“The bedroom door is locked on the inside”, said one caregiver to the other, as they were on their way to check on Mrs. Sheridan in the Clover Leaf Care Home in central England. (Names of people and places changed).
“I’ll get the master key”, said the other employee, and started back down the stairs…..
In the world of Alzheimer’s, Mrs. Sheridan’s changing habits are not an uncommon thing. Often, she’ll think she’s at a holiday resort, and needs to lock her hotel room door….
When she’s in the cafeteria area in the mornings, when the nurses are taking their morning break, she’ll ask for the keys to the bathrooms which, some of them are locked, because they’ve just been cleaned and the floors are still wet…
She doesn’t remember that she just came from using the bathroom, there is no recollection of this for her.
In her mind, the last memory is that she was thinking of needing to go there and hadn’t done it yet. The flow of events is not available for her to tap from, as we would remember a string of happenings this very morning, like what lead up to making breakfast, and what we did during the time between that and fetching the newspaper from the mailbox.
The nurses must then explain to her how recently she’d just had her bathroom visit, and that it was now time for a hobby- or sitting break with some coffee or tea. That very afternoon her son was scheduled to visit her, they say, and this conjures up a smile, and her whole body relaxes….
But what happens 10 minutes later?
She asks again. And again.
Dementia care workers are trained to expect this. They know how fragile their patients’ memory can be. It’s a part of their job to react to the same questions again and again.
Something else is also taking place, if you observe Mrs. Sheridan over a longer period of time. At some level, she’s conscious that she is living in a world of confusing snippets of memory that make no sense to her.
At those moments, she’ll come to the nurses’ coffee area and sit down with them, coming close to someone, just to feel comforted and reassured.
You’ll notice how hard she tries to convey, in a short sentence, how she feels…..
Because the words for this have started slipping from her memory a long time ago, the monologue consists, in effect, of a simple description of her present plight, the coldness of the room, getting another jacket or shawl to warm her shoulders….
These needs are quickly met, but they don’t seem to help. She still feels cold, and alone. At this point she knows that her resource is a coming visit, or perhaps going home soon.
In fact, there are days when she doesn’t seem to remember that her new home is here, in the care home.
Mrs. Sheridan will come up to me and ask: “Is my son coming this afternoon, so I can finally go home? I don’t have enough money to stay in this hotel any longer!”.
This is absolute reality to her, she cannot imagine being in a place like this for any other reason. Large blocs of memory involving living and being cared for here, are missing.
It’s a sad situation. How much would I like to tell her: “Don’t you remember the many happy hours of knitting, in that chair over there, or the games we played together here, at this table? Or eating dinner with us at the staff table yesterday?”
I know it won’t help her remember. I know she can’t connect to those great feelings from her perception right now.
Mrs. Sheridan and doors. It’s a bit of a standing joke of us all, needing the humor we need to have in order to cope without going crazy. A few weeks ago, she asked for the key to the reception area, she’d forgotten to fetch some freshly typed papers from there, her boss was waiting for them….
Another time, it happened in the middle of the night. The night nurse was doing her rounds, and came across her rummaging behind an open door to a closet in the hall.
When asked what she was looking for, she replied: “Where is that big old key, you know, the one to the attic, where my older radio cassette tapes are? I want to listen to a recording of the Old Disc Jockey, because it will help me fall asleep”.
Early last month, she suddenly went missing. We were looking for her everywhere on the grounds of the residence, to no avail. Finally, someone thought of checking the laundry room in the cellar.
Down we raced, only to find-
…the door locked, from the inside…..
After we’d opened it, we found her sitting on the floor, folding clothes and towels of the home residents.
“Hello, I’m just finishing the laundry” she told us as we went in. “Where is my stool down here, did someone take it upstairs?”
It’s hard for those of us who don’t have Alzheimer’s, to understand what is going on in the mind of someone who does!
A simple barrier like a cupboard or a door can change their whole train of thought in an instant.
Maybe it’s a memory of something they’ve seen, which associates to that which is in front of them now.
Maybe the mind takes a leap of faith to grasp the first memory that appears, the only one that may appear….
And old habits can be straws to grasp in the search for continuity. Things like locking doors from the inside, for security reasons. We do this as well, it gives us a sense of completed tasks, of privacy and being able to relax and do whatever we wish, away from prying and curious eyes.
Everything that would give an AD patient, who already has so much confusion to deal with, this feeling, can attain a high level priority in their search for some direction in their lives….
And so it happens that doors can be locked, to rooms which are otherwise easily accessible to care personnel and regularly visiting relatives, furniture can be rearranged in curious ways or things can be hidden away in strange places, where no-one looks for them, where the person has forgotten themselves, where they’ve put them…
(Sometimes it happens that these things are found again after many years….)
Mrs. Sheridan is still with us.
When I’m on duty, I see her every day of it. I get the feeling she still recognizes me. Maybe not personally, but she remembers my presence.
So often, she will sit on a sofa-like chair which we have close to the cafeteria’s kitchen door. That way, she’s close to all of us employees, filing in to place our coffee cups in the sink tray inside. Just the fact that we’re rested and ready to be of help and comfort, relaxes her and gives her relief and encouragement.
For Mrs. Sheridan, it’s another door.
This time, an open door. A door bringing comfort. A door full of hope. A door that is her anchor of stability in an otherwise stormy sea of events and happenings….