Health
Thu Feb 22 2024
The Hardest Patient Experience In Nursing Homes
Dr Lee Penn, Phd
Dr. Lee Penn, PhD
Psychologist and Author
The Hardest Patient Experience In Nursing Homes Hero


How does one cope when faced with death?


In our current times, death is often a distant concern. When someone passes away, we learn about it by reading an obituary or by catching up with an old friend. Maybe we hear about the cause of death, but not always. We as common citizens hear the headline and are usually spared the details.


Part of this unspoken arrangement is protective in nature. It is tough to confront the reality that we all someday must pass away. In fact, it is not uncommon for people to avoid or even actively reject the topic. We do not want to carry the weight of our own existential dread or accept the hard truth that our loved ones may pass away before we do.


It is a privilege to reflect on such universal issues on one’s own terms and one’s own timeline.


Not so when it comes to nursing homes. As a psychologist who works in this setting, I bear witness to the end of human life on a weekly basis. In these respite centers for the sick and dying, patients with whom I’ve worked for years can pass away very suddenly, leaving little more than a medical record and a few knick-knacks.


I’ve seen hardened nurses burst into tears because a resident with a nickname like “Poppa,” “Pa-paw,” or “Grandma” has just died, despite the best efforts of the medical team.


Even the most difficult and onerous of patients are missed dearly. The whole unit feels the loss, staff and patients included. A heavy curtain drapes over everything, muting talk and causing individuals to sink into introspective thought.


It is a profound feeling of helplessness to do this kind of work.


And yet I choose to do it. What truly concerns me about our current infrastructure of later-life care is that the patients — the friends, the neighbors, the roommates — do not have a choice. They are forced to bear witness to the dying process regularly, sometimes down the hall, and sometimes in the same room where they sleep and take their meals.


For them, it is traumatizing. Arguably, it is causing harm in the form of mental duress and stands in exact opposition to their own goals of healing and returning home. And, it can happen multiple times throughout a patient’s stay.


One incident in particular brought this issue to the forefront of my work.


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A range of patients from all walks of life can be found within the confines of a nursing home. While I work predominately with patients who are aged 60 years and older, I’ve had patients on my caseload as young as 20.


There was one long-term patient who fell on the younger side of the curve. Due to his younger age, he tended to keep to himself, choosing to read fantasy novels, play 1990s and 2000s alternative rock at high volumes, and play copious numbers of video games. When he did interact with other residents, he was snarky, curt, and sometimes rude.


Obviously, he felt out of place, and I couldn’t blame him for that.


I had met with him a few times to provide therapy services, and yet he wasn’t too interested. He adopted a strategy of putting his head down and ignoring what was going on around him. He couldn’t escape the situation in his body, so he escaped with his mind.


Then one day the roommate he had actively ignored died. Out of the blue, the roommate let out a groan and stopped breathing. My patient immediately called for help. The roommate, who had been bedridden for over a year, had ceased breathing for more than 10 minutes (despite CPR) before EMS arrived. When the paramedics took over resuscitation procedures, they were forced to intubate the roommate. They continued chest compressions until the roommate was finally revived and sent out to the emergency room, where he later passed.


My patient, who himself was unable to get out of bed, was forced to watch the whole thing. Even with the courtesy curtain drawn, he could hear the efforts of nursing and EMS staff members to restart his roommate’s heart. Listed as a “Full Code,” EMS was obligated to revive him at all costs.


The process is not gentle.


…..


I met with my patient more frequently after that. He needed someone to help process what he had seen and what he had felt as a result.


“It really messed me up,” he said. “I can’t sleep, and I’m afraid of who they’ll place in the room next.”


The experience changed him. He cried more easily, but in other ways I observed him to be more sociable. Instead of isolating, I often saw him chatting with other residents, helping them when he was able to help them, and making jokes with staff.


By witnessing death so close at hand, he seemed to seek out companionship. Perhaps he felt a new value in human life, or maybe his neighbors now offered a much-needed distraction.


He soon transferred out of the facility, so I never got the chance to ask.


…..


The above is not meant to suggest that it is helpful or positive to confront death in such a way. If anything, it serves as testimony to my patient’s resiliency. Though it is common procedure to remove a roommate from a dying patient’s room, a nursing home does not always get that opportunity.


Now, I work hard to advocate for my patients. If I observe a similar situation unfolding, I strongly encourage my patients to request a room change (STAT!). Even if death is inevitable, I don’t believe it should be observed so closely. In a way, it’s like protecting my patients’ innocence.


I think there’s a reason we spare people the details about death, but maybe that’s the wrong assumption. Human beings can be amazingly resilient.


But, in my opinion, we don’t need to test that resiliency so hard.


…..


Note: The above qualities of persons and settings have been altered to protect individual identities. Characteristics from multiple patients and nursing staff have been combined, though the content and overarching message are true reflections of my experience as a mental health provider.


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If you’re interested in exploring these ideas more, check out my first book available on Amazon: The Golden Rules of Retirement: A Psychologist’s Guide To Living Life to the Fullest, No Matter Your Financial Situation. Kindle and paperback editions are available now by going to the following link: https://www.amazon.com/Golden-Rules-Retirement


As well, check out my new book, The Golden Rules of Life Satisfaction: A Psychologist’s Guide to Living a Longer, More Satisfying Life No Matter Your Age!


And, stay tuned for details, including release date, upcoming sales, and future books in the Golden Rules series by visiting my website: lifecanbegolden.com/


-Lee Penn, PhD

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