Jennifer L. Promes is a gerontological clinical nurse specialist and Magnet Program director in Omaha, Nebraska. In this post, she describes an experience she had early in her career while working as a certified nursing assistant in a nursing home’s memory support unit.
Daniel had a kind, mild-mannered disposition, but because of his advanced dementia he would sometimes become agitated and belligerent, especially at night. Most of the staff didn’t want to help him prepare for bed. I knew Daniel was much more cooperative if you distracted him by talking about his past, so one night I volunteered to help him with his personal care.
All of the residents had just finished their evening meal and were waiting patiently at their tables to be assisted back to their rooms for the night. As I approached Daniel–a short, stocky bald man in his late 80’s with thick-rimmed glasses, always dressed in a button-up flannel shirt, polyester slacks, and square-toed, diabetic shoes—I could tell he was “working on something.” He had a table knife in his hand and was prying at the seam between the two leaves of the table. He was quietly muttering something under his breath as he worked, his head nodding as he grew more tired.
Daniel would “fix” anything he could get his hands on. A farmer in his younger life, he had many years of experience with problem solving. After watching him for about a minute, I told him that he’d better get to bed so he could get up early in the morning to feed his cows. Seeming to accept my reasoning, he put the knife down.
I pushed his wheelchair into the bathroom in his room and suggested he wash his face and brush his teeth before bed. Expecting an agitated response, I was surprised when he agreed to my suggestion. I thought it would be best to continue to engage him in discussion about his farm while helping him get ready for bed. As we talked he didn’t seem to notice me helping him onto the toilet or helping him brush his dentures.
I guided him back into his wheelchair, took off his glasses, and washed his face with a warm washcloth. As I moved the washcloth over his cheeks he looked up at me and said, “That’s warm . . . that’s nice.”
In that moment I looked directly into his eyes, which were more grey than green and had pretty advanced cataracts. I had the sudden impression that I could see the dementia in his eyes. Looking past the cloudiness of his lenses deep into his eyes, I found nothing but a dark empty blankness. It was as though he didn’t see my face in front of him at all—his eyes didn’t deviate from their forward stare. An eerie feeling washed over me, as if I were standing in the presence of a ghost.
In many ways I was: due to the dementia, he really was a ghost of his former self. But I knew Daniel was still buried deep behind those eyes, his personality locked away somewhere inside his mind. When we were lucky, we could still catch glimpses of his former self from time to time.
When Daniel stood up from his wheelchair, this was my cue that he was ready for bed. I helped him use his walker to take the few steps from the bathroom over to his bed. He plopped down onto his bed and I helped him slip his feet under the covers. As I pulled the blankets up over his body and tucked them under his chin, he quietly said, “Goodnight, Sarah.”
Gazing into Daniel’s eyes, I replied, “Goodnight, Daniel.” Then, looking up at the wall above his bed, I smiled at the picture hanging there.
I knew that the beautiful young woman in the picture was his wife, Sarah. Some days Dan would cry and talk about Sarah. Sometimes he would yell her name and tell her to help him with the cows or some other job around the farm.
I knew he loved her and had suffered a great loss when she left his life and I felt honored for him to call me Sarah. I knew doing so provided him a brief moment of respite from his confusion—a moment of comfort removed from his relentless dementia, a remembrance of his former self and the wife he so deeply cared for.