Depression

Hot, dry sand crunches with each step. It’s the end of summer, but somehow the sand hasn’t been softened by the endless plodding of feet along the shore. Despite the coarse feel, it’s not entirely unpleasant. The beach is filled with couples and families savoring one last weekend at the lake. Terry cloth portraits of superheroes and unicorns are strewn along the sand. Carefree legs race through sandcastle villages. A Labrador leaps with abandon as he chases a neon ball.

Putting one tentative foot forward into the crisp lake water, I gasp. There is nothing inviting about moving forward, yet one foot follows the other into the green, murky water. My feet begin to numb. At each step I expect the water to be less biting, while the chill continues to spread from feet to calves to thighs. Other swimmers plunge ahead, diving under and emerging with smiles. They gracefully stroke the surface with suntanned arms. They splash and flip with ease.

Internal voices shout, “Be like them!” and I’m suddenly submerged in icy wetness. Every inch of my skin is covered with goosebumps. I shiver and gaze back at the happy shoreline. Children inspect the sand for tiny seashells. Red plastic frisbees soar through the air. Sand sparkles. I should return to that place where I was warm and dry and happy, but sinewy hands begin to grasp at my heels and pull me under. I’ve gone out too far and my feet lose their grip. My head dips under again and again, and I gasp for light. Shrieks of laughter echo in the distance, taunting me. It’s cold and it’s dark and I want to go back, but my unseen adversary grips my legs and binds my arms.

The shoreline is hazy, with one person’s movement blending into another. Perhaps it’s only a mirage, and the truth is found in current misery. Uncertain, I lunge forward as my legs fight against the heavy current. I’m thrown back every few steps as I strain towards some distant, happy memory. Fetters of darkness loosen as I stumble out of the stagnant lake and collapse onto shore. The sun warms and dries my body, and I shudder with one final chill.

Looking out onto the water, waves shimmer. Sailboats are dashes in the distance. My hands grasp the sand. I turn my face towards the sun and greedily gulp in sunshine. A giggle of relief bubbles in my throat but is smothered before it erupts. Despite the firm ground below me, I can feel the darkness lurking, threatening to pull me under at the slightest slip.

 

Goodbye

Last Friday we watched your birds. We sat in the shaded part of the cement patio, both remarking on the delightful warmth of the day. The three-tiered stone fountain bubbled and splashed a lulling rhythm. Playful sparrows hopped along the edges, dipped beaks in for a quick drink, coming up with feathers askew in a mohawk shape that made you laugh. Cardinals swooped in with a flash of scarlet. A rambunctious squirrel darted among the doves for discarded seeds, grasping his cache between grateful paws. There were an unusual amount of birds accompanying us on the patio. They were not deterred by our presence. We were amused by theirs.

We had many afternoons similar to this. Once I discovered your fondness for the outdoors, it became a welcome part of both of our days. We’d pause during our sessions to just observe the world around us. Not knowing the names of the different trees, you’d point out your favorite ones by the shape of the leaves. I’d notice the pattern of the bark. One day, we watched a mom and son cart a wagon load up that steep hill, and we took bets on whether they would make it. Guessing at their load, we wondered why they took the wagon instead of the truck sitting in the drive. You told me stories about this neighborhood from when you were a kid, and you came to this very building to visit the residents with your grandfather. As I carefully navigated the wheels of your chair back to the building, I imagined you skipping up the sidewalk as a young girl.

Monday afternoon I am called to your room. You cannot speak. You try, but we cannot understand. Your eyes have a faraway look in them, which I mistake for fatigue. Illness. As I smooth back soft strands of wispy white hair from your forehead, I call your name. Do you see me? I wipe away beads of sweat with a cool washcloth and pat your arm. My mind is searching for a way to comfort you. Does everyone else understand what I do not? Your sister prays aloud as she holds your hand and I am still calling your name over labored breathing, when I am suddenly aware of an audible silence. A final calm falls over your body, and in that moment my composure breaks as hot tears sting my eyes. Quiet whimpers and sniffs fill the room. A small crowd gathers in disbelief. It was so fast. 

