Illustration by Audrey Isaacson

"You need to be okay with poo"

When I turned 39, I took an inventory of my life. What I found there struck me thoroughly unremarkable. At best, it seemed my world and the life I had made in it could be summed up in one word: mediocre. The entirety of my twenties and thirties had been spent diapering, cleaning, cooking, doing laundry, making doctor’s appointments, assisting with homework, and shuttling my kids to and from school and sporting events. Almost half my time on earth had been spent performing the sort of banal tasks that women in La Jolla pay other people to do. And I wasn’t even good at the gig. My oldest son was barely passing his high school classes, my kids were behind on the immunizations, and there were almost always dirty dishes in the sink. I was glad I hadn’t had to interview for the job of mothering; I might have been deemed a bad fit for the position. And now, my kids were growing up. They just didn’t need me that much anymore. I began to feel less like a contributor, and more like drain on my household.

Illustration by Audrey Isaacson

The funny thing was, up until my 39th birthday, I had been okay with my second-rate housewifery. I consoled myself with the knowledge that I had three amazing kids and a very cool husband. Besides, it felt like I had my entire life ahead of me to become impressive. There was still plenty of time for the sorts of achievements that would inspire my mother to pen a braggy Facebook post about me. But after I turned 39, after there was nothing between me and 40 but a lump of months, I began noticing the wrinkles forming around my eyes. When I spotted a lone pesky gray hair sticking straight out of my left eyebrow, I began to panic. I realized that I did not in fact have my whole life in front of me. I had half, maybe less. And as everyone who has ever hit a downhill slide knows, the ride gets faster as it goes.

It didn’t help that my sister, who was just 19 months older than me, had recently secured her hoity-toity dream job with Amazon up in Seattle. She was climbing the corporate leader, wowing everyone she met. She drove an Audi. Lorde played at her company Christmas party. Then there was my brother, who was succeeding in the opposite direction: living a minimalistic bohemian lifestyle, teaching sustainable farming at UC Irvine, decreasing his carbon footprint and teaching those around him to do the same. I was by far the biggest failure in my family, a stain on my immigrant parents’ names. They had come to this country to raise impressive Americans, not sloppy stay-at-home moms.

I was headed for a mid-life crisis. I needed to shake things up before I found myself undergoing invasive plastic surgery, or worse, taking on a mustachioed lover. So, I pretended that the past 20 years had not happened, and did what many 20-year-olds do when they discover they have no skills, talents, or even hobbies to speak of: I started looking at trade schools. One evening, two glasses of wine deep, I began Googling the trades. Welding seemed cumbersome. I wasn’t likeable enough for real estate. And given my history of giving my children terrible DIY haircuts, beauty school was probably out of the question. Mid-Google, I fell asleep. Deciding on a new life path was exhausting.

But my crisis wasn’t about to let me quit that easily: a few days later, a flier from Grossmont Health Occupation Center appeared in my mailbox. They offered certification courses for pharmacy techs, medical assistants, vet techs, EMTs, and nursing assistants. Not exactly what I had in mind, but something.

Hello, nursing assistant!

“I think I am going to do one of those vocational certificate programs,” I told my friend Laurie during school pick-up later that day.

“Like one of those programs that high school drop-outs and parolees do?’ she asked, bemused.

“Uh-huh,” I shrugged, gritting my teeth.

“Is healthcare even in your wheelhouse?” she asked, stifling a laugh.

It was not. But then, what was?

Upon revisiting the Adult Ed flier, I noticed that the orientation date had passed. But my crisis was not about to be deterred by red tape and schedules. I checked the Grossmont Health Occupation Center website and discovered they were hosting additional orientations for the programs that still had openings — you know, the leftovers. Thus it was that on a muggy Monday morning, I drove to the school, which was located next to West Hills High School in Santee, ready to begin my new life. I meant business; I even wore an underwire bra. And despite my general fear and queasiness surrounding anything remotely medical, I went inside.

A secretary wearing pantyhose two shades darker than her skin tone explained that the only program that still had openings was the one for CNAs (Certified Nursing Assistant). Even among the options that were not what I had in mind, this one was not what I had in mind. But I told myself that the limited options were fine — one less decision to make, one less moment to hesitate and so be lost. The woman explained that I needed to pass a math and English assessment test and attend a brief orientation.

“Don’t worry, most people pass the assessment,” she said with a wink. Was I giving off idiot vibes? But I did pass, even if the math section proved a little dicey. Afterwards, I slid into an open seat in the orientation room next to a brunette who was snapping her gum. An older lady shuffled to the front of the room to address the prospective students. Honestly, she was probably my age, but I needed her to be older than me. She had streaky highlights and wore orangey-red lipstick. Her white blouse sported a small round oil stain — maybe from lunch? As she droned on about the program, I found I couldn’t stop staring at that stain; it was impossible to focus on anything else. Was it, was she, my future?

