As a social worker in a chronic illness setting, life on the edge is a constant presence just as the occasional death is inevitable. Facing, dealing, accepting this reality keeps us on our toes. Sometimes elevating our status at other times denigrating it because we could not rise up to the mark.
One such seminal moment occurred last week. This is a story of two Jims, very different tales yet leading to the same end. One took charge of his life the other could not, did not; making me wonder if I had done enough. Let me tell you about them, may I?
Jim K and Jim N were men in their mid-eighties. Race, religion, ethnicity are not important. Both had been in long-term relationships as well as had adult children, two daughters and a son. Both lost their life-partners about a year ago, Jim K’s saw a gradual deterioration of a fragile Southern belle, Jim N witnessed a sudden demise of his beloved Nellie, after a hip fracture rushing around to take care of her husband. Their sons had disappeared from the scene, Jim K’s to a gay nether world of San Francisco, only to appear now and then while Jim N’s offspring took off to the far-away land of his wife and her family.
As the two Jims dealt with their losses, recent as well as those from years gone by, each carried a heavy burden. Jim K was weighed down from having taken care of his child-wife, the other troubled by the sudden loss of the more active partner and his inability to protect his daughters from it. One was unable to express his conflicted feelings, withdrawing further and further into a deliberate dementia while the other aired his insecurities by flirting with every fleeting female on the clinic floor. One withered like a flower, forlorn and dried up, the other blossomed socially, spouting sexually laden innuendos to make time pass. One evoked sympathy and empathy, the poor Jim syndrome, while the other fueled the chagrin of the younger staff and the exasperation of the older caregivers who had seen the drama of life unfold many times before.
Why am I telling you all this? Because the chronic setting is a mini-world, we become inter-connected, create intimacy, possibly a pseudo-intimacy that affects us as well as others around us. This reflection intrudes on the reality that we think we are a part of outside the clinic walls.
The clinical routine may keep us in check but the human beings under the scrubs are brushed by life in all its nakedness. Often we do not know what we can do, or question if what we did was enough, are we the true miracle workers or just insensitive bystanders. It all depends on the flavor of the day.
But coming back to the two Jims, they are so similar in many ways, making identical choices but dealing with the inevitable in their individual ways. After the death of his spouse Jim K was taken into the home of his older daughter, where he could be part of a family, spend time with his grandchildren yet he continued to withdraw, ever so slowly. Finally hospice was called in and he remained relatively comfortable. But the psychic pain was apparent. He who had continued to work till recently, delivering prescriptions to the elderly, was now totally homebound. He smiled and chatted but you knew his body was emptying fast.
Jim N on the other hand became more and more jovial, his tongue looser and looser, the double entendres flowing with greater ease. His dialysis became the show-screen to express his sexual prowess, harmless but a definite nuisance on the floor. He had moved into an assisted living home, creating havoc there, as well as at our clinic. As a social worker, I was asked to intercede. Of course when you can find no one, get the social worker is the credo in most medical settings.
Jim N and I had a good connection and we had dealt with this issue before. His daughters with whom I had worked closely were in on the dilemma and had tried to set limits. As a systems oriented therapist I try to address the whole and not deal only with the part. So the work had been initiated from the time of admission.
In recent weeks Jim N’s daughters had been struggling with their father’s terminality, finding it difficult to let go especially when they had lost their mother so unexpectedly only a year ago. Our sessions were focused on letting go, with giving their father permission to die and assure him that he need not worry about them. His half-ass sexual advances were just that, a half-ass desire to be a man in control. Together we worked on how, each one of us, needed to release the control.
Because of my close association I could talk with Jim N quite openly. We laughed and joked about his sexual advances, assuring him that he was not dead yet, but also setting clear boundaries. One of my tasks was also to let him know it was ok to bid good-bye and that his daughters were adults and could fend for themselves. As for his son there was a lot of family to take care of him and as a father he had done what he could. It was time to allow him to go too!
That last session, as I sat at the chair-side, holding his hand we cried together, he loudly and openly, I silently and quietly. Words were exchanged but even more than that a connection had been made.
With Jim N there was a time of communion, with Jim K there was none. He had drawn a curtain through which it was not possible to penetrate. His daughters have accepted their father’s death and are moving on. Jim N bid good-bye too, somewhat boisterously. His daughters too have moved on, relieved that they could permit him to go. The families have come back and we at the clinic have had a closure. But the sons, the sons have not and a part of me wonders how they are doing.
So life happens as death does too — on a dialysis unit, once again teaching and showing that the cycle goes on. No, we may not be the miracle workers but I am glad we are the stopping places where we can provide reprieve and get so much in return. That alone makes it worthwhile to spend endless hours and days doing nothing, or seeming to be doing nothing.
PsySR member Latika Mangrulkar is a social worker, educator, writer, and storyteller. This essay was written in “celebration” of social work month. Latika can be reached at firstname.lastname@example.org.