Sometimes the real issue is avoiding embarrassment

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Robin Lenart
Robin Lenart
I love riddles. I especially enjoy searching out their secret, which is usually hiding behind the obvious.  Here's one I first heard from a sixth-grade grade classmate, Ray Fender. As most riddles, it was presented as a question: If you were confronted with a bear behind you, a tiger beside you on your left, a lion on your right and a church in front of you, which way would you run?

Right on cue, I picked the “correct answer” and said, “I'd head for cover to the church.”  My friend Ray enjoyed asking again, this time with a giggle, “You'd go to church with a bare behind?”  With 11-year-old vivid imagery, the thought of being exposed in the most respected setting would make meeting a tiger almost doable.

In real life, embarrassment can be like a riddle, confounding our senses and reason. While the choices might not be so painful as fighting off wild animals, the pain vs. shame decisions are made quite often in the long-term care setting.

You know the feeling if you ever stayed a night or two at your local hospital: You catch sight of your friendly nurse coming in your direction carrying a washbasin and towels.  She's heard it all before, I'm sure.  You casually say, ”Thanks, I'll wait till I get home … I can do it myself … Ugh, I don't need a bath anyway, really.”

Fear factor

Why can't you just tell your attending nurse the “naked” truth? Like a seasoned riddle solver, she has to decode your excuses and discover the hidden message:  Fear of embarrassment.

Our most visible organ, the skin, can give us clues about the emotion we'd rather hide. It's both public and private, our very real boundary to the world around us.  Our skin turns pale and clammy when afraid and blushes with embarrassment.

Why do we hide it?  We might choose not to express it verbally, but it will find expression through our body.  Remember your high school physics regarding the “law of conservation of energy”?  Emotional energy cannot be created nor destroyed. It only changes form and plays peekaboo.

It can express itself with troubling symptoms sometimes riding piggyback on previous injuries. These masked offenders cause the body to take the blow for the hidden emotional stress, including embarrassment.

Discomfort zones

During a class I was teaching on dignity preservation, I conducted a real-life experiment with adult students training to become medical assistants. My quest was to identify the many emotions associated with embarrassment. 

My assignment for the students was staged to be real-life practice, which, like blood drawing, could be learned best by experience. I cheerfully announced, “We are going to do assisted showers today, so pair off with a buddy.” I reassured the students that the staff prepared a spare room to ensure privacy during their “practice.” 

Each would take turns being the patient. I encouraged the “patient” to be creative with the role. For the “healthcare professionals,” I reminded them of the importance of closing the door.

I then gave them an option to do a homework assignment instead: Pairing up with a family member, role playing with their mom or dad and having them play the healthcare professional, too. 

With that, the backs straightened and eyes narrowed. It was quite a learning experience. With a shout of “Freeze!” we paused to observe the crossed arms and legs, the familiar body language of anger, fear and rebellion. As I looked around the room, I thought about my stressful teaching on embarrassment, as the role-playing was indeed quite real to each person.

We then talked about how they felt when they fully understood the possibility of being exposed. Also important to note was the lack of verbal communication, specifically stating the real problem of embarrassment. 

We explored the remedies. Having a choice to say no was the popular solution, but if bathing was truly needed, then what? From my own survey, the CNAs I questioned said about half of their new clients refused baths due to embarrassment.  

Oddly enough, among the “bath dodgers,” I heard doctors were the worst offenders! Perhaps because the medical community offers a variety of cover-ups for almost every procedure or exam. Even though we make jokes about the dreaded “hospital gown,” we are grateful it is not taken away from us.

Psychologists who study the mind-body relationship say the stress of anxiety on our body can be harmful.
 
Death before dishonor

Those legally choosing “death with dignity” in Oregon were interviewed regarding why they would want a physician to help end their lives. Can you guess the number one reason given? Fear of dignity loss. Would dignity preservation strategies have made a difference?

Patricia B. Smith, Mary M. Kenan, Psy.D., Mark Edwin Kunik, M. D., M. P. H., together with Leeza Gibbons wrote “Alzheimer's for Dummies.” They explain the simple formula for the body-shy bathers:

"Good: Modesty Garments.  
Bad: Birthday Suit.”  

They say a big reason Alzheimer's disease patients may refuse to bathe is embarrassment over being seen naked. One of their 10 tips for AD caregivers spells out the solution: 

“A modesty garment for your loved one can completely eliminate the problem. Available in models designed for both males and females, modesty garments cover private areas but still allow easy caregiver access for bathing and toileting. They preserve the patient's dignity and greatly reduce problems with personal hygiene related to modesty concerns. They're inexpensive but worth their weight in gold for preserving the comfort and dignity of AD patients who need help with personal hygiene.”

My encouragement to those who want to help calm the storm of embarrassment for those they care for? Cover what's private and offer a personal garment during bath time. The gift of dignity feels great: It blesses the giver as well as the receiver.

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The Dignity Resource Council, is a non-profit 501(c) (3) organization. Learn more at www.dignityrc.org.
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