Dementia is a unique and interesting thing. It may affect one person one way, and another, the complete opposite. Some days in our line of work, it is impossible to determine if dementia is the culprit to a certain behavior, or was the individual always this way. I understand that not every single 90 year old was not always a sweet, cute ball of happiness , but geez, can there be so many vicious, mean ones?
Let me tell you about Shirley to give you an idea of what I am referring to when I say “mean.” Wow. Shirley is a full packed pistol. This morning as I was walking through the facility, I encountered her or should I say, heard her.
” All of you can go to the pits of hell. All of you belong in jail. I am going to kill you all. You all are Godless heathens who need to go to jail and never get out. Let me get up from this chair and you will find out what kind of person I am. I don’t mess around. I mean it. I will kill you all. You hear me? Answer me!!!!!! Fine, don’t answer. But I tell you one thing, when I get my hands on you, you better get running and hope I don’t catch you….” Shirley continued on and on, and seemed to be working herself up, so i felt the need to visit with her for a while and see if I could redirect her and reduce her anxiety.
” Hey Shirley, how are you this morning?” ( Okay, that was a dumb question. )
“How am I doing? I will tell you how I am doing. You are a heathen. You hear me? I hate you. You are stupid, stupid, stupid, stupid. You belong in the jail. No you don’t. You belong under the jail. you dumb dumb. I wouldn’t feed you a scrap from my table. I will give it to the cow before I give it to you. You hear me? Huh?” Stand there looking dumb ‘cuz that what you are. Dumb.”
Well, goodness. I wonder what re-directional technique would work? Hmmm. Certainly with all of me experience and education I can calm her, right?
Kneeling down beside her, I tried to adjust the volume of my voice to hopefully have her match mine….
” Ms. Shirley, what has you so riled up today? Is there anything I can do to help you……” Before I could finish, Shirley drew back to throw a right hook punch, aiming for my nose. I quickly moved out of the fire.
” Anyone ever tell you how ugly you are? Ugly. You are ugly, ugly ugly.I bet you aren’t even married. Nobody would be stupid enough to marry an ugly thing like you……” She continued on and on with her insults, carefully crafting her next plan of attack.
Without hesitation, Shirley changed gears. ” Who did you say was getting married? Tommy? Well I hope he finally found somebody. He may be son, but he is one useless man. He ain’t worth the dirt he drags in on his shoes. Nothing worse than a useless man. Wonder who is marrying him? I hope it ain’t Patty’s daughter. That girl ain’t got good sense. Maybe they will make a fine pair, useless pair……… She continued for 15 minutes discussing Tommy and his lack of use..
It never ceases to amaze me at how dementia creates a whole new personality that differs dramatically from the who the individual use to be. Shirley, prior to the onset of dementia, was an elementary school teacher. Now, we all know the patience needed to be a teacher, especially an elementary teacher! So how did Shirley go from that person to the one screaming hateful words today?
The brain is a mysterious thing, yet carefully studied by the greatest minds of all times, yet some questions will always remain unanswered. The best any of us can do is to simply try to understand, reassure and comfort.
The key being try. All of the sweet talk in the world is not going to redirect someone who has lost the emotionally connect. The medial section of the brain may shut down, causing a loss for impulse actions as well an emotional balance……… who really knows?
Shirley continued to vent, rant and rave….eventually calming down after the nurse gave her her morning meds. After a few hours, the meds will wear off and she will once again return to her previous state……..until it is time for her afternoon meds……..and the cycle continues.
People who do not advocate the use of psychotrophic meds have never seen the results of an unmedicated dementia resident who has absolutely no impulse control. The purpose to medication is not to sedate or create a zombie, but rather to decrease anxiety, promote a sense of well being and overall sense of peacefulness.
Shirley is sleeping now…….all is well for the moment, and that is a all that matters…….for now.