When the social worker came into his room to do her quarterly assessment, she asked him what the date was today. He raised up on an elbow, glared at her and said "If you don't know what f**king day it is, what the hell are you doing in my room? Go look on a g**damned calendar!"
The nurse practitioner says she thinks he's depressed but his nurse says "There's nothing wrong with him. He's just a grumpy old man, that's all."
I look at the chart. It says he can't walk because he has sores on his heels that won't heal. He's diabetic. He has dementia and he's only in his early 70s. His demographics say he has a graduate degree and worked in accounting.
The social worker says "Good luck!"
The first time I walk in his room, he's asleep. A frail, white-haired man with baby-smooth cheeks and a death-pale complexion.
They bring his lunch tray but he doesn't wake up.
I circle the hall. I walk in on one of my patients and find him covered in feces, his colostomy bag split open. It's all he can do to press his call button and I wonder how it is his lunch tray can be so recently placed before him without anyone noticing his distress.
I talk to another patient who tells me he's been shot in Korea and is a prisoner of war.
I visit a man who's lost his wife and hopes his daughter will sign a release to let him leave the facility to have lunch with his buddies. "She's a little over-protective," he says, sighing.
I walk back into the grumpy old man's room and find him awake, staring at me with intense gray eyes, his expression unreadable.
I adopt my cheerful fairy godmother face. I'm just here to check in and see how he's doing. He stares at me, gives me a quarter-smile so phony and angry it takes my breath away. So, I cut the crap.
"Are you depressed?" I ask.
A simple "yes."
Every time I ask a question there's a long, empty space before the words come out, as if he resents himself for humoring me.
He liked to read before he came into the nursing home. He enjoyed mysteries. "A forensic writer," he says. "I can't remember her name."
I get my first somewhat genuine smile.
"She went to Davidson," he tells me.
"No. I couldn't afford it."
"So, where'd you go to graduate school?" I ask. I'm not so much needing to know as I am out of gas. Part of me stands there talking while the rest of me just wants to run out of the nursing home and never, ever come back.
"Union Seminary," he says.
Seminary? He's a Presbyterian minister...really?
"Were you ordained?" I stumble.
Long silence. "Yes."
"Did you have a church?"
Another long pause. "Yes."
I nod. Okay. He's been where I am. He's been where all of us are and now he's on the other side, stuck in a bed while unhelpful helper types pigeonhole him and patronize him with questions about his hobbies and today's date. No f**king wonder he's angry.
Posted by Nancy at 4/15/2014 08:55:00 PM
The new aide caught my attention when she poured the Tuesday "red juice."
The drink is a staple of the Snack Lady's visits. Every Tuesday she pushes a metal cart up and down the hallways of the nursing home, representing the charitable good wishes of the local Women's Club, church or whatever do-gooder organization it is that sponsors her. Almost a candidate for admission herself, this little woman trundles in to the rooms bearing cookies, candy and always, red Kool-aid.
For whatever reason, this week the Snack Lady was absent, so the job fell to the aides to dispense the juice sans treats. I was sitting behind the nurse's station desk, perched on a black, swivel stool, writing notes when the aide began to pour a cup full of the Tuesday liquid.
"You'd think they could do better than the same thing week after week," she muttered. "They're sick of it."
That got my attention. I looked up and saw the woman wrinkling her nose in disgust. She shook her head and looked at me. "I can't tell you how many of them have told me to get out of their room with this stuff," she said. "They say it's the same thing all the time- red juice. How much would it take to do something different for them?"
I stared at the offending plastic pitcher and nodded. "Yeah," I agreed. "What would it take to do orange or grape now and then?"
"It's hard enough being in here without this kind of mess," she sighed and I realized she was referring to the patients, not herself or her low-paying job.
"Do you work on this hall?" I asked, indicating the one behind us. "Do you work with Mr. Marsh?"
I asked because I'd overheard her being pulled aside by another aide who was clocking out and wanted to brief her about my patient before she left. I'd thought it unusual at the time because it seems only the nurses brief each other about patients but here were two aides talking with concern about a patient. It's rare. They're underpaid and overloaded. They just don't usually have the time or the energy.
At my question, the aide's eyes widened. "Oh, yes," she said and abruptly backed away from the desk. "But I'm new. I've only been here two days. I don't know anything- not really."
Before I could tell her I almost always valued the aide's opinion of how a patient's doing more than the nurse or doctor's, she'd practically run off down the hallway and left me to my pile of paperwork.
A few minutes passed and the 108 year old woman who rarely speaks wheeled up, cradling a baby doll and a stuffed black dog.
"Is this your baby?" she demanded of another resident, terrifying the elderly lady.
"Nooo," she answered, shrinking away.
"Well, is it mine?" the 108 year old barked.
The other woman wheeled hurriedly away and the 108 year old turned her attention to the stuffed dog and plastic baby in her lap.
