Kelly had started working with the elderly as a high school student. She volunteered 3 days a week at Maplelawn Gardens, the largest nursing home in Roanoke Virginia. It was then that she fell in love with the residents and she has been working with them ever since.

Anybody who has worked as a nurse has stories to tell. Sad, happy, funny and touching stories, and now Kelly added Mr. Dillon’s passing to her list of stories.

Kelly had held the hand of many dying patients over the years. It never got any easier for her but she knew that if she wasn’t there, these people would have died alone and that thought kept her coming back to the nursing homes day after day, year after year. She was Dr. Demorest's nurse practitioner. Kelly made his rounds for him, visiting his patients at anyone of the three nursing homes in the Roanoke Valley.

On Monday and Wednesday afternoons, she went to visit the patients at Yardley Extended Care. On Tuesday and Thursday, she visited the Vinton Memorial Retirement Community. Every morning Monday through Thursday she went to Maplelawn Gardens.

Kelly volunteered at Maplelawn as a teenager and it was while she was there that she decided to become a nurse. She had always wanted to become a teacher because she loved children but she found something that she loved more than children, old people. She loved that they always had a story to tell or some little piece of wisdom to impart. The old people loved her and she knew it. She loved them too. They knew that Kelly would never walk past them and ignore their please for help as most of the staff did. She could never understand why anyone would take a job caring for the old folks and then just ignore their requests for help. But, they did. Most nursing homes are terribly understaffed and the residents are the ones who suffer because of it. Kelly found her patients lying in urine soaked beds on a daily basis. The best nursing homes in the world are no better than the worst nursing assistant that they employed.

The day that Mr. Dillon died was a bad day all around. Kelly’s marriage was falling apart, a victim of adultery. Rick, her husband, was spending his afternoons in the trailer park on the Southeast part of town, the worst area in the entire Roanoke Valley. Gail Jeffries, a woman who lived in the trailer park, in trailer #11, was well known for sleeping with any man who knocked on her door. Kelly never thought that her husband would ever visit Gail, he had always spoken about her in such a negative light that the entire situation was a shock to Kelly. But, isn’t that the way it always went?

Kelly threw herself into her work to keep busy, it was all she had left. When she walked down the halls of any of the homes that she visited, she felt so bad for the residents that she couldn’t feel too badly about her own personal problems. Nothing that Kelly was going through could compare to the awful conditions that the old folks had to endure. They were just waiting to die and many of them prayed for death to come and release them from the bodies that had betrayed them.

So many of them had perfectly intact minds enslaved in bodies that had been ravaged by the years and others had perfectly healthy bodies that were controlled by a mind that no longer recognized their own hands.

Many had families that wanted them kept alive no matter what and then there were the folks who had no one, no one to care if they lived or died.
There was a man on Unit F, the unit for the “wanderers”, who had the state of Virginia listed as his next of kin. There was a social worker who visited him once a month, but other than that, there was no one in the world who cared for him. His name was Ted, and one day Kelly noticed that he was walking down the hall barefooted. When she mentioned it to the nurse caring for Ted that day, the nurse told her that she had been calling the social worker for a week trying to get Ted some shoes. That night, Kelly went and bought the man a pair of slippers so that he could safely walk down the halls of Unit F. She often bought her patients things that they needed and even some things that they didn’t really need. Kelly didn’t work on the weekends unless there was an emergency but she did come at least one day every weekend to visit her patients who had no one else to visit them. When Kelly’s kids were young, she often brought them to work to visit the old people who loved children. It seemed that the most confused of patients would perk up and smile when they saw a child. And, of course, the children benefited as well.

After Mr. Dillon passed away that April morning, Kelly walked out to the courtyard off of Unit F and sat on the bench thinking about her own Grandmother who had died years before. Kelly’s grandmother had a stroke one morning and when Kelly heard about it, she prayed.

She prayed to God begging Him not to let her grandmother be paralyzed. She prayed to God asking him not to let her grandmother become aphasic (not able to speak). And she prayed to God asking that he not let her grandmother be confused and unable to recognize her. The one thing that she never thought to ask the Lord for was to let her grandmother survive the stroke. It never occurred to Kelly that her grandmother would die after that stroke. She had worked for years with stroke patients who were left with one disability or another. Kelly thought about how happy she would be if she had her grandmother now, in any condition. She realized that it was selfish of her, but she missed her grandmother something awful and it was days like that day that made her miss her grandmother the most. She was looking up at the sky, thinking about her Grandmother, when all of a sudden she heard a scream from behind her. She looked back to see Mrs. Leedy lying, face up, on the sidewalk that led from the door to the courtyard. She ran over to Mrs. Leedy, calling anyone within earshot for help. There was no one around to help her so she left Mrs. Leedy just long enough to find someone. She could tell that Mrs. Leedy had a broken hip because one of her legs was longer than the other and it rotated outward, a classic sign of a broken hip.

