Pages from a CNA’s Notebook 
JOMO wrote this about her job and her organizing at a nursing home in Washington State in 2010. Given the COVID19 crisis, we are reposting the piece with an intro from JOMO.
In a few short days, the greater Seattle region became the epicenter of Covid 19 here in the US. It all began in a nursing home at Kirkland, Washington. Management knew that some of the elderly who had been rushed to the hospital had tested positive for COVID 19, but failed to notify the workers — nurses, janitors, nursing assistants. No one took any precautions in the nursing home to prevent the spread and transmission of the virus. It wasn’t until the first responders/fire fighters told the workers, that they knew that they had been exposed for too long, and had been carriers of the virus.
Our lives are valued differently on a hierarchy of race, gender, class, nationality. It is this same level of denigration, absurd disregard for the well-being of workers, that reminds us exactly how little value our lives have within capitalism. It is a reminder that management, the state, capital do not care about our wellbeing, and if we are to survive, we have to trust our gut, as workers who give two shits, as workers who care about our patients, as workers who care about one another — skills and values we cultivate *in spite of* capitalism, what we are able to squeeze through the cracks of this horrendous and massive system.
We are living in strange times. In the last few weeks, our communities in Seattle have come together to push out mutual aid to each other, to organize worker solidarity networks, to push out abolitionist demands, to connect with community. I feel grateful to be here among loved ones, family and friends. It is the cumulative caring labor we have done over the years, that allows us to be resilient, to trust, to feed and support each other in times of crisis. But homelessness still exists. Big Tech is still lauded for philanthropy and their complicity in creating a company town with a housing crisis is left unspoken. We deserve so much more than a few pennies from amazon and big tech. We deserve the whole damn campus, the whole damn city, to be used toward emergency efforts right now.
The conclusions of caring labor is one of liberation, connection, autonomy, compassion. It will defy the rules of private property and commodified labor because these don’t make us safer. They dispose of some of us, and strip the rest of us of dignity.
The Machine endangers all we have made.
We allow it to rule instead of obey.
To build a house, cut the stone sharp and fast:
the carver’s hand takes too long to feel its way.
The Machine never hesitates, or we might escape
and its factories subside into silence.
It thinks it’s alive and does everything better.
With equal resolve it creates and destroys.
But life holds mystery for us yet. In a hundred places
we can still sense the source: a play of pure powers
that — when you feel it — brings you to your knees.
There are yet words that come near the unsayable,
and, from crumbling stones, a new music
to make a sacred dwelling in a place we cannot own.
Rilke (Translated by Joanna Macy)
This piece is dedicated to all nursing home workers, residents and their family members. Be patient with me, as I share our silenced stories.
All names have been changed to protect the identities of my coworkers and residents
I work in a place of death. People come here to die, and my coworkers and I care for them as they make their journeys. Sometimes these transitions take years or months. Other times they take weeks or some short days. I count the time in shifts, in scheduled state visits, in the sham monthly meetings I never attend, in the announcements of the “Employee of the Month” (code word for best ass-kisser of the month), in the yearly pay increment of 20 cents, and in the number of times I get called into the Human Resources office, counting down to the last one that would get me fired.The nursing home residents also have their own rhythms. Their time is tracked by scheduled hospital visits; by the times when loved ones drop by to share a meal, to announce the arrival of a new grandchild, or to anxiously wait at their bedsides for heart-wrenching moments to pass. Their time is measured by transitions from mechanical food to pureed food, textures that match their increasing susceptibility to dysphagia, their appetite changing with the decreasing sensitivity of their taste buds. Their transitions are also measured by the changes from underwear to pull ups and then to diapers. Even more than the loss of mobility, the use of diapers is often the most fearsome adaptation. For many people, lack of control over urinary functions and timing is the definitive, undoubted mark of the loss of independence to dementia.
Many of the elderly I have worked with are, at least initially, aware of the transitions they undergo, and respond with a myriad of emotions such as shame, anger, depression, anxiety and fear. Theirs was the generation that survived the great depression, armed with fervent missions of world war. Aging, that mundane human process, was an anti-climatic twist to the purported grandeur and tumultuousness of their early 20th century youth.
“I am afraid to die. I don’t know where I will go, Jennifer,” a resident named Lara once said to me, fear dilating her eyes.
“Lara, you will go to heaven. You will be happy.” I reply, holding the spoonful of pureed spinach to her lips. “Tell me about your son, Tobias.”
And so Lara begins, the same story of Tobias, his obedience and intelligence, which I have heard over and over again for the past year. The son whom she loves, whose teenage portrait stands by her bedside. The son who has never visited. The son whom I have never met, but whose name and memory calms Lara down.
