That Face

I don’t know how long this is going to take to write this but I’m sitting down and writing it all at once. If I don’t, well, it may be too late and no one will ever know the truth.

I was a nurse tech, CNA, professional butt-whiper, whatever you want to call it. I was on a long track to becoming a nurse, as most young CNAs are that work in nursing homes like myself. There was a crew of girls that I specifically loved to work with and every time I saw their name written on the schedule next to mine I knew we would have an easy-going night. The crew- Sam, Jenna, Kera and myself, Colleen, knew how to run hall 2 like the back of our hand.

When it was us four working, there was no need to have a discussion on how the four of us would manage the 48 residents for the most optimal form of care. What most people don’t know is that nursing homes have routines, and my crew of girls and I had our own distinct routine.

All residents must be turned at minimum every two hours. Some residents, depending on the day, needed their vitals taken, shower, bed linens changed, etc. We worked like clockwork. Kera and Jenna would take the south side of the hall and Sam and I would take the north side. At 2:30 PM we would start the next 8 hours by going through and changing everyone who was soiled, give showers, assist with toileting, etc. At 4:15 PM, we alternated in taking a quick smoke break, well at least for Sam and me, we were the only two that smoked. At 4:30, we would go back through the hallway, same as we began, except getting people up in their wheelchair or out of bed if they wanted to go eat dinner in the dining room. Dinner was served at 5:30 PM, on the dot. Everyone got fed, two of us went on lunch break and then we’d alternate. At 6:30 PM, we were back through changing everyone, putting residents to bed if they wanted, filled their cups with ice, and answered call lights. We would whiz in and out of rooms, flying past the med technicians dispensing medicines and the RNs answering medical needs, because keeping up with 48 residents can be tough between the four of us. At 8:30 we’d put everyone else to bed that hadn’t wanted to go to bed earlier, change and rotate everyone, and then relax for the last two hours, except for the stray call-light a resident might put on. This would last until we turned and changed everyone one last time before 3rd shift came onto shift.

I guess we could’ve always skipped that last round of changing around 10:00-10:30ish, because TECHNICALLY it would’ve been 3rd shift’s job to follow up as soon as they came onto shift. But I’d worked 3rd shift a few times, and I knew that there were some sketchy folks on that shift who didn’t always get right to work when they got there, instead reading a book or playing on their phone. Then when 2:00 AM rolled around and they were stuck doing a complete bed change because Mrs. Smith had urinated 4 times since our 8:30 PM roll through, they’d find a way to blame it on 2nd shift and say it was our doing for being lazy and never changing her in the first place. Just because the signs in the room reminded us that you MUST change and clean each resident and rotate them every 2 hours does not mean that everyone there obeyed the command.

I to this day wonder how many bed sores couldn’t been prevented if some of those lazy folks on 3rd shift would actually do their job every 2 hours and rotate the resident. But, hey, I couldn’t blame it ONLY on 3rd shift. There was some that were very dedicated on 3rd, and there were still lazy ones on 2nd shift and 1st, but it seemed that the ones on 1st and 2nd shift that were incredibly lazy always got pushed into 3rds. I don’t know if it was their choice, knowing they wouldn’t be caught as often for the acts of neglect towards residents, or the company’s to keep them out of eyesight of the traditional visitors who come during 1st and 2nd shift hours. I was thankful I never had to worry about that with ‘the crew’, because we were so dedicated to the job and ensuring that all our residents were happy and as healthy as they possibly could be, even with the residents who would strike out against us in their dementia fueled rage or the residents who could just be plain mean with no excuse such as disease or mental illness.

One of those special days, a day when ‘the crew’ all happened to be scheduled for the same shift, we had a new resident join the facility. Wasn’t anything new, people came and went all the time in the skilled nursing home facility. Her name was Ava, and the first time I saw her face I had no clue just how much that face would come to haunt me in the future.

Like usual, Sam and I always volunteered for the introduction to the facility, we were the bubblier personalities of us four. After we had all her belongings stowed away and had finished the beginning paperwork, with the help of her sweet-faced husband who had tears in his eyes, I asked her politely, “Are you ready for the tour of the facility?”

Ava, who had been mostly quiet, sitting in her wheelchair, staring out the window, looked into my eyes with piercing anger and said, “No.”

I was alarmed at the response. No one, who was cognitively aware at least, had ever turned me down. I looked to Sam for some kind of response, but got none as she was also bewildered. I then looked to the husband, who just simply sighed when he turned to me and shrugged his shoulders.

“Well, if you change your mind, just click this call-button.” I smiled again but received nothing but disgust in her scowl towards me.

When Sam and I exited the room, I asked, “What was up with that?”

“I dunno, they said she’s just here for recovery and rehab, she’s not here for long-term. Hip surgery, I think.”

“No dementia?” I asked, wanting to clarify.

Sam looked over the initial paperwork that we were returning to the chart, “Nope. She’s 68, healthy as a horse from what this looks like anyways, just had hip surgery is all and husband can’t help her at home. Just here for rehab.”

This would not be the last concerning conversation I’d have with Sam about Ava.

Ava eventually became a part of our routine as well, a part of our routine we had to add into our well-established routine. Which was difficult, because Ava was on her call-light every 10 minutes it seemed. Which in general isn’t that abnormal, after all Mrs. Johnson was on her call-light frequently as she was fighting not to become incontinent and any time she had the urge to go she would be quick to hit the light- which I understood her want to hold onto that piece of independence, even if it meant we were in her room every 30 minutes.

Ava on the other hand, her call-light went on for anything and everything. The light from outside is too bright, she wants the shades down further, she wants the TV off (with the remote sitting right beside her), she wanted the lights off in the room, someone in the room next to her was too loud (“make it stop!”), the wheels on the med cart were too loud and she could hear them, she wanted her head lifted (and I had to remind myself that there was nothing wrong with her fingers, she was here for her hip), she wanted her head lowered, she wanted her pillow fluffed, (a few times) her pillow was too fluffy, the phone was ringing in her room (“unplug the darn thing!”), to close the door, to get her another blanket (even if she was covered in 5 already), wanting her socks put on (which usually ten minutes later was followed with another request to take them off), and most of all to complain about her roommate- Nellie.

