Care home castaway
published in The Hippocratic Post,
28 January 2017
In Cast Away, the epic survival drama film, Chuck Noland (Tom Hanks) is stranded on a deserted tropical island for four years, with a volleyball named Wilson as his only friend. In the nursing home, residents are sometimes abandoned for years on end.
In fact, there are a surprising number of similarities between Chuck Noland’s desert island experience and that of the forgotten elderly; a comparison of the two can help explain some behaviours observed in the care home.
The screenwriter himself recognised that the Cast Away experience “wasn’t just a physical challenge. It was going to be an emotional, spiritual one as well”. The same is true for the nursing home resident.
Clinging to the life raft
After crashing into the Pacific Ocean, Chuck clings to an inflatable life raft, drifting all night, before being washed up onto the island, which he soon discovers is uninhabited.
Before admission to the nursing home (which can feel deserted because of the apparent lack of life and activity), the frail elderly can cling to their now oversized, unmanageable homes, living in fierce denial of their inability to cope alone, or in fear of the dreaded care fees. Sylvia had wasted away to barely five stone as she tried and failed to cook for herself; John’s depression and dementia had undoubtedly worsened as he sat alone for twelve hours each day between care visits; Ruby developed a pressure sore as she lay in wet bedclothes, convinced she could manage. Sometimes, the Englishman’s home really is his castle.
Burying the dead
In the movie, Chuck has to bury the corpse of one of the pilots as it washes up on the island. Joan has lived in the care home for seven years; fifty fellow residents have passed away during this time. Being one of the oldest residents, it can be hard to discuss or even mention the deaths to Joan without implying that death will soon come knocking at her door. Sometimes, then, the news is broken by the empty chair at the breakfast table or the newly vacant room. Joan’s dignified silence masks her sorrow.
Attempting to escape
Chuck makes an early attempt at escape on the remnants of his life raft, but is beaten back by the powerful sea currents.
George made a quick dash for freedom from the nursing home last September when he boldly walked through the open front door and boarded a local bus. A heroic receptionist pursued him, waving frantically at the bus driver not to let him on. The driver assumed the receptionist was mad, let George board, and the receptionist was forced to accept money from a kind passer-by to pay her bus fare into town (George had a bus pass). The police intervened seconds before George (and the receptionist) left on a train bound for London…..
Making unusual friends
Wilson is Chuck’s only friend: he’s a volleyball with a face drawn onto a bloody hand print. Chuck talks to Wilson, sleeps with him and is inconsolable when he is lost at sea.
Kathleen is to be found tucked up in bed (day and night, by request) in the nursing home with three very important bears (one is even named after a Greek philosopher). Care staff address the bears by name, ask Kathleen about their wellbeing and wash them upon request. John likes to clench a tabard clothes protector (an adult bib) in his hand as a comfort; Stanley talks to himself and doesn’t like care staff to interrupt. Family photographs adorn the walls of the nursing home; Chuck clings to a pocket watch photo of his girlfriend, Kelly.
Taking its toll
The film viewer is staggered when the story takes a four-year leap into the future and shows Chuck as dramatically thinner, bearded, with long hair and a loincloth.
Whilst the care is excellent in most homes, the effects of old age are plain to see. Weight loss can occur as appetite reduces, perhaps due to a loss of smell or even as a side effect of some medications; showers and shaving may seem burdensome and unnecessary (every time Gladys is offered a shower, she looks with disbelief and asks yet again if staff know how old she is). Eileen used to love to dress her best, though the wheelchair and catheter make this difficult now.
Returning to civilization
A passing cargo ship finds Chuck, drifting on a makeshift raft, and he is rescued.
Violet’s daughter hadn’t paid a visit to the care home for years, and she had stopped telephoning. At first, the excuses were real: an important work project to complete, a friend in need, long distances to travel. We respected her decision and did our best for Violet.
Despite her dementia, Violet was keenly aware of her daughter’s absence, and would occasionally express words of frustration. It was hard for Violet to communicate her loss, owing to severe dysphasia but I had spent time just listening to Violet and had somehow tuned into her way of speaking. We often returned to the subject of her daughter and in the early days, I felt that I could offer no more than a listening ear.
One evening was different, however. I decided to telephone Violet’s daughter to attempt to re-establish contact. It was a brave move: family wounds can run deep and it was not my place to interfere. It was a remarkable conversation: within seconds the daughter was expressing deepest gratitude and admitting that her mother’s dysphasia, dementia and occasional aggression had been too much to handle. As I handed the telephone to Violet, she beamed and later thanked me.
“Thank you” are the last two words in the Cast Away movie: the screenwriter explains this to represent “the idea of acceptance [of his fate], that there is no rationale for some of the things that happen to us. But finally, there is gratitude.” It’s a profound human experience, and something that nursing home nurses can engender.