This is an old journal entry I stumbled upon this morning and thought I would share.

Tuesday, May 08, 2007

When working with Alzheimer's, death is inevitable. I know, I know, death is one of the few things in life we can all count on. But, with Alzheimer's, it's expected. It always sits at the back of your heart throbbing like a dull pain that you can usually squelch with some Tylenol.

Mental health is not so cut and dry.

There were months at my last job that I would lose 4 or 5 residents. That's 4 or 5 people I had loved and nurtured. It took it's toll and was one thing I was not sad to leave.

This last year I have lost a total of 3 residents. Two went like most- I have this uncanny ability to just sense when the time is drawing near. I get them on Hospice and once that begins, the grieving, the comforting, the process of saying goodbye begins. One, died unexpectedly very early one morning without any sign it was coming. No matter how it happens, it hurts.

I have often been scolded by friends and family- "you shouldn't get so close to these people." Why the fuck not? I don't get it. The day I stop getting close to them is the day I should be fired because I am clearly not effective at my job. It hurts like hell to lose someone you care about, whether they "are old and lived a good life" or died "way too soon." But, I would rather mourn them when they are gone and live on with the memories of having known them than hold them at some sterile distance that won't effect me at all. I have learned so much from those I have taken care of. That is something I wouldn't trade for the world.

I now find myself in uncharted territory for me. A couple of weeks ago I got a call from the Hospice company that I use. They have a client at a hospital that can't go back home. He's dying, he just fractured his hip and he is absolutely refusing to go to a nursing home. The one compromise he said he would possibly make was "a group home." Would I consider taking him?

I have fought tooth and nail with hospitals and discharge planners who try to stick my residents in nursing homes because "they are dying." They have the right to die where they choose damn it and with Hospice, we can continue to meet their needs in a place they consider their home, surrounded by people they consider their family. Hell, in some cases, we are literally all they have. Now, I have someone I've never met before in the predicament where he can't go back to the home he knows to die and he can't bring himself to go to a nursing home. I can't blame him on that one. So, without even pausing, I agreed to go assess him and if we could meet his needs, he was more than welcome to join our dysfunctional little family.

So on a dark, cold, rainy morning (cliche isn't it?) I met "Guido" for the first time. I know, you had to smile at "Guido." I have to alter his name for privacy and I'm telling you, if you had to pick another stereotypical Italian name, his would be it. So, "Guido" it is. I always like to go through their chart first. It allows me to get a picture of them and opportunity to ask them face to face any questions that pop up in it.

Before I got there, he was described to me as "a little rough around the edges." While going through his chart, I couldn't help but notice the little OT come running out of a room, crying. I looked at the nurse next to me and said "Let me guess, that's "Guido's" room?" She laughed "you must know him pretty well."

When I got in there, I did not see some big ogre. Instead, a tiny little Italian man who looked like he hadn't bathed or shaved in quite some time. He was drinking a bottle of Miller Genuine Draft for breakfast (I kid you not) and using it to wash down a couple of chocolate chip cookies. I explained who I was and where I was from. He wasn't impressed. Before I left, I looked at him and said "Look, I understand you want to go home. I also understand it's not an option. We may not sound like much, but we're not a nursing home, you can still drink your beer and we'll take really good care of you. Plus some of my staff are pretty hot. I'm not sure you're going to get a better offer hon. But, if you're a gambling man, you can hold out and try. In the mean time, stop being so mean to the therapy girls, they work hard, are only trying to help you and have to put up with shit from all the other patients they have too."

I almost got to the door when he said "Hey- what's your name, wait a minute." I said "It's Natali." He said "Well, toots, you drive a hard bargain, but count me in."

The next day, Bell Ambulance brought him in. The staff doted on him and he just sat there grinning and kissed their hands like a little gentleman. I cut his hair and shaved off his scraggly beard. Monday morning one would barely recognize him. He's actually quite a handsome little devil. He's attached himself to my assistant and I and likes to hang out by the office now that we've gotten him out of bed and in a wheelchair to join the land of the living. Such a warm, fuzzy story- right?

The problem is he is dying. It's a fact we can't forget. Actively dying and not from the fractured hip (which is the kiss of death for most people his age), but from a very, very large mass in his lungs which he wants no treatment for. He wouldn't even allow further testing to officially diagnose it. It could be quick, he could linger on. Unfortunately, it's out of our hands and we won't know until it is too late. At a a time and stage where I am usually starting my goodbyes to people, I am just getting to know him. The staff have already fallen in love with him. They were angry "Why would you bring him here for us to fall in love with and he's going to up and die on us?" All I could do was be honest- he deserves to be surrounded by love when he goes, rather than rotting away in some nursing home. He's crusty, he's smelly (as soon as those staples come out, he's getting hosed down!), he's got a smile that would melt your heart and the manners of a prince when he wants to. It's hard for me to remember, there is going to be a day sometime not that far off where I will walk into to work and not hear him yelling at his roommate and calling him an asshole. Where my day will go by and he won't roll up to the office door several times and say "hey gorgeous, wanna come smoke with me?" or "you know I get 2 more cans of beer today, can you make it 3?"

When that day comes, it's going to hurt like hell.



And it did.