There’s two things I need to REALLY explain here: the whole using the call-light being annoying and what was up with Nellie.

As CNAs we WANT people to use their call-light, we would never want to deter residents from using it. No one had forgotten how it took two nurses and 4 CNAs to get 400 pounds Mr. Larson off the floor when he decided to walk to the bathroom by himself without his oxygen mask attached even though he knew he was supposed to use his call-light and let us know, because it took three of us to walk him there safely. When we found him screaming on the floor that night, he gave the excuse, “I know y’all are busy. I didn’t want to bother y’all.” He didn’t really recover from that fall, broke his hip and did something awful to his back.

So why was it annoying that Ava used her call-light the way she did? Because she got some sick enjoyment out of it. I don’t know how to quite explain it, but when you would go in there to ‘resolve’ whatever issue there was that she had called you in there for the first place for, out of the corner of your eye you could see her smirking. All our other residents were polite enough that if they needed multiple things they’d ask in one go, like, “Hey, Colleen, I need help going to the bathroom and I need my water filled. Oh, and could you grab my needlework too? Thanks!” But not Ava. It was like she worked hard to come up with new tasks for us to complete and would press the call-light for every, single one.

Sam and I usually took lunch break together, and even though I didn’t need the carbs and sugar, we usually found ourselves at the Freeze Queen- a local greasy diner that had nothing on the menu less than 1000 calories. I grabbed my favorite milkshake while there, again- not like I needed it, a chocolate banana shake to go for dessert. When we clocked back in and hit the floor to go back to work, Kera and Jenna looked super pissed.

“What’s wrong?” I asked taking a slurp of my heavenly delight.

Kera threw a thumb over her shoulder towards our end of the hallway, “Your girl down there. I’ve about had enough.”

Sam rolled her eyes and I looked down. We couldn’t help but feel responsible for our residents, even when the other half of our crew was supposed to be watching out for them and their call-lights while we were out for lunch. I knew who she was referring to, “our girl” down the hall in room 213.

“What now?” Sam asked, with a bit of an attitude that wasn’t aimed at them but more towards Ava.

“I swear, I can’t make this shit up. Like clock-work she was on that call-light every five minutes asking for a refill of water, then she had wet the bed, then refill of water, then telling us again she wet the bed, and then another refill of water. She kept drinking the damn 40 ounce cup full before I could even come back to fill it up and then-“

Jenna kicked in, “And then I went in there and asked her if I was going to have to bring her the whole pitcher after the literally sixth time she was asking for a refill and she smiled at me and said ‘no, just one more’ and so I went to fill it up then-“

Kera, who was spitting mad took up, “And then we waited in the hallway behind the door just a bit and watched her- she was pouring the water between her legs. Seriously, lifting the blankets and pouring it between her own damn legs!”

Sam and I were quiet for a bit. “Go on to break, I’ll see what’s up.”

After they were out of sight, Sam grabbed me by the arm. “Do you think she is seriously that lonely? Is that what all this is?”

I thought about it for a second. “No,” I said slowly. “It’s more like I think she gets a kick out of this.”

And as if she knew we were talking about her right then, her call-light went off, giving the ever-blaring noise of the BEEP- BEEEEP- BEEP down the hallway, causing us both to jump.

We went in there to see what was going on and in my ever so pleasant voice, “Yes, Mrs. Ernington, how can we-“

“Call me, Ava, I’ve already told you!” she snapped.

“I’m sorry, Ava, how can we help you?” I said trying not to shutter at the cruelty in her voice.

“I believe I wet the bed.” It was as if she could barely contain her excitement.

Sam, who’s always been a bit braver than me, tried to hold her accountable as I sat down my milkshake to grab fresh bed sheets from the closet. “Now Ava, you know you’re continent. You know you can let us know when you need to go, what’s g-“

But Sam didn’t finish her sentence because right then Ava deliberately swung her hand out and knocked my milkshake off of her bedside table to the floor. Chocolate banana shake splattered all over Sam’s scrubs.

“Whoopsies,” she said in a small child-like voice as we both turned back up to look at her with alarm on her face. “As you were saying?”

We worked in silence as we made her bed new. I could tell Sam was livid but she was not going to take it out on Ava.

As if I needed any more evidence to convince me that Ava was possibly just pure rotten, then came the issues with Nellie. Let me go onto explaining Nellie for a bit. Nellie was a 9 year-old girl mentality trapped in a 49 year old woman’s body. She’d had a terrible accident while riding horses when she was little that had caused a brain injury, but she was just the sweetest of people you could ever meet. That kind of innocence was appreciated by all the staff, especially since we were the only family or home she’d known since turning 18. Both parents died before then and she really had no place to go, no one to come visit her. She played with baby dolls and would coo at them, showing them off to the nurses and CNAs every chance she got. Everyone truly loved Nellie.

Except Ava.

Our deep love for Nellie had been a part of us making sure she steered clear of Ava. It really hadn’t been that difficult as Ava usually demanded her door to be shut and refused to eat any meal with the rest of the residents in the dining hall. But Nellie’s roommate was on her deathbed and we had to move her for a few days until they passed on, because Nellie didn’t quite see nursing homes like the rest of us. Nellie had this perception that the nursing home was the best thing ever, everyone was nice to her, she had a warm bed, and all the residents adored her and those that were cognitively aware, or with it so to speak, helped take care of her too and made sure she was never lonely. Any time one of her roommates started having signs of passing, we’d move her to an open bed. No one wanted to take that innocence away from her. When they came in with body bags to collect whoever had passed, Nellie had somehow assumed they were being adopted- I guess from living some of her years in an orphanage. She would be so happy for them, and no one wanted to take that innocence away from her.

