Bob - Created to Work

"But as for you, be strong and do not give up, for your work will be rewarded."
2 Chronicles 15:7

When the kids were little,  I would read to them from the book "Created to Work."   
Work, the author proclaims, is a gift from God.  In fact, when we first meet God in the book of Genesis, He is working; making the heavens and the earth. Then, having set the example, one of the first things God gave his newly-created people was a job to do. Adam was assigned to name the animals, right from the get-go.  God knew that he would be much happier and more fulfilled with a job of work to do.  After the Fall, when they were exiled from the garden, God gave them work to do to help them deal with their grief and shame.  

Scripture is replete with examples of people whose lives were enriched through work, like the Proverbs 31 woman.  We are also given examples of people who got into trouble when they weren't working.  For example, in the Spring when  the Kings went out to war, David stayed behind.  And in one of his idle moments, he got his first glimpse of Bathsheba.  

Much of the hopelessness found in nursing homes comes from a lack of purpose.  Residents will describe feeling "useless" or "bored to death."  Keeping them engaged is part of my job as a Life Enrichment Director - to ferret out what God has gifted each person to do and help them re-engage in that activity. Physical disability, injury, pain, and cognitive disability complicate this process immensely, but when it works it can be amazing.

I was thinking about this today, and I recalled "Bob."  Bob started out in our long-term-care floor, but after a year or so his dementia progressed and he was moved downstairs to our self-contained memory care wing.  For a week or two he was showing signs of adjusting well to the smaller, safer environment.  But then, one night, his obsession started.

Many patients with dementia suffer from a confusion of their circadian clock.  They'll sleep half the day and be awake half the night.  Bob entered this phase near the end of his first month in residence.  At first he only wandered, propelling his wheelchair all over the unit and into other residents' rooms.  Staff put up STOP signs to help him remember which rooms were not his.  Since there was only one room that  WAS his, he was pretty much limited to the hallway, dining room, and his room.  He became agitated by all the stop signs, and stayed up later and later every night. He forgot that he couldn't stand without help, and he fell a couple times.  Sometimes after breakfast he would try to go out the door, because "I need to go to work!"  Bob had been a handyman, and had been going out to work after breakfast for most of his life.

One morning, the AM shift arrived and began trying to set up for breakfast. But when they went to the credenza to take out the clothing protectors, they found the knobs were missing on that drawer and one other.  A brief but thorough search revealed no knobs.  After two more shifts failed to locate them, maintenance was enjoined to provide replacements.

But the next day the replacements were gone as well.  Staff began watching, and soon it became clear that Bob had found an amusement: as soon as the lights were dimmed in the evening, he began going around unscrewing knobs.  He stored them in the cupholder of his wheelchair, then when it was full he took them to his room and transferred them to the drawer in his nightstand, and then went back for more.  When we looked in his nightstand, we found all the other knobs from previous nights.

Mystery solved, the staff began emptying his nightstand drawer and re-applying the knobs as soon as Bob was asleep every morning.

But every morning, they'd have to do it again, because as soon as everyone else went to bed, Bob went to work.  It became irritating. Then annoying, as Bob expanded his efforts and removed every knob on every drawer he could reach.  The staff cried foul.  Something had to be done.  First line of defense was maintenance: they tried putting wingnuts on the backs of the knobs, which Bob seemed to consider a delightful puzzle to solve.  It took him half an hour to figure it out.  He removed the wingnuts, placed them all very carefully in his eyeglass case, and then went back and removed the knobs. 

As soon as the nurses realized he could get the wingnuts off, that was the end of that, as they could be swallowed by him or others. Maintenance tried gluing the knobs in place, but Bob twisted and twisted until he'd stripped out the holes, and he could still get the knobs off.

At our Interdisciplinary Team meeting, it was suggested that the Activities Department should find something for Bob to do  that wasn't "destructive." It was actually a comment from the Director of Nursing that helped me think of the solution. "Why do the behaviors have to be destructive?" she complained. "Why couldn't he build something instead of taking it apart?"

You know that niggling feeling you get when you feel an idea coming on but just don't quite know what it is?  That feeling followed me around for a couple days.  I tried leaving a set of building blocks out for Bob, but he had no interest in them.  I felt badly for the care staff who now had to screw knobs on while setting up for breakfast. I worked early, so I helped out when I could by taking a turn at retrieving and re-attaching the knobs.  

One morning, Bob was up earlier than usual, and watched what I was doing with interest.  "Here, Bob, I bet you can get this one back on," I said, exasperated.  He nodded philosophically and, taking the knob from my hand, screwed it back in.

The idea that had been stalking me ambushed me as I watched, and I grabbed my coat and left the building.

The Dollar Store had little plastic tackle boxes that were black with yellow latches.  I got two of them, and a "receipt" pad and hustled back to my office.  That night, before I left work, I went to the Memory Care Wing and began removing the knobs from the drawers.

"Hey!" said the care staff. "What are you doing?"

"Trying something," I said. "Don't worry - I'll come in early tomorrow and put them back before breakfast if it doesn't work."

The looks they exchanged said quite clearly that they thought I'd be moving into that wing next.  In my office, I put all the knobs in the tackle box. Dinner was just being cleared away when I returned to the wing.  I sat down at Bob's table and placed the tackle box on the table in front of me. His eyes were riveted on the box.

