Geriatrics...

Neonatal Doc gave me an interesting topic to think about this morning and it even brought back some good/bad memories.

The topic on his blog was a trip to a nursing home and his reaction to the place and his reasonings for choosing pediatrics rather than geriatrics.

When I was 16-years-old we had to start earning Career points. We had a class called Career And Personal Planning (CAPP) and the motto was 'No CAPP no Gown' meaning if you did not complete CAPP you wouldn't graduate. Now about the careers, you had to earn work experience either through going to work somewhere or volunteering. Many of my classmates rushed off to The Gap, La Senza, Futureshop, and various sport stores. I however was interested when a counsellor began an announcement over the PA every day saying that the local extended care facility was looking for volunteers so I went and applied. I was given the orientation along with at least 40 other students from other high schools in the city and we were all given pins and a water bottle since 2001 was the 'Year of the Volunteer'. Afterwards I scheduled to be at the nursing home 4 days a week for 4 hours at a time.

Originally we were only supposed to help with dinner, clean-up and organize the bar night/bingo night on Thursdays. After that we were supposed to shred old documents, clean up the office and that sort of stuff. In between we were asked if possible to visit and entertain some of the residents. Out of the 40 or so students that were at the orientation, only 6 of us remained and only 3 of us worked more than once a week. The two I worked with wanted nothing to do with interacting with the residents and so I was relegated this duty which I took in stride.

I count myself luckier than my coworkers because I was given the opportunity to meet and interact with some very interesting people. I was able to hear about their life story, their adventures, their children, grandchildren, great-grandchildren and in some cases great-great-grandchildren. Whether any of their stories were true didn't matter to me, the fact was I could see how happy it made then just to be able to talk to someone other than the nurses. So many of them were alone all the time because family members were too busy to pay their parents a visit, or see their ailing grandparents. There were a few times when, while visiting with a resident, a family member would appear and automatically try to take charge of the conversation in a rushed and hurried manner. Many times they wouldn't even take off their coat or sit down. The resident would be happy to see them but after a few minutes they realized the visit was to be short-lived and it just about broke my heart to see the look on their face. There was one lady who had a daughter who lived by herself only two blocks from the care home, you would think that with your mother ailing and near death and you living by yourself with no family commitments you would be able to visit her at least once a week right? Wrong. This woman would only come on Christmas day and her mother's birthday, stay for an hour and then leave. When I saw this in October of 2001 on the resident's birthday I just about cried - correction, I'm sure I did cry. I was so disgusted and so angry with the woman, her attitude while with her mother and the way she spoke to her as if she were a child was just so abhorrant I could hardly contain myself from throttling her into the next week. When she left, the resident had tears in her eyes. She patted my hand and said "Well, at least I get to see her in December". I cannot imagine the type of rejection this poor, sweet woman must have been feeling.

You see, to me it is different with babies. They are not fully aware of what is going on around them, if you visit with your child for an hour and then leave your baby will cry but ultimately they'll forget until you return. With an elderly, they know. They know and they can feel the pain and understand why they hurt. They know you're rejecting them, they know you feel like they're a burden and they know that you'd rather be anywhere else but in the stinky retirement home visiting someone who just. wont. die. "There's no hope for them, so why bother?" I overheard one daughter say to her husband, the words made my stomach turn and it was all I could do not to make a scene.

Once I was asked if I wanted to take an elderly man to see his wife who was in the hospital. I said sure, that'd be great. So I escorted this frail shadow of a man to the hospital in the cab and gave him his privacy while he visited with his wife who was recovering from a stroke. I waited in the hallway and when one of the nurses noticed my uniform she stopped and asked me "why are you volunteering there" she said, the last word spat out like something vile. "Wouldn't it be more fun to work here? At least here you don't have to deal with them, you don't have to listen to their pointless stories or anything. You should be a candy striper here". I just smiled, told her that I got more out of being around the elderly than I would around those who were young, injured, and angry because they didn't like their bread pudding. At least the elderly appreciated the food they got and they knew that if it weren't for being in the nursing home many of them would be hungry or homeless; or both.

