A few days ago I was shanghaied by a desperate hospital administrator into working in a ward for elderly people with neurodegenerative disorders and acute mental health needs. My feeble protests that I’ve never cared for elderly people before and I know hardly anything about dementia were waved aside, and at seven o’clock in the morning I found myself standing in the bedroom of a lady who was more than a little displeased to find me there, trying to work out how to put the brakes on her commode. The last time I worked in an unfamiliar psychiatric ward everyone kept mistaking me for the on-call doctor and thrusting their foot infections in my face, but today it was clear that I wasn’t going to be taken for anyone so competent. After despairing of my inability to make her commode safe for her to sit on, my first patient of the day started yelling, “Nurse! Nurse! Get this bloody woman out of my room!” and, when the nurse came running, she enquired in long-suffering tones, “Nurse, is this girl dead? I can’t do anything with her!” As the morning progressed she became more tolerant of my deficiencies. Having delivering a stinging critique of the way I pulled up her trousers after the toilet, she sighed and said, “Well, one of us is pitiful, and I don’t know which.” By breakfast time we were quite pally, and we were sitting holding hands in the living room, looking at the fish in the aquarium.
This ward is quite a harrowing place to be. For some patients (including my new friend Sarah) it will probably be their last home. Sarah has been here for years, receiving regular visits from her equally elderly husband, who always comes shuffling in under the weight of half a florist’s shop. At various points in the day I saw her grasping hold of passing nurses and imploring, “Take me home.” “I can’t,” one of the nurses said gently, disentangling herself. Another patient received a visit from a woman who might have been his wife or his sister; when I asked who she had been, he looked at me blankly. He’d forgotten she’d even come.
Some patients seemed to be experiencing hallucinations or delusions that frightened them a lot. This is a common aspect of dementia. Because of the deterioration in speech and language that is also part of the disease, it can be very hard for people to show what’s frightening them. I spent three hours sitting with a woman who kept clutching at the air and wailing, shrinking back into her chair away from things I couldn’t see. Her spoken language seemed restricted to “Horrible, horrible, I don’t want”. Sometimes she cried. I tried to comfort her by taking her hands in mine, which sometimes helped and other times made her pull away with a shriek. I don’t know who or what she believed me to be.
The tricks that neurodegenerative disorders play on the memory can make caring for people who have experienced psychological trauma especially challenging. My introduction to this came through Judith Hassan’s book A House Next Door to Trauma, which is based on her work at a social centre and a care home for Holocaust survivors in London. Because of the residents’ background, staff in the care home don’t wear uniforms. The sight of many uniformed figures moving about the corridors could be terrifying to a camp survivor whose sense of time has collapsed and who may or may not be aware of where she is now. In certain Palestinian communities, especially the West Bank refugee camps, people with dementia find that the past colludes with the present in the same way. The grandfather of a boy in one of our youth groups, expelled from Jaffa in 1948, responded to the military incursion of Bethlehem during the Second Intifada by screaming for his suitcases. Another elderly woman who died in 2011 passed away in the serene belief that she was still in the home to which she was denied return.
The right of return for Palestinian refugees seems to be a hot topic in the Israel/Palestine blogosphere at the moment, due to the latest round of US-brokered talks. As always the arguments against RoR and in favour of a decisive partition are based on numbers. Many people who would describe themselves as sincerely committed to peace apparently do not see anything incongruous with characterising other human beings as a threat simply by virtue of who and what they’re born, with a communications intern at J-Street, the AIPAC alternative that styles itself as ‘pro-Israel, pro-peace’, writing on its official website: “I am not satisfied with a pro-Israel voice that shouts about military threats from Hezbollah but is silent about the demographic threat from a stateless Palestinian population. Just as Israel needs to prepare for war, it must also prepare for peace.” This is the view taken by Peace Now, easily the largest and most mainstream peace organisation in Israel, which produced a cartoon video showing what horrors lie in a store if the two-state solution should fail. These horrors were represented by Palestinian population statistics and the sinister sound of a minaret’s call in the background. The demeaning indignity of this approach to peacebuilding was captured by Roddy Evans when he wrote, “What we have in Northern Ireland is the sight of one section of the people, the majority, saying to the rest: ‘We could never live in a country where you were in the majority.’ Now that is deeply hurtful; it is an insult.”
In a place where segregation has been the norm for so long it is perhaps difficult for well-meaning individuals from the privileged community to recognise why that would hurt. I understand that much, but looking round the dementia unit, I do wonder how anyone is able to invest so much faith in the protection accorded by majority status.
A few decades from now I could be sitting in Sarah’s place. I might get an efficient nurse who can help me to the toilet properly, or I may get some bungling idiot who is incapable of applying the brakes to my commode and who nearly pitches me headfirst down the lavatory pan when she pulls up my trousers. I will rely on other people to feed me, to wash me, to dress me, to give me the time of day. Perhaps I will repeat the same questions again and again and the nurses will get frustrated with me. Perhaps they’ll keep their temper. All of that will be completely out of control. Even more frightening is the thought of the cognitive deterioration that usually comes with age and the serious (and common) medical forms it can take. Perhaps one day I will be sitting in my chair clawing panicked at the air, with difficult memories colliding with my present reality and my mind unable to sort through what is real and what’s not. Intrusive memories crowding on the periphery of my consciousness: an elderly man crying out for his suitcases, his voice jarring with the songs in the park on Yom Ha’Atzmaut; children pressing their faces to a securely fastened window, peering in at the person who eats breakfast where their grandparents once did; Lebanon transformed into a locked closet with the skeletons threatening to spill out at the lightest touch. No one can work in a dementia ward for longer than half an hour without realising that untangling the past from the present is not so easy and that there isn’t much you can do to protect yourself from the memories you would rather not carry. Except, perhaps, to sit and hold a stranger’s hand.
Sarah kept squeezing mine. “I’m a bloody nuisance,” she said dolefully. “You’re lovely,” I told her. She glanced up, wearing a toothy grin, and dropped a kiss on my hand. “I will go to the Lord,” she said with great contentment, as though announcing her intention to stop by the shop on the corner; and as I tucked her into bed that night I was suddenly reminded of the words of St John of the Cross: “In the evening of life we will be judged on love alone.” Sarah certainly doesn’t seem to have much else left. Perhaps that is why she has her peace. Her lined face was soft as I spread the blanket over her. “You won’t put me in the dustbin, will you?” she said drowsily. “I didn’t think you would.”
At last she was still, no longer twitching anxiously. I looked round her room, at the roses left by her husband and the favourite colourful blanket she had brought from the home she can’t visit, and bit back a smile as I remembered her criticisms of my nursing skills: “Well, one of us is pitiful…!” I tiptoed out. Her dreamy voice followed me down the corridor: “I knew you as a little girl, you know. You played with my young ones. You were a good kid, except when you weren’t…”