Therapeutic Lying

Alzhimer’s is not an easy disease to deal with. I remember watching my Great-Grandfather, confused, throwing out accusations at nurses and family. It’s hard on the caregivers, and you’d better believe that it’s hard on the person who has it. Alzheimer’s isn’t the same thing as the romanticized version in books and movies. It’s painful, exhausting, and often taxes emotion and mental emotions more than anything else.

I had the privilege of working with Alzheimer patients from the very beginning. I was a CNA at an assisted living specifically for Alzheimer and Dementia patients, and from there on out, it became one of my passions.

I’ve talked to many people over the years who have some issues with one of the recommended therapies for Alzheimer’s patients: Therapeutic lying.

Therapeutic lying doesn’t mean lying to the patient about their cares or about the situation. In most cases, the patient (or family member) doesn’t live in our reality necessarily. I’ve had many patients believe they’re sixteen years old, or twenty, or even five. They think they’re a mother, waiting for their kids to come to school, or an engineer, directing the maintenance department.

As odd as it might be for caregivers or family, their reality is as real to them as ours is to us. How would you feel if you were talking to a husband, a brother, a daughter, and every time you said something, they’d argue? Telling you that you’re crazy and that what you’re seeing, what you’re feeling is wrong?

Let me give you an example:

One of my patients, Carl*, was admitted at the same time I started working in the facility. He was a vivacious man, happy, energetic, and he loved to flirt with the female staff. He loved to laugh, and he always had a smile on his face. I loved working with him, to feel his energy. He had Alzheimer’s, and he was confused. During the day, he would ask where his wife is. I’d been taught that for Alzheimer’s, you step into their reality. Something like:

“Where’s Deborah?*”

“I don’t know.” Glance at watch. “It’s about three o’clock. Do you think she’s out picking the kids up from school?”

“Oh, yes, you’re probably right.”

Conversations like this help to calm the patient down. It helps them believe that they’re not missing someone, or that something bad hasn’t happened. Carl’s family, however, did not approve of lying to him, and they insisted we always tell him the truth. I overheard a conversation between Carl and his family, and it about broke my heart.

“Where’s Deborah?”

“She’s dead, dad.”

“Dead?” Carl began to sob, long, loud tears. “How? When did that happen?”

“A year and a half ago. You were there, remember?”

No, he didn’t remember. It’s part of the short term, the first thing that goes when someone has Alzheimer’s. He remembers his wife, how much he loves her. He does not remember she’s dead. As staff, we weren’t allowed to use thereptuic lying, and each time I had to tell her she’s dead, it broke my heart even more. His family even went so far as to hang signs in his room, over the phone, by the door.

“Remember Carl, Debora’s dead. You can’t call her.”

In three short months, Carl became depressed. I know what you’re thinking. He’s confused, he doesn’t remember. So why would he get depressed? Here’s the thing I’ve learned over years of working with Alzheimer’s patients.

They don’t remember events. They don’t remember names or faces, but they do remember how they feel. They may not know why they feel angry, or sad or confused, but it lingers. The longer a person is depressed and upset, the more it sticks with them. Poor Carl was reminded, over and over again about his wife’s death. He grieved each time like it was the first time he’d been told. Soon, he stopped walking, and then he stopped eating. Finally, he refused to get out of bed.

His family blamed us. They said we weren’t doing enough for him. He was removed and put into a different nursing home.

The lesson Carl taught me was a powerful one. Each experience we make for our patients, each word we speak, is going to make a difference. They may not remember in the distant future, but they will remember how you make them feel. It’s the reason why some patients naturally bond with certain nurses and CNAs. They don’t remember why, but they know that they can trust that person.

As terrible as it sounds, therapeutic lying is necessary. They don’t always live in our reality, and we don’t live in theirs. But that doesn’t mean we can’t help them make sense of what they’re living, and what they’re experiencing.

For more information on therapeutic lying, go to: Alzheimers.net

*Names have been changed

My Favorite Things

At the beginning of the year, I went to an activity for the women in my church. It was a getting to know you activity, because we’d had so many people move in and out. That’s what happens when everyone’s a student. As the night wore on, I realized I didn’t quite fit into the mold. We each brought something small to represent our favorite thing. We put it in a brown paper bag and then we drew names out of a bowl. Each person took a turn answering simple questions.

1.       What are you studying? What are your life goals?

2.       What is your favorite animal?

3.       Who is your celebrity crush?

4.       What is your favorite movie?

I was one of the last to go. I listened to each of their answers and realized there seemed to be a theme. Life goals involved school, or family. Favorite animal: either cat/dog or something exotic like a panda or koala. Celebrity crushes ranged from Ryan Gosling to Damon from Vampire Diaries. Honestly, I’d only heard of half of them. Favorite movie consisted of a lot of Rom Coms. Don’t get me wrong, if I’m in the mood, Rom Coms are great, but most of the time, the plotline makes me roll my eyes. And probably seventy percent of them had chocolate in their bag. If not, it was some kind of food, or something cutsey.

When it got to my turn, I was a little nervous.

Swallowing, I started.

