Advocacy, Annie & Cricket, Antipsychotic drugs, NHBPS

which way to the bathroom?

Which way to the bathroom cropped

This is one in a series of vignettes based on the Nursing Home Behaviour Problem Scale (NHBPS), which is used to measure agitation in people who live with dementiaThe vignettes are told from the point of view and in the voice of a fictional character called Annie, a woman in her mid-eighties who lives with dementia of the Alzheimer’s type in the mid- to later-stages of the disease. Annie resides in a long-term care facility somewhere in Canada. This vignette is called “what a shame.” There’s a link to all the vignettes at the end of the post.

what a shame

I have to go to the bathroom. I’m desperate. I really need to go.

I walk down the hall looking for the ladies’ room, but I can’t find it. What a strange hotel. It doesn’t have any toilets. The doors to the rooms are open, but most of them have stop signs in front of them. I guess I’m not allowed to go in, but I’m not sure. I’m not sure. What an odd place. Here’s a room with no stop sign, there’s an old lady inside; I’ll ask her. The old lady is in a chair. The chair is tilted back. She has a blanket across her legs. When I walk in, she leans forward, and stretches her arms out to me like she wants something.

“I have to go to the bathroom,” I say. “Do you know where the toilet is?”

Ahhhhhhh ahhhhhhh ahhhhhhh,” she says. I don’t understand what she’s saying. It looks like she’s trying to get out of the chair. But she can’t. Maybe she needs help too. Maybe she can’t hear me. I walk closer.

“I have to go to the powder room. Do you know where it is?” I repeat a little louder in case she’s deaf.

Ahhhhhhh ahhhhhhh ahhhhhhh,” she says again as she takes hold of my wrist. Her fingers are bony; her grip is light. Old ladies aren’t strong. The poor thing. I wish I could help her, but I can’t. I have to find a bathroom. I feel wetness between my legs. I put my hand there, and press it into my body. I walk knock-kneed out of the room, my inner thighs rubbing together. The hall is empty.

I can’t wait. I can’t. I’m going to pee my pants. I’m going to pee my pants. Oh no. Oh dear. Quickly now. Undo the button. Pull the zipper down. Pull the pants down. Quick. The pee is already coming. Squat. Put your hands down so you don’t fall over.

Dark yellow liquid gushes from me onto the floor. Relief. A sunny puddle spreads on the white linoleum. It surrounds my shoes. Move your hands! Move your hands!

“Annie! What are you doing?” A young woman is walking down the hall toward me. “What are you doing Annie?”

My hands are wet. My cheeks are hot. I can’t stand up. “I had to go to the bathroom.”

“I see that,” the young woman says. “But why are you doing it on the floor? You have to go to the toilet when you need to pee.”

I know. I know. I couldn’t wait. I couldn’t wait. She helps me stand up; she pulls up my underwear and pants. The puddle is still spreading. I feel sick.

“My hands are wet,” I say.

“C’mon, let’s get you cleaned up. And next time, when you need to pee, go to the bathroom, okay dear?”

“Okay,” I say. “Okay.”


©2016 Susan Macaulay /

Image copyright: hikpic / 123RF Stock Photo

17 thoughts on “which way to the bathroom?”

  1. Mom had terrible anxiety over not knowing where the bathroom was. I was constantly telling her. And she would go just to make sure. I guess because of the anxiety she always thought she had to pee. 😦


  2. I just wanted to leave a note to let you know that long goodbye has ended for Momma and me, She passed March 28th at 6:15 am. You gave me such peace and understanding during the journey and I thank you Susan. Bonnie and Dan have resumed their love affair, SIMPLY GRAND!


    1. Oh Kat. I stand with you in your grief and celebration of a life well lived. I am grateful to have made a difference and to have supported you in spirit from a distance. It means a lot to me that you should say so, as I sometimes wonder if what I’m doing has an impact. Comments such as yours keep me on purpose. Thank you from the bottom of my heart ❤ I will toast Bonnie and Dan tonight with a glass of fine wine 🙂


      1. Never question your impact, you are doing a fine service for those of ust that are close to this. Thank you for toasting my parents! Cheers…


  3. I remember Mum going to the doctors. They told Mum they needed a urine test and gave her a white bowl thing. They did not tell her where the toilet was. Mum thought they meant her to use the bowl so down with the trousers ( in the nurses station ). The bowl filled and flooded all over the floor! The nurses were horrified. I wasn’t with Mum that day but a friend had taken her. Really they all knew her condition. Their lack of understanding led to the incidence.

    John living at home gets lost in the home – he looks in every door as he goes past to see what is in there – Mum also used to do the same. The familiar world shrinks for them.


    1. Exactly. It’s inexcusable for medical professionals who are meant to understand the disease to blame the people who live with it for behaviour which they call aberrant but which is in fact perfectly logical and rational under the circumstances. To medicate them for it just adds insult to injury and is abuse in my opinion.


  4. Your example was an ambulatory patient with dementia who should not have been walking the halls alone. A deficiency of the nursing home. She should have had an alarm attached to her wrist to alert staff monitor that she was out of bed. I would say poor management. Urine control is an area that the staff should be directed to control as part of the caregiving routine. This proves inadequate staff training, no excuse and needs to be part of the caring protocol.


  5. Hi Susan! Great webinar today. I’d love to connect with you. I recently wrote a book that Teepa contributed to called Songs You Know By Heart: A Simple Guide for Using Music in Dementia Care. You can read a bit more about what I do on Teepa’s site under Teepa’s Picks or on my own site at
    Looking forward to exploring all the posts on your site. I’ll promote it through my facebook page etc. tomorrow.
    Thanks for all you do!


    1. An underused memory jerker is available through a commercial source. I can direct you to the commercial source that is available for promotion. It is great concept and has proven effective as a tool.


      1. Susan an editorial license, actually implies a memory boost like to jerk somebody, a push. Sorry for my originality.


      2. Before the past vanishes completely a containment therapy in addition to music, reading aloud to the patient, massage, t Reiki or what have you add a visible DVD as a helpful intrusion that might trigger some memory or delay the patient sliding into a complete lapse. Prepare a signature DVD with light favorite music background,very low. The content is everything familiar to the patient, house, clothes, pet,, bedroom, kitchen, garage, car, garden, family members a meal on the table in other words take them back not forward. The DVD would be ideal at sundown but caution no loud music and could be played on and off as required. I call this the Duncan Reversal System.DRS


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