In December of 2002 I experienced the first death outside of my family. His name was John*, he was Polish. He was a war veteran and he was a born-again Christian. He was absolutely the most sweet, gentle man I have ever met. If I close my eyes, I can still see his face. Most of the time I saw him John was in bed, he was too weak to get up. His family had brought him a little stuffed Dalmation dog wearing a firemans cap, which he absolutely adored. He made sure the stuffed toy sat on his shoulder while he ate, and he hugged it as I read Bible verses to him. One time, it fell under the bed without anyone knowing and neither John nor I could find it on the bed or in the sheets. He was frantic, near tears and muttering in Polish. When I found it at last, he held it to him and told me "my family lives 3 hours away, they can't see me a lot but when they do they bring me a gift. He (the dog) was a gift my grandson picked out; I don't know what I'd do without it. Everytime I hold him, its like holding my grandson, or my daughter.". I met John's daughter once, she gave me the biggest hug and said to me "my dad loves you, he says it's like talking to me. Thank you so much for taking the time to be with him when I can't". She was the sweetest woman and I knew she had gotten that from her father.

Christmas 2002 and I worked Christmas Eve. I had helped set up the tree in the main lounge and the carolers that were hired were singing. The big screen T.V was turned to the local cable company channel because they ran, through Christmas, 24/7 video of a fireplace. There was eggnog with rum and 'virgin' eggnog and lots of little finger foods. George, the handyman whose wife was a resident said it was okay for me to have a small glass of the rum filled eggnog, so I did. Then I saw John, in a wheelchair with a tartan like blanket covering his shoulders. I went up to him and he motioned me close. I gave him a hug and whispered "Merry Christmas John, may God bless you this season". He gave me a kiss on the cheek and pushed a box of chocolates into my hands. "Merry Christmas sweetie, enjoy your holiday".

When I went back to work on January 1 I had a stuffed dalmation to bring to John. It was slightly bigger than the one his grandson found but it was the only one I could find. I carried it in with me and went right to John's room which he shared with three others. His bed was closest to the door and so I saw it first.

It was empty.

I went out to the nursing station down the hall and asked. They said he died Christmas Eve. He was holding his Bible as he passed away, his fingers holding different pages open to different verses he liked. I didn't finish my shift, I walked home crying. I felt like a very dear friend had left me. I felt like I had lost a member of my family even when this man was not related to me in the least and he was so very much older than I was it was strange to think of him as a friend, but he was.

I was invited to the funeral but it was held 3 hours away and neither my parents nor I could drive (parents were working). I did however send the stuffed dalmation to them.

There were others I remembered, Margaret* was one of my favorites. She was a little lady that was in a motorized wheelchair. She had suffered a stroke some years back and couldn't speak very clearly and so on her wheelchair was a table (like you'd find on a high chair) with a large print out of letters. Most of the time she didn't use these and those of us who were familiar with her were able to understand her. The things I remember most about her was:

• She had really long, snow white hair which was braided every day and wrapped into a bun ontop of her head. Around this were at least 10-15 of those butterfly hair clips. They were alligator type clips with butterflies on top of them. Some of them were on springs so they wobbled as her head moved and all of them had beautiful wings decorated with gems or sparkles. She loved her butterfly clips and I made a point every time I saw her of telling her how beautiful she looked.
• When I observed her she was so childlike. She took such joy in small things, a joke or even something funny on tv would make her giggle in her own unique way.
• I remember thinking of her like a gorilla; and this is not said in a mean way but in a very affectionate way. Her mannerisms were very much like a gorilla from the way she looked physically with her facial features somewhat of a cross between the two (human and gorilla) to the way she did things such as peeling a banana, which she loved beyond any other fruit.
• She always had a hug available and one only needed to ask. Her hugs, while weak, meant so much to me. They were filled with love and happiness.
• Her wonder at everything. Like I said, she was so childlike in this way that it was unbelievable. The nurses said she was like that before her stroke as well.

Margaret had a rough past. She came to the ECF with her twin sister and they had a private room which they shared. Before this they had lived together for quite a while, both having never been married. Then one day her sister died and Margaret was never the same. She stopped talking, she wouldn't eat, and she'd lay all day in her sister's bed crying. After that she had the stroke and was bound to the wheelchair and unable to speak or at times even feed herself. We would both laugh at the mess she'd make at dinner and she'd roll her head back slowly, look up at me and just grin. The Christmas after John died and my last Christmas working there, I met her at the mall. One of the nurse organizers or something had taken a group to do shopping. Margaret recognized me and her arms flew up and she moaned and tried to call out my name. I was with my mother at the time and as I gave Margaret a hug and wished her a merry Christmas my mom just looked on, smiling with tears in her eyes. "So, that is why you like working there" she said afterwards. While she herself used to be a NA, some 30 years previously, she could never understand why I chose the ECF over the SPCA or the Hospital. Now she knew.

