j. l. navarro

Notes from the Very Last Resort

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This non-fiction piece was originally published in the San Diego Reader on 1/18/1990.

"One of your patients is dead."
...the reward for the best of us...
"Did you hear what I said?"
Mrs. Jeffries' dentures are in my hand.  "Which one?"
It is still early.  I have already gotten some of my other patients up and in their chairs.
"Mr. Lawson."
I glance at Alice Sims, our team leader.  Mrs. Jeffries is sitting up in bed, looking at us like an 80-year-old child.  "Daddy," she says.  "Daddy."  She'll look better once I get her teeth in.  The woman had once been beautiful.  Now her face is a wrinkled chamois, twig-like limbs attached to a lean torso.  Yet, curiously, her blue eyes hold a sparkling quality that belies her condition.  Terminal senility.  Regression?  A numbing of the brain.  Old age, pure and simple.
Mr. Lawson.  Who the hell is Mr. Lawson?
Ideally, nursing assistants handle eight patients a day.  In the little less than a year that I've been working here at the Very Last Resort, we have had a full NA staff maybe two, three times.  Usually, we care for 10 to 15 patients, dividing up sections among us that would have gone to NA's who've called in sick.  Nursing assistants get sick a lot.  Of course, there are the exceptions.  The sibling clones of Florence Nightingale.  Cheerfully there every day, despite bad backs, sore feet, or stiff shoulders from lifting dead-weight quadriplegics or stroke victims.
Alice Sims, Certified Nursing Assistant par excellence, a 16-year veteran, is one of these.  A black woman in her mid-40's, of average height, with a firm body and exceptional stamina.  As far as I know, she's never missed a day since I've been here.  A team player to the gills.  And now she is looking at me as if I should have known, by osmosis perhaps, that Mr. Lawson has gone his merry way.  It is not a vindictive look.  More like, "Why aren't you on your toes about these matters."
After brushing Mrs. Jeffries' teeth in the sink, I pop them in her mouth. 
"Daddy," she says contentedly.
I follow Alice to Lawson's room.  It is a divided section that belongs to an NA who didn't show up today.  Alice has partially drawn the bed curtain to shield Lawson's body from prying eyes.  She could not have been more right--the man is dead.  And though I did not know him by name, I had seen him before when delivering trays to this room.  Lawson himself ate 24 hours a day through a tube down his nose.  I always saw him with his eyes closed, unmoving, comatose.
From the hall, I hear the arrival of one of the huge stainless steel food carts.  I will not be passing out trays with the others.  At least not for a while.  Mr. Lawson has to be washed before the paramedics show up to take him away.  They will be here soon.  A corpse is not left on the ward any longer than it has to be.  Alice pulls back the covers, and we check to see that he has not had a farewell bowl movement.  He hasn't.  I get a warm washcloth and wash his face, wiping away the clustered green bird's eye from his tear ducts.
Behind us, an elderly woman in street clothes stands nervously.  His wife?  As it turns out, it's his sister.  She is understandably upset to find her brother gone.  "Where are his teeth?" she says.
Good question.
"I'm going to help pass out trays," Alice tells me, heading for the door.
"His teeth," the woman insists.  "He needs his teeth."
There is no denture container on the nightstand.  I open the drawer and find the pink enamel creatures staring at me from a tray.
I pry Mr. Lawson's jaw open and snap his teeth in.
"I don't think that's right," the woman says.  "They should go in the other way."
I know they're in the right way, but to make the woman feel better, I take them out and put them in the way she wants them.  His upper dentures are now on his lower gums and, of course, they don't fit.
"I'm sorry.  I guess I was wrong," she says.
When I attempt to extract the dentures, they slip from my fingers and slide down Mr. Lawson's throat.
"Oh, my goodness," the woman says, visibly more flustered than before.
"Don't worry," I assure her, sticking my fingers farther down the man's throat to retrieve the teeth.
"He was such a good man," the woman tells me.
Dentures in, mouth shut, Mr. Lawson looks deader than ever.  I have three feeders on my list today; I am already running behind.  But the woman seems to want me there.  Moral support.  Reassurance.  I don't know which.  Death affects people differently.  But if you're related to the person in question, then it's that much more profound.  No one remains unmoved under these circumstances. 
"He was such a dear, good man," the woman says again, staring at her brother.
