For the love of Mr. Benson

Arts Entertainments

As a director of nursing at a long-term care facility, I had the unique privilege of caring for many precious people who had been diagnosed with Alzheimer’s disease. Caring for these patients has many rewards and challenges. Compassionate care is essential to successfully caring for Alzheimer’s patients. Each patient is incredibly unique and her care must be tailored to her unique individual needs.

I’ve had nurses come to me with black eyes, bruises, and scratches complaining that Mr. Benson in 12B was “combative.” I knew Mr. Benson very well and whenever I saw him he was silently counting his money or whistling sweetly as he wandered the halls. He had a classic case of Alzheimer’s disease.

The disease is relentless and merciless in the way it manifests itself. Caring for these patients is challenging because each patient is different and her symptoms are different. Stages or progression cannot be predicted. Treatment has to be individualized. There is no standard nursing care plan for Alzheimer’s. God sent me one such patient to care for and I would like to share with you what we all learned from him.

His speech was slurred and made no sense, but he talked a lot. He couldn’t really hold a meaningful conversation, but he thought it made sense. He just babbled so sweetly as long as someone listened, compassionately. He may not have been able to speak coherently, but he could spot a fake smile from a mile away. He would let me hug him and take my hand as we walked together. When he made my rounds each morning, he usually caught up with me and walked with me. When I entered another patient’s room, he would patiently wait for me. All he wanted was love, and I fell in love with this precious soul.

When the nurses started complaining about him being combative, I just couldn’t understand it. He was so sweet and compliant with me, I knew there had to be a cause for the combativeness they were reporting. I observed caring for him for a few days and quickly determined why he was being “combatant” with his morning and evening grooming.

I arrived early, early one morning and snuck (yes, snuck) into the adjoining bathroom to secretly observe these alleged combative incidents. It only took me a second to realize why he had some black eyes. The LPN and CNA were in the room. They were coming at him in all directions, talking loudly and getting angry at him for not cooperating. “Mr. Benson, raise your arms and put on your shirt, we have to get ready for breakfast now, come on, and stop fighting.” Mr. Benson was a little late for breakfast that day because we had a talk about Alzheimer’s and the right approach.

Nurses learned that you can’t bark a million orders at a person with Alzheimer’s, or anyone else. Nurses can’t be so active and rushed unless they really want a black eye. I taught nurses to make slow, deliberate movements and explain things in short sentences with only one command at a time. They had to learn to approach them carefully and never from behind unless they really wanted a black eye. You must smile when you talk to them. If you’re faking a smile, they can tell a fake smile from a genuinely sympathetic smile. It amazes me that an Alzheimer’s patient can’t perform the most basic task but can tell a fake smile from a genuine one. They can distinguish fake love from genuine love.

It took my nursing staff some practice, but they eventually got used to the new approach.

Giving him a bath was a different story. I don’t care how sweet and nice he was accosted at bath time, he was going to fight and it was my job to figure out why and fix it. At the time we had an old-fashioned whirlpool tub that would lift the patient up in a chair, then lower them into a tub filled with swirling water. He was absolutely terrified of that whirlpool. So we tried the showers at his place and started with the feet going up to the head. He was still combative and he would get very upset during bath time. He had to do something, but he also had to be clean.

Finally, one of his grandsons came to care planning and told us that Mr. Benson had never bathed or showered. He had always used a basin. So we changed the care plan and started using a sink in his room. It worked. He’d even take most of the bath himself that way if we set it up for him. The miracles of communication.

It presented another care plan dilemma that ultimately led to us having to lock the guest bathroom in the hall. He would go in there and dunk a glass of water, or whatever was in there, out of the toilet and drink it. If we tried to redirect him, he would get very angry with us. This was not good for him or for us. We locked the bathroom and with careful observation and documentation determined the time of day he used to do it. At that moment we were going to offer him some water and take him to another bathroom.

It’s not that we weren’t offering him hydration or taking him to the bathroom as we should, it was just that he was doing this wetting thing at times we didn’t expect. Our assessment revealed that he always reached for a full ladle right after lunch. We knew that he had eaten well and drank his fluids on his tray at lunch, so no one really thought that he might still be thirsty at that point. I don’t think he was thirsty.

We talked to his family and found out that it was a habit, an old farmer’s habit of many years. He had always kept a rain barrel and bucket close by when he worked on the farm. This was how he cooled off during his long agricultural days. So we started asking the medical nurse to offer him a cup of nice “spring water” after lunch. He was satisfied and happy with that and the guest got his bath back.

I loved Mr. Benson. I know I’m not supposed to play favourites, but I have to confess that he was one of mine. He would come to my office and chat me up. I acted like I knew what he was saying, just nodding and smiling and laughing with him. He loved to count money so I got him some play money and he would be fascinated for hours with it.

He couldn’t utter a sentence anymore, but when the Christian church would come and sing hymns, he would be the first in the activity room. He could sing every word of every hymn they bleed. It’s been amazing to watch. It was so obvious where his love was.

Mr. Benson’s story goes to show that individualized care planning and compassion go hand in hand. Without true compassion and care for him, we could never have individualized his care plan to such an extent. If we had not cared deeply for him and his well-being, we would have missed opportunities to provide care that would enrich his quality of life. The nurses would have continued to have black eyes.

I will never forget the first time I saw it. I guess it was my first day on the job. I was circling and there he was working very hard to get off a Geri chair that was facing the wall in the corner. He had no idea that putting someone in such restraints violated any state or federal regulation, but he knew it wasn’t right and I didn’t like it, not one bit.

I checked his file and he was taking so many psychoactive drugs that it was a miracle he could move. I went home that day, didn’t sleep much and came back very early. There it was, still in the same place. My heart just sank. He looked so sad and was still diligently working his way out of the meat. I asked the “vet nurse” why they had him in that chair. She said because he “doed her business” in the corner. I immediately had him lifted from the chair and carried to the bathroom. We had a small service of taking patients to the bathroom. I knew I had my work cut out for me. And I also knew that those nurses hated to see me coming, I was about to turn their world upside down.

We put him on a bathroom schedule that was tailored to his individual needs as far as we could assess. With some care in a few weeks she did not have any corner incontinence episodes. His habit of going to the bathroom in the corner again stems from his past as a farmer when I’m sure he used the nearest tree many times. The nursing staff thought he was doing it out of meanness or spite or something. They just didn’t understand. But they did know that they would put him in that chair and leave him there until he was exhausted from trying to get out. There were some nurses who were actually punishing him by putting him in the Geri chair and locking him up.

To make sure they knew how it felt, my admin and I had mandatory restraint training. I had a good lunch and lots of cokes for the nurses. I then went over the regulations and rationale for not using restraints as punishment. Near the end of the service, when everyone had eaten and had a Coke or two, I brought in volunteers to sit encased in a Geri chair. I locked them up, turned them to the wall, dispatched the service, turned off the lights, and closed the door. I stayed outside the gate. At first they laughed and carried on but by the time the 15 minutes was up they were screaming and wanting to get out. -point done. Trust me, they went and told everyone how they felt. After that, I had the full attention and cooperation of the nursing staff. We successfully eased the restrictions and everyone understood why.

Mr. Benson lived his days in blissful oblivion until Alzheimer’s progressed and he passed away peacefully in his sleep. I sleep better knowing that we did everything possible to make his days comfortable and happy. All it took were a few compassionate nurses who were willing to turn things around and fire a few who weren’t.

Excerpt from the recently published book, THE NIGHTINGALE PROTOCOL by Angela Posey-Arnold RN BSN

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