"They don't do a thing for you around here. But don't you worry," she crooned to her little family. "I'll take good care of you."
Before I could get up from my seat, a physical therapist popped around the corner, wheeling a silver-haired man, two other wheelchair-bound patients emerged from the dining room and a traffic jam ensued.
"They're all crazy," the silver-haired man growled to his therapist. "You know, everybody tells me they don't know what they're doing, but look at this mess! I think they do it on purpose!"
I could've sworn the 108 year-old smiled.
Every Thursday I see an 83 year old grandmother who recites the events of her week in great detail. At the end of every session, without fail, she sighs and says, "You know, it's never the big things. It's the little ones that make or break you."
Posted by Nancy at 3/18/2014 06:36:00 PM
I'm trying to quit cake. Cold Turkey. Haven't had a bite since February 15th. I tell myself, if I can go three weeks without it- without a crumb crossing my lips, without looking at a new recipe or perusing pictures on Pinterest, I'll be in the clear. That's just two more days away. Everyone knows if you do something for three straight weeks it becomes a habit, right? I know this. It's a mantra I repeat every morning in the mirror and every night as I switch out the lights in the kitchen and head up the stairs to bed..."Three weeks," I whisper. "I can do anything for three weeks."
Then yesterday I read an article in the Huffington Post that said the Three Week Habit rule is nothing more than a myth.
I haven't stopped thinking about cake since.
Posted by Nancy at 3/06/2014 06:23:00 PM
Tuesdays are not good for self-pity. I can feel like the loneliest woman on the planet at 10 a.m and utterly ashamed of myself by two in the afternoon. That's how it was last week. I came dragging into the home, miserable and I left, well, I left more miserable...but somehow more grounded.
My last patient of the day was new and I did the intake sitting on a stiff-backed chair between him and the bed where his wife lay dying.
I knew her...Well, had known her a year or so before- back when she was angry at the disease trapping her inside her uncooperative body. She was angry at her husband, too, for bringing her to the nursing home against her will and insisting they both live out the rest of their days there.
Now she was almost free. Wasted away to a bony skeleton of her former self, her mouth stretched open in a round O as she breathed in deep, irregular, crescendos of sound that are the hallmark of active dying. Periodically, she would stop and every time I would silently pray that this wouldn't be her last breath. Not just yet. Not while her husband sat quietly crying by her side and telling me the story of their 63 year marriage.
"She had a way of making her will known," he said at one point, chuckling softly. "It wasn't always easy being married to Doris, but we made it work."
When I asked if the hospice nurse had been helpful, he nodded. "Oh, she's an angel," he said. "She's been so good to us. But she's brutal. I told her I was praying Doris could get healed and the nurse just looked at me and said Doris had less than 48 hours left to live." A tear spilled over onto his cheek and he wiped it away with a shaking hand. "She tells it like it is and that's good. At a time like this, you need to hear the truth."
I nodded and sat quietly listening to Doris breathe.
I suppose we all need to hear the truth spoken when it's time to say goodbye- we need to soak it in until our minds can make sense of it. We need to let it echo in us until it resounds in our hearts, until finally, the pain of our goodbye is overshadowed by the peace of memory.
Posted by Nancy at 3/03/2014 05:13:00 PM
When I stop by his room, Freddy's up in a Gerry chair- a sort of rolling lounge chair for people who can't sit up in a wheelchair. It's the first time in months, since his double, below-the-knee amputation, that I've seen him out of bed. He's got his new upper plates in. His hair's been cut and he's been to physical therapy and had lunch in the dining room. A big day, surely, but Freddy looks glum. He stares down at the watch on his wrist, the one he bought from the Avon catalog during happier times at the retirement "hotel," and sighs.
"Are you feeling down?" I ask.
"What?" His face wrinkles like maybe he didn't hear me, something he's taken to doing since his return from the hospital.
"Depressed," I say. "Are you depressed?"
He just stares at me through thick-rimmed, black glasses and shrugs. "Well, sure. Wouldn't you be?"
There's no other accessible chair in the room, so I sit down on the hard linoleum floor beside him, so we're closer to eye level with each other.
"What's got you down?" I ask this like I don't know the answer because it's what you do when you're the social worker. You don't assume. But really I ask because what the hell else is there to say? And he answers with exactly what I knew he'd say.
"Oh, I don't know. My condition. Being in here. Where I used to be. Who I used to be. The loneliness. Missing my wife. Christmas. I guess that's about enough."
I nod and wait for some wonderful piece of solace to fall out of my mouth, only it doesn't. Instead I feel myself sinking right down with him because really, what can you say to that? So, what do I finally say in all my therapeutic wisdom?
He glances at the Avon watch, then at me. "Deep subject," he says.
I sigh softly. "I wish I had a magic wand," I tell him.
