Madeline --- Mental Health and the Aging
A Good Puller
Michael A. Ingall

YOU COULD HEAR HER AS SOON AS the elevator door opened. "Help!!!! Help!!!!!!! You son-of-a bitch!!!" I followed the noise to my next consultation.

She had been at the nursing home for many years, and she had been a problem from day one. We call old people "feisty" when we find their spunk and twinkle attractive. We think perhaps they and  we will never die, never become frail or disabled. But when they turn on us, when they throw food or worse at us, we call them agitated, combative, demented, or a management problem.

Madeline was a management problem. Her screams for help terrorized the other residents of the nursing home and their families. When staff came responding to her cries, she berated them with oral aggression --- she cursed, she bit, and she spit. She patted her hand over her mouth and whooped like a Mohawk.

My job, whether or not I chose to accept it, was to do something about her.

Madeline has that tight thin parchment skin dotted with small red skin cancers that makes so many very old people look alike. Her cheeks are drawn, and she has no teeth. Her long, thin fine white hair falls down to her shoulders. Wizened is the word. She comes from rural New Hampshire, and I picture her stepping out onto her wooden front porch, with a 20-gauge cradled in her arms, staring defiantly at the intruder on her lawn. She begins to curse loudly at me when I enter, and as I approach the bed, she reaches for my tie. I step back, knowing from past experience that her strong hands will try to choke me. We strike up a conversation. I must shout, because she is deaf. She is set off from the world by her lack of ears and legs.

She was a nurse many years ago at a Children's Hospital. I tell her that I was a patient there in 1951 after my polio. "Perhaps you took care of me," I tell her. "It's possible," she says, "But I don't remember you." I ask her why she screams, and she answers, looking at me as though I am the village idiot, "Because it makes people listen."

I am charmed and seduced. No Vitamin H (Haldol) for you, my dear. You just need a little attention and companionship.  I make this recommendation to the director of nurses. She looks at me with amusement. "We go in when she calls, but the sooner we respond, the more she attacks us."  I listen to the recitation of her most recent transgressions: she threw three consecutive dinner trays on the floor; she showered her roommate's daughter with oatmeal;  she has bitten two nursesí aides and a priest. I am swayed. She has crossed the line from feisty to demented. I finish my consultation, "Recommend Haldol 0.5 mg bid."

I was apprehensive about my next visit to the nursing home. I had a certain sense of guilt about what I had done to Madeline? Was I trying to drug her into oblivion because she was being a nuisance?

The elevator door opens to silence. She smiles as I approach her bed. She says, "My brains are all mixed up." She knows her age, and knows it is not quite New Year's Day.  She eyes me with a twinkle and reaches for my tie. My instincts tell me it will be safe today --- she is feisty.  She fondles the cobalt blue fabric and winks at me. "That's a good puller," she says.

I feel better. I push the down button to leave. As the elevator door closes, I hear, "Help!!!!!"

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