SHARING A PIECE OF THEIR MIND

You walk like a duck with a stick up your ass.  That’s what one of my dementia patients yelled down the hall at me today. 

Whoa!  Look at your stomach.  Are you going to have a baby? This after I gained 10 lbs during the Covid lockdown and subsequent months of comfort food.  

Working with dementia patients can be very humbling.  Every day is a new day of self realization brought on by one of these beautiful residents.  

One of my favorite residents is Joan.  She is an elderly African American woman with a short afro that she forms into little braids when she is bored. She is missing many of her teeth but has a big smile and an even bigger laugh and she is laughing most of the time.  A typical conversation with Joan will go something like this: 

Joan: Well you know I told him and he went to do something else and I didn’t know anything. 

Me:  What did you tell him Joan?  

Joan:  It’s as if it was like this all the time and now you know too. 

Me:  What do I know now?

Joan:  (laughs)  It’s just about well you know (chuckles) they just didn’t want it anymore. 

Me:  OK Joan.  (What else can I say?) 

Joan:  (laughing harder)  That’s what I mean.  It was all about that time.  

Me:  (laughing)  I have no idea what you are talking about Joan. 

Joan:  That’s right and it will get better if I can just do something else without him.  

There are three things that happen when I talk to Joan - #1 For some inexplicable reason I always believe I am going to have an intelligible conversation with her and  #2 I always walk away more confused than I was when we started the conversation but #3 I always walk away feeling happy. Joan is one of our most social residents.  She self propels around in her wheelchair and talks to all of the other residents.  Sometimes I will see her with another one of our dementia patients and they are deep in conversation and to this day no matter how much I eavesdrop I cannot figure out what they are talking about.  But she keeps the other residents happy and engaged so really does it matter that her conversations are incomprehensible to me?  

Carolyn has this habit of dying about once every 4-6 months.  She will be sitting in her wheelchair and just stops.  Her breathing stops, her heart stops, no blood pressure, no response.  Since she is 92 and a “do not resuscitate” there really is nothing we need or should do.  It has happened enough times that when it does happen we simply take her back to her room and within about three to four minutes she comes back to us.   Eventually she wakes up and smiles at us.  When we ask her where she has been she says “someplace beautiful.”  

Larry tears off the dressing on his injured arm at least 3-4 times a day.  I have tried every kind of bandage and every way to wrap it up.  I have tied it, taped it, and wound it around and around.  I have put a sling over it and clipped the sling closed.   And still he manages to pull it all off.  The last time I spent 15 minutes reapplying the dressing and I said “Now Larry, don’t take that dressing off.”  He smiles sweetly and thanks me for my care as he always does and then he says “Yes, ok.  Well then, you better wrap it up tight so I don’t.” 

Nick is on a pureed diet.  If we give him regular food he hacks and coughs and chokes and it is not pretty.  He HATES pureed food.  Sometimes while sitting in his wheelchair at the end of the hall he will yell out some specific food he is wishing he had.  “hot dog with a bun!”  “hot dog with a bun!”  One evening he was sitting in his bed and a box of graham crackers fell from his roommate’s bedside table and appeared under his curtain.  Nick picked them up, tore them open and immediately began to eat them.  The nurse happened to walk in on him and said “Nick where did you get these?  You can’t have graham crackers.”  Nick looked up from his find, his eyebrows raised and very seriously said,  “These are mine.  I prayed to God for some real food and he sent these!” 

Unlike most of our patients Debi is rather young and can walk around.  She came to me one day and said “Do you need a receptionist?”  

“No”, I said, “I don’t think we do.” 

She looked at me confused and a little bit angry,  “Well, then why did you hire me?”

Really, they catch you by surprise.  There is no answer.   

As we work with our dementia residents we get to know them like family.  We know all their little quirks and one of the hardest things to teach the new nurses is those quirks.  We know that Lorrine hates having her meds crushed up in applesauce and if you give it to her that way she will spit them right back out at you. We know that Margaret will tell us that her father is waiting out in the car for her and that is why she needs to leave.  But if we tell her he called and said he is coming tomorrow instead she will agree to stay.  We know that when Barbara is bothering everyone with her constant chatter all you have to do is let her hold her lamb and listen to 70’s music and she will calm down and quiet down.  Gwen thinks we are running a drug cartel and Dean tells his family we keep him in a cage at night. When Ima comes to complain that there are bees in her bed we go in and pretend to chase them away and she will be able to relax again until the dogs show up.    May has a strong right hook so stand back when she’s in a mood.  Genevieve likes to hold Howard, our anatomically correct male doll, but don’t let her hold her own juice because she will try to pour it into Howard’s mouth.  Andrew wants his door closed at a 45 degree angle and do not touch his beside table.  Nick will take his meds but only if you bring him a cup of coffee with two creams.   And whatever you do, don’t let Lynda be near the front door when a new admission comes in because she will tell them “Sweetie, you should turn around and go right back to wherever you came from coz once you come in here you never get out.”

And sometimes they will hit you with something so profound your mouth will drop open and you will feel a stitch in your throat.    Sandra walks our halls in a frenetic way, unable to sit still for more than a minute or two.  She shuffles along with the nurses, her contracted hands held up in front of her like a boxer, her toothless mouth hanging open. When I asked Sandra what I could get for her as she paced back and forth in front of the nurses’ station she responded “Purpose in Life”.  And a few days later when she was agitated and couldn’t sit still we walked down the hall together to get a chocolate from my office.  I handed her the chocolate and I asked her what else she needed and she replied “Peace of Mind.”  

Don’t we all . . .