Lessons Learned

After a year and a half of applying and interviewing (and being rejected) for counseling jobs, I started one three weeks ago. And God, in His infinite wisdom and otherworldy sense of humor, made sure it was one that would ensure my discomfort. I am part of a team that provides psychological services to residents of nursing home. The case load is unreasonable. The patients are challenging. The facilities are crowded. And my brain is likely to explode.

I've learned a lot about what "is medically necessary" and "requires expertise." I've learned to work around the activities schedule and chase down missing charts. And I've learned some things I never expected...

1) Not all nursing home residents are elderly. I have three that are in their early 30s. They have crippling diseases. Their spouses and/or families have abandoned them. They no longer have access to their children. They will not be recovering, and they will not be returning home.

2) Patients suffering from dementia or senility will likely not remember you from one day to the next. At least not until halfway through the session, at which point they suddenly smile and say something like, "Hi! I'm fine! I don't have anything to talk about. Go away!" I can't bill unless I spend at least 20 minutes with a patient. That can be a long 20 minutes...

3) You really do get used to the sights and sounds and smells.

4) Sometimes there is no good way to respond, at least not without sounding condescending. OF COURSE they are depressed. OF COURSE they experience anxiety. OF COURSE they feel hopeless and helpless. OF COURSE they lose track of time. Who wouldn't? My new motto - when in doubt, be kind.

5) At first glance, nursing home residents look pretty much the same. But they are not the same. Beneath the confusion and frustration is the person that always was. The uniqueness of each individual is evident if only one will take the time to wait for it to surface.

6) "Therapeutic" takes on a whole new meaning in this setting. It may just be the same old story to everyone else, but to the dementia patient it may be the one thing that prevents the decline of what little memory is left. Hey, it's not about me. I truly can survive hearing Mrs. Jones (not her real name) tell me about her childhood dog one more time if it helps her to do so.

7) Tears come. I try to fend them off until I get out of the building, but they are sneaky little devils. It hurts to hear some of these stories. The walls threaten to go up to protect my dadgum marshmallow heart. And yet I hope I never get callous. I hope I always have the kind of heart that welcomes these souls.

8) In the private setting, if a client were to tell you that they love you, you would have to address the inappropriateness of that statement. In a nursing home sometimes a confused 90-year-old woman will hold out her hand, longing for human contact, and say, "I love you! Come back and see me!" I see no benefit in "correcting" her.

9) In the private setting a therapist would point out delusional thinking and assist a client in recognizing the difference between reality and fantasy. So far I have had no luck convincing Mrs. Smith (not her real name) that she does not actually work in production, that she is not actually going on a Hawaiian vacation when she can get time off, and that she is not purchasing tickets for everyone who is nice to her. And I am not convinced myself that patients who accuse the nursing home staff of stealing their personal belongings are suffering from paranoiad delusions...

10) And finally, there will be no therapy during lunch or bingo. Period.