'Patient' is a virtue
Maybe I'm getting old, or the world is more complex, but lately I find my thoughts drifting to simpler times and moments that shaped me into the person I am today. While some were professional and others personal, I assure you that none were rooted in predictive analytics!
I devote this blog to one such memory that was sparked by this statistic: 45.33% of people living in a skilled nursing facility have dementia, with the top quartile having 67% and the bottom quartile at 21%.
Her name was Helen, she was 90 and I was 18. I was a nurse assistant; actually, they called me an “orderly” at the time, opting for a gender-specific term intended to make everyone comfortable with the idea of a man doing the work of a nurse assistant. Helen was one of seven people assigned to me on the extended-care unit of a local hospital. (Translation: They couldn't find a nursing home bed.) She had Alzheimer's disease and spent the majority of her immobile days in a geri-chair with the lap-table tightly secured. She was a lovely lady, with snowy-white hair and careworn hands, a classic “Grandma” type. The staff, including me, loved her very much.
Helen was mostly non-verbal with only one exception: She called out “Nurse” repeatedly, over and over and over again. Whenever she wasn't interacting one-on-one, she would start calling “Nurse!” “Nurse!” Nurse!” If you've ever worked in a nursing home, this is an all-too-familiar call.
We were quite creative in how we engaged Helen, although it never lasted more than 20 minutes at a time. We gave her face cloths and towels to fold, socks to match, stuffed animals and dolls — we kept her close to the busy activity at the nursing station, complete with endless call bells and ringing phones. To my knowledge, she wasn't restrained beyond the geri-chair table, or medicated to “quiet” her. (Remember, this was pre-OBRA, our industry's own “Age of Enlightenment.”)
On one particularly difficult day, I remember feeling completely drained. “Nurse!” “Nurse!” “Nurse!” I had just left Helen for what seemed the 20th time that hour. “Nurse!” “Nurse!” “Nurse!” echoed from her room. “Patient!” I replied — then paused, hoping my frustration (and exhaustion) wasn't audible. Without pause, Helen replied: “Is a virtue.” Silence. More silence. My reaction was a combination of shock, disbelief and … humility.
Was Helen reminding me that “Patience is a virtue,” or in her own way was she letting me know that even with dementia she was a person of virtue? Helen and others entrusted her care to me, the highest honor one could bestow. Could it be that “Patient is a virtue”?
After all these years, I remain forever grateful to Helen for this poignant lesson. It guided me in my advance study of geriatrics, when “start low, go slow” and “wait and watch” felt careless and lazy. (“Patient” is a virtue.) And it continues to guide me when “the business of healthcare” feels like our most frail elders are “getting the business” and forgotten in place of younger, short-term rehab patients, or overlooked by unrelenting regulations and unfunded mandates. (“Patient IS a virtue”.)
My memory of Helen is both calming and motivating, reminding me to take a deep breath when a provider colleague insists that there is no dementia in her 24 buildings. (Deep breath) So much work to do.
I'll reiterate the motivating statistic here — 45.33% of people living in a SNF have dementia, with the top quartile of homes having 67% and the bottom quartile at 21%.
Sorry, I couldn't help myself. But the numbers make my point: Helen is everywhere. Whether you can hear it or not, she is asking for patience and reminding us that patience – and the patient – are truly virtues.
Steven Littlehale is a gerontological clinical nurse specialist, and executive vice president and chief clinical officer at PointRight Inc.