Yesterday's Gone
Nurse who works with Alzheimer's patients finds satisfaction amid sorrow

By Phil McPeck
April 18, 2002

For three years now, Ola Arije, RN, has ensured the physical and emotional well-being of 30 long-term care residents. Arije's patients, whom she regards as her second family, are Alzheimer's disease patients.

She is beginning one of three 12-hour shifts--6 a.m. to 6 p.m.--that make up her workweek at Garden Terrace in Aurora, Colo. From the driveway portico, she passes through a double set of smoked-glass doors and across a hotel-like lobby, complete with complimentary coffee and plush sofas grouped on lightly patterned carpeting. She reaches high on a wall next to a white enamel doorjamb and fingers a keypad. The secret code hushes an alarm for a few seconds, long enough for her to pass into another world.

Until the end of Arije's workday, time consists only of now and tomorrow. Yesterday rarely exists at Garden Terrace, one of six Alzheimer's facilities in the Life Care Centers of America system. No childhood memories. No raising of families. No gold-watch careers. For some, conversations and activities of 15 minutes ago are gone as if they never happened.

"Sometimes, it's depressing," Arije said. "There's nothing we can really do to make them get better," she said. "Hopefully, one day they'll find a cure. It's a degrading disease, with no known cause and a diagnosis that only can be definitive at autopsy. But at least we can improve their quality of life."

After taking her morning report, Arije passes medications. Support staff then come in to reinforce residents' daily living skills for physical therapy and for activities that range from singing to reading to gardening. Arije said she also insists that she and her CNAs sit and talk with residents during activities for two reasons: "We want them to feel at home" and it's a good way to ensure that they are drinking and snacking adequately during the day. Some Alzheimer's patients can't even tell you they are thirsty and dehydration always is a threat, she said.

At 38, Arije, who is from Nigeria and started nursing in geriatrics, said she first became familiar with Alzheimer's in 1994 when President Reagan publicly announced that he likely would be afflicted with the disease. "It's something that can happen to anybody," she said.

In the years since the Reagan revelation, she's come to regard Alzheimer's care as her calling. "I love it," she said, despite the trying nature of dealing with Alzheimer's patients.

Among Arije's challenges is the phenomenon known as "sundowning," in which the agitation that is a hallmark of Alzheimer's disease essentially becomes contagious. It typically happens in late afternoon. "Everybody gets hyper," Arije said. "You need just one person to start it and you never know what to expect," including residents screaming and throwing things. "You just have to love them," she said, her soft-spoken voice trailing off. "Even if they're going really, really crazy, they kind of calm down."

The flip side is the satisfaction of persuading residents to eat or shower when they are-to put it mildly--reluctant to do those things. "When we find a way to make them do things they don't want to do--eat, for example--I feel like we've done something good today," Arije said. There also is the joy of conversations that at least temporarily tap into a resident's yesterdays, she said.

To further stimulate memory, residents have shadow boxes at the entrance to their rooms, which line a hallway running in front of a central nurses' station. The boxes are a common tool in Alzheimer's care, Arije said, and are used as reminders of oft-forgotten lives. They feature pictures of residents in much younger times, family snapshots, perhaps flowers if gardening was a significant part of a resident's life and mementos of careers.

The most memorable part of any day may last just an instant. "I have a lady I always call the most beautiful woman," Arije said. "She gives me a big smile. It makes me happy, something that makes them happy. An Alzheimer's smile is from the heart."