When Kelly walked through the door, she saw no one in the halls except a few residnets. It was lunchtime and most of the residents were eating in the day room and the staff was all in there helping feed those who couldn’t feed themselves. Judy, the charge nurse, was there, too. She was passing out her noon medications and helping the CNA’s feed the residents when Kelly walked into the day room. Judy could tell my the look on Kelly’s face that something was wrong.

“What is it?” Judy asked.

“Mrs. Leedy is out in the courtyard, lying flat on her back with a hip fracture!”

“Oh my God!” Judy responded, “What do you want me to do?”

“If you can just fill out the transfer sheet, I’ll call the ambulance and then go back and sit with her until they get here.”

Kelly went to the nurses station and dialed the number to United Care Ambulance and told them to send someone right away. Then, she headed out to sit with Mrs. Leedy.

When Kelly knelt down next to Mrs. Leedy, she held her hand and asked her if she was in any pain. Alzheimer’s patients don’t always perceive the pain that they should based on the seriousness of their injuries and fortunately for Mrs. Leedy, she didn’t seem to be suffering from any pain. Kelly wiped some sweat off of Mrs. Leedy’s brow and grasped the old woman’s hand in her own.

She thought about her own grandmother again and wanted to cry but she didn’t. She just sat there for the ten minutes that it took the ambulance to arrive. The paramedics asked Kelly what had happened and she explained how she was sitting on the bench when she heard the scream. She asked them if they had the transfer sheet and they said that they didn’t so Kelly went back into Unit F and as she did, Judy was coming down the hall with the paperwork. Kelly took the papers from Judy, thanked her and headed back out to he courtyard. As she opened the door that led outside, the paramedics were coming back in with Mrs. Leedy on the stretcher. She handed them the paperwork and watched as they wheeled the woman down the hall and out the double doors of the unit.

Immediately after they walked out the doors, another stretcher was coming into the unit. Kelly looked over at Judy who was still at the nurses station and asked her, “Are you expecting a new admission today?”

“Yes. The hospital is sending Mrs. Couch over.”

Kelly knew who Mrs. Couch was. Everyone in the Roanoke Valley knew who Mrs. Couch was. She was a 58 year old woman who had been in the news for the past 6 weeks. Mrs. Couch was in her garage with her 3 year old grandson one morning trying to get his tricycle down from the nail on the wall where her husband had placed it. The Couch’s were caring for the little boy while his parents vacationed in Europe that spring. Mrs. Couch was standing on a small ladder to reach the tricycle when she lost her balance and fell back, hitting her head on the concrete floor of the garage. She had been in the hospital for the past six weeks but there was nothing that could be done for her. She had severe brain damage, her hypolthalamus was damaged. That part of the brain controlled certain body functions and with the damage she sustained in the fall, her body couldn’t even regulate it’s own heat.

She knew all of the residents there and they all knew her. Of course there were many who were too confused to recognize her, but she had known them before they had succumbed to the ravages of Alzheimer's, stroke, diabetes, whatever it was that had left them in such a condition. Roanoke wasn’t a very large town, everybody knew everybody and Kelly was quite well know to most of the people in the Valley because sooner or later, someone that they loved was admitted to one of the facilities that Kelly visited.

It was still dark as Kelly pulled up to Maplewood Gardens. She sat in her car for a few minutes, finishing her coffee and thinking about the patients that she would be visiting that morning. Kelly was Dr. Steven Demorest's nurse practitioner. Her job was to visit his patients at the three nursing homes in town. On Tuesdays, she saw the patients at Maplewood Gardens.

As she got out of her car, she looked at the silhouette of the facility and wondered how the night had gone inside the old building. Before she left the office the afternoon before, she had received 3 phone calls from the nurses caring for Clara Anderson. Clara was one of Kelly’s favorite patients. Kelly had been caring for Clara since her high school years. It was her time spent candy-striping at Maplewood Gardens that sparked Kelly’s desire to be a nurse in the first place. Up until then, she had always wanted to be a lawyer. But, when she first started visiting the old people at the home, she fell in love with them and decided that she wanted to work with the elderly for the rest of her life. Kelly admired the nurses and when it was time for her to go to college, she chose a career in nursing. When she walked into the facility, she turned right and headed straight for Clara’s room instead of checking in at the nurses station.

Clara was lying in her bead with her eyes open. She seemed to be gazing out the window and when Kelly walked in, she didn’t so much as blink. The messages left by the nurses had Kelly worried. “Mrs. Anderson confused.” read one message. “Mrs. Anderson has increased blood sugar.” read another. The third message was left by a new nurse who, apparently, was not at all familiar with Clara. “Mrs. Anderson’s legs swollen bilaterally.” was the message left by Linda Eck, a name Kelly hadn’t heard before.

