Monday, May 31, 2010

Memories of a little old lady

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.

Tuesday, May 25, 2010

Dancing on your own grave

“Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night

Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.”

Dylan Thomas- Do not go gentle

When I was in my early 20’s, I used to enjoy the idea of global warming. Sometimes I used to dream about an asteroid hitting the earth. None of these thoughts were in a suicidal kind of way, but I used to think how nice it would be if something would happen that got us all got back onto equal footing. Credit scores, friends who graduated from college way too fast, endless comparisons with my neighbors and classmates? None of this would matter anymore, as we concentrated on survival in the rapidly approaching nuclear winter. This thought filled me with a feeling of great warmth.

On the other hand the poem at the beginning of this essay was a steady companion in those days, and I vowed to “rage against the dying of the light,” whenever I got the chance. I was however always curious about what he meant by the “wild men” who “learned too late they grieved it on its way.” I spent half my life trying to figure out exactly what that meant. What did they learn? What were they grieving? Now all these years later I think I have come to understand what this line means, or at least what it means to me.

I think what he was trying to say is that even when we are in the prime of our lives, when we seemingly have everything a person may need to live a passionate and rapturous life, we still find a million things to complain about. Later we wax nostalgic about the good old days, not remembering how much we complained about these very same days when we were actually living them. Rarely do we acknowledge the prime of our life when we are actually living it.

Studying the work of Joseph Campbell helped me understand that maybe, just maybe, this is the kingdom of heaven. Right here, right now, every breath we get to take in is a chance to experience the amazing gift of awareness. What if all of the ways we poison this life were just traps of the mind, and there was a way of freeing ourselves from these traps? I am certainly not the first one to suggest this idea, and it is one that has been proffered by people from the Buddha thousands of years ago to Eckhart Tolle more recently.

It’s very difficult to feel anything akin to being in the kingdom of heaven when bill collectors are ringing our phones and doctors are telling us our bodies are falling apart, and I am as guilty as anyone of finding ways to poke holes in my own happiness narrative. But truth be told, for all of its loss and heartbreak and disappointment, truthfully this is the best life I can imagine. Everything is possible, and if I am disappointed in something, it is, as long as I am drawing breath, possible to choose another way to live. In the words of George Bernard Shaw, “This is the true joy in life: Being used for a purpose recognized by yourself as a mighty one, being a force of nature instead of a feverish, selfish little clod of ailments and grievances, complaining that the world will not devote itself to making you happy. I am of the opinion that my life belongs to the whole community and as long as I live, it is my privilege to do for it what I can. It is a sort of splendid torch which I have got hold of for the moment and I want to make it burn as brightly as possible before handing it on to future generations.”

Which brings me to one of my favorite scenes from a TV show called Northern Exposure, which was a wonderful character study of people sharing their lives in the Alaskan wilderness. There was one friendship in the show I particularly enjoyed between Ed, the twenty-something filmmaker, and Ruth Ann the woman in her 70’s who ran the local store and who had lived a wonderful life of adventure.

In this particular episode, Ruth Ann turns 75, and Ed begins to treat her like her death is imminent. Ruth Ann, who has truly learned to savor every moment in her old age, dislikes being treated like an old woman, and throughout the episode they discuss the subject of death, and how it is not something to be feared, but instead something to be reflected on to enhance the meaning and value of our time here.

The last scene is what really stuck with me, as Ed purchases her a grave on the top of a mountain, and the final scene shows them both dancing joyfully on top of it. It took rewatching this as an older man, but finally I think I got it. There was no grieving the sun on its way down here, they were actively celebrating a pure moment of mindful living, and in that moment they were blessed with that fleeting gift of appreciation for the miraculous set of circumstances that brought them there.

I think about these things when I wax nostalgic about my own “prime” and how much better life was at some other point in my own existence. This is a lie, a trick of memory that allows us to forget the bad and remember the good. One day we will likely even look at this period of our life with a kind of fond reminiscence, forgetting the thousand ways we rationalized how life could be better. For better or for worse, this is where we are, right here, right now, and it’s the only piece of our destiny we have any power to change. Give it a shot. Dance on your own proverbial grave and see how it feels. This is the power of emotional choice. We can be, as Shaw suggests, “selfish little clods of ailments and grievances,” or we can chose to laugh and be here now with total acceptance that where we have landed is exactly the place we’re supposed to be. All of our previous choices have led us to the now, and taking responsibility for how we are going to proceed from here is what we have. All we have.

Monday, May 24, 2010

Defending your life

I watched one of my favorite movies last night called “Defending your life,” with Albert Brooks. Although there have been hundreds of books and movies that speculate about what happens to us when we die, this movie did it in a way that has stuck with me since I first saw it when I was a kid. The premise is, that at the end of your life a small panel of judges examines 10 or so representative days of your life to see if you have conquered your fear during the duration of your time on earth. If they found you had, you got to move on to a higher level of consciousness, if not, you got sent back to earth to do it all over again.

