Author: Lauren Davis

On Sunday, March 29, the newest (eighth) season of BBC’s Call the Midwife began airing on PBS.  I was very excited because, dear readers, this is my favorite show currently on television.  One of the many reasons I like it so much is that it tackles truly intergenerational themes.  The main characters live in an intergenerational community, and this isn’t always easy, but everybody learns from each other.  Regular characters include both lay midwives at the beginning of their careers and nuns nearing the ends of theirs.  And since these characters are nurses and midwives, every episode features births, and many feature deaths as well. 

If you haven’t seen Call the Midwife, it follows the adventures of a group of midwives, some of them Anglican nuns, based at a convent called Nonnatus House in London’s impoverished East End.  The first seasons are set in the late 1950s, but by this point, we’re in 1963.  It took me awhile to start watching, as I was afraid it would be a downer of a show.  After all, poverty and childbirth don’t exactly make for an uplifting mix.  Except when they do.  Once I started watching, I fell in love, because the midwives of Nonnatus House spend their time making unbearable conditions bearable.  The show isn’t afraid to tackle hard things, and it manages to avoid being sugary, but I almost always finish an episode feeling good.

One of the hard subjects the show tackles is aging, and it’s the only show I’m aware of that has a regular character with dementia.  Sister Monica Joan is not a “story of the week.”  She appears in almost every episode and plays key roles in quite a few, including the season premier that aired on Sunday.  One theme that repeatedly recurs around Sister Monica Joan is that as she ages, she feels more and more useless.  She is no longer a practicing midwife, and her dementia makes it hard for her to contribute even in more minor ways.  At the beginning of the series, she’s able to knit and crochet, but as she declines even those tasks become harder.  Even when she could still do these things with ease, Sister Monica Joan would often exclaim that she was not useful.  She knew she was being given busywork, and she hated it.

This issue was on full display in the Season 8 premier.  At the beginning of the episode, the Midwives get new work bags to replace the bags they’ve used for decades.  The old bags are shabby and in need of replacement, and National Health (the British agency that regulates midwifery and other medical services) regulations have changed.  Fred, the midwives’ handyman, takes the old bags out back to burn them.  When Sister Monica Joan sees this, she is very upset, especially since one of the bags he is burning had once belonged to her.  When Fred is called away, she takes it and hides it.

When Sister Monica Joan falls ill, boundaries between past and present blur even more—as they so often do for those with dementia.  She takes her bag and goes off in search of a mother and baby she believes require her services.  The other nuns and lay midwives are frantic, of course, and they search high and low for her before finding her, shivering and terrified, in an abandoned building.  It’s clear that Sister Monica Joan ran away because she believed she was needed elsewhere and because her identity was so tied up in her work that when her cognitive abilities were at their weakest, she went to do her job.

Sister Monica Joan is a beloved character for many reasons, not least of which is her ongoing dedication to the profession she once pursued.  She loves helping women give birth, and she sees that, in addition to her religious vows, as her calling.  Call the Midwife reminds us that people with dementia do not lose their core selves, even when they lose their professional skills.

Those who have loved ones with dementia or work with seniors will certainly notice that Sister Monica Joan’s dementia is not entirely realistic.  To be sure, she improves and worsens as the plot requires.  I’m sure many viewers wish their loved ones with dementia would bounce back as well as Sister Monica Joan often seems to do.  That’s part of the problem with television, of course—while the marvelous Judy Parfitt would surely be up to portraying the decline, it would eventually become very painful to watch.  Charlotte, my coworker in the Foundation office, has already mentioned that she starts every season with the fear this will be the year we lose Sister Monica Joan.  If we were seeing a more typical progression of dementia,* we’d probably be a lot sadder.

If you want to join me in watching this wonderful show, all the previous seasons are available on Netflix.  If you decide to take the plunge, you’ll probably find yourself binge watching, so I recommend stocking up on the following:

• Popcorn (a binge-watching staple)
• Hot chocolate (the midwives drink a lot of it, so it’ll start to sound pretty good after a few episodes)
• Tissues (just trust me—buy them at Costco)

Season 8 episode will be up to stream on the PBS website as they air, and they stay around for a week or two before they go behind a paywall.

*I feel sure my colleagues who are experts in dementia support would want me to mention that every case of dementia is different and there is no typical case.  However, most types of dementia are progressive.

Today, I’d like to introduce you to a member of the Immanuel team you might not have met before.  Her name is Sammy, and she works mostly in the Lodge at Buffalo Hill and the Immanuel Skilled Care Center.  It’s safe to say that Sammy is the only member of the Immanuel team who’s been with us almost since she was born.  If you’re wondering how that’s possible, it’s because Sammy is a goldendoodle.  She turned seven last November, and she became part of the Immanuel family when some volunteers, led by Jim and Ron Pettis, purchased her for the organization when she was a newborn puppy.

