Working with elderly people is a balancing act. Sometimes it feels like I have a facility full of grandparents, all prying into my personal life and kvetching about the everyday things that grandparents do (mail not arriving early enough in the day, why would a pretty girl like me get tattoos of all things, remote controls have too darn many buttons these days). Other times I see them as patients, as boxes on my run sheet (that's the sheet each aide carries around that tells us who we're responsible for that day and what they will need) that I'm never going to have enough time to check off.
Right now I do both home care and facility work, which is normally a nice balance. With home care, I get to spend one-on-one time with my client, and see him or her in their own environment. I can make sure that they have clean clothes to wear, or learn to recognize their children by the photos on the walls. At the facility, I get the faster pace, the medical environment, and the teamwork.
Usually it's reasonably easy to balance all this, and to try to see my clients as somewhere between the meddling grandpa and the low blood pressure number. I try to keep their diagnoses in the back of my mind when conversing with them, and check up with them without making it feel too much like an evaluation. I deflect the personal questions with my stock answers ("When will you have children?" "When the stork gets my address right!") and try to come up with ways to get the shy new resident to let me bathe her or the cranky old man to get out of his room and join in life a little more.
However, Jimmy is both my home care client AND a resident at the facility, and it's hard for me to leave him behind when I clock out at the end of my shifts. I happen to know Jimmy's family, and have for years, long before I ever began caring for him. And Jimmy has Alzheimer's. When I'm falling asleep at night, I have to force myself to stop mentally calculating whether Jimmy got enough protein to help him recover from a wound he is healing up from, or trying to come up with ways to help him remember the things he wants to remember. At his dinnertime, on my days off, I hope his aide remembered to escort him to the dining room. And when he declines, reaching a new stage in his disease, unraveling a little further, I feel weighted down imagining the tangled synapses in Jimmy's brain and trying to understand what the world must seem like to him these days.
Jimmy is the first client I cried in front of. Jimmy's wife is dying, and because of his memory loss, he doesn't remember this. I told him both of those facts: your wife is dying and you cannot remember it. I asked him if he wants to be reminded of it or not, because maybe it would be easier to not know. And I cried. Jimmy said he does want me to remind him, as many times as it takes, so I did. I've probably told Jimmy 20 times that his wife is dying, and I've cried a lot of those times. Because every time I tell him, it's the first time all over again. And it hurts him and surprises him and he reacts differently depending on the day. Sometimes he asks why no one told him this before, and I explain that I have, and that he's asked me to make sure he knows about it, which is why I'm telling him now. And I ask him if he wants me to tell him again, and he says yes. So we've continued for a few months now.
This week, though, I think it's time to stop telling him. I offered him that option, the burden of that knowledge, when he was still present enough to make an informed choice. But I can see that has passed. Jimmy isn't the same as he was then. He's deteriorated further.
I was hoping it was an infection, something that would be reversible. I collected samples from Jimmy and pushed for him to go see his doctors. Some days now he resets so frequently that I haven't finished answering his question when he asks it again. He refuses to eat, staring balefully at nothing, and I know, I know he doesn't know why he feels compelled to be contrary but he just can't help himself. It sucks. Jimmy is currently a man who cannot take on any extra responsibilities. So I'm not telling him about his wife anymore. And I'm not crying in front of him anymore. But tonight I'm crying for him, for the loss of him.
And in the morning, I'll go and have another day with him, and enjoy every second that he's able to come back through the confusion and be who he is. And when he can't, I'll keep him safe during the in-betweens. A lot of really excellent writers say that nursing is an art and a science, and explain what it's like to be around life and death really eloquently. I'm not an excellent writer, and big concepts like that are hard for me to express. So I'll just say that on days like this, nursing doesn't feel like an art or a science. It feels like a duty that I couldn't put down even if I wanted to, which I don't. It's just holding on to what you can and letting go of the rest. And sometimes that's sad.