But we weren’t able to hide Nellie from Ava forever and it was happening in the worst way. The charge nurse came up to me and asked me to move Nellie into Ava’s room. All the rooms on the hallway we worked in had double occupancy, but they were all filled except for Ava’s- something I had been trying to contain for a while now.

“But-“ I tried to explain to the nurse.

“I know, no one seems to like Mrs. Ava, but we don’t really have a choice.”

I knew I needed a smoke before I could go on with this ordeal that I was sure this was going to come back and bite me in the ass sooner rather than later. I nodded to Sam to come with me as she had seen the troubled expression on my face after my interaction with the charge nurse. Over a few Marlboro reds I filled her in.

“Fuck,” she said as she exhaled a large cloud of smoke. “I would almost prefer to quit before I had to be the person to do that to Nellie. Ava is just… plain evil.”

I nodded in agreeance, putting out my cigarette hard in the metal fold-in ashtray. This was not the first time the idea of quitting had hit me, but it was feeling more and more of a potential possibility. I’d always loved my job, but Ava was really getting on my nerves.

“Out of all days this HAD to happen when I was working,” I said begrudgingly.

We were lucky to get most of Nellie’s belongings moved in while being extremely quiet enough not to wake Ava. But as soon as Nellie came in to check out her new living quarters, she boomed in a loud voice, “Well Lawdy Lawd! I ain’t ever been in this room before!”

Ava woke up, startled, and examined the room like a hawk. Her side of the room, which was dank and dark, no decorations at all had become overshadowed by the cheerfulness of Nellie’s colored coloring sheets taped on Nellie’s side of the room, the neon pink comforter, and all of her baby dolls swathed in bright blankets.

“What in the devil is this?” she hissed.

Nellie frowned momentarily but then brightened back again. “I’m sorry, ma’am! I don’t think we’ve met, my name’s Nellie and I’m going to be living with you now!”

Ava looked at me and Kera (as Sam had said she’d prefer to eat shit than be a part of this situation, which I totally understood) with the most go to hell look. “You trying to torture me, are you?” she spat out, and then in a soft whisper, “You’ll regret this.” She grabbed the curtain that can be used as a divider in the room and yanked it until we were out of sight, nearly ripping it off the ringlets that held it in the metal scaffold.

Oh and did we end up regretting it.

After a few days though, it seemed as if it wouldn’t be SO bad. Ava actually laid off the call-light for a bit. But then one day when we were coming onto shift (the crew, thank God), I heard a blood-curdling scream come from 213. I hadn’t even clocked in yet but went running that direction. I skidded to a halt in front of the room and there was Nellie holding a baby’s head- detached from it’s body.

It took me a second for me to jolt back into the realm of reality to realize it wasn’t a REAL baby’s head, but rather a baby doll head, but to Nellie it didn’t really make a difference. She was just screaming “WHY? WHY?” at the top of her lungs.

I got Nellie to step out of the room and took the decapitated baby doll from her arms. Sam, who’d been close behind me to find out what the commotion was about grabbed Nellie up in her arms like the 9 year-old she really was on the inside, and said, “It’s okay, it’s okay,” over and over again until she calmed.

“What happened, Nellie?” I asked after I thought Nellie was clear of having another breakdown.

“I-I-I was just walking Mrs. Corton back to her room and when I came back, they was just all de-de-dead!”

Ava’s smile caught my eye over Nellie’s shoulder. She pulled the curtain shut once she realized I had deadlocked my eyes in on her.

Sam caught my gaze and it hit her too like a ton of bricks. This was Ava’s doing, plain and simple. Sam unglued herself from Nellie and stomped into room 213, she’d obviously had enough.

She ripped the curtain back and pointed a finger in Ava’s face, “Do you seriously get off on hurting other people? I don’t quite get what your act is about but I’ve had it up to here and this is absolutely uncalled for! You don’t GET to BULLY people here!”

“That’ll be enough, Ms. Hollond.” Sam, Nellie, and I all jumped to see the director of nursing, who had also apparently come to see what had caused the screams.

Sam began to stammer, “Oh, Clara, it’s not what you think-“

“Meet me in my office.” She turned to me. “Colleen, you and the two others will have to work extra hard tonight as I think it will only be you three available for this hall to work the rest of the shift.”

I swallowed hard. As if managing 48 residents between 3 CNAs wasn’t hard enough. I’d actually spent time researching before the laws in our state on CNA ratio to residents- there isn’t any, only for RNs and doctors. What bull shit. But what I was afraid of would be even more bull shit was how they were going to handle Sam.

When I got off work that night she met me in the parking lot of the facility. She was sitting on the trunk of her car, smoking a cigarette. She actually had a smile on her face, she was always pretty spunky. When I think back on her, I like to remember her like that. Her silhouette against the artificial light produced by the exhausted bulbs from the security lights, the glowing ember of fire beaming between two fingers, expulsing carbon monoxide.

Kera and Jenna were walking out with me and they finally saw her too; I’d filled them in earlier on what had happened outside room 213. “If you got fired, I’m going to kill you,” Jenna shot out in a half joking half not-joking yell as we began to near her.

Sam laughed heartily, “Nope! Not fired, suspended for 3 days with no pay and can no longer work North hall, so that means one of you bitches,” she took a dramatic draw off her cigarette and pointed between Kera and Jenna, “is going to be my lucky new hall partner.”

“Oh you, bitch!” Kera turned toward me. “Your side of the hall seriously sucks ass since Ava moved in.”

“Tell me about it,” I said through the clenched teeth trying to hold a cigarette as I searched for a lighter. I was somewhat relieved that Sam hadn’t been fired but still pissed that I wouldn’t have my childhood friend to work with any more directly by my side.

“Well, y’all can figure that shit out on your own,” Sam said laughingly as she jumped down from the trunk of her car. “But I’m going home to get drunk tonight. Anyone want to join?” This wasn’t necessarily a special event for her to be drinking, but this was also a routine for Sam.

We all turned her down for the night. I kind of wanted to be alone, which didn’t make sense to me at the time because I already felt lonely enough with the thought of not working beside Sam. Even though I loved Kera and Jenna, it would not be the same.

