pastoral clinical week 11

(I'm late getting this written partly because it's not due to be turned in for another week and partly because I've been writing it in my head for a couple weeks. it's actually a reflection of a pre-christmas situation.)

CPE REFLECTION 11

I’m not certain how upset I ought to be over this situation, as it may be me simply over-thinking it by placing myself in the resident’s place. But I’m fairly certain I wouldn’t have let the situation remain if I were still working in group homes.

Earlier this week I stopped in to visit a resident who’s been on a rollercoaster of health lately; sometimes in good shape, sometimes otherwise. When he first joined my floor he was starting the slow descent into dementia which has sped up in the ensuing months, to the point at which he sometimes seems uncomprehending of his surroundings. When I dropped in on him it was roughly 6:30 in the evening. His door was closed completely, which is unusual, and at first I thought he might be in bed already. But I knocked gently anyway and walked in. He was sitting in his wheelchair, indulging in his habit of ripping pieces of paper into smaller and smaller pieces of paper.

Nothing seemed out of the ordinary. We were having our usual conversation about how he was feeling and how he was doing when I noticed his sweatpants were down around his hips. I said, “Were you trying to change your pants?” He started to absently pull at them like he was pulling them up but I asked him to wait a moment I couldn’t see whether his undergarments were on. I looked behind him and realized he was sitting in a very messy undergarment that he’d obviously recently shat in.

I told him, “Wait a minute while I get someone.” I stepped out into the hall and caught a staff I knew and told him, “This guy's Depends are messed and I think he might have been trying to change his pants.” He said okay, and followed me back into the resident’s room. When we got there he gave him the medication that he’d been preparing, then asked if he was all right. The resident said he was. The staff couldn’t have helped noticing his pants were around his thighs and the undergarment was soiled but turned around and shrugged at me and then left the room. I stayed with my resident a few more minutes until I simply couldn’t take the smell any longer and left.

This disturbs me because I’m not at all certain I handled the situation right. My first inclination was to help him change (but I don’t do that work anymore) so my second inclination was to find someone who would help him change. However, that person seemed to take my resident’s word that he was all right sitting in messy undergarments.

On reflection that night, it struck me that the door might have been closed so that no one would enter and he could have some privacy to sit in his room. But I can’t imagine anyone opting to want to sit in a shit-filled undergarment, privately or not. The staff I approached is someone I’ve worked with on the floor for my whole length of time there and I trust his judgment. I didn't get the sense he was simply walking away from a situation but was acting on how he understood the resident to prefer. But I also can’t imagine allowing someone to decide for himself to remain in such a situation, particularly someone with the recent history of health issues of this resident. Should I have confronted the staff afterward and asked if we were making the best decision? Should I have alerted someone else?

I’m conflicted about the situation. My immediate reaction was to change the resident’s undergarments, and frankly I’m glad I waved that option away because I’m not qualified to do that anymore. I’m glad too of my second reaction, which was to recognize my role as being part of a team and report the situation to someone who could correct the situation. This is a role I've been working at. But I’m uncomfortable with the way the situation ended. Is it, I wonder, all right to let a resident opt to sit in shat-in adult undergarments, however privately, for an unspecified amount of time? Should that be within his rights? And can someone like this resident, whose thinking has been muddled at the best of times but is nearing the end of his life and is clearly showing increasing dementia, be permitted to make that decision?