"Bob," I said, "We have a problem"
"Oh?" he said.  By this point, he was down to monosyllables.
"Look around," I said.  "All the knobs are gone from the drawers."
"Yes."
"The staff can't pull the drawers out without the knobs." I made my voice sad.
"Yes." He sounded sad for the poor staff as well.
"Look here."  I opened the box and showed him all the knobs.  His eyes lit up and he reached for them. I closed the box and sighed.  "I have new knobs for the drawers, but nobody has time to put them on. I don't know what we're going to do."
Slowly, he reached out and pulled the tackle box toward himself. I sat up as if having an inspiration. 
"Hey!  You put one of the knobs on this morning.  Do you think you could maybe put these on all the drawers?"
"Yes. Yes!"
"I don't know," I said, pulling the box back toward me. "There are a lot of them.  It could take HOURS."
"Yes."
"And it would have to be done before breakfast....won't you be in bed?"
"No. No."
Well, if you'd be willing to try, I'll talk to the nurses and make sure it's OK with them."
"OK.  Yes."
I walked out of the dining room, stood in the hall for a few minutes, then went back.  
"You're all set. I'll leave these with you, and you see what you can do.  OK?"
Bob slid the tackle box down next to him in his wheelchair, and I went on my way.

When I came in the next day, I was excited to see that all the drawers had knobs.   

That was the beginning of a very happy period for Bob.  A call to his family gave me some details I needed about his handyman business.  The second night, I took the knobs off and went to Bob's room.  
"Bob, some of the knobs have fallen off the drawers again.  Those pesky knobs!  Do you think you could put them back on for me?"
"Yes, yes."
"Well, that's very kind of you. Thank you for helping.  How about any time the knobs fall off I put them in this toolbox for you, and you can put them on?"
"YES! YES!"
"Good. Oh, but how will the nurses know it's for you.  I know!"
I took my metallic marker out of my pocket and wrote his name right on the box.
"There. Now it has your name. It's your box.  And here...." 
I took out the receipt pad and scribbled "WORK ORDER: Install knobs on drawers. Thank you!"
Bob couldn't read any more, but I read it to him and he was in awe.  He folded the work order carefully and put it in the pocket of his robe.

Every evening I did the same thing: remove the knobs and put them in Bob's tool box, which was kept carefully for him on its own little shelf in the nurses' station. Sometimes he picked it up and carried it around with him, but he never lost it. I taped a work order to the outside of the box and left.  The nurses would call him over and say "Bob, we have a job for you!"
Sometimes he didn't understand, but as soon as he saw the box he was all business.  

One day the Charge Nurse came to me and said, "Your great plan backfired."
"Oh?  How so?"
"Bob wants a paycheck."
He'd started saying "Pay me!" when he brought his box back to the nurses.
So then I supplied the nurses with some realistic-looking play money.  We settled on $5 a night as the going price for knob installation.  Most nights he forgot to ask, and some nights he asked but promptly lost his "pay".  If he did manage to keep it until he woke up the next day, the nurse would bring him down to my office to buy "groceries." He liked Pringles, Fun-size Snickers, and Diet Pepsi and would smile proudly when I handed him a grocery sack with his loot, took his play money, and thanked him for his business.
Once he said hopefully
"Beer?"
and I told him,
"No beer, but I have rootbeer."
It was clear what he thought of that idea.
I probably spent a total of $20 for his "groceries," and it was a bargain for all the peace of mind it gave everyone.  Bob was contented and happy with his job, the knobs were always on the drawers when needed, and instances of agitation and wandering into others' rooms were gone.

 As with all phases of dementia, this one was short-lived, and after a few months Bob would take his box down and carry it around all night but couldn't remember what to do with it.  I put the knobs back on and went in early one morning to find them still attached. I realized sadly that Bob wasn't interested in them.  Eventually he stopped going to the nurses' station, and I put the toolbox with a spare knob or two on his dresser.  He wouldn't pick it up any more, but he would look at it and open it and finger the knobs.   He no longer spoke, and his smile faded away.

Depression, fear, and agitation are common with dementia, but tapping into Bob's God-given handyman gifts broke through it all and gave him back some pride and dignity. 

"He has filled them with skill to do all kinds of work...."
Exodus 35:35

Lessons Learned

This post will begin a new series of reflections.

As you may know, I am primarily a teacher. I have been teaching since I was a child, and it is one of my greatest gifts.  The corollary is that I love to learn; I am always seeking out new information and new people who can teach me what I do not know.  Over the past several years I have taken quite a few courses and classes, achieved several certifications in fields that were entirely new to me, and read at least a dozen books about my specialty areas.  But as always, it is the residents from whom I learn the most important and enduring lessons.  I will change their names as required by law, but the stories are real.

This new series will share some of the most significant and life-changing lessons I have learned as a Nursing Home Chaplain, and during my brief career as an Activities Director for a skilled nursing facility. I hope you enjoy this opportunity to walk alongside some of the best teachers I have ever encountered.

Ramona – a Touching Story

“Ramona Victoria Quinn!”

“Ramona Victoria QUINN!”

“RAMONA!  VICTORIA! QUINN!”

The screams reverberated in the busy hallway.  

Ramona!  

I crashed the tray onto the "dirty" cart and sprinted around the corner.  There stood Ramona, her face contorted with rage, tears practically spraying from her eyes.  Her hands were clasped in her hair, causing her parka to ride up and show the ragged hems of the four sweaters underneath, and her hospital pants sagged alarmingly. This posture made her look even larger than her normally-imposing stature.  Her back was pressed up against the hallway wall across from her room, and she focused all her fury on the tiny aide in front of her.