—–

You always wondered at the language of the birds. Often you would gently talk to them. It seems fitting that so many came to visit you that Friday afternoon. There are pieces of our conversation that come back to me, but there is one quote that stood out then and even more so today. As you tried to describe your enjoyment of the simple pleasure of delighting in nature, you said, “Being out here like this, it just lights me up inside.”

All week I half expected to see you sitting in the dining room. It feels strange to walk by your room. Your absence is palpable. I know this will fade in time. And I know I already said this while you were with me, but it bears repeating. Thank you. Thank you for all of the peaceful afternoons we spent together. Thank you for sharing your warm memories. Thank you for sharing your light.

 

Perception

I sit at the edge of her bed and talk about nutrition, hydration, and the recent eating problems she’s been having. She’s a wisp of a woman who I could easily lift out of bed. Her clothes hang askew in a way that shows recent weight loss. Her cheeks have a wrinkled, sunken look and she’s more bone than muscle, with not even a trace of fat. As we talk about her progress, the “limited intake”(speech therapy code for “not eating”), she opens up and admits that it feels good being thin. She doesn’t want to get fat again. When I mention she could easily gain 5 pounds and notice no difference, her eyes widen in disbelief. Maybe fear. She tells me that she used to be “big”—at least adding 50 pounds to her current slight frame. There are no pictures in her room to confirm this, but I read the truth in her eyes. And I find myself telling her, “I used to be chubby, too. When I was a teenager.” Her eyes widen further and she shakes her head in disbelief. But when I describe what I think she’s feeling, she sees truth in my eyes. Suddenly there aren’t 45 years between us. We could easily be girlfriends talking late into the night.

We talk openly about how difficult it is to get past those old perceptions of ourselves. I assure her I am not trying to make her gain weight—that I just want her to be healthy—and her posture relaxes. She smiles. She’ll work with me on this “food” thing. She’ll try.

What kind of broken world do we live in when an 85-year-old woman has issues with body image? What kind of dark path has society walked that a clearly malnourished elderly woman finds worth in being thin? Yet, we pretend that these are the problems of youth. If a young woman in her teens or 20s struggles with body issues, we figure she’ll grow out of it. Severe cases might warrant therapy, but we otherwise adopt an attitude that these problems will somehow disappear over the years. What do we assume is the cure? Marriage? Parenthood? I don’t see how women are supposed to break free of this when body image is so ingrained in our culture.

I can walk into any grocery store on any given day and see “fitness” magazines full of images of thinness that are not realistically achievable by most women. And even if they are, what values are being driven out to achieve them? Physical beauty is something we’re born into. Or we’re not. The preferred body type of the decade is something we’re genetically predisposed to. Or we’re not.

How do we combat this? I wish I had more answers. I am filled with a general angst and frustration with the value placed on the physical beauty of women. We’re all a bit guilty, and we all buy into the lies in one way or another. We all want to believe in a better world where we see people for inner beauty. In the movie Shallow Hal, the main character is brainwashed into seeing people for their inner beauty—or ugliness. The results are irreverent, silly, and strangely heartwarming. As light as the movie is, I’ve often found myself wishing I could go through life being brainwashed like this, whether I’m looking at others, or looking in the mirror.

Perfect

Perfectionism is one of the most joy-stifling mindsets. Beyond decorum, it’s the idea of avoiding mistakes to a paralyzing degree. It leads to willful silence for fear of saying the “wrong” thing, looking silly, or being laughed at. There should be a better word for it, because while I use “perfectionism” to describe my attitude, I do not see perfection in my life. There’s nothing perfect in standing stiffly in the corner of the room while everyone else is dancing. There’s nothing perfect in sitting mutely with unspoken ideas for the conversation. For many years, these responses would win out over the possibility of regret and the loop that would play over and over in my head as I critiqued my actions. If I don’t try, at least I can’t fail.

When I’m confronted with something new, the flight or fight response is activated, and I want to choose flight every time. My frustration threshold is low, and there are lists of activities I have abandoned over the years because frustration was stronger than perseverance. If I care about my performance and an action is not coming easily, I become irrationally angry. As a kid I tore apart a new badminton net and broke the racket when I just couldn’t keep that birdie over the net. In my early adulthood I tried to learn how to play guitar, and I had to restrain myself from throwing it at the wall, instead opting for tearing up replaceable sheet music. Emotion overcomes reason and tells me others have natural skills I wasn’t blessed with.