I sat down with Tammy Miciewicz, recreation coordinator in the Lodge and Sammy’s chief handler, to talk more about the furriest member of the Immanuel team.  I learned that Sammy isn’t the first goldendoodle Immanuel’s had.  Before her, another goldendoodle, Fergie, had been part of the team.  Fergie was donated by a community member who couldn’t take care of her anymore.  When the first staff member who looked after her was no longer able to do so, the Miciewiczes took her home with them.  So, when Fergie passed away and it was time for a new dog, it was natural that Sammy would make her home with them.

Sammy was born in Missoula in 2011.  Immmanuel volunteers had noticed just how much of a difference Fergie made in the lives of residents in the Skilled Care Center so, when some time had passed after Fergie’s death, they urged Tammy and other recreation staff members to get a new dog.  When they saw that a litter of goldendoodle pups had been born in Missoula, they took initiative and went down to meet them.  The volunteers spent an entire day with the puppies, and Sammy was the one they felt had the best personality to work with residents.  When they picked her up, they also brought her favorite blue bone toy.  Tammy tells me it had belonged to the entire litter of puppies, but the volunteers noticed how much Sammy loved it, and they wanted to be sure she had it with her.  They met Tammy in the Murdoch’s parking lot in Kalispell, and from that point on, Sammy had two homes: Immanuel and the Miciewiczes’.

At first, Sammy worked almost exclusively at the Skilled Care Center, including in the Bratsberg Dementia Unit (Tammy is a memory support specialist).  These days, she spends most of her time with residents at the Lodge, Immanuel’s Assisted Living Memory Support community.  She is an integral part of life there and is particularly good at calming residents who are having a difficult time.  Sometimes petting a dog helps an emotional resident calm down.  She provides a sense of safety and familiarity.

When she’s in the common spaces, Sammy goes from resident to resident, putting her head in each person’s lap in turn.  The residents pet her and play with her ears, and Tammy notices that Sammy knows who likes her best and goes to them more often.  She’s also good at getting the less responsive or social residents up and about.  When Sammy goes into a resident’s room and engages with them there, they’ll often follow her out to the common spaces.  Even if the resident just hovers at the edge of an activity and doesn’t really participate, it’s good for them to get out of their room, and Sammy seems to know it. 

On her twice-weekly excursions to the Immanuel Skilled Care Center, Sammy plays much the same comfort and support role as she does at the Lodge.  What I’ve noticed about her is that she always knows she has a job to do.  While she’s generally a friendly dog who wants to stop and say hi to everyone, she knows she needs to get back to the residents.  Even when she goes outside, she doesn’t linger.  The residents are her main concern.

According to Tammy, Sammy takes a two-hour nap every day when she gets home from work.  Then, she likes to run around the yard.  While she isn’t fond of most toys, she still likes to play with the blue bone she brought with her from Missoula.  Sometimes she’ll hide it or bury it—but she always finds it again.  All in all, Sammy is a mellow dog who knows what her job is, and we’re lucky to have her here at Immanuel!

On a recent trip to New York City, I had the opportunity to see Jez Butterworth’s 2018 play The Ferryman.  The show has been a hit both in London and on Broadway, and it’s garnered numerous awards and nominations for both the writing and the incredible (and huge—20 actors) cast.  Because of where I work, one of the things that stuck out to me was how intergenerational the cast is.  The oldest characters are in their eighties while the youngest is about six months old.  As the past and the present converge in The Ferryman, the play’s three oldest characters all attempt to lead their younger relatives toward a better future.  The play is notable for its deployment of older characters for both plot and thematic purposes, and I’d like to think through what it’s trying to do with them.

There’s a lot to unpack The Ferryman, and I’m not going to attempt it all here.  But there’s a little bit of background that’s helpful for understanding its treatment of aging.  The play is set in the midst of the Troubles, the decades-long conflict in Northern Ireland between Unionists who want the North to become part of the Republic of Ireland and Loyalists who want it to remain part of the United Kingdom.*  During this period, the provisional Irish Republican Army carried out numerous attacks, and the British police and military struck back hard.  The Ferryman takes place in 1981, in the immediate aftermath of the hunger strikes in which ten Irish republican inmates died in a futile attempt to have themselves declared political prisoners.  Tensions in Northern Ireland were running very high, and the long history of conflict between British forces and Irish people desiring independence was very much at the front of everyone’s mind.

The play’s three oldest characters represent this long history.  Uncle Pat, Aunt Pat (yes, really, they’re both called Pat), and Aunt Maggie Faraway have seen much of it, and they insist on placing the play’s present events in historical context.  The three characters have different approaches to history, memory, and the future, and their attempts to share it have direct impacts on events in the play. 