The aide, Joy, was alone in the hallway. Everyone else – three nurses, the Interim Director of Nursing (iDON), five aides and the Medical Records Assistant – had taken cover behind the nurses’ station. Ramona had a rep. Large, brooding, unkempt and rude, she had several significant mental illness diagnoses and was given to outbursts of violent verbal and physical rage “for no apparent reason.”  We had accepted her for admission, and now we couldn’t really get rid of her unless she hurt herself or someone else. She hadn’t hurt anyone yet, but we all knew it was coming.   And now Joy – 5 foot 2 and maybe 90 pounds – was facing Ramona alone.

Joy lived up to her name; she was one of our most cheerful, caring and gentle aides. She had a real heart of compassion for the residents she cared for, and she was operating that way now with Ramona.  Quietly, she reached out a hand to guide her.  “I know you’re upset, Ramona. Come on with me. Let’s go back to your room now.”

Ramona watched Joy’s approach with outrage. If she had been a dog she would have torn the extended  arm off. And then I saw something that chilled my blood. Ramona turned her head and looked down at the wheelchair footrests someone had left in the hallway.  Weapons. This was it.  The time we knew was coming. Ramona would kill her. And it all could have been prevented if Joy had just read the Care Directive. I admit I was angry.  I dodged around a treatment cart and skirted the vitals machine.  Practically tackling Joy, I pinned her arms to her sides, jerked her back and called out, “Ramona! I’ve got her.  You can make it now!”

Immediately she took her hands out of her hair, grabbed the waistband of her pants and scooted across the hall. She was still wailing, but the tone had changed from furious to forlorn.  She crashed the door open and disappeared into the room.  

In the silence that followed, a small tearful voice came from the darkness. “Are you coming in to talk to me?”

“I’ll be right there,” I said, almost panting, as Joy looked at me with shock, confusion, and betrayal in her face.

When I came out of Ramona’s room, still alive, a half hour later, the staff glanced at me out of the corners of their averted eyes with a mixture of disbelief and respect. It was at that point that the Director of Nursing began to call me “The crazy person whisperer.”

The lesson I learned from Ramona is one of the most important and influential of all. It has brought me more success and been the source of more anguish than any other lesson I can think of.  Ramona’s lesson was the vanity of assumptions.

When she arrived, I completed her intake assessment, and as part of that process I read the summaries from other people.  She was in her 60s, had mental health issues, had been homeless, was a smoker, and could not live on her own.  She refused to participate in our required assessment process when it was done formally, so I started in observing her behavior so I could craft my own assessment and begin to take a whack at care planning. 

Observing her was not difficult; she spent much of the first few days stalking briskly about the building, rattling her walker, glowering at everybody.  Whenever we invited her to an activity, she would either shake her head or bark “NO! Leave me alone!” She would occasionally make herself coffee, and she always knew when it was time for smoke break.  I marked “smoking” down under favorite activity, and gave it a 4 out of 4 on the importance scale.  I supervised the smoke break once a day and so was able to observe her for a longer time. She came down, took her cigarette, sat down as far away from the others as possible, and smoked.  If addressed, she would draw on the cigarette until it glowed red and the ash grew in volume alarmingly, but would not answer.  When she had finished her single cigarette she would put it in the ash can and leave abruptly to go back into the building.

Right off the bat there were a couple of odd things about her.  First and foremost, she wore all her clothes at one time.  Even though it was a warm Spring, she put on five sweaters and her winter parka every day. After a week she doubled up the hospital pants and added a knit beanie in a very incongruous shade of pink.  Incongruous because all her other clothes were dark, masculine colors. Olive drab and black and grey and brown. She wore no socks under her unlaced lumberjack boots.  Her voice was low-pitched and gravelly from smoking; her salt-and-pepper hair shoulder length, unkempt and lank.  She presented an altogether masculine appearance except for that bright pink beanie.  

Another unusual behavior I noticed was that she always came down last for smoke break.  She was invariably early; waiting by the elevator up to half an hour before smoke break, but when the smoke break supervisor came with the cigarettes she let everyone else go first. 

I thought about what I’d read and decided I at least had an explanation for Ramona’s layered look. She’d been homeless.  She was used to wearing all her clothes so they wouldn’t be stolen, and to keep warm through the cool Pacific Northwest nights. So I mentally checked that item off as “resolved” and added it as a brushstroke in the painting I was making of her. In her willingness to go last I saw some vestiges of politeness, or perhaps animosity or low self-esteem.

After a month she began to relax and to sit sometimes at the intersection of two hallways, still glowering but not stalking.  But then things began to go wrong.  She swatted an aide.  Leaped out of bed and fell when the night nurse came in to give her meds. Started screaming at people to leave her alone.  She threw a pillow. Picked up her walker and slammed it into the glass door.

The staff stepped up their efforts to connect with her, to no avail.  Her behaviors became worse, and we began to talk in our daily Stand-Up Meeting about needing to transfer her someplace else.  Someplace more suitable; better able to handle her outbreaks.  Unfortunately, noplace else would take her.  The word “Dangerous” began to be used.  “I’m afraid of her…” was said at least weekly. The instructions given to staff were “Care in pairs. Don’t engage her. Just let her alone.” Of course, it's not possible to totally avoid a resident (particularly if you're their aide or nurse), but she was given a wide berth, but still she had outbursts, at “random” times.

