Day 3/10 of Geriatric Level I Fieldwork in an Alzheimer's Day Center

Today was Day 3/10 of my geriatric Level I fieldwork at an Alzheimer’s Day Center.

Today was a little bit more intense! When I came in this morning, one of the women who had previously been quiet was having a mini melt-down and yelling at one of the PCAs. The non-stop talker was there, as was the faithful anguished wanderer, of course. I took aside the woman I had chosen to do my school project on since she is pretty high functioning, let’s call her Miss Betty. She answered questions about her life, including admitting she wants her own apartment and a “MAN” (leer), and that her daughter bosses her around too much, and she has to tell her daughter sometimes to “Step to hell”. This cracked me up TO NO END, that is the greatest expression ever. Step to hell. At one point she said “I love coming here, but I don’t need to be here. I don’t have that disease where you forget things….what is that disease called, I forget.” I was like hmmmmmm. LOL. But seriously, she is very high-functioning, sweet, and kind, and I’ve learned a lot from her on how to interact with others.
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We had several random sessions – most of which were dispirited and somewhat boring today – I’m realizing that a lot of their stuff is pretty repetitive and that even the residents (the ones paying attention anyway) are bored too. It’s not the fault of the person running the session or anything, it’s just that it’s difficult to entertain people all day every day, with a range of skill levels. The facility has a lot of stuff, and I’m trying hard to brainstorm new ideas or at least pump in some energy, but I’ll admit I have so many things on my plate right now that it’s not getting the attention it deserves. I think my plan for the rest of this week is to continue stepping up my assistance and meeting different people, reviewing more charts, and continuing to take aside people for one-on-one time. Then this weekend I can focus on some serious brainstorming and see what I can implement next week.

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I asked to see a few specific charts today – the charts were in good order and everything, but since they are just a day center they aren’t medical model or anything, and they lacked quite a bit of detail. For example, one of the women there (FixxyLady), is now making no sense at all 99% of the time, but if you were to look at her chart, you wouldn’t realize the severity of it, because when she first started coming there, she was considerably more normal. I guess I’m used to seeing a lot of specific OT documentation instead of an occasional checklist assessment, so I was a little bummed there was not more information within the charts, that I could possibly use for “detective work”.

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I felt like I was in an Oliver Sacks book today, more so than before, as I encounter more and more interesting behaviors. Like a woman who was talking about “this thing, you know, that…” and pulling on her ear. When I volunteered “Ear?” she said yes, that! I also spent some time outside with the nonstop talker and the anguished wanderer, and if you listen to the talker, he actually makes sense to some extent, although he never stops talking and there is a lot of repetition so it’s not easy. The anguished wanderer just seems to be in torment, as if in a living Hell. She’ll wail like a little girl and the PCAs or whoever is near, including me, will hold her for a few seconds until she wanders more. One of the most awesome PCAs and a team leader was out there with them and they are a handful. This PCA is really intriguing to me because she is VERY VERY VERY good at what she does and tries to make sure everybody gets some personal attention and is okay. She is great at making people feel good. She has been doing her job for like 18 years and loves it. I think she feels slightly threatened by her lack of real-world education though, based on some of her comments to me. I don’t know, but I really like her and have a lot I can learn from her.

Now for the most interesting and surreal time of day. I have been interested in a woman who walks jerkily and walks around with a sippy cup. She speaks clearly and looks intellectual, but nothing she says make any sense. This is the one I said sounds like she came out of Alice in Wonderland. I had learned yesterday that she reads things well (reading hymns out loud) and I was intrigued. I asked her if we could sit down together today and chat, and that I like to write things down so I can keep my thoughts together. While I missed a ton of things of course, here are just a few of the random things she said that I wrote down.

“That I need what I have to have”
Do something with him because he is doing very well…he’s worked on almost anything…he’s the one you must have come. He loves “up” (gestures).
And I saw him. And they are nice people because when you get this you can get it. You can look at them.
“I am a mother of it. She loves it.”

I handed her a slip of paper and a pen after a while to see what she would do with it. She said “Can I use this on this?” and clearly meant using the pen on the paper, which of course I said yes to. She has really lost her ability to name things but you could tell that what she says would make sense if that weren’t the case, lol. She didn’t ever really do anything exactly though, so I drew a picture of a flower on her paper and said “What’s this?” and she said “She’s going.” Also, previously, I had pointed out a cat walking around in the distance and said “Oh look, a kitty” and she said “Oh yes, a fixxy”. So later on I asked her what a fixxy was, to see if she would retain the same strange word, but she said “I took it”. Her chart confirmed she tends to make up words and has a lot of word-finding problems. The progress notes show a steady decline over the years in her ability to communicate properly, although she used to be very social and appropriate. It’s sad.