Perfectionism is something I’m striving to root out of my life. One way I’m tackling this is by purposefully pursuing actions outside of my comfort zone. Sharing my thoughts with a public audience is one recent venture. Now, I’ve added ballroom dancing into the mix. Dancing may be the extent of discomfort for me when it comes to physical activity. Give me the controlled movements of yoga or the measured steps of running and I’ll tune out the world and become happily consumed by pushing myself to new limits. But dancing involves skills I just have not developed. Rhythm. Spatial awareness. Graceful movement.

“Slow, quick, quick, slow,” our instructor, Laura, calls out the measured beats of our steps over the music. I hold my arms stiffly in position as I mentally picture the steps, but the connection is lost by the time my feet move. I lead with the wrong foot over and over. Just as one series of steps becomes comfortable, we learn new ones and my feet become confused all over again. Laura models a new step with Matt, then nods at me to try, and I stare blankly. We learn several steps, and we begin putting them together to move across the smooth wooden floor from one mirrored wall to another. The corners of my mouth begin an upturn. My feet are moving where I want them to and there’s a light bounce in my steps. Then we begin spontaneous movement in response to the music, and while Matt moves lightly and naturally, I’m irritated that no one has given me the game plan. My feet fumble and I stop mid-step with a sigh.

We’re several weeks in when we have the shoe discussion. Apparently Nikes and ballroom dancing don’t jive. As Laura shows me the dancing shoes from her catalog, she innocently asks, “What size heel do you wear?” My mouth hangs open dumbly as Matt chortles. She looks at both of us and takes a deep breath. “Okay, we’ll keep it on the shorter end.” My usual joke about wearing heels is that I can walk in them as long as I have an arm to hold onto. Comfort zone officially exploded.

The first time I put on the shoes, I am seized with regret for ever considering ballroom dancing. It’s not the bronze satin fabric or the rhinestone buckles that I object to, even if they do strike a contrast with every single shoe I’ve ever owned. The straps criss cross around my arches and tug tightly across the tops of my feet. More straps at the front squeeze all of my toes together and my pinky toes go numb. An image of a cartoon hippo in a tutu comes to mind. As we begin to dance, concern for the steps is overtaken by the discomfort of the shoes. Laura tells me to limit my first session in them to an hour, and I am willing away the hour in my mind. When I finally remove the shoes and allow my feet to resume their normal, plodding shape (cartoon hippo now dons a sweatsuit), I wonder if I’ve just made an expensive mistake.

“Should I wear the shoes when I practice at home?” I ask as I massage the indentations in my feet. Laura takes another deep breath, and with careful words she replies, “In a few weeks you won’t be asking me that question.”

Will I ever be a good ballroom dancer? I don’t know. Practiced movements have become easier. I’m learning to respond to spontaneous movements, and I’m dancing through my mistakes. A month ago I could barely walk in heels. Now, I’m dancing in them. Most importantly, I can feel this chipping away at my perfectionist mindset. I’m pushing through frustration, and I’m giving myself grace to enjoy learning something new without the fear of failure. For me, that’s a pretty big deal.

Tree Moments

The room is filled with soft evening shadows. A backpack rests askew on the rocking chair, carelessly discarded the minute its owner stepped in the door. My honey-colored dog stretches across the back of the couch, her hind leg stretched out as she sniffs at the cool spring air through the window screen. A tuft of white fur straggles across my arm as another dog’s head rests contentedly on my knee.

Peace. Silence settles in the house and is only broken by the ticking of the clock. Windows are open and the neighborhood is so quiet I can hear the distant whish of tires on wet pavement miles away. A dark barks staccato in the distance. A motorcycle whirs down the road. Neighbors arrive home, conversing in muffled tones as they shut car doors. Her tinkling laughter fades with her steps up the sidewalk.

Spring holds the promise of summer, which is my favorite season. Increased warmth and sunshine have always meant more time outdoors. As a kid, I spent nearly half of my summer hanging out in some tree. My favorite one grew at the edge of our yard. A barbed wire fence separated our property from the vast acres of a neighbor, as part of his yard snaked around the woods to meet with ours.

