1. Ngaruiya, Nancy BSN-BC, RN, PCCN


In a long-term care facility, a nurse takes note of one patient's ritual.


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I watch him shuffle past the nurses' station of the long-term care facility where I'm working this morning as an RN. He's one of a group of residents whose care I will be managing and overseeing in collaboration with other disciplines.

Figure. Illustration... - Click to enlarge in new window Illustration by Annelisa Ochoa.

As usual, a pack of peanut butter cookies is securely tucked into the top pocket of a soccer jersey that has seen too many trips to the laundry room. He can hardly walk, even with the use of a rolling walker, a recent upgrade from a quad cane and before that a straight cane. I find myself counting the uncertain steps, the huffle and shuffle-one, two, three-hoping the next will not send him tumbling to meet the ground.


He has advanced osteoporosis and has fallen twice before, so far with no serious injuries. But at his age, bone fractures could further reduce his already compromised quality of life.


The first time he fell, there was a scramble to revise his care plan and implement new safety measures: bed and chair alarms, a wheelchair with a lap buddy, close supervision, physical therapy to condition and improve strength.


At his care plan meeting, after initially sharing nothing except a blank countenance and a few discontented grunts, he told us where to shove the care plan and what to do with the fall protocols, then retrieved his rolling walker as if nothing had happened and left the meeting.


Despite his loud outbursts, especially when he's questioned about his life, he still has his mind. Sometimes in such circumstances we reach out to family and friends for support, but he has no family that anyone knows of. Angelica, the nun listed as his contact person and power of attorney, no longer answers the number he provided in his admissions record so many years ago.


Perhaps we will see family and friends when the news of his inevitable passing gets published. It frequently happens, especially if there is monetary gain-newly hatched connections, with strained or imaginary credentials.


We make our own happiness. We define what makes us content, what actions help us find that happiness. Sometimes the recipe takes just a few ingredients. Even in an environment where freedom is limited, where rules dictate when to wake up and go to bed, what days of the week we will get assistance with a full bath and who will do it, what meals and activities are or are not available, he has defined what makes him content, perhaps even happy.


So I watch him shuffle down the hallway and finally arrive at his destination, a window seat facing east at the end of the hallway. Here he sits, catching the early morning sun as it peeps over the distant Shila Hills and stalks across a cloudless midsummer morning. Outside, the morning traffic crawls up Route 21 on the way to Jersey City and beyond.


The barely warm sun gently caressing his bald head, he sits on the bench, eyes half closed as he munches on peanut butter cookies. His teeth are almost gone and his risk of choking is ever increasing, but the dietitian fought and lost the battle of trying to implement a pureed diet. They drew a truce, agreeing on a mechanically chopped diet, and his few remaining teeth faithfully do justice to the cookies.


Soon everyone else will be up and herded to the main dining room for breakfast at 8 am. It's a generic day like any other: wake-up, bathing, vital signs taken, medications administered, meals served at set times, the usual predictable activities like bingo and sing-alongs, lights off at 9, repeat. For most, visits from family and friends are few and far between.


He grows older by the day-his eyes dim and his pace slows; more teeth refuse to stay in place. Time is pushing him through the last miles to a destination where there will be nothing else to remember, nothing else to forget.


"Do you remember how you used to walk to your spot by the window to eat peanut butter cookies?" I ask him one day. He has had another stroke. The last one took his mobility and speech. He is wheelchair bound and aphasic, but his rheumy eyes signal acknowledgment.


He still can swallow. I'm feeding him his beloved peanut butter cookies and milk, his little bits of love and passion.


He can no longer move by himself, so in the morning before breakfast, before everyone else wakes up, we have him ready and roll him to the east window by Route 21. There he watches the morning traffic as the sun crests over the hills.


We can at least help him achieve this small measure of contentment, even happiness.