So anyway. I’m just finally getting to the surreal stuff. I noticed in her chart that she enjoys babies and dolls. I had seen a few dolls in a cabinet earlier so I got an idea. Occupational therapy is all about using occupations that are meaningful to the patient, and this was information I hadn’t known. I discovered a small room I hadn’t noticed, and got permission to take aside FixxyLady alone. They told me they weren’t allowed to be alone with patients but I could take one aside whenever I wanted as long as I checked in and wasn’t going to do anything crazy, lol. All the areas have windows too. Anyway, I found FixxyLady being somewhat of a pain that afternoon (the chart noted she started getting more anxious in afternoons), and I took her to this small room. I got out two small babies, one for each of us, and asked her to hold the babies with me. We sat down in the recliners in this small quiet room with them. She held her little blonde baby girl doll for a while and I held my little brown-haired baby boy doll for a while, resting him as if he was sleeping. We talked about them as if they were real – discussing how beautiful they were, how mine was sleepy and hers wasnt, etc. And she became LUCID to some degree, it was an amazing transition. It was obviously calming to her. She would say appropriate things like “Look at the little rash on his face” and I said “Where?” and she turned him around to show me and say “There”. Or she’d whisper things to the baby that made sense. Eventually she said something along the lines of “let’s salt”, but by her gestures I could tell she wanted to trade babies. So we traded, and I asked if she wanted me to get a third baby, which she did. I got that third baby and gave her all three at that point, which I arranged on her very carefully as if the dolls were real. She rocked and rocked. I realized they had a fake sleeping puppy in there (one of those ones you see at a drug store intended for lonely elderly), so I grabbed that and petted the dog while she rocked her babies. One of the PCAs came in and turned on the colorful bubble lamps, a project
ion of the sky, and this really long fiber optic green glowing horse tail thing, and then turned off the harsh overhead light and left us again. So she sat there rocking her babies, I petted my dog, and we watched the room change color and glow all around us, while the sounds of music penetrated the room. PCAs would occasionally look in on us and she even said with a slight laugh”Oh look at them looking in on us”. Sometimes I couldn’t tell if FixxyLady was grimacing normally or wanting to cry, she seemed rather sad. She said some things about no one to care for, and it broke my heart. If I asked her questions like “Do you like the girl baby or boy baby better?” she would go off on one of her unusual answers, but if it was a simple question related to the dolls, she could handle it. Like if I said “Oh look, your beautiful blonde baby is getting sleepy”, she could say “Yes, she sure is”. If you could just compare her normal talk to her talk with the babies, you’d know how AMAZING the difference was in her level of clarity.

We rocked there a long time, and I eventually started to get a little uneasy. I realized my experiment had been successful and I was glad it was calming and nice for her, but I wasn’t quite sure how to bring her back out into the big room of commotion with noise and light. We probably stayed in there easily an hour, and I sat there petting my stuffed puppy and thinking how surreal this entire experience was. I eventually let her know it was time for our snacks, but we could lie the babies down for a nap in the meantime. I carefully took each baby, watching their necks, and laid them out, one by one. So then we re-joined the commotion and it was snack time. The adorable little old lady was out there constantly asking for food and asking what she was doing there, and every time I answered (every few minutes) she smiled so kindly and said sincerely “Oh thank you so much. You are so kind. You are so wonderful. You are so beautiful. You are a true angel. I love you so much.” or something very close along those lines. The poor lady only kept about 3 minutes in her mind before re-starting the loop.

After snack time, I discovered FixxyLady wasn’t so happy anymore. At first I thought it was my fault but it appears this is common behavior for her. She was getting agitated. She came up to me and pulled at my volunteer smock, wanting to see the papers I had been writing on before. I showed her one and she read the information on it angrily. (I had written a few lines that said things like FixxyLady is cute. FixxyLady loves her son.” to see if she could respond to written things easier). She ranted a while, grabbed my hand and clearly wanted some things from me that I didn’t understand. She even threw a book down onto the counter for emphasis, and was obviously angry. I was like ummm. lol. I said, FixxyLady, I have to go now, but let me go get one of the babies that woke up. Will you hold her and rest with her?” And she smiled when I handed it to her and was fine again. And I breathed a sigh of relief. I found out that she sometimes spanks the PCAs when angry so I didn’t feel so bad, but I could totally see her spanking me and it made me laugh lol.

So this was ridiculously long yet again but this is an amazing and fascinating experience and so I don’t want to forget anything!!! I love these people and I’ll end up visiting sometimes after fieldwork ends. :)And now I need to go work on making handouts for well elderly and working on a communications proposal….boo….so uh, more tomorrow

Mar 27, 2008 | Category: Occupational Therapy | Comments: none

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