Margaret was still alive when I stopped working there, but she died a year or so later. My heart broke all over again for her but I figure she was happy now, with her sister again.

Then there was Rose*, a frail 98 year old lady who weighed even less than that. She was on constant oxygen and couldn't walk because she didn't have the strength. Still every day when I got in I'd see her sitting in this huge overstuffed Lay-Z boy recliner by the nurses station, a blanket over her lap and a cup of tea resting on the table; though half the time it went cold before she remembered it. Rose was the sweetest lady, she would talk your ear off about anything and everything if you let her. I painted her nails a few times, she wanted something "different" and "wild" so we went with fuscia and lime green. She loved it. Her daughter was less than thrilled on me wasting time on such "juvenile things". Thankfully Rose's daughter didn't visit much even though she lived in town and when she did she was always rude to myself, her mother and the nurses. There was no pleasing this woman who kept insisting she had her mothers' best interest at heart.

It was about a year into my time there when Rose was in bed permanently. She was too weak to even be lifted out of bed to go to the chair in the hall and so I came to her. I sat for my whole shift sometimes talking with her, reading her articles from Readers' Digest and laughing with her at the jokes they printed. We ate dinner together a lot and always made fun of the "steak" which was just hamburgers.

• Rose passed away though, as I knew she would. And again I cried and mourned for her. It was different than with John but it hurt all the same. I was not invited to the funeral this time, her daughter did not like me or what I was trying to do for her mother. I was, after all, just a volunteer - and a teenager at that.
  Other things I remember from my time there:
  
• Dying one lady's hair bright purple. Her husband, when he came to visit her, LOVED it. He said it made her look like a plum and that he just loved plums. The lady adored it and made sure to tell everyone that it was me who did it for her.
  
• Having a snowball fight with one of the younger, though still old, residents.
  Wheelchair races down the hallways which irritated the nurses and got me in trouble more times than I can count.
  Bingo nights.
  
• Church services, many of the residents were Catholic - old school Catholic. The women, a lot of them anyway, wore head scarves and many of the men that were able to and were of Irish descent stood behind the women flanking the little chapel room. The reason for this will be in a subsequent post.
  
• Halloween, dressing like a clown and passing out candy.
  
• Christmas, dressing up like one of Santa's elves and giving out candy canes.
  
• The doctors who thanked me for working there when I didn't have to.
  
• The look I'd get when I'd take time to play a game of cards, or Scrabble, or Monopoly or just sit and talk with a resident. That feeling that you're making this person incredibly happy is/was the best feeling in the world.
  

Some of the things that grieved me while working there:

• Families who behaved as though visiting their relative was a burden on their oh-so-important time.
  
• Nurses who didn't care that one lady had to use the toilet so bad she was crying. The nurse, after all, was on her lunch break and the lady would have to "F-ing wait".
  
• Nurses who yelled at me for racing wheelchairs, saying it "upset" the residents who were all getting a huge kick out of it.
  
• The hair stylist who had to be convinced every time that it didn't matter if it was "normal" for an 89-year-old lady to dye her hair blue, the fact was she WANTED it blue.
  
• Other volunteers who were loud, obnoxious, rude and uncaring towards residents.
  
• Deaths of those I considered friends.
  

The last thing that really upset me was my last Christmas there. We were given Christmas stockings to put up in the resident's rooms and the nurses would go around at night filling them with stuff. There was only one lady in the whole facility which housed over 1,000 residents who was not allowed one. She was severely mentally handicapped and very disfigured; her head was quite large and malformed. My mother said it was hydrocephalus but I don't think it was. Her arms and legs were like this as well, very large and the only thing I could compare it to in brief would be the Elephant Man though without the skin growth that caused the deep ridges. She had a small face, but a very large prominent forehead and skull which probably measured from her eyebrows to the top somewhere between 8 and 12 inches and that's being conservative. The only word she was able to speak was "Mummy". She understood you perfectly, but she could not say anything except that one word. Very sweet lady though I did not get to spend a lot of time with her.