"Oh, you do do you?" His eyes twinkle a bit and he half-smiles. "What would you do with that?"
"I'd start off by waving it over you."
He smiles, taking pity on me probably and we sit in silence for a few moments. "Well," he says.
"Deep subject," I answer.
This dance with Freddy reminds me of being in church, I think. The priest says a line- then the congregation gives their rote response. And all most of us ever seem to hope for is a tiny bubble of faith to surround and protect us- just long enough to carry us safely through from one moment into the next.
Posted by Nancy at 12/17/2013 07:29:00 PM
I love my new home. I love my new neighborhood but perhaps I failed to truly appreciate how wonderful it really is. Today I came home and was standing outside with the dogs when I caught a glimpse of someone moving toward me, someone who sparkled in the late afternoon sunshine.
I was fiddling with a solar light when he rounded the corner. When I saw the boy, dressed in a little, black, sequined cocktail dress, black men's dress socks and little, if anything, else, I looked away, pretending to focus all my attention on the glass jar in my hands. I used the moment to adjust my expression, to assimilate the information streaming into my consciousness and as quickly, let it go. I looked up, met his level gaze, returned his slight smile and said "Hey."
"Hey," he said, his smile mirroring my own as he walked by, strolling casually down the street.
I know what I did next was wrong. I leaned out into the street, fumbled with my cell phone and snapped this picture. And in the moments that followed I thought of all the things I should've, could've said...
"You totally rock that dress!"
Too much perhaps.
"Aren't you cold? If you'd hold on a minute, I believe I have a jacket that would fit you."
"What size shoes do you wear? I have boys. They left some snow boots here. I know they don't go with what you're wearing, but you must be cold."
"Are you okay? Can I give you a ride somewhere?"
This wouldn't have been the effect he was looking for perhaps. He wasn't searching for a mom. I don't know what he was looking for but it wasn't a mom.
Posted by Nancy at 11/14/2013 10:14:00 PM
Last week he arrived alone for the first time. Pushing the throttle on his electric wheelchair and advancing toward me I thought he seemed somehow smaller. I followed him down the hallway and into my office, took a seat and waited for him to speak. Marriage counseling is at best a risky proposition. Couples usually wait to seek help until they are one breath away from divorce, out of options and seeing my office as the last depot stop before court. But when a couple has been married for 67 years, as Bill and Louise have been, the task seems even more daunting. What possible help or advice could I have to offer?
They had been squabbling, they said, and this wasn't their way. But in the past few months, as the day wore on, Louise would, without fail, begin to snipe at Bill. Bill would react by retreating into his office. Once there, he'd sit staring at his stacks of file folders, all meticulously organized to contain the facts and figures of their lives- past, present and future.
"She says she wants to move back to our old house. She doesn't like the apartment. She doesn't like the woman they send in to help her get dressed in the morning. Even worse, she wants to get her driver's license again." Bill would smile ruefully and shake his head. "She's not being logical. She's not thinking about her own safety, let alone that of the other drivers out on the road. Her memory's slipping. Since the stroke, she can barely use her right leg. I ask her how she's going to be able to manage getting in and out of the car or working the gas and brake pedals and she just tells me to mind my own business!"
Louise, when given her turn, would rail against the rules imposed upon her in their "Catered Living" facility. She talked about having raised four children while Bill worked long hours and how he just didn't seem to realize she was a strong, competent person and didn't need him or anybody else telling her what to do.
"I miss the intimacy," Bill sighed. "It's hard to hold your wife when you're both in wheelchairs or hospital beds. You probably think I'm a foolish old man but I still have feelings. I miss being touched but I don't think she misses that part of our relationship at all."
We worked for months, tweaking, adjusting, reframing, explaining and finally we arrived at a happier day-to-day atmosphere between the two of them. Shortly afterward Louise got sick and nearly died.
When she came back to their upscale retirement community, she was put into the skilled care facility and Bill was stuck going to visit her two and three times a day.
"They won't let me take my electric wheelchair in, so I have to transfer to a regular wheelchair and try and push myself down the hallways to get to her room." He smiled wistfully and pointed to the boot on his left foot. "It's kind of hard to propel yourself with a broken foot and one arm that won't work. It takes me a while to get to her but she really counts on seeing me."
I sighed inwardly and thought about the foolish regulations facilities make and rigidly maintain. I looked at Bill, seeing tears spring to his eyes as he talked about missing his wife. It was as if the years had fallen away and the 88 year old man sitting in front of me was suddenly a small, lonely boy, grief-stricken and afraid.
"Are you sleeping?" I asked eventually, feeling inadequate and knowing there were no words adequate enough to soothe a pain 67 years in the making.
Bill shrugged and gave me his fleeting, familiar half-smile. "Oh, I sleep alright...as long as I turn my face to the wall and don't look back at the empty bed across the room."
Posted by Nancy at 10/28/2013 06:32:00 PM