Kelly shook her head as she looked down at Clara’s leg, the left leg. Clara only had one leg so there was no way that her legs could have been swollen bilaterally. The one leg she did have was indeed swollen. Kelly reached down to feel for a pulse in Clara’s foot. It wasn’t there. She looked at Clara again, hoping for a sign of recognition, but there was none. Clara wasn’t even confused. Confusion would have been an improvement over the condition in which Kelly found her that morning. Kelly finished assessing Clara and walked out of her room into the hall where there was a small flurry of activity with all of the CNA’s getting the residents dressed for the day.

“Please help me! Please help me!” was the cry that Kelly heard all day long as she walked down the halls of the nursing homes. Sitting in their wheelchairs, the residents begged for help when anyone passed them.

This morning the cry was coming from a little man slumped over in a wheelchair, his cry was as weak as a baby’s cry. Kelly knelt down next to him and asked him, “Is there anything that I can do for you?”

Kelly had barely gotten the question out of her mouth when all of a sudden, the man reached over and smacked her in the head. He caught her off guard and Kelly toppled over sideways, hitting her head on the wall when she fell. The same thing had happened once before with another confused resident. Kelly felt foolish for letting it happen again.

Holding her hand over her head, Kelly stood up and said out loud, “Well, I sort of asked for that.” She rubbed her head and started back up the hall to the nurses station. Kelly was hoping to catch Susan, the night nurse, before she left for the day.

“Is Susan still here?” There were about 6 nurses in the nurses station and two of them looked up and, in unison, said, “No, she already left!”

Disappointed, Kelly took a chart off of the rack of charts and sat down to read what Susan had written before she left. Susan was one of the older nurses, she knew her job well and she wrote excellent notes. Kelly learned more about her patients from reading Susan’s notes than she did by speaking to any other nurse. She was looking to see what Susan had written about Clara.

“Resident noted to be unresponsive to verbal stimuli. BP-198/110. Blood sugar-177. Skin cool to touch, diaphoretic. Will report condition to MD nurse in am.”

Kelly asked the nurses if Susan had left a message for her. None of them knew anything about a message and she couldn’t find one anywhere in the station so she just assumed that Susan had forgotten to leave the note that she mentioned in Clara’s chart.

“Oh well, do you ladies have anything for me?” Kelly was immediately sorry that she had asked. They all had one thing or another that needed to be addressed. It was an hour before she was able to get back to visiting her patients. Just when she started walking down the hall, the Director of Nursing’s voice came over the loud speaker, “There will be a mandatory staff meeting in the conference room at 9 am for all licensed staff.”

Kelly had about 20 minutes before she had to be in the staff meeting. She wasn’t a staff nurse at Maplewood Gardens, but Mrs. Ross, the Director of Nursing, wanted Kelly to attend all of the meetings that she could. It was more of a control issue than anything else. Mrs. Ross liked to think that she had control over everyone in the facility and demanding that Kelly attend her staff meetings was the only control that she could exercise over Kelly. Kelly didn’t really mind going to the meetings, but it did take time away from her visits and she didn’t appreciate that. Twenty minutes was enough time for her to visit Mr. Dillon so Kelly headed down the hall toward his room.

“Hi Mr. Dillon! How are you doing this morning?”

Mr. Dillon had a sharp mind and he was one of residents who remembered Kelly from one visit to the next. “Kelly, did they tell you about my sore back?” He had complained of a “sore back” and the nurse who checked his back noticed a small, open area on his back side. It was what they called a Stage II breakdown, a small area on his lower back that had broken down from the pressure caused by his immobility. Kelly shook her head as she thought to herself, “This would never would have happened if they had turned this man when they were supposed to.” The residents are to be turned and repositioned every 2 hours for just this very reason, to avoid the breakdowns that eventually can lead to hideous bed sores.

But right now, she was checking out Mr. Dillon and she was not at all pleased at the care that he had received lately. Mr. Dillon was a very nice man who rarely, if ever complained. His wife, Sarah, visited every single day and she was a huge pain in the neck to the staff at Maplewood. In the nursing home business, the squeaky wheel gets the oil whether it deserved it or not and Mrs. Dillon would squeak, squeak and squeak some more whenever her husband was not attended to in just the right way.

Sometimes, Sarah complained about the smallest things in the world and as a result, the staff didn’t listen too much when she complained about something legitimate. This time, she had been complaining about something that should have been fixed, but the fact that she had been complaining so much in the past sort of erased any credibility that she may have had and the staff pretty much just dismissed her concerns. It certainly wasn’t Sarah’s fault, she was right to complain and she did so out of love for her husband. The staff would look for any reason not to listen to the complaints and Sarah had given them what they perceived to be a good one.