It was Kera who eventually came to my side of the hall after she chose the losing side of a coin toss with Jenna. I felt bad for Kera, but even worse for myself. Ava was literally making our life a living hell. The call-light was constantly on and seemed to never stop. The BEEP- BEEEEEEEP- BEEP noise eventually turned into such a norm I began to hear it in my sleep. We weren’t the only people affected by it. The residents who suffered from dementia were more anxious and agitated by the constant noise never ending from room 213. Sometimes, we could hear her laughing from her room with the call-light on, just barely hear her laughing over the BEEP- BEEEEEEEP- BEEP.

And then there was poor Nellie, who never seemed to complain about anything, being so sad. There were no funds left at the end of the month from the recreational department to buy her new baby dolls, and we would often find her stealing tape from the nurse’s station to try and tape their heads back on. We would find her trying to camp out for the night in the dining room hall to go to sleep, saying she was afraid Ava was going to rip her head off like she’d done to her various ‘babies’.

We had been given strict orders that all residents must sleep in their beds, and I had been honoring this rule for as long as I’d been working there, but then one night I just finally broke.

Kera and I found Nellie one night curled up in the bathroom in the dining room that was off to the side, head on pillow leaned up against the toilet, thumb in mouth, with a halfway taped/halfway beheaded baby doll in the fold of her elbow. Kera bent down to grab her by the arm and I stopped her. I motioned for her to move away so I could talk to her without waking Nellie.

“No. I’m done. I can’t do this anymore. If upper management gets pissed, blame it on me.” Kera shrugged her shoulders and began to say something but that was when room 213’s call-light went off. She rolled her eyes and went to go handle whatever complaint there would be of Ava’s.

I began to think long and hard during work and outside of work what made Ava tick. I came to the conclusion there would be no better person to ask than her husband, who always seemed so sweet which made no sense when you looked at the disposition of his wife.

The next day like clockwork, Henry, Ava’s husband, was getting ready to leave around 5:00 PM. He normally waited around in the front lobby, which always seemed strange to most but made sense to those of us who had worked with Ava on a personal basis. He wanted to appear present and like a good husband, but couldn’t stand being in the same room with Ava for very long.

“Um, Mr. Henry?” I asked as I interrupted him from the newspaper he was reading.

“Oh, hello there! Are you Jenna?” He had a grin that reminded me of my grandfather’s smile before he had passed.

“Nope, I’m Colleen,” I said cheerfully. “Do you have a few minutes to spare?”

“Of course, come have a seat.” He patted the cushion on the couch next to his.

I sat down and tried to muster the courage that I knew Sam would easily have to endure this conversation, but she was banned from all communication with Ava or her family- which she was happy for anyways. “I feel like it’s really easy for me to connect with our residents, but I’m having a difficult time with Ava. I was hoping you could tell me more about her and maybe I can find out what I can do that will do the trick to make her stay here happier.”

“I’d be more than happy to,” he gave me a soft wink. “Well, Ava is a bit of an odd bird, right? I mean she’s had it hard a majority of her life. You may not believe this, but she has always suffered from anxiety and depression. Oh, yes. But it got so much worse after she started working in asylums. She was a nurse for a while, graduated top of her class and everything. And I really thought she had been doing better and I was against the job at the asylum, but she was dead set on it. She had an incident and didn’t stay long and never worked since. Well, I mean being a stay at home mom is a job, I’m not trying to discredit that. But she never was the same, not quite.”

It was hard for me to see Ava as anxious. Well, even depressed for that matter. Depressed and anxious people don’t plan out malicious acts, do they?

“What kind of, um, incident?” I was afraid I was prying too much, but he seemed happy to have someone to talk to, no matter how depressing the subject.

“Well, she’d really gotten attached to one patient there and they were getting better. They eventually discharged her back home, but a few months later she was back and worse than before. Raising all kinds of hell- oops! Excuse my language. But she was just, angry. She attacked Ava one night. Bit a chunk of skin out of her arm, she still has a scar. Next time you see her, check it out. It’s a battle wound if I ever saw one, and I fought in Vietnam so I think I have the right to say that. I begged her not to go back to work, but she demanded it. Equal rights, she kept saying.” He chuckled at that but then became very solemn as he told the rest of his story. “And then one night she came home from work. White nurse’s uniform wasn’t so white anymore, it was covered in blood. That favorite patient of hers had slit her wrists right in front of her and there was nothing she could do about it. She came home and just kept saying, ‘that face, that face’. Never quite the same after that. Said the face haunted her in her dreams, it followed her, she’d see that same dead expression on other people’s faces when she’d walk about and go shopping. She didn’t quite leave the house after that. Didn’t work after that. Wasn’t quite Ava after that.”

He sighed heavily. “She tried to hurt herself a few times. Pills was her ticket out, twice. Once I found her, another time our eldest had found her. Then there was the noose she hung from the rafters in the barn on the farm, rope broke though and she broke her leg from the fall. Always claiming she had to escape, get away from the face of the patient who haunted her dreams, ya know, the one that died. And then,” he motioned around where we were sitting, “there was this.”

I cleared my throat, thinking I was mistaken. “I’m sorry? I must be confused, she’s just here for a hip replacement, right?” Had we read the intake report wrong?

He looked at me quizzically. “They didn’t tell y’all?” I shook my head no. He sighed again and looked away from me. “She jumped in front of a moving car. But thankfully they had seen her as she was about to run in front of them and they slammed on their brakes. Thankfully.” He whistled a descending tune. “She hit her head good, and this time, well. This quite ain’t my Ava anymore. I love her, and I’ll be here every day until they send her home, until she gets that hip straightened out, but that is not my Ava. She seems kind of, uh, well. Angry all the time. My Ava may have been sad and uneasy, letting her nerves get to her and what not, but not angry.”