Climbing to the top of my tree involved careful footing along the ridges and branches up to a spot where two parallel branches formed a seat. I would lightly kick my legs to feel the distance below as I scanned the roof of the shed and looked down on the ominous rusted fence. Adults told us it would electrocute you if you touched it–a careful ruse to keep us off the fence and out of the woods. From high up in the tree I could easily count the rows of newly planted evergreen trees that would one day obscure this view, as well as my path to the woods.

In my tree I was alone but not lonely. Was it the presence of God I felt? As the wind rustled the leaves, I would close my eyes and imagine myself in another time, connected to other people who had lived in these houses or even the first people to explore these lands. Perhaps it was a rare moment of peace even then, as I felt far from the responsibility of chores or homework. I was in the moment. Taking in the warm sunshine peaking through the branches. Watching ants scurry around the bark. It was a sense of getting back to something essential.

Stillness is elusive to me. I must contend with the “must”s and the “should”s that cycle through my mind, the peace of relaxation broken by a nagging guilt about various mundane tasks. Busyness carries too high a value. To fill the calendar with appointments and to have an endless to-do list is lauded. Relaxation is something to be earned. As I strive for more peace, I see the need for more stillness. It’s the only way to return to the essential. I want more tree moments.

Unwelcome

It announces its arrival with an early morning restlessness that pulls me out of bed before the alarm.  My breath quickens as I begin to feel the familiar sensation of twisting and burning in my stomach. The sun is not yet up, but already the day is looming.

As the twisting turns into tightness, I strive to make sense of the illogical response my body has to simply waking up. My hands fumble in separating coffee filters.  I lose track of my morning routine. Did I already pack my lunch? Where is my phone? I should’ve been on the road 10 minutes ago.

My thoughts gallop towards an undetermined finish line for a race in which there are no winners. I breathe deeply and rehearse my inner dialogue. This is irrational, but my body has been commandeered by a powerful adversary. Reason and logic are being overpowered by a dose of fear and worry mixed with a hint of panic.

A shaky hand twists the silver knob on the car radio in a futile attempt to drown out the intruder of my peace. I sing along to mindless lyrics in hopes of slowing my thoughts. Maybe a veneer of calm will settle in before the work day begins. Maybe this will just be a morning episode that fades away by mid-afternoon. Maybe I will conquer this one day and attain a lasting sense of peace. Maybe.

Hands

My hands have many imperfections. My two middle fingers curve in toward each other before the tips turn up to the ceiling. White dots on my fingernails sporadically document my clumsiness. A white scar continues to fade on my left pinky knuckle. Despite imperfections, hands are powerful. Hands are the feature I always notice. Hands have the power to create with the stroke of a brush or the strum of a string. Hands spin webs of yarn to make blankets, hats and scarves. Closely trimmed nails with just a hint of white show careful attention to grooming. Fingers constantly stroking hair reveal an active mind. Drumming fingers expel a restless energy.

When barriers are down and vulnerability emerges, people reach out a hand. There’s such strength and warmth in hands which cannot be conveyed by mere words.  I work with some patients who cannot speak. One patient likes to run her fingers through my hair before grabbing my hand and pulling me close to her. Another patient wants to thank me for helping him to eat, and we exchange a series of hand squeezes and head nods. I leave his room with a full sense of his gratitude.

Enfolding a tiny hand in mine, I feel a protective nature of trust in the grasp. When my hand is enveloped by a stronger, more powerful one, I feel a sense of peace. Touch is underestimated and unnecessarily avoided. We seem to realize the importance and naturalness of it with infants and small children. We have no inhibitions when it comes to hugging a small child or patting their head affectionately. It’s fairly natural and uninhibited for me with the elderly as well. A daily hug and a hand placed on the shoulder is as natural as telling someone to have a great afternoon.

We shouldn’t have to be under the age of 5 or over 70 to experience the emotional power of touch. A friendly hand on my arm or a reassuring pat on my hand helps me to breathe more easily. In the subtle concluding wisdom of comedian Steve Smith on the Red Green Show, it seems to say: “Remember, I’m pulling for you. We’re all in this together.”