I did wonder, sometimes.  It seemed that everyone who spent any time on the floor had had scary encounters with Ramona, but I never had, and I was around her frequently.  My experience with residents is often different from that of others, so this in itself didn’t stand out to me. She didn’t frighten me, and I had seen some of her outbursts.  I also do know that people don’t have behaviors for no reason, so I didn't buy the "random outbursts" line.  But, to my shame, my none of that caused  me to investigate for myself. I was told it was part of her complicated mental illness, and that seemed like a good answer. I was not, after all, a nurse or psychologist, and the people who were telling me that were well-qualified to know.   

The warmer it got, the more clearly uncomfortable Ramona became in her snow clothes, but she persisted nonetheless. I wondered how long she had been homeless and how long it would take her to be secure enough that she begin to dress cooler.   

One day at the end of May I was supervising smoke break and my cellphone kept pinging.  One of the residents asked, “Who keeps texting you like that?”

“It’s my students. They are working on their final projects, and these are their last minute panic attacks going “Mrs Carson – I’m way overtime…can I have an extension…” or “Do I have to memorize this???” or “How do I set up the projector for my presentation?”

“You’re a teacher?” asked Ramona.  I nodded.  “Yes – that’s why I’m not here on Thursdays. I teach high school that day.”

I immediately forgot all about this interaction, until Ramona showed up at my office a few weeks later.  I always came in early before the Stand-Up Meeting to do the prayers over the Intercom and get my ducks in a row for the day.  My office was on the lower floor, while all the resident rooms were on the upper one, and I had never seen Ramona down there before except to go out for smoke break and come right back in again.  She came to the door.  Fantastic. How does one not engage when the resident comes looking for you?

“Morning, Ramona,” I said as I checked my Email.  “Do you need something?”

“Hi,” she answered.  This was unusual. She didn’t usually answer.  But she said nothing more. I glanced up at her but she was looking away.  I went back to my computer.

“I was wondering.” She said, and just stopped there.  I stopped typing, looked up and folded my hands in my lap.

“Yes?”

But she was looking away again. After a confusing few seconds of silence, I noticed my computer telling me I would be logged off for inactivity, and moved the mouse to dismiss the dialog.

“You’re a teacher. Could you give me some school work to do?”

“WHAT?” The response just popped out, louder than I wanted it to, and Ramona backed away and stalked toward the elevator. 

“Wait!” I called, and thank the Lord I didn’t get up.  “I can do that. You took me by surprise is all.”

She pushed the elevator button and didn’t answer.  I kept trying.

“I’ll have something for you tomorrow. What kind of school work would you like?”

The elevator door opened and she barged inside and I thought I’d lost her. But she pushed the door hold button and said quietly “Letters. And ads.”

“Ads?”  What kind of ads, I wondered.

“ADDS. You know, 2+2 is 4 and like that.” The door slid closed and she was gone.

I sat for a long time staring at my screen without seeing anything.  Letters and adds?  At home that night I went to one of our homeschooling support sites and printed out some worksheets.  Cursive writing templates, printing templates, and basic math. I looked at them doubtfully. I didn’t think I’d need them. There was no way she’d venture downstairs twice in two days.  But I was wrong. When I arrived the next morning, there she was - waiting for me.

“Got my schoolwork?” she asked.  I turned on the light and pulled out the worksheets.

“Is this what you wanted?”

She looked through them and handed some back. “Adds. I can’t do minus.”

“Oh, OK.  Would you…um….like to sit down?”

“No.” She shook her head and stood there in the doorway staring at the sheets in her hands.

“Is….everything OK?” I asked.

“Pencil!” she barked, and I fished one out of Kathy’s pens and pencils can.

She balanced herself and held the papers and tried to use the pencil.

“Really, you can sit down.  Use Kathy’s desk.”  My assistants didn’t come in until 9:30.

But she ignored me and kept struggling with the pencil and I just let her be.  At 9:00 I stood up. “Ramona, I have to go to a meeting.”

“Bye,” she said, and I’d never heard her say that before.

The next morning she was there, and had completed two of the worksheets. She held them out to me.

I glanced at them. “You finished,” I said, smiling.

She shrugged.  “Yeah.”  I handed them back and she snatched them away angrily.

“What’s wrong?” I asked in desperation.

“I thought you said you were a teacher – you’re supposed to grade them.”

I went over them and checked the wrong ones and gave the paper back.

“What’s my grade?” she asked, and I took the papers back and wrote C+ on the top.  The next day she came back and handed the same paper to me.  I just looked at her.

“I fixed them,” she said, and I checked her work while she struggled to write the letters.  In my purse was a sheet of the stickers I used for my highschool students’ writing. I took out a sparkly star sticker and stuck it to the top and handed it back.  Ramona froze, all the other pages falling from her hands and fanning out around her on the floor. 

“What’s that?” she asked, pointing to the star.

“You got them all right.  A+,” I said, and for the first time I saw her smile.

Thus began our surreal tradition. After a few days, I had an idea: before she got there I clipped some new worksheets to a spare clipboard.  She was very suspicious, but she tried it out.  It worked better, and for some time she stood in the doorway with her clipboard resting on her walker, doing her letters and adds.  Every time she got a perfect paper I gave her a sticker.  But I couldn’t get her to come into the office.

One morning in June I was coming in with my arms full of decorations and Ramona was waiting for me.  I got my keys in my hand but couldn’t reach out to open the door without dropping my load. “Here,” I said to Ramona, holding out a finger with my keys on it.  “Would you please open the door?”

