Words of Wisdom from Octogenarians in a Nursing Home

When you spend time in a nursing home the very nature of the patients you work with force you to confront mortality, both theirs and your own. My experience with Andy was a wake-up call. Even though I rarely enjoy being there, I made a promise to myself to not make the same mistake again and approach my work there with more enthusiasm.

This proved to be easier said than done. When any resident of the home is showing signs of psychological or psychiatric distress, the psychologist is called in to do an assessment and make every attempt to help the person. Common reasons the psychologist would be asked to do an evaluation include the resident reporting feelings of depression or anxiety, a refusal to socialize or take required medication, getting into arguments with staff or other residents or if the resident is showing signs of psychosis or dementia. If the resident has no family (or even worse, a family who wants nothing to do with him) the state will often take on legal guardianship. This translates to the patient getting help whether he wants it or not, because his behavior can be disruptive to the other residents and staff. This is analogous to child therapy, where if the parent insists, that child is coming to the office regardless of level of interest or involvement.

I seem to be a magnet for residents who have little to no interest in my help. Agnes had been on my caseload for about 12 weeks, and I was basically her personal litter box. Over the course of three months, I had been labeled an “ugly Cracker,” been spit at, been spit on, been physically threatened with a bedpan, and told that my family will rot in hell if I come back next week. Of course, I did indeed go back to have the prophecy fulfilled and I was called a string of profanities that go beyond the decorum of this story.

After the vulgarity attack I decided that enough was enough and that I would cease mental health services for her. I told the director of the nursing home – a large and intimidating man – that I “would no longer be subject to such extreme castigation.” I considered using the word “vituperation” to really drive home my point, but I was so nervous that the director would say no so I couldn’t remember what “vituperation” actually meant. Fortunately he agreed and Agnes was no longer subjected to my help.

It wasn’t her fault. Agnes was not like the people you read about on this site. She was psychotic and showing various signs of dementia, believing that anyone and everyone is out to get her. People with extreme mental illness such as this generally require psychiatric medication, and even that would not have complete effectiveness. One of the harder jobs of a mental health professional is coming to grips with the sad fact that you cannot help everyone, that there are definitive limits to what can be done. To make matters worse, the psychiatrist had recently quit and, until the nursing home hired another one, all the psychologists were working against the patients’ biology.

So when I left the director’s office I felt that pang of failure, that helpless feeling that comes with not being able to accomplish something because it is out of reach. This got my thoughts running wild:

This sucks. Psychology is stupid. Getting old is terrible. People get depressed because the world is a horrible place and a nursing home is simply a symbol of that.

However, perception and reality are not one in the same. A great example of a healthier perspective on nursing home life is a group of men I refer to as The Wild Bunch.

The Wild Bunch are five men, all in their 80’s, who have been in the nursing home for many years, much longer than I’ve been working there. Even though I think the place is inherently depressing, they couldn’t disagree more. All day they play cards, watch movies, bet on sports, sneak in alcohol now and again, and even race their wheelchairs down the hallways despite the nurses’ protests. I’ll sometimes sit and watch them play dominos while discussing whether Jane Mansfield or Marilyn Monroe had “the better rack,” all the while wondering how they are happier than many of the clients in my private practice who seem to have it all. When I ask one of them, he will always impart the same wisdom that I still have yet to fully grasp:

Why wouldn’t I be happy? I have everything here. I have great friends and leisure time. All of my needs are taken care of. The staff helps me when I ask, I don’t have to worry about money, and although the food isn’t great, I could certainly be in worse places.

“Jesus, like where?”

Kid, I could be homeless, in a hospital bed, in hospice dying from cancer or even in a house with a wife who hates me or a family that doesn’t want me around.

“Do you ever think about dying?” I ask.

Sometimes, but not much. Every day is great, and of course someday that will end, but thinking about it and worrying about it isn’t going to change that. And who knows, maybe things are actually better on ‘the other side.’ I don’t waste time on what I can’t control. A good-looking kid like you needs to let that sink in.

