Nighttime as a CNA: The Quiet Work

 For honesty’s sake, I will not lie: I had no idea what a CNA did before I signed up for the class. I assumed I would be helping nurses directly, maybe by helping them retrieve medications or finish charting. I never expected the work that came with the job to be as hands-on as it is. It wasn’t until the second day of training that I heard the word “pericare” for the first time. For those of you who have never heard that term before, pericare refers to the process of washing and cleaning the genital and anal areas of your patients. That concept sounds incredibly foreign to someone who has never done pericare before, or never had pericare done on them. Most of what a CNA does on a shift is pericare. Bedridden patients cannot stand up to use the bathroom on their own, so they urinate and defecate in their briefs, and then CNAs go in, change the briefs, and clean up the patient. Similarly, paralyzed patients cannot move and turn so we can change their briefs, so two CNAs will go in instead of one, so that turning the patient becomes easier. 

I was 16 years old when I started working as a CNA, and, in typical 16 year old fashion, my classmates would ask, “does it smell?”, “what does it look like?”, and “how do you clean it?”. What they don’t see is that it does not matter. It does not matter what it looks like or smells like, because whatever CNAs do, no matter how intimate, is done for the well-being of our patients. Yes, the idea of pericare is hard to get used to, and yes, when I did clinical rotations for the first time, it took practice and a lot of determination to master it. But after just two days of clinicals, it became a reflex. 

I have noticed a pattern among a lot of teenagers, the pattern being that even the topic of genitals or “private parts” makes them giggle. Especially when I would talk about the work I do, no one could take it seriously. The phrase “pulling down the foreskin to clean it” would be met with nothing but laughter, so I stopped talking about being a CNA at school. I questioned, however, the humor behind someone being in such a condition physically that they cannot clean themselves on their own. How humiliating must it be for them when a teenager has to clean them instead of them being able to do it with their own hands? How dependent and low must they feel? I have had patients who have requested a small washcloth to cover their genitals with while being given a shower, and it made me think about how I would feel if I was in their position, fully dependent on someone who will never understand what they truly feel and what they truly need. 

I once interviewed a CNA at a facility in Casa Grande, and she told me about how during showers, she would play music to help her patients feel more at ease with someone else bathing them. Showers are a very stressful experience for many residents, and music calms people down and makes them feel less awkward. One time, one of her patients, who had dementia, started singing along to the song that was playing word for word, despite having memory loss. Moments like those prove how important empathy is in patient care. We will never be able to understand what a patient is going through, what they need, or how they feel. It is simply not possible for us to comprehend their situation from the position we are sitting in. The only thing we can do is give our absolute best to show them that we are there for them physically and emotionally, with no judgement about their body or mind.