Lost in Time

I thought I'd share a few more nursing home memories with you today.  I was thinking of the dementia patients we had.  Not those who were depressed but more those who had Alzheimer's or hardening of the arteries, which was an old diagnosis that appeared on paperwork prior to the 1990's.

We weren't equipped to handle Alzheimer's patients at our facility and the field was just changing at the time when I worked in the nursing home.  The medical profession was transitioning out of the old drug Haldol, which was used as a chemical restraint.  The medicine was meant to help those with schizophrenia but was widely used for most all dementia patients.  It gave them a glazed look in their eyes, might cause them to drool and they tended to scuff their feet when they walked, a symptom spoken widely of as the Haldol Shuffle. 

It was both a blessing and a curse when they began to severely limit that medication usage in nursing homes.  Some people regained something of quality of life.  They could often function but the inability to physically or chemically restrain a patient also meant that monitoring patients who had Alzheimer's or dementia and measures to protect their safety could be very difficult.

In my time at the nursing home, we had a few memorable patients with dementia.  I didn't know them well.  I had only brief medical histories and their current bewildered state and seldom any of their personal background.

Dulcie was an older woman who was gentle as could be and really a very easy patient.  But one day, she somehow managed to escape notice and the nursing home at the same time.  The story ends on a happy note.  When she was found, she'd only been gone a matter of a half hour or so.  She'd walked two blocks downtown to the pool hall, ordered herself a beer and was playing a game of pool.   Someone called the police who notified the nursing home, and she was brought back.  

Most of our mental patients didn't attempt to leave the building. It was their familiar place.  We as staff were meant to re-orient confused patients to time, date and place.  This often led, during a particularly bad episode of mental confusion to emotional distress.   Frankly I found it best to go along with them in their own world.  If Theron was convinced the mules had gotten out, I'd redirect him down the hall towards his own room and say, "They went down the road that way and took a left..." and off he'd go down the hall to his room which somehow signified a familiar safe place and he'd settle in his chair and wait to be called to the next meal or told to go to bed.

On the other hand, if I tried to convince him that it was no longer 1937 and the mules hadn't gone astray, he grew upset and things escalated so that he became angry and uncontrollable.  This often led to either illness or distress so great that he'd be in bed for days after.  

Some of the nursing and housekeeping staff soon began sending him back down the hall with the directive, "I saw them head that way," and off he'd go to his room.  He wasn't so confused all of the time but when it happened, it was a kinder means of helping him than reorienting at the wrong moment.

Miss Eunice had private means and a sunny corner room to herself.  She was a quiet Southern lady type and conducted herself as such but one day I found her chasing another resident down the hall with a fly swatter.  "She was in my house!  She was messing with my things!" she kept repeating.  

Miss Bea was a soft spoken, gentle black woman and never caused a ruckus but when she was confused, she just naturally gravitated over to the other wing and into Miss Eunice's room.  Miss Eunice never did harm to Miss Bea but the two fought like cats.   Miss Eunice was the most vocal.  Miss Bea just tended to mumble about 'that woman is out of her head..." The behavior of the two was often brought up at patient care meetings and we were all at sea about why they fought as they did.

This went on for four or five months with Miss Bea making weekly forays into Miss Eunice's room.  One day a part time staff member appeared in my office to tell me that she'd just caught Miss Bea in Miss Eunice's room and that Miss Eunice wished to speak to me.  I sighed deeply because these interviews with Miss Eunice generally were her complaining and me assuring her that we would do all we could to keep Miss Bea out, but obviously we couldn't.  I said, as I gathered up my note pad and pen, "I wish we knew WHY Miss Bea keeps doing this!"  To which the part time employee, a girl with whom I was barely familiar replied, "Oh that's easy!  Miss Bea was Miss Eunice's housemaid for years."

I sat down in my seat again and laughed out loud.  Of course!  That explained why Miss Bea only cleaned the room when she went in!  She never took anything out of the room.  Miss Eunice's didn't have any memory of family or of her former maid either, but Miss Bea remembered Miss Eunice in her moments of confusion and went off to attend to her 'work'.

We never did stop Miss Bea going into Miss Eunice's room until she was no longer able to walk and one day, we found Miss Eunice sitting in a chair by Miss Bea's bed.  Some grain of memory had flourished suddenly, and she'd gone off to find her former companion and maid.  

One of our parttime nursing staff and her husband placed his mother in our home.  Mrs. W only ever wore a housedress and slippers most days and was dazed and confused as could be.  She had proper clothing, but she simply wouldn't put it on.  She insisted on the housedress and slippers. 

Mr. W, the son, could barely bring himself to visit his mother.  His wife succeeded in convincing him that he really should come see her and he strode in one day just as his mother was coming down the hall.  She broke into a wide smile and held her arms out to him.  When he came to her, she placed her arms in the pose of one dancing, one arm around his shoulder, one handheld out to him.  Her son immediately put his arms about her.  Much to our surprise, they waltzed about the lobby, son smiling as broadly as his mother.  When the dance was done, she stopped, looked confused and was blank faced.  She slowly walked away.  Mr. W sobbed out loud.  

