I work as a certified nursing assistant (CNA) for an inner-city hospital on the Pacific coast. Two years ago, charge nurse Carmen Sanchez assigned me to sit with a twenty-two-year-old Chinese patient named Alex, who’d had a rough life. He’d survived three cancerous brain tumors, the second leaving him blind. In addition, his mentally disturbed older brother shot him in the head and stabbed him in his right side, leaving an ugly scar. Alex said the bullet caused serious brain damage. He called his mother daily, and she came to see him once or twice a week, but he was homeless because it was too dangerous for him to live with his mother, since his violent and crazy brother often visited her.
When I first met Alex, he’d just been transferred from a psychiatric hospital to our acute care facility because he’d contracted sepsis, a systemic infection that can quickly prove fatal. Alex had been in the psychiatric hospital because he suffered from deep depression and often had suicidal thoughts and intentions. Eating constantly to comfort himself, he weighed about four hundred pounds, and he told me he had a certain type of diabetes—he once peed three liters during my eight-hour shift, but he hadn’t had anything to drink!
Finally, a permanent itchy rash covered Alex’s back. He constantly asked his caregivers to apply skin lotion, hydrocortisone cream, and to scratch his back with our gloved hands or gently with a comb. This is not an approved medical procedure, but I perfected a way to scratch his back with a comb so that it satisfied his urge to scratch without aggravating his rash. Alex also asked his caregivers to keep his head shaved, since hair made his scalp itch fiercely.
Despite his depression, Alex had a sunny personality and enjoyed childhood delights, such as listening to Disney shows targeted at older children on TV or YouTube. He also loved listening to children’s books, his favorite being The Boxcar Children by Gertrude Chandler Warner. Every day I sat with him, I lent him my cell phone and charger so he could listen to books and children’s programs all day long, his beat-up Android lacking this capability.
Alex owned a braille typewriter and had the exceptional ability to create art for the nurses and CNAs he liked. He made me a picture of a teddy bear and a complex scene with clouds, sailboats, seagulls, the ocean, and the beach. For my wife, he created a complex design of teddy bears and hearts and another piece with hearts inside of hearts.
Some might call Alex developmentally delayed (the current term for the obsolete label of mentally retarded), but I think he lives in a world of childhood fantasy because of brain damage, trauma, and mental illness.
One day, Alex said, “You and Susie are my favorite CNAs—you’re the only ones who take good care of me.”
“What’s wrong with the other CNAs?” I asked.
“They won’t talk with me, they don’t want to lotion or scratch my back, they won’t shave my head, and they never let me listen to their cell phones. Also, they don’t like to help me with showers. You and Susie are the only ones.”
I was proud Alex thought I provided excellent care, and I felt a stronger connection to Susie—I didn’t know her very well, but she seemed to share the same deep level of compassion I felt toward most patients.
I was surprised Alex hadn’t mentioned Alicia, my favorite CNA in our unit. When I told her he felt ignored by some of the CNAs who sat with him, she said, “Sometimes you can’t give him as much attention as he wants because the other patient in his room is much sicker and needs a lot of help. For example, the other day, his roommate was a helpless man with the mental state of a two-year-old. He needed constant care—I kept telling Alex to call out if he really needed me, but his roommate required almost all of my time and attention.”
I believed this because I’d once been in this same position with one of Alex’s roommates. Although we left behind four-patient rooms when we moved from our old hospital into this new facility, our unit has two two-patient rooms, and the charge nurses didn’t hesitate to put two sitter patients in these double rooms sharing a single CNA sitter—it would be better for all parties concerned if two-patient rooms hosted one sitter patient and one independent patient. If two sitter roommates require a lot of time and attention, their level of care suffers because their CNA can’t be two places at once.
When a doctor orders a one-on-one sitter for a patient, her intention is that the patient be assigned a dedicated sitter CNA, but our director Victor Chukwu had no qualms about breaking the spirit of these orders if it saved him labor costs or any other expense. All of us CNAs believed Alex should be in a single-patient room with a dedicated sitter.
