Christmas at Midnight

Working as an R.N. on Dementia Ward B makes it seem that a matutinal death is as commonplace as a pre-dawn birth. My dear sweet patient, Margaret Brown, joined Jesus on this early Christmas morning. I'm not sure if she extraordinarily left this world or not. I was there; I did see it, yet it all seemed like a dream. Maybe the old myth is true, Christmas at midnight is when heaven and earth meet.

Margaret's story plays in my mind like the repetition of elevator-style Christmas tunes I have listened to all month; it’s most likely cemented into my subconscious. I suppose I didn't notice, as repetition as it is part of life with my Alzheimer's group. Margaret's exact words for the last five months were, "Have you seen Yvonne? I smelled her perfume and knew she was close by." 

Her words, always said in the same way, while slowly combing through the non-distinct hallway. I could hear her walker and I thought she was looking for a ghost or a shadow, but by all means, only a figment of her imagination-end stage Alzheimer's does that to a person.

As her mind deteriorated, she started calling me Yvonne. It began with a stare and then a couple of blinks. Margaret then reached out to touch my face and said, "Yvonne, have you come to take me home?"

Gently I pointed at my name tag and said, "I love you, dear sweet Margaret, but I am not Yvonne. See my name tag reads Helen Ruth Fuller R.N." 

Yvonne is significant to Margaret’s fragile brain, but what gets to my heart is the unbearable yearning. I have compassion for all my patients, but how bad I felt for this tiny little thing, always searching yet never finding. All of 4 foot 11 and ninety pounds soaking wet, her naturally curly snow-white hair allowed ringlets to outline her angelic face. I looked forward to seeing her every day as she reminded me of my recently deceased mother. 

I've only been a geriatric nurse for six months. Before, I served as a terminal pediatrics nurse over at Saint John's Hospital. Like the babies there, the patients here will die, and it's expected. I mistakenly thought the only significant difference between people in this last stage of life from the beginning is the size of diapers they need.

That is how I grew a unique relationship with Margaret. While cleaning her up at bath time and providing her with a new comfortable diaper, she looked directly at me and thanked me for being kind to her. I wish I could say spoken gratitude was a common occurrence here in Ward B, but it is not. 

Besides bathroom habits, most of my patients have forgotten manners and how to have a conversation due to extensive damage of nerve cells in their brain; most experience a decline in vocabulary and emotions. The ability to control their movement is void for most, making my aides Miranda and Ricardo diligently watch each patient chew their food. Close to the end, patients will forget the progress, sometimes entirely forgetting how to swallow or breathe. Margaret didn't get that far. I didn't see her die; I only saw her leave.

That is why Margaret's story will stick with me forever. A patient cannot simply walk out of Ward B. Our patients live behind a locked door; they cannot choose to walk out. At the Midvalley nursing home and care center here in Ft. Collins, Colorado, we are the ward no one likes to mention. There are few smiling visitors and little holiday cheer although, the music repeats, Homeward Bound for Christmas.

Our institutional green walls were playing with my seasonal depression. We are probably the most forgotten department for the entire complex as there is never anything special given to us. At the beginning of December, I used my own money to buy the garland and light strands I mounted on the wall high enough that no one could grab them. I brought my wreath from my front door and placed it on the interior side of that sadly locked security door to tame it down a bit. I also bought a sad little tree and a couple of C.D.s with various religious and good old-fashioned Christmas tunes. I did it for everyone, including myself, as the long shifts can play with my psyche. 

I played the prerecorded Christmas music over the loudspeakers for the patients to enjoy and put the little Christmas tree on the counter of our nursing station. The last week of Margaret's life was a good one for her. She loved the music and tried to sing along but could not. Margaret listened to her favorite-In the arms of an angel, I’ll be going home for Christmas. Ricardo noticed Margaret would smile then cry, showing great emotion. 

I make up games that include everyone: even Mr. Clifford Hayes, a dementia patient who is bedridden because he refuses to open his eyes. When Ricardo is on shift with me, he will play along, and everyone loves him. One day we played a made-up game called 'decorate the Christmas tree.' Ricardo played the tree, and I gave each patient a sticker ornament to place upon him. Miranda and I wheeled each wheelchair up to our Ricardo tree, and they reached out to put their sticker on him. It's a game preschool children love, so the same for Ward B. 

When it was Margaret's turn, she asked if Yvonne could do it for her. I asked her if she could point to Yvonne, and she held out her finger, pointing at Ricardo, and said, "She is standing there." 

I said, "Silly, that's Ricardo." 

She then replied, "I know. Yvonne is going to kiss him on his cheek." 

With that, Ricardo quickly removed his tree garb made of our extra garland and started frantically rubbing his cheek, "Something shocked me!" he exclaimed. 