Now, as a result, Mr. Dillon had an open area on his back the size of a quarter. If the staff couldn’t prevent this from happening, they would never be able to heal it. At least that’s what Kelly thought as she wrote the orders for the treatment.

Cleanse open area with normal saline, apply triple anti-biotic ointment and cover with 4 x 4 once a shift.

Kelly had hoped that the area would be treated at least once a day, if she ordered it once a shift, it may get done once a day. She left the orders at the nursing station and then she started back down the hall to check out Clara’s bedsore. She was looking down at her notes when she heard the gentle, “Help me, please help me.” that she had grown so accustomed to hearing. This early in the morning, the soft cries were just starting. As the staff brought more and more residents out of their beds and into the halls, the cries would become much more apparent.

This morning, the “Help me, please help me” was coming from a tiny lady sitting in a wheelchair over to the left of the hall way that Kelly was walking down. Kelly walked over to the wheelchair and looked down to see Mrs. Hashiyoto wrapped up in a blanket, staring up at anyone who might answer her cries.

Reaching down to wipe the hair out of her face, Kelly smiled as she saw the frightened eyes of this woman who spoke no English at all. Mrs. Hashimoto has been brought to this country by her daughter who worked as a news anchor at the local television station. As Kelly looked down at this sweet women, she remembered thinking that the staff would certainly pay attention to this lady! If they didn’t want to end up on the evening news, they would be sure to give this lady every bit of attention that they could. But it didn’t take long before the staff realized that the daughter didn’t pay as much attention to her mother as she could have. Mrs. Hashimoto was relegated to the background sounds of Maplewood Gardens, a silent murmur of moaning and crying that was too sad to hear but too real to ignore.

“What can I do for you?” Kelly asked, wondering if this foreign lady could even understand the question.

Mrs. Hashimoto understood. She tried to answer the question but she couldn’t.

Kelly asked her, “Do you need to go to the bathroom?”

“Chop chop,” responded Mrs. Hashimoto with a nod. The nod was all that Kelly understood, “Chop chop” was nothing that she knew, but she did know what most of these resident’s usually needed when they called out for help. So, Kelly held her arm out for the lady to grab onto. The frail little women slowly pulled herself up and shuffled along as Kelly guided her to the bathroom toilet. Kelly shut the door and sat on the bed, waiting for Mrs. Hashimoto to call out that she was done.

When Kelly lead Mrs. Hashimoto back to her wheelchair, she wanted to cry as the lady said, “Thank you...I thank you forever...my daughter pay you.!” She was far too thankful to Kelly. Kelly knew that the reason that this woman was so very grateful was that she didn’t want to sit in her wheelchair wet and if Kelly hadn’t come along, surely she would have.

Every person admitted into Maplewood Gardens had diapers slapped on them by the nursing assistants who did not want to clean up wet patients and certainly didn’t want to rush to the aid of a resident who had to go to the bathroom. These people moved very slowly and the nursing assistants didn’t want to take the time to take anyone to the bathroom. Kelly considered the long and proud life that Mrs. Hashimoto must have lived before she was brought to this country...supposedly to be cared for by her daughter. For just a moment, Kelly ached for the lady who thought that her troubles were over when she came to America.

Kelly thought about the daughter who never visited and she almost caught herself crying before she shook her head, straightened her back and started off down the hall again.

Kelly had started working with the elderly as a high school student. She volunteered 3 days a week at Maplelawn Gardens, the largest nursing home in Roanoke Virginia. It was then that she fell in love with the residents and she has been working with them ever since.

Anybody who has worked as a nurse has stories to tell. Sad, happy, funny and touching stories, and now Kelly added Mr. Dillon’s passing to her list of stories.

Kelly had held the hand of many dying patients over the years. It never got any easier for her but she knew that if she wasn’t there, these people would have died alone and that thought kept her coming back to the nursing homes day after day, year after year. She was Dr. Demorest's nurse practitioner. Kelly made his rounds for him, visiting his patients at anyone of the three nursing homes in the Roanoke Valley.

On Monday and Wednesday afternoons, she went to visit the patients at Yardley Extended Care. On Tuesday and Thursday, she visited the Vinton Memorial Retirement Community. Every morning Monday through Thursday she went to Maplelawn Gardens.

Kelly volunteered at Maplelawn as a teenager and it was while she was there that she decided to become a nurse. She had always wanted to become a teacher because she loved children but she found something that she loved more than children, old people. She loved that they always had a story to tell or some little piece of wisdom to impart. The old people loved her and she knew it. She loved them too. They knew that Kelly would never walk past them and ignore their please for help as most of the staff did. She could never understand why anyone would take a job caring for the old folks and then just ignore their requests for help. But, they did. Most nursing homes are terribly understaffed and the residents are the ones who suffer because of it. Kelly found her patients lying in urine soaked beds on a daily basis. The best nursing homes in the world are no better than the worst nursing assistant that they employed.

