Not All Jobs Work Out

A couple of weeks ago, I started a short-term assignment, caring for an elderly man with dementia.  He had been hospitalized with sepsis and then spent a couple of weeks in a rehab facility to gain strength before going home.  Once home, he was to have round-the-clock care for a couple of months to see if he could go back to his previous pattern of help just a few hours a day or would need to be moved to a care facility.

The timing of this job worked well with my schedule, as I’ll be caring for BabyBoy full-time in January and so wasn’t looking for long-term work.

The odd thing about this job, right from the get-go, was that I was interviewed by the other caregiver, not a family member.  It’s not unusual to get work through caregiver networks, but most of the time, a family member is involved somewhere.  Not in this case, though, it was just her.  She placed the ad, did the interviews, and hired me.

I had some misgivings during the interview, which was at the rehab facility.  CaregiverK (as I’ll call her) kept misusing common medical words, and not just once in a while but continuously.  She kept using the word “apnea” when she was clearly talking about cyanosis, and prostrate instead of prostate, for example.  The other thing that raised my eyebrows was the way she was talking to and about the client, who was sitting right there in his wheelchair.

He was upset because she had put denture paste on his upper plate, something he never used.  (Denture paste is very sticky stuff.)  He had his plate out and was trying to get the goo off his palate with his fingers, which just got his fingers all sticky.  He got very agitated because he wanted the goo out of his mouth and he wanted his fingers cleaned.  He repeatedly asked for hot water and baking soda to rinse out his mouth, saying that he always had a clean mouth and didn’t like the stuff in it and why wouldn’t she get him hot water?

CaregiverK was cleaning his upper plate with a tissue, then went to the bathroom nearby to rinse it and bring the client some cold water.  He wasn’t pacified, again insisting that hot water would help him rinse his mouth.  I suggested we go to his room to get him some hot water but CaregiverK didn’t want to, it was too far away from the lounge where we were sitting.  She insisted that the client was just being ornery.

That bugged me.  He had a valid complaint and she was not dealing with it purely because she didn’t feel like going down to his room.  But, I wanted the job and knew I’d be nicer to the client when it was just us, so I didn’t pursue it.

The other thing that struck me as odd was that when I said I could work through Wednesday mornings but I had to leave at seven on those mornings, CaregiverK said that she couldn’t get up that early and I could just leave the client on his own until she was able to get there.

That was really weird.  Clients needing 24-hour care don’t usually get left on their own.  She insisted it was okay, though, saying he used to be on his own all the time except for a few hours a day.  

Whatever.

I got the job.  CaregiverK was to be my contact.  She said the client’s son, who lived nearby, didn’t want to be contacted by me, that he wanted her to handle everything.

A week later, the client came home and three days later, it was my turn to stay with him.  I started Saturday.  Sunday he complained of burning on urination, so I informed CaregiverK.  Monday morning, she got the client an appointment with his doctor, and I took him there.

It was a urinary tract infection, which we’d guessed, as his sepsis had been caused by an inappropriately treated UTI.  While in his office with the client, I heard the doctor say to his assistant that the client couldn’t have a certain antibiotic.  He wrote a prescription for another antibiotic, which I filled at the pharmacy on the way back to the client’s house.  Once back at the house, I gave him a pill and let CaregiverK know by text what the upshot of that visit was.

CaregiverK called me, very upset and angry, saying the doctor got the prescription wrong, that the client was not supposed to have that medicine but another one instead.  There happened to be a full prescription of the other medicine in the kitchen, and she wanted me to give the client that medicine.  I told her I was sorry, but that I wouldn’t do that without a doctor’s order.  She kept insisting, getting very emotional.  I told her again that I was sorry, that while I believed her, changing a medicine without a doctor’s order was a line I wouldn’t cross.

She came to the house, found some documentation from the recent hospitalization, went to the doctor’s office, got the prescription rewritten (because she had been right, the doctor was using old and erroneous information) and brought the new prescription back to the house.

Okay.

The biggest problem I had with the job to that point was that the client didn’t sleep at night.  He would be up every half an hour to hour, needing to go, getting confused, yelling for help, or just yelling at himself.  That first night was horrible.  The next night was a bit better, and of course I knew things would probably settle down some once the medicine kicked in and his bladder was happier.

The advice from CaregiverK, regarding the nighttimes, was that I should just ignore the client and not get up.  She suggested doing as she did, keeping my door closed (it was) or buying earplugs.  Oh my.  Why bother with overnight care if the caregiver was going to ignore the client?  This man was way too confused to be ignored.  CaregiverK told me that on one occasion she drank some of his brandy to get to sleep.  Oh my again.  I didn’t get earplugs and didn’t drink brandy and just managed.

Then came Wednesday morning, the end of my shift.  The client had gotten up early, so I had time to give him breakfast and his medicine and get him settled in his favorite chair in front of the television, then I left.  I sent CaregiverK a text that he was up, had eaten and had his medicine, and was watching tv.  

I’d spent three days with the client and disagreed that it was safe to leave him on his own.  He needed a walker and was confused to the point that he needed directions to find his bathroom.  

I went to KidOne’s house to watch BabyBoy while she went to class.  A couple of hours after I’d arrived there, I got a text from CaregiverK, asking if the client had eaten, as he didn’t have much appetite.  I sent back that he had, and got a response saying she’d wondered why he didn’t seem hungry.  Hmm.  Clearly, she hadn’t read my text, or hadn’t bothered to understand the words in it.

