The Standing Order

The new CNA didn’t know I needed shakes. She brought solid food and set it in front of me. I explained, and she went to find what I actually needed. It took a while, but she got there.

That was breakfast. It was the easiest part of the day.

At lunch they were out of shakes. They had talked to my mom, and she had told them I can sometimes eat solid food, that I know what I can and can’t eat. They seem to have heard that as permission to keep offering it. They put the solid food in front of me where I could smell it, and then took a long time figuring out the shakes. So I ate some of the solid food. It turns out they were out of shakes entirely, so I got two cups of Medpass instead, which is not complete nutrition. I got sick after that. Gas, bloating, nausea, a trip to the restroom.

At dinner the CNA asked if I needed shakes. I said yes. Then he left and never came back. I pushed the call button twice. It was an hour after dinner before anyone came. When they did, I had to ask about the shakes, and they had to go find out what was going on. I got one. I had to ask for a second, and the CNA didn’t seem to understand what I was saying for several minutes.

None of this is about the food. It’s about the fact that there is no standing order.

A standing order is a boundary. It says: this person needs liquid nutrition, every meal, no negotiation. It means a brand-new CNA on a random shift doesn’t get to decide whether I eat. It means “we’re out of shakes” is a supply problem to solve, not a reason to hand me solid food and hope for the best. It means my needs are a settled fact, not a question that gets reopened three times a day.

Without it, every meal is a negotiation. And I am the one who loses every time.

I have to explain myself to someone who has never met me. I have to hope they believe me. I have to wait while they go find out what’s going on. I have to ask twice for the thing I already asked for. And when the negotiation goes wrong, the cost lands in my body. I get sick. I miss a meal. I sit with gas and bloating and nausea because someone decided my mom’s comment was a loophole.

My mom was trying to help. She was telling them I’m not helpless, that I know my own body. But the system took that and turned it into a reason to keep pushing solid food. That’s what happens when there’s no order. Every piece of information becomes a reason to make me prove myself again.

I have a dietician now. She said she’d call the nursing home and ask some questions. That’s a start. But a phone call asking questions is not the same as a written order in my chart. What I need is the thing that makes the questions stop.

I don’t want to be a difficult patient. I want to be a person whose needs are already known. The difference between those two things is a piece of paper, or a line in a computer system, that says what I need and doesn’t ask me to defend it.

That’s all a standing order is. A boundary that lets me rest instead of fighting for food.