"What did he do," I ask her, "when he was alive?"
"He was a butcher."
"Good trade."
"He was such a good, good man," she says.  There is a strange, vacant look in her eyes as she gazes at him.  I have a feeling she is about to burst into tears, and this makes me uneasy.  After washing my hands, I excuse myself and hit the floor to pass out trays.
Lena Ortiz, one of the housekeepers, is mopping a section of the floor.  She looks up at me and blows a wisp of hair away from her shiny face.
"Can't you work someplace else until the trays are passed out?"  The question is delivered, in her usual offensive tone, by Rachel Rattus, nobody's favorite LVN, licensed vocational nurse, the permanent med nurse on the ward.  Her face is a road map of creases.  She is an ever-present pain in every NA's rectum.  Not to mention patients'. 
"My God, you people are stupid!" Rattus blurts at Lena, maneuvering her med cart past a mop bucket.  Lena is visibly cowed.
"Don't pay any attention to her," I tell Lena.
"You mind your own business," Rattus spits at me.  "Haven't you got any feeders?"
"Drop dead."
"You're in a good mood today, aren't you?"  The smirk on her face is a target beyond my reach.
I ignore her, take a tray, and head for Mrs. Lowe's room.  I find her with a gob of pale green mucus resting on the corner of her mouth.  She is a massive black woman who loves to read religious tracts.
"Morning, Joe."  She has a gravelly voice.  I take a pink tissue from her nightstand and wipe away the snot.  "You're here again," she says.  ""I thought you'd have quit by now."
"I was here yesterday too."
"I didn't see you yesterday."
From the hall, a nurse says, "Someone get the call light in room 301."
"I am in 301," I yell back.
"Then for God's sake, see what they want."
I should have known.  The call light is cherry red above Mrs. Lowe's bed. 
"What do you need, Mrs. Lowe?"
"I needed someone to wipe that bugger off my face."
"It's gone."
"Thank you."
She could easily have done it herself.  But Mrs. Lowe is that kind of patient.  Her call light will be going on and off all day, and it will continue to do so long after our shift is over, into the night.  It will be a beacon for the dawn.
Mrs. Lowe likes to be cranked up only so far in bed (no more, no less) when she eats.  I proceed to crank her to the specified angle when she suddenly says, "I have to pee."
After I wedge the plastic bedpan under her huge behind, I wash my hands and leave, grateful that she is not on my care list for today.
From one day to the next, I don't know what section I'll have.  I'm what they call a floater, assigned sections on a day-to-day basis, covering for whatever CNA doesn't show.  Today I have 12 patients, more than I should have.  Four have to be showered, their beds changed.  Two are going to the beauty parlor and have to be dressed and ready.  Most have to be dressed and gotten out of bed.  Some will have to be cleaned up much like infants, some on more than one occasion.  Vital signs have to be taken for a few.  The ones from the divided section will receive the least care.  Some of these patients might be due showers but probably won't get them.  If there's time, they might get a quick bed bath and shave.  Maybe just the shave.  Maybe not even that.
Everything would run much more smoothly, of course, if all the nursing assistants showed up.  But that's like wishing the deficit away.  Some of the more conscientious CNAs will forsake their coffee breaks to catch up and make sure their work is done.  Some will even cut short a lunch break or not take one at all.  But this is unlikely.  Legs get wobbly after a while, knees begin to buckle, even for the fittest of us.  It's no wonder that fresh faced, enthusiastic guardians of the aged come to work their first day, ready to do battle with geriatric maladies, and by the end of the week are never seen or heard from again, their idealism left to fester like a decubitus ulcer.  I've seen all types come and go since I've been here.  From the mildly sadistic to the bleeding-heart saints.  Some hack it, some don't.
Nurse Rattus herself started as an NA 18 years before.  The Very Last Resort helped pay for her nurse's training.  When that white cap went on her narrow head, she became God's gift to the ward.  Her nose went up in the air, and her conceit merged with newfound contempt for those lower in rank than herself.  Except for Lacy.  Rattus has a kind of grudging respect for Albert Lacy, a CNA's CNA.  Cheerful.  Dedicated.  I once asked him why he never advanced to at least the LVN level; by and large, it was cleaner, easier, and paid more.  Lacy told me he likes the hands-on contact with the patients.  After all, isn't that what it was all about?  Besides, who wants to do the unending ever-so-boring paperwork that all titled nurses are burdened with?  And the guy is good.  Anyone who can care for eight men, day in, day out, train them to defecate once a week (on Friday), and come in week after week with a cheerful disposition has got to be good.
