During an early part of my social work career, I worked as the unit social worker in a skilled nursing facility for older adults with Alzheimer’s/Dementia. The challenge that I faced every day was how to bring dignity and worth to the forefront of our care, when so much of that dignity had been stripped away by this disease of cognitive decline. It was a fine line, balancing quality of life and security. Too far in either direction could lead to injury. Admittedly, I tended to favor quality of life. I rallied against restraints, over-medication, and childish busy aprons and dolls. I lobbied for free spaces for safe wandering, holistic assessment, and meaningful recreation. Over the years, I was blamed for occasional falls, complicated care planning, and crazy activities that pushed the bounds of comfort. This journey takes place on one of those crazy activities.
I had a group of women, all of Polish background, who sat together daily and chatted repetitively about what they were going to cook for dinner, when they would leave to go home, and how they were going to get there. The unit staff would get nervous when they started trying to jump on the elevator, and attempts at reality orientation and reminding them “this is your home” were met with angry refusal. I didn’t buy in to this method, and had been trained instead in validation therapy. In other words, I met their stories where they told them and tried to validate the feeling and meaning rather than correct their facts. This created some tension on the unit.
I had a bright idea one day: we would plan a trip to the Broadway Market (a local collection of grocers in the old Polish neighborhood of the city) and secure enough 1:1 volunteers to insure each resident had a safe escort. I secured permission from families (some of whom were escorts) and got my volunteers lined up. My colleagues thought I was crazy. I wasn’t, but I was blissfully naive. The day of the trip, all my ladies were dressed in their market clothes, but several of my volunteers didn’t show up. I didn’t want to turn anyone away, so I took two people and another colleague took two people; the rest remained 1:1.
We got in the bus and drove, getting dropped off at the front door where we would be picked up in an hour. It wasn’t until I was in the midst of the crowded market that pre-Easter week that I realized I was indeed pushing the envelope on the safety issue. The place was packed, my residents were over-stimulated and my volunteers were nervous. I huddled everyone together and said: “just let them lead, but do not let them out of your sight.” My 1:1 volunteers fell into line and started having fun.
I had a busy journey, chasing after one of my two women who decided she wanted to find her old home. As we journeyed through the market, it wasn’t my own clinical skills that rescued the day for my distressed client. It was my other resident who caught her friend by the hand and said, “Barbara…you’re wearing me out. Let’s sit and have tea.” And suddenly, the journey shifted. I was no longer a social worker chasing wandering patients. We were three women who found a bakery, bought tea and cookies and sat sipping and people watching and laughing. Slowly and steadily on this journey, a miracle happened. Humanity surfaced. Another woman ordered six pounds of various sausages and cold cuts at a meat counter which her daughter paid for and took home, just for the joy of seeing her Mom spring into action again. Butter lambs were purchased, pierogi recipes exchanged, cookies bought and consumed to the last crumb. When it was time to board the bus again, they were happy and tired. I was the one who wished we could stay.
On that journey, I was able to see my clients as their own selves, fully immersed in their living at a time before a disease had stripped away their short term memories. They were shadows of the past in this world, living in that present moment through a past role that they once filled effortlessly. This was a conundrum of time: they stepped in to their yesterdays with grace, but I knew that by the next day…maybe even by dinner that evening…they would retain no memory of our trip. This was a journey in the present moment that could only be savored now. They were magnificent, and I deeply respected each of them in a newer and deeper way.
Then, I looked at their family members. One had tears of joy as she hugged me and whispered thank you. For her, this was a gift for the future, a new memory that would reside along with the challenges of this end of life process. I could not change the memory loss; I could only make the best of the present.
Sometimes, that is exactly enough.
A journey into the past, fully lived in the present, changing the narrative of the future. Not bad for a day’s work. I went home and fell into an exhausted heap, hearing only then all my fears about what could have gone wrong flooding through my mind. Those voices would have kept me from the adventure. But, naïveté saved me. We had all made our pilgrimage in a state of blissful ignorance and blind faith. I happen to believe that attitude serves us well much of the time.
This time every year, I find some sausage and pierogi and think of that journey as I cook it up for dinner. It’s hard to find butter lambs in Virginia, but I occasionally succeed on that, too. I thought I was just doing something kind and nice for my residents. But, I was the one who received a gift. It cemented into my spirit that dignity is the highest ideal, worth the risk even if only for a few moments.
Another small point of light for the journey….