Ramona looked as if someone had thrown cold water on her. She looked from my face to the keys and back again.  “Please? This is heavy?”

Slowly she reached out for the keys, like someone reaching into a mousetrap.  Taking them from my finger, she inserted the key into the lock, and with a last uncertain glance at my face she turned the key and stepped back.

“Um….if you could open the door…???”

I thought for a minute she was going to run away.  But finally she turned the handle and pushed the door open a tiny crack.  I went in and dropped all my stuff on the floor.  I logged into my computer and turned around but the doorway was empty.  Where had she gone?  But then I saw her behind me, seated at Kathy’s desk, scribbling hurriedly at a worksheet.  I let her sit, afraid to say anything lest I frighten her away, and prayed a rather unsteady prayer of thanks for unexpected blessings over the intercom.

For the next few weeks she came in and sat at the desk, working on her schoolwork while I prayed, graduating from individual letters to sentences. Clearly she had just needed a little brush-up.  

My assistants were not pleased.

“I won’t come in if she’s in there.  I’m afraid of her,” said one, who had had a few scary encounters with her in the past. 

“She makes me nervous. She doesn’t like me.  I think she’s evil,” said the other. 

I agreed that they didn’t have to come in when Ramona was there, and indeed she didn’t stay after I left for Stand-Up Meeting.  I began coming in earlier so she would have more time.  The only time I saw her quiet and content was when she was sitting at the desk doing her schoolwork.

Throughout this time, we had tried to do two quarterly assessments, but she would not answer any of the questions on the short MDS paper we use.  But one day I was putting together some new admit assessment packets, grumbling about having run out and she said, “I could do that.”

“I’m sure you could.”

“Really. If you give me some papers I’ll make the stacks.”

I handed her the 5 different pads of forms and she put them together and paperclipped them neatly.  She looked through one and said, “What are these for?”

“When new people come in, we ask them these questions to help us get to know them.”

“Could I fill one out, do you think?”

 My heart soaring, I pretended nonchalance, saying, “Sure. Just use a pen to do it. It has to be filled out in pen; it’s the law.”

She picked up a pen and filled out all five pages.  She had to stop several times to ask me what the questions meant.  She was flabbergasted at some of them.

"What does it mean in...inco..." her brows came nearly together as she struggled to read the unfamiliar medical word.  "Inco-TINE-tent?  Is that it?"

"Incontinent?" I asked.

"Yeah. I guess.  What's that?"

Why do these questions always come to me??

"It means can you go to the bathroom by yourself or do you have accidents."

"WHAT?" she bleated, and for once she turned and looked right at me.  "You're the church lady! Why do you need to know if I poop my pants?"

I cobbled together an answer, and she returned to the form without further comment, though I heard her rehearsing "In-content" several times under her breath. 

I skipped Stand-Up Meeting that day because we had not been able to complete any assessments for her up to that point and I wanted her to be able to finish.  My assistants came and went upstairs without stopping in the office, but at the end of 90 minutes she handed me the completed forms.

“Very nice,” I said, trying not to sound too enthusiastic.

“Do I get a star?”

“Well, not on the forms – that’s a legal record.”

She seemed to be alarmed at that information, so I handed her the sheet of star stickers.  “Here. You can put stickers on another form and I’ll keep this one to check, OK?”

She sat there staring at the stickers. Reaching above her head, she took down a blank piece of cardstock from my fancy paper pile and began affixing stickers to it.  She made an almost perfect circle.  When she was finished, she asked, “Do you have more of these pretties?”

That’s what she always called them.  

“Tons,” I assured her.

“Could you bring me some to use myself?  I might like that,” she said quietly.

The next day I brought her a bag of various stickers, and she sat happily at the desk for more than an hour sticking them onto printer paper, making designs.

Things had been so peaceful that I should have expected something to go wrong.  Ramona had begun talking – more to herself than me – while working, and at first I didn’t really hear it, because I was at my desk, typing up progress notes and making calendars and other vital tasks.

“Come see this,” she said one day, and it was the first time she had invited me over to her desk.  When I looked over her shoulder, she had filled a paper with butterfly stickers, and written a message to God on the top.  Here is the picture Ramona made:

I had no idea she thought about God at all.  “Ramona!” I said in an awed voice. “That’s the most beautiful thing!”

With a cry that nearly knocked me backward she snatched up the paper and leaped to her feet. Crashing her walker into the desk and doorframe she left the office, cursing and yelling “YOU’RE a LIAR!” before finally throwing herself into the elevator.

I just stood there for a long time, staring at the elevator door.  

What the heck? 

In the back of my mind, the voices of the others started talking. “She’s mentally ill.”  “Her behavior doesn’t mean anything…it just happens.”  “No way to prevent it..”

But I’d been spending enough time with Ramona listening to her self-talk that this time I didn’t take those comments at face value right away. I realized that we had hammered out a sort of relationship. All relationships require effort, and maybe I couldn’t do anything about her end, but I had to do what I could to make my end right.  I gave her a chance to cool down, then went upstairs after her. This was something that just.  was.  not.  done.   I found her sobbing into her pillow, her butterfly picture placed carefully on the tray table.

“Ramona,” I said quietly.

“Liar!” she screamed. 

“I didn’t mean to offend you,” I said.  “Your picture made me happy. And you said you loved God, and that made me happy. It makes God happy too.  ‘Worship’ just means telling God we love him, and He enjoys our worship.  I still think your picture is beautiful.”

“It is!” she cried out, and I left the room shaking my head, having no idea what I’d just participated in. 

