Everything can be taken from a man or a woman but one thing: the last of human freedoms to choose one's attitude in any given set of circumstances, to choose one's own way.
Viktor E. Frankl
I have written often about my time working in nursing homes, but there is one story I have never told until now. Memorial day however helped me remember one little lady, whose story reminded me in a very strange way that no matter what life chooses to throw at us one thing remains a certainty, we always have a choice.
In this particular nursing home there were several floors, each of which was designed to cater to a different group of elderly people. Our floor was for patients with moderate to severe dementia that required almost constant supervision. My partner and I were tasked with entertaining a large number of them during their waking hours, which probably sounds like a thankless and impossible task. It wasn’t.
The 5th and top floor of this particular establishment was where we made our stand. Two of us against 50 Alzheimer’s patients with very short attention spans who were as rambunctious and impatient as children. My partner Raphael had been doing the job much longer than I had, and as a former nightclub singer from the Philippines, often serenaded the troops with old standards by Sinatra, Tony Bennett, and the like. I chipped in with my limited karaoke repertoire, and both of us also spent a lot of time thinking of dozens of ways to entertain these folks. It was like being on stage for 8 hours every day, and it was the most draining as well as gratifying job I’d ever had.
Over time our floor developed a reputation as the rowdiest on the unit, often to the chagrin of both the nurses as well as the unit’s administrators. Laughter and music and games went on throughout the day, and I personally saw some amazing transformations in people who were nearly comatose as the contagiousness of this party spread across the floor.
On one winter’s afternoon not long before Christmas I saw a nurse wheeling a frail little lady who weighed no more than 80 pounds up to our floor. She had one lonely little bag of things, a lifetime of possessions reduced to what could fit into a tattered duffel bag. It was my job to spend the afternoon talking to her and finding out how we could best be of service to her based on her history and interests.
Reading her chart, I saw that she was an Italian woman named Dorothy who came to the unit after her husband died and she suffered a fall while living alone. She had been admitted to the 2nd floor of the unit to receive care for her broken hip, and after that was moved to the 1st floor, which was where we housed the highest functioning people on the unit.
This is where the story I was reading took a strange turn. The chart said she had been acting in a bizarre manner on the floor, including making barking noises at the staff and other residents. It said she was also often unable to recall her own name, and that she was unable to remember the words for common objects, which was a common sign of Alzheimer’s disease.
So they sent her to us, and here we sat. The problem was that after a 2 hour conversation with her, I couldn’t detect the slightest bit of dementia. She was a delightful woman with a number of stories about Poland as well as her life in Chicago, and she was able to recall these stories in a highly detailed fashion despite the fact that she was nearly 90 years old and had been diagnosed with dementia. As we wrapped up our conversation, she grasped my hand and winked at me as a smile spread across her face as if we were in on some private joke together. My curiosity was piqued.
It took most patients several days to get acclimated to our floor, but not Dorothy, who jumped in to all of our games and laughter and music with enthusiasm unlike anyone I had seen before. I had reported to Raphael how I had witnessed no signs of dementia while speaking with her, which prompted him to put her through a short series of tests that were indicators of Alzheimer’s disease. It was at this point that Dorothy began barking, and Raphael shook his head in puzzlement and went back to what he was doing.
Later that afternoon one of the nurses told me that Dorothy was upset and wanted to talk to me. I was surprised as well as curious, and my heart sank a little when I got to her room and saw her gently crying to herself inside. Walking in I asked her what was wrong, and she looked up at me with sad eyes.
“I thought we understood each other when we talked earlier,” she said with a sigh. “Please don’t make me bark like a dog anymore, it’s really quite tiresome.”
Not knowing what she was talking about, I retraced my memory for a clue as to what I had apparently missed out on. I thought back to the wink and that little knowing smile she had given me at the end of the interview, and slowly something dawned on me.
“Dorothy, what do you know about Alzheimer’s disease?” I asked.
Once again that smile spread across her face, and this time I knew what it meant. Dorothy’s mind was still very much intact, yet somehow she had managed to pull the wool over everyone’s eyes. When I questioned her about this she told me everything, explaining that her mind was working just fine, but also how she was very bored. She had heard the laughter coming from our floor and asked around about what we did up here, and decided that this was where she wanted to be.
“The problem is Dorothy that this floor is for people who really have dementia,” I explained. “Everything up here from the nursing staff to our program is designed for that.”
With that she asked me to sit down, and began telling me about her life. She had lived in Poland up until World War 2 with her sisters, where she reported their lives were full of laughter and music. The war had torn their family apart, and when she had come to America after the war she had almost nothing to her name. Shortly afterwards she had met a “serious” man in Chicago who wanted to marry her, and, by her report, “50 years just slipped away from them.” She reported an intense longing to return to her time as a child with her sisters, and how the nostalgia for this time had plagued her throughout her life.
Which brought us to our current state of affairs. Dorothy was pretending to have dementia to try and recapture a time in her life from 50 years earlier where laughter and music were a daily part of her life. Although I wasn’t yet licensed as a therapist, I decided this was not crazy, but actually kind of ingenious. Still, I was torn. What were my ethical considerations here and what was the right thing to do for the well-being of the patient? As I pondered these things, Dorothy made one final plea,
“You have to let me stay, you just have to,” she continued. “One thought has been keeping me going all these years, and that is that one day I might have a chance to sing again. I never had the courage all these years, and my husband was just not into these things. Now, I literally have nothing left to lose. I’m dying in a hospital and all of the things I own in this world fit into that bag over in the corner. Can’t you do an old lady one last kindness?”
Knowing she had won, I resigned myself to keeping her secret. I did however have one final question for her,
“Just one thing Dorothy, what is with the barking?”
“I saw it on an old TV show called The Judge. A guy was trying to get off on an insanity defense, and did the barking thing,” she explained. “I figured if it could work for him it could work for me,” she said as a guilty smile again broke across her face.
So I kept Dorothy’s secret for the rest of the time I worked there, and we continued our little talks in her room as time permitted. She was a beacon of light on the unit, and soon became the ringleader in leading the chorus as well as in helping the other patients with various tasks around the unit. Every so often I would hear a bark echo through the halls, and when I did, I knew Dorothy had slipped back into character. We continued on like this for several months, and when she would give me her patented wink and smile, I knew it was her way of saying thank you for keeping her secret.
I have never told anyone Dorothy’s story until now, as I always felt like it was something that was just between us. I went back to the unit a couple of years after I stopped working there, and found that Dorothy had died, but also that she was singing and laughing right up until the end of her life. Looking around the unit, I noticed nearly every one of these people I had come to appreciate and loved had died, and, although I knew I should be sad, I actually felt a different kind of emotion.
I found myself thinking of Dorothy and how she had chosen to live out the end of her life, and the full implications of her decision. Although many might consider time in a nursing home to be a kind of prison sentence, for her it was, by her own report, one of the best experiences of her life. She reclaimed a missing piece of joy that had been absent from her life for nearly 50 years, and in doing so made what would be for many people a very startling choice. Dorothy however had engaged long dormant parts of herself and found a kind of peace though her decision that I admired more than I could even understand. Sometimes when I’m moping around or feeling sorry for myself I think about Dorothy and the choices she made, and I realize Victor Frankl was correct, we always have the power to think about something in a different way, and in doing so can find happiness in even the most difficult of circumstances.
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