Florence Nightingale ablutes a penis

2001-08-22 - 1:40 a.m.

It is 5 am on a cold, icy winter day. Dinky old ramshackle cars, all of them old enough to vote, many of them without mufflers, are fanning out about this major minor metropolitan area.

Each car contains a Bath Aide, who is being paid minimum wage by a Home Health Care Agency to spend the day bathing those who are sick, handicapped, suffering from Alzheimers, or cerebral palsy. The Bath Aides are tense: they are all women; most of them have children and they need to worry about child care. Many of them have cars that won't work reliably; most of them have spent a considerable amount of time scraping ice off the windshield since none of them have a garage.

The Bath Aide gets a small amount of additional pay for mileage. Not much. Maybe enough to bring her paycheck up to 6 dollars an hour, after Uncle Sam has taken his bite.

She drives about 35 miles to a trailer in Marysville, where she bathes a fragile elderly woman, who is very fussy. The woman is also very lonely and begs the bath aide to stay and chat. The bath aide manages to put together a breakfast for the woman, and says a few friendly words. She kisses her, and says "I'm so sorry I have to leave; I would love to spend the day with you," but she has to focus hard since she has only 30 minutes to drive the 60 miles to Pataskala.

In Pataskala she works with a man who has had a stroke. She needs to give him a bath. She's happy since he is one of the few people on her route who has been able to afford to buy a bath chair. They cost almost $100 and since Medicare does not cover these safety devices, she has to put the life of most of her patients at risk as she figures out how to put them into the bathtub from a wheelchair.

The man gets a small erection as she cleans his penis, and apologizes. "Think nothing of it," she says. "It's just what your body does." He is embarrassed. She tries to clean men's penises with care--but it's almost impossible to clean a man's genitalia without imitating motions that are sexual, or quasi-sexual. She's senstive to their embarrassment, and is brisk and professional. She puts him into some sweat pants and a sweat shirt and positions his wheel chair in front of the television.

She looks at her map. Next stop is West Jefferson; about 40 miles, and she has only 20 minutes. When she arrives, she is greeted with anger. She is ten minutes late. She gives a woman a bath, hoping and praying that the slippery bath tub won't prove to be the downfall of this woman. A family member is there, complaining about how lazy the Bath Aide is: 20 minutes late. Doesn't she know what an inconvenience that is?

Apologizing profusely, she knows she must leave. She gets a page from the Home Health Care agency. Someone has had to go home early since her child is sick and was sent home by day care. She needs to manage to add two other baths today, and the patients will be angry that she will be necessarily late.

She drives up to Hilliard, not too long a drive for once and meets a woman who is fragile and can't talk. She greets the woman, and gets to work quickly. There's no time to spare for pleasantries. She stops. This woman has had a colostomy and her ostomy bag is full of brown liquid. She asks the woman how to change the bag, but the woman can't speak. Nobody has trained the Bath Aide how to change colostomy bags, or how to clean stomas. She works on it carefully, empyting the bag, and managing to clean the stoma with some sterile clothes. Finally she can put the woman in the bathtub, but she watches the new ostomy bag with care. She does not want anything untoward to happen.

Next stop is an easy one. The woman has a bathchair, so she can transfer her safely. But the woman is crying; there are no relatives alone. She is afraid that the water will get into her eyes; she is afraid of shampoo; she is afraid that she will be treated roughly.

With all of these patients, the Bath Aide must, with the greatest of sensitivity and respect, carefully clean their genitals. The men are embarrased because of their erections. She must use a washcloth to explore the womens' private parts. For men and women both she must make sure that the anus is clean. Since most of the men and woman wear depends, it's an important job, one that will prevent infection, if she can get the genitals and anus as clean as possible. And they must be dry, perfectly dry, before she can put on a new Depends.

She next enters into the inner city. She does not want to feel prejudiced, or racist, but this is Mount Vernon Avenue, and this is the site where there is a homicide almost daily. She parks her car, and enters a home where the patient is in a coma. She lies there, beautiful, looking like Lena Horne. She gives her a sponge bath and tries to talk, to say inanities that might just possibly bring a sense of the positive and the hopeful into the tiny room. The woman is being cared for by her 8 year old grandson; he's not in school since he has cancer and is in the midst of chemotherapy. He lies, exhausted, on the sofa. She asks him if she can bring him a snack or a glass of juice. He looks up at her with eyes imploring. He takes the juice and downs it but he pushes away the snack. Chemo has made him lose his appetite. She is aware that giving the boy a glass of juice is against the "law" of her job. She is not supposed to provide any service whatsoever for other family members.

She moves to the North Side of town, where the patient is a huge man who has Alzheimers. He is about six foot five inches and must weigh between 300 and 400 pounds. His Depends is full and she spends too much time cleaning it. How can she do the "average" Depends change time of two minutes when the mess is terrible? Again, she is defying rules by taking the time to clean him thoroughly.

She transfers him to his wheelchair, feeling imperilled. Will her back go out? His face is vacant. As she wheels him into the bathroom, she can smell that he is defecating onto the wheelchair. Something else she will have to clean up before she leaves, and that will make her even later for her next appointment.

She manages to get the man into the bathtub. He continues to move his bowels; big and little turds pop merrily to the surface of the water and she tries to remove them and keep the water clean and to clean the man. He is beyond knowing what is happening. He can't hold his bowels any more than she could will herself to stop breathing.

At the end of the day she gets a poor performance review. She has been late to most of the homes; relatives have called in to complain. But it happens every day.

