What A 90-Year-Old Dementia Patient Taught Me About Privilege

All of the empathy training in the world pales in comparison to experiencing the effects of real, unmanufactured hatred based on an immutable aspect of your identity.

When I saw her name on my list of patients I rolled my eyes and groaned. Ethel was scheduled for 30 minutes of occupational therapy this Saturday, but I knew I would spend the entire morning dreading our session. Ethel had been living in the memory care unit of our facility for many weeks now, receiving therapy after a nasty fall in her assisted living apartment. How this woman was able to manage in assisted living before her injury was a mystery to me—she had advanced dementia and obvious failure to thrive. She was in her 90s, extremely hard of hearing, and toothless. She was only 85 pounds and less than five feet tall, but she hated me with a passion that consumed every fiber of her being.

With eight years as an OT in nursing homes under my belt, I am no stranger to the emotional extremes of dementia; this was not the first time a patient with dementia did not respond positively to my presence. However, this was the first time that a patient seemed to hate me and only me. The weekday therapists got along swimmingly with Ethel, and were able to facilitate her participation in therapy with only the expected amount of patience and coaxing. I, on the other hand, had no luck at all.

The first time I worked with Ethel I was helping her use the toilet when, seemingly out of nowhere, she looked right at me and started screaming bloody murder. “Ethel, are you OK? What’s wrong?” I asked.

“YOU!” she shouted, spit flying from her mouth, disgust distorting her wrinkled features. “YOU are what’s wrong!”

And this, arguably, was the nicest she ever was to me. All subsequent Saturday sessions with Ethel were nearly pointless, she would not come down to the therapy gym with me, she would not let me move her, touch her, even hand her an item. She bared her teeth at me, hissing that she didn’t want me near her, and that she “hadn’t requested my services.”

Now, here’s the thing: I am a likeable person. Working as an OT with the elderly requires only three ingredients for success—basic medical knowledge learned in school, common sense, and excellent people skills. Anyone can memorize muscle origins and insertions, many people can think through a problem that occurs during a routine task and devise a practical solution, but it takes a certain personality to work closely with a population who refer to jeans as dungarees and couches as davenports. I pride myself on my ability to get along with even the crankiest of patients; I know when to tease, when to empathize, when to be tough.

But I also know that my ability to get along with older adults is not just a product of my soft skills; I am, through no intent of my own, the epitome of non-threatening. I am a petite white woman in her mid-30s. I have pale skin, long red hair, and blue eyes. When I walk into a patient’s room looking the way I look, the patient is visibly put at ease. This is not the case for many of my colleagues. For years I have watched nursing home staff members with dark skin or foreign accents struggle to build the same trust and rapport with elderly patients that I am automatically granted.

Being a woman does have its disadvantages, of course; I have experienced comments from both male and female patients lamenting my choice to work “outside the home,” and have gritted my teeth while explaining to countless patients that the male rehab aide is not, in fact, my boss. I have been professional every time a patient preemptively tells me to get help from a male staff member when I begin to help them out of bed, and every time a well-meaning family member tries to encourage their relative to participate in therapy with a pep talk along the lines of, “Well now, Dad, aren’t you lucky to have such a pretty girl helping you today,” I have successfully resisted the urge to scream, “Do you know how many years I went to school for this?” I have even fake-chuckled along with droves of male patients who all make the same juvenile jokes every time I announce, “Today for therapy we are going take a shower.”

I bite my tongue and stay cool because I have an ethical duty to act in my patients’ best interest; i.e. stay on their good side to enable therapy sessions that are meaningful and effective. This is also why I, and all of my other white coworkers, awkwardly change the subject or busy ourselves looking for spare wash clothes in the face of offhand, racially insensitive comments such as, “The nurse last night was a colored man, but he was awfully friendly.”

But back to Ethel. On this particular Saturday I approached Ethel in the common living area of our memory care unit. I asked her how she was feeling, reintroduced myself, and told her that I would like to work with her. Ethel immediately became hostile, and although her refusal consisted of more word salad than complete sentences, the meaning was clear—she wasn’t budging and I should go jump in a lake.

I sought the help of nurse Linda, who, with nearly the exact same verbal and body language as I had employed moments before, was easily able to convince Ethel to go for a short walk on the unit. As we proceeded down the hall, Ethel shuffling precariously with her walker, flanked on either side by Linda and myself, and a CNA pushing a wheelchair directly behind us, Ethel paused every few steps to turn to me and utter a nonsensical rebuke. Her speech was only semi-coherent but the repulsion in her face and the vile hate in her tone of voice was unmistakable. And then, 50 feet into our walk, Ethel whirled toward me and screamed, “Get that red hair away from me!”