The next morning, she was not waiting by my office, and I unlocked my door with a sinking heart.  But there on the floor, shoved under the door, was her butterfly picture.  Only this time, she’d written another note at the bottom. Here’s what Ramona wrote:

My autistic brain saw immediately what had occurred.  I had said her picture was the most beautiful thing. But in her mind, God was the most beautiful thing, so her picture was not. And she reacted violently to this assault on God’s majesty.  Now her “meaningless, disturbed behavior” was not only understandable; it was laudable. Why don’t we all get upset when God’s name is maligned or used in vain?

I didn’t know whether she meant me to have the picture or was just showing it to me, so I set it aside carefully in case she came back later.

She didn’t. 

I saw her at smoke break in the afternoon and I said, “I understand about the picture now. You’re right. It’s a lovely picture, but not beautifuller than God. Do you want it back?”

She shrugged. “If you want you can have it. I can make another one. Do you have more pretties?”

I told her I did, and the next morning she was back at Kathy’s desk.

By the end of the summer she had progressed from sentences to poems.  Her poems were very insightful, and short, and I committed them to memory and typed them out. I had begun praying for her, and soon I got a fantastic idea: for Christmas, I was planning to take some photos to go with them and make a photo book at Walgreens so she’d have a book of her own poems. 

But Ramona continued to have troubles upstairs.  Periodic violent rages and fits of sobbing which I only heard about the next day at Stand-Up.  The staff as a whole was afraid of her, and with our survey window coming everyone had heightened anxiety about her outbursts. But she sat for longer and longer periods in the Activities office every morning.  I shared this information with the Interim Director of Nursing, who came surreptitiously to observe a time or two.  She let the nurses know that they could ask for my help if they were having trouble or were afraid of her.

Something more significant (to me) happened in August. Ramona watched me every day when I came in.  I’d come in the door, turn on the light, take off my sweater and hang it over my chair, turn on the fishtank light and feed the fish.  Rather like Mr. Rogers, only my Keds were flag-print and not red. If I had too much in my hands, I would give her the key to open up, and she would turn on the light, turn on the fish tank, and feed the fish while I arranged my parcels.  She did not hand my keys back to me until she was ready to leave; rather, she kept them right next to her on the desk.  I’d tried retrieving them myself but she had reacted very strongly to my picking them up and so I let them be.  That amazing morning in August she stood behind Kathy’s chair, took a deep breath, and taking her parka off she hung it on the back of the chair and sat down.

I had never seen her without her parka. She even wore it in bed.  My heart was rejoicing inside but I took it in stride and said the morning prayer.  She did not remove any of her sweaters, but the parka was a big step. It was very hot in my office even with the fan running, so I had reason to hope she would remove the sweaters before the weather cooled off on the Fall.

Early in September, while we were sitting at our desks with our backs to each other with the fan running, Ramona began to talk.  She talked all the time and it was just white noise to me while I worked on my administrative minutiae.  There was nothing different about her tone of voice, at least not that I can remember, but for some reason that morning I listened to what she was saying. The first few statements were standalone, but then the rest all ran together into one long sentence.

“It’s hot in here.       It’s hot on the street.         Or cold.        Either hot or cold and never comfortable. I’ve been on the street allmylife.        Since I was 8.       Little Ramona Victoria always looking for a place to pee.       I had an uncle dan.      He put us to bed.       All of us.        Boys and girls too.     My brothers Robertvictor and ReginaldVernon and RichardVick and Rusty my sisters RainyVeronica and ReneeVeronica because they were twins and RebeccaVista because she hated me. He didn’t care boys or girls he just wanted a kid to sleep with on the floor. I never looked down. I wonder where my brothers and sisters are. They don’t care about me that’s for sure. They never come to see me. Or ask where I am. I wish someone could tell them where I am.”

I knew from prior experience that she would only talk if I kept typing, but I was flabbergasted by the appalling story that was spilling out on the other side of my office.  I kept my fingers going but I was typing jibberish, with bits of her story in it. Her voice was getting angrier and angrier as she narrated.

“But they don’t care. And I don’t want them to come. Maybe. I’d like to see them but that’s all.  Just seeing. No hugs. I’ve been arrested for trespassing 27 times because I wanted to go in out of the street but I didn’t have a key. Keys mean you can come in. No keys mean stay out. I went to jail three times for no keys. And when you go to jail they put you in a little cell all by yourself and they use their keys in the door and take them away and no one touches you for maybe a year and it makes you really sad because you just want someone to touch you but then you get used to it and then you like it and you don’t want anyone in there to touch you anyway because they always only want to hurt you. Like uncle dan and rusty and Becca and Mama. And then when you get out you’re afraid to be touched. And.you.don’t.want.anyone.to.touch.you.ever.again. But they keep on touching you and you hate them because they don't listen and sometimes you hate them enough to kill them.”

My mind was reeling. She’d given me the key.  Several keys, in fact. She kept talking, but I didn’t hear much more.  After the Stand-Up Meeting I went to the iDON and closed the door.  “I know why Ramona wears all those clothes,” I told her.

“Why?”

When I reported what Ramona had said, her eyes grew wider and wider and her mouth started to hang open. I finally finished, “And so she wears all those clothes to keep people from touching her.”  

I’d mentally reviewed all the examples I knew about.  She swatted an aide who was trying to lead her to the shower room. The night nurse probably came in and touched her arm to wake her. I told the iDON, “We need to put it in her care directives that the care staff shouldn’t touch her. She’s independent in all her ADLs and can take her own meds. They just need to not touch her.”  She agreed and told me to draft something up. 

