A colleague of mine, the same man who writes the Casual Fridays series has many stories about his time working in Memory Care. With over 15 years working in multiple positions within the elder care industry he has seen and experienced amazing things. He now works for a non-profit organization which focuses on assisting those connected with Alzheimer’s disease. He is a passionate, personable man, and a great writer. He typically writes focusing on the positive aspects of the disease. Although Alzheimer’s is not a positive disease by any means, however there are ways of looking at some aspects in a positive light. His stories are real. Unfiltered, they show a side of dementia that few see. The following story is incredibly powerful. For many it may be difficult to read. It was for me. You can learn a lot about dementia from this story. If you can find an understanding about the disease, and the actions of the people in the story, there is huge value in these words.
-Carlos Barrios, Founder of Endear for ALzheimer’s
I have dealt with death many times working in long-term care. But only once have I dealt with suicide. I was working in an Alzheimer’s community in Portland around 2007. We received a placement inquiry about a man who was temporarily staying in a geriatric psychiatry unit. His name was John, and he was in his mid-sixties. He had been living at home with his wife with no apparent problems. One night, the wife was startled awake by John, with his hands around her neck, trying to choke her. She was able to fight him off and call the police. John told the policeman that extraterrestrials had kidnapped his wife and put an imposter in her place. So he explained that he hadn’t really assaulted his wife, he was merely trying to dispose of the alien counterfeit wife. With that explanation, John was placed in a geri-psych unit and assessed. He received a diagnosis: DUO: Dementia of Unknown Origin.
Our management team discussed the possibility of admitting this man. I was against it for a couple of reasons. First, the violent behavior and paranoid delusions could be very problematic in a residential community of frail elders. Second, he was quite a bit younger than most of our residents, so I felt that he might have a hard time relating to the other people in the community. At the time, our census was low, and so I was overruled, and John was admitted to the third floor.
John was thin, very quiet and serious. He had sunken eyes and rarely smiled. He had an easy chair in his room, and he would spend most of his days sitting and looking out the window. I was the Life Enrichment Director, and tried to convince him to come to some of the activities, but he was not interested at all. John did like to go down to sit on the patio on the first floor. It was Spring, and the weather was getting warmer, and he would just sit and look up at the sky. I always felt uncomfortable around John. Although he was taking anti-psychotic medication, he definitely seemed disturbed. Some quiet people are relaxing and enjoyable to be around. But John’s silence was tense and brooding, and I felt like he was full of rage just under the surface.
John was a very intelligent man. He was highly educated and had spent his work years as an architect. Sometimes, I could engage him in a conversation about Frank Llloyd Wright or Corbusier, but for the most part, John was not interested in conversation or fitting in. He just wanted out. After a few days, John started making phone calls to his attorney. He would spend time in the nurse’s station, speaking in cryptically low tones and taking notes. He told me that he felt unjustly imprisoned in this facility, and he was going to legally contest his wife’s Power of Attorney. So for the next couple of weeks, John would either be sitting in his chair in his room, sitting on the patio, or on the phone to his lawyer.
One afternoon, a female caregiver who was getting ready to go on her break, offered to take John for a walk down the street. John agreed and the two of them went downstairs on the elevator together. About thirty minutes later, the elevator door opened and there was the female caregiver, looking a little shell shocked, with John, who was being escorted by a beefy caregiver named Jose. Apparently, when John reached the street, he made a break for it, and it took two aids to restrain him and bring him back. Shortly after this incident, he was going down on the elevator with another female aid, this time to sit on the patio, and he lunged at her, trying to put his hands around her neck. This was the last straw, and we called a care conference to tell John and his wife that we were giving him a thirty-day notice to move out. His wife was visibly upset, but John seemed impassive and did not show any emotion about the news.
The next week or so was quiet, with John continuing to talk to his lawyer in the nurse’s station and then sitting for long periods in his room. I can remember John calling me by name one morning as I was walking to my office. He had never done that before, and I took it as a good sign, as John seemed in a fairly good mood. It was a beautiful sunny day in late May. About ten thirty that morning, I was on the second floor helping to exercise some of the late stage residents, when Katherine, our community relations director stepped off the elevator breathless and said, “We can’t find John.” My first thought was that he somehow made it downstairs and walked off down the street, so I was not particularly alarmed. We arrived on the third floor and I walked the hallway and started looking systematically in each resident room I came to. Katherine went to John’s room. She came running out a minute later, ashen, and said, “He went out the window!” We opened the stairwell and flew down the steps to the ground floor parking lot. We came around the corner and lying face down in a pool of blood was John. He must have dived out the window as his skull was severely cracked with blood dripping profusely from his nose. His right arm was completely broken off in between the wrist and the elbow, and his forearm was lying next to his body, facing the opposite way it should have been, jagged bones sticking out from bloody torn flesh and muscle. John was completely still. I knelt down and felt his neck. Katherine whispered, “Is he okay?” I looked up and said, “He’s dead.” At this point, Linda, the administrator was standing next to us and became hysterical, calling on Jesus to help us. I stayed with John’s body and became very calm, keeping my hand on his shoulder and waiting for the emergency services to arrive. I was not disgusted or revolted by the gore of the scene. Rather, I was protective of the space in a strange way, thinking that here was a place where this man’s soul left his body. It felt to me like sacred space. After a few minutes, the paramedics arrived. I stepped back as they examined him and quickly realized that there was nothing they could do. Shortly thereafter, a police officer arrived in the parking lot and began asking me questions. He asked if the man had been distraught, to which I answered no. Then he asked if John had been alone in the room. I said: “as far as I know”. The policeman was trying to determine if this was indeed a suicide or a homicide.
It turns out that, upon inspection of his room, John had left a suicide note, indicating that since he was moving to another locked facility, he had no idea if he would be on an upper or lower floor. His lawyer had told him that morning that John had no recourse in contesting his wife’s guardianship. Therefore, with a grim future ahead, and a third floor window he managed to jimmy open, he decided that this was his opportunity to take his destiny into his own hands. So he did.
The staff was shocked and saddened by this incident. We are used to death in a long-term care community, but not violent and grisly death. I can remember several group hugs and tears that day. After his body was taken away that afternoon, all that remained was a dark stain in the parking lot. We went on with our routine, very careful to shield the residents from the news or the energy that anything was wrong. And truthfully, doing activities that day was very therapeutic for me, because I didn’t have to focus on what I just experienced. It was when I tried to go to sleep that night that I kept seeing the broken off arm and the blood gushing from John’s nose. Thankfully, this slight case of PTSD went away after a day, and we went back to normal. Well, as normal as an Alzheimer’s facility can get. A couple of days later, John’s wife showed up to collect his belongings. When I saw her in the lobby, it was obvious that she had been crying. She looked disheveled and shattered, like I could just blow her down with a slight puff of air. One of the aids handed her the last box of his effects, and I walked out to the car with her. I hugged her and said, “You take care of you.” She couldn’t speak at that point and she just nodded and got into her car. I walked back to the lobby with a heavy heart. I never saw her again.