Wednesday, September 4, 2013

Lying for the Greater Good....

 This is a story about a client....I am so moved by what is unfolding between us. Or maybe I should say what is unfolding in my heart toward her. 
I have told you some about my client who won't shower. Her situation is such a complicated dynamic. I wish I could just lay it all out here for all of you, because its kind of a fascinating story. To me at least. But for obvious reasons, I need to be careful about how much I share here...privacy laws being what they are.

When I first began this job, I didn't want to do it. I was trying to eliminate work, not add more on, but for various reasons I said I would evaluate this situation and before I knew what had happened, I was knee deep in the middle of it and finding it hard, if not impossible to walk away. For weeks I plotted how I could gracefully quit. This was a particularly difficult client. I had just left a challenging client and really felt I NEEDED a break. I needed an easy run, a sweet little old lady who adored me would do just fine, thank you very much.

This woman didn't want a caregiver and made no bones about telling me I had "stupid" ideas, America was filled with stupid people, only idiots didn't understand the worth in bartering, on and on it would go.....she would become angry and tell me to get out of her house in very colorful language. The good thing, if there is anything good, about Alzheimer's is that you get constant fresh starts. I would leave the room for a few minutes, come back in and it was like I was just arriving and the previous tantrum had never occurred. I was figuring out how to approach this woman through trial and error and it was draining. Remember, I am a people pleaser. I want everyone to like me!

She used to be a medical professional, a big deal in her profession. (And here the poor thing is stuck with me as her caregiver! lol)  Her son was here last week visiting and we spent a lot of time talking and he told me her story. I heard about events from her childhood that quite clearly formed her adult choices and responses. I won't go into the details, but there were some tough events. From this conversation, I understood so much. It made so much clear to me.....control equals fear and this woman's control issues were so deeply ingrained in her, for good reason.....I was filled with empathy for her. I started thinking of how I could approach her while honoring her need for control. Not stripping her of it.

Meanwhile the son went into the bedroom to talk to her and mentioned that he had a "nurse" (me, which is a blatant lie) there to clean her up. Hearing that a "nurse" was here changed her whole attitude. A nurse was someone she could trust. Someone she respected. That term had some bearing on her past life, something she could relate to. Having titleless me come in meant nothing to her. "Who the hell are you?" She had nothing to tie me to, no touchstone to reassure her that I knew what to do, that I was a safe person. With this revelation, I began to formulate my plan.

I arranged to come during an evening hour on a day that I don't usually come as the evening hours are better for her. I arrived wearing scrubs (I never wear scrubs) and told her I was a nurse sent there by her dr. That she had an infection that he wanted me to check on and clean up and that we would need to go into the bathroom and do it in the shower. She got up and went in without question. One thing led to another and she let me scrub her hair not once but twice, she let me scrub her body from top to bottom, she let me slather her in lotion and baby powder, she let me trim the back of her hair, she got into clean clothes and climbed back into bed, clean and smelling nice. In 45 minutes I had accomplished what I had spent weeks tip toeing around and trying to find a way to gently bring her along in.

I am not a liar. Lying goes against everything in me and I hate doing it, and really, I am not very good at it either. As I told her my tale I felt anxious and nervous in my stomach, and I had to work at speaking in an even and confident voice. I was just waiting for her to sit up and yell, "Thats not true you liar!" Which of course never happened. Lying to an Alzheimer patient is actually a tried and true method of treatment.....meeting them where they are at, otherwise known as validation therapy.

Our new plan is that I will add this extra evening visit, impersonating a nurse, to our weekly schedule. My other two visits I get to come as myself. What this does for us is sets us free to do whatever she wants to do on those two visits. It keeps the "nurse" separate from our fun times.

Getting to know the *why* behind her behavior made all the difference. I quite literally, as I watched her shuffle into the bathroom to do what I was asking, felt my heart open up to her. This woman who has done so many honorable and wonderful things during her life, who has lived her life being so strong, who now lashes out, pushes away, who is so tired at this point, but valiantly keeps on exerting her control... today, I feel honored that I get to be the one who takes care of her. I think God put me exactly where I needed to be. I think she and I have some lessons to teach one another, some things to learn still.


This video below is so touching....Naomi Feil using validation therapy with Gladys Wilson. It is never too late to connect with someone or to bring comfort with acceptance.


Signe said...

This is so wonderful and what a good life lesson! I don't consider it lying. I consider it finding the language she understands to be able to trust and function. If you planned to do her harm, I think lying would fit. But you are there for her to thrive and because of that, I don't think it is lying. I think it is an amazing show of love that you would leave your comfort zone to help someone who is losing herself, regain some dignity. You are a blessing.

Mary Christine said...

When our hospital had a geriatric unit, it was the unit with the highest number of patient to staff assaults. Because of the personal care that was required. So, for me, with my strange perspective, to view this woman get right in the other woman's face, is weird.

I am glad you are working with people who are a bit more "normal" than the people with chronic persistent mental illness.

Sheri said...

I love your posts. That's all :-)

Annette said...

Oh Mary...
you can't compare a psychiatric hospital's patients with life long functioning adults who come down with a brain disease in their last years. Its apples and oranges. What validation therapy accomplishes is nothing short of miraculous where no other form of communicating and connecting has worked.

SoberMomWrites said...

You, my dear, are a freaking genius!!!

Think of it this way, I was the best Santa there ever was because I interited my mother's compulsive lying but chose to use my gift only for good. I can pull off a surprise party like no one's business!!!

This is exactly the same. Your "lie" is not meant to hurt, only to help. It's simply a differnt take on the truth.

Rest easy my friend, your halo is still firmly in place as far as I'm concerned. ;-)


Anonymous said...

Annette, I'm glad that you are able to reach your client through validating her experiences. You are using a creative and compassionate approach. Wearing scrubs is a great idea......The video with Naomi Feil touched me. She had trained my boyfriend (at the time) so many years ago in her technique. It was controversial at the time. It's good to see that she is still working her magic. Her own parents were directors of a local nursing home here where I live and she grew up visiting the patients there. What's also remarkable about this video is that she is Jewish and cared enough about the patient to sing to her about Jesus.
Take Care,

Mary Christine said...

Oh but Annette, some of those patients were also life long functional adults with some mental illness complicated terribly by dementia.

I hope I didn't offend. I thought the video was beautiful. I was just saying how skewed my perspective is after having spent most of my career in this place.

Walkingthroughaddiction said...

Oh Annette,
You are truly an Angel. My sister and I have been struggling with my mother for the last two weeks because my sister moved my mother in with her and my mother is filled with anger and rage and has been impossible. This morning we are all going to look at an apartment for her. As much as my sister wanted to care for my mother my mother did not want anyone caring for her. She fought it tooth and nail. You have allowed me to accept this situation and see how scary not being in control was for her. This video was so sweet and tender and absolutely beautiful. I believe so much in the power of touch. I am a RN and I can tell you Annette you are more of a Nurse than many of the women I have worked with in the past. It takes a lot more than a college education to be a nurse. You just keep using that title you earned it. So proud of you.

Tori said...

This brought me to tears. I am seeing my Mom in an almost fragile state right now. Yet she is still if not more controlling than ever. She had a very, very tough childhood and I know that has a lot to do with her control issues. It is just worse now because she forgets everything and she is realizing that and it is really making her angry. Your post couldn't have come at a better time for me. It is so hard when they are mean to you. My Aunt was always so incredibly good to me and that last year she was so mean telling everyone I had done things that never happened. I hope that doesn't happen with my Mom. Even though she has started to say a few things that leads me to believe I will be her target too. What a horrible, horrible disease for someone to have to go through.