On my way to the office, I reflected that I now understood why my keys were so significant to her, and why she kept custody of them until she left; they were her permission to be in the office.  I recalled that she had not agreed to come in until the morning I had handed her my keys and asked her to open up.

It’s fine to put something in the care directives, because all the aides are supposed to review the care directives for their patients before each shift.  But this rarely happens; there just isn’t time.  And the notes at the bottom (the ones Activities contributes to) are often skipped because they don’t relate to important care areas, like dietary texture or how to transfer.  So training is often necessary.  I tried to go around and train all the aides and nurses, but there are always people you can’t get to.  The aides didn’t have regular assignments: there were 14 possible sets plus two shower aide positions and anyone could be anywhere at any time. But the fear of being touched explained her seemingly “random, unpredictable” behaviors, and the aides were relieved beyond description to be told they didn’t have to touch her.

So here we were, Joy and I, locked in opposition because the information that would have prevented the confrontation was buried in the care directives.  I set out to find Joy and explain all this to her, wishing once again that there was some kind of alert sheet I could use that would get information out. 

I did eventually make a sort of alert sheet.  And it was well-received.  But it was too late for Ramona.  As turnover worsened and a new Director of Nursing took over and the culture changed, Ramona had more and more problems. She still had her daily hour of peace when she came to the Activities office, and she began talking to me during the smoke break. But one Friday while I was on vacation, she attacked a staff member and was sent to the hospital for psychiatric evaluation.  From there she went to the state mental hospital, too far for me to visit her, and I never saw her again.

I have her butterfly picture hanging above my desk, and a packet of her poems in my file drawer.

From Ramona I learned humility. I could have possibly reached her sooner if I hadn’t thought I knew all the answers, or just accepted the verdict of others who thought they knew the answers. “Oh, I know why she does that…”  A little bit of observation and investigation would have shown me that the answers I was getting from other people were off track, and mine weren’t hitting very close to home either. Ramona taught me that  everyone is unique. Don’t assume.  And most importantly, nothing is beautifuller than God.

The Good Work Walk

Meet my dog, Maggie.

Maggie's here because of that prayer.  You know the one I mean.  I pray it every time I go in to the Community Care Center (CCC), and on a regular basis just generally.  "Lord, I know who I'm planning to see today, and I have some idea what I want to do. But Your plan is the one that needs to take precedence.  So, use me however You want today. Not my agenda…but Yours.  Not my intentions, but Yours.  Not my will, but Yours be done. Amen." 
It's pretty short, that prayer, but it changes everything.  Not just for me either.  Case in point:

I walked in to the CCC on Sunday with a pretty good idea what I was going to do.  It was my day to take my resident friend to African Church.  That takes all morning, and then I get his lunch and eat with him and go home.  It has always been God's will for me to be involved in his life, so I prayed the Prayer as a matter of course, because on this day of all days, I knew what God's plan was.

When I got inside, three residents came to tell me, "Kathy wants to see you!"  Good!  I'm always glad to see my friend Kathy as well. She is a ray of sunshine in the dark corners, and brings a little bit of joy wherever she goes.  I checked on my friend and he was ready to go. As I was walking down the hall. Kathy came around the corner and stopped short. "Oh, thank goodness you're here.  We need your help - we have a big problem."

Very hesitantly, I said, "I don't work here any more...I can't help with any big problems..."

"Oh yes you can," she insisted. "It's an ANIMAL."

On the way down the Truly Ancient Elevator, Kathy filled me in.  The morning shift staff had noticed a little beagle shivering in the parking lot from about 5:30 on.  She looked sick, and she was dirty and cold.  "I think she might be pregnant," Kathy said.  One of the independent residents had gone outside to sit with her and nobody knew what to do.

So I went to check her out.  She was clearly an elderly beagle. Her abdomen was hugely swollen, she was shivering, her claws were way overgrown, and she had an angry, bleeding, golf-ball sized tumor on her face outside her right ear.  The mass on her abdomen was not puppies; it was a soft, non-painful tumor of some sort (you can see the tumors in the photo).  She was filthy and she stank.  She shied away from my hand. What she needed was to see a vet. But I was taking my friend to church.

"What'll we do?" asked Kathy.  

None of us wanted to leave her outside, so I asked if Kathy could keep her in the Activities office while I took my friend to church.  She got her a blanket and a tunafish sandwich from the breakroom, and a bowl of water.  The little beagle ate the sandwich and lay down on the blanket, and I left to go to African church.

After I left the CCC, I took the beagle to a vet. Her legs were so shaky I had to carry her. He estimates she is 10+ years old. The big tumor is a lipoma. It weighs six pounds and drags the ground. The other is malignant. In addition to what I had observed, she has worms and fleas, is anemic (so no surgery yet), her teeth are rotten, and she has infections in numerous places.  She needed all sorts of medications, and who was going to do all that?  It was Sunday evening; noplace was open. So I collected her meds, brought her home, gave her a bath, and introduced her to the joys of home-cooked dogfood, a warm bed, and doggie playmates. We named her Maggie, and that's how she came to join our family.

She's doing grand now, and will have surgery to remove her tumors on March 9.  It's going to be quite expensive, so pray for provision. I have contacted the beagle rescue folks to see if there is any help available, and am waiting to hear back.

I was telling my friend Barb about this and she said, shaking her head, "You can even see the potential in a brokendown dog."

