Monday, August 15, 2011

Lessons from LTC

I was not looking forward to my rotation in long-term care. And when I started, I was relieved that it would only last for two weeks. But by the end I had gotten so comfortable there, so used to the smells, the sights, the residents that had scared me at first and I was sad to leave behind the routine, the meetings, the familiar faces to start all over again at a new site.

My time in long-term care (LTC) was mostly spent on my feet. While the dietitian I worked with had an office, she was hardly ever there unless it was to update residents' meal preferences or enter quarterly and annual assessments. Otherwise I tried to keep up as she breezed through the halls, whipping in and out of patients' rooms, checking up on them, tracking their weights, seeing how they were eating - did they need a speech or an OT consult? Were they have swallowing problems or difficulty holding their utensils? Were they able to meet their nutritional needs through oral intake or did they need liquid supplements? Were they getting their meals as they ordered it, and if so, was the temperature appropriate by the time it arrived from the kitchen? These were just some of the dietary concerns at the facility where I was working. Through these daily tasks I got to know the residents and their mannerisms, the ones who liked puzzles and the ones who ordered takeout food, the ones who spoke inappropriately to women and the ones who would grab your hand and not let go if you got too close. I learned who had their own set of teeth, who wore dentures and who preferred not to wear their dentures. I learned who was 105 and who was 85 and who was 55 and who must always always always get two cartons of chocolate milk at every meal or else. Then there were the harder parts.  I sat in on meetings with families of residents who were recommended for hospice care. During my two weeks there two residents died. I observed wound care on a patient whose foot had bad gangrene and pressure ulcers but refused amputation despite doctor recommendations.

During my first week I was focused on the sad parts, the decaying people, the empty shells of what were once vibrant lives - or were they? Many of the residents were homeless or alcoholics or, as my supervisor said, "had made poor life choices." A number of them had mental disorders and acted out and threw their trays and had temper tantrums. But there were lighter times too, and by the second week I grew to appreciate these even more, adapting in the ways people do who work in this environment for extended periods of time without losing their minds or their faith in humanity.  I joked around with the staff before the morning meetings and worked the tray line in the kitchen, hairnet and all, and laughed with the head of medical records and helped out with the Hawaiian staff bbq. I smiled at every person I made eye contact with and tried to learn the residents names to say hello to them every day. I learned that treating people with respect and dignity is paramount. I realized that everything can change in the span of two weeks.

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