The thing that resonated with me so much about this process was the emphasis on the role that fear played in determining the quality of a person’s existence, and how, according to the movie, our lives came down to a small handful of choices that gauged how much we allowed fear to influence our most important and pivotal choices.

When I first watched the movie I was a teenager, and found this to be a powerful way to think about living my life. Beyond morality or stability or security, I wanted to become truly fearless in my life, and shortly afterward took to the road. At the time I was, in my own mind, living a life without fear, perhaps even recklessly so. I spent my twenties traversing our great county, working in 5 of our national parks, traveling, performing comedy, and slinging a whole lot of liquor both as a bartender as well as a patron. Taking stock at the age of 30, I realized I had covered a lot of ground, but had little to show for my behavior but a lot of wonderful memories. A priceless thing to be sure, but it was at this point in my life that I first began to question if fearlessness was the only value worth living for.

Somewhere around this time I began to understand that there was a difference between conquering one’s fear and simply living in pursuit of pure hedonism. On a grand scale, conquering your fear was an amazing thing. It helped me bungee jump, get on stage as a terrified performer, travel into worlds unknown again and again, and hang out with a few women drastically over my head.

I look upon that period of my life with great nostalgia, but now, having been a therapist for several years, I have a little different take on tackling fear in our lives, and I find my position has changed a bit since the days of my sky-diving, hard-drinking youth.

You see I don’t think fear is conquered on a grand scale, although I certainly thought that for many years of my life. No I think the battle with fear is encompassed in a million little moments of our lives. The person we lock eyes with who we don’t quite work up the nerve to talk to. The promotion at work we don’t apply for because we don’t think we’re good enough. These are the little battles we face all the time, and as days give way to years, these are the choices that become the stories of our lives.

Even beyond these things however, there lies another layer of fear that rests at the deepest core of our psyches. This is the stuff we deny and put away on the back shelves of our minds to deal with on some faraway rainy day. This is the stuff that speaks to our deepest feelings of inadequacy and unclaimed baggage from the wounds that we never quite got around to dealing with. Stephen King describes this eloquently, saying, “So do we pass the ghosts that haunt us later in our lives; they sit undramatically by the roadside like poor beggars, and we see them only from the corners of our eyes, if we see them at all. The idea that they have been waiting there for us rarely if ever crosses our minds. Yet they do wait, and when we have passed, they gather up their bundles of memory and fall in behind, treading in our footsteps and catching up, little by little.”

So how do we stare these ghosts down? Some of the ways that have worked for me are honesty and laughter, which at least in my life are intertwined in a kind of perfect union. All of those things, those little nagging things I don’t always like about myself? We’ve all got a box that’s full of them, and sharing them in a funny way is both liberating as well as generative. Others can use them, learn from them, and through your own self-deprecating spin on these things perhaps begin to diffuse the power of some of their own fears. This is our shared absurdity as human beings, and so often the only thing that separates intense disappointment and fantastic shared laughter is a little time and perspective. It’s a useful idea to keep in mind that has personally helped me conquer a lot of my own fears, both large and small.

Friday, May 21, 2010

Unquenchable Laughter

Years back I was rummaging through my grandparent’s things, minding my own business, when I stumbled upon some books by Robert Fulghum, the author of the now famous essay, “All I really needed to know I learned in Kindergarten.” I began reading one of his other books called, “Uh Oh,” and was immediately struck by an essay about what the Greeks called, “asbestos gelos,” unquenchable laughter. It has been with me ever since, and today I went back and reread these words of wisdom. Here is an excerpt;

“To get through this life and see it realistically poses a problem. There is a dark, evil, hopeless side to life that includes suffering, death, and ultimate oblivion as our earth falls into a dying sun. Nothing really matters.

On the other hand, the best side of our humanity finds us determined to make life as meaningful as possible NOW; to defy our fate. Everything matters. Everything.

It is easy to become immobilized between these two points of view - to see them both so clearly that one cannot decide what to be or do.

Laughter is what gives me forward motion at such intersections. We are the only creatures that both laugh and weep. I think it's because we are the only creatures that see the difference between the way things are and the way they might be. Tears bring relief. Laughter brings release. Some years ago I came across a phrase in Greek - asbestos gelos - unquenchable laughter. I traced it to Homer's Iliad, where it was used to describe the laughter of the gods. That's my kind of laughter. And he who laughs, lasts.”

I was struck by this idea that choosing laughter may represent a kind of mindful living that represented a choice in the way we saw the world. Years later as I reflect on all the places I’ve been and all of the people that have come and gone in my life since that time, so many worries and struggles have receded into the distance, and what I am left with is fond memories of the times I have truly celebrated this kind of unstoppable laughter with people along the way.

Yet even as I say this, worries creep back into my mind. I forget that anxiety is a temporary virus that burrows into our sense of peace, reminding us of all the things that might go wrong. Most of the time these things never happen, but meanwhile we waste a tremendous amount of energy putting out these little fires in our minds.

