Five months ago, “little kids” started visiting my father-in-law, stealing things. The hallucinations and dementia progressed, and we were forced to move him to a memory care unit.
Memory care unit is the polite term for a lockup unit for people with dementia. Walking through the locked doors for the first time triggered in me an intense urge to run away.
First, you encounter the “dementia parking lot” with the “inmates” parked in front of a large TV in wheelchairs, sitting motionless, staring at their laps, or the walls, oblivious to the television. Most are asleep. My father-in-law fit right in.
On one visit, my wife woke him, and as his residual operating system slowly booted he reached out and hugged her, a move rarely seen when he was “normal.” We sat down and listened to his plans to travel to Washington, D.C., and to stories of nurses bringing drugs into the place.
Being 65 and “normal,” I fear becoming an inmate. But I also feel a profound sadness for these lonely folks with nothing to do and no reason to live. Perhaps I am projecting my world onto theirs, but still ….
My sadness also comes from knowing that within these residual fragments of human beings were once vigorous people with lives filled with struggles and stories, however big or small, now lost with the loss of their minds.
I wondered how long we would have to stay. I struggle not to look at my iPhone, and I struggle to avoid eye contact with any inmates. It is a giant human tragedy. I want to run.
My father-in-law loves Drumstick ice cream cones. The moment he spots the package, his eyes light up. He stares as my wife tears the wrapper off and plants it in the feverish grip of his stiff and crooked fingers. He and the cone merge into a tiny universe of joy as he devours it with the rapt intensity of a five-year-old.
Tonight, like every night, parked in his wheelchair, is a bald black man dressed in slacks and a nice shirt, sleeping, head hanging down.
My wife pulled another Drumstick from the freezer, nudged him awake, and offered it to him. His big eyes lit up as she unwrapped it. “Thank you,” he said.
His big, soft eyes melted my aversion just enough to allow a spark of interest to light the urge to talk to him. I squatted down, said hello, and asked him what his name was. I detected an accent. I asked. He was from Liberia in Africa, but lived in St. Paul for a “long, long time.”
Then it hit me — his eyes were dead ringers for the actor Samuel Jackson” eyes, and I told him so. A huge smile erupted, and he said, “Yeah, I been hearing that for a long time.”
The conversation petered out, so I stood, shook his hand, and sat down next to a rail-thin woman with a flabby paunch slouched down nearly flat in a recliner chair. “Hi,” she said, her lips retreating inside her edentulous mouth, “my name is Pat,” after which I was drenched in a tsunami of stories about her life. I had no idea how much was true.
Next, a thin elderly woman dressed in a skirt, blouse and cardigan sweater wandered over to me, said hi and “cute” with a warm smile and sparkling eyes, and told me about her son, a doctor, and walked away. She seemed normal until she returned a few minutes later, told me I was cute and about her son again, and left.
When we left, I was in a great mood, unlike the usual somber, serious mood of previous visits. I actually felt cheerful.
Later, it dawned on me why.
Normally, I tried to mentally hide during our visits, but that night I ended up seeking, spontaneously, drawn in by the elderly man’s Samuel Jackson eyes. My shift in mood highlights the difference between empathy and compassion. It is hide or seek.
Empathy is resonance with the emotional state of another person, be it negative or positive, driven by activation of specific neuronal networks. If we see someone stub their toe, we wince in response, as the same neurologic pain networks in our heads get activated, generating a natural desire to pull away, to avoid, or to hide.
Compassion is distinct from empathy. Compassion is a concern for another person’s suffering, accompanied by the motivation to help. Compassion can be triggered by an empathic response, but the empathic response and its aversive nature can be mitigated or truncated by mindfully invoking a compassionate mindset or compassionate action. Compassion activates distinct regions of the brain (medial orbitofrontal cortex and ventral striatum) that are distinct from areas of the brain responsible for empathic responses.
Tania Singer and colleagues at the Max Plank Institute in Germany have shown that short-term training in loving-kindness meditation (just several days long) led to the ability to activate the compassion network in the brain consciously. Thus, we can train our brains to be more reflexively compassionate, and we can train ourselves to “seek” rather than “hide” when confronted by a strongly aversive empathic response.
Knowledge of this extends, in the moment, to situations as I found myself in at the memory care unit. The aversion response is so common for first-time visitors to the memory care unit that nurses actually warn them. Empathy rears its head, and we want to run and hide.
Thing is, I couldn’t hide. I still had to go back to visit. Even if I didn’t, hiding just leaves it lurking in my mental jungle in a dark corner until next time. By invoking the compassion solution, I walked out in a great mood. Now I look forward to visiting the memory care unit.
Michael Maddaus is a thoracic surgeon.
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