One day soon after I met Alex, Carmen assigned me to sit with him again, saying, “He’s extremely depressed today and has been asking for you.”
When I entered his room, Alex was curled up in a fetal position.
“Hey, Alex,” I said sitting in the chair next to his bed. “How you doing?”
“Not so great,” he said.
“I heard you’re feeling kind of down,” I said.
“Man, the night nurses here are so mean. So are some of the day nurses, especially Penny. I just wish you and Susie could be the only ones taking care of me. I’m really depressed.”
“Alex, with that keen hearing of yours, you must know I sigh a lot.”
“Yeah,” he said. “What’s that about?”
“Well, between you and me, I’ve got depression. I’m always a little depressed, but sometimes I get really depressed, maybe like the way you’re feeling right now.”
“What do you do?” he said.
“I just try to focus on the things I really enjoy until I snap out of it. For example, I like hanging out with my wife, hiking with my dog, playing guitar, swimming, and reading and writing. Also, tasty food helps.”
Alex laughed. “That’s hard to get around here.”
“Well, at least your mom brings you home-cooked,” I said.
Alex’s roommate was low-maintenance, so I tried to build him a perfect day. I shaved his head, then helped him shower—I noticed his right leg and ankle were deformed, but I didn’t know the medical cause. However, it was clear he couldn’t walk for much distance. After his shower, we chatted for a long time. I felt very close to Alex, as if he were my son or a younger brother. Then he listened to children’s books and Disney and anime shows on my cell phone until he fell into a long nap.
When he awoke near my punch-out time, he said, “Thanks for hanging out with me today. You really cheered me up.”
“My pleasure, buddy.”
“Have a safe trip home,” he said. “See you tomorrow.”
“See you tomorrow.”
When I sat with Alex the next day, his mother came to visit. She was elderly with a kind face. I sat as far away from his bed as possible so they could have some privacy, but I heard snatches of their conversation.
“Alex,” his mother said. “I’m getting old. I won’t always be here for you. You’re going to be on your own eventually. You need to grow up and be a man. You have to learn how to survive in life when I’m gone. You have to stop being so childish and crazy.”
I didn’t hear Alex’s reply. When his mother left, he seemed lost in thought for a few minutes. He never mentioned what he was thinking, but I speculated that he probably was incapable of growing up and becoming independent the way his mother wished because he had so many strikes against him; I hoped I was wrong.
The next day, Alicia sat with Alex, but his roommate required constant care.
The following morning, Carmen informed all of us during our huddle that Alex had attempted suicide the evening before. He’d complained that most of his caregivers ignored him. He asked that he only be assigned good caregivers, such as Susie and me. When this demand was not met, Alex seized a large pair of nail clippers that his mother had brought him, popped them into his mouth, and attempted to swallow them.
Two sheriff’s deputies assigned to the hospital were summoned, and they fought with Alex for two hours before they finally removed the nail clippers from his mouth. After I heard this terrible news, I rushed from our huddle to my assigned patient for the day, a woman who’d fallen and fractured her skull and experienced a brain bleed. She was impulsive and a high fall risk, often leaping out of bed without donning her safety helmet. I wasn’t allowed to leave her room.
Later that morning, two ambulance crew members wheeled Alex on a gurney toward the elevators. I correctly guessed they were transporting him back to the psychiatric hospital, since we’d cured his sepsis. I couldn’t leave my room to say goodbye, and I didn’t want to shout at him, so I remained silent, feeling Alex carry away a little piece of my heart
Allen Long is the author of Less than Human: A Memoir (Black Rose Writing, 2016). “Alex” is an excerpt from his forthcoming book, Praying for Restraint: Diary of an Inner-City Hospital CNA. An assistant editor at Narrative Magazine since 2007, Allen lives with his wife near San Francisco.