Seniors and health care: The musical

The patient, a gray-haired grandmother of 75, is unabashedly hitting on her twenty-something male nurse.

“What are you going to do to me today?” she says coquettishly.

“I’m going to start by taking your vitals, ” he says, trying to quash the flirtation.

She cocks her head and flutters her eyelashes. “I think I’m going to need a bath.”

Instead of running to get a female nurse to assist him, he turns and looks sheepishly at the audience that is doubled over in laughter. The Samuel Merritt University (SMU) nursing students slap their knees, clap their hands and cover their eyes as they watch the only male in their class–reluctantly pulled on stage–suffer through an improv skit with an actor from Stagebridge, the oldest senior citizens’ theater group in the country.

The skit is a part of “See Me,” a performance that Stagebridge brings to nursing schools to help students understand how to interact with geriatric patients. As actor Joanne Grimm explains to the audience, “You’re the people that are going to be taking care of us, and we would like it to be as good as possible.”

The “See Me” program began three or four years ago–no one can seem to remember which–when SMU professor Jennifer Winters called Stagebridge’s Executive Director, Stuart Kandell, to ask if the Oakland-based theater group would be willing to perform at the nursing school. “You can only go so far with a textbook and a lecture,” she says. “I really wanted to expose students to active seniors, and bust stereotypes.”

Winters’s proposal fit perfectly with Stagebridge’s mission to “bridge the generation gap and stimulate positive attitudes toward aging.” Over the past thirty years, Stagebridge has evolved from a small drama class Kandell taught at an Oakland senior center to a full-blown theater company with 150 actors. The group offers seniors acting, signing, improv and dancing classes, as well as the chance to perform in theater productions and musical groups, and practice to story telling in local schools.

Winters received an SMU curriculum innovation grant to cover expenses–$495 per show–for three semesters, but the program proved to be so popular among students that the university ultimately wrote the cost into its annual budget. Stagebridge has also brought “See Me” to San Francisco State University and the University of San Francisco.

Understanding how to interact with older patients is very important for nurses. According to Winters, at least half the patients on the average hospital floor are seniors, and on some floors their slice of the population can go as high as 86 percent. As the Baby Boomers age, those percentages will likely grow.

According to Winters, many of the students have had little or no experience with older people and aren’t really sure how to interact with them. “When [students] go into clinical [practice], they introduce you to a very sick population of hospitalized, confused, incontinent seniors. When they see this performance, it really strikes a chord with them,” Winters says.

This unfamiliarity with how to interact with seniors can cause problems, the Stagebridge actors explain. Several have had nurses who belittled them with pet names like “honey” or “sweetie,” while others report having had nurses who didn’t believe they were in pain or didn’t listen to their symptoms. “Our purpose is to put a real face on what it’s like to grow old, and a positive face. Our goal is to inspire the nurses so that they treat [seniors] like people,” Kandell says.

“What we’re trying to do is really change the stereotypes that they might have,” agrees actress Linda Wilson, a retired psychotherapist. “It really helps them see us as individuals with rich lives.”

The “See Me’ program combines musical performance, small group talks, and improv skits based on scenarios nurses might face while treating older patients. First, the ten actors perform excerpts from their musical variety show, “It’s Never Too Late.” Like any good musical, it comes complete with jazz hands, spirit fingers, and some low kicks. “It’s never too late to have a fling/For autumn, it’s just as nice as spring,” one actress sings as she grins at the audience.

After the students get over the shock of senior citizens singing suggestively about love during their usual class lecture time, they start to laugh. The expressions on their faces are as funny as the show itself; some of the students clearly don’t know what to think of a troupe of actors in their sixties and seventies dancing in coordinating red and black outfits. “There’s always that moment where they say, ‘What are these old people doing here?'” says Grimm, who is, at 75, the oldest in the group. “And you can see when you’ve won them over.”

Even the initially skeptical students smile as the actors work through the show, which includes a soulful performance of “The Way We Were,” a song about losing various belongings–including teeth and underwear–and the reading of “genuine” personal ads from senior citizens’ magazines. “Mint condition. Male. 1939. High Mileage. Some hair. Many new parts including kneecaps, hips, valves and corneas. Not in running condition, but walks well,” recites actor Al Paltin wryly.

 Stagebridge performer Olithia O’Toole interacts with a nursing student in an improvised wellness skit. (Photo courtesy of Stagebridge)

And the zingers keep coming.

“We’re very big in Alzheimer’s homes because we keep doing the same stuff.”

“Do not work for a doctor whose plants are dead. Think about it.”

“Remember, the best medicine is laughter. And the best part is, there’s no co-payment.”

After the actors warm the crowd up, four of them take to the stage to tell the nurses about their real-life experiences in hospitals. Bertha Reilly tells the audience about the time she was misdiagnosed with ovarian cancer, only to find out on Thanksgiving Day that she wasn’t dying. Elaine Stanley recounts the time her nurses didn’t believe that she was in pain after her knee replacement, and didn’t notice that the tube to her epidural had been disconnected. Several students in the audience cry as one man talks about losing his son to brain cancer, and about the sympathetic nurses who looked the other way when the family threw a party in his hospital room, even when it resulted in telltale wine stains on the patient’s hospital gown. “The point of this story is that you’re not just treating someone who’s got the little wristband,” actor Terry Stokes reminds them. “You’re treating that whole family.”

His talk made nursing student Jessica Borlongan rethink the way she treats her patients. “I think the number one thing is just to listen. Sometimes I feel really self-conscious talking to the family-but it makes the situation better, not worse,” she says.

Grimm, a former principal at Oakland High School, talked about how she is currently watching her husband of nearly 55 years die in hospice care. Frontal lobe dementia has robbed him of the ability to speak, walk, sit upright, and eat solid foods. She talks about the relationship she has with his hospice nurses, and how they have an agreement that when the time comes, there will be no talk of “crossing over” or “passing on.” “We will talk about death and dying,” she said. “Those are the verbs and nouns that I prefer.”

Though the audience is attentive during all the talks, Grimm’s story elicits tears. As their eyes brim, some students link hands for support.

Sarah Erwin, a student currently working in the renal metabolic unit at Summit Medical Center, strongly identified with Grimm’s story. “My grandma has dementia, and I have watched her deteriorate over my lifetime,” she says. “She had a stroke, and now she has dementia, and that’s just not her anymore.”

After all, nurses feel a personal connection to their patients as well. One student, Melinda Garay, was surprised to see Grimm onstage. Garay had been in Grimm’s home over the summer, helping care for her husband while she spent time shadowing a hospice nurse. “What was really interesting was realizing that I already knew her story,” she says. After the talks, Garay reintroduced herself to Grimm. “That was nice,” Grimm says honestly. “But I think it was hard for her to hear how much he had deteriorated.”

The actors admit that some groups of students don’t warm up to the act, but today’s group is entirely engaged. When the last improv scene is over, the students give Stagebridge a standing ovation. Many of the students say the message of the performance will stay with them, and Winters believes it will. Former students that she stays in contact with remember the performance well, and at least one has recognized and treated one of the actors in the hospital. “Sometimes we never know the immediate impact of something until much later,” she said. “The more we can educate our nurses regarding aging issues, the better the outcome will be for all of us.”