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Words of Wisdom

Posted Oct 23 2008 11:39am

When you spend time in a nursing home the very nature of the patients you work with force you to confront mortality, both theirs and your own. My experience with Andy was a wake-up call. Even though I rarely enjoy being there, I made a promise to myself to not make the same mistake again and approach my work there with more enthusiasm.

This proved to be easier said than done. When any resident of the home is showing signs of psychological or psychiatric distress, the psychologist is called in to do an assessment and make every attempt to help the person. Common reasons the psychologist would be asked to do an evaluation include the resident reporting feelings of depression or anxiety, a refusal to socialize or take required medication, getting into arguments with staff or other residents or if the resident is showing signs of psychosis or dementia. If the resident has no family (or even worse, a family who wants nothing to do with him) the state will often take on legal guardianship. This translates to the patient getting help whether he wants it or not, because his behavior can be disruptive to the other residents and staff. This is analogous to child therapy, where if the parent insists, that child is coming to the office regardless of level of interest or involvement.

I seem to be a magnet for residents who have little to no interest in my help. Agnes had been on my caseload for about 12 weeks, and I was basically her personal litter box. Over the course of three months, I had been labeled an "ugly Cracker," been spit at, been spit on, been physically threatened with a bedpan, and told that my family will rot in hell if I come back next week. Of course, I did indeed go back to have the prophecy fulfilled and I was called a string of profanities that go beyond the decorum of this story.

After the vulgarity attack I decided that enough was enough and that I would cease mental health services for her. I told the director of the nursing home - a large and intimidating man - that I "would no longer be subject to such extreme castigation." I considered using the word "vituperation" to really drive home my point, but I was so nervous that the director would say no so I couldn't remember what "vituperation" actually meant. Fortunately he agreed and Agnes was no longer subjected to my help.

It wasn't her fault. Agnes was not like the people you read about on this site. She was psychotic and showing various signs of dementia, believing that anyone and everyone is out to get her. As we learned, people with extreme mental illness such as this generally require psychiatric medication, and even that would not have complete effectiveness. One of the harder jobs of a mental health professional is coming to grips with the sad fact that you cannot help everyone, that there are definitive limits to what can be done. To make matters worse, the psychiatrist had recently quit and, until the nursing home hired another one, all the psychologists were working against the patients' biology.

So when I left the director's office I felt that pang of failure, that helpless feeling that comes with not being able to accomplish something because it is out of reach. This got my thoughts running wild:

This sucks. Psychology is stupid. Getting old is terrible. People get depressed because the world is a horrible place and a nursing home is simply a symbol of that.

However, we've seen that perception and reality are not one in the same. A great example of a healthier perspective on nursing home life is a group of men I refer to as The Wild Bunch.

The Wild Bunch are five men, all in their 80's, who have been in the nursing home for many years, much longer than I've been working there. Even though I think the place is inherently depressing, they couldn't disagree more. All day they play cards, watch movies, bet on sports, sneak in alcohol now and again, and even race their wheelchairs down the hallways despite the nurses' protests. I'll sometimes sit and watch them play dominos while discussing whether Jane Mansfield or Marilyn Monroe had "the better rack," all the while wondering how they are happier than many of the clients in my private practice who seem to have it all. When I ask one of them, he will always impart the same wisdom that I still have yet to fully grasp:

Why wouldn't I be happy? I have everything here. I have great friends and leisure time. All of my needs are taken care of. The staff helps me when I ask, I don't have to worry about money, and although the food isn't great, I could certainly be in worse places.

"Jesus, like where?"

Kid, I could be homeless, in a hospital bed, in hospice dying from cancer or even in a house with a wife who hates me or a family that doesn't want me around.

"Do you ever think about dying?" I ask.

Sometimes, but not much. Every day is great, and of course someday that will end, but thinking about it and worrying about it isn't going to change that. And who knows, maybe things are actually better on 'the other side.' I don't waste time on what I can't control. A good-looking kid like you needs to let that sink in.

Yes yes, I am good-looking! But, more importantly, one of the Wild Bunch hit the sweet spot, the ultimate way to live life: don't waste time and energy on what you can't control. I couldn't 'fix' Agnes, I can't fix a lot of people. There's a lot, a whole lot in life that I can't control. The irony of that is when I embrace that fact it mobilizes me to govern what I can. So instead of focusing on the people that can not or will not be helped, I turn my attention to those who can benefit from me.

The men in The Wild Bunch are the ultimate example of making a great life with whatever you are given. Regardless of your situation in life, take a lesson from them. They are truly therapeutic.

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