A Nursing Home Mini-Series: Seeing Things That Aren't There, aka Hallucinations

Maggy was a fall risk, never knowing when she would pass out, and Beatrice, who fell in her kitchen, had an IV bag attached to her arm because she was dehydrated. They were relegated to their rooms for all activities, including therapy. And Cassey was, at last, home. So I had to find a new "eating" table, the most popular activity in the nursing home.

I chose to sit with Tillie because no one else wanted to. Tillie was always seeing things. She was 92 years old and she talked about the cats she saw so clearly on her feet, in the garden, through the plants. But there were no cats to be seen. She had a stroke 12 years ago, had macular degeneration, had a recent fall, and she was hallucinating. She was healthy otherwise, knowing that people rejected her but not knowing why.

During breakfast, she said, "Of course, the mother cat looked after her offspring. She was tawny in color and searching for food the kittens could eat." And she described the kittens, one being all white and one being striped. And she had a vision of dogs playing in the courtyard of our nursing home--one a blonde cocker spaniel, the other a tan and black beagle. 

So I decided to do some research on seeing things that weren't there. 

Oliver Sacks -- Hallucinations

The hallucination [that's what most neurologists call them] is convincingly apparent, produced by the same neural pathways as real-as-life perceptions. 

Oliver Sacks, a professor of neurology at the N.Y.U. School of Medicine and the author of a book called “Hallucinations," wrote this excerpt in The New York Times in 2012: "People with impaired sight, similarly, may start to have strange, visual hallucinations....Perhaps 20 percent of those losing their vision or hearing may have such hallucinations." Remember Tillie had macular degeneration?

Sacks added that Charles Bonnet Syndrome (CBS) is a condition where people with vision problems begin to experience visual hallucinations. This condition -- CBS -- usually belongs to the elderly. They may see active cats or flying birds, for example. Remember Tillie saw cats and dogs?

New medications or a faulty mix, or a quick change in environment, may cause hallucinations as well. I remember when my grandfather suddenly moved to a nursing home and he "saw," though nobody else did, a variety of animals soon after. Tillie went into the nursing home suddenly, too.

Given the imperfection of the human body, aka nobody is perfect, it is more than likely that something in the brain
is at fault. After all, the brain controls everything, as individuals, that make us who we are, like strokes, for instance. Any of those factors -- macular degeneration, Charles Bonnet Syndrome, sudden change in environment -- could have contributed to Tillie's hallucinations.

However, it didn't matter. Tillie, at 92, is who she is and lucky to be alive, and seeing things that aren't there is a part of her. I'd always sit with her because hearing odd shit is who I am.

A Nursing Home Mini-Series: Life with Old People

Some of you missed my last post -- http://stroketales.blogspot.com/2014/07/wake-up-stroke-survivors-before-its-too.html -- in which I told the outcome of my stroke-related surgery. The surgeon said the operation was successful. I say the surgeon did the best he could with what he had to work with. 

Anyway, I'm in a nursing home now, which is divided between residents (I say "lifers") or, as with me, people who go here to recuperate. I had surgery so I fall into the second batch.

The nursing home serves three complete meals a day -- breakfast at 8, lunch at 12, and dinner at 5, plus snacks, if anybody wants them, in between and after dinner. So you could spend around six hours just eating.

The nursing home is understaffed, so the aides start bringing  people down to the dining room thirty minutes before the meal started in order for all of the people to be there when the meal officially began.

The aides are responsible, too, for bringing the platters of all people who don't want to socialize. One aide said to me, "The people eat in their rooms, if they are sick or don't want to socialize with 'old' people." I took offense at that remark because I am one of them, the old people, I mean. I don't know when it happened and I don't feel old. But numbers never lie. I am 66.

I got to the nursing home just before dinner. In the wheelchair, I saw an open spot in the table for four. One of was the little, old lady named Gert. I don't know the reason for her going to the nursing home. She died three days later and Cassey took her spot. Cassey, who was a year younger than I was, was a geriatric/psychiatric nurse who had a hip replacement. She was quiet and liked observing the other two. 