Down the hall, a patient is screaming.  To the uninitiated, it would rightly sound as if she were being murdered.  I know the patient, and I know that no one is laying a finger on her.  She screams because that is what she does best. 
Across the hall, another patient is moaning ceaselessly and has been moaning a good part of the morning and night.  An Alzheimer's victim.  He will stare at the ceiling all the daylong.  And he will continue moaning, punctuated now and then with a piercing scream.
Tray in hand, I enter the moaning man's room.  It is not for him.  The moaning man has a tube down his nose.  The tray is for his roommate.  Mr. Mackay.  Someone has already cranked his bed up.
"The dearly departed," Mackay tells me, patting his crotch.
"Breakfast," I tell him.
But before I feed him, I take the last tray from the cart to a three-patient room.  It is for Maggie Schroeder.  This woman is going to refuse to eat.  She will drink her milk through a straw, but that is all.  She is rolled up in bed in a fetal position.  A favorite position, by the way, of many of the patients here.
She does not open her eyes.  "None," she says.  "None."  It is the only word she knows.  I have attempted to feed her in the past, and it is not easy.  Her two cartons of milk are quickly gone.  All of her solid food has been processed into a pasty, unsavory-looking purée substance that she steadfastly refuses.  I can't really say that I blame her. 
"None," she pleads.  "None."  It is a losing battle.  I take the straw and put it into a glass of cranberry juice, stopping the end with my finger to hold in the liquid.  I pry this tube full of juice into her mouth and release it.  She turns away.  "None."
Sooner or later, they're going to put a tube down this woman's nose.  Like it or not.
I step into the room next door to check on my third feeder.  There are three women in this room.  Mine is in the middle bed.  A recently hired CNA is also in the room.  She's a small Filipino girl.  The look on her face tells me she is not having any fun.  The stench in the room is gagging.  My stomach has leaped halfway up my throat.  I recognize what's going on.  Some wise-ass night nurse has pulled a mud-slide on her.  All three women have been given suppositories.  And more than likely, so have the two women across the hall, who are also in her section.
I quickly push open the patio door, and fresh air rushes in like the cavalry.  All the patients in the room are in Lulu-land.  They all have to be fed.  Evidently, the girl is in charge of the two others, but she doesn't seem to know where to begin, whether to feed them or clean them up.
"Good morning, ladies."  It's nurse Rattus, parking her med cart outside the door.  "Medicine time."
All three women look at her vacantly.  The Filipino girl has gone from bad to worse.  She doesn't know whether to run or stay.  Thank God the odor is gone.  Rattus would have hit the ceiling.  I am shoveling food into Mrs. Clement's willing mouth.  The woman is famished. 
"What's going on here?"  Rattus is looking from me to the girl, glowering.
"What are you talking about?"
"What am I talking about?"
Rattus is looking at a pile of dirty linen on the floor, at the foot of the bed of a woman who looks like she's survived two centuries.  "Who's in charge of this room?"
"I am," the girl says nervously.
"You have dirty linen on the floor!"
Quickly, the girl moves to retrieve it, rushes out to dump it in one of the hampers.
"Don't you know those hampers are to be put in the bathrooms during meal times?"  Rattus is ready to throw the book at her.  "And look at this.  Fresh linen in the room.  You call yourself a CNA?  Don't you know you're not suppose to bring clean linen in the room until you're ready to put it on the bed?"
The girl is ready to bolt out the door.
"Why don't you get off her back?" 
Rattus swings a lethal look at me.  "I have a mind to write you both up."
"Give 'em your pills and get out.  We have work to do."
"You think I make these rules up?  You think these rules are to be broken at your whim?"
"Get lost."
"I'm going to write you up.  I'm going to write you both up!"
After dispensing the meds, she leaves.
"How can you talk that way to her?" the Filipino girl says.
"Because if you don't, she'll ride you all the time.  Something you'll learn soon enough."
"But she's a nurse!"
"Sometimes I wonder."
Mrs. Clement has cleaned her plate.  I leave to feed Mr. Mackay and find time to down a quick cup of coffee off the food cart.