I thought he was playing, but then in a solum voice, "No dude, I'm serious. It felt like someone kissed my cheek, only it felt surreal or something like electricity. Like a shock dude, like I was electrified."

Ricardo left work early that day and has never returned. Alzheimer's brings frustration, yes, but this was not the case; something touched Ricardo to scare him so badly. His decision not to return feels like it will be a significant loss to the patients and me, not to mention Miranda, as her work duties will significantly increase. 

With the music continuously playing the same home for Christmas melodies, I might break down. I went to get Margaret in her wheelchair to show her the pretty garland while I prepared her meal. She said, "Yvonne told me all about them. The lights blink slowly off and on, and the garland has several red bows on it." She hesitated just a moment quite typically and continued," Yvonne also explained to me you are Helen and not her."

I looked around her room and saw no one besides Emily, her roommate, lying in her bed staring at the wall. I questioned, "Where is Yvonne, Margaret?" 

She replied in a childlike voice. "Right behind you, silly." 

I turned to look, catching a glimpse of someone exiting the room and the door closed behind them. I ran after, only seconds behind, and looked down the hallway to the security door, and no one was there. I checked the security camera that would have caught anyone exiting Margaret's room and the entire ward, for that matter, and nothing, there was no one there. Curiously, as I walked back to Margaret's room, I heard the sound of Christmas music with that one distinctive lyric, Homeward Bound for Christmas.

This Christmas we have 12 Ward B patients. My schedule includes the personal care of my mobiles Margaret, Emily Smith, Walter Reman, and my Ward of 9 non-mobiles. However, those numbers can fluctuate because people don't stay with us very long. Both Emily and Walter sit with blank stares in their wheelchairs most of the time. Walter, a retired schoolteacher, will shout out instructions to his unseen students from time to time, and Emily will chatter to herself in an odd language that only belongs to her. 

But Margaret is different; she is still capable of communication, especially in searching for Yvonne. Unlike most of my patients' who exhibit forgetting the names of friends and loved ones and have trouble recalling their family. Margaret's case is hard to decipher as she does undergo severe mood and behavior changes while experiencing increased anxiety, irritability, and delusions. Let's face it; she does see things, and Yvonne might very well be a hallucination. I investigated her paperwork, hoping to find a Yvonne listed on her emergency contact. No such luck.

However, she does have a son, and daughter-in-law, Ted and Cathy Brown; they live close, within 5 miles, I would say. In my six months here, neither have paid a friendly visit.

Margaret's son and outspoken daughter-in-law came in only once when I called them when having difficulty retrieving her pharmaceuticals, and it was some payment issue involving them. I watched the coldness they had towards Margaret. In their 50's I thought their time would come to be in Margaret's shoes. I wished her son would visit alone, as I think Margaret would respond if it were just Ted. His wife Cathy pulled him along and said how bad this place smells, and she wanted to go. No kisses or hugs for Margaret. I am only the nurse, and I suppose that is none of my business.

Margaret must have known she would leave me on Christmas and wanted to titivate herself before her departure. When I came in for my Christmas Eve overnight shift, Margaret was sitting on her bed, not her wheelchair, and she had what little clothing she owned layed out with her coat and her hat. The adorable hat I had asked her about once with the blue velvet with pink silk flowers on the rim was offset to frame a much younger face. I bet she wore it in her thirties as it was long out of style.

”How on earth did you reach the top of your closet, dear Margaret?" I asked, then I thought, Miranda.

Although Miranda has three children, she worked; all be it Christmas eve. Around ten, after we got all the patients tucked in, with one final play of Homeward Bound for Christmas, I turned off the music for the night, and I went into the office to complete my shifts paperwork. Miranda spent her break resting on the sofa in the nurse's station in the back. We both noticed it had started to snow. I made my midnight rounds to find everyone soundly asleep. A rare occurrence on any given overnight. 

That is when I heard music coming from the great room where we play our games and bring all our patients to feed them or give them a change of scenery away from the tiny gray bedrooms. It was not the repetitive music I played. Instead, it was the most beautiful music I had ever heard, "Silent Night, Holy Night; all is calm, all is bright."

It sounded like a children's choir singing, and then there was a very bright light. The first thing I thought was Ricardo had returned. How delighted the patients would be if he were standing there when I rounded the corner. Not the case, as I found the music coming from outside. But at midnight? 

My mind raced with unbridled curiosity. When I drew open the blinds in my office, my eyes were met by the brightest light I have ever seen. I heard someone play the old piano that sat in the great room corner. The light shown upon the top of the music stand made the entire thing look like glossy vermilion. I called Miranda, but she did not respond. 