I perked up a little when her voice took on a serious note and she said, “If you are going to become a CNA, you need to be okay with poo — literally.” She paused, eyeballing all of us, really letting the sentence sink in before erupting into maniacal laughter. The prospective students laughed along. I did not. Despite having raised three children, I am by no means okay with poo. Especially when it’s a stranger’s.

That night, over a dinner of storebought rotisserie chicken and salad, I told my husband that I had enrolled in a nursing program. “It is time to get my life moving,” I said.

After a long pause, he let out a confused laugh, and replied, “Okay?”

And that was that. My future had begun. A few days later, I bought the required uniform: bright blue scrubs and a pair of white Converse All-Stars, purchased in the little boy’s section at Ross because they were cheaper than women’s shoes. The following week, I found myself taking a seat in a small, carpeted classroom at the Center. Apart from our instructor — a tall and lean Hispanic man with midnight shadow — I guessed I was the only person in the room over the age of 30. I did spot a skinny blonde sitting in the front row who was probably in her late twenties; she had a speech impediment and carried herself like a person who had done many, many drugs. On the third day of class, the teacher called me by her name — let’s say it was Jolynn — and continued the mixup for the remainder of the course. I tried not to let it show how deeply offended I was by his faux pas. I also tried not to let it get to me that Jolynn appeared to be just as upset as I was over the confusion.

For the first month of school, I let the other girls copy off me. Why not? At least someone was doing the work. I learned how to convert millimeters into cubic centimeters and grams into kilograms, how to take vitals, how to do peri-care, and how to clean dentures. I kind of, sort of, liked it. I was doing well — it was nice to do well at something — and the girls in my class were a lovable group of misfits. Everything was smooth sailing until it was time for clinicals, the part of the course in which we took what we had learned and applied it in a nursing home environment. At this point in the story, it seems appropriate to switch to present tense, for the sake of immediacy.

The tense present

Bright and early on an overcast Monday, we meet at Avocado Acute, located in a seedy section of El Cajon. Our teacher instructs us to park in the Shadow Mountain Arabic Congregation lot and walk a block to the nursing home. He has struck up an agreement with a pastor to allow us to park there. “You should still walk to your car in pairs,” he instructs. “This isn’t Del Mar.” He explains this to us as we stand near Avocado Acute’s information desk, all of us decked out in blue scrubs. We look like a family of Smurfs. “Remember,” he continues, his manner stern, “some of these patients are never touched. Do not get alarmed if on occasion they become aroused. It happens. Move on. Be respectful and professional.” I have never had to be professional in the presence of an aroused person before. Just one of the exciting new experiences I have to look forward to over the coming weeks, I tell myself. Take that, crisis.

“We stand near Avocado Acute’s information desk, all of us decked out in blue scrubs. We look like a family of Smurfs.”

Siobahn Braun

Upon entering the nursing home proper, we are hit with an overwhelming odor: a mixture of urine, sweat, despair, and Lysol. As we continue our tour — meeting staff and patients along the way — we hear a steady stream of what sound like pained cries. Some of them sound tinged with delirium.

Eventually, our teacher separates us into two different wings. He introduces us to the nursing assistants on staff, the people we will shadow. My CNA is a grumpy looking middle-aged, dark-haired woman with round tortoise shell glasses. Call her Zeba. Zeba wants nothing to do with me: she barely looks in my direction when my teacher introduces me. Later, when she does look at me, it’s an up-and-down assessment, after which she wrinkles her nose in disappointment and grunts for me to follow her. Immediately, I am tasked with changing an older gentlemen’s adult diaper. I want to die. I have practiced this on dummies in our classroom lab, but never on a real human. I thought maybe I would be eased into the whole poo side of things, but Zeba doesn’t mess around. When she sends me down the hall to a utility closet for extra blankets, I run into one of my classmates. She whispers nervously, “This place is so scary! I never want to come back here, ever!”

I know I should say something encouraging, because I am her elder. Instead I whisper back, “I know!”

Before we leave for the day, my teacher pulls me aside and asks if he can speak with me privately. “Listen,” he says, there is a sex offender on this floor. He has been very disrespectful to past students. I assigned him to you. Don’t worry, I told Zeba that you are not allowed to go in his room unless it’s an emergency, okay? I didn’t want to put one of the younger girls on him.”

When I get into my car after this conversation, I cry. I never want to go back. Later, I type in the address of Avocado Acute into the Megan’s Law website, and discover that I actually have two sex offenders on my roster. Both are child molesters. I am disgusted. I call my mom, in tears.

