Elsa was having a fairly good day watching “Rick Steves Italy” She seemed interested by the colorful displays of pasta dishes, regional costumes and constant optimism of the host blowing out kisses from a gondola. Her mood darkened around 3pm, when she returned from the bathroom. She started calling out in Russian: “Papa! Papa!” To everyone entering her field of vision she was gesturing and yelling: “Ania! Come here!”
Ania is her generic name for a helper. She is not the only resident here who calls every staff by the same name. Maybe Ania was someone from her past who took care of her or her family. I have been told that “Come here” is a modern Russian expression. It is often preceded by the Russian verb “Idi!”
I sat next to Elsa. She seemed overwhelmed by the towels and the blanket covering her, folding them individually or rolling them together in a bundle. Elsa spends the day in a give-and-take dynamic asking for “possessions” and getting rid of them. One by one she handed me the white terry cloth towels. I thanked her, folded them nicely and laid them on a shelf, with her agreement. She seemed relieved to have less objects under her responsibility. I continued to sit, facing her. Her mood was oscillating between moments of anger and sadness, calling out to attract staff’s attention then expressing despair about the fate of her family.
This is the theme she has explored for the three years I have known her: “Where are…? /Children/ Papa/ Mama/ Let’s go! / Take my hand!” The first year I was asking the Russian staff for translation. The answer was: “She does not make sense.” The emotions expressed in her body language always made sense to me. Now that my Russian has improved, her words, in their unique arrangements and variations, make sense too.
I used empathy, trying to mirror her pain. We were connecting and disconnecting. My empathy was not soothing her storm of despair and loneliness. After ten minutes I proposed a stroll and slowly pushed Elsa’s wheelchair out of the communal day room. I needed to give some peace to the other residents unable to escape the roar of the outburst.
I was hoping that a change of scenery, the sensation of movement and “doing something” would distract Elsa. It did not. Along the hallways I regularly stopped pushing the chair to make eye contact. Again and again she detailed her suffering. My limited language skills did not allow me to inquire into the loss. In Russian I was saying: “I am listening.” In the moments of sadness, I would exhale with a big sigh and encourage her to do the same. Each time her response was to spit at me, another form of strong exhalation…A couple of times we held hands until she squeezed my fingers so hard that her nails pierced my skin. That ended the stroll. I placed her in front of a table and sat at a polite distance. She was angry, shaking the table and calling out. I backed out a little further, out of sight. My only goal was to assure her safety and avoid that the nursing staff invite her back to the day room before she had a chance to calm down.
It was time for the nursing change of shift. With a big smile, Christine approached Elsa and kneeled down to her level. In Russian she introduced herself and hugged her:” How are you? You are so nice. I will be taking care of you this afternoon. Do you need anything?” Elsa seemed to welcome the attention. Appeased, she was chatting and holding the staff’s hand. I relaxed too thinking that this was the text book recommendation: pass over the situation to a colleague when one’s intervention is not successful. Christine brought a cup of water. Elsa took a few sips. Christine and I were observing closely. Suddenly she threw the cup at Christine, who was not expecting that. Her scrub’s top and face were dripping wet. I run to get a towel to dry her. We laughed together. Christine showed me a small cut caused by Elsa’s tight grip. I showed her mine. She said we were like veterans comparing their wounds. I said we would get medals. Christine left to greet more residents. I continued my watch. A nurse came by with the PM medication: ”Elsa, chocolate?” Elsa opened her mouth, but, as soon as she tasted it, she spat out the spoonful of “chocolate”. The nurse walked away, disappointed. She came back a few minutes later with a chocolate drink, probably also laced with medication. Elsa drank it then spat the whole thing on the floor. Again, I went to the clean towels closet. I wiped the floor, avoiding getting too close from Elsa. She was directing the cleaning process, pointing to the spots I had missed until she was satisfied with my work. After ten minutes, another staff member came: “I will take her to the bathroom.” I wondered if this would help with the anger. I was glad someone was available to try.
When Elsa returned the table was occupied by a son with his mother. Elsa was still in a yelling mood. I invited her to watch the garden, placing her in front of a large window. She could see trees bathing in the late afternoon winter sun, and a few clouds remaining after a rainy day. I sat out of sight.
It was a new thing for me to loose eye contact, to get out of arm’s reach. I was trying to stay focused on Elsa, her back, her hair. I know it is possible to heal at a distance. Could my presence and attention soothe her? How much of me does she perceive? After all I am here for her, she should be proud of that. She became calmer. The outbursts were less frequent. Sometimes, she was turning her head towards me. I was acknowledging her with a gesture or a few words. It seemed to satisfy her need. This is often how I communicate with Elsa during a normal day. I show her what I am doing, which residents I am going to interact with and she approves. She worked as a knitting factory’s manager. Among other roles, I might sometimes be her subordinate.