Fun and Games (or Connect Four!)

(Couldn't resist the continuation of the 4 theme... LOL)




For some reason a memory popped into my head this morning of one of my first therapy clients. So naturally, I decided to share.... :)

When I was a student, one of my term projects involved visiting the home of a disabled person to practice interviewing and building therapeutic rapport. The disabled clients were a group of spinal cord injured patients who, prior to their discharge from a rehab hospital, had signed up to take part in this annual project.

I knew that these willing participants didn't sign up because they desired to be part of the educational experience of young therapy students. And, I doubt that many of them relished the thought of strangers coming into their home to poke and prod into the tragedy that their life had become. They signed up because it was a great way to get continued, free therapy services. So as part of our project, we were to establish one goal that we would work on during our 8-10 visits. That way, the client benefited from our educated creativity (ha!), and we benefited by developing our therapeutic interaction skills.

My client was a young (20 something) African-American man who lived in an undesirable neighborhood of Philadelphia. He was quadriplegic, only able to control his head and neck with a bit of shoulder shrug function, thanks to a gunshot wound. And, he lived with his very supportive mother, girlfriend (also very supportive), and their two young children. I remember thinking to myself, "yikes, how am I going to connect with him?"

First things first, I needed to interview him about his injury. What a way to connect with another human, eh? Turns out there was an unbelievable twist to his tragic story. Embarrassed by my preconceived guesses, I learned that he and his girlfriend were simply stopped at a redlight, when a gunman approached the car and shot him in the neck. It was a case of mistaken identity-- the gunman thought he was someone else.

But the point that I wanted to blog about is the goal he expressed for our time together. He wanted to find activities that he could do with his kids. He simply wanted to interact in more meaningful ways with his children. (Sigh. What a lesson in humility. As a parent now, I think of how we jump through hoops to get our kids engaged in something for 30 minutes so that we can have some "me" time, and here’s a Dad who just wants to be more than a fun wheelchair ride through the house.)

We came up with the idea of card games and board games. His boys were about 6 or 7, so they were old enough to start playing the types of games that actually engage parents, too. And, his mouthstick hadn't gotten much use since inpatient rehab, thanks to the two very loving and well meaning women in his life. (They helped him do everything.)

So, I made a cardholder out of a hunk of wood, and charged him with the task of painting it. And we spent much of our time together playing checkers, chess, connect four, and various card games.

My greatest lesson? Engaging in tasks together is far more rapport building than any conversation. He knew that, but had such limited physical ability to do it. So, we both found new ways to connect with those we love. And, now that I'm a mother, I look back to that experience, and hope that he shared many meaningful activities with his kids.

Living History

(Part 3 of "Finding a Home in Nursing Homes")


(Photo by Jason Evans)

Though the nursing center is modern and current events are blaring from TVs, I was constantly reminded of the era that shaped the residents. There was a curious duality in the Octogenarians and Nonagenarians wearing Nikes and toting CD players. Those moments when evidence of their vintage broke through are some of my most treasured memories. I'll start with Milly...

Milly

Milly was a happy, fun-loving, easy-going woman who raised 8 or 9 children on her farm in rural Pennsylvania. She had suffered a stroke which left her hemiplegic-- with little or no function of her left arm and leg. We could bathe and dress her in bed easily, but she required two aides to help her stand and pivot into her wheelchair.

No one minded the interruption when called to help with the transfer. Because Milly was a joyful soul, with wonderfully contagious laughter. Actually, the stroke damaged her emotion control center, leaving her with emotional lability: inappropriate (often exaggerated) expression of emotion. When Milly laughed, everyone laughed, then Milly would laugh harder and so on. She was known to exclaim that she had peed because she was laughing too hard, which would require a change of her "diaper." So the regular aides knew to get the laughter out before finishing the bathing and dressing routine.

When I first met Milly, two aides were in the process of helping her into her chair and laughter filled the room. Something was said that inspired a great guffaw from Milly, which sent her dentures flying across the room! Naturally this resulted in more laughs and by the time we had her dry and seated, we all were wiping the tears from our faces.

At the start of summer, a young girl who was studying nursing at the local university took a summer job as an aide. Darla was African-american, and from the city. She clearly had the disposition for nursing, and was immediately accepted by the staff. So, at the end of her first day of training, we sent her to answer Milly's call light (Milly was an "easy" resident-- generally happy and not medically complex).

Darla shuffled down the hall and disappeared into Milly's room. Next came an ear-splitting shriek and we saw Darla backing into the hall with a mixture of shock, concern, and resigned amusement on her face as Milly shouted, "Help! She escaped! Send her back on the boat!"

After a moment of confusion (we weren't accustomed to hearing Milly angry or scared), Darla looked at us and we all erupted into laughter. It was a sudden reminder of the generational differences. Milly was scared. Because she had not been exposed to cultural diversity in her quiet, rural life.

By the end of the summer, Milly enjoyed Darla's care, and was sad to say goodbye when fall semester resumed.

Finding a Home in Nursing Homes-- Elizabeth

I was introduced to Elizabeth after a warning from my new coworkers. Several of the aides rolled their eyes and sniggered as my trainer said to them, "Oh come on, she's a very nice lady…. She just likes things done her way."

Elizabeth sat in her nightgown, one arm in a sling and her eyebrow raised as we entered one of only four private rooms in the nursing home.

"Good morning!" chirped my trainer.

"You're late," stated Elizabeth, but I noted a bit of a mischievous glint in her eyes.

I soon learned that Elizabeth expected help to walk to the closet, using her four-point cane, so that she could choose which silk blouse she'd like to wear with the dark slacks that filled her closet. She also had a particular order in which she liked her sponge bath to proceed. And the entire process took at least 30 minutes, a queen's ration of the 2 ½ hours that we had to wash and dress the 12 residents on our assignment. When finished, she sat in her wheelchair with a straight back, blotting her bright red lipstick and patting her coif into place. She smiled at me.

