Reflections about an unexpected gap-year experience in a nursing home.

The summer after I finished high school I felt pretty invincible. I had spent my teenage years striving for bigger things, grabbing every opportunity to learn and explore, challenging myself and working towards getting better. This earned me a scholarship to study my two last years of high school abroad, which was an opportunity that changed my life. I thrived in this environment of equally driven and hard-working young people, were our potential for a bright and meaningful future was constantly emphasized and words such as "leadership" and "change-makers" were well integrated into our daily vocabulary. Now, imagine spending some of the most formative lives of your life surrounded mainly by people your age. And then imagine directly afterbeing put in an underfunded nursing home, with 22 residents in various stages of disability, the majority medicated for some sort of psychiatric illness. The place was first described to me as a combination of a "hospital" and a permanent care-taking facility, in other words a fitting apprenticeship for someone who like me was set on studying medicine. I had no idea how this place would challenge me beyond my imagination and make me reconsider my view on the world. 

Before this, my experience of interacting, not to mention taking care of elderly was limited at the most. My grand-parentsare relatively young and healthy and so were any other of the few elderly people I had met in my childhood and youth. Any kind of injuries or illnesses I had encountered were mostly curable, and part of the reason I wanted to become a doctor was because I truly believed in medicine's potential to cure or at least significantly improve the lives of any injured or sick person. I still believe thatand I still want to study medicine. But I will start university and medical school with a significantly more nuanced and complex view of the needs of human-beings, our own frailty and the many factors thatplay into an individualshealth and well-being.

When I tell people about my apprenticeship, people often get hung up on the fact that I´ve showered people, changed their diapers, helped them to the bathroom, fed them and assisted them with other everyday needs . But I have never been squeamish, so these tasks did not bother me. Instead, the by far hardest thing about my apprenticeship and my gap-year has been figuring out how to respond to the questions and how to give comfort to the elderly people I work with, through all the hours that I spent simply listening to them and being their company. 

Because, how do you respond to someone who is telling you that they just wish that God would let them die soon? What do you say to someone that tells you about their life´s regrets, when you know that they are in no position to change anything? What can you do for someone that spends their days sitting in a big room, waiting for the next meal and then waiting to go to bed at some point, and complains about the lack of meaning in their life, when the likelihood that their lives will change before their die is almost non-existent? (And when you can relate to their anxiety and sense of purposelessness just by spending a few hours in the place that at this point is their entire world) How do you make someone that feels like they have no one that truly loves them feel better, when their family members haven´t been in touch with them for months/years or when they indeed might not have anyone left? And how do you explain to someone that the reason they are locked into an institution and can´t leave is not to punish them, but to protect them?

I still don´t have clearanswers to these questions, questions forwhich I was unprepared and that challenged me on a daily basis in my work. Many times, I have felt frustrated for my inability to solve some of these problems and the lack of financial resources which a place like this has to be able to give people moremeaningful last years of their lives. I have been terrified about the idea of ending up in their place at some point in my life, and I have felt guilty for not being able to give them a life that I would have been comfortable or happy living myself at their age.  After a while though, I also realized the difference small things can make in the lives of lonely people in the final stages of their lives. That despite my initial feelings of inadequacy and helplessness faced by the questions and thoughts about life and death I was confronted with, a lot of these little things were things I could offer.

Icould take the time to greet everyone with asmile, sometimes a hug and the question how are you today? (and the time to sit down and listen to the answer, however long it may be). I put aside my own religious beliefs, and held people company in prayer and listened to their hopes to and thoughts about God. I could ask them about fond memories and life experiences, and sometimes got unexpected advice about anything from boys (don´t marry to soon!!!) to how to fold clothes the right way. I could find the patience to listen to a story or answer a question one, two, three or sometimes five times. And I could make sure that the blankets were tucked in the right way, that they had their favorite poncho on and that their hair was made the way they wanted it to be. Sometimes, all I could do was sit next to someone that cried (for reasons I sometimes did not understand) and hold their hand. There were all these things that I could do to make their lives a little less lonely, and a little bit more autonomous. 

I thought that my gap-year would be an adventurous, uplifting year filled with exciting sights and interesting, lively people. In a way, a continuation of my high school experience.  I was not prepared to spend a significant of time in a room with people who no longer find a meaning in life. But although different than I expected or maybe even wanted it to be, ithas humbled and challenged me in ways which caused me to develop incredible patience, compassion and a new perspective on what is important for people to be happy, or at least okay. And I can finally appreciate that after all, I did have those defining moments and eye-opening experiencesI hoped for, although maybe not where and how I thought I would before coming to Ecuador. 

 Recently I stumbled across Atul Gawande´s book "Being Mortal: Medicine and What Matters in the End". Reading it, I could finally make sense of the experiences I have had. Although I am not sure that I will want to specialize in geriatrics in the future, I think that the questions about how to help people find meaning in very difficult times, or what defines our well-being are crucial to anyone who wants to work with helping other people. I hope that I take what I have experienced with me, and that I in the future, when I´m hopefully busy being a complete nerd and overly excited and passionate about what I´m learning in medical school, take the time to remind myself of these question and that I remember my experience.

But for now, I have three days left working in the nursing home. Three days left to brighten up the days and give comfort and company to the people I´m working with. At this point, I know that I´m perfectly capable of doing so, and let me just say that there are few things that feel more gratifying than realizing exactly this.