Now as to why she was not allowed a Christmas stocking. Her daughter and son-in-law were Jehovah's Witnesses. The resident however, was a Christian. The daughter would not permit her mother to have a Christmas stocking because it went against her (the daughter) faith.
I think out of everything that I saw this angered me the most. When myself and the other volunteer were pinning the stockings to the wall of this woman's roommates areas, she laid in her bed and cried while asking "Mummy? Mummy? Mummy?" and weakly pointing at our box. I admit it, I cried. I felt so angry and so hurt at the same time. Angry at the daughter and grieving for the woman. How dare someone push their beliefs on another person just because that person cannot articulate precisely her feelings. How can that daughter sleep at night, knowing she did not permit her mother a simple Christmas stocking? Something completely unreligious all because it happened to do WITH Christmas which she (the daughter) did not celebrate. How dare she?

I took my questions to our boss, I told her it wasn't fair. I told her it was cruel and plain stupid. That a stocking had nothing to do with Christ or anything, it was just a tradition. The boss, who understood, couldn't do anything. It was hopeless. Everyone else in the room had a Christmas stocking and Christmas lights over their bed, everyone had a small Christmas tree on their night stand except this woman. I was so angry, I still am when I think about it. How absolutely ridiculous?! How stupid?! It was just insane, to me, to let this happen. I wanted so much to staple a HUGE stocking above her bed, I wanted to plaster the words "Merry Christmas" on her window, I wanted to ... I wanted to yell at her daughter, scream at her, tell her how stupid and cruel she was being but - what good would it have done? The ignorant seldom listen, they just continue being ignorant and make others suffer for it.

My time at the ECF ended in 2004 before my 3rd year there. I have always wanted to go back but now I live 4 hours away so I can't. It wouldn't be the same. John, Rose and Margaret wouldn't be there. There would be others though, I know that for sure. There is always others. And while many are victims of families who won't or can't look after them properly, I know that many of them are lucky to be there. As the population ages and health care is slashed and hacked at by the government so many of our elderly are finding themselves homeless at an alarming rate. Public housing, low-income housing, extended care facilities all being cut and some just can't make ends meet.

In other cultures, the elderly are treasured for their wisdom and experience. In some countries, they move in with the eldest son or daughter (if there are no sons) and are cared for and respected. It seems to be that the majority of abuse that happens to the elderly (while not the ONLY source of abuse) seems to occur in our Western civilization; our 'developed' countries and our 'more advanced' countries. Perhaps, instead of focusing on advancements that lead to new T.Vs, better movies, more entertainment things we should be looking inside and helping advance our ability to deal with other humans on a better level. Perhaps we should look inside and start trying to fix whatever is in us that is broken.

I can understand why Neonatal Doc felt the way he did, ECFs are depressing because they are filled with people who know there is no where else to go from there but to the grave. They know it's the last stop. Many of them have relatives who don't want to see them, who don't want to visit them, or who are "just too busy". Many of them are depressed over the loss of their independence, others are just depressed about getting old. I wasn't surprised to hear that one of the highest percentages of suicides in our country is of the elderly, that alone should tell people something needs to be done.

So much money has been pooled into children's hospitals, treating birth defects or disease, helping babies and children - why not the elderly? Is it because of the same tired old stigma that 'they're so close to death, it'd be a waste of money'? Are we really ready to start treating people based on the amount of money it would take? Is that what we're going to start basing our care on, on whether it would be a 'waste of money'? I can think of many other 'waste of money' cases than elderly - and many wouldn't like my answers.

It just really makes me sick to think about it - they are old, not dead. They are still people and they should still be treated with respect despite any and all issues they face. Yes, it's not exactly pleasant when someone looses control of their bladder, or can't get to the bathroom in time or can't feed themselves but you know - we're all going to be there one day if we don't get taken by other means first. And when that time comes we're going to be sitting in their spots, looking out the window, waiting for our family to come visit us...patiently...waiting. Hoping. Praying. That they'll remember us. In the end, all we have is family and community. If one fails the other has to pick up the slack but in this case - both are failing and the victims are present are our grandmothers, our grandfathers, our parents, our uncles, our aunts but in time we will all be victims if something does not happen soon.

I got more out of my 2 years there than I did doing 2 years of daycare. Children cannot appreciate your hard work, they expect it (and so they should). But the elderly, those who know you don't HAVE to visit them - that is where the rewards are. That is where you see the difference and feel the change in yourself and in them. I am not saying do not care about children, all the more reason TO care about them, but do not care JUST for them - if you love only those you know who are you helping? No one. Instead, reach out - love those you don't know, cherish their life and make it a mission to get to know them, to change their life even for just an hour.

Trust me - it is worth it and nothing on Earth can compare.

*All names have been changed, as well as some situations to protect their privacy.