Journal Entries

NaJoPoMo 2013 Day 4

Zombie Death: Senile Dementia and Alzheimer's Disease

Even if we recognise the futility of wishing for an Ali McGraw death, I bet we all want to slip off in full possession of our mental faculties. That sentence I just wrote was unintentionally ironic, because when we die we don't take ANY possessions along, but if you don't have your mind, you don't have anything even before you die. The Demented Ones are the living dead of Ladera. Yes, there are special "lockdown" units for Alzheimer's patients, but there is no solid rule, apparently, in the medical profession, that causes a patient to reside here rather than there. In three cases I know of personally -- because I have gone to the nurses and asked why that person is still here -- the family doesn't want to relinquish their parent or spouse to the institution of last resort. There really is a stigma, still.

A meta-note: when I use a proper name, it's the person's real name, and I use it knowing that the patients or their guardians won't mind. Otherwise you'll get an initial.

My room mate Gretchen has MS and senile dementia. According to her brother, she has been like she is now since her 40's (she is 63 now) and for most of that time she has been institutionalised. It began with a traffic accident, the dementia; she already had the MS. I don't know more because it seems impolite to press for details. She has been here at Ladera for around 6 years. A large framed collage is on the wall behind her bed, detailing her late father's accomplishments (not least of which was surviving the Bataan Death March), and if you refer to it, she will say, "Yes, he is an interesting man." Her brother says they don't visit as often as they might, but that an hour after he's gone she doesn't remember the visit anyway.

Gretchen presents a friendly, compliant personality and is more stoical than I think the staff realize, and I have become rather protective of her, now that I know something of her likes and dislikes. It's no use feeling virtuous about sharing some chocolates, because she won't remember that it was I who gave them to her! She is happy to sit in her side of the room, in her wheelchair, and watch Animal Planet because she doesn't remember that she saw the same program three hours earlier or this time last week. But most of the time she is kept in the day room, because she's a fall risk, and allowing a patient to fall is one of the deadly sins at Ladera.

I had no control over where I was sent last year, when the hospital judged me to be sub-acute, but I think I'm lucky that it was Ladera. More about that, in future journals.

F sits in the day room all day and talks in a loud growly voice. Judging from his appearance, there has been major trauma to his head. They sit him near the television. You can hear his attention ricochet off the odd phrase he hears, but the rest is just stream of consciousness.

The compos mentis residents don't interact at all with the Demented Ones. There are plenty of relationships formed, or nodding acquaintances, among the rest of the residents who can leave their rooms, but not with the vacant-minded. We residents graciously tolerate each others' imperfections, the illnesses, the amputations, the prosthetic devices, anything but the puzzled flat-eyed stare of the living dead.

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Latest reply: Nov 4, 2013

NaJoPoMo 2013 - The Art of Death 3

Different Ways of Dying
I don't mean for my journals to be grim or depressing: that would be taking death far too seriously. Pratchett's Death rides a pale horse named Binky, and in describing him thus I think Pratchett strikes exactly the right note. I have nothing to say about afterlife or afterlives except to disclose that I'm a practising Quaker, because these journals are not about the religious experience.

Several of my 25 serial roommates have died. A Separatist Catholic priest administered last rites to one such, last summer, on the other side of the curtain from where I lay with my kindle, doing sudoku. The foreshadowing, the assurances, the orders given to legions of saints to turn out and welcome her personally made heaven seem like a heavily trampled parade ground with squadrons of precisely feathered angels playing trumpets and zithers, perhaps forming religious symbols upon the ground like some marching band. Suddenly the priest was finished, plocking his vials of oil and water into a little carrying case and flicking out of the room. The woman died several hours later, so peacefully that her assembled relatives didn't even notice.

Another room mate, morbidly obese, diabetic and schizophrenic, wailed and monologued for three days, a chaos from which she passed, finally, in an exhausted silence into death. She died alone, and nobody promised her any kind of reception in a next life. A nurse was sitting with her (they do that), but had stepped from the room, and the patient chose that time to leave (we really do that).

Then there was Theresa, stricken with brain cancer and metastasis. Her children fought hard to keep her -- she's the patient whom I described having gamma ray surgery last summer --but after a certain point she made up her mind, turned away from the world, and waited to die. They moved her to long term, where she died a few days later.

In these three examples, death was more or less expected by the professionals, and all but one of the patients themselves knew it was coming.

I suspect L knows it's coming. A stroke victim who whistles or pantomimes to make his needs known, L gets up and is helped into a sort of walker the staff call a merry wheeler. The resident stands inside a square PVC tube frame with wheels at all corners, and there's a seat to catch him when he tires, Except for meals, L walks all day until they put him down (put him to bed). Oh, sometimes he stops, sits, and naps in the middle of the corridor, but the rest of the time he trudges round and round. Back at the beginning of the year I got a harsh barking laugh out of him in the day room when I tried to run over a balloon with my electric scooter, but now he barely acknowledges that I know his name. L is determined to play to the whistle, as the sports commentators say, and I admire the hell out of him for that. When Pratchett's Death comes for L, he's going to have to ride alongside him a little ways down the hall.