The day that Mr. Dillon died was a bad day all around. Kelly’s marriage was falling apart, a victim of adultery. Rick, her husband, was spending his afternoons in the trailer park on the Southeast part of town, the worst area in the entire Roanoke Valley. Gail Jeffries, a woman who lived in the trailer park, in trailer #11, was well known for sleeping with any man who knocked on her door. Kelly never thought that her husband would ever visit Gail, he had always spoken about her in such a negative light that the entire situation was a shock to Kelly. But, isn’t that the way it always went?

Kelly threw herself into her work to keep busy, it was all she had left. When she walked down the halls of any of the homes that she visited, she felt so bad for the residents that she couldn’t feel too badly about her own personal problems. Nothing that Kelly was going through could compare to the awful conditions that the old folks had to endure. They were just waiting to die and many of them prayed for death to come and release them from the bodies that had betrayed them.

So many of them had perfectly intact minds enslaved in bodies that had been ravaged by the years and others had perfectly healthy bodies that were controlled by a mind that no longer recognized their own hands.

Many had families that wanted them kept alive no matter what and then there were the folks who had no one, no one to care if they lived or died.
There was a man on Unit F, the unit for the “wanderers”, who had the state of Virginia listed as his next of kin. There was a social worker who visited him once a month, but other than that, there was no one in the world who cared for him. His name was Ted, and one day Kelly noticed that he was walking down the hall barefooted. When she mentioned it to the nurse caring for Ted that day, the nurse told her that she had been calling the social worker for a week trying to get Ted some shoes. That night, Kelly went and bought the man a pair of slippers so that he could safely walk down the halls of Unit F. She often bought her patients things that they needed and even some things that they didn’t really need. Kelly didn’t work on the weekends unless there was an emergency but she did come at least one day every weekend to visit her patients who had no one else to visit them. When Kelly’s kids were young, she often brought them to work to visit the old people who loved children. It seemed that the most confused of patients would perk up and smile when they saw a child. And, of course, the children benefited as well.

After Mr. Dillon passed away that April morning, Kelly walked out to the courtyard off of Unit F and sat on the bench thinking about her own Grandmother who had died years before. Kelly’s grandmother had a stroke one morning and when Kelly heard about it, she prayed.

She prayed to God begging Him not to let her grandmother be paralyzed. She prayed to God asking him not to let her grandmother become aphasic (not able to speak). And she prayed to God asking that he not let her grandmother be confused and unable to recognize her. The one thing that she never thought to ask the Lord for was to let her grandmother survive the stroke. It never occurred to Kelly that her grandmother would die after that stroke. She had worked for years with stroke patients who were left with one disability or another. Kelly thought about how happy she would be if she had her grandmother now, in any condition. She realized that it was selfish of her, but she missed her grandmother something awful and it was days like that day that made her miss her grandmother the most. She was looking up at the sky, thinking about her Grandmother, when all of a sudden she heard a scream from behind her. She looked back to see Mrs. Leedy lying, face up, on the sidewalk that led from the door to the courtyard. She ran over to Mrs. Leedy, calling anyone within earshot for help. There was no one around to help her so she left Mrs. Leedy just long enough to find someone. She could tell that Mrs. Leedy had a broken hip because one of her legs was longer than the other and it rotated outward, a classic sign of a broken hip.

When Kelly walked through the door, she saw no one in the halls except a few residnets. It was lunchtime and most of the residents were eating in the day room and the staff was all in there helping feed those who couldn’t feed themselves. Judy, the charge nurse, was there, too. She was passing out her noon medications and helping the CNA’s feed the residents when Kelly walked into the day room. Judy could tell my the look on Kelly’s face that something was wrong.

“What is it?” Judy asked.

“Mrs. Leedy is out in the courtyard, lying flat on her back with a hip fracture!”

“Oh my God!” Judy responded, “What do you want me to do?”

“If you can just fill out the transfer sheet, I’ll call the ambulance and then go back and sit with her until they get here.”

Kelly went to the nurses station and dialed the number to United Care Ambulance and told them to send someone right away. Then, she headed out to sit with Mrs. Leedy.

When Kelly knelt down next to Mrs. Leedy, she held her hand and asked her if she was in any pain. Alzheimer’s patients don’t always perceive the pain that they should based on the seriousness of their injuries and fortunately for Mrs. Leedy, she didn’t seem to be suffering from any pain. Kelly wiped some sweat off of Mrs. Leedy’s brow and grasped the old woman’s hand in her own.