Maggy was an 91-year-old, bust-ass, no-holds-barred, obese lady who actually was comfortable and secure being obese. Maggy was a diabetic who passed out until somebody in her family had the sense to gain her admittance to the hospital. Then the doctors figured out what it was, but I never knew. And I didn't ask. She came her to rest.

And the fourth was Beatrice, 89, who said platitudes all day like "Where there's a will, there's a way" or "If it's meant to be, it will happen." Beatrice had a fall and she exhibited black-and-blue marks on every inch or two of her body. She was also a sentence finisher, like if you paused and were trying to finish the sentence, she would finish the sentence for you. Most times, she was wrong in the word that she selected. And that got the hairs on Maggy's neck to stand up at full attention.

"I don't like when you fill in the blanks," Maggy screamed.

"Well, the right word fits the shoe," Beatrice said, mixing up platitudes. Sometimes, when Beatrice got tired, she said them that way.

So that was the table. I sat with them for three weeks until Cassey's hip allowed her to be discharged. Cassey sent me an email when she arrived home, happy to be with her boys (aka cats) and her comfy, overly high bed which, as her email said, she accessed with a step stool she borrowed from her sister.  

Maggy passed out again, and Beatrice was still hooked to an IV bag for dehydration. So tomorrow, I was on my own to find new people at a different table.

That's the thing about nursing homes. I didn't think I'd have time for making really good friends because there's a fast turnover rate, akin to a revolving door. But I had enough sense that I wouldn't die trying either.

Ho Hum: Life in the Hospital Is Mostly the Same, Except Sometimes....

The most famous definition of "crazy" comes down to doing the same things over and over again and expecting a different result. I think I am borderline crazy.

When I first go in the hospital, I think that I have a few days off, a vacation of sorts, but then I realize, no more than a half an hour in, that I want to be some place else other than the hospital. It's not the hospital's fault. I own this one.

Here is what happens every time: the nurses, due to liability issues (their liabilities, not mine), take vitals--that is, listen to my chest, take blood pressure with the cuff, and record my temperature--every 4 to 6 hours, especially when I first come out of surgery. Then comes the phlebotamist (some people say "vampire") to take the blood samples. The phlebotamists start at 4:30 am. 

Then I attempt to go back to sleep, but the nurse comes in again to check your vitals before she goes off shift at 7am. Then bathroom, dressing, brushing teeth, breakfast, therapy, lunch, more therapy, dinner which is served around 5pm, and I'm in bed by 7 pm. And I am exhausted.

Also, as a patient, I always look the same, no matter what mood I'm in, as shown in the photo on the left. If I'm sad, I put on a happy face. If I'm angry at the nurse, I won't show it, especially because maybe she'll leave out the pain meds and then say "whoops" when I call her on it. And nobody likes to be around a depressed person or one who is in pain or tired. So I hide those emotions more often than not. I don't like surprises so I don't acknowledge them. We already went over the mentally ill part.

So I was surprised, a day before I left the same old, same old hospital, that a break in the routine occurred. I had the lights out at 7 and was watching some television show about country singers when a gangly, middle-aged man opened the hallway door and wandered into my cluttered room. My gut said to me, "Danger, Will Robinson." My gut was the only body part who was talking to me. I didn't hear a peep out of my brain.

"Where's the bathroom?" the man said as he rifled through some clothes in my closet. The only thing I thought of is, I'd have to wash the clothes at some point--all of them. 

Then I spoke. "The bathroom is on the opposite wall," but he went straight ahead to the hospital bureau and opened a few drawers, touching personal items. I'd definitely wash that stuff, too.

The bed and bathroom were all that remained. Fortunately, he went into the bathroom, and I called the nursing station.

"A man just went into my bathroom. I don't think this is allowed because...." I didn't finish the sentence because the nurse already hung up.

Four nurses arrived in the blink of an eye and got the man out of there. I don't know if he was "finished" or not. Apparently, they didn't care.

The man turned around toward my bed. "Thank you, lady," he said.

"Did he hurt you?" one nurse remaining said. Once again, the nurse was worrying about her liability. I can't blame her. Jobs are hard to find in this economy. The nurse continued. "He just had a stroke and he didn't know what room was his."

"No, he didn't hurt me," I said, sorry that I called the nurses at all, considering that he was now a member of the infamous club.