Over the PA system, the charge nurse says, "Will someone please answer the call light in 301."
Mrs. Lowe wants to come off the pot, no doubt.
The paramedics arrive to take away Mr. Lawson.  It is 9:10, and the day is rushing by much too fast for all that has to be done.  After showering my first patient, I put on his leg prosthesis, dress him, and wheel him to the dining room, where he can hobnob with other residents of the Very Last Resort.
On my way to shower my next patient, I'm called by Alice Sims.
"You're in charge of Mateo Gomez, aren't you?"
"Yes, I think so."
"He'll be going down to therapy at ten.  You'll have to have him dressed and ready."
I have less than 15 minutes to do this.  Mateo Gomez is no easy patient.  He either doesn't like me or doesn't like male CNAs.  I check my assignment sheet.  Sure enough, Gomez is due for a shower today.  But he's on my divided section, so he'll have to wait until his regular CNA shows up.  But the moment I see him, I realize he will need a quick shave.  It looks like he hasn't been shaved for a week.
The other patient in the room has visitors.  It is a family gathering.  They have made a circle around the man's bed and are whispering to each other.  I draw the curtain around Gomez's bed.
"Time to get up, Mr. Gomez."
Gomez doesn't talk.  He grunts.  Eons ago he suffered a stroke, leaving him paralyzed on his left side.  He has the wet eyes of a cocker spaniel but the tenacious will of a pit bull.  I check to see if he's clean, against his protests.  He is.  He has a urinary catheter, so he's also dry as a bone.  It's just a matter of getting him dressed and into his chair.  Easier said than done.  What strength he does have, he uses against me.  The man is dead set against getting up.  "Grrraaaaaa!" he growls, waving his good right hand in the air at invisible phantoms.
It sounds as if the people at the next bed are praying.  Having wrestled Gomez's pants on, I sit him up to put on his shirt.  He deliberately throws himself forward, backward, or to the side.  Beads of sweat are breaking on my brow.
After much struggle, I finally get him dressed.  Shirt buttoned, I grab him with both arms around his waist to lift him.  He has somehow found the means to turn himself into a dead-weight sack of cement.  Gomez is slipping from my hold.  He is winning the round.  Too late to ask for help.  If I don't dredge up enough strength now, the man will end up on the floor.  A rope of saliva is dangling from his mouth.  I brace my feet, bend my knees, and lift.  Gomez lets loose a mortified groan of defeat as he realizes I am about to plant him in his chair.  And once there, he slides his bottom forward as far as possible to slump himself on the floor.  I dash behind Gomez and grab him beneath his armpits, bringing him to an upright position and quickly slip his restraining vest on.  By now, he's as tired as I am and gives up the fight.  He allows me to shave him without a hitch.  Just as I'm wiping the excess shaving cream off his face, a smiling, bubbly physical therapist bounces into the room, flashing a mouthful of perfect teeth, looking fresh and wholesome as a spring morning.
"Ah," she says.  "He's ready to go.  Are you ready to go, Mr. Gomez?"
Gomez looks at her, docile, defeated.
The PT wheels him out, and I make Gomez's bed, drawing back the curtain.  The people at the next bed are silent, staring at the man as if he were already in his coffin.  He is a fetal position, eyes closed, in a very deep, deep slumber.
In the room next door, I get Virginia Hayden dressed and out of bed, into her chair.   
"Where am I?" she says.  She will ask this question half a dozen times before the day is out.
"At the Very Last Resort," I tell her.
"In San Diego?"
"I thought so."
I put her restraining vest on and tie it behind her chair.
"How long have I been here?"
"I have no idea."
"A long time?"
"Yes," she says knowingly.  "A very, very long time."
I wheel her to the dining room, and after getting a few more patients up and making their beds, it is time for a break.
The nurses' lounge is like a fog bank.  Cigarette smoke everywhere.  Primitiva Smith, nursing assistant and Navy wife, is snacking on raw squid parts.
"How the hell can you eat that shit?" someone says.
"Eat this?" Primitiva says, surprised.  "How can you smoke that poison?"
I light a cigarette and take a chair, blow smoke into my coffee cup, and let the fatigue drain from my body.  It feels good to sit down.
"Want some?" Primitiva offers.
I take a rubbery piece of squid, pop it in my mouth, and chew.
