Dear Reader,

The Best: Sarah E. Valdez

Occupation: CNA/Direct Care Provider

Reason: It would be easy to dismiss Sarah as just another paid-to-give-a-damn professional, but that would be doing her a great disservice.

Over the years, I have been fortunate enough to have seen her growth from “Direct Care Provider," working with developmentally disabled persons, to a qualified “Certified Nurse's Assistant" (CNA), still working with DD persons as well as working with the terminally ill.

It is not just that she can be relied upon, has enormous patience, provides unparalleled care, or that she is a great teacher and role model, which makes her one of the best. Testimony to her greatness comes from hearing the happiness in the words and seeing the joy in the eyes, smiles, and body language of those she is caring for. Someone once said it is not what you see when you look into Sarah’s eyes which makes her so special, but what she sees with them.

Sarah is one of the best!

— Julian Jones

The Home of Guiding Hands (HGH), where Sarah Valdez works, stands on a 14-acre campus in lakeside. It reminds me of a high school: low-slung buildings, green blocks of lawn between roofed sidewalks, a pool, a separate administration building. The age of residents — or “consumers,” as they are referred to by the staff — runs from 10 to 80; the average is 40. All of the consumers have developmental disabilities, which means mental retardation and something more — “ambulatory difficulty, Down’s syndrome, multiple sclerosis, cerebral palsy,” or others, according to the literature.

Sarah Valdez, 20, well dressed and cheerful for someone who started work at 6:00 a.m., is working in House Three today. The strict Civil War head nurses who demanded that their employees be plain would not have hired her. When I arrive, she is moving around the perimeter of the large room that makes up most of the house, opening bedroom doors and saying, “Breakfast is here.” The main room is open and airy, divided in half by a long partition. On one side are tables and chairs. On the other are couches, lounge chairs, and an entertainment center. The bedroom doors are wide. A cafeteria-style kitchen takes up most of one wall.

Sarah begins helping Ben, who pauses to say hello to me before getting his lunch together. “Show me where your lunch box is,” Sarah asks him. “You want to put your lunch in the box? Thank you. You did it!”

Seven men and seven women live in House Three. Most share bedrooms; a couple have singles. “We try to personalize everybody’s room here, but it’s kind of hard, because some of them like to tear down their stuff.” Ben is not one of those people. The walls of his room are hung with wildlife posters. He has a TV and a VCR. A radio stands on his desk, next to a phone that is not plugged into the wall. “This is Ben’s little office. He likes to talk on the phone, act like he’s in an office.” She speaks about him almost as if he weren’t there, and he pays no attention to her unless she speaks to him, slowing her speech and raising the tone. “You cold? You want to put a sweater on for me? How’s that, is that warm? Good. And you can do your laundry when you get home.”

Ben begins setting the tables, laying napkins at each place. Later, he is told to stop, so that he can eat before he has to leave. Sarah tells me about the consumers. “We have people in here who are physically impaired, that can’t walk. We have one person in here who can’t walk, who’s also blind and deaf. He’s the way he is because he had a real bad fever when he was a baby. We have a few here that were [the way they are since] birth; we have a consumer here that had an overdose of drugs.”

Sarah turns back to Ben. “You need help brushing your hair? You’ve got your lunch, you’ve already shaved. You want to put some cologne on?” She sprays water on his head from a spray bottle and brushes with vigorous strokes. He puts cologne (a lot) on himself. Several of the consumers like to wear scents; one staffer calls them “smell goods.”

“Some of them get certain odors from the medications they take, or they have skin problems. We wouldn’t want them to go out smelling bad. Most of them have grooming boxes, where they brush their teeth, use deodorant, wash their face and hands. Guys, if they need to shave, get shaved — they have an electric razor out here. They’ll just sit there — Ben was shaving for about an hour."

Showers are given daily if the consumers allow it, usually at night. Some consumers are working on learning to wash themselves, so their showers take longer, but most run about 15 minutes. Each consumer has a Program and Behavior book that tells staff what they are working on accomplishing and limiting.

The rest of the consumers begin coming out for breakfast. Michael, his hands down his sweatpants, comes bounding out of his room, skipping barefoot and hooting at the top of his voice. He likes to say his name and laugh and run back into his room to watch cartoons. When he learns that he is having pancakes for breakfast, he is delighted and shouts about that as well. His shouting bothers Ryan, who is legally blind and begins beating his forehead with his open hand, hard. The staff, made up of Sarah and three other women, pat him on the back, ask him what’s wrong, and get him back into his room.

Barry, a tall, thin, youngish man with socks over his hands, sits in a side chair and begins bobbing his head. "He likes to pick and pinch,” explains Sarah. "So, he thinks that having socks on his hands helps him not to pick.” She gets him to use a knife and fork to eat his pancakes.

Irma — short, broad, with large eyes and a shock of vertical black hair — sits next to Barry wiggling her fingers and spitting on the floor. Her behavior is no more unexpected than anybody else’s, but as I will learn, it is more significant. A couple of staff members lead her back into her room for a few minutes. The morning news is on the television, but nobody is watching. Fop music plays from a stereo. There is a loose, uninstitutional feel to the morning — everybody is at a different stage of getting ready. Though activity never ceases, nobody seems stressed or rushed.

