MONDAY

Another week in which to excel. I wonder if I will? I arrive in the job at 2:30 p.m. -- the least desirable shift for most, but my favorite.

The unit is noisy; several residents are more than normally agitated. One claps and cries when she sees me, "Oh, I missed you, missed you." If the rest of the eight hours go badly, I, at least, have that vote of affection to sustain me. Thirty-six people, most of them over 70 years of age, 80 percent of them, except for paying the monthly bill, apparently forgotten by their families. I am, in one, their nurse, daughter, sister, friend, sometimes I even feel as though I am their mother. An overwelming role to play for any individual.

My staff arrives. We have a strong working relationship; we know we can depend on each other; we laugh and cry together. On an especially difficult day we jokingly talk about getting less streneous work, such as ditch digging or washing windows in a skyscraper.

TUESDAY

An uneasy pall today -- I sense it as soon as I walk in the door. Death is imminent; everyone can feel its presence. Yesterday, he refused to get out of bed, shook his head and adamantly said, "No more, no more." His appetite has gradually decreased for two weeks. We recognize the signs, those of us who have been in geriatric nursing for a while. When I first entered this speciality, to have a patient "give up" depressed and angered me; I felt defeated. The medical profession saves lives. If we can't save them, doesn't that denote failure?

I touch his wrist; he stirs slightly but does not seem to be uncomfortable. Last month, in a few moments of lucidity, he told me about his boyhood on a farm in Iowa; perhaps that's where his mind is now. I hope so.

It's like a clock running down and the decision is mine, whether to wind it back up. I could send him to the hospital; they could pump him full of IVs and buy him another three to four weeks. The family said "no heroics," but they didn't define what "heroics" means to them.

"No more -- no more."

WEDNESDAY

A visitor on the unit today: an attractive, well-dressed, middle-aged lady, pushing a wheel chair, the occupant messily stuffing cookies into her mouth. (I cringe -- she chokes so easily.) I think the visitor is a volunteer and casually ask which church she represents. I'm embarrassed. The icy answer is: "She is my mother."

In the two years I've worked here, even during holidays, I've never seen her before. The embarrassment should be hers, not mine.

THURSDAY

This morning I am asked where I work. By now the reaction to my answer does not surprise me, but it still hurts. Peer pressure among professionals can be as cruel as it is for teens.

Many nurses will not consider the geriatric field because of the stigma of nursing homes. To work in one is frequently considered a copout. Walk a shift in my scuffed white shoes -- this is no copout.

I know I'm too sensitive; comments such as, "What do you get out of it?" or "Why are you wasting your training there?" cause a range of emotions in me, the strongest of which is, fear.

If we are so repulsed by the aged that we scorn or criticize those who tend to their needs, and with medical science enabling us to live longer, will anyone care about me when I'm 80?

It does help to have a sense of humor in this field. Besides, where else can you spend eight hours a day, be over 40 years old, and be called "kid"?

FRIDAY

The decision to let her walk on her sometimes unsteady legs turns out to be the wrong one. She falls this evening, probably fracruring her hip. As I watch the crew from the rescue squad gently lift her onto the stretcher, I feel sadness mixed with guilt. If I had just followed my instinct to restrain her in a chair, in spite of the family's preference that we not do so . . . but it was my decision, and it is now my guilt. Restraints: I even dislike the sound of the word -- probably the most controversial of nursing home subjects. Four staff members to care for and watch over 36 patients, all confused like children at times fighting among themselves, tottering on wobbly legs and refusing to use the metal walkers provided to aid their balance. For their safety, we must resort to restraining the weakest and those most apt to fall. But, at times we are "damned if we do and damned if we don't."

SATURDAY

My weekend off. I'll spend it catching up on neglected chores at home. The lot of a mother/wife with a career if her own to fullfill is highly overrated and romanticized. Frequently I wonder if it's all worth it, but by Monday afternoon, I'll be anxious to get back on the job.

With the short-term memories of my patients, it's doubtful that they recall that I took care of them last week (and numerous weeks before that), dried their tears shed due to loneiness, encouraged them to eat their meals, changed their soiled clothes (and soothed their pride while doing so). I can't deny my desire to be recognized and appreciated, but mostly I must be satisfied with the knowledge that I, and God, know that I really do care about these people that others label undesirable.