Decisions... Decisions... Decisions, The Thin Edge of Dignity

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Decisions, Decisions, Decisions, by Dick Weinman, The Thin Edge of Dignity

I waddle my wheelchair down the hallway of my ALF to the dining room. But, I’m not alone. I see other people marching, like me, to learn what awaits them for breakfast. Some of the residents power their wheelchairs, others hunch over walkers, some lean on a cane, or walk erect – gathering from two directions, ready to make their choice for breakfast.

The decision making is a new experience for me. When I left the week before to travel to the Northeast, dining protocol was different. You ate what was given to you, or else you left it on the plate. One day, oatmeal was served; the next, it was Cream of Wheat. That was the extent of choice – which really wasn’t a choice.

I was surprised by the change in the dining ritual in which I had participated for almost a decade. Change may be a good thing, but it can be unsettling, especially for an octogenarian like me. And, as residents of an ALF, we are all geriatrics – septuagenarians, octogenarians, nonagenarians. We have even housed some centenarians. Think how upset they would have been - had they been alive.

Arriving at my destination, I roll into the dining room. Out of habit, I stand staring at the Menu Board – oops, I forgot. I’m in a wheelchair. I don’t stand. (Funny how everyday phrases stick in our minds.) Regardless of the level of my height, I stare at the black letters printed on the board. It’s affixed to the wall above the dishes containing the morning fruit choices. Easy to see.

I read the words – oatmeal, brown sugar, scrambled eggs, bacon strips, fruit. But then, behind me, I hear the same words. I hear them again when I’m seated at the table. The three caregivers audiblize them. They stand over each person seated at the table, and ask if she or he wants “oatmeal, brown sugar, scrambled eggs, bacon strips, fruit.” Or if s/he wants any one of the choices. Or any combination. Or “the works.” She addresses this question to each person, one at a time. But, though only one resident is asked, everyone at the table can hear. Since each of the three caregivers asks, the dining room echoes in a redundancy of similar sounds.

If a resident is cowed by the question, or is hard of hearing, or is hesitant, the whole array of options is repeated, and the same sounds of the same words - times three – reverberate through the room.

Furthermore some caregivers have voices that can be heard throughout the whole dining room, and everyone gets a chance to hear– all at the same moment: “ oatmeal, brown sugar…and the other breakfast choices of champions.

The tension of decision making is exacerbated, and the sound is increased, when “any style of eggs” is a featured item: just count the ways.

A rippling cacophony of multi-channel reverberating sounds bounce through the canals of my ears, sending echoes of a mosaic of names of foods. I feel as if I should be asking, Hello, Alice, are we down the rabbit hole yet?

The morning vocal symphony of residents making food choices isn’t orchestrated for the mid-day meal. The calculus of lunch – the piece-de-resistance of daily meals – is calcified in our minds a week-in-advance. Once a week, the Dietary Manager distributes a one page complete menu for the following week. We residents can decide between two entrees for the largest and proudest and showiest meal of the day. This non-threatening process allows us to make an informed, deliberate decision.

Alas, the calm and restful moments of choice about our lunch is tossed aside by the frenzy of making choices at dinner. In the olden-golden days, we were given a plate containing the traditional dinner threesome – soup, sandwich, fruit. In this new day, there’s not even a plate. We sit. Stare. Sip water. Nothing is passed out until the caregiver, also wait person, gets an answer: “Do you want the soup AND the sandwich?” Or, the choice is simplified: “Do you want the sandwich?” OR “Do you want the soup?” OR, “Do you want the works,” which is like saying: “Do you want BOTH the soup AND the sandwich?” which is rephrasing the first question. An added decision is required if the sandwich is chosen: white or brown?”

Once the big choice is made, complication looms; there is a further reduction of the question, the next tier of decision making as it were. If one chooses the soup, s/he must decide whether they want to sup a cup or bowdlerize a bowl. If one chooses a sandwich, the decision – in addition to color of bread, is between a half or whole.

While you’re fretting over the decision, the caregiver/waitperson, hovers over you and hurries you along, pad and pencil at the ready, waiting to write down your decision and hurry to report it to the cook.   Some caregivers speak gently, cooing rather asking; others sigh heavily, sigh extra-loud, and tap the end of their pencil on their pad. Some exhibit body language that exclaims, “Make up your mind, dammit.”

Under duress, the timid, the uncertain, the intimidated, the person with dementia – stutters, whispers, or just nods, so that their choice can be recorded. Then the caregiver/wait person takes the orders from each table, hurries off to the kitchen and shouts each person’s choices to the cook – as your private decision is heard by the rest of the dining room.

The on-demand requests at breakfast and dinner are unnerving. To me, it’s like an oral SAT exam. I have to think quickly. What if I’m so nervous, I make the wrong choice? What if I change my mind ? Could I later say I misspoke, when I see what I chose on a table mates’ plate and it looks icky. Can I blurt out a refusal?

Free choice and the rights of the individual may be great political concepts, but as a protocol for dining, they require cognition and quick thinking. It can produce acid-reflux. I look back fondly upon the golden days of eat-what-you’re- given!

What prompted the change in the dining room ritual?   It’s possible the caregiver’s inquisition of residents could be nobly motivated. If neither the soup nor half sandwich was consumed, it was tossed into the garbage. That’s morally wrong in this world of scarcity. It’s a sin to waste food, as our mothers often reminded us. (You remember – “all the starving kids in . . .” whatever country was in the news.) And wasted food is wasted money: it’s economically unsound, bad for ALF business.

On the bright side, menus are individualized. Residents get what we want, not what they want to serve. Dining is more restaurantish than cafeteriaish. And that should be good for business.

With my optimistic perspective, I see making decisions as beneficial. Just think, if I go out to dinner in a fancy dining palace overflowing with choices: many appetizers, several salads, a few soups, dozens of entrees, and piles of deserts – I’ll be well prepared to make a rapid selection, and send the server on her way.

Possessing a new mental acuity, I will brazenly attack the Sunday New York Times cross word puzzle – and shame Will Shortz.

And what a chance to show my prowess in Sudoku!

So, bring it on – oatmeal, eggs, or sausage; soup, or sandwich, or both. Hit me with the old decision making mallet.

I’m ready.

At the dinner meal, the caregiver/server would gently place the food-filled plate on a place mat that resembled a green pasture, blue bucolic lake, or snowcapped mountain. The plate held the dinner meal, whose colors complemented the colorful motifs of the place mats - a cup of creamy white or bold red soup, a half sandwich featuring pinkish ham, yellow turkey, or rust roast beef, a slice of some kind of sulfite-laden, harmful-to-health processed meat.

On the meat, was a thin slice of processed cheese – as equally harmful as the meat – white Swiss, orange cheddar, yellow-orange muenster. And what a treat it was when a condiment was added – thick white mayo, vomity yellow mustard, drippy red ketchup.

Moreover, each plate frequently contained a thin slice of orange cantaloupe or green honeydew melon. We residents were swept up in a rainbow!

Along with the new dinner democracy, comes the color totalitarianism. The scenic place mats, a treasure of the past, gone. First, bare, chalk white replacements; now, a weak plaid.

Gone too, bottles of bright red ketchup, greenish-yellow mustard, white mayonnaise, deep brown balsamic vinegar, licorice black soy sauce – all banned from the dining table. They made for a messy, mess hall appearance.

At lunch, such problems don’t exist. The calculus of lunch, the piece-de-resistance of meals, is calcified in our minds a week-in-advance. The prior and non-threatening decision process allows residents to chose between two options and make an informed, deliberate decision.