Start your day: an interactive exercise

Ok, imagine it’s 6 AM, and you have turned on your call light so you can request a pain pill. The door opens and….

santa hat

Now here’s the interactive part for you: Put Patty (see previous post) in this hat.  Then,  imagine the lights blinking. Then imagine that the hat is viagra-infused and stands straight up, flops back down, and stands straight up again.  The lights are still blinking.  Suddenly, music fills the air: “Have a very Merry Christmas!” the digital voice sings.  Blink blink. Erection. Blink blink. Erection.  Blink blink.

This could be a long day.

Resources

November 29, 2007

It’s hard to believe that today marks my two-week stay at OC. One of the joys of keeping a journal is being able to review events and thoughts, and see patterns emerge and personal growth take place. Without that record, I would be just like a June bug, taking off slowly and flying in erratic and wild circles until I bling against the wall and drop like a stone.  (I’d love to take credit for that analogy, but it really came from an Indian elder woman who mentored a friend of mine…).

At any rate,  I am taking stock now and beginning to think that I am strong enough and confident enough to leave here soon. I am even more amazed at how quickly the time has passed, even though I wasn’t exactly ‘having fun’.  I do bring with me some resources, however…hard earned personal strength which I’ve had to cultivate through a lot of personal crises throughout my lifetime.  And I am learning so much about personal resources here at Orchard Creek from the people who live and work here whose lives have been much more difficult than mine.  I’ve shared some of their stories in this blog, and some I have not, out of respect for anonymity—or because I simply don’t know their histories.  What I learned in AA, though, was to value the person in the present moment: it is the immediate moment which is important, not the past or the present.  The alcoholic asks only one question: do I take a drink now? And from that I’ve learned that it is today’s challenge which is the only important challenge for anyone.

My new neighbor across the hall is having a difficult time with this concept.  She did not want to be left here this morning after she was dismissed from the hospital, and the explanation that her stay was only temporary until she was strong enough to go home was not acceptable to her.  She refuses to eat and sits in her room with the door shut except for a moment of panic when her television failed.  The ever-polite support staff tries to comfort her without accommodating her resistance: it will be interesting to see how the issue resolves itself in the next few days as it becomes more clear that getting home is her responsibility and not someone else’s fault.

 “Miss!”, she shouts. “Nurse! Hey! Miss!”

I shut my door, and go back to my reading.

Finding the personal resources to meet physical wellness responsibilities is the hardest part of being here.  Watching my fellow patients’ daily struggles teaches me about strength and courage.  Beside me this morning in therapy, Al mutters “I don’t know why I do this.”  I am shocked—this crusty old man who wisecracks and jokes  his way through leg lifts and rubber band pulls has just complained a little, and it fills the room like a sour smell. But he continues, and today he knows why he kept going: his card playing buddies trooped in here for lunch and a game of euchre at a nickel a point.

Al has his cards; I have the internet.  Today I did some more Christmas shopping, answered a ton of emails, paid bills, booked a leadership training program for January, and wrote the poem and designed my Christmas card.  Bobbie brought me a mushroom-Swiss burger from Sleder’s Tavern, along with some spectacular onion rings, and Lisa-the-Wonderful brought laundry and mail.  I could dwell on the fact that I’m missing Chuck Ebert’s birthday/retirement party in Washington, DC this weekend, and feel sorry for myself.  But I am not going to.  I think I’ll take my walker for another spin, head for bed, the latest Alexander McCall Smith mystery, and the last of the Frango Chocolates.

Christmas Card

I’ve been exposed!

