She smelled like sour milk, and she looked like loneliness. My job was to meet her and come up with a written plan. She was all of eighty pounds sitting on a faded-pink wingback chair and wearing only a tattered camisole top. No underwear, no pants, just a camisole. I held her ninety year- old wrinkled hand and looked at her, the dangling skin from her thighs like old white shirts draped on metal hangers.
With both of her hands, she grasped my hand with a surprisingly steady tight grip as if I were all that was keeping her grounded for the moment. I wondered who she had been and what she had done in her life. She had no idea who I was, that she was exposing herself, that she had soiled her chair, or that her name was Erma. She couldn’t remember if or when she’d eaten or if she took any medication. Her words didn’t quite make sense, but, really, neither did her life.
We were surrounded by the dirt, dust, peeled-off wallpaper, trash, and years of accumulated belongings that stood in piles all around her small condominium. Phone bills were mixed with passports, dated correspondence, and old lemon peels. I gently helped her climb into a pair of Depends. We just sat, our two chairs an island in the middle of the chaos that her life had become.
I was the Adult Protective Services (APS) Social Worker assigned to assess if she was neglecting herself. Holding hands and sitting was the protocol of the moment. She needed me, and, truth be told, I needed this moment too. There is something about sitting with a person in silence, just sitting, that comforts as much as a warm embrace.
After a few minutes of silence, she asked, “You want some tea, dear?” She had no tea, no kettle, no cups, and no clue. “
Sure,” I said. She grinned, and her few teeth made her mouth look like an abandoned skyline. We continued to sit, her feet propped up on the box of Depends. To her, we were having tea. To me, it was delicious.
I needed to write up a plan for Erma, but how do you describe such a person or such an experience? I started to write, “Client is a 90-year-old single woman who exhibits signs of Dementia…” And signs of beauty, and signs of the frailty of existence — of hers, of mine, of all of ours. And signs of spiritual connection, of survival in being able to ignore all the horrors around her, signs of, of, of… I decided that her state of being “pleasantly demented” created a charm that was indescribable and wordless. And yet, I was charged with providing a report to would determine her future.
I climbed through her piles of belongings and found no sign of current family. I knew what my task at hand was, but it hurt to do it. “Social worker called 911 to get client evaluated for dehydration, malnutrition, and competency.” If I could, I would take her home and feed her a diet of hearty soup, real tea, and a large dose of my toddlers’ hugs.
“Client needs evaluation for placement in a Skilled Nursing Facility.” The words came painfully out of my fingers onto the computer: my words meant that her beauty and charm would get lost.
The beauty of her sweet dementia and her hands that reached out to strangers would be translated into symptomatology and Medicaid eligibility paperwork. My words would lead to an institutional existence in a cold nursing home, and a vulnerable body would be put at the mercy of rough hands of nursing assistants who get paid way too little to wipe feces from little old ladies.
There would be a lot of Ermas in my career. The moment of “having tea” and holding hands is really what the job of an APS worker is about. And really what I hope that I am about. No care plan can describe that, though, and the written word is the true determinant in what happens to people.
The lessons I take with me come from little meaningful interactions like this that happen along the way. I hope that when I need it, there will be someone there to “have tea” with me, too.