Sarah walks with Barry out to the front of the complex to wait for his bus, the one that will take him and other consumers to their program for the day, whether it be work (stuffing envelopes, filling plastic bags with nuts and bolts, product assembly) or an outing. She keeps an eye on him, because he has a tendency to throw his shoes and lunch up onto the roof. When the bus arrives, she asks him to give her the socks on his hands, her hand held out like a mother demanding the surrender of a stuffed animal.

I ask about Ryan’s headbeating episode. "Ryan was having a behavior. He does not like noise, which is kind of hard for this house, because it’s very loud. This house is considered a behavior house. We have three on the grounds and a major behavior house off grounds.” “Behavior” has a benign ring to it, a term that might be used to describe breaking into song at inappropriate moments, but its connotation in this case is negative and can mean more than head slapping. “A lot of people get beat up, both employees and residents. We’ve had people with broken necks and broken hips.” Ben, for instance. “When he becomes aggressive, he is very aggressive. He’s very strong when he’s upset; he’s knocked people out cold: he kicked somebody in the stomach that was pregnant. It’s kind of bad when he’s upset, because it can cause him to have a bad seizure.”

I think back to the house, how open it is, how little refuge there would be from an upset Ben. “There’s signs,” Sarah assures me. “You can tell when they’re gonna go off. Irma, she was sitting down in the chair, but she was doing her fingers, and she was spitting. She was very agitated. She’ll get up, and she’ll throw things at you, she’ll head-butt you, she’ll knock you down. Barry, he’ll start jumping up and down real high — he’ll come and swing at you. But then there are some residents that don’t give you any signs.”

It turns out the lack of refuge is intentional. “These homes have changed a lot. This [front desk] was the nurse’s station, and there used to he a glass wall up here. There were serious behaviors; it was bad. Somebody would have a behavior. The [staff] would dart into the nurse’s room and just let them. Now, we have to intervene, and we get hurt.”

Intervention is mandatory because “when they’re upset, they’re upset for a reason. Some of them can’t commuinicate or talk to you, so their only way of showing it is to get upset. You try to ask them what’s wrong, are they feeling well, can you do anything for them. They might have had a bad day at work or a variety of things.”

Back at the house, Clifford, a larger, newer resident of House Three, comes out after most of the others have gone. He is not going to program, because he has been kicked out for violent behavior. “When he first got here, he put a lot of people in the hospital. He gets really upset if he can’t have something. He’s had to be contained. When you have a supervisor and a nurse here, you have the okay. You’re not allowed to restrain them unless they’re going to hurt somebody else or consumers. And if you do, you have to document it. Licensing comes every year, and you have to have everything documented."

What’s happened to you in particular?

“What hasn't happened? I’ve gotten pulled into the bathtub, I’ve gotten pulled down to the ground. I’ve gotten dropped in the toilet, I’ve gotten my hair pulled. I've gotten scratched, hit, kicked —just about everything, and I’m still here.” Those first two sound worse when you consider that some of the behaviors are sexual—an adult libido and strength together with a child’s tendency toward self-gratification is an ominous combination.

So it is not surprising that few of those who sign on stay on. “I’m the only person left from my orientation class,” says Sarah, “because I have a strong heart and I’m very patient. Back when I got hired, they didn’t tell me that they may poop or pee, and you have to help dean it up.” (This is no longer the case.) “When I first started out, it was very scary. I didn’t know how to react, didn’t know if I could talk to them, touch them. It took me a good six months to get to know them. When they know you don’t know who they’ are, they try to play you for everything—they’re too funny. They’re like kids. I came to love it.”

What made her love it wasn’t the money. She started at minimum wage, and there are safer ways to make $5.35 and hour. “I just love how excited these guys get over simple little things — like pancakes. We just take advantage of everything, and everything to these guys is important. It just opens your eyes and makes you look at things a lot differently. Making a cake. I can just go into the kitchen, make a cake. It’s no big deal. But for these guys, you have to plan, you have to get money, you have to go shopping. They go in [the kitchen], and they get excited. They’ll ask you, ‘Can we make a cake for so-and-so’s birthday? I want to make them a pineapple cake with chocolate frosting, because I think they’d like that.’ ”

Christmas provides another high point, but one tempered by sadness. “They have so much fun at Christmas. They decorate the trees, wrap the presents, put up decorations, cook dinner, invite the family over — some of them go home. The ones that don’t go home, we try to make it the best possible when they’re here.” That’s where the sadness comes in. “Some of the parents come and visit, but some of the guys here are owned by the courts. The family just gave them up; they don’t want anything to do with them.” Consumers whose parents don’t visit end up watching parents who do visit. “It’s really sad. I spend my holidays here most of the time, so they can have a familiar face around.”

Sarah has been doing this for three years. A year and a half ago, she got her CNA certificate, so now she works about 20 hours a week as staff, 20 hours a week as a CNA, and then 20 hours of caring for patients not connected with HGH, patients with terminal illnesses. This too takes its toll. “You try not to get too attached to them. One patient I have, he has AIDS. He knows he’s gonna die. He’s just waiting — he’s living his life, but he’s waiting for it to happen. To see him pass on will be a little difficult, because I’ve been the only stable person in his life for the last nine months. The rest of the people that have worked with him, he’s hit and fired and told off and what have you. He really digs me. I get attached with everybody. It’s just something you have to learn to deal with. It’s hard, but it’s something I’ve got patience for. It’s something I can do.”