She thought about her own grandmother again and wanted to cry but she didn’t. She just sat there for the ten minutes that it took the ambulance to arrive. The paramedics asked Kelly what had happened and she explained how she was sitting on the bench when she heard the scream. She asked them if they had the transfer sheet and they said that they didn’t so Kelly went back into Unit F and as she did, Judy was coming down the hall with the paperwork. Kelly took the papers from Judy, thanked her and headed back out to he courtyard. As she opened the door that led outside, the paramedics were coming back in with Mrs. Leedy on the stretcher. She handed them the paperwork and watched as they wheeled the woman down the hall and out the double doors of the unit.

Immediately after they walked out the doors, another stretcher was coming into the unit. Kelly looked over at Judy who was still at the nurses station and asked her, “Are you expecting a new admission today?”

“Yes. The hospital is sending Mrs. Couch over.”

Kelly knew who Mrs. Couch was. Everyone in the Roanoke Valley knew who Mrs. Couch was. She was a 58 year old woman who had been in the news for the past 6 weeks. Mrs. Couch was in her garage with her 3 year old grandson one morning trying to get his tricycle down from the nail on the wall where her husband had placed it. The Couch’s were caring for the little boy while his parents vacationed in Europe that spring. Mrs. Couch was standing on a small ladder to reach the tricycle when she lost her balance and fell back, hitting her head on the concrete floor of the garage. She had been in the hospital for the past six weeks but there was nothing that could be done for her. She had severe brain damage, her hypolthalamus was damaged. That part of the brain controlled certain body functions and with the damage she sustained in the fall, her body couldn’t even regulate it’s own heat.

She knew all of the residents there and they all knew her. Of course there were many who were too confused to recognize her, but she had known them before they had succumbed to the ravages of Alzheimer's, stroke, diabetes, whatever it was that had left them in such a condition. Roanoke wasn’t a very large town, everybody knew everybody and Kelly was quite well know to most of the people in the Valley because sooner or later, someone that they loved was admitted to one of the facilities that Kelly visited.

It was still dark as Kelly pulled up to Maplewood Gardens. She sat in her car for a few minutes, finishing her coffee and thinking about the patients that she would be visiting that morning. Kelly was Dr. Steven Demorest's nurse practitioner. Her job was to visit his patients at the three nursing homes in town. On Tuesdays, she saw the patients at Maplewood Gardens.

As she got out of her car, she looked at the silhouette of the facility and wondered how the night had gone inside the old building. Before she left the office the afternoon before, she had received 3 phone calls from the nurses caring for Clara Anderson. Clara was one of Kelly’s favorite patients. Kelly had been caring for Clara since her high school years. It was her time spent candy-striping at Maplewood Gardens that sparked Kelly’s desire to be a nurse in the first place. Up until then, she had always wanted to be a lawyer. But, when she first started visiting the old people at the home, she fell in love with them and decided that she wanted to work with the elderly for the rest of her life. Kelly admired the nurses and when it was time for her to go to college, she chose a career in nursing. When she walked into the facility, she turned right and headed straight for Clara’s room instead of checking in at the nurses station.

Clara was lying in her bead with her eyes open. She seemed to be gazing out the window and when Kelly walked in, she didn’t so much as blink. The messages left by the nurses had Kelly worried. “Mrs. Anderson confused.” read one message. “Mrs. Anderson has increased blood sugar.” read another. The third message was left by a new nurse who, apparently, was not at all familiar with Clara. “Mrs. Anderson’s legs swollen bilaterally.” was the message left by Linda Eck, a name Kelly hadn’t heard before.

Kelly shook her head as she looked down at Clara’s leg, the left leg. Clara only had one leg so there was no way that her legs could have been swollen bilaterally. The one leg she did have was indeed swollen. Kelly reached down to feel for a pulse in Clara’s foot. It wasn’t there. She looked at Clara again, hoping for a sign of recognition, but there was none. Clara wasn’t even confused. Confusion would have been an improvement over the condition in which Kelly found her that morning. Kelly finished assessing Clara and walked out of her room into the hall where there was a small flurry of activity with all of the CNA’s getting the residents dressed for the day.

“Please help me! Please help me!” was the cry that Kelly heard all day long as she walked down the halls of the nursing homes. Sitting in their wheelchairs, the residents begged for help when anyone passed them.

This morning the cry was coming from a little man slumped over in a wheelchair, his cry was as weak as a baby’s cry. Kelly knelt down next to him and asked him, “Is there anything that I can do for you?”

Kelly had barely gotten the question out of her mouth when all of a sudden, the man reached over and smacked her in the head. He caught her off guard and Kelly toppled over sideways, hitting her head on the wall when she fell. The same thing had happened once before with another confused resident. Kelly felt foolish for letting it happen again.

Holding her hand over her head, Kelly stood up and said out loud, “Well, I sort of asked for that.” She rubbed her head and started back up the hall to the nurses station. Kelly was hoping to catch Susan, the night nurse, before she left for the day.

