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When I was a nursing student, the very first patient I was ever assigned to for clinical in 1st semester should've been a breeze. Feed a 90yo man breakfast. No dementia, no major physical issues, just very, very old. Two warning signs nonetheless. I was told he never wanted to /1
eat much, so if I could talk him through eating half his meal, that was a win. And there was no knife on his tray, not even a plastic one.
Went in, introduced myself. And he was the nicest man. He spoke to me about his wife, how they'd been together 60 years before she died. /2
Went in, introduced myself. And he was the nicest man. He spoke to me about his wife, how they'd been together 60 years before she died. /2
How much they'd loved one another. How much he missed her. About how their children stashed him away here & moved on, after she died. He was Swedish, been here 50 years; no other family in Canada & his friends were all dead of old age or illness.
He wanted to go to her. /3
He wanted to go to her. /3
He said, very calmly, perfectly rationally, that there was nothing left here for him to take joy in. That he didn't want to be alive, if being alive meant sitting alone in a room watching TV all day, missing his wife, with the monotony varied only by med call & meals - where /4
someone watched every bite he ate.
It was absolutely & utterly reasonable. And it was shattering.
I wanted to sneak him a blade. I wanted to tell him to stash his meds between his back molars & his tongue (they check between teeth & cheeks) & hide them in the bedpost. /5
It was absolutely & utterly reasonable. And it was shattering.
I wanted to sneak him a blade. I wanted to tell him to stash his meds between his back molars & his tongue (they check between teeth & cheeks) & hide them in the bedpost. /5
I wanted him to learn if he could find his wife again. I wanted that for him so badly. He wasn't entirely sure himself; he only knew he definitely *couldn't* find her on this side. But that was enough - along with everything else his life wasn't - to make him not want to stay. /6
It was my job to make him live. To talk him into putting food in his mouth to keep a body he didn't want to be in going another day. To try to make him laugh. To cheer him up long enough to fool him into staying alive by habit until the next meal, when it would be someone /7
else's job to do it all over again. To try to trick an intelligent man into believing that someone actually had his best interests at heart when they wrote that "no knives at mealtimes" order.
It was a semi-private facility, you see. Government funding was involved, but /8
It was a semi-private facility, you see. Government funding was involved, but /8
people's families were still paying extra to get residents into better rooms, instead of the 4 to a room that was the free tier. He had a room to himself. That was at least $2500 a month.
But it was my job to tell this man that whoever wrote that order cared about him, and not /9
But it was my job to tell this man that whoever wrote that order cared about him, and not /9
the money.
I couldn't do it. Oh, I talked him into eating. And I didn't break any of the basic precepts of nursing in the process. (It would've been so much easier to get him to eat if I could've just told him I was on his side.) But it fucked my head up pretty hard. /10
I couldn't do it. Oh, I talked him into eating. And I didn't break any of the basic precepts of nursing in the process. (It would've been so much easier to get him to eat if I could've just told him I was on his side.) But it fucked my head up pretty hard. /10
I had to wheedle him a little, which felt disgusting. Asking him to hurt his own interests for a stranger's benefit
And I could only make the wheedling work if I could get us both "on the same side" in his head, at least a little...without being allowed to just say, "Sir, if/11
And I could only make the wheedling work if I could get us both "on the same side" in his head, at least a little...without being allowed to just say, "Sir, if/11
it was me giving the orders, you wouldn't need to steal a knife off the tray to go look for your wife."
All I could do was practice the *language* of professional empathy while ignoring the living fuck out of its actual intent. Someone else would've found a different way. /12
All I could do was practice the *language* of professional empathy while ignoring the living fuck out of its actual intent. Someone else would've found a different way. /12
Well, it worked. But I don't remember one single other thing about that day. In fact, my memories of that entire clinical class - 6 or 7 weeks, twice a week - are fragmented in a very telling way.