“You’re fine,” she says, and I can tell that she is stifling laughter.

“Are you laughing?”

“No,” she insists, trying to compose herself. “But from the information you told me, both of them are child molesters. You are an adult. You are fine!” With that, she surrenders to a case of the giggles. What else is there to do but laugh along with her? I mean, it probably is okay.

“You can do this, I know you can,” she says before hanging up.

That is all I need to hear. I still don’t want to go back, but the next morning, I pull on my Smurf uniform and head out the door, because I am not a quitter, and I can do this. As I wait with the rest of my classmates for the start of our rounds, I can tell that many of them share my dread — a dread that for me, will endure for as long as I am there. But Jolynn, my tweaker twin? She seems to be thriving in this environment. She is one hell of a nursing assistant.

Near the end of my first week, I am carrying a bundle of dirty sheets down the hall in a clear trash bag when Zeba stops me and asks, “Are those from 117B?” I nod. She lets out a surprised laugh before commenting, “That patient has scabies!” I am horrified. I spend the rest of the day scratching my skin. I am a paranoid wreck. When I get home, I remove my scrubs in the garage and wash them in my machine’s hottest water cycle. I shower and scrub my skin raw, but I still feel itchy.

Patients

Zeba may not like me, but Dan does. Dan is one of my child molesters. He refers to me as his angel. “There she is,” he announces any time I enter his room, “my angel to brighten my day.” He wears a thick ankle monitor on one leg. He likes to talk to me about baseball and his oldest son, who lives on the east coast. He makes me feel squeamish. I remind myself that he is a person deserving of care, just like any other patient. I chant this in my head over and over during our every interaction. It works like a mantra. I am growing as a person.

Two weeks into clinicals, he gets a new roommate. Any time I assist said roommate, Dan freaks out. One day, while I am in the process of feeding Dan’s neighbor, Dan loses it. “Oh, I see,” he shouts at the new guy, his voice soaked with disgust, “You think you are the Prince of Avocado Acute.” From deep in his throat, Dan produces an out of tune trumpet sound, a bent fanfare for the new prince. His roommate rolls his eyes.

“You think you can just snap your fingers and she will get you whatever you want,” Dan rants.

“Ignore him,” I say, shaking my head.

“I need help!” cries Dan. “I need some orange juice!”

At last: a situation for which my life experience has prepared me: I have spent over a decade caring for my own bratty children. I know to keep my reaction minimal.

“I can get it for you when I am done here,” I tell him nonchalantly.

Like my children, Dan is not pleased by my lack of concern. Unlike my children, he feels free to volley a dizzying array of insults at me. I smile and shrug, remaining calm, just like I used to with my kids when they were in the throes of a tantrum. A few weeks later, when The Prince of Avocado Acute is moved to a more intensive wing of the hospital, Dan resumes his practice of referring to me as his angel.

I have other patients. There is a pint-sized man whose room is halfway down the hall. He has snow-white hair and a matching beard. He is almost always smiling. One morning, just after breakfast, he emerges from his room with two full cans of air freshener. He wheels himself slowly down the corridor, spraying both bottles simultaneously and fully saturating the air. He is met with a standing ovation from the entire staff. “You, sir, are a saint!” Zeba gushes in amusement. It is the first time I have ever heard her laugh. He salutes us and wheels himself back into his room.

The woman in room 115C has Alzheimer’s. While most residents don’t have personal belongings, her room is decked out in framed family photographs. She has floral bed sheets, and she wears soft flannel pajamas. Despite all her stuff, I have never seen a visitor enter her room. (In fact, during my entire time I work at Avocado, I see only one of patient get a visitor. Said visitor wrinkles up a nose at the smell and demands that I change the sheets. I do it, even though I changed them fewer than two hours earlier. I get it: Avocado Acute is scary, it smells bad, and the CNAs have too many patients.) One day, when I bring her lunch, she gets furious.

“What is this?” she shouts, seeing the tray in my hand

“Do you want me to bring you something different?” I ask.

She leaps out of her bed. I am so startled that I back up. She keeps walking toward me until I am pressed against the far wall of her room.

“Let me out of here!” she shouts, spraying my face with spit. “I am supposed to go to a movie!”

“Would you like to go on a walk?” I ask her sweetly.

But this only serves to enrage her more, and she shouts, “I need to get out of this place!”

I am pretty sure I am about to get my ass kicked, but then Zeba arrives. She laughs so hard that she can barely breathe.

“Stop being so nice!” she scolds me, “Let them know who is boss!”

For a few days after that incident, Zeba is less demanding and stops giving me all the nasty jobs. Unfortunately, I don’t stay on her good side for long. A week later, while I am changing a patient, he has an explosion of diarrhea. I am not properly equipped to contain it. It keeps coming and coming. It is a volcanic eruption.