I instantly thought of my intro to psych classes, where we learned about Phineas Gage and the head injury he had had that turned him from Mr. Nice Guy to Mr. I Don’t Want To Leave My Children Alone With. It certainly put things in perspective. I thanked Henry and told him I had to go, as I could see peering down the hall his wife’s call-light was on again.

Over the next few months things stayed the same. I had worked out a deal with third shift that if they’d leave Nellie alone when they found her in the bathroom of the dining room and not tell on me then I’d fill up their linen carts and dump their trash before I left my shift. Ava was her usual self, but even more of a recluse. She had begun to refuse physical therapy.

Walking by her room one day, I heard the director of nursing and physical therapist in the room talking to Henry and Ava. I stopped shortly after walking by the room to listen in.

The DON said, “Ava, we’re going to have to discharge you if you’re going against medical advice. It’s called AMA-“

“I know what it’s called,” spat Ava.

The physical therapist tried a different approach. “Your insurance is only willing to pay for 6 months of your stay here. The rest of it will have to be out of pocket, and after talking to your husband it does not seem that this is feasible. It’s about $350 a day to stay here. You’ve already been here 5 months, we have to get you well to send you home.”

I sighed in relief. Regardless if Ava got better or not, she had to leave in a month. I know that sounds fucked up, but I wanted my hall partner back, I wanted to like my job again, I wanted my other residents to be normal again, I wanted the BEEPing to stop happening so often, I wanted Nellie to be able to sleep in a fucking bed again.

A few days later I overheard from the physical therapist that Ava had officially quit doing physical therapy all together. She had quit getting up to use the restroom even.

The next week she started refusing breakfast, which wasn’t like Ava who ate heartily and was a diabetic. A week after that, she quit eating breakfast and lunch.

Sam made the terrible joke that maybe I was poisoning her. I shot her a look that made her quit laughing instantly while we were on our smoke break. No matter how much I hated Ava, her malnourished looking skin was making me sick.

The nurses said the doctor was scheduled to see her the next week, but by then Ava had quit eating completely and was barely accepting water or any form of liquids.

“Isn’t there something we can do?” I asked the nurse, pleading. I had this sick sense that Ava was deliberately trying to kill herself and I didn’t want it happening on my watch.

“Nope,” she said as she was turning on her heels to go back to the station to work on her paperwork. “She’s of full sound mind, she has her rights, ya’ know.”

No one quite seemed to understand, not even my crew.

“So what if she wants to kill herself?” Sam asked one night after work when we were in the parking lot. “She has made your life a living hell, why do you care?”

I couldn’t explain it. Maybe it was the story Henry had told me, maybe it was my guilt towards feeling so angry towards her, but I worried about her.

The next day she began to refuse her medications and her insulin. After the med technician had told me this, I walked in her room to try and talk to Ava about, well. About everything.

The room had begun to take on an odor from where Ava had been refusing to get out of the bed, refusing baths, refusing to use the toilet. Her body looked so frail, but her eyes were still full of life. It made no sense- she wasn’t like most of my residents who were sent here to die. She was here to get better, to get to go home. A pain hit me at the thought of how much I would give for Nellie to have the same opportunity.

“Ava?”

She didn’t answer. She just glared at me with a scowl across her parched lips that were cracked and bleeding.

I continued anyways. “I talked to your husband a while back. He told me about the, um. Depression?”

She glared in silence, so I just continued. “Okay. I know that you have suffered from depression, especially since your favorite patient passed away. I know about the suicide attempts. And I’m afraid that’s what this is and I want you to know, I’m here. If you need anything, I’m here.”

I felt as if I’d poured my heart out in those few sentences but the response I received was so unexpected it made me take a step back. She sat straight up in bed and started laughing, laughing so hard there was snot coming from her nose. The longer she laughed the more it streamed down and even began to fall into her mouth. Then, as quickly as it started it stopped. She cocked her head to the side, “You silly bitch, I am THAT FACE!” And then the laughter came back, sputtering and hacking snot all over the already soiled sheets.

I ran out of the room and down the hall and as soon as I did she turned on the call-light. I began to cry and shake. Ava had gone mad and I couldn’t step foot in that room.

Kera saw me and came to me. “Are you okay?” I shook my head no. She frowned and went up the hallway to check in on Ava. After a few minutes she rushed out of the room and ran past me, I was afraid I’d just sent her into that room of insanity without warning and she was more scared than even me, but that wasn’t the case.

“Where’s the nurse?” she called out to the station. “I think Ava is going into a coma!”

And Kera was right. She would have made such a great nurse one day. She had called it, sure enough- it was diabetic a coma.

A part of me prayed she’d die that night, or even on day shift, but dear God not on my shift.

But when 2:30 PM rolled around the next day and I was receiving report from first shift, it was not my luck.

I hadn’t realized how big Ava’s family was, as faces I’d never seen swarmed the space outside and inside room 213. Everyone was there for the big event- for the passing of Ava.

I dutifully went in every two hours at minimum. It was the least amount of time I’d ever spent in Ava’s room during a shift as she wasn’t awake to press the call-light. Due to her choice of DNR, we had no choice but to watch her go. Now I found myself praying that she’d wait until third shift to go. Even with her eyes shut and her laying mostly motionless she scared the shit out of me.

But my prayer went unanswered. At 10:22 PM, 8 minutes before I could clock out, Ava passed away.

I guess it’s important to explain that I have ‘cleaned up’ eleven previous residents upon their passing before. It was nothing new, a resident dying. It was horrible and there was grief not only for the resident and their family, if there was any family present, but also for myself. It was a reminder that we don’t live forever. When people die, they don’t look like the way they do in caskets. Usually there’s a slack jaw and they just appear to be in a deep, deep sleep. It wasn’t terrifying, it wasn’t easy, but it was a part of our job to clean any possible excrements before the funeral home came to collect the body.

I didn’t want to go in alone. Even though Sam had been commanded not to enter the room again I begged for her to come too, and we did it as a crew.

When we entered the room, it stank. Body odor and weeks of refusing a bath had really collected in the room. I tried to not look at Ava, I didn’t want to look, but my eyes couldn’t resist.

