Gertrude

            Her name is Gertrude, but we like to call her Gertie.  She is a 94 year-old, 142-pound woman who resides in a long-term care facility, a nursing home.  She has all the character traits that come to mind when you picture your typical nursing home resident.  She has short white-gray hair that she has permed and hairsprayed religiously on a weekly basis.  Her rolling walker has basket attached, which she keeps stocked with tissues and hard candies, the later of which she will never hesitate to give to you.  She will always try to take care of others before she does anything for herself.  She has been knitting the same rainbow scarf since I started working with her over a year ago.  She loves to tell stories of her youth.  Oh, and she will call you every name in the book before she finally comes to the right one.

            Gertie hasn’t always been the elderly woman I have grown to know and love.  She regales me with stories of her youth.  Gertie grew up the youngest child, with 4 older sisters.  In fact, this is how she remembers my name.  When she forgets, she starts naming all her sisters.

            “Evelyn?  Fay?  Doris?  Laura?”  She stops, knowing she has named the corresponding sister with whom I share a name.  This, of course, leads into a story about her older sister Laura.  Laura was the oldest of the 5 girls, and favored her youngest sister very much.  In their youth, Gertie would beg Laura to let her help with the chores.  Laura would teach her how to do housework, protect her, be her confidant.  She always smiles when she thinks of Laura.

            At the age of 19 she married her love, Henry.  They had 5 beautiful children, only 4 of which made it to adulthood.  Gertie is very proud of her large family, often indulging any ear willing to listen about how her daughters and some of her granddaughters are nursing.  She brags about how some of them care for children with cancer; how they are such warm souls to see such heartbreak day in and day out.  She talks about her great-grand babies in California.  Her walls, her bureau, her nightstand are all littered with pictures of a beautiful smiling family.

            I don’t think she sees very much of her family now that she is in a nursing home, but it doesn’t seem to bother her.  As her dementia progresses she talks to the pictures of her family as if they can actually hear and converse with her.  Even though she is developing these little quirks, she is still one of the lucky ones.  She is able to walk, just with a walker, not with someone trailing her around to make sure she doesn’t fall or try to walk out the door.  She is able to wash, dress, toilet, and feed herself, unlike many of her companions. 

            However, those same attributes that make her lucky, also, in a sense, make her unlucky.  She is more aware of her surroundings.  She is aware that the people around her do have to be fed, changed when they inevitably soil themselves, and have very free will.  She sees all this, yet there is nothing she can do about it.  This is where Gertie’s nerves get the best of her. 

            “I’m just a bundle of nerves,” she confesses.  “That’s what the doctors used to tell my mother.”  And its true.  She struggles with the frustration of being forgetful, but not forgetful enough to forget she is forgetting.  She gets anxious when its getting close to bedtime and she hasn’t been given a shower yet.  She gets all worked up when she has a confrontation with other residents about the amount of bingo cards they are allotted.  She gets agitated when she needs something and she can’t find an aid to instantaneously cater to her every whim.  It drives her absolutely up a wall when she sees a fellow resident at the nursing home getting made fun of.

            Gertie lives for the activities they have at her home.  Boy, do they have a lot of activities.  Daily, from right after breakfast to right before dinner, her days are jam-packed.  Activities can range from arts and crafts to exercise to trivia to tai chi. She gets to play bingo weekly, getting a quarter for every game won.  She makes little decorations they lay among the photos of her family, different ones for different holidays or seasons.  What Gertie enjoys is when they have people come in who sing and play instruments, sometimes they even have dancers.

            Although Gertie can claim many friends at her home, she only has one close friend, her roommate.  Her roommate’s name is Maria; she is a 89 year old who has Parkinson’s Disease.  Maria is one of the residents at the home that is unable to groom, feed, or toilet herself.  She relies solely on the people employed by the home, and Gertie makes it her job to ensure Maria is being well taken care of.  They spend evenings in their room chatting before they go to bed.  As Maria gets tired, Gertie goes off to find someone capable of helping her into bed.  They are always looking out for each other.

            Despite her medications, Gertie’s dementia is progressing.  She is becoming more and more forgetful.  She is loosing her filter that allows her to distinguish between right and wrong.  More often she can be seen with her shirt on backwards, or holding her pictures up to watch TV.  Despite those ever increasing moment where her mind is elsewhere, I will always remember Gertie as she asks me to tuck her in at night.