I don't think she's right about that. When I looked at her there in the parking lot, I didn't see any potential, except that I'd probably be the one telling the vet "She's suffering; put her down," and be a gentle hand and soothing voice while she died.   

So why did I take responsibility for her?  I don't work for the CCC; I'm not the boss any more. I don't have to take charge of every problem. I AM the chaplain, but this was not within a chaplain's scope of practice. I'm not working yet and we can't afford a huge vet bill.  We already have 14 pets and I don't really want any more. And I most CERTAINLY didn't need any more heartache right now. So why did I swoop in and take this cast off dog?   

As I reflected on this, I kept coming back to that prayer. "Your will be done."

When you pray that, you have to be ready for whatever He throws at you, and you have to know that you're probably not going to understand it while it's happening. 

Paul tells us in Ephesians 2:10 "We are God’s workmanship, created in Christ Jesus to do good works that God has prepared in advance that we should walk in them (emphasis mine). I'm not sure how that's supposed to work out practically.  Paul is speaking inclusively, in first person plural.  WE.  We believers.  So are the good works allocated specifically to one person, like a Christmas gift with my name on the tag; or are the good works allocated to all believers and it's up to us to find them and walk in them, like finding an egg in an Easter-egg hunt?  I don't know the answer to that. But here's what I do know:

That beagle wandered into the parking lot at the Community Care Center.  Not at Safeway or the high school or the assisted living place up the street. She came to the CCC. I am only there a couple hours, two mornings a week.  That Beagle could have showed up there any time during the other 162 hours that I was not there this week, but there she was, on Sunday.  When something drops into my lap like this, I consider that it’s one of those good works that God prepared in advance, and so I start walking in it.  Lots of other people saw her before I got there, and not one of them even let her into the building.  They had their chance to walk in that good work and they walked away instead. They were looking up at the huge pile of her problems and saying "I can't handle that."  I’ve learned not to do that.  Instead, I say “Well, she’s cold. I can do something about that.”  And take the first step.  And when you take just one step up, maybe you still can’t see the top of the staircase, but there’s one less step between you and the top. Maybe God doesn't want me to go all the way to the top, but until I know for sure I'm going to keep walking.

So now we have Maggie. I honestly have no idea why He prepared this good work for me. What use is it to God that we gave an elderly beagle a home? I may never know. But Maggie doesn't care about that.  She is not living a life of constant suffering any more, and she does a happy beagle dance when she sees me coming with her dish. We walked half a mile together in the park today. And yesterday she crawled into my lap to nap while I was grading papers. We're taking the next steps on this Good Work Walk together.  

Go Gladly...A Modern Parable

It was the end of a long week.  Moby and Felix had been talking and joking and watching TV and living life together, as brothers do.  But as evening drew near, Felix got quieter and quieter.  They both began to look down the road.  “Our sister is coming,” Moby told Felix.  “She’ll be here any minute…you’ll see.”  And then, there she was.  “Hey, Debbe! How’s it going?” Moby asked.  Debbe was pleased to see them, and they sat down to eat together, as they liked to do.

The three visited for a while, and Moby and Debbe laughed and teased; it was their way.  All at once, when Debbe said she would see them later, Felix looked up at Debbe and told her that soon it would be time for him to go.  Debbe said she thought he might be right, and decided to stay.  None of them wanted to be the first to say GoodBye, so they tarried, visiting some more.  Some of their friends came and wished him well, until finally the time came for Felix to go and only the three were left. But still he lingered. It was growing dark and the way was shadowy. There were bumps and pits and tree roots on the path, and Felix had never been this way before. He wasn’t sure he could manage it with his wheelchair.

“It’s alright, Sweetheart, we’ll walk you home, won’t we Moby?” Debbe said. “Hmmm?  What? Right now?  Oh, OK, sure,” Moby replied, and the three set off together, with Debbe pulling Felix’s wheelchair along beside her, like she did whenever they crossed a parking lot.  The three followed the path, talking and singing and remembering their past adventures.

Sometimes they would laugh; sometimes a memory was so special they would cry a little bit.  Sometimes Felix would hesitate, not knowing, and Debbe would take his hand and encourage him with thoughts of what a nice place his home was, and of the wonderful One who was waiting for him there, while Moby reminded Felix of all the great things he had done. Near the end of the journey, their friend Kathy joined them and refreshed them with singing.

Finally, there they were, at the very Gate of Home, and it was full dark.  The sun had gone down, the night was cloudy, and the fireflies had not yet begun to twinkle.  Moby said good bye and stood back.  Debbe took Felix’s face in her hands, looked into his eyes, and told him, “Little Brother, before I took you anyplace, I always went ahead first to check it out. To see whether you would like it, whether it was safe for your wheelchair, and how we could manage it together.  Now it’s your turn to go on first and check it out for me.  It’ll be OK. You’re alright. Let go now - -you’re almost there and there’s nothing here to keep you. When you hear Jesus calling you, go gladly.”

Felix nodded.  He looked up, and there was his Savior on the other side of the gate, calling “Felix!”  Suddenly, Felix found that he wasn’t afraid. The gate was too small for his wheelchair to go through, so Debbe helped him to stand up, just as she used to do, and he left it behind him when he stepped across to the other side of the gate.  Debbe, Moby, and Kathy stood beside his wheelchair calling out “Good Bye, Felix!  We Love You! We’ll see you soon!” and maybe they cried a little more, but Felix didn’t look back.

He was home.