"What are you thinking about?" I asked June,* a long-time resident who was sitting very upright in a dark blue armchair, eyes fixed firmly on the middle distance. June looked at me, and her expression changed from intent to worry.
"I forget," she said. Then she saw the picture that I was holding in my hand -- a photo of two dogs looking at each other from adjacent cars -- and immediately her face brightened. "It's nice," she said. After talking about the picture for a while, June was smiling and happy, and ready to get up out of her armchair and head to supper.
I met June a year ago. A community service requirement had brought me back to the assisted living facility where my grandfather had lived for the final six months of his life. I had chosen to volunteer at the facility after his death as a way to say "thank you" for the compassionate care he had received -- as well as to, quite frankly, pay penance for all the times that I had lost patience with my grandfather when he asked, for the third time in the same visit, for help in checking his email.
My first weeks of volunteer work were straightforward: helping residents with computers, serving drinks and snacks, and so on. One day, however, the director brightly announced that I was being invited to serve as a volunteer on the "fourth floor." The news terrified me: the fourth floor is the secure unit that houses memory-impaired residents, those suffering from Alzheimer's disease and other forms of dementia.
As I punched in the special code and the elevator doors shuddered closed, I began to tremble. I imagined that I had been consigned to a hospital-like, fluorescent-lit environment peopled by residents who either stared vacantly into space or dashed around wildly, yelling incoherent threats.
Instead, once the elevator doors opened, I was greeted by a perfectly ordinary fish tank. (Although I was told to watch the elevator while the doors closed to make sure no one tried to make a break for it!) And my tasks were generally simple. I took residents on short walks outside the building. I painted nails or kicked around an inflatable beach ball.
Although the workload was very manageable, the psychological adjustment and growth required for me to work with memory-impaired elders took me by surprise. Initially, I was discouraged and disoriented by the fact that when I returned to the fourth floor after a week's absence, I would not be recognized by the person whose nails I had painted on my last visit. The polish wasn't even peeling yet!
"What's your name?" asked a resident who was always very businesslike and loved exchanging information.
"Marina," I answered.
"Marina," she said, "It's nice to meet you. Will you come back again?"
"Of course, I come here every Friday. We had a really nice conversation last week!"
The volunteers weren't all the residents failed to remember. One day last July was dubbed "Ice Cream Day." I helped to prepare and serve ice cream cones to eager residents, all of whom were appreciative. After the last cone had been eaten, I shepherded a small group into the living room to play a game. In the room stood a white board bearing the happy announcement, in red marker, that it was Ice Cream Day. One of the residents turned to me eagerly and asked, "Ice Cream Day? When are we having ice cream?" I had to explain that she had the ice cream -- not 15 minutes before. The experience didn't ring a bell.
Another week, I witnessed a rather sweet exchange between two residents, Harold and Sadie: Harold offered a small bag of Hershey chocolates to Sadie, saying she deserved them. Sadie accepted them with many thanks. Ten minutes later, she held the chocolates out to me and asked, "What should I do with these?" Rather embarrassed (for Harold was still sitting right next to her), I said, "Well, you can eat them! Remember, Harold gave them to you!" Sadie smiled, looked to Harold, and said, "Thank you very much!" Harold, however, appeared crestfallen. "She had to remind you?" he asked mournfully.
Clearly, the fourth floor residents were obliged to practice a radical version of "living in the moment." They had no option. This mode of being required me, as a volunteer, to adjust my own expectations as well. While at first I found it difficult to start each visit as a stranger, with no bank of goodwill and no hope of anything beyond fleeting recognition, I, too, learned to practice an extreme form of "here and now" consciousness. The residents taught me, for instance, that, unlike at my high school, dancing doesn't have to be about image and social games; it can simply be about the joy of moving to music. And they taught me as well that connecting with others in the moment can be -- and sometimes must be -- its own reward.
As the months went by, I mastered the simple activities assigned to me and became more adept at following the residents' lead in living in the moment and for the moment. I began thinking about new ways in which I might contribute to increasing the residents' happiness. As one resident often reminded me, "depression" was everywhere.
Around this time, I happened to hear a brief piece on NPR introducing TimeSlips, an improvisational storytelling program designed specifically for people with dementia. The program entails presenting a small group with an evocative picture -- for example, an elderly woman jumping unnaturally high in order to catch a Frisbee. The group is invited to tell a story about the picture. Every response, whether or not it "fits," is acknowledged and recorded.
A small group of residents sat in a circle with me to discuss a picture of a woman on the beach. They looked at the picture for a while and introduced ideas about why the woman was at the beach, who she was with, and what she was doing.
"Having fun at the beach. That's all it is," one resident, Roger, concluded. He stood up, painstakingly positioned his walker, and began to walk up and down the hall with a faint smile on his face.
"What are you doing Roger?" I asked.
"Just taking a walk on the beach," he answered. "Having fun on the beach."
Seeing an opportunity to introduce storytelling to the fourth-floor residents, I signed up for TimeSlips training. Months have now gone by since TimeSlips became part of the fourth floor activity roster, and I continue to be impressed and gratified by the stories I hear. Residents who can't remember their birthdays are confidently providing backstories of moral complexity and humor, their imaginations allowing them to reclaim the authority and wisdom denied them in more mundane transactions.
When I read back a story to a group and got to a string of comments from one resident in particular, she jumped in and said with a smile, "I completely agree!" Even though she didn't recall that she had made the comment herself, she still felt validated by hearing her own opinion represented. I hope that all residents experience the same sense of empowerment.
My only regret is that my grandfather is no longer there. If he were, I hope that I would, after explaining yet again how his email worked, know enough to smile and say, "Now, Papa, why don't we tell a story?"
*Names have been changed to protect confidentiality.
Marina is first runner-up in this year's Alzheimer's Foundation of America College Scholarship competition.