Old-Timers

Or...Alzheimers.

We spent time studying dementia this term. I have to say, I never really thought much about this patient population before then, which is weird because both grandmothers succumbed to it. And because of it, I have often joked that I'd rather go out in a fiery ball of flames while still in my prime than lose my mind slowly. When I saw on our clinical rotations for the term that we'd be spending time at an Alzheimer's facility, I quietly freaked a little bit.

Old people scared me as a kid. I thought they smelled off. They shook. They pinched my cheeks too hard. They cough and hack up big loogies. (During my childhood, a loogie expelled by an elderly person in our front seat unfortunately stuck to the inside of our windshield during some drive...and I was the only one to notice it there, dangling and suspended for the duration of the trip. This memory has unfortunately stuck with me...and launched my fear of both old people...and phlegm in a single incident.)

I grew out of that, and now I really enjoy the company of our older generation. But I do admit that sick, old people still kind of unsettled me prior to entering this profession. I don't like to see suffering of any kind, but I think seeing older folks sick in bed touches something primal in me which says, "that'll be you someday" -- and I'd spook.

Armed with our new knowledge of the disease process and nursing care associated with Alzheimer's, we began our time at the facility -- no ordinary home, the place is dedicated to this type of patient, and one whose family can afford the six grand a month it costs to live there. It was outside of the city in a very affluent community and I already wondered where they house the ones who can't afford to live there.

I don't know what I was worried about...because I can now say I enjoyed my time with these patients so much, I had a hard time leaving them. The place was as homey as it was possible to make it, the staff were loving and very skilled at communicating with patients in various stages of the disease. Our biggest objective wasn't to provide nursing care to these folks -- it was to learn how to communicate with them effectively. So we went there primarily just to observe and interact.

What did I do?

I fed a lady who was becoming too advanced, she was close to needing to be moved into a full-time nursing facility, because she was entering the final stage. She was non verbal, unable even to eat by herself, and wandered around vacantly the rest of the time. I would occasionally redirect her, or bring her to meal times. She also fell (so common) and I was first to her side, trying to keep her from attempting to get up until a staff member could be sure she was un-hurt. Other than a nasty goose-egg, she was okay. Still, during those minutes trying to keep her still, I saw shear terror and pain in her eyes, and it was all I could do to keep her from panicking. She nearly wrenched my arm off trying to rise -- which reminds me that caring for these folks can be very physical.

I danced. When the singer came to entertain everyone, we were encouraged to act as a pep-squad; handing out tambourines, bells and other instruments for audience participation. We clapped and sang along and I was amazed how even some of the more advanced patients could recall every word to the oldies! There were a few gentlemen who were willing to get up and once they did, still remembered how to lead me in a fox-trot. It's true that long-term memory can linger when short term memory is completely shot.

I took orders. Some of these patients are quite un-patient-like. They could be mistaken for staff. One younger lady was so convincing, she started ordering us around to tidy up. "Get these chairs put away!" "This place is a mess!" Thinking she worked there...I helped stack some chairs! Doh!...she was a resident. [This was amusing to the staff, and to my instructor.] Patients wear clothing, not gowns -- and because of "white coat syndrome" (a fear of medical professionals), the staff also wear street clothes. So, for a newcomer, it can be tough to tell them apart!

I rocked a baby. Another very advanced lady carried around a doll who had a name, and who was very real to her. (This is actually quite common...to bond with a favorite item.) In any case, during the music session, I watched her point to the singer and whisper things in her baby's ear. She would rock and mother her, and bring her everywhere. When it was time to get this lady into the bathroom, she was very unwilling to put the baby down in order to go do her business. The staff member saw me nearby and offered my help to "hold the baby" while she went. I swear this patient pinned me with her eye contact as if to silently warn me that this was a Big Deal, and handed the doll over. I effusively reassured her that I took this task seriously, as any mother would, and reflexively began bouncing and rocking the baby! Then...since toileting can take a while, the staff member went to a nearby counter and began folding laundry and asked if I'd like to help. I nervously glanced back and forth between her and the bathroom door -- what was I supposed to do with the baby?! I'd made this promise to look after her! I laid the baby down on the counter, kept one eye on the door, and helped out. The SECOND I saw that door handle jiggling, I swooped up the baby, resumed my stance and surrendered the it to my nervous mother when she emerged. She snatched her back and all was again right in her world.

I passed out snacks. We all rolled a cart around and became very popular as we handed out ice cream, asking vanilla or chocolate, and serving it up. Many times when we returned to our customers...they had forgotten what they ordered, but were still happy to see us. Then, when we had made one pass around the place, we still had many ice cream cups left -- as many patients had declined. One student asked me..."Shoot, what do we do now that we have so much left?" I said, "Let's go around again, they won't remember us being there the first time!" And it was true. Many that had declined before, took us up on it the second time around. And it is so important for these patients to keep weight on, or even to gain weight, that we didn't want to waste an opportunity.

