Tuesdays in the Nursing Home- Believing

 

He is a small man now, his back bowed by age and the effort it takes draw oxygen in to his failing lungs. Until today, I’d never seen Clyde’s health bother him. On any other day, he is up, smiling and speaking to everyone he passes as he wheels his walker around the nursing home. An oxygen tank sits in the white wire basket attached to the front of his cart.

Nothing gets Clyde down.  He stopped me once and said “You know, if my wife had lived this would’ve been our 70th anniversary.” 

I put my hand on his arm, uncertain what to say- do I congratulate him or offer condolences? I settled for a bit of both. 

He smiled, told me the secret to his long marriage was keeping his mouth shut, and wheeled along down the hallway.

Today he wouldn’t leave his room and hadn’t eaten for over 24 hours.  A clear plastic mask covered his mouth and nose as he fumbled to open a packet of sugar and empty it into his coffee.

“I don’t know what’s wrong with me,” he cried.  His frail bones felt hollow as I stroked his back.  “I don’t know where I am. I don’t know what I’m doing. There were 13 of us, now there’s but 3.”  He looked at me for an instant, his eyes searching my face. “My sister died yesterday. Now’s there’s only three.”

His hands shook harder.  Packet after packet of sugar and creamer spilled into the cup and were hastily stirred with his fork.  He tasted, sipping like a tiny bird, in quick, shaky bursts.  More sugar. More creamer.  “I can’t eat,” he said, tearing up pieces of bread and tossing them into his Cream of Chicken soup.  “I just can’t,” he said, spooning the soup into his mouth like a starving man. 

The vanilla wafers were next.  He ate them all, sweeping the crumbs off his tray, into his hand and then tossing them into his mouth.

“Are you afraid of dying?” I asked finally.  No answer.  He dodged me, darting down a dark mental alleyway and putting up a smokescreen.  “We weren’t that close.  She was only two years older than me. Two years!”

But was he afraid of dying?  No answer.

“What will happen if I die? Who will look after everyone?” he asked, his voice breaking.

I am a slow study.  “Are you afraid?” I asked.

Then, “Are you worried?”

“Eh, worried? No, I’m not worried. Well, I might be. But I don’t know what for. If it’s time it’s time.”

“Do you think you’re dying?” I ask.

“No, no.  Couldn’t do anything about it if I were.  When God calls you…” 

The rapid-fire denials suddenly stopped. His eyes filled with tears. A drop of coffee dripped unnoticed from his chin, splashing on the home-sewn, light blue and red-striped bib he had absently thrown across his lap. 

“What if I’ve done something wrong in my life?” he asked, trembling. “What if I said something to someone and they were offended and I didn’t know it? What will God think? What will he say?”

I stroked his arm, circled his bony back with the palm of my hand and tried to reassure him.  The woman in the room across the hallway watched us curiously, her hearing far keener than my patient’s.  When I caught her eye, she waggled three fingers at me in a casual, to-ta-loo salute.

Clyde was trying not to cry by picking up his soup and drinking from the bowl, abandoning any attempt at using his spoon.  He was in a frenzy, panicked by the thought of being snatched by God before he could eat or explain or live enough to be ready.

“Yesterday I got down on my knees and begged him to forgive me if I’ve harmed anyone or done something wrong I didn’t know about.”

I looked around his room at the proudly displayed posters of his cherished Yankees.  I am a Phillies fan.

I held my friend, trying my best to reassure him, wishing I knew a way to soothe without shouting. 

These are the times when I long for a magic pill or a wand or a letter of guarantee from God stating death and the process of dying will not be scary or frightening and that there is indeed a Heaven.  Furthermore, the letter would inform Clyde that he’s definitely “In” and that Heaven is truly much more wonderful than anything he’s been told.

I don’t have that kind of power. 

This time is one of the rare times I walk down the hallway, worried about Clyde’s panic and breathlessness, and tell his nurse to give him the morphine his doctor has ordered for times like these.

A half an hour later, the nurse stops me.  “That rascal!” she says.  “I told him if he had the morphine, he had to promise not to get out of bed or he’d fall.”

My eyes widen.

“Yep,” she says nodding. “I walked in just in time to catch him.  And do you

know what that rascal said?”

I shook my head, too pleased to hear Clyde had been elevated from panicked to rascal status to care.

“He lay back in my arms, smiled up at me and asked ‘Who was that pretty lady come in and talked to me? I sure did like her!’ Pays no mind to the fact he could’ve broken a bone disobeying me.  Just wants to talk about the pretty lady. Can you believe it?!” the nurse demanded.