 

 

Small Talk

The sky is a pale blue and the air is warm on this March afternoon, but I’m lamenting that I can’t run after work. My running partner has an injury and I’m taking him to the doctor. During the post-work hours, I know the wait time will be long, and it’ll be too dark for even my solitary run once we return home.

Sighing as I grab the leash, Joffrey performs jump-turns in the air toward the front door. Hearing the word “ride” he chirp-barks his assent and eagerly hops into the car. Despite his excitement about all car destinations, going to the vet is an ordeal with this goldendoodle. I must tightly hold his leash at arm’s length as we check in, restraining him from hissing cats and scar-faced pit bulls. Then I’ll have to scan the room for our safest harbor, avoiding proximity with other big dogs as Joffrey reacts to them with barking bravado.

Today we settle in between a beagle mix and a Scottish terrier. Being amongst so many dog-people would usually be an instant ice breaker, easily drawing me into conversation. However, I’m also strongly averse to small talk. When it’s clear that a relationship will be limited to a 20 minute wait, my introversion calculator warns me against the investment. Avoiding eye contact, I twist Joffrey’s white spiral curls between my thumb and index finger as I stare at my phone.

“Rusty? Copper? Mittens?” Each name called moves us one step closer to getting out of this room. Finally, it’s “Joffrey?” and we’re off to the exam room. Joffrey is unusually cooperative as the young veterinarian examines the rusty-colored fur on his white paw.  A round of antibiotics is prescribed, and I’m cautioned to give my running buddy a week off from hitting the pavement. We head to the check-out line, which seems to have doubled since our arrival, and I sigh as I pull the leash tighter and join the queue.

High-pitched howls and whines fill the air as two large puppies swarm around their seated owner. Her pre-teen daughter waits in line, glancing awkwardly back at her struggling mother. The woman directly ahead of me strikes a contrast in our scene. Dressed in black pants and a red velvet blouse, she calmly watches this play out with a small smile on her face. She leans toward me and compliments my dog’s comparatively good behavior, and I feel a guilty and rare sense of pride, as Joffrey is not famous for his calm demeanor. We both agree that this mom has her hands full, quite literally, and more prudent planning would have included a pair of leashes. The daughter leaves her position in line to help her mother, and they each grab a puppy and head out the door.

The line shortens, and the woman says she and her husband have always had dogs, but today is she here to “pick up” her dog. My mind processes her sad tone, and I meet her eyes as she tells me that she is picking up the dog’s ashes. They’ve always had dogs, but this one is the last one. Travel. Grandchildren.  And perhaps a few unspoken reasons—such as other trips like this one.  I tell her about taking my pug a few years ago, and how we got Joffrey soon after that. She opens her phone to show me a picture of her recent loss—a coppery brown retriever mix looking up from his blue cushion dog bed. He was adorable. Yes, she agrees, and such a good dog.

The clinic phone has been ceaselessly ringing. Intermittently one of the clerks will answer it with a curt and rehearsed line imploring the caller to hold. There’s a good deal of eye rolling and terse responses as one of the clerks tells a caller that they have “a line out the door.” Even as I understand her ire—she’s not getting paid enough for this—I silently pray she will muster some compassion in her voice for this woman ahead of me.

“Can I help who’s next?” We exchange polite goodbyes as she moves to the head of the line, and I am grateful that she is swiftly moved through the process and is out the door so that she can grieve privately. We’re making our own exit as the mother returns with only one puppy in tow. She’s figuring it out. Some day she’ll be the one in line with the “good” dog. Some day she’ll be the one on a more somber visit. Right now, she’s just getting started.

My Treasure

Glass rectangular boxes with shiny silver frames stand in two rows before me. The chunky metal handles are cool to the touch as I turn each in hopes that a glitch in the system will produce a free prize. Each box tantalizingly displays the most coveted items on the front. Will I receive a pair of tiny handcuffs, a whoopee cushion, or a bracelet filled with sparkling green glitter?

The bottom row is more predictable. A few clicks of the handle pours out a handful of Runts, Reece’s Pieces, or a round ball of colorful gum. This is the sure bet—but I’m not fooled. The anticipation of the loot in the top machines is what I live for on these grocery store visits.

