Awakening Redux II, The Thin Edge of Dignity

Awakening Redux II, by Dick Weinman, The Thin Edge of Dignity

As a resident of an ALF, with my cognition still intact, “senior moments” at a minimum, not yet in the haze of dementia, I’m aware of “the geriatric communication mode” which seems to be, smile and speak in an ascending high pitch.

I know all about smiley voices. It’s not just the caregivers or people talking to old folks. I once was a smiley voice. As a Voice Over narrator for decades of delivering radio and TV commercials, the singular direction given to me and other voice-talents by the director was: put more smile in your voice!

Thus today, I am invulnerable to the smiley tones of the voice-overs in TV ads. After all, I was one! Even when the horrendous side effects of pharmaceutical ads are listed, the voice talent is happy. (“Good news! The only negative effect is kidney failure and dialysis.”) I can hear the director instructing the voice actor – put more smile in your voice.)

But the truth is, regardless of my perception, despite my sanity, my achievements and my life experiences, I can’t toilet or dress dress myself. I need assistance – a caregiver, as she’s called in the Caring Industry – to start the day.

To continue the morning ritual: once the caregiver enters, I roll in my wheelchair to the toilet – or “bathroom” or “rest room” or “facilities” depending on her sensibilities. The caregiver turns my chair to the left, so I face the handicap bar. I lock my wheelchair, stand and reach out to grab the bar. She tugs down my pajama pants. Naked, waist down, I sidestep to the hard plastic seat. I’m losing a little dignity. The caregiver will either leave and say, “Just pull the cord” (the ringing tone calls her), or she’ll continue the morning ritual by making the bed, entering the living room and opening the blinds, cleaning my glasses; when that’s all done, she’ll either wait for me or repeat the “just pull the cord” mantra, and leave. New caregivers leave me alone to carry out my waste disposal; they usually explore the pictures on the wall of the living room. Eventually, I say “all done.” That part of the ritual is completed.

Next, I get off the seat, stand, grasp the bar, my back – and backside – to the caregiver. I spread my legs and bend over – prostate exam style – and, get wiped. (I could say “cleaned,” but let’s call it as it is.) I’m getting closer to that edge of dignity. Usually the caregiver will ask “wet” or “dry,” meaning do I need a pre-moistened wet wipe like the ones used for babies’ little behinds, or will the ALF-supplied sandpaper - toilet paper do? I choose both (but I buy my own Charmin). She commences with the wipe. My dignity joins the results of my toileting and the TP - flushed down the drain.

A new phase: with the cleaning complete, the caregiver lifts up my pajama pants, I sit in my wheelchair and she rolls me back into the bedroom, after she has taken the day’s clothing that I chose the night before and laid out on the living room sofa the night before. She puts and the clothing on the bed, waiting to be placed on me.

So with dry mouth and sour breath (if I didn’t get to the bathroom before she entered), I dutifully stand, again back to the caregiver, waiting to have my pajama pants pulled off again. I feel stupid, just standing there, backside exposed . Another step closer.

When the PJs are down around my ankles, I grab the bed’s side rail and swing into a sitting position on the edge of the mattress. Once I’m seated, the caregiver removes my tee shirt, in preparation for putting on my shirt for the say. How she does it is important to my pain level. The least painful order is: head through the neck hole, right arm (my “good” arm), then the left arm (messed up arm.) It hurts if the arm sequence is reversed, as the caregiver forces my range-of-motion.

The slogan Certified Nursing Assistant (CNA) caregivers are taught is: “weak arm first, strong arm last.” That’s for putting anything on – tees, dress shirts, jackets, sweaters, etc. For removing, the order is reversed.

I feel that this word parsing is an acquiescence to psychological health. The arms are essentially good and bad – so why not call them that?

I raise my left (bad) arm, which she bends through the sleeve first, then I slide my right arm (good . . . sort of) into the shirt sleeve; then she puts the neck hole over my head. I’m almost there.

The caregiver has three options in the below-the-waist dressing ritual. She can bend over from the waist while pulling my underwear briefs up to my knees, pulling the socks on, and putting my legs into my pants, and pulling them up to my knees. Or she can squat – the back healthy position – and engage the same process. Not only does that save the back, it also ensures that no cleavage is revealed. Some caregivers sit on the floor or rest on their knees. I don’t know which of the three is ergonomically best. Each to her own.

The dressing and undressing below the waist is from the rear. That, too, must be difficult for the caregiver: pulling up jockey shorts, not impinging on the crotch, and straightening them around the waist. It’s the same process with pants: making sure the rear seam is straight to the spine and the waist height is correct. I like my waists ultra high, and have been referred to as the white Urkel.

To help the dressing process, I buy lounge pants, with elastic waists; no buttons, belts, or zippers – regular pants or jeans are hard to dress people in: it’s a long reach around the waist to put a button through a hole, or to zip a fly; jeans require lots of pulling, wiggling, and breathing-in.

Now that top and bottom are covered, the caregiver asks “9 or 22?” (I have two identical New Balance white and black sneakers , model numbers 622 and 609.) Faced with this critical choice, and hearing “hmmm?” from the caregiver – as if to say, “come on already, I have another call” – I make my decision. How gleeful I am if the caregiver pulls the laces apart and stretches out the shoe tops to loosen the shoe before pushing the shoe onto the foot. It’s a lost art. (And depends on how the evening caregiver took them off.)Today, many caregivers keep the shoe tops unlaced or tightly laced, so it takes a great expenditure of energy to squeeze, twist and mash my foot - especially my left shoe, since my left ankle is chronically swollen due to my accident - my into the shoe. Then, the laces are tied. I respect how hard that can be for the caregiver wearing vinyl gloves. It’s like shoeing a four year old.

Once that’s done, it’s time to stand and have my outfit straightened: shoulder seams correct, sleeves the proper length, shirt buttons buttoned, tears in the waist band of my aged and worn lounge pants covered by the shirt. Then I step backwards and drop onto my wheelchair. Another chapter written.

Almost finished, the caregiver pushes me into the bathroom for a look in the mirror at my bed-head hair, further mussed by putting on the shirt. I brush the front, which my limited range of motion allows, and she brushes out the “rat’s nests” in the back.

“Anything else I can do?”

“No thanks. I’m on my own.”

She leaves to answer another call. I conclude the waking ritual, by putting the tube of Crest to work (see the next blog) and roll into the living room, returning to the computer and glancing again at the weather to see if I chose the right clothes; I follow through with Yahoo’s news stories, and leave the apartment.

I roll down the corridor to the med room to gulp the plethora of my multi-colored pills, swigged down with my fiber drink, the Metamucil bottle among the multitudes in the medicine cabinet. The med shelves at the ALF could be called “laxative row.”

Now I’m ready for a new ritual: the dynamics of the dining room, a catty, chatty, rumor- spreading, eating assembly.

Oh, how I long for my solitary, quiet breakfast time at home with The Oregonian; the beneficent aroma of freshly ground coffee beans, and the mellow sip of just brewed black heaven.

And, to dress myself!