Nathan was one of the most challenging residents I ever had to deal with in the nursing home. He was at least one hundred years old, blind and nearly deaf. He had recently fallen and was now unsteady on his feet. Prior to his fall, he was used to walking around his home throughout the day as Alzheimer’s patients often do. Now he found himself in a wheelchair and completely confused. Because of his disease, his blindness, and near deafness, it was almost impossible to communicate with him that he needed to stay in his recliner on wheels. We could tell him by yelling closely to his ear and he would agree to stay seated but he did not retain that information for more than a few minutes.

In the activity room, he was a danger to himself. Our linoleum floors would not be forgiving to frail hips and fragile skulls. He spent most of his daytime with us in the activity room. My job was mostly administrative, but I often brought him into my office so I could keep an eye on him. The staff members who were leading activities could not easily manage him and the art projects at the same time. Even when he was staying in his chair he was incredibly loud, babbling unintelligibly.

I was frustrated with the challenge of how to keep him safe, somewhat mentally stimulated, and get my work done. Nathan was very strong and he liked to tear things. If he got ahold of a magazine or newspaper he would tear it to bits. I encouraged him to do that because I think it relieved his frustration. I borrowed an activity pillow designed for dementia patients. It had different textures of fabric, things to button, lace, and crinkle. Because he loved to unlace his shoes and undress, I hoped this pillow would appeal to him. Nathan worked to rip the pillow like a magazine and did not use it the way I had envisioned. One morning I came into work and found scraps of the pillow on the floor. He had destroyed it at the nurses’ station the night before.

One day I realized he was humming a song and I recognized it, Hava Negila.  It was a turning point, a connection. He loved music and was a former mandolin player. I put him close to a CD player and turned Hava Negila up very loud. Nathan clapped his hands and sang in his babbling way. It was beautiful. After that, Nathan became one of my favorites. I remember sitting at the sunny dining room window with him one winter afternoon. He held one of my hands while I typed away on my laptop with the other.

A few months after he had been with us he took a quick turn for the worse. A co-worker came to find me so I could say goodbye. His family would not make it in time. A nurse and I stayed with him. I held his hand and loudly gave him permission to go find his deceased wife and parents, like most caregivers do. He left this world quickly and had a slight smile on his face.

Caregiving can be so challenging, and exasperating, especially when caring for people who have mental challenges like dementia. But most caregivers have a deep well of empathy that fosters patience and love for their patients. And sometimes it is the most difficult patients that become the strongest attachments. Hats off to all the caregivers who stick with these troublesome assignments and go beyond providing basic care! You have tremendous impact that will be felt beyond your immediate circle in ways you will never know.

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