“I already finished school awhile ago. I’m a nurse. My life goal right now is for my husband to be done with school.”

Short term goal, I know, but it is VERY important to me. I don’t want to be stuck in perpetual studenthood forever.

“I don’t like animals. I prefer rocks.”

I got a lot of laughs out of that, but it’s not a joke. I honestly prefer rocks over animals. I had a rock collection growing up that had hundreds of rocks, card cataloged and separated into eight different drawers.

“My celebrity crush is Lionel Messi.”

I blame hubby on that one. He’s exposed me to a lot more soccer over the past few years, and since he’s a huge Real Madrid fan, it only seemed natural I should choose Barcelona. Only two girls knew who he was.

“My favorite movie right now is the Avengers series.”

I love the storytelling. There are plot holes, like there are in any movie, but seriously, Joss Whedon has an incredible grasp on human nature. He knows what he’s doing.

In my bag, I had a pack of pens.

“My favorite thing is writing. I’ve written 7 novels so far, and I’m the co-leader for the National Novel Writing Month group here, and my friend and I founded another writing group from that, and we meet twice a month.”

Yeah, I’m different. But honestly, after introducing myself and stating my favorite things, I realized that I wouldn’t change because I’m different. I like who I am, and I like those things because I find them interesting.

First Date with Electronic Translator

Today I’m going to tell you a love story. It’s my own.

I moved to Spain almost immediately after I graduated from High School. I lived there for two years while I studied international nursing. I was determined not to fall in love or get married until after I finished college. Famous last words, right?

Within my first few weeks in Madrid, I met a tall Bolivian. 

Unfortunately, we weren’t so impressed with each other. I thought he was making fun of my very poor Spanish (which he claims he wasn’t) and he thought I was way younger than I was, and thought I was trying to sneak into the older Sunday school group.

As we got to know each other, even though we didn’t speak the same language, we realized we definitely had a connection. We could make one another laugh without speaking. Finally, he worked up the courage to ask me on a date. Except, since he sent me a text, and I had to translate it, I thought he wanted to meet. I didn’t even realize we were dating until a few weeks later.

The first time we met, we went to a beautiful plaza in Madrid, called Plaza de España. Since he didn’t speak English and I didn’t speak Spanish, we had a very fractured conversation, consisting of mostly typing into an electronic translator and transferring it back and forth. After a few hours, we walked into the palace gardens where there was an abstract art show, and being the helpful person he is, my husband insisted on making me describe what I thought each piece looked like, in Spanish.

It took us several weeks before we could have a semi-fluent conversation and even longer before we could converse without difficulty. Because of the language barriers, we learned how to read body language and expressions very well.

It was slow, and sometimes tedious, but it was worth it. When we moved back to the US, we went through the same process as he learned English. Except I was much less patient with him as he attempted to learn English.

It’s amazing how some people think not speaking the same language is a hinderment to communication. There’s so much more that goes into communication, often words can be ineffective. I’ve found that when speaking, I don’t know the right words, and find myself stumbling. Maybe it’s better to focus on the nonverbal cues, so we can get to really know a person.

Patients That Changed My Life: Berta

As a nurse, I have the chance to meet a lot of people from all walks of life. Some are fun, and some are not so fun. Then there are those that change my life, and changed the kind of nurse I am. For privacy issues, I won’t use their real names, but I want to tell you their stories.

For other stories, click here

One such patient was Berta. She immigrated to the United States when she was in her twenties, and she was one of the sweetest women I’d ever met. She was mobile up until she died, wandering around, pushing her walker. You could always hear her coming because she loved to talk, and she loved to call to everyone around her and say hi.

One day, while I was sitting at the nurses’ desk, she came and sat next to me. She babbled for a long time, and we had a fun conversation while I charted, and all of a sudden, she pointed to one of our signs and read it to me. I was shocked, because she hadn’t ever shown the ability to read. Not that I’d really tested, but she’d never been able to sign her own consents, or find her own room, which had her name on it.

I quickly covered any sensitive information, then pulled out a piece of paper, writing her name on it.

She pointed to it with a wide grin.

“Berta! That’s me!”

I grinned. “Yes, it is.”

Again, she pointed to the paper. “Berta! That’s me!”

I knew she spoke German, and it had been years since I’d taken any German classes (3^rd-6^th grade to be precise) but I did remember a few phrases. I pulled out another paper and wrote a simple phrase. I was curious if she could read German as well.

Ich liebe dich.

She read the words silently at first, and then tears came to her eyes. She read it in German before translating into English. “Ich liebe dich. I love you.” I don’t know if it was reading her mother language, or having someone say those simple words to her. In nursing homes, they don’t get visitors very often, and as much as we care for them, I don’t know that they always feel loved.

Then she got distracted by someone walking by. While she wasn’t looking, I taped the sign right in front of her. Throughout the remainder of the time she sat with me, she would talk to those passing by, and when they left, she’d look down and see ‘Ich liebe dich.’ Every single time, she got excited, and translated it so I knew what I meant.

It’s the small things that make a difference. Sometimes, all they need is love.