Yes yes, I am good-looking! But, more importantly, one of the Wild Bunch hit the sweet spot, the ultimate way to live life: don’t waste time and energy on what you can’t control. I couldn’t ‘fix’ Agnes, I can’t fix a lot of people. There’s a lot, a whole lot in life that I can’t control. The irony of that is when I embrace that fact it mobilizes me to govern what I can. So instead of focusing on the people that can not or will not be helped, I turn my attention to those who can benefit from me.

The men in The Wild Bunch are the ultimate example of making a great life with whatever you are given. Regardless of your situation in life, take a lesson from them. They are truly therapeutic.

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14 Responses to “Words of Wisdom from Octogenarians in a Nursing Home”

  1. Drew says:

    Touching story and an important message. Thanks Rob.

  2. Shelly says:

    I have yet to meet an old person on the brink of death who has that kind of positive outlook, but it’s extremely refreshing to hear. I haven’t been a “real” adult for that long and I wonder what life’s like at that stage. Thanks for shedding some optimism on what I’ve always seen as a dark abyss of mental and physical waste. Good post 🙂

  3. John Smith says:

    Isn’t the Wild Bunch happy because they are FINALLY able to live for themselves? That because of their age they are no longer forced to obsess over how other people think of them?

    all the psychologists were working against the patients’ biology.

    Seems like quite an indictment of psychology and therapy. I usually hear the other way around, patients complaining that psychiatrists rush to medicate without exploring the underlying issues.

  4. Maggy says:

    I love the Wild Bunch. I hope to be like that when I get old. I’ve met a lot of amazing elderly people that still look forward to living instead of how much time they have left. Life really is very short and growing old is a part of that. I really enjoyed this post Doc.

  5. Jenna says:

    I hope I’m the first woman to be inducted into the Wild Bunch when I get old.

  6. Anonymous says:

    “Don’t waste time and energy on what you can’t control” is the great insight you got from this? Seriously, I learned that from ‘Garfield and Friends’ when I was about 7 years old. “There’s no point worrying about the things you can’t change, and there’s no point worrying about the things you can.” – Beau the Sheep
    Dr. Rob Note: Good point. For me, insight is when something moves from an intellectual understanding to a more visceral one. Most of us are cognizant of the fact that we shouldn’t worry about what we can’t control, but all of us still do it from time to time. It’s those moments when it sinks in further that I’m refering to.

  7. Amber says:

    I feel really sorry for Agnes and any family she may have. How can it feel for a person that’s even slightly lucid to know they’re on the brink of full blown dementia? What is it like for the family to have to watch that happen? It breaks my heart.
    I hope when and if I’m in my eightes I’m as positive as the men in the wild bunch. Great story Rob.

  8. Stephanie says:

    Love the honesty and the vulnerability that comes through in this. And you always leave me wanting more.

  9. Anonymous says:

    I wonder what the Wild Bunch will be saying in a decade, though.
    That’s essentially what my Great Grandmother was like for quite a while, but in the year leading up to her death, she made it quite clear that she wanted to die. Very badly.
    So, at 98, dead she is.

  10. […] them.  They don’t live in fear or to obtain status.  These people are like those I met when I worked in the nursing home, which is probably the last place on Earth you would think to look for real […]

  11. Annie says:

    My favorite post. There´s a profound lesson to be learned.

  12. JP says:

    My 97 year old grandmother (with dementia) attacked one of the staff with her walker.

    The moral of that story was that we should never have taken her out of her farmhouse. She only made it to 99.

    I’ll always fondly remember her 90th birthday.

    Now, I also knew a 100 year old professor (who taught until he was 103). He had a class to teach on a fairly regular basis.

    Meaningful work tends to keep people alive. It sounds like thos 80 year olds found meaninful play.

  13. JP says:

    And my problem isn’t fear of death. It’s fear of old age. I’m 37 with significant risk that I will live into my 90s.

  14. Asian says:

    Thank you Rob. Illuminating stuff.