Radiolab – "The Bus Stop" (March 23, 2010)

Host: WNYC Studios | Producers/Hosts: Jad Abumrad, Robert Krulwich, Lulu Miller

Overview

This episode of Radiolab dives into a unique and compassionate solution for dealing with dementia and Alzheimer’s patients who are prone to wandering. Focusing on an elder care home in Düsseldorf, Germany, it tells the story of how staff addressed the problem of residents escaping in search of their past lives—by installing a “bus stop to nowhere.” The segment gently explores questions of truth versus kindness, the nature of memory, and inventive caregiving.

Key Discussion Points & Insights

The Challenge of Wandering in Dementia Care

• Problem Introduction (01:39): Lulu Miller shares the dilemma faced by most elder care homes: residents with dementia become disoriented, want to “go home,” and sometimes escape.
  • “Many people who develop dementia or Alzheimer’s, they’ll become disoriented and confused and suddenly think, where am I?” – Lulu Miller (01:48)
• Real-life Example (03:03): Lulu relates her own family’s story—her grandfather, believing he needed to teach a class at Harvard, wandered off barefoot in frigid weather.
  • “He got up at 5 in the morning, left the house, and walked to the train station…he thought he had to teach a class at Harvard.” – Lulu Miller (03:12)
• The Lived Experience: The emotional toll of searching for missing residents and the heartbreaking necessity for locked wards is discussed:
  • “Some people have to be locked in, which just feels cruel.” – Lulu Miller (04:16)

The Bus Stop Idea: Creativity Meets Compassion

• Origin of the Idea (04:53): Mr. Goebe, an advisory board member at the Benrath Senior Center, suggests a fake bus stop in front of the home.
  • “Right in front of the home they should build a bus stop…that has just one crucially odd feature: there’s no bus coming. No bus, never.” – Regin (06:13)
• Initial Reactions:
  • Both staff and neighbors are skeptical and even laugh at the idea. Some consider it “cynical” and inappropriate (07:04).
• Implementation (06:44):
  • The home builds a bus stop with a bench and sign identical to regular ones, immediately visible from the entrance.

How the Bus Stop Works

• First Experience (07:39): An agitated resident suffering an episode goes to the bus stop believing she needs to go home. Nurses allow her to sit outside, and after a while her distress fades.
  • “She sat there, very patient. And she waited for the bus…Eventually she forgot why she was there.” – Regin (08:01 – 08:47)
  • “The nurse said, ‘We go in and have a cup of tea together.’ And then she came back and everything was fine.” – Regin (08:47)
• How Often It's Used (09:13):
  • Staff use the bus stop regularly—sometimes proactively guiding upset residents there, other times finding escapees waiting at “their stop.”
• Dynamic of Memory and Urgency:
  • “When the people get to the bus stop, the mood is very dark…I’m feeling so lonely. I want to go home…My parents wait for me…” – Regin (09:41–09:46)
  • With time, anxiety and urgency fade: “That urgent feeling disappears…It’s like fish is coming up to the surface of the water and then going down again and disappearing. Thoughts come up and they disappear and you don’t know that they have ever been there.” – Regin (10:29)

The Moral Question: Is It A Lie?

• Ethical Quandary (11:05):
  • Jad poses the question: “Isn’t this maybe a little bit cruel? Because it is a lie that’s happening here.”
• Response:
  • Lulu and the staff frame it as a kindness, a way to escort patients gently from their own reality back to the present, rather than forcibly confronting their disorientation.
  • “Why not just allow that other world to be true for just a beat, and then gently coax them back?” – Lulu Miller (11:48)
  • “That’s the aim of the whole thing, to lead those memories very gently into this now, this today.” – Regin (11:57)

Broader Application: Meeting Patients Where They Are

• Expanding the Approach (12:07):
  • The bus stop concept inspires the home to adapt to other residents’ past-oriented needs—like allowing a retired baker to rise early and bake in the middle of the night (12:18).
  • “They just say, okay. And they let him get up…they take him to the kitchen and let him bake.” – Regin (12:33)
• Reflection on Memory and Safety:
  • “Here’s this way in which people can be somewhat lost in their memories and yet exist in the present safely.” – Lulu Miller (12:47)

Notable Quotes & Memorable Moments

• On the bus stop’s function:
  “It’s a bus stop to nowhere.” – Regin (06:13)
• On memory’s dual role:
  “The forgetting is both the problem and the solution.” – Lulu Miller (10:59)
• On ethical caregiving:
  “Why not just allow that other world to be true for just a beat, and then gently coax them back.” – Lulu Miller (11:48)
• On the change in care atmosphere:
  “It changed the atmosphere in the home.” – Regin (12:10)

Timestamps for Important Segments

• [01:39] — Introduction to the problem of wandering in elder care
• [03:03] — Personal story: Lulu’s grandfather’s experience with wandering
• [04:53] — Mr. Goebe’s “bus stop” idea is introduced
• [06:44] — Construction and placement of the bus stop
• [07:39] — First real-life use of the bus stop with a distressed resident
• [10:29] — Discussion of how urgency and memory fade over time at the stop
• [11:05] — Ethical debate about lying versus gentle truth
• [12:18] — Expansion of “meeting people where they are” in daily routines

Tone & Language

The conversation is warm, respectful, and gently probing. Lulu Miller’s empathy and curiosity lead the narrative, with hosts Jad Abumrad and Robert Krulwich providing thoughtful questions and encouragement. The tone balances sincerity and humor, particularly when discussing the unusual but effective solution.

For those who haven’t listened:

This episode is a heartwarming, thought-provoking look at inventive dementia care, weighing the comfort of gentle accommodation against the harshness of strict truth. It’s a testament to the power of creative problem-solving grounded in empathy.