My Friend Kathryn

By Fran Harmeyer

This post is offered by Fran Harmeyer, an OT from Connecticut that has worked for years in end of life care.   It offers an excellent and typical account of subtle communication and the development of relationship in end of life care.   Thanks Fran.

I worked in a skilled nursing facility a while back. This one was for  downwardly-mobile elders, widowed factory workers, WWII veterans, maiden aunts competing with their aging sisters for care from already strained family members. Other residents included leftovers from the enlightened day of emptying the state mental institutions without a plan. This place looked a little like a 1950’s elementary school in a state of benign neglect. It wasn’t falling down, but it appeared a little weary, like its inhabitants. Once inside, the tile floors glared up at you and the fluorescent tubes above showered long sterile halls with a bilious green tinge. The odor wafting through the tinge was invariably the smell of urine and bowel evacuation, sometimes old, sometimes new, but always pungent enough to stop a deep breath short.

I worked 40 hours a week for 2 years in the rehab department. The staff was uninterested in us.  To them we were pushy therapists that just kept trying to change things. We were largely ignored. Nobody really cared what I did there anyway, I thought.

Kathryn must have been about 50, hair curly black and thinning, dark bushy eyebrows, full lips, opalescent olive skin and one large front tooth. She had had a stroke about 5 years before and was bed bound. She was not a small person, maybe 5’8” and as stiff as a board. Her toes pointed down, contracted hard toward the foot of the bed, and were exquisitely sensitive to touch. “OOHHHH God no!” she screamed when she slid down in bed pressing her toes against the foot of the bed. “OOOHHH God no!” whenever she was touched gently or roughly. I would sometimes watch as the aides cared for her. She screamed bloody murder whenever she wanted anything. It was her way of asking. In this nursing home, generally, it was the only way of asking and she wasn’t the only one.

My office was directly across the hall from Kathryn’s room, so I always knew when she needed anything. In fact, when Kathryn needed anything, I was unable to work. Her screams were so authentic, unnerving and …loud. This is how I met her. One day, I couldn’t take it anymore, so I went across the hall and asked her what was wrong.

As soon as she saw me, she went quiet, her face became placid and she politely asked me to get her a drink of water. Easy enough I thought. I got her a glass of water, put a straw in it and held it for her to drink. She couldn’t reach with her right elbow stiffened and stuck in an “L” shape preventing her from reaching her mouth and her wrist was almost folded over on itself. Her left arm was limp from the stroke. When she was finished drinking, she thanked me very much, asked God to bless me and thanked me again. I left the water on her bed tray.

Her speech was very rapid, tumbling in short bubbling streams. She had a kind of urban dialect that suited the speed of her words well. I seemed to always understand her though.  I came to admire her resourcefulness in getting things done. She was a person with no ability to care for herself, at the mercy of the schedules of others, and still finding a way to get things she wanted and needed.  After weeks of tending to some of her daily needs, I asked her if I could move her arm a little (the contracted one). As I took her hand in mine she yelled loud and clear “Oh no, lord ahmighty God no”. I asked her if I had hurt her, she turned to me and said calmly and clearly “no, but sometimes I get afraid”. I sat with her hand in mine for awhile and then left.

Each day after that I would get Kathryn something to drink, ask her if I could work with her arm and each time she would let me know when the session was over by yelling loudly as if the end of the world was nigh. It was unsettling at first, but I eventually came to accept her communication as if she had said “ok, thanks for coming, but we are finished for today, I’m tired of you.”

During our sessions we would either chat or watch TV and for Kathryn her “stories” became intertwined in our conversations. She would tell me I didn’t have to have that baby if I didn’t want to and that I should never let him hit me like that.   I usually agreed with Kathryn’s pronouncement, because she made many good points about survival ala soap opera story line. I liked talking to Kathryn about life. We were both pretty philosophical and thought a lot about decisions people made and why people did what they did, at least it seemed that way to me.

My life was difficult when I met Kathryn. I was unhappy in my marriage of too many years, trying to recover from unsuccessful fertility treatments and dealing with my husband’s drug habit. It occurred to me in the odd sane moment that there was some incongruity in the flow of these three issues.  Why go through fertility treatments with a man who is a drug addict? Why stay married all that time to someone who is more seriously committed to joints and lines than the well-being of his family? I obsessed about divorce but spoke to no one.

One day I entered the room with a brace for her hand and, by this time, she let me move her wrist to a normal position. Before I could start the session, she looked at me with wildness in her big buffalo brown eyes and said “If it’s no good, you just got to go. You just got to leave him if it’s no good. Uh-uh, he don’t treat you good? Git on outta there.”  “Really? Kathryn? I should just go huh?”  She replied, “Yes ma’am, don’t you stay another day, he don’t treat you right, ain’t no use with a man who no good”.  “What are you doing in my head, Kathryn?” I asked myself.  I had a feeling she knew what a “no-count man” was. Yep, she knew what she was talking about. She told me a story about a big man who came at her to cut her and she fought back and didn’t let him do it. It was hard to get the details or a clear chronology of what actually happened, or if it did happen. But there was something about her animation, a wild look in her eyes and the tension in her voice that I always believed.  Kathryn was my buddy in those days. She needed what I needed, what we all need, want and deserve: A hand to hold, someone to help, someone to care. 

I was working with Kathryn’s roommate one day and at the end of the session suddenly became overwhelmed with the desire to hug Kathryn and give her a kiss on the cheek. There was no rhyme nor reason to it. A strong feeling just came over me. Of course I wasn’t going to do it. It wasn’t the professional thing to do. She wasn’t even on my caseload anymore.   Just as I turned to leave the room, Kathryn stopped me and said, “You know what I would really like you to do?”   “No Kathryn, what”?  “I would really like you to come over here and give me a big hug and a kiss!”

 So I did. You don’t argue with a mind reader.

Frances Harmeyer OTR/L  writes little stories about the people she meets in the world of inpatient rehabilitation at skilled nursing facilities. She is currently completing a Master’s Degree in Geriatric Health and Wellness. As a rule and on a daily basis, she is amazed by the variety of human experience at the end of life and is a strong advocate for choice at any stage of life.

Contributions to the Kairos Network Blog are made by its members and others who do elder and end of life care.  If you are interested in offering your stories and insights to this blog or joining the Kairos Network, please send me a note at jdenney@email.com.