So often when patients with mental issues came to us, we didn't know their backstory.  We knew only that "Mama is confused," and the family was usually so caught up in the emotions of losing their loved one in this manner that they seldom gave a family history.  It was almost as though it was too painful for them to tell us what these people had been.  They were so firmly caught up in the pain of the present that they hadn't room for the pain of remembering how they had been, too.  We had to piece our histories together a bit at time.

So it was that we learned that day about Mrs. W's past.  She'd been a successful relator, always well dressed.   She and her husband had competed as professional ballroom dancers.  We'd only ever seen her as she was in the facility: tired, confused, dowdy.   Perhaps Mr. W reminded her of his father that day.  Perhaps she simply needed to be who she'd once been for a few moments and his timing in arriving had been perfect.  I can tell you only that the dancing was breathtaking and the transformation back to her current mental state heartbreaking for all of us to watch.  Mr. W didn't come visit again.  Somehow, we all understood better how devastating it was for him to see her in that state and none of us thought less of him for it.

Mr. David was a small man, neat and tidy in appearance and absolutely the nicest man you'd ever hope to meet.  He was downright courtly towards women, quick to open doors, to offer help if they were carrying a heavy load, and polite as could be.  He was almost shy, never prone to talking much.

One day however, I saw the other side of him.  I was walking through the courtyard going from my office to the front office.  He was sitting at the table in the courtyard and as I approached his face lit up.  "Well, hello!"  "Hello Mr. David, how are you?"  "I'm doing just fine!  What are you up to?"  "I'm working..." and that's when it happened.  A completely lascivious look came over his face and he said with a huge grin, "Is that what you call it?  Why don't you have a seat here on my lap and show me how you work?"  I was embarrassed and shocked.  It was the last thing I ever expected to hear out of such a quiet nice man!  I hurried indoors and called the Director of Nursing and told her I was sure something was wrong with Mr. David.

Bonnie went out to the courtyard and spoke to him and eventually two other nurses had to join her.  Mr. David was like an octopus with hands going everywhere and a smirk on his face that just wouldn't go away.  We were all mighty surprised by this behavior.  Eventually they had to call one of our orderlies to the courtyard to help.  Perry was a huge man with broad shoulders and stood over six feet high.  He gently lifted Mr. David and brought him indoors to his room.  Eventually they had to give Mr. David a mild sedative to calm him down.

When his son was called to report the behavior and the result of it, he sighed sadly and said "It's the same everywhere we've placed him.  He really IS the quiet nice man you normally see, but something just comes over him and he acts in a way that I never dreamed my father would ever act."   We assured his son that now we were aware we'd be on the watch for when these moments came upon him.  Eventually he was moved to a larger nursing home with a proper Alzheimer's Unit.  

Miss Nell was a petite, thin woman with a pretty face who stood all of five feet.  She looked taller because she was slim built, not prone to the plumpness that many short women have.  She too was a little confused looking for the most part, with an almost worried look about her as though she knew she wasn't herself.  Like so many others she was fairly quiet, rarely speaking.  Her behavior was never an issue but again, a glimpse of her dementia came out unexpectedly one day.  

Two State Patrol officers walked into the South lobby and over to the nurses' desk as Miss Nell was coming out of the activity room.  Honey, those uniforms caught her attention right away.  Miss Nell lit up like a Christmas tree and sashayed, yes sashayed, right over to the tallest of the two men and began to flirt for all she was worth.  The two men were a bit embarrassed but very nice and spoke nicely to her, but I decided it was time to distract her.  As I approached them, she looked at me and with sparkling eyes, began to sway her hips and said to me "Which one do you want?  I prefer this one right here, but you can take first choice."  The officer upon whose arm she'd laid her hand turned about fifteen shades of red and his partner looked quickly at me. "I think we'd best just go on and get lunch Miss Nell and leave these gentlemen to do their job.  They are still on duty."  "Well, you boys come on by later when you're off!  We'll be waiting on you!"  

Finally, my last experience with a nursing home patient came about after I'd left my job as social worker and had taken a temporary position as a phlebotomist at the hospital while a girl was out on maternity leave.  I was sent to another nursing home in the county to draw blood for annual exams on several patients.   All went well until I came to the last patient's room.  I found a woman in a private room, lying looking out of the window.  I explained who I was and why I had come.  

The moment the needle was placed in her vein that woman cursed and cussed and called me every vile thing she could think of.  I hadn't been warmed at all by the nursing staff that this woman would react in such a way, but her voice carried far down the hall and a nurse promptly came to the room.  As I finished up my blood draw and was putting things away the nurse calmed the woman down and soothed her.  We exited the room together and the nurse said, "You know she's the doctor's mother.   I've heard that she was one of the nicest, most God-fearing women you'd ever hope to meet but now she's got a horrible mouth on her."  Having just heard a bit of her vocabulary, I could only nod in agreement.  Yes, indeed, she had a horrible mouth on her!

Perhaps I was meant to know these people because of what later happened with Granny and her diagnosis of dementia after her 92nd birthday.  It helped me to cope with the loss I felt long before Granny's death.  I thought often of former patients who'd struggled so and of their families who were often as bewildered and helpless as the patients, unable to understand a disease that is a long goodbye.

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