Before I go any further, I want to clarify how all of these characters are related to each other.  At the center of the play are former IRA operative Quinn Carney, his wife Mary, and his sister-in-law Caitlin, the wife of his brother Seamus, who was killed by fellow IRA members in 1972.  Seamus’s body has just been found in a bog, and that’s the impetus for the action in The Ferryman.  Uncle Pat, Aunt Pat, and Aunt Maggie Faraway are all siblings of Quinn and Seamus’s deceased father, Big Jack.  Rounding out the family are Quinn and Mary’s seven children, ranging in age from late teens to young baby, and Caitlin’s teenage son Oisin.  There are also three cousins from Belfast who come down to help with the harvest, a priest, three IRA men, and a mentally disabled Englishman who lives nearby.

Uncle Pat is the least controversial and the most peaceful of the three elders.  He’s a scholar at heart, and during the play, he’s rereading the ancient Roman poet Virgil.  For Uncle Pat, the violence of the Troubles is a complete waste.  He wants peace, and most of all, he wants no more of his family members to die.  Since we learn later from Aunt Pat that one of their siblings was killed in the failed Easter Rising of 1916 and his nephew’s body has just been discovered, it’s not surprising that Uncle Pat simply wants the carnage to stop.  He certainly doesn’t support forgetting the past, but he doesn’t want to keep fighting its battles.  For him, remembering the past means learning from it and moving on.

Aunt Pat is the play’s firebrand.  She does want to keep fighting the battles of the past and in fact insists on it.  Early in the play, Aunt Pat carries a radio around with her and is determined to make her younger family members listen to the speech in which Thatcher formally announces that she will not declare the hunger strikers to be political prisoners.  Since the family is trying to get ready for the harvest (they are farmers), the intrusion of politics is extremely unwelcome.  Aunt Pat’s insistence on rehashing the past, and on telling the story of how she followed her beloved older brother to Dublin for the 1916 Rising only to have him die in her arms, forces the family to confront history.  For Aunt Pat, the Troubles in 1981 are part of a struggle that goes back to her young adulthood, and Seamus’s death is a result of the same conflict as her brother’s.   Because Aunt Pat discloses that she kept her brother’s pistol, this confrontation with history eventually leads to tragic consequences in the present.

The third and final elder, Aunt Maggie Faraway, has a different relationship altogether with the past.  Aunt Maggie is suffering from dementia, so she only remembers the past occasionally in, it has to be said, convenient moments.  Aunt Maggie spends much of the play sitting silently off to the side in her wheelchair, but in her lucid moments, she shares both stories of the past and prophecies for the future.  She tells one of her four great-nieces that she’ll have nine children but refuses to answer the same child’s question about whether her father is a murderer.  If Quinn wasn’t a murderer at the time young Honor asks this question, he is by the end of the play, so Aunt Maggie could be refusing in this moment to tell either the past or the future.

At the heart of Aunt Maggie’s few reminiscences and prophecies lies the idea that without intervention, the past and the future will be very similar.  And indeed, after the dramatic climax, Aunt Maggie gets the last word.  Her ambiguous final declaration is, “They are coming…  They are coming…”  “They” might be the banshees, the UK police, or the IRA.  The audience doesn’t really know.  We only know that the Carney family has not been able to overcome the demons of their past.  Quinn has committed murder, and though the men he kills are pretty awful and he kills them in defense of his family, there will certainly be consequences.  He will at best go to jail and could be killed, and his children will know for sure that their father is a murderer.  And one member of the youngest generation is dead because he could not resist his cousins’ goading or the lure of Aunt Pat’s republican pistol.

The lesson The Ferryman teaches through its elder generation is not a generalized “we must learn from the past in order to go forward into the future.”  Taken together, Uncle Pat, Aunt Pat, and Aunt Maggie Faraway tell us that we have to be very, very careful about what lessons we take from the past.  The character who most takes to heart Aunt Pat’s lesson—that Ireland must fight until it’s a united, independent republic—winds up tragically dead.  Uncle Pat’s calls to look to the ancients instead of to the 1916 rebels go all but unheeded.  In the end, it’s Aunt Maggie’s lesson that looking to the past for the future is dangerous that plays out on stage.  “They are coming,” and all the Carneys can do is wait.