Lara is a German immigrant to the US, haunted by memories of Nazi Germany. “Do you like Hitler?” she would ask frequently in her distinct staccato accent, amid the clutter in the dining room at lunch time. Her eyes staring intently at us, she would declare, “Hitler is no good. I don’t like Hitler.”
Lara was always on the look out. She cared especially for Alba and Mary, the two women with severe dementia who sat at both sides of her in the dining room. To find out if Alba was enjoying her meal, she would look to my coworker, Saskia, to ask,” Is she eating? If she doesn’t want to, don’t force her to eat. She will eat when she is hungry.” Alba, always cheerful, would smile as she chewed her food. Did she understand? Or was she in her usual upbeat mood? “Lara, Alba’s fine. With you watching out for her, of course she’s OK!” We would giggle. These are small moments to be cherished.
In the nursing home, small warm moments are precious because they are accidental moments.
We run on stolen time in the nursing home. Alind, another CNA, once said to me, “Some of these residents are already dead before they come here.”
By “dead,” he was not referring to the degenerative effects of dementia and Alzheimer’s disease that caused Lara, for instance, to occasionally spit her food out at us in anger and spite, or hit us when we are assisting her. He was not referring to the universal reality of human beings’ temporary abilities and our susceptibility to pain and disease. By “dead,” Alind was referring to the sense of hopelessness and loneliness that many of the residents feel, not just because of physical pain, not just because of old age, but as a result of the isolation they face, the sorrow of abandonment by loved ones, the anger of being caged within the walls of this institution where their escape attempts are restricted by alarms and wiry smiles. This banishment is hardly the ending they had toiled for during their industrious youth.
By death, Alind was also referring to the many times “I’m sorry,” is uttered in embarrassment, and the tearful shrieks of shame that sometimes follow when they soil their clothes. Those outbursts are merely expressions of society’s beliefs, as if old age and dependence are aberrations to life, as if theirs is an undeserved living on borrowed time. The remorse so deep; it kills faster than the body’s aging cells.
This is the dying that we, nursing home workers, bear witness to everyday; the death that we are expected to, through our tired hearts and underpaid souls, reverse.
So they try, through bowling, through bingo and checkers, through Frank Sinatra sing-a-longs, to resurrect what has been lost to time, migration, and the whimsical trends of capitalism and the capriciousness of life. They substitute hot tea and cookies with strangers for the warmth of genuine relationship bonding with family and friends. Loved ones made distant, occupied by the same patterns of migration, work, ambition, ease their worries and guilt by the pictures captured of their relatives in these settings. We, the CNAs, shuffle in and out of these staged moments, to carry the residents off for toileting. The music playing in the building’s only bright and airy room is not for us, the immigrants, the lower hands, to plan for or share with the residents. Ours is a labor confined to the bathroom, to the involuntary, lower functions of the body. Instead of people of color in uniformed scrubs, nice white ladies with pretty clothes are paid more to care for the leisurely activities of the old white people. The monotony and stress of our tasks are ours to bear alone.
Yet despite this alienation, residents and workers alike struggle to interact as human beings. Not perfect, not always correctly, not easily. In the absence of emotional and mental support for both residents and caregivers, under the conditions of institutionalized ableism that render the lives of people with disabilities as worthless, under the abject conditions of overwork, racism, and underpayment, “caregiver stress” sometimes overrides morality and ethics and becomes a tragic reason, or lousy excuse, for mistreatment. These imperfect moments are swept under the rug, the guilty institutions absolved of them through paltry fines and slaps on the wrists. Meanwhile, these trespasses become yet another form of “evidence” for why poor immigrant women who clean bedpans and change diapers cannot be trusted and need heavy managerial control.
The nursing home bosses freeze the occasional, carefully selected, glorified, picture perfect moments in time, when they blow these up on the front pages of their brochures, exclaiming that their facility is, indeed, a place where ”life is appreciated,” where “we care for the dignity of the human person.” In reality, they have not tried to make that possible. Under poor conditions, we have improvised for genuine human connection to exist. How we do that, is something the bosses have no idea about. They sit, calculating in their cold shiny hall ways, far from the cacophony of human interaction that they know only to distantly publicize and profit from.
We CNAs also run on stolen time. It is the only way that the work gets done. When I first started my job, fresh out of the training institute, I was intimidated by the amount of work I had to do. The biggest challenge was the level of detail and thoroughness that each task required. I held on to my care plans tightly. My residents’ specific transfers, their diets, their habits, whether or not they wore hearing aids or glasses, their shower schedules, whether they needed alarm mechanisms when they were in their wheelchairs, whether or not they needed footrests, hand splints, blue boots, catheters, portable oxygen tanks set to level 2, or was it 3? All this was a barrage of information for me to absorb. Harder still, was trying to figure out how to cram the schedules of eight residents with different transfer methods, including the use of machine lifts, toileting needs every two hours or less, unpredictable bodily functions, and one shower per shift, into an eight hour day. Out of the eight-hour day, two hours were already designated for meal times. Squeezing in all the work within six hours, was to say the least, highly intimidating. Being a café barista for years at various coffee joints had trained me well for highly stressful jobs that consist of multitasking and planning, but apparently not enough.
