Preface: I just wrote this after a string of tough nights at work. It's all more or less true, but in accordance with HIPAA, I've changed all names and a few circumstances to protect patient privacy. Moreover, I hope my story doesn't come off as callous to those who may either struggle with diagnoses of dementia or else love others who do, or did. I strive to approach all of my patients with the respect and dignity that they deserve. I invite you to share your own stories so that we may honor people who are too often marginalized.
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A couple weeks ago, I watched M. shave his face. He was in on an Emergency Detention Order, waiting long term placement at a state facility for threatening to blow up the President. He dragged the safety razor down his cheek in short, brutal strokes, leaving behind angry red patches of skin and beads of blood. He never once paused to wash the crust of stubble from the head of the razor, which bothered me. Into the mirror, he asked:
“Don’t you know them Gero boys talk to the dead?”
It was the sanest thing I think I’ve ever heard him say. “Man, I believe it.”
That stopped him. He looked at me for the first time in the shift. “You commune with spirits?”
“No, but I’ve worked Gero.”
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More or less, I can handle just about any unit I’m assigned. I’ve worked shifts on Peds where three-year-olds get one ten minute phone call to mom before lights out. They cry afterwards, sometimes for hours, big yawning toddler wails. Shifts like that, I go home and crawl into my eldest’s bed and hold her for a couple minutes, or just stand in the doorway and watch my twins grow in their sleep.
Adult is easiest; there’s always the possibility of violence, but for the most part it’s just people who need help. Fifty percent of the adults on unit are there for major depression, maybe thirty are overflow from the Chem Dependency unit. Only twenty percent or so are ever truly psychotic, and more often than not, they’re lovely people (1). Either way, just people needing help. Teachers, bus drivers, once we had a cop.
Gero though, I have trouble with. I think it’s because it represents a timeline still available to me. Maybe just one or two branches off the decision tree. Gero patients move as I imagine ghosts do, up and down the corridor in the same tired pathways, from room to room without earthly intent. Some stand up from the couch in the day area as if they’ve remembered something important that needs doing. They’ll sway for a few moments and blink before sitting back down. Some give a sort of “well, don’t that just beat all” chuckle. Forgot what I was about to do! How about that. I’ve seen it enough times now that when something slips my mind at home, when it takes a few seconds to recall what I had for breakfast, I have to struggle against green tendrils of panic.
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It’s bad when a Gero patient talks to you. We had an orthopedic surgeon once. Her diction was still impeccable, and clipped sharp by a tidy British accent. But she believed herself to be just out the door for a rooftop party, and needed help finding her coat. For eight hours. Forever, for all I know. Each time I explained to her that she was at a hospital, and the doors didn’t open, her face would cloud with bemusement, as if her soul was struggling into standing position from the back of her head. She was polite even in her confusion: “oh yes, oh yes.”
It’s worse, though, when Gero patients talk to each other. Understand: the rhythm and cadence of human language persists long after meaning has drained away. So when two Geros corner each other in a doorway, they default mechanistically to all the old rituals of social grace. They’ll nod, and their voices take on a convivial tone, and their faces crinkle in recognition. But as you get closer, the words melt into each other, until from three feet away you recognize no more or less than the cooing of doves. Like ghosts talking to one another. Unable to extricate themselves from the situation, they’ll persist until you redirect.
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Each shift I work on Gero, there comes a point at which I question my own presence of mind. Two nights ago, running a safety check in one of the bathrooms, I wondered whether this was actually my job at all, or if it was just the job the staff gave me to feel useful and get me away from the nursing station for a while. It’s a notion I greet with increasing familiarity- even now, as I type these words, it’s all too possible to imagine that I’m not really here, but rather sitting under a blanket on a cedar-and-vinyl chair, waiting for the next cup of pills. Maybe my forefingers are twitching with the memory of the keyboard; I might be mumbling quietly, words that make no sense outside of a dream. I worry that one day, I’ll walk to the door at shift change, and it’ll stick, and a tech will walk up to me and say, “Mr. Sam, those doors don’t open, go back to bed.”
(1.) M., for his part, had his own brand of charm. He was known to sneak back from smoke break with a load of dip in his mouth, and then cuss out the nurses who had to manually remove it. Still, he never bit them even though it must have been tempting, and I know more than a few staff who teared up when he left.
The possibility of having dementia when I'm older terrifies me. I think what I find most unsettling is when you can see that moment where they realize that it's not real. I remember once when I was a cashier this elderly man, in the middle of the order said something along the lines of "I bet you wish you listened to your parents and stayed in school now". Most people would assume that guy was just a dick but it made no sense... I was a teenager and it was Saturday. I think he thought I was someone else because right after he said it he had this confused look on his face that you don't see often. The other time I saw that look was when I was working housekeeping and a man threatened to call the US coast guard if I didn't let him in what he said was his room. It could be nothing but they seem like early signs that I find very unsettling. A relative was telling me about one patient she had who thought she owned the retirement home and so was telling the nurse she had paperwork for her to fill out. All she had on the table was newspapers though so at one point she realized it and told the nurse they could do it later.
Yeah, I've worked with folks who think they either own the hospital, or else they've clearly worked in a similar setting. Hits too close to home. In a way, though, I really appreciate working with people like that- reminds me that I'll be that age and maybe in that situation sooner rather than later, and I better treat everybody on unit with the same care that I hope to receive some day.
This really hits home. Not because I have anyone I know with dementia but the thought of growing old and having it. As oyster says, the worst is when they realize that something is not real. The story was delivered very eloquently.