"You'll do fine, she likes you," my trainer remarked as we swept from the room.

Elizabeth had more grace and dignity than any other resident I had ever met in my career. Though the aides joked and called her "the queen mum," I detected a friendly undercurrent. They simultaneously hated answering Elizabeth's call bell and loved receiving her approval.

As months passed, I grew closer to Elizabeth. She warmed to me quickly when she discovered that I had graduated from the same college as her son. And she appreciated my gentle touch, when other aides were a bit gruffer (which was necessary with some residents-- much like the difference between a strict, but fair teacher and a warm, gentle teacher.)

Elizabeth's stroke had left her with right-sided hemiparesis: weakness in her right side. She wore a special shoe with a brace which was difficult to put on. It required massaging her foot and ankle to relax the abnormally high muscle tone in order to slip her foot into the shoe. Many of the aides got frustrated. It soon became known that a few of us were more adept at donning the shoe. So whenever possible, we'd be called in to help. When I was called in, Elizabeth would give me the "thank goodness it's you" look along with a scowling grimace and a fake bop on the head of the aide who was kneeling in front of her, intent on stuffing her foot into the shoe. I'd smile and take over.

But the real gem underneath the dignified exterior was revealed when one of my co-workers (my best friend at that job) began teasing Elizabeth. Her sense of humor reluctantly emerged as she felt more at ease with us.

One day, the aide who trained me, my best friend, and I were in Elizabeth's room. The trainer was telling us the story of how she thought her vacuum was broken.

"I attached the hose, you know, and it wouldn't suck! It would only blow, not suck!"

Elizabeth burst into laughter along with my friend and I, as a look of embarrassed surprise came over the trainer's face.

"Oh! I didn't mean it to sound that way," she exclaimed as she giggled. But Elizabeth just waved her off and laughed heartily.

And then there was the day that Elizabeth called my friend and I into her room, blushing and insisting that we close the door. She had a book in front of her, she'd been reading a romance.

"I have a question for you. What exactly is…" she paused with a nervous smile, then whispered, "oral sex, you know, for the woman?"

My friend, who thankfully was embarrassed by nothing, explained.

"You mean… the man… does that... there?"

She had a horrified look for a moment, then, "Oh… oh!" And she smiled, causing my friend and I to giggle like teenagers at a sleepover.

Elizabeth taught me that day that it doesn't matter what time period we live in, how sophisticated we try to be, or how old we are… we are all human. All the same. These withered, weakened bodies who had lived through world wars, gender inequality, and a culture that held family values higher than any generation since, were just like me. There was no reason to feel fear or shy when helping them with basic daily tasks. I could be in that wheelchair one day. And I wouldn't want to be treated like a mothball ridden relic either.

Finding a Home in Nursing Homes

The summer I turned 19, with aspirations of becoming a physician, I landed a summer job in a nursing home. I was a Nurse's Aide. Back then, there was no licensure or educational requirements. It was all on-the-job-training. And what training it was! (Especially for a teenaged girl…I'll share more about that later!) After college, I again worked as a Nurse's Aide to gather more hands-on experience before entering graduate school for Occupational Therapy (OT) . Finally, I began my OT career specializing in geriatric rehab. Since I have many stories and experiences to share, this will be an ongoing blog series.

Photo found on Flickr

The Experience

Many people shudder at the thought of nursing homes. They conjure sad images of frail people waiting to die and cold, sparsely decorated rooms. Reality often validates these impressions. But only on the surface.

Nursing homes assault your senses. The smell of cleaning products mixed with body fluids. The sight of people napping in wheelchairs. The sound of pain, confusion, and croaks for help. (Once a woman with a stroke-damaged smile pointed and shouted to me, "There! Do you see it?! A lemming!")

However, the hushed, depressive atmosphere and the sense that you are in a place between worlds are false. In truth, nursing homes are much more warm and familiar, fun and alive, and surprisingly comfortable. A visitor can't experience those depths. Let me take you inside.

In a way, working in a nursing home is like caring for 15 infants and toddlers at once. You scramble to:

• Wipe noses and wash hands.


• Help them stand at the sink to wash and dress.


• Soothe one crying in the corner while catching one trying to escape out the door.


• Mediate squabbles.


• Help people use the toilet (and wipe).

At mealtime, there are drink boxes to open, food to cut, and fork-fuls to be fed. And there's diapers! You feel like you are constantly changing diapers. Not to mention, there's always the threat that you'll discover the source of the unseemly odor too late, only to find an artist fingerpainting with poop. Naptime seems like a break, but you've got to make sure that each one has what they require to sleep.

But despite the work, most of my days ended with a smile and a warm heart. Why? Because working with adult-sized people is about more than meeting their physical needs. Each one has a lifetime to share and lessons to teach. History lessons (I've met several folks who were born in the 19th century!). Cultural lessons. And plenty of psychology.

A nursing home is a home-- an extended family. And nothing is warmer than that.



Elizabeth

One of my beloved "grandmothers" called me into her room one day. Elizabeth knew I was engaged, and had even met Jason once. She gave me a piercing look, set her lips firmly, and declared "You must have something blue with you when you marry." Then she handed me the embroidered handkerchief pictured below.

Months later she suffered a second stroke. The charge nurse phoned me on my day off to let me know that it was "time". I sat with her for several hours, the other aides joined me when they could spare a few minutes. She quietly slipped away later that night.

And I proudly carried "something blue" down the aisle six months later.



Next time, I'll tell you about another time Elizabeth called me into her room....
:)