As I push onward within my accelerated nursing program, I find myself busy most of the time between the various didactic and clinical courses they require us to take each semester. Nevertheless, despite the speed of the program, the curriculum still does a good job in ensuring that we get a taste of all the different aspects/specialties of nursing. Having completed my second semester and thus reaching the halfway point of my program, I cannot help but reflect on some of the more powerful experiences that I have encountered as a student.
A few months ago, I had the opportunity to observe an Alzheimer’s facility, a specialized nursing home, as part of my Gerontology class. Like (I suspect) most people, I originally thought of nursing homes as depressing, sickly buildings where the elderly would go to pass from neglect. I was pleasantly surprised however to see this particular facility shatter my expectations, as I got to experience a wonderful community full of social activities to engage the elderly residents.
Though the majority of my time was spent walking around the facility to observe the registered nurses interact with the residents, one of the UAPs (Unlicensed Assistive Personnel) asked whether I could assist them in feeding some of the residents during dinner time. I had extremely limited experience in feeding patients from my medical-surgical rotation in my first semester, but I was happy to assist. The UAP directed me towards a cozy little dining room situated next to a hall tucked away on the right side of the facility.
The hall I was placed in was designated for “low-functioning” residents; this meant that the severity of its inhabitants’ Alzheimer’s had progressed to a point that it affected their normal daily functions.
…I will never forget the man that I was to feed.
Perhaps the worst part is the fact that a part of me was hoping not to be paired with him. He was an elderly, incoherent man who was making what appeared to be a disgusted grimace while moaning loudly. He was incapable of communicating and appeared to be paralyzed for the most part; he would spend his days bound to his wheelchair, completely dependent on the nursing staff to take care of his daily needs. My first notion was to be unsettled by him — I didn’t have any reason to dislike him, but I had never seen or dealt with anyone like him during my short nursing student career.
So, of course I was paired with him.
I slinked to the table that his wheelchair was parked at and took a look at his meal. A plate full of green, yellow, and white mush (albeit beautifully presented) with a glass of thickened “nectar” drink and pudding for dessert. He continued to moan “angrily” while I hastily tried to sort out my thoughts internally.
If there is one thing that I hold very closely, it is my humanity. I am terrified of losing it and becoming a burnt out, jaded individual. I feel like I came close to losing it at TCOM, and I now take great care to remember the spiritual, humanistic aspect involved in caring for others. So in the heat of the moment, nervous of the situation I was in, I did whatever I would have done to a normal patient.
I began to make conversation.
“Smells pretty good, doesn’t it?” I ask as I take out the silverware. Of course he wasn’t going to respond; there was no way he could. There wasn’t even a guarantee that he could comprehend what I was saying to him. But I also remembered what I learned last semester — the fact that one’s hearing is the last sense to go before death. There had been circumstances where a comatose patient finally was able to let go and peacefully pass after hearing a family member say the right things. So if there was any chance that he could hear me…
“I’m a little envious of you! It looks pretty tasty!” I remarked as I lifted a spoonful of the white mush and placed it into his mouth. He would swallow, then resume his disgusted expression and grating moaning. I would repeat the process, alternating between the different colors of mush in case they tasted differently, and offering his drink every few spoonfuls.
I have to say — I’ve never felt so helpless as I did then. Yes, I was making conversation, but I was desperately straining to look for any sign of communication. Anything. Sometimes I would gather that perhaps he liked the yellow mush more than the green mush and prioritize on feeding it to him. At one point I thought his moaning sounded like “driiiiiiiiiiiiiiiiinkkkkkk” so I gave him his drink. I would ask, “would you like some of your dessert?” and then I would maybe hear him say “yyyyyyeeesss.” In reality, everything sounded the same, but I was trying — I was trying so hard to communicate.
As one could imagine, it was a slow process of feeding and “communicating”. I’m sure some of the regular UAPs must have rolled their eyes at me for how long I was taking. I was certainly a little taken aback to see how they were approaching feeding — they were moving much more quickly (though most of their patients were more coherent than mine) and were letting the food drip down the residents’ chins to collect on their bibs. Meanwhile, I had been tenderly wiping the man’s chin each time his food would start to drip.
As a student, I obviously could not understand the day-to-day career intricacies that the UAPs may have been accounting for in their manner of feeding, but I was determined to treat the man in front of me like a human, despite how hard a time I was having. I kept trying to remind myself over and over that there had to be a person tucked away in some corner of his brain. On some level that I was struggling to reach, there must be a person there.
Then the moaning stopped.
He looked directly into my eyes and struggled to lean forward in his chair. His face was blank — it was neither smiling nor grimacing, but I thought I could see a slight hint of fear in his eyes. He leaned forward and placed his trembling hand on my shoulder.
And then he allowed himself to lean back into his chair and he began to moan again with his characteristic disgruntled grimace. I was caught completely off guard. He was definitely trying to tell me something. When I resumed feeding him, he would repeat this gesture a few more times before I had to bid him farewell. To this day, I do not know what he was trying to communicate, but I would like to think that he was perhaps trying to tell me, “thank you.”
I saw some difficult things while working in the Emergency Department prior to nursing school, but if there is one thing that consistently makes my heart bleed, it is seeing a patient locked inside of his or her own mind. It doesn’t matter if the patient is a coma patient, an Alzheimer’s patient, or a stroke victim — there is something heartbreaking to see a human struggle to be… human. To have a functioning mind inside of a body that is asleep… I can only imagine what that person’s universe would be like… because for that person, their reality is their mind and the world outside them is but a dream.
When I see such patients, I cannot help but wonder: what was this person like before their affliction? What dreams did they have? What brought them joy? What type of mischief would they get into? Did they have a favorite hairstyle? Did they have a boyfriend / girlfriend who once dominated their thoughts?
It’s impossible to know. It’s impossible to know what happens in their reality encased within a body that cannot wake.
My encounter with the man burned him brightly into my memory and I would go on to recount this experience to both my parents and my Gerontology teacher. Years ago, I would have counted myself fortunate to not have to “feed” a patient. But this… this was an honor. A deeply personal, connection; a union of human spirits. Whatever he may be thinking about right now, or wherever he may be right now, I hope that man is, on some level, at peace in his world.