The 9 O'Clock Train to Chambersburg

Today we went to visit an elderly relative we haven't seen for quite a while. She has moved into an assisted living residence since we last saw her and has had some memory deterioration. A few family members alerted us before our visit to some of the memory slips and gave suggestions to help mitigate any confusion or anxiety. We had a nice visit and only once when I asked her a wrong question did Jason and his brother suddenly signal me behind her back to drop my question and move on fast to another subject.

​There's quite a technique to navigating the sticky waters of dementia without confusing the individual more or upsetting them. When I was in my first nursing job out of school I worked on a medical and oncology floor at Mount Vernon Hospital in Virginia. Mary was a patient I had every evening for months. We couldn't leave her alone in her room because she'd get into trouble. Even in five-point restraints (that's wrists and ankles plus a wrap-around vest with long belts to tie onto the bed or chair) Mary had a way a finding her way out like she was Houdini. More than once I found her on the floor, with one foot still tied to the bed and Mary tugging against it, trying to scoot toward the door. "If you could just get me a pair of shears, I could still make the 9 o'clock train to Chambersburg!" she'd say looking up at me when I came into her room.

At 92, Mary forgot her age and believed she was once again a young bride, often thinking it was her wedding day, reliving the events of her wedding and describing to me what she was experiencing--including her wedding night.

Mary had worked for the train line in Pennsylvania. While her husband had been a train engineer, she had worked as a switchboard operator for the railroad. They'd never had any children of their own but her sister had had twins. When it wasn't Mary's wedding day (or night), she often thought those twins were her own babies. And she needed to get home to them.

When I came in to begin my evening shift at 3:00, Mary was already out at the nurses station, tied into a wheelchair.

"Hi Mary," I'd say. "How are you doing today?" She be tugging on her vest. Then she'd point over to the unit secretary's desk. "If you could just hand me those shears over there, I could cut this off and still make the 9 o'clock train to Chambersburg and get home to the twins."

Being the green nurse that I was who still played by the book and tried the things my instructors had suggested in the controlled environment of the classroom, I realized I should reorient Mary to reality. I bent down low to speak with a soothing, calm voice and said, "No Mary, you don't have twins. There's no train to Chambersburg. You're going to stay here with---" Before I even finished I was reeling and seeing stars. She'd wound up and clocked me in the side of the head harder than anyone had ever hit me. She scolded me and yelled profanities that there certainly were twins and she was indeed going home to them.

Once the ringing in my ear stopped and the throbbing in my head eased, I made sure the shears were out of reach and wished her a great trip. I never again tried to orient her to reality. And from then on, both of us were much happier.