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This is chapter one of a new book by Grace Rudolph, author of Ice Floes and Polar Bears: An Inside Look at Nursing Homes. You may purchase this book of nursing home articles by clicking here.

My six children each had a special childhood friend who was more or less a permanent fixture in our home. My days were filled with scrounging up lost clothing, dealing with non-compliant teenagers, and fielding complaints about food, rummaging siblings, territorial issues, window seats in the station wagon, and of course that old favorite, "Maaa! Heís changiní the channel in the middle of my show!"

After the children grew up and moved on I wanted to try my hand at something new so I returned to college full time and received a degree in social work. It didnít take long to discover that I was involved in the same-old-same-old, with a twist.

Now I scrounge up lost dentures, deal with non-compliant residents, field complaints about mechanical ground diets, rummaging roommates, territorial issues involving who gets the window bed and get called when angry old men shout at female soap opera addicts, "Social worker! Sheís changiní the channel in the middle of the play offs!"

Iím swept back in time as I go about my daily tasks. A churning wave of dťjŗ vu engulfs me when the television wars heat up.

When I was asked to arrange cable service for newly admitted residents I found that the wide menu of cable and non-cable choices coupled with diagnoses of dementia created problems. I was amazed to discover that not everyone enjoys PBS and the Biography channel, which happen to be my personal favorites given the state of the evening news. I confess I had a hard time dealing with setting up pay for view wrestling events, especially if they involved midgets, women, or mud.

The residents who wanted television but couldnít afford it broke my heart. After begging and groveling with a cable company rep to provide service gratis for a sixty-five year old long term care resident whose son didnít want her to know he had lost his job and was struggling to put food on the table for his family, I was debating the pros and cons of picking up the cable tab myself; until the son arrived one evening with a box of aluminum foil in one fist and a pair of old fashioned Ďrabbitís earsí in the other. He settled the Ďrabbitís earsí on top of the TV, wrapped them in foil and tweaked them this way and that until Ö Voila! Vanna White. Click. Lawrence Welk. Click. I Love Lucy. Click. The reception was the clearest in the facility and because her son had developed this creative solution to meet her needs her status and bragging rights as That Guyís mother made her a minor celebrity.

Television is usually the preferred connection to the outside world. Occasionally itís a police scanner.

A coy, petite wheelchair bound lady named Emily had grown up, married, and raised her family in the same town where she eventually became a resident in the local nursing home. Emily flirted outrageously with the male visitors who came to the home. Since her link to the world was her police scanner she knew everything that happened both inside and outside the facility and would rush to the lobby when she knew an ambulance had been called for a routine run or an emergency pick up. The firemen, the police, and the paramedics in this particular town all, without exception, looked like they had been hired through central casting. They were all over six feet tall, all muscular, and they all had that swaggering, authoritarian walk. Besides that Ö they all wore uniforms!

On the day Emily flat lined the police scanner on her dresser squawked out the 911 request for a STAT response. Rumor spread through facility like wild a flash fire. Residents, staff, and visitors began to gather in the hallway outside her room. First to arrive were the police, two of them, one talking urgently into the small mike nestled on one massive shoulder. Next, four paramedics burst onto the scene with life saving paraphernalia swaying off heir belts. Heart stoppers all! Doors were flung open and as the medical SWAT team swept past the nurseís station and into her room Emilyís police scanner blared updates on her worsening condition to the people huddled outside her door. Very quickly it became apparent that all efforts to revive her had failed. By then an honor guard had gathered in the hallway. The paramedics maneuvered the gurney out of her room and as they passed her nurseís aide, who was standing by my side, we had a clear view of Emily. She was bundled in blankets but her face was visible. One blue eye was half open and a small, coy smiled turned up the corner of her mouth. Her nurseís aide looked from Emily to the paramedics and then gave Emily a thumbs up. "You go girl!" she whispered.

Usually, however, the window on the world is a television set. Or two. Arguments about how long, how loud and what program should be watched simultaneously would test the patience of Mahatma Gandhi. The shows often contain disturbing material with the power to deliver a negative wallop to the emotional life of the viewing public. So much so that sometimes, during a flash flood of misplaced maternal post-traumatic stress syndrome, a condition known only to those who have raised large rollicking families, Iím tempted to shout, "Turn the TV off, NOW! HEAR ME?"