She rarely sees a patient more than once. The Agency wants to make sure that patients don't get attached to any one Bath Aide, since the Bath Aides usually quit after a short time. And they certainly don't want the Bath Aide to develop an attachment to a patient. What if the Bath Aide spends time in casual pleasantries? Time that Medicare if paying the Agency.

She has tried talking to a couple of families about getting bath stools. It will make the bath so much safer; the risk of a fall or a slip will be minimized. "Can I buy the Jones family a bath chair?" she asks the agency. "No," they are adamant. We would be getting into liability here. But isn't there greater liability if we break a patient's bone because of unsafe bathrooms?

She would like some of her patients to have guard rails in the bathroom, but they don't respond. Is it the money? The installation? Medicare does not cover guard rails.

At the end of the day she meets briefly with her colleagues in Bath Aiding. They compare notes briefly: "Try not to get that woman in West Jeff." "Stay away from that family in Dublin if you can." "That man on Morse Road has the most slippery bathroom. You have to be careful there."

_______________________________

She had been haunted by the Buddhist precept of "right livelihood" and she had wondered if it really was "right livelihood" to earn her money from the state teaching football players how to understand Wordsworth's Tintern Abbey. She has not given up her professorial job, but she has decided, quixotically, that the Bath Aides, the very lowest on the health care feeding chain, are the unsung heroines of life. They get plenty of complaints and little gratitude. Working with not much more than minimum wage, they are abused, insulted, and many of them end up with crippling back injuries.

She decided that it was a life of luxury--too much luxury, in fact. Unlike other bath aides, her car is not old enough to vote. She wanted to volunteer her time. She wanted to be Florence Nightingale. She found out that because of liability laws, she had to be paid. Minimum wage. She can't work on Tuesday and Thursday afternoons, since she teaches classes at the university. "That's not a problem," the Agency tells her. "All of our aides have second jobs."

She returns to the agency to deliver her notes and tells them all about the homes that are unsafe; all about the patients who have bathrooms that might kill them. They say "There's nothing we can do." They don't care. They are getting about $20.00 an hour from Medicare and the Bath Aide only sees slightly more than $5.00 an hour.

She desperately wants to quit this job, but is deterred by the chronic shortage of bath aides and by the knowledge that many people out there are not getting enough baths. She begins to feel resentful and egotistic. All those skanky relatives complaining to her because she is a few minutes late. They don't know how far she has driven. She thinks that her students would applaud, would appreciate it if she were late to class.

She is on the bottom rung of society in this job. No respect. She hears too many racist remarks: "Well, at least they finally sent out a white girl." "Oh, you speak English? Your the first bath aide we've had who speaks English."

"I want you to come back; I don't like all those niggers they send out."

She can't contradict, can't argue, can't turn this into a 'teaching' moment, since the Agency regulations forbid it.

She bristles. Sick people are not so bad, even when they have a loaded Depends. It's the relatives who are despicable. But the sick people...most of them....can't even say what they are thinking.

She feels guilty around her colleagues. She's the only one who speaks "standard English" and that seems to be the calling card to better jobs. She is probably the only one who has graduated from high school. She would rather die than tell any of them that she is a professor in the afternoons. What would they think? Why would a professor moonlight cleaning up Depends, soaping penises, gently exploring the inner recesses of the anus to remove all those little orts of shit that stubbornly cling to the body?

She can't bring herself to quit, but she inquires about being a respite volunteer at Hospice. She knows that will be an easier job. No hands on. And gratitude. Her ego gets in the way. She tells herself that she won't be any good to her family if her back goes out.

She wants to quit.

She wants to quit.

Every day at 5 am she gets a call. Someone has called in sick; she must drive to Worthington, Newark, Marysville,--all over about five counties.

One day she gets a telephone call from Viking Penguin. Would she be interested in writing a book about Jane Austen for them? Previously, she never ever would have pimped for Jane Austen. But this is her way out. It's not right livelihood, but she "owes it" to Viking Penguin to say yes. She rationalizes her decision. It would be easier on her mental and physical health to write about Jane Austen. She is having a rough time when she goes into the office and sees a red line through a patient's name--he or she is now deceased, when only 24 or 28 hours ago, she had rubbed soap along his penis, or had carefully dried off the tiny rosette of her aging anus.

She quits the agency. In five months, she has become one of the senior bath aides. She knows that the problems with the system cannot be fixed by her alone; she knows that each bath she has given has made a small difference, but it's like throwing a drop of water into a sea of misery and despair.

"I am not Mother Teresa, nor was meant to be," she tells herself, as she goes to the library to take out all the books on Jane Austen. She settles back into the upper middle class existence of an academic.

And now her mother has Bath Aides. She thanks them profusely every time. She tells them how wonderful they are. She knows that they are not getting paid what they are worth.

A Bath Aide should earn more than the First Resident. She works longer, harder, and under much more challenging circumstances.

She would give her mother a bath, but she promised that she would preserve her mother's modesty. So far she has managed to keep all the promises she has made.

But over the years, and often, she thinks about the bath aides with their uncooperative elderly cars; their minimum wage jobs, their patience and persistence in the face of an abusive system; the way they have learned not to flinch from the dirty work. She did not have the guts to stick with them; she retreated back into the safe and clean world of books and computers. But they are out there still; their numbers are legion and they are the ones who will be there if you are lucky, or unlucky, enough to get old and feeble and they are the ones who will keep your penis or your vulva clean. Quietly and professionally.

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