House of the Setting Sun

I went to a nursing-home visit this evening. It was a high-care facility where all the residents are highly dependent on the nursing staff for even their most basic daily activities like going to the toilet, feeding, and showering.

Walking through the front door, I was immediately surrounded by that characteristic "old folks home smell," a mixture of antiseptic solution, stale air, urine, and the occasional heavy scent of air freshener someone had sprayed in a vain attempt to make the air more breathable. With my olfactory glands quickly and fully saturated and desensitized, I walked with my GP down the hallway starkly lit with fluorescent lights and decorated with generic paintings of flowers. The paint on the wall and the lighting together gave off an eerie green-hued tinge to everything inside.

We went from room to room, visiting the dozen or so residents my GP was responsible for. Some gave a half response to our questions, others were loquacious and intent to chew our ears off. Some had their mental faculties more or less intact and were sitting in the dining room chatting to other residents, others were so demented they were only a shell of their former selves lying in bed completely unaware of their surroundings. Some had pictures of their families and flowers next to their beds, a result of their families trying to make their corners of the rooms as homely as possible. Others seemed not to have anyone left in this world, with the walls and nightstands on their corners of the room completely bare and not a sign of visits by anyone was detectable.

My GP started to review the drug charts. Anti-depressants, sedatives, and stool softeners seemed to be the staples of the elderly population in the nursing home as they are in the community. One by one, the charts are reviewed, the drug dosage adjusted; then the stack of charts are set aside like a pile of freshly-finished homework.

"This place is so depressing." I commented to the nurse.

The nurse chuckled, "Well, it can be depressing. But you get used to it."

For the residents here - some of whom depend on anti-depressants to even get the energy to chew their bland meals, who are on sedatives and kept in a low-stimulus environment so they can sleep their days away and so the overworked nurses would not have to deal with any delirious residents, to whom a 5-minute visit by the doctor once a month may well be their only contact from the outside world other than the nurses - the remainders of their lives are no more than a disorienting drag from one meal to the next in an infantilized existence. The flickering images on TV no longer mean anything; it might as well be showing an alien world on Mars. Are the residents with more or less intact mental faculties thankful for being alive each day, or are they envious of the demented ones who are blissfully ignorant of their terminal predicament?

The visit came to an end. As I walked past the front doors, I took a deep breath of the fresh cool night air. I reminded myself again that I am here as a health care profession (albeit one in training) and despite my personal opinions, these residents are here to stay; all we can do as doctors and nurses are to make their last days as comfortable as possible.