A complex network of individual routines, habits and foibles form the basis of our sense that our lives are as we expect them to be – that they’re exactly the same when we wake up in the morning as we left them the night before. The day is filled with hundreds of these personal indicators and we pay little attention to them, because they’re not so much the content of our lives as the framework we live within.
Here are a few examples drawn from my own life: Upon waking up I put on my glasses, get out of bed, put on a robe and walk towards the bathroom. Passing through the kitchen, I set my glasses on the table before entering the bathroom. This is so they won’t steam up while I shower, which I do immediately after brushing my teeth. After showering I shave (using a hand towel near the sink to wipe clear a circle in the center of the mirror), I floss my teeth before I put on some aftershave. I’m not sure when the flossing ended up not being directly adjacent to the pre-shower teeth brushing, but that’s where it’s been for some time. I floss first because of too many experiences of tasting the aftershave which had been on my hands and then transferred into my mouth. Of course I could have just rinsed my hands, but being as this was me solving my own problem, I just moved the flossing up one place in the parade of events.
That’s just one list of small actions that create the outline of structure in my day, allowing real events the greater importance and attention they deserve. The list and the manner in which the tasks are dispatched are as unique to me as my fingerprints. Everything in that morning ritual occurs within the span of about twenty minutes. I could go on enumerating other actions throughout my day – from opening mail to taking a message on the phone to putting things away, but the idea remains constant. They’re filled with the tics and tendencies that in total are uniquely mine.
Having worked at a nursing home, I’ve seen that people enter because of some sort of notable decline. In one way or another they’re no longer adequately able to care for themselves, or to be cared for at home. Whatever diminished capacities were documented on admission can be monitored by an assortment of professionals. However, brought on by the move itself, another form of decline occurs with the loss of personal routines, the bulk of which are left behind when leaving private life.
These patterns, though rarely the object of any conscious focus, quietly assure us that we’re in control of our days and our lives. Most people would be hard pressed to take a full accounting of the myriad personalized tasks and habits they execute constantly. What happens when we give up these routines? We lose our reference points. More and more of the emotional tethers which anchor us to the earth snap away and we drift powerless, wherever the winds may carry us. It’s a loss of one’s personality.
This loss isn’t unique to the enormous change of leaving one’s home and entering an institution. It can be seen any time these routines are packed away. It happens to someone who enters a hospital for even a few days. They’re in a weakened state, food is brought to them, they’re wearing a hospital gown – all the conditions for a personality in full bloom are stripped away. Another example would be taking a solitary cross-country bus trip, seated alone, reading a book or magazine that intermingles with falling in and out of sleep. Arriving at the destination, not only do limbs need to be reacquainted with their full range of movement, but so does one’s personality.
The experience of entering a nursing home or other form of long term care institution is much like being on a bus ride and never getting off. It is the nature of these facilities that the range of common needs are most easily seen. Simply being aware of the less visible losses can help family and staff understand the source of a form of decline that doesn’t show up on any charts or histories.
– David Greenberger
(published in Contemporary Long Term Care magazine, March, 1998))