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The Toolbelt

Administrators in long term health care settings wear many hats. You may find us writing zero based budgets, drafting care plans, resolving conflicts, overseeing daily operations, hiring, firing, plunging toilets, changing light bulbs- on and on the list goes. They truly are “jacks of all trades”! If they wore a toolbelt- it would house so many things, the load would be too heavy to bear.

I personally do not mind doing the oddball or mundane things, even though some administrators do. I find that being present and tending to things others cannot do, or aren’t there to handle, shows everyone under your leadership that “not my job” are words not in our vocabulary. The task is there, it needs to be handled, so we do it. Pretty simple.

However, there are some tasks that are emotionally taxing. It is the hardest of hard duties. It is the part of my job that is not required of me by Home Office, Regional Operations Officers or anyone else. Rather it is mandated by no one other than me. Let me share with you a recent occurrence and maybe you can identify what it is that drives me insane and is the most challenging for me.

Pete was one of my most favorite residents- simply because he was a challenge to care for. He had lived with his wife until he became “too much to care for her”. He would become aggressive during care-making for an unsafe environment for them both. She brought him to the facility, dropped him off and never returned to visit. She would call occasionally, only to ask me if I thought he would die in the near future. Ummmmm, he was perfectly healthy aside from having dementia, so how could I possibly answer that???? I would tell her that he was doing well and seemed outwardly healthy- thinking she would be pleased. Rather she would reply ” Well, he cannot outlive his money”.         Look, I get it. I understand that dementia is a slow, silent goodbye that seems to drag on and on. People question quality vs quantity of life- but those are not my decisions to make or my judgement to pass. All I can offer is …” I understand” or ” I will keep you informed of any changes.” What else I can offer?

Two years passed. Pete continued to thrive. Then came COVID-19. It struck out of nowhere and he was hit fast and hard. I called the wife, explained how sick Pete was and explained the care we were providing. She told me to let her know “when he was close” so she could have the children looped in. He had children???? For 2 1/2 years, this guy had not had the first visitor and now we are talking about “looping the children in?” Alrightly then.

The phone rings……I answer it. It is Pete’s daughter who lives in Texas. She cries, I listen. She tells stories of her childhood and how great of a Father Pete was. I listen. She explains how she would come visit, but she has a demanding job, two kids and 4 dogs and it is a long drive. I listen. She continues with her childhood reminiscence of her dad teaching her to ride a bike, taking her to his office to work, teaching her to drive a stick shift and walking her down the aisle at her wedding. I listen.

After she hangs up, I return to Pete’s room, where he remains in critical condition and unresponsive. I sit with him, knowing he could draw his last breath at any second. His eyes are closed, his respirations are high, and he is struggling to hang on. I tell him I talked to his daughter, and that she loved him and missed him and “wished she was here” with him. I tell him his wife called as well. Then I sit in the silence, listening to the oxygen concentrator drone on.

The phone rings, I answer it. It is Pete’s son. He wants an update on his dad. He tells me he got his love of classical music from his dad. He owns over 300 vinyl records that his dad had collected over the years- some of worth a lot of money today, he explains. He tells me about the composers, the melody, the rhythm of the orchestra- things I do not even understand. I listen. He cries, I listen. He explains that he lives in the next town over, but “can’t deal” with his dad not “being in his right mind”. I listen. He tells me he will call back later and see how dad is doing.

I return to Pete’s room. I tell him his son called. I tell him he said he loves him and misses him. I sit in the silence not wanting him to die alone. I tell him his wife called, and said she loved him. I tell him his daughter called again. I tell him how much he is loved and that everything is going to be okay…….

Days go by. The calls stop. I sit and repeat myself ” Your wife called, your son called, your daughter called. They all love you”. “Everything is going to be okay.” I sit. I wait.

Nowhere in my job description does it say that I have to do this. Nowhere does it give me the right to pass judgement on the family. No one has empowered me to “understand” how difficult it is to “deal with dementia”. Nowhere is it written that I must sit with a dying patient, so he does not die alone. No one in my chain of command can make me understand why those who “love him so much” cannot be the ones at bedside with the man who did so much for them- not because I don’t want to do it, but rather because they want to do it and be there.

So, which part do you think was the hardest for me? Listening to the family, sitting with Pete or not having the ability to understand the dynamics of his family?         The answer?     The family dynamics and my inability to understand why they never came to see him, nor wanted to at least come say “goodbye”.   Is it empathy for not understanding their position and not wanting to see Pete “that way’, that I am lacking?    Is it compassion for the family I am lacking?    

There will always be another Pete situation. Another family with reasons for not being there.   My question is…. what am I am missing from my toolbelt that can better equip me for the next time?