The Meaning of Life

Yesterday I had a three-hour shift. It is one of my regular small shifts which are arranged when the nursing home cannot fill up the schedule. Except that it wasn't a regular shift.

I entered the nursing home, expecting an easy-going shift. Usually, all I have to do is watch my patients and help them get lunch. I like this type of shift as it leaves me time to spend much-needed individual time with patients. For these people, I also need the time, since two of them have been physically fighting any chance they get. This day seemed like no other day. Everyone was very calm, which is very beneficial to especially patients with dementia. I discussed the patients with my colleague from the previous shift.

"Well, everything is calm and peaceful. Patient A is on a walk with her family. Patient C has been experiencing shoulder pain and we're keeping track of heart rate and blood pressure to rule out cardiac involvement. So far it seems OK, but keep an eye on him. Oh, and did you read the recent emails?"

I answered that I've not been working lately so I didn't read the emails.

"Patients D and E have passed away. Patient D died a week ago and is already at the undertakers. Patient E died last night and is still in his room. The room is locked."

Patients D and E. The patients who were fighting ever since E got here. Two patients in four days, no wonder it's calm. We talk about them for a bit. You never get used to deaths. I talked about this before after experiencing my first deaths. My opinion hasn't changed and I've been told that it will never get easier. Still, this is a very confronting way of deatg, with the patient still being present.

At the nursing home, life goes on. We can't stop every time someone dies. So I tak a bit with my patients and help them get lunch. Two plates less than usual. After lunch, many family members come visit the patients. I don't know many of the visitors. Two women enter. They look lost. "Can I help you?" I ask. They appear to be E's family. They ask me to open the patient's door. As I do this, I see the patient. He looks peaceful. His wife is very sad, his daughteris more relieved. I can understand their feelings. The patient has made it very clear that he never wanted to live the way he did for his last months. Still, it doesn't make his death OK.

I leave the room so the family has some privacy. In the living room, it is very calm, almost too calm. But not for long. Patient C needs to go to the bathroom. I help him get to his room. He tells me his left leg hurts. I find out that his pain, previously in his left shoulder, is now in his left side, radiating to his leg. His pulse is 115. I get a colleague who checks his blood pressure (normal). She decided to call the nurse, though, as his pulse and pain are a cause for concern.

My three hours are up and my colleague takes over. I leave the nursing home. I don't know how patient C is doing. Patient D and E are still dead. It left me thinking a lot about death and the meaning of life. What do I want out of my life? Why does it even matter? Will I ever be able to answer these questions?

Life or Death

Actually, life, death and everything in between. It is one of hard things when dealing with vulnerable people. Sometimes people are unmistakenly alive in every aspect. They are independent and lucid and completely able to do what we consider to be normal. Then there are deaths.

Deaths are, without exeption, very tragic. A friend's mother, still far too young, dying after a car accident, a little boy dying of cancer, but also the woman with progressed Parkison's who can't move, can't speak, can't think, can't understand. Yes, it might be better for her and for her increasingly worried family. But that does not make any death OK.

But is death really the worst thing imaginable? There are a lot of gradations between life and death. In a lot of circumstances, death is obviously worse. I cannot imagine a world where a good quality of life is exeptional. I know there are times and places where it is a luxury and I am very thankful to have such an easy-going life. But even in my limited world, certain ethical questions are raised. Is a poor quality of life better than death? Who gets to make decisions like that?

Personally, I draw the line at being sane. I would be able to live with physical handicaps, but dementia could very realisticly drive me crazy. The thought alone of losing my memory and the safety of reasoning... I don't think I would want to live like that. But when do you decide to die? When you are still lucid, you are not yet at the point where you think life is pointless. Then, when the dementia has progressed, nothing you say makes sense as you lose the skills to think long-term. This is probably why so many people are in this debilitated state of confusion. Or would they be OK with their bodies deteriorating until death?

I don't know how geriatricians deal with this. I'm not even sure whether I could be one. How can you go against your moral standards every day? Life can be so mean.

Just An Ordinary Day

A woman I don't know comes walking towards me across the hallway. "Help! Hėėlp! I'm being abused!"
I am at the psychogeriatric part of the nursing home. In other words, the place where patients with progressed dementia have a safe environment adapted to their specific needs. In theory, because it is hard to manage a group of patients often harmful to themselves and others.
The woman, who has now reached me, is clearly upset. I quickly screen her, as I learned to do over the past months. I look at her and try to assess her mental status. Her incoherent answers to my simple questions tell me she does indeed suffer from dementia. (Important lesson: never assume. I can imagine that upset family members would appreciate a different approach.)
"Hèèlp! Police! Oh, finally. Someone who can help me. Let's go to the police station together."
I try to calm her and convince her that it is not a good idea to leave the nursing home. From the fact that she starts trying to hit me, I conclude my approach is not working. I find out where her room is and take her there. As if a switch was flipped, her mood changes instantly. No one is abusing her anymore. She continues wandering around the building like nothing had ever happened.

Just ten minutes of an ordinary day. They left me thinking. Only then I realized how vulnerable this group of people it. The chance that she was actually abused is small - she also talks about how she should get home to her little kids - but still. If she was abused, would I believe her? Probably not. Everyday there are many concerns like this. Even if it is just an ordinary day.