I enter the communal room where I was scheduled to play accordion. I see three staff members gathered around a body lying on the floor. Did someone just fall? Are they waiting for a nurse to assess the situation? Walking closer, I recognize the patient. K. lies on her side, a pillow under the head. I feel a shock in the stomach. My curiosity turns into sadness. The scene is still. Was she badly hurt? Eyes open, mouth tightly closed, K. is not moving. A staff member tells me: “She does not want to get up.” I take a breath of relief.
At the request of her care team, I have been in intermittent contact with K. since nearly a year. She has memory impairment and disorientation. She is legally blind, but she can see her close environment and recognize faces. She has some hearing loss. She ambulates with a wheelchair and can walk a few steps with assistance.
She often feels unsafe, scared by residents who mistakenly bump into her chair or table. Sometimes, K. expresses her anxiety in words, other times through screaming, spitting, flailing her arms and kicking. At the age of ninety eight, K. still has a lot of energy but also likes to take naps during the day.
I have had different opportunities to hear stories and advice about elders on the floor. All come rushing through my mind. The reflections of Elliot Kukla and of one of his friend who has trouble with balance, due to a brain injury, come to the forefront:
“I think people rush to help me up because they are so uncomfortable with seeing someone lying on the floor. But what I really need is for someone to get down on the ground with me.” This simple teaching is ninety percent of spiritual care: get down on the floor yourself before you drag someone to her feet!
I decide to lie on the floor next to K. First, I go get a pillow in her bedroom. When I return, the staff is not surrounding K. anymore. Instead, a few empty chairs have been positioned to prevent other residents to inadvertently trip over K.
I settle on my side, mirroring K.’s position, my head on the pillow. It feels good to be lying on the floor. I relax thinking that I had a short night and this is a welcome rest. K. and I are facing each other, two feet apart. I observe K.’s face wondering if she sees me. Are her eyes vitreous? Is she going to die? What is going to happen? Am I welcomed or will she reject me? Her eyes are small and dark, her mouth tight with lots of little wrinkles above the upper lip, like a child who refuses to eat; more defiance than anger. For a couple of minutes I look for changes in K.’s body position, her expression, her breathing. No visible change; the slight up and down motion of her chest is reassuring.
“Hi K., I am Olga. What is happening?”
… (No visible reaction, silence 1 minute)
I look into K.’s eyes from time to time. I try to accept her silence. I feel safe. I wonder what I should say.
“Is there something that makes you angry?”
… (Silence 30 seconds)
K.’s face does not move. Am I imagining that there is a bit less tension in the upper lip? Is there some amusement in her dark eyes?
“Let me know if I can help you with something.”
… (Silence 2 minutes)
K. moves her legs a little. I put my hand lightly on her forearm. Is it O.K.? It is unusual to be lying together, like sharing a virtual double bed. What is K. thinking about it? She closes and reopens her eyes, as if she was falling asleep. Is she going to die? Are we living her last minutes together?
… (Silence 3 minutes)
K. moves her arms a bit. I take my hand off her arm. It seems that her lips are less tight.
… (Silence 3 minutes)
I put my hand lightly over her folded hand.
“K., I am going to go back to my work now. I will play accordion for you. Let me know if you want to get up. I will help you.”
… (Silence 30 seconds)
It seems that K.’s face relaxes a bit more. Her gaze is less intense, more brown than black. I separate gently my hand from K.’s and get slowly up on my feet.
I greet the group and start playing accordion. After five minutes I notice that K. has started to sit up on the floor and is fiddling with her wheel chair. A worker stands close-by to monitor her safety but does not intervene or speak. After five minutes, another worker enters the room, sits next to K. and asks her if she wants to get up in her chair. K. says: “Yes.” She is lifted into her wheelchair. The worker starts an animated and joyous conversation with K. Both clap hands and react to the music. K. asks to sit closer. The staff wheels her near me. K. intensely enjoys the music: clapping, smiling, marking the rhythm with her body and complimenting between songs. We are all happy.
THE SPIRITUALITY OF MADNESS, by Elliot Kukla, published in the spring 2010 volume of ZEEK, A Jewish Journal of Thought and Culture, p.27.