My Memior

            We all have some kind of connection to health and medicine.  We have all been sick, we have all been to the doctors at some point in our lives.  Some of us may have been in the hospital at one point, and most of us have visited a hospital to see a loved one.  We can all tell a tale of at least one vivid memory regarding health and medicine.  I can tell you stories till the cows come home about my medical experiences, but this tale is unlike many others.

            I was sitting patiently, picking through my Army issued MRE (meal ready to eat) for something actually edible and awaiting my turn.  I was nervous.  I was mentally going over everything I had learned in medic school in the last 14 weeks. This was my last obstacle, trauma lanes.   All my hard work had lead up to this.  I had done astonishingly well, and if I didn’t pass this, I wouldn’t be able to claim my place as an honor graduate.  I had to do well.  I had my aid bag; I knew where everything was in it.  I had to.  I had my ever-present M16 rifle by my side.  I was decked out in full battle gear, waiting for my name to be called.

            I had heard stories from those who had gone before me, by nothing could have prepared me for what was about to happen.  The moment I crossed the threshold of those double doors my senses were bombarded.  My ears were filled with booming rock music and instructors yelling.  My eyes darting from student to instructor to mock battle casualty, all set up in 8 little mock battlefield areas.  My mouth instantly dried and I started to sweat.  My heart was pumping; adrenaline was racing through my body.  But that was the point, to stress us out and push us to our limits to try to simulate a real combat situation. 

            At this point my mind was racing.  I see my casualty; I am already mentally evaluating him.  I have two battle buddies with me, and we make our way over to where he’s lying.  I do my quick “care under fire” assessment, my ABC’s. Does he have a working airway?  Yes. Is he breathing?  Yes.  Is his circulation visually compromised?  Yes.  He has no left foot.  This is definitely something that needed to be taken care of before he can be moved.  I grab the tourniquet out of his aid pouch, remembering that one should never use their own tourniquet when avoidable, you never know if you will need it yourself.  I tighten the tourniquet around his leg, two inches about the wound, just like I have practiced countless times.  I mark his forehead with a “T” and the time the tourniquet was placed.  It is now safe to move my casualty, his recovered foot, and all of his gear to cover where I can perform a more detailed assessment.

            Once we are situated in the safe area I begin to assess the casualty further.  I go back through my ABC’s making sure I haven’t missed anything.  At this point I needed to start an IV.  I know it is important to have venous access incase fluids need to be started to replace the blood he’s lost.  I start the IV in one of my battle buddies, because it is important to practice all the skills I’ve learned and manikins aren’t that receptive to needles. 

            Now it was time to do a head-to-toe assessment.  I start at the head, looking and feeling for anything abnormal.  I am looking for bruises, cuts, deformities, blood, burns, swelling.  I am feeling for tenderness, instability, crepitus.  I move down the body, checking the neck for any vein distention or tracheal deviation.  I make my way down the torso, not finding any abnormalities.  I check the arms, I find that the right forearm is unstable, and as I palpate I hear crepitus, the grinding, cracking noise of bone bits rubbing against each other.  I secure his arm with a splint from my aid bag and move on.             

            As I move around his unconscious body I am sure to take my weapon and my aid bag with me.  I know that if they are out of arms reach they are no use to me and my instructor will not hesitate to snatch them from me.  Similarly, he does not hesitate to shout and spray me and my uniform with fake blood as I work quickly to assess my patient. 

            I finally reach the tourniqueted leg and can bandage the exposed stump.  I quickly do so, and know it is time to assess my casualty’s back.  I set up my litter so I only have to turn him once, and my battle buddies leg roll him onto his side.  I quickly check his back for abnormalities and place the litter against him.  We collectively roll him and the litter back to the ground and work to fastened him it.  The litter straps get fastened at his noggin, nipples, navel, and knees.  His gear gets placed on the litter with him, and we ready to carry him out to where he will be evacuated to a hospital. 

            The three of us carry him out to a clearing and set him down.  My last task is to call for evacuation using the 9-line medevac procedure we had been taught.  I give them the pertinent information regarding the casualty and his wounds, and all that’s left to do is wait for the imaginary helicopter to come get my make-believe casualty.  A half hour after I began, some fake blood, real sweat and tears later, I am done.  I have succeeded at my task, and hope that someday when I reach the real battlefield I can be equally successful in saving lives.