No, I couldn’t.  But then, it doesn’t matter what I do or don’t believe.

Faith it seems, is very much in the eyes of the beholder. 

 

Technorati Tags: death and dying,aging,nursing home life

Eulogizing Life

My old guys love homemade food...any homemade food. But it's Strawberry season and the old guys love strawberries it seems, more than anything else.

They were making quilt squares when I saw them Tuesday, sitting around the table, some sleeping, others just hanging on to their fabric pieces and staring past them at something or some time none of us were privvy to.

The assistant director and I have bonded in one of those soul deep ways that transcends who we are on the outside. We love our old guys. She likes to tell me that on her worst day, coming to work always makes her feel better- that they give more to her than she does to them...but I don't know about that.

Once she and the director drove Pearl all the way to the beach...five hours away, and stayed in a hotel, just because blind Pearl had never "seen" the ocean. That picture is taped to the side of the assistant A.D's file cabinet.

Last month, when we lost so many, the Assistant A.D had to give their eulogies at the memorial service. The hospice chaplain was late and as it so often does, the job fell to Benny.

I had slipped into the room, filled with residents and family...but oddly enough, not staff. Benny's eyes met mine. In front of everyone she said, "I don't know if I can do this y'all, but I'm gonna try."

I have never heard anyone so eloquently capture the essential spirit of a human being like Benny does.

Last week Benny sat in her office, crying with me. She was mad at the staff for overlooking her partner, the Activity Director. "She's done so much for them, and now, when she needs them, they can't even get up off their asses to sign a damned card!"

And then she cried for "Papa Franks." "I don't know if I can let myself get that close to anyone again. He was like my father, Nancy. He was!"

But we are too alike, me and Benny. We will look into a resident's eyes and take them into our hearts without a second thought about the cost later- when we lose them. I tell her this. I tell her we have been given such a gift to have these old guys in our lives and that there is never a guarantee, with anyone we love, that they will be around tomorrow. "We will all die," I tell her.

But I don't tell her that when I go, I hope she does the eulogy.

Doing Battle With Demons

Yesterday I sat for hours with a man who is dying and worried that God won't understand the things he did during World War II.

He has been having flash backs and episodes of panic so intense he seems unreachable.

As I sat beside him, holding his hand and listening, he took me with him through, I believe, every major battle fought during that war, with the exception of those fought in the Pacific Theater.

He was 18.

My eldest boy is 18 and I can't imagine him facing the horrors my patient had to withstand.

He was tapped to be in the 101st Airborne and placed in Intelligence and Reconnaissance. It seems this boy from North Carolina had a gift for spotting tanks and airplanes on aerial maps. He was also fluent in French and German- a by-product of his German heritage. His reward was to be the youngest of 76 men selected to parachute behind enemy lines, to record and scout out enemy activity, to lead men years older into battles that resulted, a lot of the time, in their death.

He was forced to do things that I know many soldiers have to do- but rarely tell upon their return to civilian life.

As I sat beside him, he was there again, the years melting away as he screamed out in flawless German, begging the unseen before him to put down their weapons.

My man is the sole survivor of the 76 men he went to war with and he tells me it will not be long before he joins his brothers. He is terrified that when he dies, their memories will die as well- they will vanish like the men who died in battle, and not be remembered or understood by anyone. He is worried that no one will believe what he is saying is true, that it could have really happened.

I ask him if he would like me to write down their stories.

Wrong move.

"No, those are my stories! Mine alone! No one can have them, do you hear me? No one! You must never tell what I am telling you!"

I soothe him, reassure him that his stories, his memories, are safe, locked away inside me in a place where I keep all the atrocities that my patients need to set free. I am the landfill for trauma so unfathomable sometimes I have to create conscious rituals to cleanse myself before I can return home to my family.

I pretend I have been in an operating theater, gowned, gloved and masked. When I leave, I am soaked in blood, but I strip off my gloves, throw away my gown and toss the mask in the trash on my way to the car.

I will not tell his stories. I want to, oh I really want to, because for every commercial glorifying the Marine Corps or the Army, there are the walking wounded who return, their lives unalterably changed and not for the better. They have been told to put the war out of their minds, not to speak of it to anyone.

My man obeyed the rules but at a terrible price.

We will spend whatever time he has left trying to cut the thick chains that hold him hostage. We will try to let go of these terrors so he can die without feeling so afraid and ashamed.

