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Get Your Free Subscription! Selected Articles 2001-2004

Caring for the Ages
Selected Articles from
April 2003;
Vol. 4, No. 4
Implementing AMDA's Falls & Fall Risk CPG in the Clinical Setting
A Systematic, Evidence-Based Approach to Managing Challenging Behavior in Nursing Homes
Clinical AbstractScan
Pain in the Elderly: Listen to the Patient's Voice
A Daughter's Journal: During a Visit, "the Play's the Thing"
Reducing Medication Errors in Nursing Homes
Elders Urged to "Dance to Your Heart's Content"
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A Daughter's Journal

During a Visit, "the Play's the Thing"

by Ann D. Gross

All the world's a stage
And all the men and women merely players:
They have their exits and their entrances;
And one man in his time plays many parts,
His acts being seven ages...
...Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans every thing.
  - William Shakespeare, As You Like It, II.7.137

In addition to actually seeing my mother, there's another reason why I love visiting her at the skilled nursing facility (SNF): as soon as I walk through those double glass doors, I am transformed into a gliding, magical persona. Princess Xena has nothing on me. I enter the world where my elegant mother from Boston now resides, and it feels more like theater than real life. I guess that's my own "adaptation," to borrow a title. I feel like I'm playing a part in an unfolding drama that is Mom's life at the SNF.

Suddenly, instead of an aging, 49-year-old woman with aching joints (who balks at walking up steep subway stairs and is always grateful for a seat on the bus), I am Youth Herself. I have all my teeth. And I can brush them without help. Standing up. When I want to. Not only can I walk, but I can stride along the corridors and get to the nurses' station before most residents can push their call buttons. I can speak and the CNAs and nurses seem to respond. I can go out of the doors, get into my car, and drive away to my own (my Mom's) place. With no one there to tell me when I can and can't shower, and no cold draft from the corridor when I do shower. And I don't ever have to come back through those doors if I don't want to.

Playing the Supporting Role

And while at the SNF I am the embodiment of Youth Herself, in my eyes, I am still the supporting actress to The Grand Dame, my Mom. But she is in a death struggle with life--none of this "aging gracefully" stuff for her; she is angry at aging at all. People say, "it beats the alternative." But my Mom doesn't accept this. She is trying to beat the daylights out of aging. Of course, landing in a SNF presents its problems for La Grand Dame.

And so the scenes unfold for this visit.

Scenes I & II Play Out

Scene I takes me to the fourth floor, where my Mom resides. Several residents are lined up in their wheelchairs intently watching the activity at the nurses station as if it were a Broadway show (and the closest they're likely to get to live action drama with a rotating cast).

I make my entrance, waving to the staff at the nursing station, and turn to greet some resident friends. The bowed white heads look up at me from the wheelchairs as expectantly as if I were the kosher version of Our Lady of Lourdes herself, come to heal all.

"Hi Pauline, hi Rae, hi Anna," I say. As for the ladies whose names I don't know, I try to smile at each one in her turn. I ask some of the ladies their names, but they respond only with sweet smiles or stares, as if hearing me is not what matters. Just getting my attention, if only for the time it takes me to greet them, is what counts. After all, with such attention from Youth Herself, they are center stage in the scene as well. They seem to bask in the moment, as if the spotlight were trained right on them. They are the Ladies' Chorus, perfectly placed on their marks. But I know all I can do is make my entrance, and now, my exit, until later scenes.

I walk quickly down the corridor to Scene II, which takes me to my Mom's room. Mom is wearing her finest wig and best makeup. She is wearing a clean sweater set that I gave her, and clean pants. She feels she's waited years to see me.

When I enter Mom's room, her face lights up, and I imagine the applause from her adoring fans is thunderous as she suddenly appears in the spotlight. She becomes shy, looking away from me and then down at the floor, as if she can't bear for me to see her in a wheelchair in a nursing home (perhaps I am projecting). Mom doesn't make eye contact when she doesn't feel beautiful. And lately, no matter how good the Makeup Department in the place, she doesn't feel beautiful. We hug awkwardly, folding around the metal arm rests and wheels, each trying to take in the moment and feel as much joy as we feel pain.

I forget all my lines.

"Oh Annie, it's so good to see you. It's been so long."

Mom remembers her lines, no problem.

The Therapy Room as Theater

This afternoon, she has physical therapy, and I've arrived just in time for her main scenes. We transition to the first floor, and she smiles at everyone we pass. "See," she seems to be saying, "this Young Lady playing Youth Herself, is mine. She's with me." I expect her to greet people with inward hand waves like the Queen of England--but she doesn't . Not this time. I smile too, genuinely happy to see the occasional resident without wheels, as well as residents with their rolling exits and entrances.

Scene III, the main scene, takes us to a giant stage with many props on it: The Therapy Room. There are free weights and balls, and long, thin beds with hospital curtains around them. There are chairs and intermittent steps on the floor, and green and pink stretch bands and elaborate weight machines.

Mom, not one to be upstaged in any forum, doesn't need any cues. She is finally in her element--in the theater and out of her dressing room. In she rolls, with me at the handles of her chair. By instinct and practice, I roll her right to her mark: center stage.

Once my Mom is center stage, she revels in the spotlight. We are all part of her supporting cast. The two lovely PTs, lanky and delightful Helen and Kathy, are stage right, with other residents, when my Mom enters.

Once a Leading Lady...

Even in a wheelchair, my Mom has a commanding presence. She is the embodiment of the Grand Dame: old-fashioned style and universally-recognized "classiness." She loves to hear about her looks or bearing from strangers, especially. She looks the part of an aging movie star, with a face shaped like Vivien Leigh, even now. Before entering the SNF, she was known in all her haunts by her signature "safari" hat--a straw helmet. On her, it looked like a Chanel. When she met my father, some 55 years ago, people often mistook her for Barbara Stanwyck. Mom was the woman center stage, propped up on the piano, while crowds of impeccably dressed, eligible, gay young men sang to her, back in the days when "gay" meant "swell."

I have always yielded the role of leading lady to her. That's why it's so difficult for me now. I don't want to take over the leading role, not yet. To me, she will never lose her star quality. No matter where she's living or how she feels, her nails are perfectly manicured with the latest colors. Once, when she was so sick she had to be hospitalized for a flare-up of the miserable intestinal curse of C. Difficile, she asked me to bring over a few hospital essentials: toothbrush, makeup, and wig.

To many who care for her, I suppose she is just another resident. Not "just another resident," actually; she's known for being a particularly "difficult" resident. To them, she's a cantankerous, angry old lady, with endless demands. To me, she's a diva, who can't suffer being without her makeup and personal dresser, and who is understandably agitated at having to wait so long for her cues and entrances.

A Daughter's Wish List

  • Remember that even the most difficult residents were once young like you. Maybe they are being difficult because they hate being treated like just another old person.
  • Remember that each resident has a fascinating past, and that each person, including the Alzheimer's patients, has a lot to teach us.
  • If you notice that a resident is more angry or difficult than normal, ask to have him/her evaluated. As illnesses in older adults often present with symptoms that are vastly different from those of younger adults, they may need to be screened for a UTI or some other organic cause.
  • Don't take angry or bad behavior personally. As miserable as it makes you feel, presumably the older person presenting with the behavior is feeling even worse.

This article originally appeared in Caring for the Ages, April 2003; Vol. 4 No. 4, p. 48. Caring for the Ages is an official publication of the American Medical Directors Association, published by Elsevier. This article may not be reproduced in any form, print or electronic, without permission.

The opinions expressed by the authors are their own
and not necessarily those of AMDA or of Elsevier.

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