Ava was staring at the ceiling, her eyes as wide as discs, with this crazy drawn out smile that showed all the way to the back of her teeth. It was like a cheesy smile someone gives to photobomb a picture in the background. I tried to look away and then that was when I saw her hand move. I still swear to this day I saw it move. Sam said, well, she used to tell me, that I was full of shit. But I swear I saw it move, to have a finger point in our direction.

Sam turned to look at us, “Come on, gals, let’s get this show on the road. I got a twelve pack at home calling my name and I don’t want to be late.”

We walked over to the body and spoke directions on our plan of action. Sam and I both stood at the head of the bed on either side while Jenna and Kera were at Ava’s legs. With a gloved hand, Sam closed Ava’s eyes and tried to position the mouth closed. We’d been informed by plenty of funeral home directors that the quicker you can close the mouth the less likely they’d have to damage the body to keep it in place or less glue they’d have to use to keep the eye lids shut. We decided to roll her mine and Kera’s way first to check for any excrement and to clean her from Sam and Jenna’s side.

We began to heave Ava my way and I kept telling myself, don’t look her in the face, don’t look her in the face, but as soon as she began to tilt my way those eyelids shot open and her mouth slung wide in a crooked smile. ‘That face’, I thought to myself.

I wish I could say that’s all that happened, but it wasn’t. What comes next is something so vile, like one big last fuck-you from Ava (or at least I thought it would be at the time). Bile shot out of Ava’s mouth, a thick, slimey red bile that covered my hands and arms and scrubs.

I held back a scream, biting my lip until it bled, knowing that the family was just outside of the room. Everyone gasped at the putrid smell that was now covering me.

We hurried the best we could, got her back on her back, and left the room almost tripping over each other. We didn’t speak another word to each other that night, even in the parking lot we just got into our own cars and went our separate ways.

I’d decided that night I’d take a leaf out of Sam’s book and stopped at the liquor store before heading home. While digging around in my purse for my debit card, I heard the window open up and I was asked how I could be helped.

‘There’s no help for me at this point’, I thought, and I spat out my order, “A fifth of bourbon and a pack of reds if you got them. I looked up to hand the attendant my card and screamed. The bulging eyes, the crazy, wild grin was on the attendant’s face.

It took me a second to gather myself. I blinked hurriedly until that face went away before me and things went back to normal with my eye sight. “You okay, ma’am?” the attendant asked with genuine concern.

“Fine. Sorry,” I muttered as I hurried up with my transaction. I’d never wanted to be home so badly in my life.

But if I thought home would resolve my horror filled night, I was surely mistaken. I drank the bourbon fast, feeling it’s hot warmth go down the hatch and into my belly. It made me feel hazy and I thought surely it would be the night cap to put me to sleep.

I woke up and went to work the next day but work was different. No one was there and all the resident’s doors were shut. It was so eerily quiet, I called out for someone. No one answered. I started slamming resident’s doors open, finding empty bed after empty bed, until-

Room 213 had it’s call light on. The BEEP- BEEEEEP- BEEP noise blaring. My heart thought it would leap from my chest as I grabbed my forehead in my palm. Sweat was pouring off of me. I hesitantly walked closer to the room and as I placed my hand on the door knob it was swung open of it’s own accord and-

And there was Ava sitting up in bed, hospital gown falling low exposing more of her deadening malnourished skin on her chest. Eyes bulging out like discs- bulging farther than humanly possible and that huge toothy grin, “Come to join me, Colleen? I got an extra bed in here for you, I’ve been waiting!” And then the laugh, oh God, that fucking laugh.

I woke up. Just a nightmare. A possibly bourbon induced nightmare. I ran for the toilet and began to vomit.

The next two days were utter hell, even though it was my weekend off. Unexpectedly, every time I left the house for something and encountered another human being, I would see them holding the same expression as Ava had had on her face when she’d died. It was so shocking and so scary that I would jump, which caused me to look like a spectacle in front of everyone else I’m sure. I learned to quit looking people in the face and on the accident that I did, I tried to numb myself to what I knew would be crossed over their face.

Monday crawled around and I didn’t know what to expect. I was seeing Ava everywhere I went, out of the corner of my eye when I would walk into a new room, even at the mall in the crowd of people, but when I would turn to look at her in full view she was gone. But I knew at least that at work I would no longer have to deal with her.

It was us crew working. As if some unspoken rule had been created, Sam worked on the north hallway with me. We went back to the same routine, except there was no laughing or cutting up between us. We were all silent as we worked and even the hallways seemed silent. The occasional call-light would go off, but it was nothing like the incessant noise of the call-light system when Ava had been here. Around 8:30 PM that night, this all changed.

BEEP- BEEEEP- BEEP, went room 213.

I turned to look at the girls, as we had all settled down to do our paperwork. They all appeared just as bewildered as me. Even though Nellie had now finally gone back to her own room to sleep at night, Nellie never used the call-light. She was able-bodied and would just get up and walk down the hallway to greet us at the nurse’s station, usually clutching her newest baby doll (head intact, the director had found one of the small ones at a yard sale, the kind that could fit in the palm of your hand).

BEEP- BEEEEP- BEEP. Sam and I trailed up the hallway to see what was the matter with Nellie. Sam went to open the door, which was closed. The knob wouldn’t turn. She looked up to me frantically. I grabbed the door knob and with all my weight tried to get it to turn. Nothing.

We started beating on the door, “Nellie, are you okay?”

We got no response.

It finally hit me that the room was shared with a conjoined bathroom, so I rushed into room 211 (scaring the dickens out of Mrs. Hogdins and Mrs. Ruth while doing so) and grabbed for their bathroom door, it swung open easily, but when I tried for the bathroom door that would enter into room 213- nothing. The door knob would not even turn.

BEEP- BEEEEP- BEEP, continued to blare overhead down the hallway.

They eventually had to call the handy man that was paid for by the nursing home to come and open the doors, but no sooner had the call been placed and the nurse attempted to open the door, it swung open with creaking sigh.

