David

by Giles Coverdale

David

On my gap year I worked as a care assistant in a nursing home. Many of the patients were in the final stages of Alzheimer's and needed our assistance in performing even the most basic of tasks such as eating and bathing. It became my regular duty to help look after one particular patient -David.

David was was relatively young -in his seventies. He had Alzheimer's and MRSA. He never had any visitors although apparently he had family living quite near. There was little in his room to give me any clues about his life before his incapacitation. Every morning the task fell to me to help him eat.

David was a difficult patient. Admittedly this was not by his own volition as his Alzheimer's was so debilitating. He could no longer speak or understand anything anyone said and every time I walked into his room he would always be curled up on his bed in the foetal position, fixing me with a venomous, unwavering stare.

It was a time consuming task feeding David. Often he would push his tongue out so that it was almost impossible to spoon anything into his mouth. Other times he would refuse to swallow and just dribble over the bedsheets. Occasionally he would decide to spray it all over the room, covering me in MRSA coated food and forcing me to scrub my arms and clothes clean. Speaking to him did not seem to register at all and certainly no amount of coaxing made mealtimes any easier.

I never let my growing irritation show but sadly! began to develop what can only be described as real loathing for David. Although I knew that this was completely irrational as he was almost certainly entirely incapable of realising the anguish he was causing me, I found it almost impossible to retain any kind of empathy or compassion. I think part of the problem was that he did not really look ill when covered by his bedsheets. His facial expression was that of a grumpy, irritable old man who would stare at me with petulant wrath at being disturbed while I was trying to help him. In a way I found it difficult to truly convince myself that he really was unable to make my task any easier and that he was not acting out of pure spite.

After a while I left the nursing home to go travelling in the latter part of my gap year. Although I occasionally thought about my old job in the nursing home, I never really wondered or cared what had happened to David.

When I arrived back from my travels I heard through a friend of my mother's who worked at the same nursing home that David had died. He had finally succumbed to the MRSA that was infecting him. I felt terrible. It was not anything I had done that made me feel guilty, as I had tried hard to never let my feelings affect my behaviour, it was the fact that I had been harbouring such poisonous thoughts for so long for such irrational and uncharitable reasons. To be honest it worried me that I was capable of having such a lapse of compassion for someone who really did need my help. I had forgotten to think of the man behind the disease.

Giles Coverdale

names and details changed to maintain patient confidentiality.

Reflection

I think this experience was exceedingly useful as it showed me the patience that is sometimes needed when dealing with patients. I hope that I will remember the guilt that I felt in the future when I am placed in similarly challenging circumstances and not let my emotions build up in the same way again. I am glad that I was careful not to let my thoughts dictate how I behaved but it was a warning to me about how easily compassion can be lost when difficulties arise. The whole nursing home experience was hugely rewarding and taught me a lot about interacting with patients and dealing with people who are completely dependent. I’m sure it will help me in the future.

Whole Person Care

Comments

Sean Scattergood

23 October 2009 - 10:16:57
"I have great respect for people who work in nursing homes. The patience and understanding these people have to complete tasks as mentioned above every day is amazing. This story for me, highlights this fact as even Giles, who worked for a relatively short amount of time in a nursing home, succumbed to thoughts of loathing and irritation; as i think is normal. I also think that if Giles had talked to someone he was close to, or perhaps a member of staff, about his feelings he may have relieved himself of his 'poisonous thoughts'."

S Growcott

23 October 2009 - 10:16:27
"This was a very open and poignantly honest account of caring for a person with dementia. It’s evident from Giles’ narrative that he felt exhausted and frustrated having to care for David so intensely, which is a common, normal reaction for carers to experience, however, difficult to accept. I sympathised with Giles enormously when he spoke of feeding David, ‘no amount of coaxing made meal times any easier’ (paragraph 4). The situation seemed extremely taxing and little wonder that Giles felt such destructive thoughts. ‘I found it almost impossible to retain any kind of empathy or compassion’ (paragraph 5). Giles felt a sense of duty, rather than an understanding or tolerance of David’s illness. Occasionally, he was disgusted by David’s behaviour, especially since he didn’t appear to be ill. Although Giles had unpleasant thoughts, he controlled how he responded to those feelings. He maintained he was ‘careful not to let my thoughts dictate how I behaved’ (paragraph 8) and ‘never let my irritation show’ (paragraph 5) and was able to sustain a professional and respectful approach on the surface. There was no mention of how Giles coped with his job, which surprised me as he was clearly bottling up ‘poisonous thoughts’ (paragraph 7). Suppressing pent-up emotions can be damaging. Perhaps talking things through with a professional colleague or counsellor or doing activities that made him positive may have made him more charitable and unprejudiced. Ultimately, this may have improved his relationship with David and essentially looked after his own well-being and would have helped to rid him of any guilt. Caring for someone so intensely is stressful and feelings of anger or frustration are natural reactions in this situation. To have identified when he was likely to become irritated was paramount if he were to have developed coping strategies to have diffused a tense situation, i.e. to have left the room and counted to ten. Giles states that he felt the ‘experience was hugely rewarding’, however, he also felt ‘a real loathing for David’. Grief and anger are healthy responses to a challenging situation. But if Giles felt ‘loathing’, he may not have been best placed in such a demanding role. There is such potency in ‘loathing’; it is another thing entirely to feel anger or resentment towards someone. To me, ‘loathing’ is almost irreversible or at least extremely testing to overcome. From reading his narrative and reflection, I do feel that Giles was genuinely remorseful and felt very guilty about his feelings for David. I understand that these feelings can’t be helped or controlled how you feel about a person and David was clearly a difficult patient. Although he’s admitting his feelings to the reader now, I feel had he spoken to someone at the time, these feelings may not have led to ‘harbouring such poisonous thoughts’. However, I appreciate the delicacy of his situation and the difficulty he may have had expressing his thoughts to others. I feel that Giles should have written about coping tactics in his reflection, so that should he ever be in a similar situation in the future, he would be able to keep on top of these difficult feelings and not to suppress them."