So what is the antidote? For me I know the answer is laughter. The simple fact is that all of the ways we worry about our problems rarely get us any closer to finding a solution. Here is where we come to a fork in the road. We can worry or we can find a way to reframe our problems in terms of laughter. As Gilda Radner wrote about so eloquently when she was diagnosed with cancer, “it’s always something.” Dark humor to be sure, but also an amazing example of the kind of resilience a life committed to laughter can provide.

How to we learn to find this line between the thousands of little tragedies and comedies in our lives? I certainly haven’t mastered it, but more and more I’ve learned to mentally confront these tragedies with a question. Will this really matter to me in a year? Even a week? Almost always the answer is no. As I retrace my own memory banks, I find that more and more the things I thought I should be worrying about were never the real things. As Mary Schmich says in Everybody’s free to wear sunscreen, “Don't worry about the future; or worry, but know that worrying is as effective as trying to solve an algebra equation by chewing bubblegum. The real troubles in your life are apt to be things that never crossed your worried mind; the kind that blindside you at 4pm on some idle Tuesday.”

I would encourage you to develop your own set of questions when these viruses of the mind attack, so you can find your own way to laugh about the inevitable rain that falls into all of our lives. Try it, try to really challenge these worrisome reminders and see if they really hold up to serious scrutiny. If they do I’d like to gently suggest to you that you are perhaps a bit too invested in the seriousness of your own private universe. In the grander scheme of things, this will certainly pass. It always does. Laughter however is forever. I know this because I’ve been fortunate enough to relive so many wonderful memories of laughing with people throughout my life, and if I had it to do over, I would have had a whole lot more of them. I’m learning. All of us are learning. Let’s listen to each other a little more often rather than listening to the voices in our heads so often. I promise you your reward will be a lighter load to carry.

Yes, and versus yes, but.

Yes and, and yes but. They seem like such simple little phrases, but strangely they have both had a significant impact on my life. The power of both these phrases and their relevance to the integration of comedy and psychology recently became clear to me after a conversation with the comedian John Heffron. Allow me to explain.

Although I became a therapist after a comedian, in this case it is useful to start with a style of interaction I learned in my first year studying psychology. The yes, but personality. Sounds so innocent, but this phrase is actually at the root of one of the most frustrating styles of personal communication around.

At first glance, people who use this phrase seem perfectly agreeable. They nod and smile, and listen carefully to your well-thought out advice. Perhaps they will even compliment you on the wisdom and poignancy of your opinions.

But invariably the other shoe drops. As quickly as they initially embrace your ideas, they swat them away. This is the woman who asks you for relationship advice who keeps going back to the same guy over and over again. The lonely guy who asks you to set him up who finds a problem with each and every person you suggest. Think about the yes butters in your life and how you feel after a conversation with them. What is conjured up?? Confusion? Frustration? If so you’re not crazy, and you might be thankful to know that psychologists such as Alfred Adler were talking about this personality style nearly 100 years ago.

The “yes, but” style of communication may best be described as a passive-aggressive personality. People who suffer from this personality style are often stuck in a state of personal conflict that makes it extremely difficult for them to make decisions, and they often become quite adept at passing this intrapsychic turmoil on to the people they interact with.

To some degree we all have a “yes, but” conversation going on in our heads, and I suspect it holds us back from doing a lot of the things we want to do. How often do we talk ourselves out of taking a chance or following a dream by conjuring up counterarguments in our heads? I don’t have enough time, or, where would I get the money? and a million other restraints echo in our heads all the time, reasoning, rationalizing, and otherwise throwing cold water on the creative forces that exist inside of us.

Which leads me to “yes, and.” I was introduced to this phase when I first got to Chicago and enrolled in Improv classes at The Second City theatre, home to many of my comic idols, and I was sure the launching pad to my own illustrious career in the field. Not knowing much about Improv, I grew fascinated by its central tenet, the concept of “yes, and,” which was based on the idea that you added something to everything your scene partner offered. Therefore if someone came on stage and said, “I see you’ve been to the psychiatrist,” you might respond with, "Yes, AND I saw my gynecologist, they’re in the same complex so I just see them together now.” Point being that you take an idea that someone offers, listen to it, and then add even more. This concept and this school of thought has produced many of the greatest comedians who ever lived, several of whom got their start in this same little theatre I was studying at.

I never did become world famous as a comedian, but years later I’m a therapist and I found myself thinking about the value of “yes, and” and how much creativity is produced when our initial response to things is in the affirmative. So often we fall into cognitive traps that make it very difficult for us to change, and most of the problems start directly inside our own heads. Yes, and, takes work. Our minds fall into a default state of comfort where we are comfortable with the demons that we know. Yes, and is scary and different, but perhaps it is also an important part of making real changes in our lives. I’m challenging myself to try using this the next time I find myself rationalizing why I don’t follow through on a goal that is important for me to accomplish. Try it out, AND perhaps even add something to this simple premise that I have suggested. For me at least, much of the great laughter in my life has started with Yes, and, and I hope that it can work for you as well.