"Mr. Santini came back from the hospital today," says a CNA who likes to dress like an El Cajon Boulevard whore when not on duty.  "They cut off his left foot."
I remember Santini.  He's a lithe 90-year-old who doesn't look a day over 60.  Like the majority of the patients here, his mind is gone.  Not completely, but enough to qualify him as a permanent resident of the Very Last Resort.  I liked him because he was feisty, though terminally senile.  When he came in, they put him on our floor.  Rachel Rattus didn't like him from the beginning.  She considered him a troublesome patient because he liked to get out of bed on his own.  For a man his age, Santini was fairly strong.  And his mind wasn't so far gone that restraining him in bed could stop him from untying his harness, allowing him to climb over the bed railings.
When I knew him, he was in better physical condition than most of the others here.  Not a bedsore on him, continent, and fairly ambulatory.  Like other "troublesome" patients, he was shipped out to another floor.  I hadn't seen him since.  And now Gail is telling us that he contracted some kind of foot infection that would not heal.  The remedy, it seems, was to just lop it off.
Diabetics are by far the most likely candidates for amputations.  During my clinical training at another convalescent home, I met a diabetic concert pianist who had both legs amputated.  He was a pretty colorful patient.  In the 1920s he was in Europe, and I asked him if he'd ever met Hemingway.  He told me he was never formally introduced, but he saw him once in the back room of a bookstore hangout for artists and writers in Paris.
"I didn't like the man," the legless pianist told me.  "He was rude and belligerent."
This patient's mind was lucid, and I had no reason to doubt what he was telling me.  The upshot of our conversation was that Hemingway had walked into the back room of the bookstore and tripped over a blind man's cane.  Anyone else would have excused himself, the pianist told me.  Not Hemingway.  He allegedly took the cane from the blind man and broke it across his knee.
"The man was a barbarian," he said.
Convalescent homes are like neighborhoods.  Some are better than others.  Here at the Very Last Resort there might be a few historical luminaries.  But by and large, most them now couldn't tell you if it was night or day.
Rachel Rattus comes in for a quick smoke, and half a dozen of us get up to leave.  "I love to see you eager beavers move your tails," she calls after us.
In the hall is the austere presence of Nurse Cunningham, Director of Nursing.  Aside from her lab coat, she is dressed impeccably in street clothes.  She is making the rounds.  Are beds made?  Are patients up?  Are the nursing assistants moving fast enough, are their tongues hanging out yet, have any of them dropped dead on the job?
At the nurses' station is a congregation of wheelchairs manned with patients and lined against the wall.  All the patients have lap quilts and are restrained with vest harnesses. All are waiting.  Some sit with hat-rack devices that dispense the malt-like liquid down their noses, metered out drop by drop.
Over the PA comes a plea.  "Will someone please answer the light in 301?"
Randomly, Nurse Cunningham goes to a patient near the nurses' station and checks beneath her quilt.  I assume she is checking to see if the patient is dry.  We're supposed to check our patients every two hours.  If you can remember.
"Who's in charge of this patient?"
As it turns out, the patient is mine.
"She has no underwear on," Nurse Cunningham tells me.
I know this.  I dressed her.  The patient, Rose Chambers, sits on an "egg-crate" cushion covered with a bed pad.  Her dress is hoisted behind her back so if she pees, or worse, she will not soil it.
Cunningham is not angry.  She is simply being professional, as she always is.  I do not want to tell her that many patients, men and women, on this floor as well as others, are not wearing underwear.  One less garment saves time, a trick any good CNA will readily admit.  But of course, this is not the question.  What is at hand is that Mrs. Chambers lacks underwear.  Period.
"We have to concern ourselves with the patient's dignity here," she tells me. 
"We cannot have patients sitting here without underwear."
The truth is that Mrs. Chambers had no underwear among her personal items. 
I inform Nurse Cunningham of this.
"That's no excuse," she tells me.  "There's plenty of clean underwear in the laundry room."
This is true.
"Now, if we are to consider Mrs. Chamber's dignity, we will have to get underwear on her immediately."  "We" of course means me.
After I wheel Mrs. Chambers to her room and restore her dignity, I go on to help another NA dress an especially heavy patient.  No sooner do we have him dressed and ready for his chair than Ester Santos, charge nurse for the day, walks in with a small cup in her hand.  She is a clone of Nurse Rattus.