I shift from one foot to the other in my dirty Keds as my yellow ponytail sways back and forth. Already hoping for the quarter that Mom may give to me, I peek beyond the cashier to see how close she is to the end of the checkout line. She sees me watching and nods my way. I smile and just know one of these treasures will soon be mine. My window shopping will not be in vain.

Customers pass by me in the doorway as Mom strains to watch me beyond the passing bodies. I hold her gaze and she becomes reassured as the crowd thins and she turns to pay. I’m still smiling as a woman begins to shuffle past me, her uneven gait causing me to stare longer than a few polite seconds. She has a black leather change purse in her hands, open with the silver knobs pulled apart. Before I can open my mouth to protest she is pressing two quarters into my small hand and nodding toward the machines. She shuffles out the door as I look for Mom, unsure of what to do with this unexpected gift from a stranger. When Mom arrives moments later, her brow furrows and she looks towards the doors in a futile attempt to glimpse my benefactor. It’s too late. She has disappeared into the bright summer afternoon, and now it’s a different head that nods towards the machines.

What precious prize did I receive from my windfall that afternoon? Was it a disappointing neon green sticky hand that became ruined the moment I dropped it in the dirt? Was it a pack of trick gum that would snap the finger of some unsuspecting friend? My memory has wiped out those details long ago. What has persisted for over 30 years is the kindness of one woman who saw a small but meaningful chance to brighten one little girl’s day. She has given me the gift of a lifetime.

Playing Cards with Jim

The sun peeks through the blinds and casts a striped glow in the room. I casually shuffle the cards and bring them softly together. Jim looks at his own hands and turns them over as he expresses admiration for my bridging skills. He smiles when I say that it was my grandma who taught me.

When the cards are dealt, I say, “Kings in the Corner. Do you remember the rules?” He nods and we begin our game, as I make small talk about the weather and today’s menu. He takes a long pause on his turn and I think aloud, “We need a red two…” or audibly wonder “Where are all the sevens?” After he takes several turns, I lead him into a topic of conversation that results in a story I’ve heard four or five times already this week. My voice belies how well I know these details as I strive to listen with fresh ears.

Short-term memory. Problem solving. Planning. These are the keywords for my goals when I play cards with my patients. They know I’m doing my job. This is where I work. But for most of them, this is their home.  When I visit their rooms, I am offered refreshments. Hilda gives me a Little Debbie snack in the festive shape of a Christmas tree or a pink heart. Dorothy doles out fistfuls of Hershey kisses from a hidden stash in her closet. Bob gives me a cold Diet Pepsi from his mini-fridge. It’s much like visiting a grandparent’s home.

As I first began working with Jim, he would question the purpose of our activities. That’s not uncommon, and I must carefully navigate the truth—that I am working to preserve their mental faculties—while respecting each person’s dignity. Jim’s questions started to fade away to be replaced by familiar greetings in the hallway and a friendly wave in the dining room. We established a routine of meeting in the afternoons. Besides knowing that Jim is not much of a morning person, I purposely wait until the end of my day to see him. It gives me something to look forward to at the end of each work day.

After a few weeks of working together, I arrive at Jim’s room to find a table and chair already set up for our game. I feel a little flutter in my chest as I realize he’s been waiting for my visit. He has prepared his home for our card game, and he’s sitting in his arm chair waiting for me to arrive. Jim cannot remember what he’s eaten for lunch 5 minutes after the meal. He has a sign posted on the door to remind him to always use his walker when leaving the room. But he looks forward to our afternoon visits so much that he has remembered to prepare the room for me.

I’ll admit that I’m trying to throw the game. I’ve already won a hand and I’m withholding plays as I try to secure a win for Jim before the end of the session. Our scheduled time has run out, but I remain as we play out the hand. For the moment, I’m just playing cards with Jim. Faint beeps and voices travel in from the hallway, causing us to glance up occasionally from the table. Finally, the last card is placed and Jim’s hands are empty. He’s won the game. I shake my head in mock disappointment at my loss and announce that we’ll have a tie breaker tomorrow. We hug and exchange “I love you” before I emerge into the bright hallway. Even as I prepare to leave work for the day, I’m already looking forward to my next afternoon of playing cards with Jim.

(*Please note that the names have been changed to protect the privacy and dignity of my patients.)