One evening shift, I was asked to work on the "Senior Care Unit" of the Walker Baptist Medical Center in Jasper, Alabama. This is equivalent to a geriatric psychiatric unit. I'd have a patient that they could not control and would have to have constant supervision. The following are notes written while sitting with this patient, unedited.

"There are 14 patients in a small room; all are elderly with some form of cognitive impairment.

Two unlicensed caregivers, taking vitals, BP.

Television on, no one watching. No other stimulation. Walls are bare except for a dry-erase board in a corner with basic information written in black - no one looks at it. Some mumble incoherently.

My patient looks rarely at me, eyes droopy. Totally confused/disoriented. Zero stimulation.

Zero interaction between caregivers and patients except to tell patients what they can, cannot do. Very little interaction between patients and nurses. No physical assessment.

One patient is facing away, facing a dark green/gray wall.

Communication between staff - complaints about procedural changes, staffing shortages. Nothing positive. How can patients even have some quality of life? One hospital employee - not from this unity - stated that, "some people yell at them. It hurts my feelings." These are people. Human beings that have a history that far exceeds that of any of us, and should be treated as such.

From a video that I'd seen about someone singing to a patient with dementia, I tried to sing to the man. His face brightented somewhat at my naming of age related musicians. First contact w a patient: "hey, what's your name?"

Another nurse approached a patient with calm, loving voice and words. He had a phone call. However, he cannot give consent but is all smiles about it.

Another big issue I am experiencing is the foul smells eminating from not just MY patient, but all through the room. One question as I watch these pitiful folks.. When was the last time their teeth were brushed or hands were washed?

A patient of mine last week asked a really good question. "What does a patient like tme that can't get out of bed, do to wash our hands when we've used a urinal (bathroom)?" He's paralyzed on one side, can't do much.

We started to listen to different types of music - from Willie to Cash, Skynyrd to Hank Jr. We became sleepy and with a back rub and a back scratch this recently and oft confused man curled up in his chair and went to sleep. Hank did the trick. He (the patient, not Hank) couldn't sing any of the words but like a curious puppy, he tilted his head toward the music. Within 10 minutes he was awake again, but only long enough to have his medications in yogurt, water, and reposition."

I must add that the nurse attempting to give him his medications was unsuccessful, so I offered to help. It seems the soothing sound of my voice :-( allowed him to enter a state of compliance! Go me!

"He's like an overgrown boy. Precious. All it takes is creativity, patience, love and a tender hand - oh, and a back rub.

While my shift watch is far from over, I now must sit in his room, in a hard plastic chair. No clock, door open, cold room. Not supposed to have anything to distract me from this job, but I'm sorry, I just can't sit and stare. So, to enhance the sleep for this guy, I have a Jim Brickman playlist on, I've ordered some Christmas gifts, played a few mind numbing phone games, written. Why? Because unlike the other constant observer across the hall from me, my patient has been mostly asleep. Except for a few restless and disoriented moments, having to pee, being thirsty, he has, for the first time in a while, stayed in bed, stayed asleep. One has called me, "The Miracle Worker."

While I don't attribute any of this to miracles, I attribute it to my experience, and also to the fact that I don't have to do this every day. Not sure how I'd react if the situation got worse. I tend to lose patience at times, might do as the others do, and use a sharp "stay in bed!" tone of voice that invariably doesn't fucking work."

Then I scribbled the word "done" with a hard line across the paper. But the shift was not quite over - sort of. When the morning came, I helped the man to the bathroom and got him dressed. I gave report to those I thought I should give report to. I was done for that day. I thought it was quite an experience, and ended the shift with a good feeling.

Again, it was not over.

In my journal writings, I started another entry. Again, unedited.

"Jan 11. An update on my experience "babysitting" the one-on-one patient in senior care: A few days passed - and one morning, after work, I was sleeping. I received a text message from my nurse manager. It read "call me to schedule a meeting".

"After a few text exchanges, I went back to sleep. It's my day off, and I intended to be productive and happy regardless......"

And my note ended just like that. I remember it distinctly. I was so angry, first of all, that once again I am woken up from my sleep, on my day off. And once again, it wasn't to thank me. That never happened. Not even for my help on a unit I had never been trained on.

It just so happened that there were several complaints about me from that night. The first of which was that I never stayed with him the entire shift. What the hell? The ONLY time, and I stress ONLY, was when I got up and stood in the door way to use light to document my shift and Q15min checks, because I could not see in the dark. Oh, and I went and got my lunch, after asking staff to sit with the patient. I actually ate my lunch in the room with him. The second thing was ... and really pissed me off ... that I used BLUE ink instead of BLACK. They didn't congratulate me for getting him to sleep all night. They didn't say thank you for helping to give him the medication he usually spits out. They didn't say thank you for staying awake then entire night, while the patient care tech across the hall was CLEARLY ASLEEP WITH HIS HEAD BACK AS FAR AS IT COULD GO, WITH PATIENTS EVEN COMMENTING ABOUT HIM BEING ASLEEP! I was livid.