"Mr. Lorne," she says to our freshly dressed patient, "the med nurse says you don't want to take your medicine."
"I don't need it," the man says.  He bears a remarkable resemblance to Ed Begly, Sr.
"Oh yes you do," Nurse Santos sings.
"I don't want it."
"The doctor says you must have it."
I know what the stuff is.  Mr. Lorne is an "active" patient.  He's hell on wheels.  When he first came in, he would sometimes go into another patient's room and claim it as his own or invade the sanctity of the nurses' station and rifle through whatever caught his fancy.  The red liquid in Nurse Santos's hand would knock out a horse; it usually leaves Mr. Lorne like a bleary-eyed zombie.
"It's for your own good," Nurse Santos says.  She snatches Lorne's jaw in one puffy hand, squeezes his face into the shape of a puckering mackerel, and deftly pours the red potion down his throat.  The ordeal leaves Mr. Lorne sputtering and coughing.
"See?" the good nurse says to us.  "Simple."  Santos is beaming.  "By the way, he needs a shave."
"He has no shaving cream," Janet says.  "The supply room is locked."
"He has a razor?"
"Let me have it."
Janet hands the RN a Bic disposable.  Then, with those very capable hands of her, Nurse Santos begins to whack off the whiskers.  I do not believe what I am witnessing.  She did not so much as wet the man's face with water.  First one side, then the other.  The chin.  Whack, whack, whack.  I can't help but wonder if she shaves her legs that way.  Now the throat. Whack!  Swift upper strokes, and then one more for good measure.
"There," Santos says with obvious satisfaction.  Lorne's face is red as a lobster.  The medication must be taking effect because he looks dazed.  There are a few nicks here and there, an especially nasty one on his lower lip.  Tomorrow he will undoubtedly look as if he had been shaved with a cheese grater.
Santos looks at Janet and says, "You remember that."
Janet, a green-eyed petite CNA, looks at her and blinks but says nothing.  After imparting this wisdom, Santos makes an about face and exits.
The PA system announces, "All nursing assistants who have forgotten their nutrition, it has been here for an hour."  I am among those who have forgotten.  I locate and feed my three patients who are on a nutrition thick substance that resembles the liquid taken by the nose-feeders.  Few patients eat it without a struggle.  Another of my patients, Mrs. Kingsley, refuses her scheduled shower, but I convince her she needs a bed bath.  (The beautician, she says, will wash her hair.)  And her dentures need to be cleaned.  Her bed linen has to be changed.
Mrs. Kingsley taken care of, I head out to check on my turning schedule.  Three of my patients have remained in bed and have to be turned every two hours.  The first is Mrs. Schroeder.  She is facing the door, so I turn her toward the window.  The woman is as light as a bird and every bit as skinny.
"None," she tells me.  "None."
After turning her, I mark it on the chart, the time and position: 11:30 a.m., and W for window. 
Then I proceed to Laura Groton's room.  This woman has suffered a series of massive strokes that have left her completely befuddled and paralyzed on one side.  Her eyes hold life in them, but whether she can perceive anything is beyond me.  As I'm about to enter her room, Alice Sims comes up behind me and says, "Laura Groton needs a shave.  Her family is coming today, and I want her to look her best."
To be perfectly truthful, shaving women is something I have never completely gotten used to.  Bathing them, cleaning them, all in a day's work.  But shaving them is something I find personally discomforting.  Nevertheless, it has to be done, and once completed, I give her a fresh gown for good measure.
There are fifteen minutes left for lunch.  I rush to the elevator, head for the patio, and proceed to smoke three cigarettes, posthaste.
Then I go back inside and find Albert Lacy to help me get Sally Osgood into the whirlpool chair.  It is virtually impossible to do this on your own.  Even though the woman is not paralyzed, she is dead weight.  Sally has a feeding tube in her nose and is never fully awake.  She seems to be having a perpetual nightmare from which she is unable to wake.  She whimpers constantly.  If I hurry, I can get this done before the lunch carts arrive.
Lacy is in his sanctuary, a six-man room that's neat as a pin.  There seems to be an aura of blessing about the place.  Every bed is made and creaseless.  Some of his patients look as polished as if they were waiting for Sunday services.  When I tell Lacy I need help with Sally, he immediately leads the way to her room.  Lacy and I get Sally in her wheelchair, and I grab her hat-rack feeding apparatus and push Sally and her perpetual feeding machine awkwardly down the hall.