“I am so sorry,” he says.

“It’s fine,” I assure him, “no problem.”

I call out to my friend Jasmine — a curly-haired 20-year-old who sat next to me during the classroom portion of our class — and ask her to bring another changing pad and more washcloths. Minutes later, she joins me as we tackle a literal mountain of shit. She wraps up a soiled washcloth, looks at me, and with a sarcastic smile, utters, “Can you believe this shit?”

“I cannot,” I reply.

Jasmine laughs first. She tries to contain her giggles, but within seconds, we are both laughing. I am laughing so hard that I have tears running down my face. Soon our patient joins in, letting out a big belly laugh — which causes even more diarrhea. We are dying when Zeba finally marches in. She is not laughing.

“Come on, Zeba, stop being so serious,” pleads Jasmine.

“Oh, for goodness sake,” Zeba says, sucking in her breath hard. Noting the mountain of soiled wash clothes, she demands, “Pull yourselves together and bring those rags down to the laundry!”

Of course, we weren’t laughing at the patient. Jasmine has a huge heart. She plans on becoming an RN. I’m sure she’ll be great at it. She is thriving here. I am not. My patients like me, and I enjoy keeping them company, but I am in a constant state of fear. I am terrified I will break one of their bones. I am scared that one of them will slip while I am bathing them, or worse, choke while I feed them their lunch. I am scared I will completely forget how to perform CPR.

It’s not that losing patients is unusual; it’s that I don’t want it to be my fault. One patient died my third day on the job. He slept in the same room as molester Dan, in the third bed furthest from the door. He was the skinniest human I have ever seen. He had wiry white hair. He resembled Popeye before Popeye was introduced to spinach. My second day, he grabbed a fork off his food tray and started furiously scratching his skin with it. When I managed to pry it out of his hands, he put a death grip on my arm and somehow forced me to scratch his back with the fork I was now holding. I was frozen with horror until I remembered to drop the fork. The next morning, his bed was empty. When I asked Zeba where he was, she said “Dead.” That was all the explanation she gave. I felt an unexpected pang of sadness over the loss of skinny Popeye.

Past tension, past tense

I didn’t tell many people I was doing the nursing program. As I have said, I am not a quitter, but I still wasn’t sure I would make it through the clincals. And even if I did, I knew I was not cut out to be a CNA.

But I did make it through, and after our last day, one of my classmates took a few of us to the bar she waitressed at, and we all did shots in celebration. Not a single one of us had quit. We took our final exam. All but two of us passed. Our teacher sent us job opportunities, and invited a few different speakers from local nursing homes to address our class. My classmates started applying for CNA jobs. Avocado Acute offered us all bonuses to stay on. A few of us did; most of us did not.

In the parking lot after it was all over, I gave Jasmine a hug, said goodbye, and cried. I knew there was nothing holding our friendship together outside of work, and that I would not see her again. But I think about her often. I imagine her as a full-fledged nurse, out there in the world, being impressive. As for me, I thought about applying at a hospice center. The idea of comforting patients in their final days appealed to me. But my crisis intervened; perhaps it was satisfied that I had suffered enough. Because even as I searched CNA job listings, ads for preschool teaching jobs kept popping up. I decided to apply for a few. I have always been great with kids.

I got a call back about a job at a Grace Lutheran preschool in Hillcrest. I scheduled an interview. Assistant director Anita, met me at the gate and gave me a tour of colorful rooms filled with little people. In the toddler room, I helped an adorable round-faced boy named Duncan build a tower out of wooden blocks. He giggled uncontrollably after knocking it down with a swift karate chop. Outside, a class of four-year-olds marched by in single file, singing a dinosaur song at the top of their lungs. A little girl in a purple dress with braided pigtails growled like a T-Rex. A curly-haired boy with saucer-sized brown eyes looked up at me with a shy smile and waved a chubby hand in my direction. “Hi, nice lady,” he shouted with a grin. I smiled and waved back. He looked almost identical to the toddler version of my oldest son. My heart felt like it might explode. I felt such a strong sense that I had landed exactly where I was meant to be. Zeba was a fading memory.

“I’ve got a good feeling about you,” Anita said as she walked me back out the gate. Zeba disappeared altogether. If I could have bottled up that moment in a snow globe to keep on a bookshelf, I would admire it often. I was so overcome with joy that when Anita called me a few days later to offer me the position, I said yes immediately. Maybe a job teaching preschool at minimum wage wasn’t going to rate a braggy Facebook post from my mother, but I was okay with that. I felt hopeful — even though I still needed to be okay with other people’s poo. Two weeks shy of acing my Certified Nursing Exam, I went to work at a preschool. It was exactly what I needed.