There’s one more thing I want to note about The Ferryman’s older characters: they’re all played by aging actors—or at least, actors who are aging by stage standards.  At 66, Fred Applegate, who plays Uncle Pat, is the youngest of three.  Ann McDonough (Aunt Pat) is 69, and the incomparable Fionnula Flanagan (Aunt Maggie Faraway) is 77.  There aren’t a lot of great roles for actors who have reached those points in their lives, especially for women, but Butterworth has provided three pretty juicy ones.  I felt especially privileged to see Flanagan, who made a role that could have been faintly comic into something very powerful.  Butterworth’s and Director Sam Medes’s appreciation of what older actors bring has a lot to do with this, of course.   Though none of these three is the lead, they all have a lot to do with how the plot plays out, and I was delighted to see seniors play such key roles.

*The Irish Studies scholar in me would be remiss if I did not mention here that the Troubles have their roots much farther back in Irish history than decades.  You might even say that they began in the twelfth century, when Henry II invaded Ireland.  The British were always a colonial power in Ireland, and there’s never really been a time in Irish history when nationalists/unionists/republicans weren’t trying (mostly unsuccessfully) to throw them out.  However, the Troubles are usually understood to have lasted from the formation of the modern Ulster Volunteer Force in 1966 through the Good Friday Agreement of 1998.  I also want to note that polling indicates that a majority—though sometimes a slim one—of Northern Irish want their country to remain part of the UK.

Communities like Immanuel offer an option for seniors who either want to live in community or can no longer take care of themselves in the way they’d like.  But there are thousands of seniors across the Flathead Valley and even more across the United States who prefer to stay at home, and that means a lot of family members end up caring for their aging spouses, parents, and other loved ones.  Most family members are happy to provide this care.  However, many have very little training and sometimes, they don’t get the support they need to offer care to their loved one and take care of themselves in the process.

According to the Eldercare Workforce Alliance, “Family caregivers need more recognition, training, and support in order to provide high-quality care to their loved ones and maintain their own health and well-being.”  Immanuel tackles this problem head-on.  Because we want to be a resource for all seniors in our valley, not just those who live here, we regularly run a Caregiver Education class for anyone interested in gaining more knowledge about and support for looking after a loved one.  Right now, Carla Wilton, the Executive Director of Buffalo Hill Terrace, is offering her class on local radio station KGEZ.  There are two sessions left, and you can hear them on Wednesdays at 12:45pm.  To listen to previously-recorded broadcasts, go here.

I talked with Carla about what she thinks are the most pressing challenges for caregivers and about what you can do to help make both your and your loved one’s lives run as smoothly as possible.  The biggest challenge, Carla says, is that family caregivers often feel strong emotional attachment to the person they’re caring for.  While those of us who work in senior living care about the residents we serve, we don’t have anything like the level of personal attachment felt by a spouse or child.  This emotional attachment means not only that caregivers struggle with seeing their loved one in pain but also that it can be hard to make choices the care receiver doesn’t like, even when the caregiver knows it’s best.

And emotional attachments aren’t always simple—or positive.  If a person is caring for someone with whom they have negative history or unresolved conflict, caregiving can be very difficult indeed.  Family members might care for each other out of obligation rather than genuine desire, and in these cases caregivers have a lot of emotions to work through.

Even where relationships are positive, people in a caregiving relationship have a different kind of intimacy than they previously had.  Caregiving is also a role change, and in some cases, such as a child caring for a parent, it’s an outright role reversal.  And the caregiver might be taking on other roles they’ve never done before, like paying bills or making sure housework or yardwork gets done.  Since the care receiver can already feel powerless because of their health situation, the caregiver has to negotiate both their own emotions and those of the person they’re caring for.

Of course, this is a lot to handle, and Carla notes that it’s natural for caregivers to feel overwhelmed.  It’s more than okay to ask for help—in fact, it’s vital.  Because caregivers are often very competent people who appear to have everything together (many times, that’s why they end up with the caregiving role!), others won’t necessarily see that they need help.  So, if you’re a caregiver who needs assistance, you’ll probably have to ask.  Carla recommends starting by making a list of the things you need.  Then, identify people in your existing network who might be able to help with those things.  Family, friends, and faith communities are all great places to start.  For example, if you need someone to stay with the person you’re caring for while you run errands or just have some time to yourself, you might set up regular times when a friend can both visit your loved one and give you a break.  Or, if lawn maintenance is what you need, you might have a relative who has the tools and skills to help you with that.  It’s a matter of figuring out what you need and whom you know who might be able to fill that need.  Often, family and friends really want to help, so if you ask, chances are they’ll say yes.

Of course, your network may not be able to fill all of your needs, so the next step is to figure out where else you should look for help.  In the Flathead Valley, the Area IX Agency on Aging is a great resource.  They provide some respite care resources, and they can help direct you to additional paid providers.  You can also check the United Way Answer Book—a document full of resources for all kinds of situations in which local residents find themselves.  And Immanuel can help too.  Even if our services aren’t right for your family, our staff is happy to help direct you to others who can help.  We care about all area seniors, and we want caregivers to have the support they need.