Alice Sims stops me.  "Hi-nee," she says, pointing a finger at Sally's bottom.  A cheek is showing.  I quickly arrange the sheet to cover her.
When the whirlpool bath is complete, Lacy helps me get Sally back in bed.  And just in time, too, because the lunch carts have arrived.
Every CNA on the floor has to help pass out trays.  Whatever you're doing must be dropped.  By the time the first cart is emptied, the second one arrives.  Everyone is fluttering about delivering trays, cranking patients up in bed, placing bed tables over wheelchairs.  Lunch is, in fact, easier to serve because many of the patients eat in the dining room at this time and therefore are in the care of those assigned to that section.
Lunch also means noontime meds, and Rachel Rattus is on patrol again.  As I deliver a tray to one of the patients, I hear Rattus across the hall tell one of the CNAs to show her the resent bed sore found on one of the patients there.
"I would say its about the size of a dime," Rattus comments.  "Be sure to chart it."
Mrs. Levi is half blind.  She is already in her chair ready to have lunch.  But she tells me she is not hungry.  All she wants is milk.  I pour the only carton on her tray in a glass, and she quickly empties it.
"Have you got anymore?"
"You only had that one carton," I tell her.
"She can have mine," another patient says.  "I hardly touch milk.  I haven't even opened it yet."
Rattus storms into the room.  "Mrs. Levi is not to have any milk unless she eats her lunch."
The two patients and I are dumbfounded.
"You're nothing more than a mean old lady," Mrs. Levi says.
"You have to eat your lunch," Rattus tells her.
"I'm not hungry!"
"Be that as it may, you still have to eat."  And with that, Rattus leaves.
As soon as I'm sure that she's in the next room, I take the milk from Mrs. Levi's roommate and pour it into her glass.  What Rattus doesn't know won't hurt her.
No sooner does this stream through my mind than Rattus comes whirling back into the room. 
"I said you're not to have any more milk until you eat your lunch!"  By this time, Rattus has hold of the glass that Mrs. Levi is bent on keeping.  "Give me that," Rattus says.  "Give it to me!"
The milk is swooshing in the glass and spilling on the tray.  At last, Rattus wins the battle and is about to walk out the door with her prize.
"What the hell's the matter with you?"
She swings around and glares at me.  "She has to eat her lunch!"
"But she's not hungry!"
"That makes no difference."
"It makes every bit of difference to me."
"Stop it!" Mrs. Levi says.  "Stop it!  The both of you."
Rattus and I look at her.  Mrs. Levi's cataract-ridden blue eyes stare at the wall.  After a moment, Rattus leaves with the milk glass.  The room is silent.
"She's a very bitter woman," Mrs. Levi's roommate says.
There is nothing more to say, so I pick up the trays and take them back to the food cart.  As in every other profession, low man on the totem pole has very little recourse in these circumstances. 
After lunch, we wheel some of the patients to the dining area, where a singing trio is expected to arrive shortly.  Taking vitals on other patients follows this, and of course, my turning schedule has to be updated.  Some patients have to be put back to bed; others have to be ambulated up and down the corridor.  Those of us lucky enough to have a spare moment take a break.  Others begin their charting: thumbnail sketches of patients' behavior for the day; how much each patient ate for each meal; the amount, consistency, and quality of their urinary output and bowel movements.  Were they shaved, showered, nails trimmed, put in wheelchairs, turned, etc?  If nothing else, this mundane detail gets us off our feet.
After my charting is out of the way, I notice that some fresh troops for the next shift are streaming in.  One of the RNs is going about the hall asking already exhausted nursing assistants if they would like to work a second shift.  When she comes to me, I tell her I have other things to do.  (Like rest my feet.)
A voice on the PA system begs, "Will someone please answer the call light in 301?"
Besides, we get to do it all over again tomorrow.

In 1989 I worked for two convalescent hospitals in a little less than a year.  This article chronicles some of the events that took place during that period.  Up till then I had done what I considered to be some heavy labor: landscaping, truck driving, construction, etc; but nothing like the arduous, low paying, thankless work of the CNA.  I salute them and their aching feet.