Meeting a Hero

As I mentioned before, I had the awesome opportunity to attend LTUE last month. It was the experience of a lifetime, and for more than one reason.

Last year, when my friend mentioned the symposium, I was excited to go, though I wasn’t sure what to expect. Then, Shannon Hale posted on her blog she’d been asked to be one of the keynote speakers.

I am a huge Shannon Hale fan.

When I was in junior high, I randomly found her book, Goose Girl, at the library. I’m one of those nerds who read fairy tales from all cultures along with Nancy Drew while in elementary school. I immediately recognized the name of the fairy tale, and I picked it up, intrigued. I hadn’t really read very many fairy tale retellings, and I believe at that time, they were just beginning to become popular.

I took it home and devoured the book. It quickly became an all-time favorite. While reading it, I realized how much fun it would be to write a story of my own, a retelling of one of my favorite stories.

It took me a few years before I found the perfect story, but that novel, inspired by Shannon Hale’s Goose Girl, was the first novel I ever wrote. It was a retelling of Beauty and the Beast, and it holds a very special spot in my heart, because it’s what started me on this whole journey.

When I finally went to LTUE, I was so excited to meet Shannon Hale. She gave a Keynote speech that blew me away. My friends and I couldn’t stop talking about it, and I’ve told my family, friends and coworkers about it. She’s an inspiration in more ways than one, and I was nervous about meeting her.

I’m sure it’s stressful, being under the spotlight like that, having everyone recognize you wherever you are for an entire weekend. But she was pleasant, and took the time to interact with her fans and fellow writers.

One of the things I heard while at LTUE was ‘Pay it forward.’ You never know when something you do for someone else will affect the series of events following. I’m so grateful I have the example of such gracious writers, who are willing to help cultivate the love of writing in young, budding authors.

I just wish I’d written down a list of things to ask her when I finally had the chance. My mind kind of went blank in the moment.

Part of a Set

I’m the oldest of four girls, and we’re all Asian. Have you ever heard the phrase that all Asians look alike? By the way, it goes both ways. There are times when I think all white people look the same.

But I’m digressing…

We do look pretty similar. When I was getting my senior pictures taken, I ended up borrowing clothes from my sister and wearing my hair a little bit differently than normal. When my mom excitedly showed me the final, framed copy, I was confused. I asked her why she framed a picture of my sister.

So if I have a hard time telling us apart, I guess it makes sense that other people can’t see a difference either.

The Sisters, ready for a performance

One of my neighbors once told us: “If you were all the same height and width, you’d be twins!”

We’ve joked about that for a long time, mostly because he couldn’t even remember how many of us there were, and also because we wanted to know why he mentioned the widths.

I’m used to being one of a set. Growing up, I was just one of the sisters. No one really bothered to know our names unless they were close friends. People would call my mom and ask if one of us could babysit. No specific girl, really, we’re interchangeable, just as long as it’s one of the sisters.

When I left home and struck out on my own, it was a little disconcerting to be the only Asian. I wasn’t part of the set anymore, I was a unique individual. I wasn’t quite sure what to do with that.

Over time, I changed my appearance, finding my own look. I cut bangs and reverted back to glasses. It took me several years, but I finally feel like Krista Quintana. I’m me, and I’m unique, no longer one of a set.

Why I Became a Nurse

When I was seven-years-old, my mom was driving me somewhere. I don’t remember where we were going, but I remember the exact spot. We were at a stoplight on Drake and Lemay, and another car pulled up beside us. An older man, probably sixty or sixty-five drove the car and he turned, smiled, and waved to me.

It was at that moment the epiphany hit.

I turned to my mom and announced: “Mom, I know what I’m going to be. I’m going to be a nurse for old people.”

There were only two times I ever questioned that decision.

The first time was when I was about nine-years-old. My dad took us to see a production of Oliver! During intermission, my younger sister was swinging around my dad’s legs and fell, splitting her chin open. We were rushed backstage, where the only first aid kit was, and when they couldn’t stop the bleeding, we rushed to the ER.

I was terrified the entire time, and it made me think maybe I was afraid of blood. It was a reasonable conclusion. She was bleeding, and I was scared. It wasn’t until years later I realized it wasn’t the blood that terrified me. It was not knowing what to do. I felt helpless and useless, and I hated the feeling. In emergency situations, I was afraid of making it worse. It took years of training to get over that.

(Now, I draw blood almost every day I work, and it doesn’t bother me, just for those wondering.)

The second time was when I was in nursing school. During the summer, I worked as a CAN at an assisted living. I absolutely loved it. I was finally achieving my dream of working with old people. However, the longer I worked there, the more I noticed that the nurse never did anything. At least, not that I could see on a day to day basis. I wanted to be a nurse to help my patients, but if a nurse doesn’t do that, I figured I might as well stay a CNA.

One of my patients changed my mind. I disagreed with the way his family planned his care. I wanted to do something for him, but as a CNA, I couldn’t. Not really. If I was a nurse, I realized I could advocate for him, because that’s part of the job. It made me want to be a nurse even more, because I could make a bigger difference in the lives of my patients than I could have as a CNA.