 

Yikes!  Everyone on the  OC staff seems to have discovered this blog, much to my dismay.  Well, after thinking about it, I am not really all that dismayed—it’s just easier to have an audience whom you don’t see every day, as opposed to the nurses, aides, and therapists who are my constant company.  But after thinking about it, I decided that just because my cover is blown doesn’t mean I am going to change anything I might write and clearly the supportive reception I’ve received from my readers indicates that they are not offended or threatened by anything I’ve said so far.  In fact, one administrator said, “Your blog is an opportunity for us—we so seldom get feedback from our customers (patients).”  Of course there is feedback…most patients in this unit seem very positive and always have a ‘thank you’ for any form of assistance, however small.  On the other hand, most of the residents aren’t going to fill out a Customer Satisfaction Survey, either…and like most service organizations, the complaints management hears are from the discontented, not the satisfied.

So OK, exposure is not so bad, even if I’ve always been a behind-the-scenes person.  Here in the world of healing bodies, exposure takes on a different sort of meaning—it means ‘no physical secrets’.  None.  Lynn was here yesterday and quite amused when an aide came in and asked, “How many times did you go to the bathroom today?”  “OK,” she said, scribbling on her clipboard. “Any bowel movements?”

Sheesh.  Good thing Lynn and I are friends.  I don’t have many secrets from her, but this was kind of a new level of intimacy….

There is a delicate line, I think, between the acceptance of the body in its functional aspect and a patient’s personal dignity.  Here in the confines of a nursing home-physical recovery setting, there can be no false modesty: withholding information from a caregiver is not a good idea.  On the other hand, the caregivers are most respectful of personal boundaries: they knock when your door is closed, cover up your exposed body parts whenever possible, and adjust your clothing to protect your modesty. Sometimes it’s even laughable: this morning I found myself lying on my bed, naked from the waist down, while the nurse clipped the last remaining staple out of my butt and carried on a discussion about online Christmas shopping.  The incongruous scenario continued during my shower, when Patty dried my back and discussed the computer printer sale at Wal-Mart, and how she was going to buy one for her son for Christmas.

The point here is that one’s body is considered objectively, even scientifically, while one’s dignity is valued and respectfully maintained as much as possible, given the circumstances.  The caregiver sets this tone, and it is up to both sides to maintain the balance. 

It’s been a long day today, beginning with the nurse remarking that that last staple in my rear end was “officially the most difficult staple she ever had to remove”, through a fairly strenuous workout this morning, a couple of friends visiting (bring chocolates!) to these middle of the night moments, when I’ve just asked for a couple of pain pills (see ‘fairly strenuous workout this morning’) and now it’s late and quiet in the hallway and I feel sleep settling down beside me, at last.

Missing Kathleen

November 27, 2007

It’s cold and snowy out there today, with gray skies and a temperature that doesn’t climb above the mid-thirties all day long. People come in complaining about the biting wind and the slippery roads, and visitors are at a minimum all day long. From the dining room I can see the paved trail that winds through Lelanau County, and there are only a few hardy walkers around noontime who brave the snowy, slippery pathway. They are dressed in garish colored spandex, making not only a fashion statement but also a safety statement: it’s deer hunting season and the amateurs are out shooting cows, dogs, and each other.

We’re safe and warm here, though some of us are a bit saddened. I guess I hadn’t written about my friend Kathleen who lived across the hall from me when I first arrived here. When I first came here I was in a lot of pain, and spent most of my time in my room just surviving. About the second day, Kathleen came over in her walker and introduced herself. She was warm and friendly, sympathetic and welcoming. “Come on down to dinner,” she said. “You can sit with me and I will introduce you to everyone. It can be kind of intimidating when you first get here.”

I didn’t go to the dining hall for the next several meals—intimidation might have been a part of the process, but mostly it was just the constant knife-like jabs in my right hip. Sociable I was not.

Kathleen asked me to join her a couple of times again, and finally one evening she said, “I really want to do this. I am going home tomorrow, and I don’t want to leave you stuck in your room with no friends.” Now if you know me, you know it’s been a long time since I felt intimidated about walking into a room full of people, but Kathleen was so friendly and so insistent, I gave in on the last morning she was here at O.C. and made the long journey down the hallway in my wheelchair.

