled and uttered joyful indecipherable syllables
as she grabbed Trace’s arm with one hand, patted it with
the other, and followed along. Positioning Lavinia and seating
Helga, Trace was psyched it was just one minute past eleven,
for this meant Mass was just starting. Trace adjusted the volume,
wished the ladies a good service, and walked back out to the
hallway.
An overworked, yet efficient, CNA had remembered
it was time for Trace’s sensory stimulation group and
had already wheeled two clients up to the round table. Trace
reminded himself how lucky he was to work with such an effective
nursing staff and turned to collect other patients for the group,
but he stopped short of doing so when he saw Jimmy seated up
in his Geri chair and facing the wall outside his room. Jimmy’s
wife would be less than pleased, if she saw him facing a blank
wall and so would the facility's executive director. Trace relaxed
as he told himself he caught the problem and that he still had
time to move Jimmy into the living room. Following the same
visual first approach, he approached the aphasic Jimmy and invited
him to watch Mass and then quickly rolled Jimmy into the living
room.
Leaving the living room, Trace found a third
patient had been positioned at the round table, and he wondered
what amazingly efficient CNA he had to thank for that, but before
he could think who it was, he was interrupted by Catherine’s
scream. Trace looked up and saw Howard mistaking Catherine’s
room for his own, and Catherine yelling and trying to push him
out of it. This was potentially a dangerous situation, for the
six-foot aphasic and disoriented man tended to respond to moments
of stress with quick and sudden punches, and Catherine’s
emaciated frame would be no match for Howard’s strength.
Trace tempered his voice with a manly and friendly tone and
told Howard he was just going to Howard’s room. He asked
if Howard would like to walk with him. Howard turned toward
Trace as Catherine continued to yell and push at him. Howard’s
eyes flared with anger as he attempted to negotiate his dementia
of the Parkinson’s type. He finally expressed himself
with a guttural expression and an aggressive nod. Trace quickly
offered his arm; Howard gripped it tightly, causing Trace some
pain. As soon as he felt Howard’s grip firmly on his elbow,
lace, Trace led him away from Catherine’s door. Knowing
Howard would not need, or want, further interaction, Trace looked
toward Catherine, who still stood in her doorway, and flashed
his warmest glance toward her and began to sing: “Embrace
me, my sweet embraceable you.”
Catherine’s eyes lit up, and she instantly
forgot her anger as she began to sing: “Embrace me, my
irreplaceable you.”
Trace led Howard away as he attempted to redirect
Catherine verbally: “Miss Catherine, you have a very nice
voice. We’ll sing later, but now Mass is on in the television
room.”
Catherine eyes filled with the concern of the
religious as she stopped singing and began patting her hands
against her hair: “Oh my, where is it?”
Trace knew Catherine was the most place oriented
patient on 2A, but he was not certain she could follow verbal
directions this particular day, and as he turned the corner
with Howard on his arm, he said: “Catherine, you look
fine. Go the end of the hall and turn left.”
“Thank you, honey. You're always so
good to me,” replied Catherine as she turned and walked
toward the end of the hall.
Trace lost sight of her as he and Howard rounded
the corner but was able to catch a glimpse of her as she slipped
into the television room. Trace smiled as he thought to himself:
That’s my girl.
Settling Howard into bedside chair, Trace walked
back toward the round table, and along the way found Tony facing
the wall just outside his room. Tony was unable to express himself
or participate in his own care, and he was probably most in
need of the sensory stimulation group, for his dementia had
struck him young, and as the disease progresses with most patients
who exhibit Alzheimers while young, his disease progressed very
quickly, and now, at the age of 59, he was in a persistent vegetative
state. His body was riddled with muscular contractions, and
he was literally bent into a seemingly permanent fetal position.
The sight of Tony struck at the existential core of anyone who
saw him, and the dieseae struck at the core of Tony himself,
and almost daily, he released a low and sustained howl that
would permeate the unit for hours at a time, until he was finally
silenced by a per diem dosing of Ativan that relaxed him enough
to stop his howling. Today, Tony was not holwing, as he had
for most of last week, so Trace was excited to have him as part
of the sensory group.
Positioning Tony at the round table, Trace
counted four patients in total. He and his boss thought this
was a low number of participants, but checking his watch, Trace
realized, it was now 11:20. The group was already starting five
minutes late, and if he didn’t start now, he would not
have enough time to conduct an effective group. Pulling his
work cart up the table and positioning himself in the center
of the table, Trace decided he would just have to work with
four patients. Unlocking his cart so he could retrieve his work
supplies, Trace was stunned by the sound of metal carts being
wheeled onto the unit. He looked up and saw the CNA Jo-Jo walking
toward him, wearing stress in her eyes and a supportive smile
on her face, she looked at Trace and announced: “That’s
lunch. They’re short in the kitchen, so the breakfast
crew stayed on to do lunch. No sensory group today; we’re
getting lunch now.”
Trace locked his cart, which had barely been
opened all morning, and redirected himself to the task of assisting
the unit through lunch. He sighed as he realized between the
morning’s report, the staff meeting, and the late morning
patient care, he had not produced one activity for his patients
that morning.
Jo-Jo patted Trace on the back as she kindly
offered: “Well, at least you did a great job getting everyone
settled down for lunch.”
Trace smiled as he watched Jo-Jo retrieve a
towel from the care cart and disappear into a patient’s
room, closing the door behind her. As the door closed, Catherine
ran in front of it and began fishing through the care cart Jo-Jo
retrieved the towel from.
Trace extended his hand as he redirected Catherine
to the dining room: “Embrace me, my sweet embraceable
you.”
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