May 2008 Table of Contents

THE LAST WORD

A Night at the Nursing Home



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Sometimes, our patients give us gifts far greater than anything we've given them.

Fam Pract Manag. 2008 May;15(5):46.

I started working in nursing homes when I was a first-year medical student. I really don't know why. They called me, and I answered. Many years later, my nursing home patients are still at the center of my practice. After visiting them, I almost always leave with the feeling that I have learned and grown wiser, and that I have taken away more than I have given.

The walk of love

It was a beautiful spring evening, and as I arrived at the nursing home, I spotted Mr. and Mrs. Adams out in the parking lot. I had met the couple years earlier. After his “strongly encouraged” retirement from an accounting firm due to early cognitive loss, Mr. Adams and his wife retired to Arizona. They moved back to Tacoma when his dementia became severe and Mrs. Adams needed help from their adult children, help that never came. Soon after, Mr. Adams was admitted to the nursing home, and I resumed his care. Five years earlier, he was a 71-year-old man in good physical health with signs of early Alzheimer's. At the nursing home, I found him to be a nonverbal and frail man of 76, wheelchair bound and with end-stage cognitive impairment. It was a pleasure to resume his care but a sadness to see his decline.

Since coming to the nursing home, Mr. Adams has not said a word or made a purposeful movement. His wife visits every evening, talks to him, shows him pictures from family albums and pushes his wheelchair through the facility, always with a smile on her face.

That night, I found them in the parking lot, and I watched her pushing his chair and talking to him. I said hello, and Mrs. Adams told me her husband always liked to takes walks in the evening when the weather was good. “I can tell he enjoys it,” she said.

I told her how nice it was for her to do this, and Mrs. Adams replied: “Every minute I get to spend with him is a blessing. He is my one true love.”

I asked if she had concerns about his care, and Mrs. Adams said no, noting her appreciation for the staff and thanking me for all I had done. I smiled and nodded but couldn't speak as I silently marveled at this gracious woman and her enduring love for her husband.

The song goes on

I entered the facility and saw Mrs. Hansen and her daughter Ann in the lounge. Mrs. Hansen is a 94-year-old woman who has suffered several strokes but is still able to move around with a walker. Although she is unable to speak more than a few words, she is still able to sing. Her daughter has been a nightly visitor, coming in after work to sit with her mother and sing. Mrs. Hansen cannot begin the songs, but she chimes in after her daughter gets them started – old songs like “Bicycle Built for Two” and “Happy Days Are Here Again.”

Years ago, Mrs. Hansen had been a music and voice teacher and had sung and then led the church choir, Ann told me. “I don't remember a day in our house without music,” she said.

Joining them for a few verses of “Meet Me in St. Louis, Louis,” I felt a great joy and realized what power music has to ease the pain life can bring.

The words of wisdom

I made my rounds, finished my charts and headed for the front door. There, I met my patient Mrs. Davis, a charming 94-year-old woman with advanced dementia who walks through the building in a supported walker, always with a smile and always with a good word.

“Good evening, Mrs. Davis,” I said, and she smiled at me and reached out for my hand.

“Are you going already?” she asked.

“Yes,” I said, “it's time for me to go home.”

“Well thank you for coming to visit,” she said, “and remember, every day is a good day.” Then she reached out and gave me a hug.

My eyes teared up then, just as they do now as I write this. As usual, Mrs. Davis was right, and I try every day to remember her wise words.

About the Author

Dr. Waltman is a family physician in Tacoma, Wash. Author disclosure: nothing to disclose.

Send comments to fpmedit@aafp.org. Note: All patient names have been changed to protect confidentiality.

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