I work on the Alzheimer’s and dementia unit of a skilled nursing facility. I won’t lie and say that I love my work. There are days when it’s all I can do to drag my carcass down the stairs, put on my scrubs, and drive in to see what awaits me on the floor. But who doesn’t feel that way about their job? Sure, there are a few happy kooks out there singing “Whistle While You Work,” but the rest of us are buying scratch tickets and playing Powerball. I don’t love my work, but I do love my vocation. I love the people I care for on the Alzheimer’s unit. I love every difficult, odd, impossible, combative, unique, amazing, funny, devilish, sweet one of them.
Still, it’s a tough old life being a CNA-cum-nursing student, and I’ve been asked many times why, at 42, I’ve chosen to make such a dramatic career change. I’m a professional writer. I’ve published two novels, I write regular columns for Q View Northwest and other magazines, and I was, until recently, the Director of the YWCA of Washington State University. Now, I help people to the toilet — confused people who often don’t make it and who then need a clean-up on Aisle 3. I answer repetitive questions from elderly women who can’t remember their maiden names or how many children they have. I remind old men how to shave, and then, when they’ve finished, I remind them five and six times that they’ve already shaved and so they don’t need to do it again. I help people get dressed, comb their hair, brush their teeth, cut up their food, clean their glasses, put in their hearing aids, stand up, sit down, walk, use the remote control, call their children, read the newspaper, and remember who they are.
A good part of my job is an exercise in Job-like patience. I didn’t know I had any patience at all until I began working in a nursing home. I’ve been pleased to discover that I have a good deal. My patience with the elderly is considerable. Once someone has reached his or her 80s, they’re like a book. Most are not thrillers or even histories; they’re short story collections. Sit back and listen. Enjoy. You’re bound to learn something.
The rest of my work is all about creative thinking. How do you explain to someone how to urinate? How does someone forget how to pee? What are the steps to take when you’ve got a man standing in front of the toilet, trousers open, waiting for you to tell him how to do something you always thought came naturally? A thousand bad ideas ran through my head before I turned on the bathroom sink and asked him to listen to the water and, sure enough, one flow triggered another.
When I face down a challenge like this, as small and as strange as it may seem, I feel that the subsistence wage, the long hours, and my tired back are all worthwhile. In training to care for Alzheimer’s patients, we’re taught that no matter what stage of the disease someone has entered, the person is always still in there somewhere. Because they can’t reach us, it’s our job to try and reach them. I’ve come to think of it as a kind of spelunking. If you look at scans of an Alzheimer’s brain and compare them to a healthy brain, you’ll find that the Alzheimer’s brain has both withered and developed cavernous spaces where memory and function used to reside. If the person is still in there, what can you do except spelunk in those caverns until you find them?
We have a tall, thin, difficult and combative woman on the unit — I’ll call her Ms. Firecracker. She’s ornery. She’s ill-tempered. She can curse like a stevedore. And yet what I find when I go spelunking for her is a woman who at 80-plus is just as passionate and strongminded as she must have been at 18. She’s fascinating and she’s funny. The thing about working in nursing homes — and this is probably true about working in medicine, period — is that we rely on gallows humor. People are funny and, in extremity, they’re funniest of all. Ms. Firecracker has a husband who’s about ten years her senior, and she’s as jealous of him as if he were George Clooney. When he comes in for a visit, the women CNAs and nurses have to be careful not to be too friendly to him or else we’re suspected of wanting to steal him from her.
Fortunately, Ms. Firecracker believes that her husband and I are related — cousins — and so I’m exempted from this international female onslaught. I’m allowed to talk with him and bring them both coffee when he visits. Still, even this relationship is fraught. Over the weekend, Ms. Firecracker tried to enlist me in a plan to murder her latest rival, one of my fellow CNAs. The idea was that I would supply Ms. Firecracker with some rope and a truck, then she’d tie up the CNA, drive her out to the woods, and leave her there for the coyotes. Suggesting that Ms. Firecracker’s 96-year-old husband might not be at the top of our 45-year-old CNA’s to-do list would do nothing to relieve her anxiety. Instead, I left it to her husband to reassure her that she was the only woman for him, just as she had been since 1935.
As crazy, and as funny, as this stuff sometimes seems, I take great comfort in Ms. Firecracker’s wild jealousy. When I look into her dark, serious eyes, I see the person she was nearly 70 years ago — young, uncertain, and very much in love. Undying passion? No need to think that the poets and Mark Sanford have cornered the market on that. Here’s a woman from Middle of Nowhere, Idaho who puts the Rossettis to shame. That she still feels so strongly about her husband is a wonderful thing, even if she expresses it in repeated attempts at criminal conspiracy.
Make no mistake, Alzheimer’s is a terrible disease. It attacks the very heart of who we are, destroying our mind, our thoughts, and our memories, but as it destroys, it distills. It seems to me that one of the things Alzheimer’s does prior to its final progression is reduce us to our basic essence. Who are we at heart? A lover? Then we’ll be boiled down to our greatest passion. A salesman? We’ll want to work the room, charming everyone. An intellectual? Then we’ll be reduced to some academic obsession or the need to teach one last, elusive lesson.
I have no regrets about my career choice. Working with Alzheimer’s patients has made me a better writer. I’d say that it’s made me a better person, but that would be egotistical and probably a lie. I’m just as irritable, just as flawed and foolish as ever. The difference is that I laugh more. I’ve always laughed a lot, but now I see the humor in just about everything. That’s the wisdom to be gleaned from working with the old, or perhaps it’s just my personality distilled.
The Hell You Say 