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itisallfiction · 13 years

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Don't You Ever Grow Up

I was completing activities logs in my office the other day when this song came on Pandora. It, along with a lot of other things, made my last month of work seem more poignant, and more important. I have spent a lot of my life considering immortality, and in a state of constant anxiety about aging and growing older. While I haven't figured out how to handle my neurosis surrounding growing up, I have learned a few things this summer. I would encourage you to listen to it while you read some of these thoughts.

When I started working with Alzheimer's and dementia patients, I thought it would be similar to working with kids. The regiments are similar. Each day, we have a strict and consistent schedule, to foster a sense of stability in the resident's lives. We do puzzles and daily "Brain Bogglers" to jog logic and reasoning skills. We have PE. We share a lot of our entertainment programming with the local elementary schools.

And for a person who only works with these patients occasionally, or to an outsider visiting the memory care unit, a similar assumption about the mental capabilities and function of my residents might arise. But in the four weeks I spent interacting with these people, I realized they are very different from children. Children are constantly learning, growing, building on the previous day's knowledge. With advanced Alzheimer's and dementia patients, every day is the first. Though I've never done it, and it's probably too bold of me to make this statement without the experience, I can imagine its a lot like working with adults who are mentally impaired in some capacity, or who have significant brain damage other than these two diseases. I can teach Alice or Betty how to make a box out of paper, but the next day, I will have to teach them again. New skills are very difficult to build upon. This makes activities like physical therapy particularly difficult, but also interesting to observe.

One man, I'll call him Roy, is working on using his walker less. He has been in the memory care unit since it opened, about two or three years ago, and doing physical therapy almost every day. Our PT will set up a sort of obstacle course for him of hula hoops, step-aerobic blocks, and pool noodles for him to navigate without the use of his walker. Every day for Roy's brain the course is new. But Roy's body has been learning the course for three years. Watching him is like being in one of my old performance classes, and hearing music for a dance I used to know by heart. If I can learn the first few moves, my body naturally begins to "remember" the rest of the routine, without having to think about it. Obviously I am not a neurologist, or even a physical therapist for that matter, but this active memory/physical memory disconnect is clear and observable in many of the residents I work with. Unfortunately it does deteriorate in some of our lower functioning residents -- the reason for Roy's walker-less therapy. If he doesn't walk each day, consistently, then he will forget the physical mechanisms walking involves. If one walks into a memory care unit, I would encourage you to take note of how many residents are in wheelchairs, and how many are walking independently. Then ask a CNA who has been around for a while. I wouldn't be surprised if you found that most of the wheelchair residents were veterans of many care facilities, and had been around this one for a while.

My job is miscellany at the retirement home. Some days I am in charge of making a book of receipts of telephone orders in the Medical/Billing department. Other weeks, I meet with the families of new residents to go over our facility's policies, and explain to them why we only settle out of court. I have hard days when I ask a family,

"Does your mother have a living will? A DNR form?"

And harder days when I have to explain what these things are. I've spent evening at the front desk, taking calls from California dads who want to send their aging mothers birthday bouquets, but don't have the number for any local florists. I decipher signatures on cards from friends, brought to me by shaking hands and cataract eyes. I have directed people to the coffee machine, to the prayer/meditation room, to the bathroom.

But my favorite days are in memory care. I thought working with Alzheimer's and dementia patients would be like working with children. It's not. Nor is it entirely like working with developementally challenged individuals, or other varieties of mental handicaps. Because some days, out of nowhere, Marge will tell me about her childhood spent in Catholic school, and the year of secretarial school afterwards. How in 13 years she had acquired all of the skills she needed to perform a life-long job. Other days I get to be Jake's secretary. It's 1960, and maybe it's my pencil skirt that has sparked his brain to remind me to get him all the necessary paperwork and a copy of that form BEFORE 1 PM, and to wink at me every time we make eye contact from across the room.

My last day, Al and I were painting, an activity he loathes to do. He would look at the paper, the brush, the watercolors, and blow a raspberry at me. After five or six minutes of my frustration building, I eventually stuck my tongue out back. He looked at me, shocked, and then barked. I barked back. He sniffed me. I sniffed him. What proceeded is best described as two seemingly crazy people, one 97, and one 20, making very silly noises at each other for half an hour. Then we marched to dinner like we were in the army.

Al's wife, and the wife of another man, Leo, come almost every day for a few hours. Their husbands remember them, and regardless of how functional they are in a given day, they remember certain sweet things, tasks they always did for their wives. Whenever Al's spouse shows up, he goes to the sink in the kitchen and starts washing dishes. Leo, who rarely speaks, will silently take his wife's purse and hold it for her for the duration of her visit.

Babs' family doesn't come anymore. Her husband used to visit often, but as her condition has deteriorated, so has the frequency of his visits. Babs can't hold a subject, focus, immediate attention to the present or a present task, for more than about 30 seconds at best. I can understand why, for her kids, it might be easier to live out their lives as though she were already gone. For all their purposes, she is.

But for me, she and the other 40 or so residents I came to love over the last month are my purpose. Although they're living in some strange purgatory, I make it livable for them. I bake with them, listen to their stories (though they sometimes don't make sense and are often the plots of old Laverene and Shirley episodes), and when May cries but won't tell anyone why, I sit with her and hold her hand. Some days they hate me for making them stay. They yell and scream at me. Valerie pushes her walker throughout the facility, mumbling under her breathe, "No... no... no...", and Elma sits in the same chair outside the dining room for hours, each time I pass asking, pleading, "Why won't you take me home?" There are residents that I forget even have a condition, because they are so high functioning on a regular basis. Then they do things like ask me to help them find their car keys, because they need to get back to their house, their children, get dinner in the table. I have to explain to them that they don't need keys. That I'm making them dinner. That their children will come to them (hopefully in the next month, I think), and that they are staying here tonight. They look at me, confused. The best reaction is outright denial, because then I can just divert them to another task. Distraction is the number one tactic in my unit. But the worst reaction is that sad, accepting look. Like a prisoner, who just woke up from a dream of life on the outside.

Anyways, I could write a lot about this, but I saw this on the Today Show this morning, and was fascinated. It's a study, still extremely early, and as the doctor involved says, don't tell families to get their hopes up. But it is yet another step in the right direction. And as the human life extends into previously unheard of spans, if we can hault or reverse the spiral into purgatory for anyone, we will be saving a life.

http://www.latimes.com/health/la-he-insulin-alzheimers-20110913,0,6983680.story

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