Elder Care - Dealing With Confusion

I was on night shift in my father’s bedroom during the final days of his palliative care.  I heard him struggling with his covers and opened my eyes.  The digital clock read 4:00 a.m.  He was sitting up by the time I turned on the nightlight and came over to his side. 

I helped him walk to the commode, then back to his bed where I handed him a glass of water.

“The ship is rocking a lot.  There may be a storm tonight and they’ll be closing down the ship’s casino.  Is the sea very rough?” he asked.

“Probably is,” I replied. “Do you feel the floor moving?”

There was a long pause.  We sat on the bed, side by side.  “Wait one second.  You’re putting me on.  We’re not on a cruise ship, are we?”

“No dad.  We’re not.” I replied.  ‘You’ve been dreaming.  And that’s no surprise considering the amount of morphine they’ve got you on to manage the pain of your cancer.”

He turned to look me in the eyes.  “Then why did you lead me on instead of correcting me?  Tell me the truth, am I losing my mind?” he asked.

I put my arm around his shoulder.  “No, you aren’t losing your mind,” I answered.  “Absolutely not.  Far from it.  I didn’t want to contradict you, that’s all.  Despite the morphine you seem to be able to see through the haze just fine on your own, at your own pace, in your own time.  You don’t need correction.  Here, have some more water.”

He lifted the glass to his lips with two gnarled hands.  “I never knew water could taste so good,” he chuckled.  “All my life I’ve drunk coffee and maybe orange juice in the mornings, beer and booze in the evening.  I don’t think I ever really tasted water when I was younger!”

“You’re probably right.  As a kid I don’t remember that we ever had water at the dinner table.  Now thanks to Helena, one of your Personal Support Workers, we have noticed that drinking lots of water clears your mind.”

“And gets me up all the time to go to the can.  I’m glad we’ve got the commode here in my bedroom.”

“You’ve exercised all your life and you’re still moving around a lot now,” I said.

“All these years I’ve been a dehydrated old alcoholic.”

“Yes, dad,” I laughed.  “You’ve been a lusty, thirsty man.  Here, have some more water.”

He tilted back the glass and enjoyed another few gulps of Toronto’s finest tap.   

The Economics of Accountability

My job as a conflict mediator is built on skills I learned as a high school owner and teacher.

A few years ago I had a student and his mother in my office one morning, glaring across at each other.  The school day had not yet begun but they were already hard at it, locked in stubborn conflict. 

Mom: “He doesn’t do a stitch of homework, any more than he helps out around the house.  And that’s zero.   I swear, if it wasn’t to eat and borrow the car he’d probably never come home.”

Son: “Which might make all of us happier.  It’s a madhouse when I am home.  I don’t get any freedom and all you do is nag.”

Mom: “What else can I do?  You’re in this expensive private school so you can get into university.  If it wasn’t for my nagging you’d never get accepted.”

I stepped in, “Let’s look at what you’re both saying.  You’ve described a perfect lose-lose arrangement.   If you are correct, Mrs. Wilson, then even if Evan gets acceptance, the credit will go to your nagging, and he’ll be set up for disaster when nobody is there to nag him.  And Evan, you’re so angry at your mom you’re prepared to sabotage your own success. ”

I continued.  “This is a classic vicious circle.  It can actually get a lot worse, or we can make an agreement right now to spin it the other way, into a positive spiral.”

“Really?” He asked, “What are we talking about?  Brain transplant?”

“More like a behavioural transplant,” I answered.  “But it has to be both of you.”

“I’ll try anything,” the mother said.

“What about you, Evan?  Be honest with me, do you actually want to go to university, or is that your mother’s ambition?  I know you’ve got the brain, but unless you care about being there you’d be happier setting your sights in a less academic direction.”

“Yes.  I do want university.  I’ve wanted to study science since I was a kid.  I always intend to work.  I just go nuts and flip out when she won’t leave me alone.  Then I can’t think or work at all.”

“So the more she nags the less you work, and the less you work the more she nags.  That about it?”

“Pretty much,” he smiled.

“Then let’s turn it around.  It’s time for you to grow up, Evan, and time for you, Mrs. Wilson, to let him.  I want you both to think of being a student like having a job.”

“What do you mean, “like a job”?” he asked.

“I’m talking about getting paid in privileges, one of which is not to be nagged.  Prove to your mom that you CAN do the work on your own, that you’re actually ready to earn the freedom you want.”

“Mrs. Wilson, you need to leave him alone.  Give him one month.  Check in with his teachers for academic updates but don’t pester him.  Pay him with the car and other luxuries only when he’s earned his paycheck by doing his schoolwork and chores.  

Think of this as a contract to adulthood, or as I call it: the economics of accountability.”