I took a walk. One lady appeared quite standoffish, and was even referred to as snobby. She had this old-world, old-money feeling to her. Considering the zip-code, she very likely was! She kind of glared down her nose at everyone, and mostly wandered the hallways, looking at the driveway, as if expecting her chauffeur to arrive at any moment. None of the students had engaged her yet, so finally I mustered up courage to ignore her glares and offered to take her for a walk. One of the things we learned is that in those patients who were raised in higher social circles where manners and "social graces" were expected -- they can cover the onset of their disease in the early stages with meaningless pleasantries. In fact, on our walk, I relied on that and she graciously answered my remarks about our fine weather, these lovely roses, and other generally acceptable social ice-breakers with the expected replies. Anyone listening in on our conversation wouldn't really guess she had Alzheimers. This is because I didn't ask her any questions that required recall. However the answers were robotic, and yet allowed her some feeling of normalcy as we strolled.

When it was time to go, I had bonded with so many of these folks, and with the amazing people who cared for them, that I was a little sad to leave. On my way out, I approached the lady that I had fed, the one who was non-verbal. I said good-bye expecting no response and instead she reached out and hugged me and then, plain as day said, "Thank you. Good to see you." And all of the nursing students, and our instructor just stood amazed, grinning. They were the only words we ever heard her say!

Okay, I got a lump in my throat after that.

I have a whole new outlook on the subject of Alzheimer's now...and consider my time with these folks a gift. So many of them will end up in my hospital, and because they will be out of their environment, in crisis, and away from the caregivers who know them and their particular needs so well -- they will be frightened.


I'm so glad I got to practice how to reach them.

Shock of Re-Entry -- Summer Break

I've been so busy, I neglected to blog the whole last term! And now I've been home for three days. Time to catch up.

It would be too much to try to cover all of my impressions and experiences I had during this term in one blog post. I'll make it a summer project to reflect on all of that. Tonight I'll focus on current events.

Friday, on 48 hours with little to no sleep I wrote my final. My study group and I had to literally pull each other across the finish line because individually we had all hit our respective walls. Among us we had chain-smoking, endless fits of crying, incoherent babbling and fits of rage. Pure adrenalin pulled me through and then I clenched for the "rest of the story" -- because as much as we all wanted to celebrate in our usual fashion (corner bar at 11:00 am over beers), we knew we'd be saying goodbye to students who found out they failed out of the program. So far I know of 7 good people who won't be with us in the fall. It makes me profoundly sad to see some of them go. So the last day of any term is bittersweet.

On top of that we said goodbye to our graduating seniors that night. So after a couple of beers, I went back to the dorm for two hours of precious sleep, before rousing to attend the graduation ceremony. So...more tears, albeit happy ones. Still-- I'll be missing some of the good friends I made this year. The seniors did provide some great insights and encouragement in terms of getting through this first year. I can't wait to hear how they all do writing their boards this summer and landing their first jobs. They must know They Are Being Watched!

During finals week, students were succumbing to illness all around me, and I smugly boarded the plane home thinking I had avoided it for once. Don't know what I was thinking. I got sick my first day back and I may be getting sicker by the day. Bronchitis, rhinitis, laryngitis and otitis. You know another -itis? -- I probably have that too! This may be the universe's idea of a joke, because I was going to be without health insurance for only about a week and a half before I start back at work next Tuesday. So, of course, I'll probably get pneumonia the way this is going.

I feel out of sorts being back home.

At school, we literally have bars around us when we go out on the porches (to keep us from jumping off??) Of course, it feels like prison. Many jokes are made about this, and...like prisoners, we fondly start off many conversations during middle of the night with, "When I get outta here, I'm gonna...." (Fill in the blank.)

So now I'm out. I'm free!! At least for about 6 weeks. Maybe its the time zone change, maybe its illness, or...more likely, its Post Traumatic Stress Disorder -- but being on the outside feels very strange. Like I've forgotten something. Or I should be doing something. I just don't know quite what to do with myself. Reconnecting with friends and family is lovely, and I'd be enjoying that more if I wasn't coughing up a lung and without a voice. But, there's this nagging feeling, it's almost surreal. I walked down the steps to my home, for the first time since I left for nursing school last summer, and I thought..."Did I just wake up from a bad dream?" It all felt quasi-normal: heading back down to the cabin on the beach, walking the same steps, trailing behind my son who was carrying all the heavy stuff as usual. But this is only a brief interlude at the mid-point of this journey called nursing school. The friends and family here can't really know what it's like doing this...and my "fellow prisoners" are all enjoying their brief parole back east.

I think it's time for self-care just now. I better bite the bullet and go in for a throat culture before this pestilence in my throat turns into full-blown pneumonia -- which will waste too much of my precious time. In a few more days, and with the help of some really good drugs, I'll finally ease into my summer and enjoy it!