This proclamation opened the floodgates and Ethel continued screeching, “No red hair, I hate red hair, get away!” She then proceeded to slap my arm over and over, an attack I could barely feel, but the effort of which threw Ethel so off balance that it took considerable effort on my part to prevent a major fall. The CNA, as well as other staff members on the hall, family of patients, and even a few patients themselves dissolved into astonished laughter. I did not respond, focused entirely on supporting Ethel’s body as she continued down the hall. Kind Linda tried her best to help.

“Now, Ethel, be nice, her hair is beautiful.”

“Get it away, I hate red hair, I hate it!”

“But that’s the way God made her, Ethel.”

“I don’t care, I hate redheads! Ahh ahh ahhhhh!”

At this point, biceps burning from more or less dragging this woman down the hall, face bright red from embarrassment, and unable to concentrate with all the screaming, I decided to call it quits.

Once she was safely seated in her wheelchair, I crouched down in front of Ethel, uttered a few perfunctory lies about how well she had done, and then, as she glared at me as if I was dog shit on the bottom of her shoe, asked her what she had against redheads. Ethel curled her lip and spat, “I’ve always hated redheads and I always will. It’s none of your business, you just stay away from me!” And then she slapped me one more time, for good measure.

In that moment, staring at a woman I only wanted to help, who despised me to the degree that she was driven to inflict physical violence on me, the senselessness of the situation was staggering. Whether her bias against redheads was a recent product of dementia or a long standing feud with an actual origin was irrelevant; the result was irrational hatred and there was absolutely nothing that I could do to change it. The minute I came to this realization a variety of mundane sentiments washed over me: frustration, annoyance, mild indignation. However, more powerful than these expected feelings was one I would not have previously anticipated: the feeling of complete and utter futility. This woman had made up her mind about me based on something I had no control over; why should I waste a single second of my time trying to alter her opinion? Why bother?

Later, reflecting on my experience with Ethel I wondered how my coworkers respond to discrimination that renders them professionally ineffective. Unlike typical workplace discrimination, you can’t go to HR and file a complaint against an 88-year-old patient who refuses to let “Mexicans” change his Depends. When confronted with bigotry, are my non-white or LGBTQ coworkers as quick to throw in the towel as I was? I had the easy out of Ethel’s dementia as a valid reason to call our interactions a wash—without the cognitive capacity for new learning, Jesus Christ himself could have emerged from the supply closet and been unable to convince devout Christian Ethel of the benign status of red hair. However, when working with a patient who makes rude comments, exhibits guarded behavior, or displays open resentment who is cognitively capable of change, is there a compulsion to try to make the world a better place, one dotty old racist at a time? Odds are, if someone experiences discrimination at work, they experience it in their personal life as well. What strategies do they use to make it through the day? Do they ever get used to it? I have no idea.

I have read so many articles and studies about strategies to develop empathy, ways to explain white privilege, team building exercises designed to promote equality. There are workshops, conferences, and lectures dedicated to the grueling work of creating a more racially just world. The arduous work that activists and organizers do every day is astounding and impactful. That said, no protest march, no well written think piece, no documentary has affected me as much as five minutes of a demented nonagenarian screaming at me that she hates me because of my hair color. All of the empathy training in the world pales in comparison to experiencing the effects of real, unmanufactured hatred based on an immutable aspect of your identity. Being cognitively aware on a surface level that your friends and coworkers experience rampant prejudice is different from having it directed at you. While I can’t imagine the frustration, resentment, rage, and impotence that I would endure if I lived in a country that had systematically oppressed redheads for centuries, I have to thank Ethel for a rare opportunity, no matter how brief, of legitimate empathy.

The next Saturday I arrived at work with a plan. My plan was a hair tie and a hat. Placing my disguise on my desk, I glanced at my schedule. No Ethel. Apparently she had been discharged home to assisted living. As with the majority of individuals with dementia, Ethel would, in all likelihood, fare better in a more familiar environment than she had during these last liminal weeks of rehab. “Good luck, Ethel,” I thought to myself. “Hope there aren’t any redheads at your facility.”

Although really, maybe it’s OK if there are redheads forced to deal with Ethel. Maybe they’ll learn something about empathy, privilege, identity. Or maybe they’ll just go on break every time Ethel presses her call button, because, like I discovered, five minutes of irrational, unmodifiable bigotry really sucks. I can’t imagine a lifetime.

Alece Kaplan is an occupational therapist who lives with her awesome husband, two amazing sons, and lazy bulldog in the beautiful state of Colorado. She enjoys dominating her children and patients at balloon volleyball at home and at work.

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