She was good as her word: she made a space for me at ‘her’ table, and introduced me to Marmie and Irene, and we had a good old gossip and critique about the oatmeal and the under-ripe melon. I came away relaxed about my dining companions and sorry that Kathleen was going home before lunch. But I also found that she lived about a quarter of a mile from me, and she said, “When you escape from here, you come over and visit. We’re neighbors!” I’ve sat at the same table, in the same seat, ever since: that was Kathleen’s legacy to me.

Her full obituary was in today’s paper. I quote it here because it’s proof of what we already knew: “She was well-known for her loving, charismatic personality and her presence would light up a room. Kathleen had a love for music and dancing, in her earlier years she was recognized for being an extraordinary dancer; she was called the jitterbug queen. Her fun-loving, vivacious personality was admired by everyone around her. Kathleen loved people and had a passion for helping and giving to others.”

The other thing I will remember about her is that she was always dressed well, with matching accessories and manicured nails. Every morning she would ask for help with her make up: she had Parkinson’s Disease, and couldn’t quite manage the touch of color she put on her lips and cheeks. The staff didn’t mind helping her—it was just a few seconds of assistance for a woman who took pride in her appearance despite what her body was telling her, and who was very pleasant and always thankful for their help.

Kathleen was home for Thanksgiving. That’s what she wanted—to be with her family. But it saddened us all, losing her so quickly.

On a brighter note, this place is decorated for Christmas. Just a few low key items, but a tree here and there, and a wreath. Yesterday morning my friendly aide Patty greeted me at 6 AM with a cup of hot coffee, wearing a Christmas tree hat “I’ve got a bunch of them,” she says. “It’s time to bring them out. You gotta have some fun in life!”

Patty in the Morning

Partners

November 26, 2007

Partners

Sarah left this morning, taking the early flight back to DC. It’s been delightful, having her here—we are good friends, better than I could have ever been with my mother, and we share many personal confidences. I don’t mind asking her to do my laundry, or scrounge through my underwear drawer, or pick up some toothpaste. I don’t ask for help easily, even when I know people want to be of assistance. I’m not sure if my reluctance is driven by privacy, independence, or false pride, but whatever it is, being in a nursing facility exacerbates the problem. When I first came here, I was really helpless: someone had to lift my legs up for me to get in and out of bed, and I needed help getting to and from the bathroom. I would lie for a long time needing pee, reluctant to ring the call button. Mercifully, I’ve learned to become pretty independent, and even last night when I spilled a full cup of ice water into my bed at 2 AM (don’t ask) I managed to take care of the ugly mess and get back to sleep.

It’s a delicate balance between the need to be independent and to know when (and how) to ask for help. I don’t do it gracefully sometimes—well, frequently. For instance, tonight I wanted to leave the dining hall before everyone else. Since I am in a wheelchair, it’s not always easy to wend my way across the crowded room filled with people and littered with their various walking devices. I thought I saw a clear path, though—doable if I just backed my chair through the space and out the door. Well, let me tell you, backing up is not a competency of mine, either in a car or a wheelchair. So first I backed into Jean, causing her to dump some cranberry juice into her beef stew. Then I caught the leg gizmo of my chair on the walker of some other patient. Finally, with an exasperated sigh, the cook came out from behind the steam table and pulled me back through the narrow opening. Once in the hallway, I was fine…I can do a straight path forward down a doublewide hallway. But needless to say, I am sure everyone was glad to see me go, in all my graceful glory.

Now I can ask Sarah for help when I don’t seem to be able to ask anyone else. It’s probably easier because I’ve had so many years of practice—she’s helped me through a couple of cancers and a major health collapse, and we lived together for more than 25 years. Sarah is ‘family’, as is my son and his wife, in the truest sense of the word—and that in no way diminishes the importance of my friends who support me and whom I dearly love. But what’s interesting to me here is the role that the patient’s family plays in the nursing home dynamic. I always had mental pictures residents of a nursing home as abandoned, lonely, drugged and lethargic, waiting out the days.