“Is Susan still here?” There were about 6 nurses in the nurses station and two of them looked up and, in unison, said, “No, she already left!”

Disappointed, Kelly took a chart off of the rack of charts and sat down to read what Susan had written before she left. Susan was one of the older nurses, she knew her job well and she wrote excellent notes. Kelly learned more about her patients from reading Susan’s notes than she did by speaking to any other nurse. She was looking to see what Susan had written about Clara.

“Resident noted to be unresponsive to verbal stimuli. BP-198/110. Blood sugar-177. Skin cool to touch, diaphoretic. Will report condition to MD nurse in am.”

Kelly asked the nurses if Susan had left a message for her. None of them knew anything about a message and she couldn’t find one anywhere in the station so she just assumed that Susan had forgotten to leave the note that she mentioned in Clara’s chart.

“Oh well, do you ladies have anything for me?” Kelly was immediately sorry that she had asked. They all had one thing or another that needed to be addressed. It was an hour before she was able to get back to visiting her patients. Just when she started walking down the hall, the Director of Nursing’s voice came over the loud speaker, “There will be a mandatory staff meeting in the conference room at 9 am for all licensed staff.”

Kelly had about 20 minutes before she had to be in the staff meeting. She wasn’t a staff nurse at Maplewood Gardens, but Mrs. Ross, the Director of Nursing, wanted Kelly to attend all of the meetings that she could. It was more of a control issue than anything else. Mrs. Ross liked to think that she had control over everyone in the facility and demanding that Kelly attend her staff meetings was the only control that she could exercise over Kelly. Kelly didn’t really mind going to the meetings, but it did take time away from her visits and she didn’t appreciate that. Twenty minutes was enough time for her to visit Mr. Dillon so Kelly headed down the hall toward his room.

“Hi Mr. Dillon! How are you doing this morning?”

Mr. Dillon had a sharp mind and he was one of residents who remembered Kelly from one visit to the next. “Kelly, did they tell you about my sore back?” He had complained of a “sore back” and the nurse who checked his back noticed a small, open area on his back side. It was what they called a Stage II breakdown, a small area on his lower back that had broken down from the pressure caused by his immobility. Kelly shook her head as she thought to herself, “This would never would have happened if they had turned this man when they were supposed to.” The residents are to be turned and repositioned every 2 hours for just this very reason, to avoid the breakdowns that eventually can lead to hideous bed sores.

But right now, she was checking out Mr. Dillon and she was not at all pleased at the care that he had received lately. Mr. Dillon was a very nice man who rarely, if ever complained. His wife, Sarah, visited every single day and she was a huge pain in the neck to the staff at Maplewood. In the nursing home business, the squeaky wheel gets the oil whether it deserved it or not and Mrs. Dillon would squeak, squeak and squeak some more whenever her husband was not attended to in just the right way.

Sometimes, Sarah complained about the smallest things in the world and as a result, the staff didn’t listen too much when she complained about something legitimate. This time, she had been complaining about something that should have been fixed, but the fact that she had been complaining so much in the past sort of erased any credibility that she may have had and the staff pretty much just dismissed her concerns. It certainly wasn’t Sarah’s fault, she was right to complain and she did so out of love for her husband. The staff would look for any reason not to listen to the complaints and Sarah had given them what they perceived to be a good one.

Now, as a result, Mr. Dillon had an open area on his back the size of a quarter. If the staff couldn’t prevent this from happening, they would never be able to heal it. At least that’s what Kelly thought as she wrote the orders for the treatment.

Cleanse open area with normal saline, apply triple anti-biotic ointment and cover with 4 x 4 once a shift.

Kelly had hoped that the area would be treated at least once a day, if she ordered it once a shift, it may get done once a day. She left the orders at the nursing station and then she started back down the hall to check out Clara’s bedsore. She was looking down at her notes when she heard the gentle, “Help me, please help me.” that she had grown so accustomed to hearing. This early in the morning, the soft cries were just starting. As the staff brought more and more residents out of their beds and into the halls, the cries would become much more apparent.

This morning, the “Help me, please help me” was coming from a tiny lady sitting in a wheelchair over to the left of the hall way that Kelly was walking down. Kelly walked over to the wheelchair and looked down to see Mrs. Hashiyoto wrapped up in a blanket, staring up at anyone who might answer her cries.

Reaching down to wipe the hair out of her face, Kelly smiled as she saw the frightened eyes of this woman who spoke no English at all. Mrs. Hashimoto has been brought to this country by her daughter who worked as a news anchor at the local television station. As Kelly looked down at this sweet women, she remembered thinking that the staff would certainly pay attention to this lady! If they didn’t want to end up on the evening news, they would be sure to give this lady every bit of attention that they could. But it didn’t take long before the staff realized that the daughter didn’t pay as much attention to her mother as she could have. Mrs. Hashimoto was relegated to the background sounds of Maplewood Gardens, a silent murmur of moaning and crying that was too sad to hear but too real to ignore.

