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Waking at the ALF

By Dick Weinman, The Thin Edge of Dignity


Darkness shows through the windows, a few stars flicker, the moon is a lighted roundness, an orange haze circles the top of the street light. Through fuzzy eye lids I lie in the in-between state – awake, yet asleep, gazing over my shoulder out the window.  I turn my head toward the digital clock on the nightstand, and I wonder . . . . Who will it be this morning?  I have pulled the cord to alert a caregiver.  I can’t get up and dressed without her. Where is she? “Good Morning!”  she sings, as she knocks gently – or bangs, depending upon who she is this morning. The door gently eases open – or tosses back suddenly - again depending on who the waker is.  But the Good Morning! remains the same.  Is it the “morning mantra” for the geriatric: gooooddd moorrning!  an ascendancy of singing how gooooodd it is and how wooooonderful that it’s morning  (and we oldies made it through the night.)  Is it retribution for how we spoke to our children as we pinched their cheeks, wiggled their skin, “kootchie cooed” them with a smile and false falsetto.

Excited Young Female Doctor

(I’ve delivered commercials radio and TV for decades.  The singular direction given to the voice-talent by the director was:   put more smile in your voice!  I am invulnerable to the smiling faces in TV ads - having good teeth is a prerequisite for TV commercial work – and the smiley tones of the voice-overs.  Even when the horrendous side effects are listed, actors smile and the voice talent grins.  I can hear the director instructing the actor – put more smile in your voice.) As a resident of an Assisted Living Facility ( 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 deems to be,   put a smile in your voice ( and use your high pitches.)  But the truth is, regardless of my perception, despite my sanity, my achievements and the variety and depth of my life experiences, I still can’t get up in the morning without help nor dress myself. I need assistance - a caregiver, as s/he (mostly she) is called in the Caring Industry. So who will come to my aid this morning?  One of the many undergraduate girls?  A forty-fiftyish full time staffer? The person who just tolerates me?  The person for whom I’m a confidant?  The person who likes me, or doesn’t? The person who respects me? The person who has no clue as to what she’s supposed to do? Is the full shift here? Are we short-staffed? How long will I have to wait? Anxiously I listen for the knock. ****** After living in the ALF for seven years, certain processes fall into place.  They are rituals of assisted living.  Getting me up is one of them. It begins with the entrance. In she bounds  - or slinks -  depending upon the night before: is it the Friday after “Thirsty Thursday,”  ( an OSU ritual for college students to a drink and sleep elsewhere than home.)  Or the Tuesday after “Margarita Monday.” Or any Saturday or Sunday when the weekenders work. Or, God forbid, the Sunday after a football victory. First, she throws off my covers. I sit on the edge of my bed. (Ironically, during rehabilitation I had to sit fifteen seconds without falling over.  Eventually, I made it.) I extend my arms like a cute puppy, and she takes off my hand braces.  . if they’re still on. If  I had gotten up during the night a to use the toilet or get a drink, my hand braces have all ready been removed. I have a brace for each arm, extending from my finger tips, covering my palms and extending up my forearm. The sides of the brace are held together by 2” wide straps of cotton fastened with Velcro strips.  A narrower strap crosses the knuckles of each hand. The reason for this overnight hand and arm coffin is to straighten the damaged tendons in my arm and to prevent my fingers from curling fist-like into my palm. (All this therapeutic activity and more is because of the traffic accident which left me disabled, as you read in the first blog in this series, The Thin Edge of Dignity. ) From the bedroom we roll in my wheelchair to the toilet - or “bathroom” or “rest room” or “facilities” depending on the caregiver’s sensibilities.   The caregiver faces my chair to the handicap bar.  I push down on the brake levers so the wheelchair won’t slip as I rise.  I reach forward to grasp the bar, hold it tightly, and stand.  My pajama pants are pulled down and I am gently guided to the hard plastic seat to sit . . . for awhile.  The caregiver will either leave and say, Just pull the cord” (remember blog 2?), or she’ll continue the morning ritual by making the bed, entering the living room and  opening the blinds, cleaning my glasses, squeezing tooth paste onto my brush, or, when that’s all done, just chilling,  usually exploring the pictures on the wall of the living room - until I say “all done.” Mission Accomplished on the toilet! Time to get off the seat. Here’s where dignity begins to crumble:  I stand  facing away from the caregiver, spread my legs and bend over  - prostate exam style  – and, most undignified for both of us, get wiped (I could say “cleaned,” but let’s call it as it is.)  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 –like toilet paper do?  (I buy my own toilet paper when I roll my wheelchair to the super market.) With the cleaning complete, the caregiver lifts up my pajama pants and rolls me back into the bedroom.  First, she takes the day’s clothing choices that I’ve laid out on the living room sofa the night before.  She lays the clothing on the bed, waiting to be placed on me. So with dry mouth and sour breath, I dutifully stand, again back to the caregiver, waiting to have my pajama pants pulled off; down they come. I feel so stupid standing there. Dignity moves closer to the edge. 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.  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), left arm (messed up arm.) It hurts if the arm sequence is reversed, as the caregiver forces my range-of-motion. Let the dressing begin! The caregiver has three options in the below-the-waist dressing ritual. She can bend over from the waist while pulling up my underwear briefs, pulling the socks on, and putting my legs into my pants.  Or she can squat – the back healthy position – and engage the same process.  Not only does that save the back, it also ensures that her blouse top doesn’t reveal any cleavage to this DOM. 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. Now that my bottom half is on the way to be covered, it’s time for my shirt. The mantra Certified Nursing Assistant (CNA) caregivers are taught to speak to themselves 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 a sot 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 - but first. . . She asks orange or blue? This refers to the color of the rubber around the sole of my sneakers and the in-step . Faced with this critical choice and listening to the humming of the caregiver – as if to say, “come on already, I have another call” -  I make my decision. The sneakers are squeezed onto my feet – it seems no one anymore pulls laces apart to loosen the shoe before pushing and wiggling the shoe onto the foot.  There’s a lot of squeezing and foot turning and downward pushing, especially my left shoe, since my left ankle is chronically swollen due to my accident’s left side impact.  Then, the laces are tied.(I respect how hard that can be, with vinyl  gloves, facing the shoes backwards to the heel.) The dressing and undressing below the waist is from the rear.  That 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 is not too high or hugging the hips.  That’s why 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. I’m ready to stand and have my outfit straightened out: shoulder seams correct, sleeves the proper length, shirt buttons buttoned, tears in the waist band of my lounge pants covered by the shirt.  Then I step backwards and drop onto my wheelchair. The caregiver then grasps the handles, and 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 tangles from 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, with a swish and gargle of Listerine.  Then I roll into the living room to the computer and glance at the temperature to see if I’ve chosen the right clothes.  I scan the CNN news headlines . . . and I’m ready to go. I  roll down the corridor to the med room for a gulp of  the plethora of my multicolored 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 the next ritual:  the dynamics of the dining room, a catty, chatty, rumor- spreading, eating assembly. Oh, how I long for my solitary breakfast at home with The Oregonian and my freshly ground coffee! And, to dress myself!

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