Over the next several days, CaregiverK sent me several texts, including one that said she was tempted to give the client valium to get him to be quiet, a sentiment I certainly understood.

She also forwarded a text to me that she'd sent to the son at one in the previous morning, a long, rambling, angry rant that looked as though the writer were under the influence of something.  I, in turn, forwarded that text to both Sweetie and KidOne, both of whom agreed that it was seriously inappropriate (to put it mildly).

A little after that, she sent me a text asking if I thought she'd gone too far (in the text to the son).  In a masterpiece of understatement, I told her I thought it was a conversation better had in person.  Her response cracked me up--she said she communicated better in writing.

Then it was time for me to relieve CaregiverK.  I got to the client’s home that Saturday morning after nine, as I’d stopped on the way to pick up another prescription for him.  CaregiverK was in the middle of fixing the client’s breakfast.  After that, she stayed for a couple of hours to visit.  Among other things, she referenced a bottle of wine she’d brought, calling it her sleeping pill, and told me that she had given the client one of her valium so she could get some rest.

Oh lordie.  I had been considering leaving the job because of the difficulty getting some sleep, but while that first night had been so horrible, the following two hadn’t been too terribly bad, but after hearing that CaregiverK had given the client her valium, I decided I was probably going to quit.  The only problem with that was that I really liked the client, and certainly needed the money.  What to do, what to do, what to do.

Then came Sunday evening.  I went to give the client his medicine from the pill tray that CaregiverK had filled.  Hmm.  For some reason, there were six pills in the tray for that evening, instead of the usual three.  I took out the extra pills and gave him the usual ones.  The pills had come from containers that were empty, so I didn’t know what the extra ones were, but enough was enough--that was all too much liability for me.  The client’s son, whom I had met once during my first shift there, was due the next day.  I decided to give him my two weeks notice, but wasn’t sure how much I was going to tell him about the other caregiver.  On the one hand, he certainly needed to know, but on the other hand, CaregiverK had been caring for his father for almost a year and I had only been on the scene for ten days.  Plus, he really didn’t want to deal with any of that sort of issue.

What the hell.  He came by the next day and I gave him my notice (saying I’d work the following week), and I told him why.  I told him the lack of sleep was a problem, but that the real reason was that I wasn’t comfortable with the level of liability I faced.  I told him about CaregiverK’s drinking to get to sleep, giving his dad her Valium, and messing up his dad’s pills.  I also told him I thought his dad should be in a care facility.  

The son wasn’t happy to hear any of this, but understood.  He told me he’d been looking into some places for his dad, and asked if I’d be willing to help while he made arrangements.  I told him I would be willing, but that I wouldn’t work with CaregiverK.

I don’t think he really understood about the liability issue, but he accepted my notice and said he’d handle things.

Well.  Several hours later, I got angry texts from CaregiverK.  She was furious that I’d talked to the son, furious that I’d given my opinion, furious that I’d cost her a job she needed.  She called up, still furious, wanting to fight about my experience v hers, etc., but I wouldn’t engage in the fight she so clearly wanted and she hung up.

The angry texts continued throughout the evening, but then she stopped and texting returned to dealing with client issues.

For my part, I told Sweetie and KidOne that I’d gotten it over with.  To KidOne, I said that I thought CaregiverK would not have my work that last shift, that she would want to deprive me of the money for those last days.

I also remembered that evening that pill containers had a description on them of the pills inside and so checked to see what the extra pills in the tray were.  Wow--the client would have had a double dose of his prostate medicine, and a TRIPLE dose of his hypertension medicine.

Wednesday morning came around and I left the client in front of the tv again, having had his breakfast and his medicine, and sent a text to CaregiverK saying so.

A couple of hours later, I got a text from her asking if he’d eaten.  Geez, I was glad I’d resigned.

That afternoon, I got a text saying I didn’t need to work that next (and last) week, that she’d hired someone who didn’t need her beauty sleep.  She said I’d stepped way out of bounds by talking to the son, that I was out of line, and that she took full responsibility for things turning out badly because she hadn’t called my references to see if I really had any experience caring for the elderly.  It was a lulu of an email, even for her.

On the plus side, the son had clearly honored my request to not repeat what I’d told him about CaregiverK until I was out of the line of fire, as she didn’t reference any of those issues.

When KidOne came home, I asked her if I was right in thinking that a triple dose of hypertension medicine could have caused the client’s blood pressure to bottom out and give him a heart attack.  She said it sure could.  If I’d given those pills to the client and he died, it wouldn’t have been CaregiverK sitting in jail, it would have been me.  And on those Wednesday mornings, if he’d gotten hurt after I’d left and before she arrived, it would have been me charged, because I’d been the one to leave him on his own.  If I’d changed that one prescription on her say-so with negative results, it would have been me charged with neglect or endangerment, not CaregiverK.  CaregiverK was just that, a caregiver, with no more legal relationship to the client than I had.  I could just hear a judge, “Ms. Brown, you’ve been in healthcare, on and off, for thirty-five years, and you did WHAT?”

I’m well out of it.

Now to get my paycheck.  I’ve asked the son to mail it to me, since I won’t be going in to work on Sunday morning (it would have been waiting for me there).

We’ll see.

A