I had to walk away from a job assignment with a terminally ill client. This was quite possibly the most difficult thing I had to do professionally. My hope is that this story may help non-relative caregivers know that they are not alone experiencing an unstable and potentially hazardous work situation. (For caregivers who are relatives, I will post an article soon regarding my personal experiences).
The first month working with Susan* went very well. I avoided using any fragrances when I visited. She was a medically fragile client, suffering over the past decade from a plethora of ailments that left her immune system destroyed and her body emaciated. Although she kept her house in excellent condition, she needed additional assistance with those hard to reach places in her bedroom, kitchen, and bathroom.
The second month, after we became comfortable with each other’s company, I began to notice a change in her personality. It was little things at first – nitpicking at cleaned areas, talking incessantly and excitedly about conspiracy theories like 9-11 being an inside job, and complaining continually lament about her stressful marriage that ended fifteen years before.
I do my best to not get involved with a client’s political leanings or personal relationships. I accept who they are, and I do not attempt to debate them on most subjects.
Things went from slightly odd to alarming – she claimed her sensitivity to chemicals would not allow her to step outside. Any outdoor work I did would be done last; I could not come back into the house. The dust I brought in would give her asthma attacks for days. Her last doctor prescribed incorrect medicine that made her ill for months. The neighbors would call her from unlisted numbers, quickly hanging up. She was adamant that all these things were true, and wouldn’t listen to a morsel of reality from me.
During the third month, she told me about Jenni*.
“Let me tell you about my last caregiver,” she would gasp in between breaths, her nasal cannula a constant irritant. “She wasn’t an LVN, but her rates were good, and she seemed to really care about people.
“One day, I asked her to buy a pound of organic, raw almonds at the store. That’s the only kind of almond I can eat. She came home with a plastic bag of almonds with the produce and price sticker attached.
“I was irritated with her, because my specific instructions were to take the almonds out the bag and place them in the glass jar I provided to her once she paid for them. She claimed she forgot the jar. When she came home, she discarded the bag and placed them in a ceramic bowl.
“I waited two days before I took them from the kitchen shelf to snack on. Well, guess what?”
She was so animated at this point, she needed about a minute to lay down on her bed and breathe as normally as she could.
“I looked through the trash to find the bag. It appeared there was an original sticker, and it was replaced with a sticker that was printed as organic, raw almonds. She switched the organic almonds for regular almonds. Oh, she tried to pull a fast one on me, but the moment I bit into one, I could tell it wasn’t organic. I was sick for days.”
She looked at me from her bed, dejected.
“Why would she do that to me?”
The next week, I scheduled a handyman to come by to repair and replace most of the lights from the garage. He entered the garage and never stepped foot in the house. Susan would not allow it, so I was the point of contact, running back and forth from the garage to her bedroom, receiving her instructions.
She insisted on using another halogen bulb, and so three light bulbs were replaced. Halogen light bulbs are expensive compared to compact florescent bulbs, but she did not want to deal with the mercury inside CFB’s if they exploded.
Early the next week, I received the following email from her:
I received her phone call the next day. Her voice was soft. She apologized for the misunderstanding, and hoped I could come back later that week. I agreed, and I visited her. I felt it was best that I did not bring up that touchy subject again. She appeared drained and was unusually quiet.
The next week was uneventful, but Susan continued on one tirade after another, whether is was 9-11, weather modification, or how the chemical industry has a stranglehold on Congress.
I did my work, only nodding slightly at her to stop her from expending so much energy by talking. Every visit was draining for me. Eventually, my twice weekly visits were now once a week.
One day, an hour before visiting Susan, I emailed her about speaking to her about an important matter. I kept it opaque so that we could talk face to face.
At the end of my shift, I sat down with her and gave her a three week notice. My explanation for leaving was very generic; I felt telling her the truth at this time in her life, and with the illness so advanced, that it would physically harm her.
I tell you this story not to complain about my work. I find helping the disabled and the elderly very rewarding. This is an explanation of how I saw my frail, kindhearted client become this raging, paranoid invalid.
So when is it time to give a heart-to-heart talk and leave? What should be said to someone who is clearly no longer thinking rationally?
I am not a psychologist, but I have helped the disabled, the elderly, and special needs families for many years now. What I do know is that every human is unique, precious, and fragile. We all have a breaking point, and it is not my job to determine when that is. My job was to provide a safe environment while I worked, but once that trust was broken, it was no longer safe to do my work effectively. I did the only prudent thing I could think of: prepared a heart-to-heart talk, offered reliable resources for her, and left.
* Names and details have been changed to protect identities