Thoughts on "Water for Elephants"
I just finished reading the book "Water for Elephants" by Sara Gruen. Told by a 93-year-old man named Jacob who is living in a long-term care facility, it's a story about life in the circus. In a series of flashbacks between the present day and the 1930s Depression-era, Jacob recounts how his life changed drastically after both of his parents were killed in a car accident that occurred right before he was to sit for his senior veterinary school exams. Even though he returns to college to take his final exams, he is unable to write a word on the paper. Dejected and despondent, he wanders around town aimlessly until he sees a train coming and decides to hop on board to see where it will take him. The rest of the story recounts the sordid details of life on the circus, of Jacob falling in love, of him dealing with animal cruelty, and of harsh and unethical business tactics.
While the story of the circus was interesting and Jacob experienced many hardships during that period in his young life, I found myself feeling more sympathetic toward the older Jacob. I naturally attributed those feelings to working on a magazine that covers the long-term care industry. Jacob's passages about life in the facility just reek of loneliness, as Jacob has this internal dialogue with himself over losing his independence. For example, on page 107 he says "One of the greatest indignities about being old is that people insist on helping you with things like bathing and going to the washroom."
Jacob also struggles with what appears to be dementia. At times, he's not able to remember his children's names or other important details, like whether he is 90 or 93 years old.
Few of the pleasantries Jacob experiences in the facility center around his interaction with a favorite caregiver, a CNA named Rosemary, who often acts as his daily caregiver and knows his needs and preferences very well. Jacob feels an incredible bond toward this woman, even as he can't remember her name.
The relationship between Jacob and Rosemary reminded me of the importance of the person-centered care movement, a topic that ADVANCE for Long-Term Care Management has covered widely. Jacob calls Rosemary his "angel" and relies solely on her to enhance his quality of life. For example, she shields him from isolation by coercing him to sit with other residents during meal times, even though he doesn't particularly like another resident at the table. She senses when he's not feeling well and asks if he wants to eat dinner in his room or in the dining room. She knows he likes the circus so she helps him get to a window in the facility so he can watch the circus tent being set up. Rosemary asks permission to do simple things for Jacob, such as opening the window blinds in his room. This experience is very different from Jacob's interaction with another aide, who says "I have 12 other patients to take care of," when he gives her a hard time about taking a newly prescribed drug for depression.
Person-centered care was just one idea that came to mind after reading about Jacob's experiences in the long-term care facility. I'll explore some other ideas in future blog posts.