“What can I do for you?” Kelly asked, wondering if this foreign lady could even understand the question.

Mrs. Hashimoto understood. She tried to answer the question but she couldn’t.

Kelly asked her, “Do you need to go to the bathroom?”

“Chop chop,” responded Mrs. Hashimoto with a nod. The nod was all that Kelly understood, “Chop chop” was nothing that she knew, but she did know what most of these resident’s usually needed when they called out for help. So, Kelly held her arm out for the lady to grab onto. The frail little women slowly pulled herself up and shuffled along as Kelly guided her to the bathroom toilet. Kelly shut the door and sat on the bed, waiting for Mrs. Hashimoto to call out that she was done.

When Kelly lead Mrs. Hashimoto back to her wheelchair, she wanted to cry as the lady said, “Thank you...I thank you forever...my daughter pay you.!” She was far too thankful to Kelly. Kelly knew that the reason that this woman was so very grateful was that she didn’t want to sit in her wheelchair wet and if Kelly hadn’t come along, surely she would have.

Every person admitted into Maplewood Gardens had diapers slapped on them by the nursing assistants who did not want to clean up wet patients and certainly didn’t want to rush to the aid of a resident who had to go to the bathroom. These people moved very slowly and the nursing assistants didn’t want to take the time to take anyone to the bathroom. Kelly considered the long and proud life that Mrs. Hashimoto must have lived before she was brought to this country...supposedly to be cared for by her daughter. For just a moment, Kelly ached for the lady who thought that her troubles were over when she came to America.

Kelly thought about the daughter who never visited and she almost caught herself crying before she shook her head, straightened her back and started off down the hall again.

When Kelly walked into the dying man’s room, she was surprised. She had visited him the day before and he seemed fine. His condition had deteriorated rapidly overnight. He was suffering from lung cancer, one of the most hideous illnesses that Kelly had ever seen. Not only did it’s victims patients die in pain, but like this man, they would drown in their own fluids...a frightening way to go indeed.

As Kelly looked down at her patient, she felt totally helpless. He looked up at her and said, “If you can’t make this stop, at least do something to make me feel better.”

The nurse went to the nurses station and grabbed the man’s chart. She quickly flipped to the lab results to get the results from the labs that she had ordered the day before. She glanced through all of the results until she found the one she was looking for, the arterial blood gas report. Her face seemed to lose the blood in it as she read the results of the test. The man, Mr. Dillon, was not going to survive much longer. Kelly called the doctor and reported to him what she had found. The doctor asked her what she wanted to do, there really wasn’t much to be done except for trying to make Mr. Dillon comfortable. Dr. Demorest ordered 2 mgs. of morphine to be pushed IV. Kelly saw that all of the staff nurses were busy passing their morning medications and she knew that none of them would have the chance to give Mr. Dillon any morphine any time soon. She decided to do it herself.

She went to the medication room and grabbed the morphine and a syringe and headed to Mr. Dillon’s room. She sat down on the bed next to him and pushed the morphine into his veins. Nothing happened. She went back and called Dr. Demorest again. He gave her an order for another 2 mgs. of morphine. When she gave that to Mr. Dillon, he was still in agony. She tried suctioning his lungs but she couldn’t seem to keep up with the rapid production of the murderous fluid.

After a few more phone calls to the doctor, Kelly finally heard the order that she wanted to hear, but dreaded.

“Kelly, just give him whatever it takes. That meant that Kelly should just give the man all of the morphine that she needed to in order to ease his suffering and then she was to calculate how much morphine she had given him and write the order for exactly that amount. It wasn’t a legal order, but it was the order that was necessary to help Mr. Dillon. So, she filled the syringe with morphine and went back to the room, pushing 2 mgs. every few minutes and waiting to see if it would help. Finally, after about 16 mgs. of morphine, she saw something she hadn’t seen all morning. A smile on the face of her dying patient.

“What are you smiling at?, Kelly asked her patient.

Mr. Dillon smiled as he answered her. “On my 28th birthday, my wife left me. I prayed to God that day saying, I don’t care what you do to me, just let me die with a redhead in my bed.”

Kelly smiled, her red hair glistening in the sun that flooded into the room. “Go for it.“ she told Mr. Dillon.

Mr. Dillon did just that, passing away at 11:38 am on April 28th. Kelly was proud to be the redhead in Mr. Dillon’s bed that day, even if it wasn’t quite what he had expected when he prayed to his God on his 28th birthday.

When people heard that Kelly worked with geriatric patients, they always said the same thing, “Why would you ever want to work with old people?”

Kelly always answered them the same way, “You just have no idea how rewarding it is.”