He is a brave and loving man, a father, a grandfather and a great-grandfather. He loves, no adores, his wife...and none of his family know what he is carrying.

He looked at me before I left, still holding my hand tightly in his own. "You know," he said, his eyes piercing through me. "I studied Psychology. I got to be a fairly good judge of human character and I have learned- there are those you can tell things to and those you know to avoid. I told you things today I have never told anyone."

I squeezed his hand, an unspoken promise for our future talks, and told him I would be back on Thursday.

I didn't want to run out of the nursing home yesterday. Days like yesterday are the reason why I haven't quit yet.

A Kiss Is Worth a Thousand Germs, But Two Kisses...

So...I am on my way to the nursing home yesterday when my cell rings. "You have a crisis at Nursing Home #1. A suicidal/homocidal patient." Then they add their normal spiel..."He will be a regular referral and is in room blah,blah,blah. Have a nice day!"

This means I can see him more than once a month, which if you're doing therapy is totally the only way to go...if you want to see someone get better that is. I mean, what can you do for a suicidal guy you see only once a month? I'm thinking magic wand for those type cases because talking about the problem in 20-30 mins. just doesn't cut it!

But when I reach my first stop, the social worker greets me with, "You don't want to stay here too long. We're infested with the Norovirus." Great. I'm one of those people you say, "One time, when I was three, I got carsick," and I'm already heading for the commode. It must be a narrow form of hypocondriasis limited only to stomach viruses!

"But," she says, cocking her head to one side and frowning, "I don't think it's hit that hallway yet, so if you move fast and don't breathe on your way, you might be okay...and he is suicidal...or else he's just attention seeking because both his kids are out of town..."

So, off I go.

I do not consider it a good sign when I walk through the swinging double doors onto the hall and half the staff are wearing surgical masks.

My little fella comes tottering out of his rest room, gasping for air, his hospital gown open in the back to reveal a flat butt in saggy tidy yellows (no way were these ever tidy whities.) His gray hair is standing up in tufts, his skin is as gray as his hair and the aide quickly hooks him back up to his oxygen. She is wearing latex gloves.

He sees me, smiles or grimaces, I prefer to see it as a smile, and beckons me in. The aide walks past on her way out and says, "Oh, he's got diarrea now."

Uh-oh. But it's too late. He's looking up at me expectantly and it's time to get underway.

Turns out he doesn't think he's suicidal or homocidal. It's more like he's having "bad thoughts" he can't control. Furthermore, he's fairly certain God is punishing him for something because why else would his kids be gone? And why else would something real bad be wrong with him, something so bad people have to wear masks and gloves around him and won't tell him what's wrong?!

So I tell him his kids just went on vacation and he has a virus and that the staff is wearing gloves and masks to keep from getting or spreading the virus.

"Eh?" he says. "What was that?"

This is when I learn how hard of hearing he is.

So, I wind up broadcasting the virus news to the bottom half of the hallway.

And when I finish he says, "I just wish they'd tell me what's wrong with me. Why did God take my kids?"

This is when I realize he has no short term memory.

So I say, "How about them Yankees?" Because there is Yankee stuff everywhere. He can remember the Yankees, so I try tying the virus information and the kid whereabouts to the Yankees. After 20 minutes he remembers the kid stuff but still wants to know what's wrong with him and who the Yankees got in their trade for some pitching staff.

But when I leave he stretches out his hand, clasps mine and brings it to his lips, kissing me goodbye.

Uh-oh.

Halfway down the hallway, on my way out, I run into Lazarus. He doesn't look so wild today. In fact, he is dressed and sitting in his wheelchair and looks for all the world like a 7 year old boy waiting for school pictures.

The smile he gives me is like spring returning after a long winter's cold snap. Then he takes my hand and he kisses it!

That's when I notice the kidney-shaped throw-up pan on his lap. But it's too late to stop the kiss. Lazarus has a grip like iron and eyes that beg for love. I stoke his hair, smile and say a few words before making a beeline for the antibacterial hand sanitizer.

I practically shower in the stuff. I clean everything I have with me. Then I turn to the social worker who's waiting expectantly for my report.

"Well," I say. "There's good news and there's bad news. First of all, Norbert isn't suicidal or homicidal- just anxious and lonely."

"So what's the bad news?" she asks.

"The Mudwing Hall has Norovirus."

She sighs. "I was afraid of that," she says.

You were?! Really?! What was I, your science experiment?!

Stay tuned for a further report on the incubation period for Norovirus...