I hurried in, ignoring the pathetic look the nurse was giving Sam and me, as if the door not opening had been due to our weak strength, and turned on the overhead light. Nellie was curled in a ball on her bed, silently crying facing what was Ava’s side of the room.

“Nellie, sweetheart, what’s wrong?”

“Please- please- please don’t!” she stuttered.

“Please don’t what?” Sam asked, kneeling beside her with me right next to her.

But I noticed what Sam had failed to see. Nellie wasn’t look at her or me, she was looking right behind us, where Ava’s old bed was.

“Please don- don’t h-h-h-hurt these girls, they’re so good,” Nellie sounded like she was pleading.

Sam rubbed the hair out of Nellie’s eyes, “We’re not going to hurt anyone.”

Nellie’s eyes fell on Sam then and the change of her view was so obvious I could throw up. “Not-not you, Mrs. Ava. She’s coming for you.”

We jumped up and ran from the room, grabbing Nellie up to join us as she grabbed up her new, small baby doll.

That night broke the silence between us four. Instead of having the conversation in the parking lot after work, as Kera said it was too creepy in the dark (and I know I at least agreed with that), we went down to the diner where the lights were bright and I could order me some comfort in the form of a chocolate and banana milkshake. Kera went first. She told us how her weekend had gone, trying to go to sleep to only keep getting an invitation from Ava to come join her. Jenna’s almost mirrored the exact same story. So did Sam’s. So did mine.

Once every one had told their story, we sat in silence for a bit.

Sam was the one to break it. “So what the fuck do we do?”

I reminded them of the story Henry, Ava’s husband, had told me. How that patient had been discharged. She had become ‘normal enough’ to reenter society. How that same patient came back, how she was different. How she killed herself in front of Ava and there had been nothing she could do about it. How ‘that face’ had haunted her. How she tried to kill herself multiple times, no success. But this last time, jumping in front of vehicle, well that time had been different. Her personality changed.

Sam rolled her eyes. “You think that patient somehow killed Ava from the oooh-great beyond?”

“I don’t fucking know, Samantha, but some kind of answer would be really fucking great right about now,” I replied haughtily.

We paid our tabs and left the diner, in silence. Something I would get accustomed to when it came to the crew because we were never the same again and no one wanted to talk about it.

Nothing too crazy happened on the hall after that. Occasionally I would think things were going back to normal, one of us would be laughing or telling a joke- actually talking for once, but then we would be interrupted by room 213’s call-light. We would take turns answering it, always expecting the worst like that one night when the doors appeared to be superglued shut. But that never happened again, it was just the call-light dinging off. Someone chalked it up to possibly bad wiring. No one had the nerve to tell them that we’d eventually unplugged the thing out of it’s damn socket.

Slowly over time, whether my brain adapted or it was finally slowing down, the nightmares happened less frequently and when I looked into people’s faces they didn’t dawn ‘that face’ Ava had made in death. I never asked the crew if they were experiencing the same thing, but I was pretty sure they were, they at least seemed happier anyways.

About six months after Ava’s death, things actually seemed they might be going back to normal, that is, until we found Nellie.

On our last round one night at work, Sam and I were going through rooms checking everyone. Usually, as Nellie was ambulatory, we’d just peep our head in and tell her goodnight. She would always whisper back a quiet goodnight through the mouth that was sucking on a thumb. But this night was different.

“Goodnight, Nellie,” Sam whispered.

No response.

I turned on the light and Nellie had the sheet pulled over her head. Sam went to grab the sheet down, and I wish she never had.

That fucking face was there. And the fucked up thing? It took me several shakes of my head to try and figure out if this was my imagination or real life. It became apparent this was real life. Sam went down the hallway screaming for the nurse. I felt a cold shiver run up my spine, as if Ava was still in the room, watching me.

There were still fresh tears on Nellie’s cheeks, her hands grabbing at her throat, finger nails bloodied and torn off into her own skin. In the glint of the light I saw something shiny in Nellie’s mouth. I opened her mouth a little further, taking it out of the position of that awful grin, and saw a-

“You’re fucking kidding me,” I sighed.

It was the small baby doll head. She’d choked to death on the baby doll head. I heard the call-light go on overheard. I peered out of the room and up, sure enough it was room 213. I looked over to the bed that once held Ava, and there was the other half of the baby doll. It’s body sitting neatly on the pillow.

Kera was the first to quit. That night had been too real for us. If I could afford it, I would’ve quit right then too. She got married and had a baby within a year of leaving. I didn’t feel like I really knew her anymore anyways, so it didn’t bother me too much when I wasn’t invited to the wedding or the baby shower.

But I went to the funeral, that’s for sure. All three of us were there, though we didn’t speak. None of us wanted to point out that jumping off of a bridge sounded the furthest thing away from what the Kera we had come to know and love would do.

Then there was Jenna. Maybe a year after Kera had went. She ended up going out with a bang, so to speak. I know that’s a fucked up joke, but a shotgun under the chin while pulling the trigger with her big toe- well. That seemed brave. Most women kill themselves and leave their body intact, but not Jenna.

Sam and I both attended the closed casket funeral. We didn’t speak and avoided each other like the plague. I could smell the liquor on her breath when we did accidently cross paths to the bathroom. I wondered if she was thinking the same thing I was, who was going to be next? Sam or me?

Over the years Sam had lost her job at the nursing home, coming in to work too many times reeking of booze. I could feel that pain, because on sleepless nights when I was too afraid to sleep but knew if I went another day without going to sleep to try and avoid the nightmares I would go insane, I would drink until I passed out. But Sam, well, she’d always been a bit more of a drinker anyways, always thirsting a little bit more for another drop of the poison.

I had quit the job too. Dropped out of nursing school and all. I was done with that profession. I took up computer design instead and actually met a really nice guy in one of my classes. We’ve been dating for about six months now and I have never told him about Ava. Never even told him about the crew, the girls I loved so much. Which makes me sick on the inside, my heart actually ache, because when I imagined getting married one day I always knew they’d be my bridesmaids.