What I find here, in many cases, is a real partnership between the patient, the facility and the family. At least two residents have family members who join us at every meal. EVERY meal! It’s not unusual to find a daughter helping her mother through physical therapy, or a husband learning how to help his spouse do rehabilitation work after a stroke. I greet these familiar faces just as I do my fellow patients, because they are in fact important partners in our community here. But I am also learning that for all of the instances where family does play a crucial daily role in strengthening the patient, families can also greatly contribute to the stress and anxiety of the nursing home resident. My friend Mary C. is in her mid-eighties, and lonely for her home. She is very focused on getting back there: it’s an obsession with her. In therapy she always does more than asked, 30 reps for every 20, and sissy squats that would put the ladies at Fit for You to shame. She wants nothing more than to have everyone say, “Mary C., you are OK!!! Get outta here!”

At the heart of the problem, Mary C.’s and others, is the family. Family dysfunctions (and everyone has ‘em) don’t disappear when there’s a difficult group decision to be made about a senior family member. In fact, one study which I read tonight said that over 30% of the time when a family expresses anger and hostility toward a nursing home (“Mama isn’t getting enough therapy.” “You are neglecting Papa.”), the real issue is family dysfunction which manifests itself in blaming of the caregivers. I haven’t seen much of that here, and I think it’s probably because there is so much inclusion of family in the nursing home setting. I’d guess there’s a counseling service for families, as well: I know there’s a social worker on staff here who asks some pretty thoughtful and probing questions of patient and family alike upon admission. But in one case I know of here, there’s a son and a daughter arguing over their mother’s future. They can’t agree, and as a result the resident has real anxiety and depression—there’s no real guidelines for what the next steps are and, it seems, no real advocate for the confused parent.

In my own family there was ambivalence about my coming here: my children thought they should be caring for me, and that there was some sort of weakness in engaging someone else to do the job. I think we are all comfortable with it now: this is a good place for me to recover. And through the decision-making process we have all been learners in how to communicate with each other and—hopefully—how to reach consensus when the time is right. In some families reaching consensus is not a common skill; these families are battlegrounds and adversarial relationships are the order of the day. As a result it is the parent who is the victim as she sits and wonders when, if ever, she can go home again.

Lemme outta here!

Sunday, November 25, 2007

Lemme outta here!

That’s not me speaking, despite how I sounded in my last post. That’s James, who is in a room down the hall from me. James a shortish man who may, in fact be younger than I am. In his day, he was a respected professional. He still dresses like an LL Bean poster boy—navy blue down vest, jeans, crew neck shirt, deck shoes. He seems to get around fairly well, too—sometimes he uses his walker, and sometimes I hear his shuffling steps as he paces unaided down the hallway past my door.

My room is the last room in the hallway, the one right before the exit door to the outside—which is why James keeps coming to this end of the building. He thinks nobody can see him when he gets to the alcove where the outside door is, and if makes it to this safe harbor he can make it outside. Of course he can’t, but that doesn’t stop him from trying, over and over again:

Beep beep beep beep beep….crash.

“Damn.”

‘James! James! Where are you going, buddy?”

“Home. I need to go home for a couple of days.”

“James. I keep telling you, that door doesn’t work. Come on back to your room now.”

“I need to get some clean clothes.”

“No, James, you just put on clean clothes this morning. Come on back to your room and I’ll show you all the clean laundry in your wardrobe. Come on, now.”

And away they go, back down the hallway, James and the nurse. She’s always patient with him, always kind. And James is pretty docile, when caught and redirected back to his room. The problem is, he’s stubborn and when the wanderlust hits him, I know he’ll be back past my door, trying the same thing over again, and always with the same results.

I’m sure James was a good lawyer in his day, before the stroke. He’s smart like a fox, and persistent. He doesn’t take no for an answer, either—within a few moments he’ll be back, doggedly trying to guess the combination, or even weasel it out of someone he thinks should know it:

“This combination is five-five-five-five-five, right?”

“Sorry sir, I don’t know the combination.”

“Well, would you try it? It doesn’t seem to work for me.”