Then I heard laughter and people talking. It must be Miranda and a patient, maybe Margaret, I thought. When I walked around the corner of my office wall, I saw them. It was not Miranda; It was my patients, all of them- young, healthy, and vibrant. I fell to my knees and folded my hands in prayer, and whispered, “Thank you, God. Lord Jesus, please make this true. Make it a celebration of Margaret’s return to the place she considers home.”

Youthful Margaret danced over and grabbed my hand to show me that my tiny little pathetic tree was now the beautiful seven-foot-tall Christmas tree that stood before me. It had the loveliest decorations, and the star on top looked like gold. The choir started singing; God rest ye Merry Gentlemen.

Margaret had on the most beautiful party gown, just like my mother would wear on special occasions. The man playing the piano began to sing, Hark the Herald Angels Sing. Why it was old Mr. Clifford Hays, young again, he played as Emily and Walter, dressed to the nines, danced together. All my patients were so beautifully dressed in their party outfits. The light became brighter, and I could barely see, but the glowing figure that entered the room through the back wall looked like an angel I once learned about in Catechism. 

The young woman with wings glided slowly towards Margaret and took her hand. Margaret knew this angel, I could tell. The peace that surrounded her was exceptional, and it was the kind of peace one could experience during reuniting after losing touch with someone or finding something precious once lost, now found.

I thought of Miranda. She would tell me the truth. Have I gone mad and delusional too? I ran in to get her and found she was sleeping soundly on the sofa. How could she sleep through the music? "Miranda, please hurry," I shouted, waking her out of a sound sleep. "Come, with me, my dear," I said as I led her to the great room. We both looked around. She through blurry sleep-ridden lenses and me with the look of horror upon my face. 

As much as I felt embarrassed for Miranda's reaction, the experience piqued my curiosity. My tiny tree sat untouched just as I had left it, and there was no sign of an intruder angelic or otherwise, and the old piano sat sadly untouched. Then I ran to check on Margaret. She lay cold in her bed, looking like she was asleep; she had passed in the night. Her face had a relaxed look—a look of contentment. 

Miranda and I cried before starting our final procedures. We were both standing there wiping our childlike tears when the music played over the loudspeaker without provocation. The song that Margaret loved was playing, and as I listened, it was as if I had heard the words for the first time. The song told Margaret's story. 

Locked behind a hidden door, she made plans for Christmas that included a lost soul; she told them how much she loved them all, in her own unique way. An angel is waiting; there is no time to waste. She will take me home for Christmas as a gift. I'm homeward bound. I’ll be home for Christmas.

I took three long breaths before I dialed the number. Choosing to be understanding and empathetic will also go a long way in dealing with dementia but even further when speaking to their loved ones after passing. 

"Hello Ted Brown, this is Helen Fuller. I am your mom's nurse over here at Midvalley. I apologize for waking you this early on this Christmas morning, but I must notify you that your mother Margaret has passed on in her sleep." 

I was shocked by his response, "Oh no, I'm so sorry to hear that and appreciate your call, Ms. Fully, but because it's Christmas and all, can we take care of everything tomorrow?" 

"It's not Fully, Mr. Brown; my name is Helen Fuller." At that moment, I overstepped my boundaries as an R.N. and asked, "By the way, Ted Brown, who was Yvonne? Your mother always spoke of her, and I'm curious."

He replied, "Oh my goodness, now that's a name I haven't heard for 30 years or more." Then he said while yawning. "Yvonne was my big Sister that went missing in her first year of graduate school. The police took it that she had run away with her boyfriend. They said she probably couldn't handle the stress of school and ran off, and my father believed them and forbade any of us to mention her again. Moms' disease probably was the cause for her to say her name. But I must say Mom hasn't said but three words to me in the four years she has been in the home."

I didn't tell Ted about my encounters with Yvonne or how much I loved caring for Margaret. Now I am so happy that I had the pleasure of knowing them both. 

Living with the mental cruelty of having a missing loved one takes a toll on one's heart and soul. It's a hideous game of 'hide and seek' where the hider is never found, and the seeker grows bitter, never finding. Although detrimental to Margaret's overall mental health, Yvonne's misstep did not cause her mother Alzheimer's, and why blame it on her? 

There was a miracle in Ward B, and I was blessed to witness it. Somehow, I became part of Margaret's visions, her beloved daughter Yvonne was a harbinger of her death. As her attending nurse, I won't write about her death as a welcome event with pomp and circumstance, no mention of the surprising and welcoming arrival of an angel. It instead will be noted as death all scientific and therefore considered a natural cause. But I know differently. Like the song's lyrics, just as Margaret predicted, she went home with her daughter Yvonne for Christmas. Margaret had found her at last.