Jack’s, my boyfriend, lack of knowledge about the crew or the nursing home or Ava made October 12th, 2016 even more creepy for him.

I had went to sleep next to him, as usual for weekend nights, and in my slumber I found myself staring down the hall of the nursing home. All the doors were closed to the resident’s rooms. It was just me, silent, until-

BEEP- BEEEEP- BEEP, from room 213.

I’d been through this drill several times before. I was compelled to that fucking room. I couldn’t stop my feet from putting themselves one foot in front of the other. I was trapped.

I stood before room 213 and it swung open, a whoosh of air scooping me inside the room. There sat Ava, straight up, eyes gone milky over time, mold growing on her skin. She just sat there, with that face. “Come to join us, Colleen?” The cackle was not nearly as haunting as where her hand motioned.

While entering the room, I’d failed to recognize the two additional beds in the room. Sitting straight up was Kera and Jenna. Except, they weren’t the Kera and Jenna I remembered. Kera waved with a hand that had fingers pointing in unnatural positions, broken from her fall. One of her eyes bulged out, handing on a thin cord attached to somewhere back deep in her skull. “I’ve missed you, Colleen,” she said smiling, revealing half of her teeth missing and the other half broken to sharp shards.

Jenna, well, half of Jenna, leered at me. Half of her face exposed as she was missing the right side of it. Blood and brains, pieces of skull and tissue plopped on to her right shoulder. With half a mouth, half a tongue, she beckoned in a congealed croak, “Come join us, Colleen.” They all three began to laugh as Jenna and Kera jumped out of bed, grabbing me by the arms, forcing me into a fourth bed I’d also failed to notice was in the room.

“We’re going to have fun,” Kera said through broken teeth.

I screamed and flailed about but they were so strong, I could smell the overpowering stench of iron from the blood dripping on me from Jenna’s face. Her tongue lolled around, “So much fun.”

“COLLEEN!”

I woke up. Jack had a hold of me, shaking me by the shoulders.

I began to cry.

“What the hell happened?” he asked, his normally sweet and consoling face now turned into a look of terror.

Before I could even begin to explain, I got the call. It was from Sam. I answered the phone.

“Hello?”

“You had it too, didn’t you?” I could tell she was drawing off a cigarette, I heard the deep exhale. I didn’t need to respond. She knew. “What the fuck are we going to do?”

Oh hadn’t I had that thought to myself a million times before, long before Kera and Jenna had passed on. “I don’t know,” was all I could offer. Selfishly inside of me I knew I was hoping it was Sam that they chose, not me. But how long would I have until they wanted me to join? Until we could be one big happy crew again?

So that leads me to this past week’s events. This is why I’m writing this down, because if I end up going I want it to be known I didn’t really kill myself. I would never take my own life, just like Jenna and Kera didn’t. And Sam, well, she’s the living proof to me at least that none of them did.

Sunday I woke up to a call from Sam’s mom, Patrice. I could barely make out the words she was saying through the tears and screams. All I knew for sure was Westen Hospital. I was barely dressed and out the door before Jack realized I was leaving at 2 AM.

When I arrived, there was paramedics running around like mad between four rooms. I didn’t know which was Sam’s but as if it knew I didn’t know, a call-light went on over the room number 13. And then I knew, that was where Sam was.

I walked in, confused, as Sam laid in the bed. What had happened? The monitor showing her heart bleeped-bleeped on, but slower than what I thought would be normal. I saw Patrice in the corner, crying.

“What happened?” I asked.

She grabbed me by the shoulders and took me out of the room and told me the events. Sam had been in and out of rehab for her ‘alcoholism’ that past six months. On October 12th she had left her most recent rehab, went AWOL. That was the same night I had had the nightmare, and so had she. No one knew where she was until a few weeks ago. She’d turned up at their house, paranoid, scared, clutching a decanter with her. Sam seemed different, she seemed scared. She had covered all the mirrors in the house, refused to look anyone in the face. Kept muttering to herself the words ‘that face’. But a few days ago, she seemed better, and Patrice felt safe to go back to work and leave Sam home alone with her two brothers and husband.

But this morning when she came off her 3rd shift at the local factory, the house was quiet. Too quiet. She walked in and found Braxton and Elijah still in bed, having missed the school bus. She looked outside and saw her husband’s truck still parked in the driveway. He hadn’t left for work. When she began to investigate further why they were still home, she found all three of them in their beds, stabbed in the chest, and faces melted off. They later found out from police that the decanter Sam had been holding what she called ‘holy water’, no one is sure if she actually went to a priest or made it herself, mixed with newly added lime powder. Their faces were disintegrated. And Sam? Well, she was found in her own bed, alcohol poisoning with a mixture of pills she’d ingested. Over her bed she’d scrawled into the wall with the knife she’d used to murder her family members the words: THAT FACE. She died in the ambulance ride over, but they were able to revive her, barely.

I asked what would happen next. Patrice, who was holding up better than I could ever imagine, said she didn’t know.

Sam lived, believe it or not. And she’s at Crawford’s, the same state mental institution I would bet money Ava had worked at. I visited her today. Again, this is why it’s so important for me to write this all down. But when I went there, it wasn’t Sam I was talking to, not at all.

“I see you came to join me,” said the not-Sam.

“I see you’re back where you began,” I spat.

The not-Sam laughed, a laugh I was used to, the laugh that had haunted my sleep off and on for years now. “No, I did not begin here, you silly bitch. I just simply visited.”

I ran out of the room and threw up. Drove home. And now here I am. Writing this.

I don’t know what happens next. I don’t know if I’m just supposed to wait around until the non-Sam finally does her in and then comes after me? Or does she come after whoever finds Sam dead? I just don’t fucking know. But let it be known that Colleen Case would not kill herself, I would never do that. So if you are reading this and I am dead, please know it was not by my own hand.

I’m so afraid to go to sleep tonight, I’m so afraid I’m going to see that face.