I received a lot of help and support from the other new hire, Saskia, and the two other CNAs who were in the same unit. Jess and Maimuna were very supportive. “Don’t rush. It’s OK. If you rush, it gets harder and you forget things,” Maimuna used to remind me. Never mind that we were still always running down the hallway trying to get the work done. As long as in our minds we kept a grip on our stress levels, as long as we took deep breaths, we would be less anxious and more careful with the residents.
The worst was when there were episodes of Clostridium difficile (C. diff), a bacterial infection that spreads easily among residents on antibiotics. The clearest symptom of C. diff infection is loose bowel movement, or diarrhea. My second week of work, five of the residents I was assigned to had bouts of C. diff. No matter how much mental stamina and mindfulness I tried to keep, for a week, I was a running around like a chicken without a head. Cleaning, scrubbing, changing soiled diapers, bed pans, machine transfers, dressing the resident, undressing the resident, changing the bed sheets. Repeat, repeat, repeat. Doing such undesirable work so fast was exhausting.
Nonetheless, the work made me appreciate my coworkers whom I was just getting to know. Saskia and I bonded over many episodes of diarrhea “accidents,” cracking jokes and giggling with each other and the residents as we cleaned, as we aired out the rooms after the work was done. We shared stories of our new experiences with the bosses and coworkers: who were the nice ones, and who were the ones known to harass CNAs unreasonably? We all knew to be careful of Marilyn, the Filipino treatment nurse who switched between being a darling with her bosses and being a monster to us. Even -toned speech was out of her voice range. She only knew how to scream accusations at us. “You are lazy!” was always the last word out of her mouth to any of us, regardless of circumstance, regardless of identity. In her eyes, all the contradictions of the institution and of the residents could be boiled down to one problem: the poor individual work ethic of the CNA. It was not surprising that many CNAs had gotten fired under her watch.
My friendship with Saskia gave me access to a wealth of knowledge about workplace dynamics. The trust we built and solidarity we offered one another during the hectic times on the job immersed me in relationships with other Ethiopian coworkers who similarly offered advice about the the ins and outs of the work. Saskia, the college graduate from Ethiopia, newly arrived in America, was full of excitement to embark on this dream. This nursing home job was meant only to be her first stop and I was one of her first non-Ethiopian friends. There was a lot of excitement in our new friendship. As Saskia translated the hard learned lessons shared over break times in Amharic, I learned to appreciate the importance of “having eyes on my back,” to avoid being targeted unfairly by disgruntled, prejudiced nurses. It was only later that I would learn the practical application of Saskia’s advice.
Over time, I would also learn that reporting the health hazards, safety violations, and broken equipment to the overworked staff nurses, or the arrogant charge nurses, would be rendered useless. When someone got injured, only then would there be a flurry of activity. The rest of the time, unless the state inspectors were conducting their annual visit, precautionary actions were thrown to the wind. No one updated the care plans, no one gave us crucial information about new residents, no one saw the importance in updating us on the necessary precautions we needed to take as CNAs, or bothered to fix faulty wheelchairs in a timely manner.
We had to push hard, nag, ask relentlessly, and document, document, document our attempts. Not for the purpose of having someone read them, but just so that when some avoidable accident did happen, we would not be so conveniently blamed. Too many times, we literally had to depend on our own eyes, and our own ears, to assess the residents’ well beings, or strain our backs and arms to compensate for what a few tools and expertise could fix. At times, we had to fight and argue to get protective gear even when our residents had bouts of C. diff. “You just have to be careful it [the diarrhea] doesn’t splash on you. You don’t need a protective gown now,” or, “Are you sure it’s C. diff and not just diarrhea? You know you only get the protective gowns when it’s C. diff.” For a cheap, paper-made protective gown, and an ever cheaper mask, one had to be ready to have a stand off with the charge nurse. The mythical “chain of command” was a train wreck to nowhere…..
***You can read the rest of JOMO’s piece on the recomposition blog
1. CNA: Certified Nursing Assistant is a person who assists patients or clients with healthcare needs under the supervision of a Registered Nurse (RN) or a Licensed Practical Nurse (LPN). Nursing homes, hospitals, and assisted living facilities all require nursing assistants to act as a helpful liaison between the RN or LPN and the patient. In many cases, the nursing assistant serves as the RN’s or LPN’s eyes and ears. Excerpt from http://nursingassistantguides.com/what-is-a-certified-nursing-assistant-cna/