I had always been pretty sure that geriatric care was NOT what I wanted to do. /13
I had always been pretty sure that geriatric care was NOT what I wanted to do. /13
No matter how many times the college told us that that was where all the jobs would be.
That twenty minutes made me certain clear through. It was...look, it was FIVE YEARS AGO. I still can't think of it without...
Without doing the thing where the end of every damn sentence /14
That twenty minutes made me certain clear through. It was...look, it was FIVE YEARS AGO. I still can't think of it without...
Without doing the thing where the end of every damn sentence /14
turns into an ellipsis because I don't have words for the chasm that opens in my mind. The window into total horror. Of complete rejection. Of being forced to become, for no matter how short a time, something & someone one is fundamentally NOT. It's an endless black pit. /15
A wormhole whose other end opens into a black hole, or the bottom of the Marianas trench.
There's something Ouroboros-like about it. Trauma is what rips that wormhole open, yet the act of looking through what's been opened by trauma, traumatizes in & of itself.
Here, try a /16
There's something Ouroboros-like about it. Trauma is what rips that wormhole open, yet the act of looking through what's been opened by trauma, traumatizes in & of itself.
Here, try a /16
bite of tail...what do you mean, "OUCH"?
That's how I learned elder care wasn't for me. I'd end up doing 25 to life, no question - unless I ended up in the nuthouse first.
I've thought about that man so many times over the years. That 20 minutes I remember so clearly that /17
That's how I learned elder care wasn't for me. I'd end up doing 25 to life, no question - unless I ended up in the nuthouse first.
I've thought about that man so many times over the years. That 20 minutes I remember so clearly that /17
everything even kind of related to it, that happened afterward, is a blur. I don't care how fucked up this sounds: I hope he died. I hope he died days after I last saw him. Quickly, painlessly, in his sleep. I hope he opened his eyes one time & started laughing & laughing, /18
when he realized he'd gotten out of his body at last. And I hope the first thing he saw was his wife, not having to wait on him any longer. I hope that so much.
Why am I thinking about this now? There are reasons. I can feel them. Nothing that might break me, I don't think
/19
Why am I thinking about this now? There are reasons. I can feel them. Nothing that might break me, I don't think
/19
But also nothing I can quite articulate yet. Too far under the surface still. Can't reach to pull them up. Gotta wait for them to rise in their own time.
Something about moral ambiguity. About...black & white. No, not quite. About *degrees of shades of grey*. Uh. What's /20
Something about moral ambiguity. About...black & white. No, not quite. About *degrees of shades of grey*. Uh. What's /20
bearable. What's not. Circumstances affect many things, but not all things. How dark a grey does it have to be before circumstances don't affect it at all, for me? What is the point at which the graph lines representing exigency of circumstance & darkening grey cross? Do I /21
need a million different graphs for a million different situations? What are the patterns?
No, I don't expect to find answers to all those questions right now. None of them are QUITE the right question, anyway. But it's a warning. That's why the old man is back in my head. /22
No, I don't expect to find answers to all those questions right now. None of them are QUITE the right question, anyway. But it's a warning. That's why the old man is back in my head. /22
Consider these things in advance, he's saying. Not to find answers before the event, but so you're not blindsided when the events arise, as they will.
There are degrees of harm in the name of healing that are...tolerable. When the overall result is sufficiently good as to, /23
There are degrees of harm in the name of healing that are...tolerable. When the overall result is sufficiently good as to, /23
not justify or excuse, but render temporarily acceptable the degree of harm caused, because the net outcome is *enough* of a plus.
There are degrees of harm in the name of healing that are never tolerable to me under any circumstances. That's what the old man taught me.
There /24
There are degrees of harm in the name of healing that are never tolerable to me under any circumstances. That's what the old man taught me.
There /24
degrees of harm etc that are either tolerable to me or not, depending on the exigency of other circumstances. No way to know exactly what's what in advance. All I can do is be aware of the question, & do everything I can to ensure we do a good enough job that it doesn't come up.
