“Naaa, I just want to die.” That’s what one of my patients said when I went to his room with our intern in the morning and offered him that we’d like to freshen him up a bit so he can have breakfast. The man was very old, a good 80 years old, had dementia and had undergone an operation. After surgery, many patients are initially confused and need something to fully be themselves again. If dementia is added, this is all the more true. And so the man continued grumbling to himself, eyes closed. My intern wanted to start washing, but I held her back.
It is an understandable impulse to just get started, especially with very old patients. But even an 80-year-old with dementia can do certain things without help. Then it is important not to give in to that first impulse. Instead, it is a balancing act: as little support as possible, but as much as necessary.
I knew from our patient’s medical file that despite his dementia he took care of himself at home as much as possible. To wash someone’s face all of a sudden, even though he does it himself every day at home, would be absurd and also a bit patronizing, after all he can do it himself.
So first of all I raised the headboard of the bed so that the man was sitting upright. Because such small external circumstances should not be underestimated: who washes their face while lying down? The natural position in which an activity is usually performed is important. Then they often happen like a reflex.
Intensive care specialist Pola Gülberg from the Ebersberger district clinic.
(Photo: Peter Hinz-Rosin)
As our patient sat, he opened his eyes, looked around, and looked at us too. Only now was he really present. My intern handed him the washcloth – and lo and behold: without any further requests from us, he immediately buried his face in it and washed himself. The brushing of teeth continued in the same way: He took the toothbrush and brushed, perhaps not as thoroughly as a dentist would wish. But that wasn’t the most important thing at that moment. He went along with it, without grumbling or “no, I just like dying” exclamations like at the beginning when he was still lying in bed with his eyes closed. Repositioning to sit had changed everything.
Finding out what someone can do independently only works with trial and error – it could just as well have been that brushing your teeth doesn’t work despite the sitting position. Then we would have done it for him. Care is not synonymous with all-round care, the ultimate goal is always to use and strengthen the patient’s resources. No matter how old he is. All of this takes our time and patience – and the older the patient, the more of it.
Pola Gülberg is an intensive care nurse. In this column, the 38-year-old talks about her work at the district clinic in Ebersberg every week. The collected texts are below sueddeutsche.de/thema/Auf Station to find.