Marx was wrong. Television is the opium of the people.

When my youngest son was six he had a friend, Daniel. Danielís parents were vegetarians who grew their own organic food. These flower children had aged gracefully to become teachers who practiced yoga to counteract the stress they dealt with in a high school where violence ran counterpoint to their math and science classes. Their home was a Feng Shui castle and television was not allowed to cross the moat and corrupt the serenity of their gentle lives.

Each morning on their way to work they would drop Daniel at our home to wait for the school bus. Daniel would wave wistfully from the front door and as soon as their Volkswagen bus pulled out of the driveway he would rush to hunker down in front of the magical, glorious, forbidden TV set to watch Tom and Jerry beat the living daylights out of each other. Slowly his thumb would drift to his mouth. Entranced, lured into nirvana by the taboo fruit of cartoon violence he became oblivious to the world around him. When the bus was spotted turning the corner and heading our way my kids, shouting, shoving, and pushing, would rush behind Daniel and around him. The last kid to vault off the couch and over Daniel would slam the TV off and as the set teetered on its stand Daniel would startle, blink, jump to his feet and join the mad dash to the early morning chaos of the orange bus revving its engine at the curb.

Today I see that same expression, sans thumb in the mouth, on the faces of elderly residents as they watch talk shows and newscasts. They arenít hunkered down like Daniel; instead they are reclining in geri chairs, wheelchairs, or lying in bed. But, the intensity of their gaze tells me theyíre there not here.

We always knew what the theme of Geraldoís show was because one of our residents, a single portly middle-aged woman, slipped into the personae of Geraldoís guests. Sometimes she was a man trapped in a biker babeís body. Other times she was inconsolable because she thought her sister had seduced her husband. Still other times she was the illegitimate child of a dead celebrity who had appeared during the night to confess they had abandoned her at birth on a Hollywood sound stage or, in a Vegas casino, or in a dark corner of the balcony at Graumanís Chinese restaurant.

Ed, a cantankerous TV junkie, used to wave me aside during one-to-one visits if a commercial came on. Then with an annoyed look he would bark, "YES?" and before I could answer he would hold up his hand if something in the commercial caught his eye. Having worked in an ad agency I must admit Iím a sucker for commercials and have been known to pull up a chair next to a bed, sit down, tune in and zone out. TV commercials are my drug of choice.

Because of the insular environment of long term care facilities TV is a major link that presents a perception of the outside world. What itís like out there and where and what the perils are. If itís unsafe out there is it safe in here?

I once met a woman who had been a partisan during WWII until her capture and interment in a concentration camp. Ruth and her son and daughter survived; the rest of her family perished. Alzheimerís disease had begun its deadly erosion of her mind when we first met but some of her memories were left untouched.

One afternoon the soap opera Ruth was watching was interrupted by a late breaking news bulletin. There were unconfirmed reports of a shooting in a high school in Colorado and viewers were urged to stay tuned for updates as the drama unfolded. Throughout the day and into the early evening the bulletins continued and gradually there was speculation that the shooting dovetailed with the anniversary of Hitlerís birthday. Ruth became increasingly agitated and was given a mild dose of Ativan. As the calliope of frantic news updates blared from the TVs in other residentís rooms Ruth finally dozed off in a recliner near the nurseís station. During the evening med pass the nurse touched Ruthís shoulder to wake her and Ruth struck out. She became increasingly combative until her agitation gave way to grief as she was transported back in time to the concentration camp she had survived but never escaped.

Imagine being bed bound or wearing a motion alarm that alerts people to your whereabouts at all times. Now imagine that you are delusional and you hear that a gunman has entered a building and the only survivors are those able to run and hide.

Residents have the right to watch what they want to watch and no one has the right to say, "Turn that TV off NOW! HEAR ME?" But how do you offer comfort and reassurance to cognitively impaired residents without redirecting them away from the source of their anxiety.

Most residents in long term care facilities werenít desensitized at an early age by shock television or the acceptance of violence as entertainment. They grew up believing empathy was a virtue and, once learned empathy, like long term memory, is hard to forget.


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