James is an obvious lesson for all of us, of course. It’s the old proverb, “if you keep doing what you’ve always done, you’ll get what you’ve always gotten.” Yes, he gets an ‘A’ in Persistence. But he’s not doing so well in the ‘creative problem solving’ department….which is probably a good thing. It’s cold out there, James, and snowy, and a pretty long walk home.

Wasteland

 

Friday, November 23, 2007

It probably isn’t going to surprise anyone that I am bored to within an inch of my life. It’s not that there are not busy schedules and things to do, or that just surviving my body’s limitations is a time and energy-consuming activity these days. Figuring out how to pull my sweat pants up and how keep the fitted sheets from slipping off the plastic mattress: these events demand time and energy and resources. However the engagement between the task and my mind is pretty superficial, and I find myself murmuring little encouragements to myself. “C’mon, Judith. Find the little pants-puller-upper gizmo (Bet even Terry doesn’t have one of these…) and hook it over the waistband. Now snap it shut. Ok, pull.” And then after a while I answer myself, “You can DO this. Just take it easy. You are not coordinated in the best of times, go slowly.”

And there you have it. Problem-solving conversationalist, that’s me! My dinner conversation is just as stimulating:

“Is that supposed to be fruit?”

“Not much snow today.”

“May I help you cut that?”

“The name’s familiar, but no, I don’t know her”

Later, Sarah comes to visit and talks about how everything is at my house, how much the dogs miss me, and how she’s coming on redecorating her new home. After she leaves I hear the tv game shows filtering through every door, louder and louder as people remove their hearing aids and settle down for the night. I check my email one last time and climb into bed, adjust the blanket, and stare up at the ceiling fan and the sprinkler heads dotting the walls.

Inertia settles down around me like a hot, wet blanket.

At least I have internet access and a laptop. When I first made inquiry about coming here, we asked about internet access. “None,” they said. “Our patients just aren’t the type to need it.” “Well, THIS patient needs it,” I fumed, and promptly set about getting a wireless modem though my cell phone company. Fortunately, it works very well, and I can prop my Vaio on my tummy and blog, surf, and work to my heart’s content.

Granted, most of the patients are not, I suspect, great surfers and e-mailers. The irritant in the reply is the presumption of ‘our patients’…and it extends to more than just internet access. The presumption seems to be that we seniors don’t have a brain, or at least we don’t have a brain that needs care and nourishing and demands some respect. It’s ironic that a facility dedicated to healing does not think of mental and spiritual healing and sustenance as well. What passes for mental stimulation is the soporific of television…which is everywhere! In every room, hanging on the wall of the dining area, in the ice cream parlor, in the lobby.

Now my dislike of tv is pretty well known, and I am not happy when I am relegated to having no other choices for information and entertainment. It’s not that I want to be provided with free broadband access or some such—I’d just like the availability of a choice. A newspaper in the morning, for instance. Some good magazines in the lobby. A lending library. Some board games. Some digital games with good sized screens and keyboards for slow fingers.

Technology can certainly be used to provide more intellectual and spiritual engagement at very little cost. But so can just plain ‘attitude’—a movie discussion group, spiritual enrichment programs like guided meditation, tai chi, an internet station in the lobby.

Marian, my current dining companion, is a case in point. Marian has lived in Traverse City all of her 80-plus years, worked at the State Hospital, married a local boy, and has a large assortment of children and grandchildren. I am really enjoying the history she brings into my day. She remembers Saturday morning films at the State Theater, and knows much of the local perspective on our community events. I look forward to talking with her, whenever the television isn’t blaring during meal times preventing even the most superficial conversations.

But generally, between the noise of the TV and the emphasis on body healing in the most programmed sense, one’s brain begins to atrophy—at least mine seems to. It would be far too easy to retreat into my own world as a barrier against the noise and the daily organization of food, baths vital signs, and toilet habits. And sit at the dining table, staring at my empty plate, impervious to the voices of FOX TV.