A famous psycholinguist once wrote that in spoken language, intensity of feeling is not always reflected in the frequency or amplitude of a response. He suggested, tongue in cheek, that if this were the case art galleries would be really loud places, as people stand in front of each painting yelling "BEAUTIFUL!" at the top of their lungs. I recall finding that image hilarious when I first read it. Now that I experience the phenomenon with some regularity, I no longer find it funny.
I spend a lot of time in nursing homes, where many of the residents do in fact express themselves with high frequency, high amplitude speech. If they want something, they yell: "I need to go to the bathroom. I NEED TO GO TO THE BATHROOM!" Unfortunately, nursing home staff are required to reinforce this behavior with attention to the demand, increasing the likelihood that it will be repeated. As a result, some residents develop communication styles that strongly resemble that of loud, petulant toddlers caught mid-tantrum.
Anyone who thinks age brings patience has not spent time among the aged, who sometimes lose all perspective about the need to wait for things. Many older folks experience the endurance of discomfort for even a few seconds as an outrage, and respond accordingly. From the outside, this behavior is easy to dismiss as a minor annoyance. Spend a few hours surrounded by people who literally fly into panic mode and begin screaming at the top of their lungs when there is no straw for their drink or they cannot reach the TV remote, and you begin to grasp the insidious nature of the problem.
I recently got a taste of how and why the perception of time and need might warp so painfully for elders. I was sitting on an examining table in my doctor's office, wearing a paper dress-not a power position. Due to some oddities of décor in that setting, I was facing a full-length mirror.
"Doctor will be with you in just a few minutes," I was told.
OK, no problem.
I admired my graceful turn of ankle, and fretted over some old scars down one knee. Minutes passed. Where the hell was he? Has he forgotten I'm here? More time passed. I reminded myself how nice he'd been in the past, fitting me in on short notice when I was really sick.
More time passed. I began to feel irrationally panicked and abandoned, and dealt with those feelings by getting seriously ticked about the cavalier waste of my valuable time. I composed a pithy rant, to be delivered as I stormed out. Sanity kicked in before I did anything I'd live to regret, and I took inventory of what was actually happening: I was being mildly inconvenienced. I was chilly and bored and a bit anxious, but that was about it. However, I realized that it hadn't taken much to get me convinced that I'd be sitting there for all eternity, and angry enough to lash out at the person who was actually there to help me.
I started to wonder how I'd handle the situation if I were truly uncomfortable and dependent on others, and realized that I'd probably be yelling my displeasure at the top of my lungs, over and over.
It occurred to me that some reassurance or an explanation would have done a lot to ease my mind. I then thought of Joan. Joan's voice is loud and nasal, and has a nails-down-a-chalkboard quality at the best of times. The cardiologist, the pulmonologist, the wound specialist, and the entire nursing staff have all warned her of the dire consequences of too much time in bed. Sadly, that's where she'd rather be. Her care plan specifies the number of hours she needs to be up in the wheelchair, and the times she is to be returned to bed. In theory, Joan agrees heartily with the plan-she wants to be around a long time, and would prefer to be healthy. In practice, she'll usually begin demanding to be returned to bed at least an hour before the agreed-upon time. Staff will remind her of the many health benefits of staying upright in the chair, and will try to distract and re-direct her-usually to no avail.
If you live with a "broken record" you learn coping responses. Some of these responses are helpful; you become adept at anticipating others' needs and addressing problems before they arise. However, since you cannot meet all the needs and ward off the negative feedback effectively, no matter how hard you try, you will very probably also develop some less-than-helpful responses. Selective deafness can become a way of life, as you teach yourself to tune out the sound. "Slow mo" is another commonly-used defense among caregivers of overly demanding elderly-you're coming to help, you're on your way, but you'll get there when you get there.
I am grateful for my escape options. If the sound gets too overwhelming, I can stand up and leave the unit, and at the end of the day, I exit the building entirely enter blessed silence. I am in awe of those caregivers who do not have such options. To those living with "broken records" I suggest that you build in some much-needed respites. Make time for yourself. Put in your iPod earbuds, focus on your books on tape, find a voice you love to hear, and rest a while.