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Latest reply: Nov 3, 2013

NaJoPoMo 2013 - The Art of Death 2

I should tell you about Bertha first because she's already 101 and a half. Longevity is its own form of celebrity, and for the past two years she's had a special party in her honor, and been interviewed by local radio. Until recently she has maintained remarkable physical and mental condition. She and her room mate live next door to me; both of them are very deaf, so when they chat it sounds as if a Monty Python skit is playing out on the other side of the wall. Usually they give up and resort to writing notes.

The day after her 101st, Bertha slipped and fell, in her room. Up to that point she had used a walker, but after the fall she was restricted to a wheelchair outside her room. Most residents are wheelchair-bound, and the therapy department issues them without leg rests so that, if they wish to move, they have to use their lower legs to get around. The benefits of this are obvious, I think, although it looks strange at first, people sitting down but walking from the knees down.

Last week I heard one of the male nurses greet her in the hall, calling out, "Bertha! How ya doin'?" and she answered right back in her archaic Texas drawl, "Ohhh, ah'm doin' everybody ah can!" And her favorite activity is watching entertainment wrestling on the television.

But lately, she has begun to lose track of time. She sleeps a lot of the time now, but can be heard looking out of her room in mid-afternoon, sometimes, inquiring about breakfast. She has started losing items, or failing to see them when they are lying in plain sight. I get the sense that she is receding, as opposed to breaking down. She has a few chronic problems, like high blood pressure, but -- barring trauma -- she appears to be heading for a tidy quiet death.

I was joking with the restorative therapist who does range-of-motion work on my legs the other week, and we had a laugh over the idea of the "Ali McGraw death." You know that movie with Ryan O'Neal, "Love Story." Ali is dying. She is lying in bed with full make-up, thick, lustrous hair, clear eyes and perky boobs. What woman dies like that, unless she was just struck by a car or something? No, the ideal death might be more like the one Bertha is headed for. I don't know whether I would want to live to 102, even if I had my health, but it would be nice to be given the leisure to disengage from the world at my own pace. It's the myth of having your life all neatly wrapped up at Expire Time, with the bucket list completed, the cat litter box cleaned out and the bills paid, and of course that's impossible.

"OK, I'm ready to die now."
"No, wait, I --"
smiley - sillysmiley - ghost

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Latest reply: Nov 2, 2013

NaJoPoMo 2013 - The Art of Death 1

So here I am in a nursing home, a genteel barracks for people who can no longer look after themselves and who will die. We all die sooner or later: old age can put you on the fast track, as can the failure of your body to remain in working order.

The first time I wheeled into the so-called activities room, I was repulsed on several levels, and I'm not proud of it. On one level, there was the presence of Sickness. In the activities room, also called the day room, staff gather those who require constant attention, who can't be left alone. I came to think of the day room as the bristlecone pine farm. Aged people twisted in body and mind. Some choose not to communicate. Some look around, seemingly stunned at where they find themselves. Others close their eyes. Several can't seem to stop communicating. Several, including my room mate, have some form of dementia or outright Alzheimers. Some of the men have outsize libidos from which the veneer of civilization has begun to slip. I'll introduce some of my fellow residents in the next weeks.

Another level on which I was repulsed is more difficult to describe. I immediately thought, I am not one of these! I might be paraplegic and in a wheelchair, but please don't let me be as one of these. Snobbery? Vanity? Good old-fashioned denial? Have you ever seen Tod Browning's "Freaks"?

Ladera has two wings or halls, for a total of 116 beds. "Skilled" is for patients whose condition is expected to improve enough for them to be discharged, and "long-term" is for those who are no longer patients. They are residents. I was on skilled for 11 months, poised for flight, refusing to mix with residents on any level but that of disdainful civility. And then suddenly I was homeless, with nowhere to be discharged to. And as soon as "corporate" -- the private for-profit company that owns this and many other such places across the country -- as soon as corporate became aware of my plight, it was inevitable that my status would change. And so I was moved to a long term hall called South Back.

Somehow, word got around quickly that I had "gone long-term." And somehow my attitude toward my fellow residents began to change, to mellow. And I became a student of the art of death.

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Latest reply: Nov 1, 2013

Room Mate #24

J___ couldn't stand my use of air conditioning in the room, so she packed her portrait of Jesus and moved next door to be with her friend B___, who is 101 and even more deaf than J___. Their conversations sound like a Monty Python skit, one I can hear fairly clearly through the wall.

In her stead I got Gretchen. She has MS which has confined her to a wheelchair and which has made its way into her brain, according to her brother and guardian. And so she acquired senile dementia... in her forties. She is a very pleasant lady, and one can have a conversation of sorts with her, and she laughs at jokes, truly gets them, but after a couple of hours she'll have forgotten what was said. I make sure her teevee is tuned to Animal Planet, knowing that frequent re-runs will not perturb her in the slightest.

And I am now permanently institutionalized. The medical people deem me unfit for independent living, at least for now. Maybe, after the matter of my possessions is resolved, the stress will abate and my motor skills will improve.

On the subject of improvement, the manager of the dietary department has left rather suddenly, and our corporate overlords have stepped in. The quality of food might improve soon: we only need to keep an eye on the platers, now.

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Latest reply: Jul 3, 2013


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