The Lady In The Basement

ORIGINAL POST DATE 5/15/09:

Yesterday I was assigned to cover for a fellow CNA and see one of her regular patients, Mrs. B., who has end stage renal failure, and has been a patient of ours for quite some time.

Mrs. B. lives with her grandson, his wife, and their two young boys in a quiet, lower middle class subdivision. When we visit Mrs. B. during the day, the entire family is out working and in school, so Mrs. B. spends the entire day alone except for our visits.

Three years ago, when we signed Mrs. B. on as a patient, she enjoyed a bedroom upstairs in the main part of the house, very close to any of the family members if she should need anything, or feel like coming out of her room to sit in the living room and enjoy their company.

Then the baby came. Mrs. B's granddaughter in law gave birth to her second son, and suddenly there came the need for a nusrsery, and the question of what to do with Mrs. B.

The question was quickly answered, when a downstairs room adjacent to the garage, laundry area, and spare bathroom, was cheaply remodeled with commercial carpet and inexpensive wallpaper, and made into a new bedroom for Mrs. B. Problem solved...not quite.

The house Mrs. B. lives in is a split-level colonial, similar to a house owned by the family of my high school boyfriend. There are two distinct levels, and two very steep flights of stairs that must be negotiated in order to travel in between them.

Mrs. B. is in her late 70's, with renal failure and a host of other life threatening health issues, (or co-morbidities, as we call them in the industry.) Climbing stairs in order to fellowship with her family is not possible for her. Walking across her bedroom to get something is not possible for her. Standing steady at her walker while I wash and change her is barely even possible for her. Basically, Mrs. B's existence consists of moving in a four foot square, from bed, to easy chair, to bedside commode. This is her whole life, these three destinations, broken up only by visits from the hospice team, and the cheerful Meals On Wheels volunteers.

As the months progressed, it became increasingly apparent that something was wrong in the B. household. When we come to visit, we often have to go upstairs to do various tasks, like obtain ice water for Mrs. B. from the refrigerator, or use the kitchen microwave to reheat her meals. Upstairs it is obvious this is the house of a busy, suburban family. The B's are not very good housekeepers, and their house is well lived in. It seems as though they forego organization and spotlessness in exchange for enjoying their active, young sons whenever they are home for work.

But, as life seemingly goes on upstairs in the B. household, downstairs is a different story. Dust is building up in Mrs. B's room, piles of it, dust bunnies so big one can literally scoop them up into one's hands without the assistance of a broom. Dust covers everything from the dresser, to the bedframe, to the oxygen concentrator in the corner of the room, a fact which, as anyone who is familiar with oxygen use will know, is a terrible fire hazard.

The dresser where Mrs. B's clothes are kept has gradually also become the family "junk depot" for odd items that don't seem to fit into any category where they can be stored upstairs. In the midst of Mrs. B's underwear and pajama sets lie drinking water filters for the faucet, used batteries, telephone cords, old bills, and an array of dirty and broken CD's, some of which can't even be identified.

It is also obvious, when one has come to see Mrs. B. on a regular enough basis, that she is not often visited by the members of the family upstairs. In fact, in her own words, Mrs. B. relates that her grandson comes to visit with her once or twice weekly, bringing her a plate of food from the restaurant where he works, sometimes sharing it with her. Mrs. B., it seems, is never visited by her grandson's wife, or their children. She is not offered the joy of watching the children grow, or being a great grandparent, and getting to talk to them about their school day, etc. To her they are just noisy children who live upstairs, and her granddaughter in law is still referred to by her as "that girl who lives here", even though her grandson has been married to her for eight years!

Mrs. B's laundry sits in the corner, overflowing out of several plastic trash bags, often not washed for weeks, even months at a time, literally. I have personally found more than three bags of dirty laundry on her bedroom floor at one time, in desperate need of laundering, the room in desperate need of an open window and fresh air, and two or three sets of brand new MEN's jersey pajama sets laid in her dresser drawers for her to wear after we bathe her. Rather than was her clothes regularly, or keep them out of her room where she won't have to endure the smell, they simply buy her cheap new ones. Once, out of anger and frustration, I even started a load of her laundry during my visit, even though it was not on my assignment, and since I did not have time to dry it completely, I left a very terse note to the family and demanded that they follow through and finish the load so that the poor lady could have some clean socks and underpants. Such an act could have bought me a stern reprimand, but I didn't care, and, incidentally, the load never got dried. It sat in the washer until it mildewed and I had to do the entire load again, this time staying an extra hour and a half to dry and fold it.

Mrs. B. has a bathroom downstairs where she lives, but she cannot walk far enough to use it, and it has gradually taken on the atmosphere of a janitor's closet in a school building or a jail. A large janitor's mop and bucket sit inside the shower stall. The gray stone tile floor is cold, without any rugs. There are no pictures on the walls, no towels on the rack, and no soap or anything pretty smelling at the sink side for Mrs. B to use while bathing. The only personal care items she owns are the hospital type cleansers and lotions we provide from the hospice.

On the most recent day of my visit, I discovered that Mrs. B. had her oxygen concentrator running, but no tubing was attached to it. Apparently, the durable medical equipment company came out to deliver her a much needed replacement nasal cannula. Her other had become dirty and brittle with age. (Typically these should be replaced monthly.) The only reason they even came was because I reported the condition of the previous one to the RN case manager the week before. (Makes me wonder about the diligence of our nurse, as well, but that's another matter.)

The tube that was delivered to Mrs. B. was 12 feet long, but due to the configuration of the room, and the location of the oxygen concentrator, the tube was not long enough to go with Mrs. B. to her three primary locations, the bed, the chair, and the potty. So, she simply removed it and coiled it up neatly under her pillow!

Upon seeing her need for longer tubing, or an adaptor so I could connect the shorter tube to a longer one she also had available, I again contacted her case manager (who is also covering for the regular nurse, who is recovering from surgery). I stated the problem, and since the nurse is overwhelmed with a caseload not only of her own patients, but others belonging to another nurse, she was not immediately able to identify which patient I was talking about. I gave her additional details to jog her memory, and suddenly her voice lit up and she said, "Oh, the lady in the basement!"

Yes, nurse K, that's the one.

Peace out.
soul